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final: endocrine Flashcards

1
Q

what are the glands of the endocrine system? what does the endocrine system do?
what does exocrine system do?

A

Pancreas, parathyroid, pituitary, adrenal, thymus, testis, thyroid, ovary PPPATTTO

endocrine: secretes hormones into the bloodstream and sent to parts of body to induce specific actions
exocrine: secretes hormones into ducts

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2
Q

what does hypo secretion of hormones cause?

what does hyper secretion of hormones cause?

A

hyposecretion: agenesis, atrophy, destruction
hypersecretion: tumor and hyperplasia

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3
Q

what is the master gland that controls most other endocrine functions? where is it located? size? structure? connected to what via a stalk, what does the connection do?

A

the pituitary; located at base of brain in the sella turcica, about the size of a pea, made of anterior and posterior lobes connected to hypothalamus via a stalk, the hypothalamus regulated the pituitary hormones

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4
Q

what are the 6 hormones produced by the anterior pituitary?

whats produced by the posterior pituitary?

A

anterior: TSH, prolactin, ACTH, GH, FSH, LH
posterior: ADH and oxytocin

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5
Q

anterior pituitary hyper function is almost always associated with what? symptoms produced via what?

A

anterior pituitary hyper function almost always bc of adenoma and symptoms produced via hormone production and mass effect

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6
Q

what is cushing syndrome and nelson syndrome caused by

A

ACTH and POMC derived peptides

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7
Q

what is hypogonadism, mass effects and hypopituitarism cause by

A

FSH

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8
Q

hyperthyroidism caused by?

A

TSH

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9
Q

GH causes what associated syndromes?

A

gigantism ; children

acromegaly: adults

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10
Q

prolactin causes what associated syndromes?

A

galactorrhea, amenorrhea, sexual dysfunction, infertility

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11
Q

prolactin and GH causes what associated syndromes?

A

combined features of prolactin and GH exces

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12
Q

what can be the causes of anterior lobe hypo function of the pituitary?

A

nonfunctional pituitary adenoma, postpartum ischemic necrosis (needs 75% destruction) and ablation/ destruction by surgery, radiation, or adjacent tumor

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13
Q

manifestations of anterior lobe hypopituitarism include what?

A 
GH: pituitary dwarfism
Gonadotropin: amenorrhea and infertility in women, dec libido, impotence, lack of pubic/ axillary hair in men
Prolactin: no post part lactation
TSH: hypothyroidism
ACTH: hypoadrenalism
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14
Q

manifestations of posterior lobe hypopituitarism include what?

A

mainly with ADH: less retention of water, diabetes insipidus

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15
Q

Describe the two important concepts of gigantism

A

ccurs before closure of the epiphyseal plates (growth plates in long bones
caused by an adenoma in the anterior lobe of the pituitary that secretes GH

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16
Q

clinical features of gigantism?
Tx?
Prognosis?

A

gigantism: generalized INC in size of body, arms and legs disproportionally long
tx: surgical removal of adenoma
prognosis: fair to good

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17
Q

describe the two important concepts of acromegaly

A

Acromegaly: INC GH secretion due to an adenoma

occurs AFTER closure of epiphyseal plates and skeletal maturity

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18
Q

what are the clinical features of acromegaly?
Tx?
prognosis?

A

acromegaly: enlarged bones of hands, feet, and face, prognathism development of diastema, hypertension and congestive heart failure
tx: : removal of adenoma
prognosis: guarded bc of hypertension and CHF complications

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19
Q

what are the potential causes of pituitary dwarfism

A

lack of response to GH by the pts tissues, failure of pituitary gland to produce GH

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20
Q

clinical features of pituitary dwarfism?
tx?
prognosis?

A

pituitary dwarfism: short stature, small jaws and teeth

tx: hormone replacement therapy is the problem is lack of GH production
prognosis: good if HRT works

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21
Q

what arises at the base of tongue and migrates down into the next to its location anterior and inferior to a certain cartilage? what is the hits of this gland?

A

thyroid: known as lingual thyroid, the gland is made up of follicles filled w colloid

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22
Q

what is the function of the thyroid gland? where is it located? what shape is it?

A

thyroid gland= bodys thermostat: produces hormones that regulates the RATE at which body carries out its necessary functions
located in middle of LOWER neck below larynx and above clavicles
bow tie shaped

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23
Q

can you always palpate a normal thyroid gland?

A

NO!!!!

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24
Q

what are the causes of hyperthyroidism?

Diagnosis?

