Gen Path Exam 2 - Endocrine Pathology Flashcards
Which organ?
Hyperpituitarism
Pituitary gland
Which organ?
Pituitary adenoma
Pituitary gland
Which organ?
Hyperthyroidism
Thyroid gland
Which organ?
Graves disease
Thyroid gland
Which organ?
Multinodular goiter
Thyroid gland
Which organ?
Hypothyroidism
Thyroid gland
Which organ?
Hashimoto thyroiditis
Thyroid gland
Which organ?
Thyroid adenoma
Thyroid gland
Which organ?
Papillary thyroid carcinoma
Thyroid gland
Which organ?
Thyroglossal duct cyst
Thyroid gland
Which organ?
Primary and secondary hyperparathyroidism
Parathyroid gland
Which organ?
Hypercortisolism (Cushing syndrome)
Adrenal gland
Which organ?
Adrenal insufficiency (Addison disease)
Adrenal gland
Which organ?
Pheochromocytoma
Adrenal gland
Which organ?
Type 1 and 2 diabetes mellitus
Pancreas
Which category of disease?
Graves disease
Immune mediated
Which category of disease?
Hashimoto thyroiditis
Immune mediated
Which category of disease?
Type 1 diabetes mellitus
Immune mediated
Which category of disease?
Pituitary adenoma
Neoplasia
Which category of disease?
Thyroid adenoma
Neoplasia
Which category of disease?
Papillary thyroid carcinoma
Neoplasia
Which category of disease?
Pheochromocytoma
Neoplasia
Which category of disease?
Thyroglossal duct cyst
Developmental
Which category of disease?
Hyperpituitarism
Metabolic
Which category of disease?
Hyperthyroidism
Metabolic
Which category of disease?
Multinodular goiter
Metabolic
Which category of disease?
Hypothyroidism
Metabolic
Which category of disease?
Primary and secondary hyperparathyroidism
Metabolic
Which category of disease?
Hypercortisolism (cushing syndrome)
Metabolic
Which category of disease?
Adrenal insufficiency (addison disease)
Metabolic
Which category of disease?
Type 2 diabetes mellitus
Metabolic
What are the 2 clinical problems of the endocrine system?
Too much hormone
Too little hormone
What are the 2 pathologic problems of the endocrine system?
Problem in brain/pituitary
Problem in end organ
“Master gland”
Pituitary
The pituitary gland secretes hormones that regulate what?
Endocrine glands
What is the anterior pituitary controlled by?
Hypothalamus
Where do most problems occur?
Anterior pituitary
What are the hormones of the anterior pituitary?
GH
Prolactin
TSH
FSH
LH
ACTH
What are the hormones of the posterior pituitary?
ADH
Oxytocin
Too much anterior pituitary hormone
Hyperpituitarism
What is the most common cause of hyperpituitarism?
Pituitary adenoma
What is the clinical presentation of hyperpituitarism?
Endocrine abnormalities
Benign tumor of pituitary gland
Pituitary adenoma
What disease?
Affects any age, but incidence increases with age
Pituitary adenoma
What disease?
Clinical presentation includes headache, vision problems (compression of optic nerve), functional, non-functional, silent
Pituitary adenoma
Too much hormone producing
Functional clinical presentation
No hormone produced
Non-functional clinical presentation
Normal amount of hormone produced
Silent clinical presentation
What disease?
Diagnosed by hormone level testing and imaging
Pituitary adenoma
What disease?
Tx includes surgery, radiation, meds
Pituitary adenoma
What type of growth hormone adenoma?
Pre-puberty
Gigantism
What type of growth hormone adenoma?
Generalized increase in body size
Gigantism
What type of growth hormone adenoma?
Disproportionately long limbs
Gigantism
What type of growth hormone adenoma?
Post-puberty
Acromegaly
What type of growth hormone adenoma?
Growth of soft tissue, skin, viscera
Acromegaly
What type of growth hormone adenoma?
