Lecture 6- Endocrine pathology Flashcards
the …. is the master gland because it controls most other endocrine glands. it is located in the sella turcica, is the size of a pea and has 2 lobes
pituitary gland
hormones produced by the anterior pituitary
GH TSH PRL ACTH FSH LH
hormones of the posterior pituitary
oxytocin
ADH
hyperfunction of the anterior pituitary is almost always associated with…
adenoma
causes of hypopituitarism
nonfunctional pituitary adenoma
postpartum ischemic necrosis (need 75%)
ablation/destruction by surgery, radiation or adjacent tumor
hypofunction in GH causes
dwarfism
hypofunction in gonadotropin causes
amenorrhea/infertility in women
decreased libido, impotence, lack of pubic hair in men
hypofunction of prolactin causes
no post-partum lactation
hypofunction of TSH causes
hypothyroidism
hypofunction of ACTH causes
hypoadrenalism
… and … is caused by an adenoma in the anterior lobe of the pituitary that secretes GH
gigantism
acromegaly
gigantism occurs before or after the closure of the epiphyseal plates in the long bones?
before
what are the clinical features of gigantism
generalized increase in size of body
arms and legs are disproportionately long
tx and prognosis for gigantism
surgical removal of adenoma
fair to good
acromegaly occurs before or after the closure epiphyseal plates in the long bones?
after
clinical features of acromegaly
enlarged bones of hand, feet and face
prognathism, diastema
HTN, CHF
tx of acromegaly
surgical removal of adenoma
prognosis for acromegaly?
guarded due to complications of HTN and CHF
causes of dwarfism
failure of pit gland to produce GH
lack of response to GH by patients tissues
clinical features of dwarfism
short stature
small jaws and teeth
tx and prognosis of dwarfism
hormone replacement therapy
good
the thyroid gland develops from an invagination of …. which arises at the base of the tongue in the region of the …
endoderm
foramen cecum
most common cause of hyperthyroidism?
diffuse toxic hyperplasia (graves disease)
other causes of hyperthyroidism
hyperfunctional multinodular goiter
hyperfunctional thyroid adenoma
TSH-ecreting pituitary adenoma (rare)
dx of hyperthyroidism
elevated TH and decreased TSH
hyperthyroidism symptoms
hypermobility
GI hypermobility-malabsorption/diarrhea
tachycardia
nervousness/tremor
exophthalmos (bulging eyes)
excessive sweating/ heat intolerance
weight loss despite increased appetitie
… is a sudden onset of severe hyperthyroidism and is usually triggered by stress. patients usually die of cardiac arrhythmias if untreated
thyroid storm
tx of hyperthyroidism ?
depends on cause
reactive iodine can be used to destroy overactive thyroid tissue
graves disease (diffuse toxic hyperplasia) has a … predominance, is common and is an autoimmune disease with a significant … component
female
genetic
pretibial myxedema is present in…
Graves disease
causes of hypothyroidism
ablation by surgery or radiation therapy
hashimoto thyroiditis (autoimminue)
iodine deficiency
hypothyroidism can either present as … or …
cretinism (children)
myxedema (adults)
clinical features of cretinism
impaired development of skeletal and CNS
short stature
severe mental retardation
protruding tongue
clinical features of myxedema
generalized apathy
mental sluggishness (mimics depression)
obesity
cold intolerance
enlarged tongue
hashimoto thyroiditis has a … predominance, seen in …. and has a significant
female
older
genetic
with hypothyroidism, patients are at risk for other autoimmune diseases and …
B cell non hodgkin lymphomas
most common of thyroid cancers? (>85%)
more common in women or men?
papillary thyroid carcinoma
women
some cases of papillary thyroid carcinoma is related to radiation exposure and many have mutations in ….
RET proto-oncogene
pathology of papillary thyroid carcinoma
papillary projections
nuclear clearing- orphan annie nuclei
nuclear grooves
papillary thyroid carcinomas are …. and have a 10 year survival rate of …%
indolent
95%
in follicular thyroid carcinoma what must you see?
invasion through the capsule or into the blood vessels
2nd most common type of thyroid cancer?
follicular thyroid carcinoma
follicular thyroid carcinoma may resemble
follicular adenoma
T/F patients are usually older with papillary thyroid carcinoma than follicular thyroid carcinoma
false
…. … carcinoma is uncommon (5% of thyroid cancers) and is derived from parafollicular (C) cells. may be sporadic or familial (MEN syndromes)
medullary thyroid
all medullary thyroid carcinomas have mutation in
RET proto-oncogene
in medullary thyroid carcinoma you see increased serum…
calcitonin
serum TSH in hypothyroidism
increased in primary due to loss of feedback inhibition
not increased in cases caused by primary hypothalamic or pituitary dz
T/F thyroid nodules are common
true
most nodules of the thyroid are non-neoplastic. ….% are carcinomas and nodules in … and … patients are more likely to be neoplastic
1%
males
young
there is an increase risk for thyroid neoplasms with radiation exposure in the first…
2 decades
… accounts for 5-15% of thyroid cancers and usually patient is older than in papillary thyroid cancer. Occurs in areas with iodine deficiency and may resemble adenoma with a discrete capsule
follicular carcinoma