A

hyperthyroidism causes: diffuse toxic hyperplasia (graves disease), hyper functional multi nodular gland, hyper functional thyroid adenoma, TSH secreting pituitary adenoma, ingestion of exogenous thyroid hormone
diagnosis: elevated TH and DEC TSH - primary hyperthyroidism

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25
clinical features of hyperthyroidism? TX? prognosis?
hyperthyroidism: hyper metabolic state and overactivity of sympathetic nervous system clinical: hypermobility, GI hypermotility, malabsorption and diarrhea, tachycardia, palpitations, irritability, nervousness, tremor, proximal myopåthy, wide star gazing with eye lid drag, EXOPHTHALMOS (bulging of eyes w grave disease, heat intolerance, soft warm flushed skin, weight loss w INC appetite tx: depends on cause, reactive Iodine to destroy overreactive thyroid tissue prognosis: : good if treated
26
what is the thyroid storm?
sudden onset of severe hyperthyroidism, usually trigger by stress. A medical emergency- pts often die of cardiac arrhythmias if untreated
27
What is diffuse toxic hyperplasia - Graves disease? who is it most predominant in? What clinical manifestations does Graves disease result in?
Graves disease is a autoimmune disease with a significant genetic component with a common female predominance of 7F : 1M. graves disease results in hyperthyroidism, exophtalmos (40%), skin lesions called pretrial myxedema
28
what causes hypothyroidism: the general causes and specific causes?
hypothyroidism is caused by a DEC thyroid hormone production Iodine deficiency autoimmune destruction of thyroid - Hashimoto's thyroiditis Ablation by surgery or radiation therapy
29
what are the clinical features of hypothyroidism?
cretinism: hypothyroidism developing in infancy or early childhood myxedema: hypothyroidism developing in children and adults
30
What does cretinism result in? what is cretinism?
cretinism is hypothyroidism developing at infancy or early childhood results in impaired skeletal and CNS development, short stature, mental retardation, protruding tongue
31
what is myxedema? what does myxedema result in?
myxedema is hypothyroidism developing in adults myxedema results in generalized apathy, mental sluggishness- mimics depression, obesity, cold intolerance, enlarged tongue, mucopolysaccharide rich edema
32
explain the serum levels of TSH in hypothyroidism
in primary cases INC due to loss of feedback inhibition | NOT INC in cases caused by primary hypothalamic or pituitary disease
33
Tx of hypothyroidism? | prognosis of hypothyroidism?
tx: TH replacement therapy prognosis: good unless delayed tx, damage to skeletal and CNS systems could be permanent
34
what is hashimoto thyroiditis? predominant in who?
hashimotos thyroiditis is a autoimmune progressive destruction of gland that is a common cause of hypothyroidism female predominance 10/20 : 1 F: M : older women have significant genetic component
35
what are hashimoto thyroiditis pts at risk for?
at risk for other autoimmune diseases and B cell non hodgkin lymphomas NO established risk for thyroid neoplasm
36
what the most common manifestation of thyroid disease?what does this reflect? and what is it due to?
GOITERS!!! goiters reflect in impaired synthesis of TH | goiters are due to diet deficiency, some idiopathic
37
goiter most common clinical features include?
cosmetic problem, airway obstruction, dysphagia, compression of vessels
38
can a long standing non toxic goiter change into a toxic hyper functional goiter?
YES!!!
39
are thyroid nodules common? what percent are carcinomas? in what pt are nodules more likely to be neoplastic?
thyroid nodules are common! most are NON neoplastic! 1% are carcinomas. males in young pts w nodules are more likely to be neoplastic
40
what factors put a person at risk for thyroid neoplasms?
genetic and environmental factors w exposure to radiation in first 2 decades
41
what the most common thyroid cancer? when is its peak incidence? most predominant in who?
Papillary thyroid carcinoma most common more than 85% of thyroid cancers, peak incidence 30-50 y/o. FEMALES more than males
42
what is the genetic component of papillary thyroid carcinoma? some cases related to what?
RET proto oncogene mutation! | some cases related to radiation exposure
43
Whats the pathology of papillary thyroid carcinoma | survival rates?
microscopically characterized by papillary projections nuclear clearing orphan annie nuclei nuclear grooves indolent lesion 10 year survival is 95%
44
what thyroid cancer arises at an older age in areas with iodine deficiency, and what must you see to classify this? what percent of thyroid cancers?
follicular thyroid carcinoma 5-15% of thyroid cancers | must see invasion through the capsule or into the blood vessels!!
45
what an uncommon thyroid cancer, derived from parafollicular cells? what percent of thyroid cancers? what may it be?