Enlarged bones of face, hands, feet
Acromegaly
What type of adenoma is a growth hormone adenoma?
Pituitary adenoma
Primary or secondary problem?
Thyroid growth
Primary
Primary or secondary problem?
Hormone synthesis
Primary
Primary or secondary problem?
TSH
Secondary
What are thyroid lab tests measuring?
T3, T4, TSH
Euthryroid (normal) lab results
Normal T3, T4, TSH
Primary hyperthyroidism lab results
Increased T3, T4
Decreased TSH
Secondary hyperthyroidism lab results
Increased T3, T4
Increased TSH
Primary hypothyroidism lab results
Decreased T3, T4
Increased TSH
Secondary hypothyroidism lab results
Decreased T3, T4
Decreased TSH
What are the most common causes of hyperthyroidism?
Graves disease
Multinodular goiter
What disease?
Clinical presentation includes weight loss, tachycardia, heat intolerance, tremor, anxiety, thyroid storm
Hyperthyroidism
Abrupt onset of severe hyperthyroidism; medical emergency
Thyroid storm
What disease?
Diagnosed by elevated T3 and T4
Hyperthyroidism
What disease?
Caused by autoantibodies against TSH receptor
Graves disease
What diseases?
Autoimmune
Graves disease
Hashimoto thyroiditis
What disease?
Caused by increased thyroid hormones and proliferation of thyroid follicles
Graves disease
What disease?
Most common cause of hyperthyroidism
Graves disease
What disease?
More common in women between 20-40
Graves disease
What disease?
Clinical presentation includes symptoms of hyperthyroidism, exophthalmos, enlarged thyroid, dermopathy, thyroid storm
Graves disease
What does exophthalmos look like?
Eye bulging
Scaly thickening and induration of skin on shins
Dermopathy
What disease?
Diagnosed by increased T3 and T4, decreased TSH
Graves disease
What disease?
Tx is anti-thyroid meds, radioactive iodine, surgery
Graves disease
What disease?
Caused by enlarged thyroid, decreased TH, increased TSH, can result in increased TH with time
Multinodular goiter
What is the most common cause of decreased thyroid hormone, as seen in multinodular goiter?
Dietary iodine deficiency
What is the most common manifestation of thyroid disease?
Multinodular goiter
What causes increased serum TSH, as seen in multinodular goiter?
Hypertrophy + hyperplasia of thyroid follicles
What disease?
Most common in women
Multinodular goiter
What disease?
Clinical presentation is enlarged thyroid and causes symptoms of hyperthyroidism over time
Multinodular goiter
What diseases?
Diagnosed by ultrasound, biopsy, thyroid function test
Multinodular goiter
Thyroid adenoma
What disease?
Tx is radioactive iodine, surgery
Multinodular goiter
Deficiency of thyroid hormone (TH) production
Hypothyroidism
What are the most common causes of hypothyroidism?
Hashimoto thyroiditis
Iodine deficiency
What disease?
Clinical presentation includes fatigue, weight gain, cold intolerance, dry skin, constipation
Hypothyroidism
What disease?
Diagnosed by low circulating T3 and T4
Hypothyroidism
What disease?
Caused by autoantibodies against thyroid antigens
Hashimoto thyroiditis
What disease?
Caused by progressive destruction of thyroid epithelial cells
Hashimoto thyroiditis
What disease?
Caused by inflammatory response
Hashimoto thyroiditis
What disease?
Genetic component; affects middle-aged women
Hashimoto thyroiditis
What disease?
Clinical presentation is painless enlargement of thyroid, that is usually diffuse and symmetric
Hashimoto thyroiditis
What disease?
Clinical presentation includes symptoms of hypothyroidism
Hashimoto thyroiditis
What disease?
Diagnosed by biopsy, thyroid function test, detection of autoantibodies
Hashimoto thyroiditis
What are the autoantibodies that are detected when diagnosing Hashimoto thyroiditis?
Anti-thyroglobulin antibody
Anti-thyroid peroxidase antibody
What disease?
