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REGUB > L20, 21, 26 + 27: Endocrine System > Flashcards

L20, 21, 26 + 27: Endocrine System Flashcards

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1
Q

What is endocrine pseudohypofunction?

A
  • appears to be decreased function of endocrine gland

- but really, the target organ receptors are not functioning

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2
Q

In which part of the skull does the pituitary gland sit in?

A

sella turcica (in middle cranial fossa)

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3
Q

What are the 2 parts of the pituitary gland?

A
  1. Anterior Pituitary

2. Posterior Pituitary

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4
Q

What is another name for the anterior pituitary gland?

A

adenohypophysis

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5
Q

What is another name for the posterior pituitary gland?

A

neurohypophysis

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6
Q

What is the anterior lobe of the pituitary gland derived from?

A

Rathke’s Pouch - composed of endocrine cells

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7
Q

What is the posterior lobe of the pituitary gland derived from?

A

the 3rd ventricle - composed of neural cells

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8
Q

List the 3 cell types of the anterior pituitary gland

A
  1. Acidophils
  2. Chromophobes
  3. Basophils
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9
Q

List the 7 hormones that the anterior pituitary gland releases

A
  1. Growth Hormone
  2. Prolactin
  3. Thyroid Stimulating Hormone
  4. Follicle Stimulating Hormone
  5. Leuteinising Hormone
  6. Adenocorticotrophic Hormone
  7. Melanocyte Stimulating Hormone
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10
Q

List 2 causes of hyperpituitarism and state which one is the most common pathology

A
  1. Functioning Adenoma - most common

2. Carcinoma

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11
Q

What is a functional adenoma vs. a non-functional adenoma?

A

Functional = pituitary adenoma having hormonal effects

Non-Functional = pituitary adenoma not having any hormonal effects

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12
Q

What is the most common functional adenoma of the pituitary gland?

A

Prolactinoma

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13
Q

List the top 5 most common functional adenomas of the pituitary gland (from most common to least)

A
  1. Prolactinoma
  2. Somatotrophic Adenoma
  3. Adenocorticotrophic Adenoma
  4. Gonadotrophic Adenoma
  5. Thyrotrophic Adenoma
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14
Q

What is a microadenoma of the pituitary gland?

A

pituitary adenoma less than 1 cm

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15
Q

Which is a macroadenoma of the pituitary gland?

A

pituitary adenoma greater than 1 cm

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16
Q

Functional pituitary adenoma symptoms are dependent on the hormone being overproduced.

There also may be “space effect” symptoms - list some of these symptoms

A
  • Bitemporal Hemianopia (due to optical chiasm pressure)

- Hormone Deficiency (due to increased size of adenoma)

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17
Q

What is the presentation of a prolactinoma in males?

A

Hyperprolactinaemia

  • asymptomatic
  • low libido
  • impotence
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18
Q

What is the presentation of a prolactinaemia in females?

A

Hyperprolactinaemia

  • amenorrhea
  • sterility/infertility
  • galactorrhoea
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19
Q

How can brain stalk/stem compression lead to increased prolactin?

A
  • dopamine normally released from hypothalamus (has inhibitory effects)
  • stalk compression = decreased dopamine
  • increase in prolactin secreted
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20
Q

How can prolactinomas be treated?

A 
Dopamine Agonist (Bromocriptine)
Surgery
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21
Q

What is the drug, bromocriptine, used for?

A

dopamine agonist

used for prolactinomas

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22
Q

If a somatotrophic adenoma occurs before puberty, how would the patient present?

A

Giantism

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23
Q

If a somatotrophic adenoma occurs after puberty, how would the patient present?