medullary thyroid carcinoma, about 5% of thyroid cancers. may be sporadic or familial. may be a componet of MEN syndromes
46
medullary thyroid carcinomas have what genetic component and what lab measurement?
medullary thyroid carcinoma= RET proto oncogene mutation! INC serum calcitonin
47
what thyroid cancer has solitary nodules of 3-5 cmm in diameter and are grossly separated from the normal thyroid by a thin discrete capsule?
follicular adenoma
48
what is a very rare thyroid cancer that presents as a rapid enlargement in a long standing goiter and has a an extremely poor prognosis?
anaplastic thyroid carcinoma
49
Describe the embryology, anatomy, and histology of the parathyroid glands
embryo: arise from the 3rd and 4th pharyngeal pouches anatomy: 4 glands on each pole of thyroid histo: mostly chief cells (principal cells) produce PTH, oxyphil cells have unknown function
50
what is the function of PTH?
PTH responds to dec blood calcium levels, by INC the absorption of Ca by the kidneys, INC the change of vitamin D to its active form which INC GI Ca absorption, INC excretion of phosphate in urine, and INC osteoclastic activity to release Ca from bones. net effect is to increase free calcium blood levels which has negative feedback inhibition dec PTH secretion
51
What is an important cause of hypercalcemia? discuss the two types of this disorder
hyperparathyroidism is a major cause of hypercalcemia primary: excess production of PTH secondary; in pts w renal failure
52
Primary hyperparathyroidism is common in who? caused by what? classic constellation of symptoms of what? what oral signs might there be?
Primary hyperparathyroidism is common disorder in adults mainly females (4:1) that is often clinically silent. Caused by a parathyroid adenoma or hyperplasia painful bones, renal stones, abdominal groans, psychic moans = classic constellation of symptoms symptoms: weakness, brown tumor in jaws, ground glass appearance of bones on oral X-rays, metastatic calcifications
53
secondary hyperparathyroidism is common in who? leads to what kind of bone changes? what is the serum calcium levels like?
pts with renal failure bone changes: renal osteodystrophy serum calcium near normal bc of INC PTH
54
is hypoparathyroidism common or uncommon? causes? | clinical manifestations?
hypoparathyroidism is uncommon causes: surgical removal of parathyroids, congenital absence, auto immune disease clinically: hypocalcemia, INC neuromuscular excitability, cardiac arrythmias, INC intracranial pressure and seizures
55
what is the congenital absence of the parathyroid glands called that causes hypoparathyroidism?
Di Georges syndrome
56
what is the function of beta cells in the pancreas? Alpha cells? delta cells? PP cells?
``` Beta = insulin Alpha = glucagon Delta= somatostatin PP= VIP ```
57
how many americans are affected by diabetes? diabetes is the leading cause of what 3 things?
diabetes affects 20 million americans - 7% | diabetes is the leading cause of end stage renal disease, blindness, and amputation
58
describe type 1 diabetes, what % of cases? symptoms appear when? symptoms include what?
type 1 diabetes= juvenile diabetes = insulin dependent= 10% of diabetic cases. symptoms appear before age 20 once 90% of beta cells have been destroyed. leads to severe insulin deficiency symptoms: polyuria, polydipsia, polyphagia w weight loss, KETOACIDOSIS (dec in blood ph can cause diabetic coma)
59
describe type 2 diabetes, what is it? usually present when? symptoms?
type 2 diabetes = adult onset diabetes= non insulin dependent diabetes usually presents after age 40 polyuria and polydipsia may occur and INC risk for infections like perio
60
what is the diagnosis of diabetes based on? normal glucose levels?
normal glucose is 70-120 diagnose diabetes if: a) random blood glucose of over 200 b) fasting glucose greater than 126 more than once c) blood glucose greater than 200 within 2 hours of ingesting 75 grams of glucose
61
what is an absolute lack of insulin that has an abrupt onset and pts require exogenous insulin for survival?
type 1 diabetes
62
what results from a collection of multiple genetic defects, obesity, pregnancy, and stress? what % of these pts are obese? describe the basic results of this disease
Type 2 diabetes: peripheral tissues unable to repsond to insulin, beta cell dysfunction results in inadequate insulin secretion and insulin resistance and hyperglycemia develops. 80% of type 2 diabetics are obese
63
what happens to the pancreas in diabetics?
reduction of the number and size of islets | heavy inflammatory infiltrate, amyloid deposition
64
what happens to the vasculature of diabetics? how many deaths are related to vasculopathy in diabetics?
80% of DM related deaths are vasculopathy related! | atherosclerosis, MI, stroke, gangrene, microangiopathy
65
what is the 2nd leading cause of DM behind vascular disease?
kidneys! diabetic nephropathy
66
what is a nepropathy specific to diabetics that affects 15-30% of long term diabetics?