Tx is thyroid replacement therapy
Hashimoto thyroiditis
What disease?
Caused by benign tumor of thyroid
Thyroid adenoma
What disease?
Arises from follicular cells
Thyroid adenoma
What disease?
More common in women ages 30-50
Thyroid adenoma
What disease?
Clinical presentation includes painless thyroid nodule, symptoms of hyperthyroidism, may be euthyroid
Thyroid adenoma
What disease?
Tx is to monitor, possibly surgery
Thyroid adenoma
What disease?
Caused by thyroid malignancy
Papillary thyroid carcinoma
Is Papillary thyroid carcinoma more common in men or women?
Women
What disease?
Clinical presentation is a painless thyroid mass, may have lymphadenopathy
Papillary thyroid carcinoma
Metastasis to regional lymph nodes
Lymphadenopathy
What disease?
Diagnosed by ultrasound and biopsy
Papillary thyroid carcinoma
What disease?
Tx is surgery; good prognosis
Papillary thyroid carcinoma
What disease?
Caused by congenital cyst from remnants of thyroglossal duct
Thyroglossal duct cyst
What disease?
Present from birth; usually apparent in children/young adults
Thyroglossal duct cyst
What disease?
Clinical presentation is MIDLINE neck mass, moves with swallowing, can be confused with other neck masses
Thyroglossal duct cyst
What disease?
Diagnosed by imaging
Thyroglossal duct cyst
Secretes parathyroid hormone (PTH)
Parathyroid gland
What does PTH regulate?
Ca2+ and phosphate levels
What gland plays a crucial role in bone metabolism?
Parathyroid gland
What disease?
Caused by overproduction of PTH
Primary hyperparathyroidism
Most commonly due to parathyroid adenoma (benign tumor)
Primary hyperparathyroidism
What disease?
Most common in women and older adults
Primary hyperparathyroidism
What disease?
Clinical presentation is hypercalcemia, kidney stones, bone pain, constipation, frequent urination, depression, confusion
Primary hyperparathyroidism
What disease?
Clinical presentation is “stones,” “bones,” “groans,” “thrones,” and “psychiatric overtones”
Primary hyperparathyroidism
stones = kidney/gallbladder
bones = pain
groans = constipation
thrones = frequent urination
psychiatric overtones = depression/confusion
What disease?
Diagnosed by increased Ca2+ and PTH, and decreased phosphate
Primary hyperparathyroidism
What disease?
Tx is surgical removal of adenoma
Primary hyperparathyroidism
What disease?
Caused by chronic low Ca2+ levels
Secondary hyperparathyroidism
What disease?
Most often secondary to chronic kidney disease
Secondary hyperparathyroidism
What disease?
Results in overproduction of PTH by parathyroid
Secondary hyperparathyroidism
What disease?
Less frequently due to vitamin D deficiency or malabsorption
Secondary hyperparathyroidism
What disease?
Affects pts with chronic kidney disease
Secondary hyperparathyroidism
What disease?
Clinical presentation is decreased bone mineralization and calciphylaxis
Secondary hyperparathyroidism
Decreased bone mineralization
Renal osteodystrophy
Calcification of blood vessels secondary to hyperphosphatemia
Calciphylaxis
What disease?
Diagnosed by low or normal Ca2+ levels, high PTH and phosphate levels, and low vitamin D levels
Secondary hyperparathyroidism
What disease?
Tx is treat underlying cause
Secondary hyperparathyroidism
Where are the adrenal glands located?
On top of each kidney
Outer layer of the adrenal gland
Cortex
Inner layer of the adrenal gland
Medulla
What is made in the adrenal cortex?
Glucocorticoids (cortisol)
Mineralcorticoids (aldosterone)
Androgens
What is made in the adrenal medulla?
Catecholamines (epi + norepi)
Cushing syndrome
Hypercortisolism
What disease?
Caused by elevated glucocorticoid levels (exogenous + endogenous)
Hypercortisolism (cushing syndrome)
What causes elevated exogenous glucocorticoid levels in hypercortisolism?