A

Acromegaly

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24
Q

List some of the characteristics/clinical presentation of acromegaly due to increased growth hormone

A
  • prognathism
  • brow protrusion
  • broad nose
  • large hands and feet
  • enlarged tongue
  • carpal tunnel syndrome
  • joint pain
  • deafness
  • glycosuria/diabetes
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25
What is prognathism a/w?
acromegaly due to GH excess after puberty
26
How may a ACTH-producing (functional) pituitary adenoma present?
- usually silent | - can present w/ Cushing's Disease
27
What is the difference between Cushing's Syndrome and Cushing's Disease?
Cushing's Syndrome - excess glucocorticoids; whatever the cause Cushing's Disease - excess glucocorticoids due to pit. adenoma -- leads to bilateral adrenocortical hyperplasia
28
What disease leads to bilateral adrenocortical hyperplasia?
Cushing's Disease (due to ACTH producing pituitary adenoma)
29
List some of the common causes of hypopituitarism
- adenoma (compressing pit. gland) - trauma - iatrogenic - Sheehan Syndrome
30
What is Sheehan Syndrome?
- causes hypopituitarism - due to postpartum necrosis of pit. gland - due to excess loss of blood during child birth
31
A lack of what hormone during childhood can lead to dwarfism?
Growth Hormone
32
A lack of what hormone during childhood can lead to delayed sexual development?
FSH/LH
33
What 2 hormones are released from the posterior pituitary gland?
1. Antidiuretic Hormone (ADH) | 2. Oxytocin
34
List some of the effects of oxytocin
- myometrial contraction during labour | - release of milk from lactating breast
35
What occurs if there is an increased secretion of ADH from the posterior pituitary gland?
Syndrome of Inappropriate ADH Secretion (SIADH) - excessive water reabsorption - causes hyponatraemia
36
What occurs if there is a decreased secretion of ADH from the posterior pituitary gland?
Diabetes Insipidus - unable to conserve water (polyuria, polydipsia) - caused by head injury, neoplasm, inflammation
37
What is Diabetes Insipidus (NOT nephrogenic DI)
- decreased ADH secretion - unable to conserve water (polyuria, polydipsia) - caused by head injury, neoplasm, inflammation
38
Which type of cells of the thyroid gland are the thyroid hormones secreted from?
Follicular Cells
39
Which type of cells of the thyroid gland is calcitonin secreted from?
Parafollicular C Cells
40
Is T3 or T4 (thyroid hormones) the more active form?
T3
41
What is present in the colloid of the thyroid gland?
Thyroglobulin (necessary for thyroid hormone production)
42
What does "euthyroid" mean?
normal thyroid status + function
43
What is Struma ovarii and what may it cause?
- ovarian teratoma - tumour composed of thyroid tissue - causes ectopic production of thyroid hormones Effect = HYPERTHYROIDISM
44
List the symptoms of hyperthyroidism
- heat intolerance - weight loss + increased appetite - tachycardia; palpitations - hypermotile GIT - tremor - irritability - exophthalmos
45
What is exophthalmos and what condition is it a/w?
- bulging of the eye out of socket | - hyperthyroidism
46
List some of the symptoms of hypothyroidism in adults
- myxoedema (face swelling) - apathy - mental sluggish - cold intolerance - hoarse
47
List some of the symptoms of hypothyroidism in children
- cretinism - impaired skeletal development - mental retardation - mental sluggish - cold intolerance - oedema of face, tongue and some viscera
48
What is myxoedema a/w?
hypothyroidism in adults
49
What is cretinism a/w?
hypothyroidism in children
50
What is Graves' Disease?
- autoimmune disorder w/ hyperthyroidism - familial tendency - IgG autoantibody to TSH receptor
51
List some of the clinical features/symptoms of Graves' Disease
- exophthalmos - "lid lag" (when looking down) - dermopathy; pretibial myxedema (thickening of skin) - ± thyroid swelling
52
What is Hashimoto's Thyroiditis?