nodular glomerusclerosis
67
what is the 4th leading cause of blindness? what causes this?
diabetes! causes by microangiopathy, and micro aneurysms, retinal detachment and vision loss
68
what is diabetic neuropathy?
autonomic neuropathy causing disturbances in bowel and bladder function and impotence
69
what causes more death Type 1 or 2 diabetes?
Type 1 cause more deaths!
70
what are main causes of death in diabetic pts?
MI, renal failure, cerebrovascular disease, atherosclerosis, infection
71
how common are pancreatic islet cell tumors? | what can they be?
very uncommon less than 2% of pancreatic neoplasms | can be functional or nonfunctional
72
what is a beta cell tumor, that results in hyperinsulinism and most are adenomas? what occurs in these pts? what percent are malignant? symptoms? tx?
Insulinoma! (insulin secreting islet cell tumor) hypoglycemia quickly occurs from fasting or exercising nervousness, confusion, stupor tx: surgical excission
73
what tumor arises in the duodenum, peripancreatic tissues or pancreas? what does it cause? what percent of recalcitrant peptic ulcers are because of this tumor?
gastrinoma= results in gastric acid hyper secretion | 90-95% of recalcitrant peptic ulcers
74
what is zollinger ellison syndrome? what % are malignant? tx?
zollinger ellison syndrome is a pancreatic islet cell tumor that causes hyper secretion of gastric acid and severe peptic ulcers 60% are malignant tx: surgical excision
75
what does adrenal context produce?
mineralcorticoids glucocorticoids sex hormones: estrogen / androgen
76
what does the adrenal medulla produce? describe the adrenal medulla
catecholamines (Epi) | adrenal medulla: neural origin, chromaffin
77
what is Cushing syndrome? what are the causes?
cushing syndrome is hypercorticolism causes: mainly by excess exogenous glucocorticoids primary adrenal hyperplasia Primary pituitary source (ACTH oversecretion= cushing disease) ectopic ACTH secretion by a neoplasm
78
what are the short term signs of Cushing syndrome?
short term: weight gain, MOON facies, Buffalo hump
79
What are the long term signs of Cushing syndrome?
dec muscle mass, diabetes, OSTEOPOROSIS, | cutaneous strie - hirsuitism, mental disturbances, mood swings, menstrual irregularities
80
what are the results of hyperaldosteronism- chronic excess aldosterone secretion?
hyperaldosteronism causes sodium retention, potassium excretion, hypertension, and hypokalemia
81
Describe primary hyperaldosteronism
very rare, hyperplasia, neoplasm, idiopathic, DEC levels of plasma renin
82
describe secondary hyperaldosteronism
aldosterone release in response to activation of renin angiotensin system,. INC levels of plasma renin
83
what leads to DEC levels of plasma renin?
primary hyperaldosteronism
84
what leads to INC levels of plasma renin?
secondary hyperaldosteronism
85
what results from dec stimulation of adrenals from deficient ACTH but doesn't appear until 90% of adrenal gland has been destroyed? what are its clinical manifestations?
hypoadrenalism | manifestations: weakness, fatigue, GI disturbances like anorexia, nausea, vomiting, weight loss, diarrhea
86
what is acute adrenocortical insufficiency? what are the clinical symptoms?
acute adrenocortical insufficiency results when pts maintained on exogenous corticosteroids have a rapid withdrawal of steroid or a failure to INC steroids in response to acute stress leading to an adrenal crisis. symptoms: vomitting, abdominal pain, hypotension, coma, death
87
what is progressive destruction of the adrenal cortex leading to INC ACTH levels and skin and mucosal pigmentation?
Addisons disease: primary chronic adrenocortical insufficiency
88
what does Addisons disease result in? | what are the causes of Addisons disease?
Addison disease results in K retention, sodium loss, hyerpkalemia, hyponatremia, volume depletion, and hypotension causes of addison disease: 60-70% are autoimmune destruction of steroid producing cells TB, AIDS, metastatic disease
89
What is any disorder of the hypothalamus or pituitary that REDUCES output of ACTH called? how is it different from Addisons disease?
REDUCES output of ACTH= secondary adrenocortical insufficiency different from addisons in that there is NO skin or mucosal pigmentation
90
what is a neoplasm of chromatin cells that occurs more in females than males and common in 30-60 year olds? results in what clinical symptoms? pathology?
Pheochromocytoma! F > males! results in hypertension, tachycardia, tremor, headaches, pathology: large polygonal cells with variable pleomorphism
91
what is multiple endocrine neoplasia syndrome? types?Genetics of MEN? what are the oral facial syndromes of the most notable MEN subtype?
Tumors of multiple endocrine organs: Type 1, 2A, 2B RET proto-oncogene MEN 2B: Mucosal neuromas, large blubbery lips, marfanoid body

Pathology Sp 16 (7 decks)

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