Corticosteroid use
What causes elevated endogenous glucocorticoid levels in hypercortisolism?
ACTH-producing pituitary adenoma (most common)
Ectopic ACTH production (lung cancer)
Adrenal adenoma (benign tumor)
What is the most common cause of hypercortisolism?
Corticosteroid use
What is the 2nd most common cause of hypercortisolism?
ACTH-producing pituitary adenoma
What disease?
Affects pts taking long-term steroid therapy; more common in women age 20-40
Hypercortisolism (cushing syndrome)
What disease?
Clinical presentation is hypertension, weight gain, moon facies, buffalo hump, secondary diabetes, cutaneous striae
Hypercortisolism (cushing syndrome)
What disease?
Diagnosed by elevated ACTH and high levels of excreted corticosteroid in urine
Hypercortisolism (cushing syndrome)
What disease?
Tx is gradual tapering of exogenous corticosteroids, surgery to remove adrenal/pituitary tumor, meds to reduce cortisol production
Hypercortisolism (cushing syndrome)
Addison disease
Adrenal insufficiency
What disease?
Caused by decreased production of cortisol and mineralocorticoids
Adrenal insufficiency (addison disease)
What is the result of decreased production of cortisol and mineralocorticoids?
Increased ACTH
What disease?
Caused by autoimmune destruction, TB, sarcoidosis, adrenal hemorrhage, metastatic cancer
Adrenal insufficiency (addison disease)
Most common cause is autoimmune destruction
Adrenal insufficiency (addison disease)
What disease?
Affects broad range of people, dependent on cause
Adrenal insufficiency (addison disease)
What disease?
Clinical presentation is weakness, fatigue, GI symptoms (nausea, vomiting, weight loss, diarrhea), and hyperpigmentation of skin/oral mucosa
Adrenal insufficiency (addison disease)
What disease?
Diagnosed by low cortisol and high ACTH
Adrenal insufficiency (addison disease)
What disease?
Tx is glucocorticoid and mineralcorticoid replacement therapy; treatment of underlying condition
Adrenal insufficiency (addison disease)
What disease?
Caused by benign adrenal tumor, tumor of catecholamine-producing cells, excess epi + norepi, leads to hypertension
Pheochromocytoma
What disease?
Can be syndromic and sporadic
Pheochromocytoma
What causes syndromic Pheochromocytoma?
Multiple endocrine neoplasia (MEN) types 2A and 2B
Neurofibromatosis type 1
What disease?
Broad, can affect anyone
Pheochromocytoma
What disease?
Clinical presentation is hypertension (episodic or continuous), tachycardia, headache, sweating, tremor
Pheochromocytoma
What disease?
Diagnosed by urinary excretion of catecholamines and their metabolites
Pheochromocytoma
What diseases?
Tx is surgical exicision
Pheochromocytoma
Thyroglossal duct cyst
What hormone?
Targets liver, adipose tissue
GH
What hormone?
Stimulates growth, metabolism of carbs and lipids
GH
What hormone?
Target is mammary glands
Prolactin
What hormone?
Production of milk
Prolactin
What hormone?
Target is thyroid
TSH
What hormone?
Secretion of thyroid hormones
TSH
What hormones?
Target is ovaries, testes
FSH
LH
What hormone?
Regulates reproductive function
FSH
What hormone?
Production of sex hormones
LH
What hormone?
Target is adrenal gland
ACTH
What hormone?
Secretion of glucocorticoids
ACTH
Overproduction of what hormone?
Gigantism
Acromegaly
GH
Overproduction of what hormone?
Galactorrhea, amenorrhea, sexual dysfunction, infertility
Prolactin
Overproduction of what hormone?
Hyperthyroidism
TSH
Overproduction of what hormone?
Ovarian hyperstimulation, menstrual irregularities, testicular enlargement, precocious puberty
FSH
LH
Overproduction of what hormone?
Cushing syndrome
Hyperpigmentation
ACTH