- autoimmune disorder w/ hypothyroidism | - a/w chronic thyroiditis
53
What is thyroiditis?
disorders with thyroid inflammation | e.g. Graves' disease, Hashimoto's thyroiditis, De Quervain's thyroiditis
54
What is De Quervain's Thyroiditis?
- subacute granulomatous thyroiditis - viral aetiology: most pts have history of an upper RTI - pts return to euthyroid state in 6 to 8 weeks
55
What is the clinical presentation of De Quervain's thyroiditis?
sudden painful enlargement of thyroid fever history of upper RTI
56
What is a simple/multinodular goitre of the thyroid gland?
diffuse enlargment of the thyroid gland - most often caused by low thyroid hormones - this stimulates TSH - hyperplasia/hypertrophy of the thyroid
57
What is the difference between a thyroid nodule and a multinodular goitre?
Thyroid Nodule = localized Multinodular Goitre = diffuse enlargement of thyroid
58
Thyroid nodules undergo "triple assessment." Explain what triple assessment is
1. Clinical 2. Radiology (US, radionuclide imaging...) 3. Pathology (via FNABx)
59
Give 2 examples of a BENIGN thyroid neoplasm?
1. Follicular adenoma | 2. Hurthle cell (oncocytic) adenoma
60
List some of the risk factors for malignant thyroid tumours
- ionizing radiation exposure - iodine rich diet - genetics
61
What is the most common malignant thyroid tumour?
papillary carcinoma
62
List the common malignant thyroid tumours from most common to least
- papillary carcinoma - follicular carcinoma - medullary carcinoma - anaplastic carcinoma
63
Where do papillary carcinomas of the thyroid gland often invade?
regional lymph nodes
64
List some of the histological features of a papillary carcinoma of the thyroid gland
- small whitish nodule - pale/clear nuclei - overlapping nuclei - nuclear inclusions - nuclear grooves - psammoma bodies*
65
Where do follicular carcinomas of the thyroid gland often invade?
haematogenous spread - to bone marrow
66
What are the 2 possible treatments for follicular carcinoma?
1. total thyroidectomy 2. radioactive iodine - thyroid hormone given after surgery
67
What is a medullary carcinoma of the thyroid gland?
- malignant tumour of thyroid - neuroendocrine neoplasm of parafollicular C cells - they secrete calcitonin - a/w MEN (multiple endocrine neoplasia)
68
List the histological features of medullary carcinoma
- distinctive amyloid stroma | - often spindled cells
69
What is anaplastic carcinoma?
- malignant tumour of thyroid - elderly - sudden rapid growth into adjacent neck structures - poor prognosis - hard, gritty; undifferentiated giant cells
70
List the 3 zones of the adrenal cortex from outside to in
1. Zona Glomerulosa 2. Zona Fasciculata 3. Zona Reticularis
71
What are glucocorticoids?
cortisol
72
What are mineralocorticoids?
aldosterone
73
Where in the adrenal cortex are glucocorticoids made?
zona fasciculata
74
Where in the adrenal cortex are mineralocorticoids made?
zona glomerulosa
75
Where in the adrenal cortex are sex steroids created?
zona reticularis
76
What hormones are created in the adrenal medulla?
Catecholamines = adrenaline, noradrenaline and dopamine
77
What is another term for hypercortisolism?
Cushing Syndrome
78
Hypercortisolism can be exogenous or endogenous. What is the most common cause of hypercorisolism (Cushing Syndrome)?
Exogenous
79
What is an exogenous cause of hypercortisolism?
iatrogenic - administration of glucocorticoids/cortisol
80
List some of the endogenous causes of hypercortisolism
1. Pituitary Adenoma [Cushing Disease] 2. Adrenal adenoma/carcinoma 3. Paraneoplastic - secretion of ectopic ACTH by a neoplasm (e.g small cell carcinoma, carcinoid tumours...)
81
What happens to the structure of the adrenal gland in iatrogenic cushing syndrome?
- cortical atrophy | - reduction in the size of the adrenal gland
82
What is Cushing Syndrome and list the clinical features of it.
