PathEndocrine Flashcards
3 classic symptoms of prolactinoma
Galactorrhea, amenorrhea (females) Impotence (males)
A typical complication of prolactinoma
Fracture
Secondary complication of growth cell adenoma (besides growth) and its mechanism
Diabetes Mellitus, because growth hormone is gluconeogenic
Diagnostic test for GH adenoma
Failure of glucose to suppress GH
bone condition seen in women with prolactinoma and its mechanism
Osteoporosis Prolactin inhibits GnRH = no estrogen = increased osteoclast activity
Lab findings of GH cell adenoma GH: Glucose, IGF1, OGTT test
Elevated GH, elevated glucose, low IGF-1 in serum and impaired OGTT test
cell of origin in prolactinoma
acidophilic cells of ant. pituitary
Woman gives birth, begins breast feeding and then a week later she notices loss of pubic hair and difficulty with breast feeding
Sheehan syndrome
Sheenan syndrome pathogenesis
During pregnancy, pituitary swells 2x but doesn’t increase blood flow. If blood is lost during labor, pituitary infarcts (coagulative necrosis)
Empty sella syndrome defect
Herniation of arachnoid and CSF into the sella, destroying the pituitary
Sudden onset severe headache and bitemporal hemianopsia and diplopia
Pituitary apoplexy
Major cause that central DI
Null cell adenoma, hypothalamic injury, etc
Lab findings of nephrogenic DI (serum ADH, urine sp. gravity)
high, low
Most common site of ectopic ADH production
Small Cell Lung Cacner/oat cell carcinoma
2 lab values that distinguish SIADH from DI
Sodium and serum osmolality SIADH is hyponatremic, low osmolality, the others are hypernatremic, high osmolality
Midline anterior neck mass in a child
Thyroglossal duct cyst
Graves disease defect (name one antibody)
IgG stimulates TSH receptor
3 PE findings of Graves
Goiter Exophthalmos Myxedema and skin pigmentation
mechanism of exopthalmos and pretibial myxedema
T cells stimulate Fibroblasts release to glycosaminoglycans –> increases osmotic swelling and adipocyte size –> exopthalmos
3 major cell types involved in exophthalmos
Fibroblasts T cells Fat cells
Histology of graves
Tall follicular cells, papillary processes with colloid scalloping Scalloped colloid looks like little tombstones –> like…GRAVES
Patient with hyperthyroidism undergoes a surgery under general anesthesia. When they wake up they develop severe hyperthermia, Delerium, tachycardia and arrhythmias
Diagnosis?
Thyroid Storm
Are hot nodules (with I131 thyroid scan) benign or malignant
Benign (mostly)
Infant with pot bellly, swollen face, protruding umbilicul, tongue falling out of mouth
Cretinism –> congential hypothyroid
6 Ps of cretinism
Pot belly Protruding umbilicus Protouding tongue Pale Puffy Face Poor brain development
Myxedema cause
accumulation of glycosaminoglycans in skin and soft tissue
Patent states they’ve been gaining weight despite not eating more, feels fatigued and has noticed deepening of voice and feels like their tongue is larger than normal
Hypothryoidism
Hashimoto defect (3 Ab)
IgG ab against thyroid peroxidase, IgG against thyroglobulin, Antimicrosomal Ab
HLA association with hashimoto
HLA DR5
classic paradox in lab findings in Hashimoto
Patients initially present with elevated T4 levels and SSx of hyperthyroid, then come back and have SSx of hypothyroid
Why do T4 levels initially increase in Hashimoto
follicle damage causes release of T4
2 unique histology findings of Hashimoto
1- Germinal center formation (appears like a lymph node), with plasma cells 2- hurthle cells
hurthle cell description
Eosinophlic metaplasia that lines the follicles
which cancer does hashimotos increase risk for? why?
Diffuse large B cell lymphoma b/c germinal cells are being formed
Patient has an upper respiratory infection, then develops periodic episodes of tachycardia, sweating, increased appetite. C/o Jaw pain and anterior neck pain.
Subacute granulomatous Thyroiditis
Subacute granulomatous thyroiditis labs
Elevated ESR
SGT clinical course
Hyperthyroidism that may progress to hypothyroid
SGT biopsy
Granulomatous inflammation w/ giant cells
20-year-old presents with dysphagia and wheezing. The thyroid is firm when palpated but not painful, and it doesn’t move when palpated.
Diagnosis?
Riedel fibrosing thyroiditis
how does I 131 uptake help distinguish hyperthyroid/toxic goiter from cancer
Cancer is a cold nodule (doesn’t take up I 131)
5 classic cancers of the thyroid
Follicular Adenoma Follicular Carcinoma Papillary carcinoma Medullary carcinoma Anaplastic carcinoma
Hallmark of follicular adenoma on gross exam/histology
Follicles are surrounded by a thick fibrous capsule
CLassic risk factor for developing papillary carcinoma of thyroid
Radition to the head and neck area as a child
Papillary carcinoma histology (2 unique features)
Empty nuclei with central clearing (orphan annie cells), Psammoma bodies Papillary = Psammoma and Pupils (eyes)
Most common pituitary adenoma
Prolactinoma