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Clin Med - Endocrine > Lecture 4 - Pathology > Flashcards

Lecture 4 - Pathology Flashcards

1
Q

What are the layers of the adrenal cortex?

A

Glomerulosa (outmost layer) - produces mineralocorticoids under RAAS regulation

Fasiculata and reticularis - produce and store fluocorticoids and sex steroids – controlled by ACTH regulation

Medulla - catecholamine production

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2
Q

What are the 2 different types of adrenal disorders?

A

Morphological

Functional

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3
Q

Adrenal Hyperplasia

A

bilateral disease
glands are equally enlarged on both sides

if ACTH excess – this is limited to zona fasciculata and retinularis

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4
Q

Adrenal Adenoma

A

solitary nodules, yellow
may or may not be functional disorder

incidental finding d/t imaging for something else

if its functioning and producing glucocorticoids –there will be atrophy of surrounding cortex

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5
Q

What are the NIH guidelines for incidental adrenal adenomas? (nodules)

A

if >6cm –> absolute remove

if <6cm –> monitor

if the nodule is hormonally active take it out

what people actually do is >4.5 cm remove!

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6
Q

Adrenal cortical carcinoma

A

rare
50% hormonally active

typically very big d/t retroperionteal space prevents you from feeling it grow and grow since there are no other organs to compress it and thus cause sxs

bimodal age: peds and >50y/o

poor prognosis –resistant to chemo

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7
Q

What are types of morphological adrenal disorders?

A

hyperplasia
adenoma
carcinoma

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8
Q

When are glucocorticoids highest?

A

highest on waking

lowest in early sleep

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9
Q

What are the clinical findings of Cushing’s syndrome?

A 
obesity 
HTN
poor wound healing
hyperglycemia
hypokalemia
alkalosis (d/t cortisol excess) 
hirsutism 
menstrual problems (d/t androgen excess)

moon face
buffalo hump

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10
Q

What causes cushing’s disease?

A

over production of ACTH in pituitary

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11
Q

What is the difference between cushings syndrome and disease?

A

syndrome is d/t ectopic ACTH production usually from SCC tumor in the lung

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12
Q

Adrenal Insufficiency

A

might result in mineralocorticoid deficiecny or glucocorticoid deficiency

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13
Q

Mineralocorticoid deficiency

A

dehydration
decrease in Na+
increase in K+
metabolic acidosis

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14
Q

Glucocorticoid deficiency

A

weakness
weight loss
vomiting
hypoglycemia

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15
Q

Primary Adrenal Insufficiency

A

Addison’s disease

lack cortisol and aldosteron
increase ACTH which causes abnormal pigmentation

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16
Q

What causes secondary adrenal insufficiency?

A

only lack of glucocotricoids

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17
Q

____% of the CORTEX must be destroyed to have insufficiency

A

> 90%

destruction occurs via infection or autoimmune disease

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18
Q

What are the main causes for destruction of the cortex?

A

infection in developing worlds

autoimmune disorders in Western world

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19
Q

Waterhouse - Frederichesen

A

adrenal hemorrhagic necrosis due to gram negative sepsis (often meningococcal)

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20
Q

Adrenogenital Syndrome

A

enzyme defect of the adrenal gland –abnormal hormone synthesis
inherited deficiency

usually the 21B hydroxy enzyme is missing

decrease in cortisol –> increase in ACTH –> hyperplasia

21
Q

What determines external genital development?

A

androgen —> female

if you have excess androgen you will have male-ish or ambiguous genitalia

22
Q

Which drugs stimulate the release of Epi in the adrenal medulla?

A

clonidine
ACEI
CCB

23
Q

What drugs inhibit the release of Epi in the adrenal meduall?

A

MAOI

24
Q

Neuroblastoma

A

childhood malignant tumor of the adrenal medulla

25
Q

Pheochromocytoma

A

tumor in adults from the adrenal medulla

“10% tumor”

  • 10% being familial
  • 10% extraadrenal
  • 10% are malignant
26
Q

What are the sxs of pehochromoctyoma?

A 
HTN 
sweating
tachycardia
hyperglycemia
feeling of DOOM
27
Q

How are neuroblastomas dx?

A

Typically found as an abdominal mass

28
Q

Basophilic vs ampiphilic vs. eosinophilic

A 
pink = eosinophilic
purple-ISH = ampiphilic
true purple (like the nucleus) = basophilic
29
Q

Can you tell if pheochromocytomia is malignant?

A

no
10% of them are malignant but we can’t tell if they are or not

only if they have metastisized

30
Q

N-myc amplification

A

a detectable genetic change of the neuroblastoma that indicates poor prognosis

31
Q

What is the most common tumor of the adrenal gland?

A

primary tumors are RARE

metastatic tumors are common (one of the most common metastatic locations besides LUNG)

32
Q

Where is the pituitary located?

A

in sella turcica at base of skull

right underneath the optic chiasm

33
Q

Which CN might an enlarged pituitary gland effect?

A

CN 2,3,4 and 6

34
Q

What happens to your pituitary gland during pregnancy?

A

doubles in size

35
Q

How many hormones are produced by the anterior lobe of the pituitary?

A

6 hormones

the posterior lobe doesnt produce anything but stores 2 types of hormones

36
Q

How is the pituitary activated?

A

feedback from end organ

stimulation from hypothalamus

37
Q

Overproduction of GH?

A

gigantism (children)

acromegaly (adults)

38
Q

Underproduction of GH?

A 
pituitary dwarfism (children) 
few sxs in adults
39
Q

What are common sxs of pts with GH excess?

A

thick, oily skin
HTN and cardiomegaly
glucose intolerance (DM)
degenerative joint disease

40
Q

How can you clinically dx GH deficiency (dwarfism)?

A

failure of GH to respond to at least 2 stimuli

41
Q

What chemical/hormone inhibits GH production?

A

glucose

you can’t measure GH levels so you have to test by giving the pt glucose

42
Q

Prolactin

A

stimulates milk production

inhibits GnRH production

43
Q

What causes prolactin to be released?

A

stress (illness)
sex
exercise
higher in sleep

44
Q

What are the sxs of increased prolactin?

A

galactorrhea (milk discharge not associated with breastfeeding/pregnancy)

decrease gonadal function (menstrual irregularities)

45
Q

What causes elevated prolactin?

A

prolactinoma (MC)

medications (sedative, antidepressants, blood pressure meds)

46
Q

How do you evaluate excess prolactin?

A

prolactin levels
upper reference limit 20-25ng/mL

> 200ng/mL - almost all tumors

47
Q

Macroadenoma

A

pituitary adenoma >1cm

48
Q

Mass effect

A

NOT DONE HERE

49
Q

Empty Sella Syndrome

A

herniation of diaphragma sellae allowing CSF to enter sella and compress pituitary gland

Clin Med - Endocrine (13 decks)

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