Cushing Syndrome: excess cortisol due to any cause - hypertension - truncal obesity - buffalo hump - decreased muscle mass - hypergylcaemia (gluconeogenesis) - fragile, thin skin - cutaneous striae - osteoporosis - susceptibility to infections - mental disturbances - hirsutism - menstrual abnormalities
83
What are the aldosterone and renin levels in primary hyperaldosteronism?
``` Aldosterone = Increased Renin = Decreased ```
84
Why is there decreased renin in primary hyperaldosteronism?
increased aldosterone will suppress RAAS and decrease plasma renin
85
What is another term for primary hyperaldosteronism caused by an adrenocortical neoplasm/adenoma?
Conn Syndrome
86
What is Conn Syndrome?
primary hyperaldosteronism caused by an adrenocortical neoplasm/adenoma
87
List the causes of primary hyperaldosteronism (Conn Syndrome)
1. Adrenocortical Neoplasm/Adenoma (Conn Syndrome) 2. Adrenocortical Hyperplasia 3. Glucocorticoid-Suppressible Hyperaldosteronism (rare)
88
What is the treatment for primary hyperaldosteronism caused by an adenoma?
surgical removal
89
What is the treatment for primary hyperaldosteronism caused by adrenocortical hyperplasia?
aldosterone antagonist - spironolactone
90
What is secondary hyperaldosteronism?
overproduction of aldosterone due to the activation of RAAS
91
What are the aldosterone and renin levels in secondary hyperaldosteronism?
``` Aldosterone = Increased Renin = Increased ```
92
List some of the causes of secondary hyperaldosteronism
- congestive heart failure - decreased renal perfusion - hypoalbuminaemia - pregnancy
93
What is the treatment of secondary hyperaldosteronism?
correction of underlying cause
94
What are the 2 compounds that are produced in the adrenal zona reticularis?
1. dehydroepiandrosterone 2. androstenedione they are converted to testosterone in peripheral tissues
95
List the causes of androgenital syndromes/androgen excess
1. Androgen Adrenocortical (Reticularis) Neoplasm | 2. Congenital Adrenal Hyperplasia
96
What is 21-Hydroxylase Deficiency?
- a congenital adrenal hyperplasia - no mineralocorticoid or cortisol synthesis - excess production of androgens - hyponatraemia, hyperkalaemia inducing acidosis, hypotension, cardiovascular collapse and death
97
What are the 2 causes of primary adrenocortical insufficiency?
occurs in adrenal gland 1. acute adrenocortical insufficiency (adrenal crisis) 2. chronic adrenocortical insufficiency (addison's disease)
98
What is adrenal crisis?
- primary adrenocortical insufficiency | - acute adrenocortical insufficiency
99
What is Addison's Disease?
- PRIMARY adrenocortical insufficiency - CHRONIC adrenocortical insufficiency - progressive destruction of adrenal cortex
100
List some causes of acute adrenal crisis (primary acute adrenocortical insufficiency)
- stress (infections, trauma...) which requires increased steroid output - rapid withdrawal of exogenous steroids - massive adrenal haemorrhage (e.g. Waterhouse-Friderichsen Syndrome)
101
What is Waterhouse-Friderichsen Syndrome?
bilateral adrenal haemorrhage - usually due to N. meningitidis septicaemia - rapid hypotension = shock - treated w/ antibiotics
102
What organism most likely causes Waterhouse-Friderichsen Syndrome?
Neisseria meningitidis
103
What are the 3 causes of Addison disease?
1. Autoimmune Adrenalitis - MOST COMMON 2. Infections (e.g. TB) 3. Metastatic Carcinoma
104
What are the most common carcinomas to cause Addison's disease?
lung/breast
105
The frequency of autoimmune adrenalitis is increased with which 2 histocompatability antigens?
1. HLA-B8 | 2. DR-3
106
List the clinical manifestations/symptoms of Addison disease
- progressive weakness - fatiguability - GI symptoms - hyperpigmentation of skin - aldosterone deficiency: hyperkalaemia, hyponatraemia, hypotension - glucocorticoid deficiency: hypoglycaemia
107
What is secondary adrenocortical insufficiency?
lack of adrenocortical hormone production due to lack of ACTH secretion
108
What is the most common type of adrenocortical neoplasm?
Adenoma > Carcinoma
109
What is the histological presentation of an adrenocortical adenomas?
- well circumscribed - appear yellow (due to lipid content) - haemorrhage - cystic degeneration - calcification
110
What is the treatment of an adrenocortical adneomas?
surgical excision
111
What is the histological presentation of an adrenocortical carcinoma?
- usually >20 cm - poorly demarcated - necrosis - haemorrhage - cystic change
112
Where do adrenocortical carcinomas invade and metastasize to?
- invade adrenal vein, vena cava and lymphatics | - metastasize to regional lymph nodes, lungs or other viscera
113
What is an adrenal myelolipoma?
- benign | - has fat and haematopoietic cells
114
What are the 2 cell types present in the adrenal medulla?
1. Chromaffin Cells (neuroendocrine cells) | 2. Sustentacular Cells (supporting cells)
115
Which cell type of the adrenal medulla secretes catecholamines?
Chromaffin Cells (neuroendocrine cells)
116
What is a phaeochromocytoma?
neoplasm of chromaffin cells (in adrenal medulla)
117
What is a histological feature of phaechromocytomas?
Zellballen: small nests of polygonal/spindle cells
118
Zellballen is a histological feature of what tumour?
Phaechromocytoma
119
List some of the clinical features of phaeochromocytoma
- hypertension - tachycardia - palpitations - headaches - sweating - tremor - abdominal/chest pain - paroxysmal episodes of hypertension
120
How is a phaeochromocytoma diagnosed?
24 hour urine collection of: i) catecholamines ii) metabolites e.g. VMA and metanephrines
121
Give 2 examples of metabolites that would confirm the diagnosis of a phaeochromocytoma
1. Vanillylmandelic Acid | 2. Metanephrines
122
What is the treatment of a phaeochromocytoma?
surgical excision (after medication w/ adrenergic blocking agents)
123
What are the 2 cell types present in the parathyroid glands?
1. Chief Cells | 2. Oxyphil Cells
124
Which cell type is PTH excreted from?
chief cells
125
What is primary hyperparathyroidism?
- overproduction of PTH due to error in parathyroid gland itself
126
List the 3 causes of primary hyperparathryoidism
1. Parathyroid Adenoma 2. Primary Hyperplasia 3. Parathyroid Carcinoma
127
What is the most common cause of primary hyperparathyroidism
parathyroid adenoma
128
What is the secondary hyperparathryoidism?
any condition a/w chronic decreased level of calcium leading to compensatory activity of parathyroid gland - e.g. renal failure
129
What is the most common cause of secondary hyperparathyroidism?
renal failure - renal failure = decreased PO4 excretion - hyperphosphataemia = depressed calcium levels - stimulates PTH gland and PTH secretion
130
What is tertiary hyperparathyroidism?
parathyroid activity becomes autonomous and excessive w/ resultant hypercalcaemia
131
What is the treatment of tertiary hyperparathyroidism?
parathyroidectomy
132
List the 4 causes of hypoparathyroidism
1. accidental removal due to thyroidectomy 2. congenital absence (DiGeorge syndrome) 3. primary idiopathic atrophy (autoimmune) 4. familial hypoparathyroidism
133
Chvostek's sign is indicative of what?
hypocalcaemia
134
Trousseau's sign is indicative of what?
hypocalcaemia
135
List some of the signs/clinical manifestations of hypocalcaemia
- numbness + tingling in the extremities and perioral region - muscle cramps - bronchospasm - laryngospasm - seizures - Chvostek's sign - Trousseau's sign - intracranial manifestations - conduction defect w/ prolonged QT interval
136
What are MEN syndromes?
- familial diseases a/w neoplasia or hyperplasia of several endocrine glands - AD
137
What is another name for Wermer's syndrome?
MEN Type 1
138
What genetic defect is associated with MEN Type 1?
MEN1 gene on chromosome 11q13
139
MEN Type 2 is a/w which mutation?
mutations of the RET proto-oncogene at chromosome 10q11.2
140
What is another name for Sipple syndrome?
Men Type 2A
141
What is another name for MEN Type 1?
Wermer's Syndrome
142
What is another name for Men Type 2A?
Sipple Syndrome
143
What are the 3 characteristics of MEN Type 2A?
1. Medullary Carcinoma of Thyroid 2. Phaeochromocytoma 3. Parathyroid Hyperplasia
144
What are the 3 characteristics of MEN Type 2B?
1. Medullary Carcinoma of Thyroid 2. Phaeochromocytoma 3. Extra-Endocrine Manifestations (e.g. marfanoid habitus - long axial bones)
145
What are marfanoid habitus (long axial bones) a/w?
MEN Type 2B
146
What is the treatment for MEN syndromes?
any pt w/ germline RET mutation is advised to have a prophylactic thyroidectomy to prevent inevitable development of medullary carcinomas
147
What test can be used to test for a lack of GH and ACTH/Cortisol production in the pituitary gland?
Insulin Tolerance Test - insulin decreases blood glucose - this will normally trigger an increase in GH and ACTH
148
An insulin tolerance test may be done to assess the production of GH and ACTH from the pituitary gland. What are 2 contraindications to this test?
- seizures | - ischaemic heart disease
149
In those that an insulin tolerance test are contraindicated, what test may be done to assess pituitary gland function and cortisol levels?
Short Synacthen Test (SST) - done to see if cortisol levels will rise - where is the problem occuring?
150
What is synacthen? What is it used for
- synthetic ACTH | - used in the Short Synacthen Test (SST) to test for pituitary function
151
What test is done to see if there is a GH excess?
Oral Glucose Tolerance Test (OGTT) - glucose inhibits GH secretions - if GH still high then there is a problem
152
List 3 types of drugs that may be given to a patient with GH excess
1. Dopamine Agonists - Cabergoline 2. Somatostatin Analogues - Octreotide, Lareotide 3. GH Receptor Blocker - Pegvisomant
153
What type of drug is Cabergoline and what is it used for?
dopamine agonist | - used to treat GH excess
154
What type of drugs are Ocreotide and Lareotide and what are they used for?
somatostatin analogues | - used to treat GH excess
155
What type of drug is Pegvisomant and what is it used for?
GH receptor blocker | - used to treat GH excess
156
What 2 investigations/test may be used to look for Cushing Syndrome?
1. 24-hour Cortisol-Free Urine [assessing overall cortisol secretion] 2. Overnight Dexamethasone Suppression Test [this lowers ACTH and should drop cortisol levels] - if cortisol is high, this is an adrenal problem
157
What is the MOST sensitive marker of thyroid status/function? Why?
TSH | - changes occur early before T3 and T4
158
Which antibodies are present and diagnostic of Hashimoto's Thyroiditis?
Thyroid Peroxidase [anti-TPO]
159
Which antibodies are present and diagnostic of Graves' Disease?
TSH Receptor Antibodies [anti-TRAb]
160
What is subclinical hypothyroidism?
- normal free T4 - but raised TSH (so T4 should be raised, but isn't) - can progress to over hypothyroidism note: increased rate of miscarriage if TPO antibodies are positive
161
Subclinical hypothyroidism can increase the rate of miscarriage under what condition?
if TPO antibodies are positive
162
In which 3 conditions should subclinical hypothyroidism be treated?
1. TSH > 10 2. Pre-Pregnancy/During Pregnancy 3. Infertility
163
What is thyroid scintigraphy and what is it used for?
- examines uptake of iodine in thyroid | - used to diagnose hyperthyroidism
164
What is subclinical hyperthyroidism?
- low TSH | - normal thyroid hormone levels (should be low as well)
165
What is the most common cause of subclinical hyperthyroidism?
exogenous levothyroxine (used in hypothyroidism)
166
List some of the risk factors of developing a carcinoma when a thyroid nodule is already present
- solitary nodule - had radiation to neck in teenage/child years - growing quickly - symptoms of pain or pressure - change in voice

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