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Pathology > Pathology: Endocrine Disorders > Flashcards

Pathology: Endocrine Disorders Flashcards

1
Q

Peptide Hormones

A

PTH, pituitary and hypothalamic hormones, insulin

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2
Q

Steroid Hormones

A

Adrenal, sex hormones

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3
Q

Endocrine Organs

A

Pituitary, Adrenal, Thyroid, Parathyroid

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4
Q

Organs with Endocrine functions

A

Pancreas, ovary, testis, hypothalamus

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5
Q

Benign Neuroendocrine Tumors

A

paraganglioma, pheochromocytoma, islet cell tumors

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6
Q

Low Grade Malignant Neuroendocrine Tumors

A

carcinoid tumor

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7
Q

High Grade Malignant Neuroendocrine Tumors

A

large cell neuroendocrine carcinoma, small cell carcinoma

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8
Q

Neuroendocrine Morphology

A

Salt and pepper nuclear chromatin
Immunohistochemical markers
Neurosecretory granules

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9
Q

Feedback Inhibition

A

Secretion of a stimulating hormone inhibited by increased activity of target organ/tissue

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10
Q

Endocrine Hyperplasia

A

Diffuse or nodular

Primary or secondary

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11
Q

Endocrine Adenoma

A

Solitary, non functional

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12
Q

Endocrine Carcinoma

A

Less common than adenoma, well differentiated

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13
Q

Pituitary Gland

A

Located in sella turcica
Connected to hypothalamus by stalk
Anterior lobe (adenohypophysis)
Posterior lobe (neurohypophysis)

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14
Q

Anterior Pituitary Hormone

A 
Thyroid Stimulating Hormone
Adenocorticotrophic Hormone
Follicle Stimulating Hormone
Luteinizing Hormone
Prolactin
Growth Hormone
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15
Q

Pituitary Adenoma

A

Most common cause of pituitary hyper function
25% are nonfunctional
If functional - produce 1 hormone
Effects: imaging, expansion of sella, visual disturbances, increased intracranial pressure
Hormonal Effects

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16
Q

Prolactinoma

A

Galactorrhea, amenorrhea, infertility, symptoms most prominent in childbearing age

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17
Q

Growth Hormone (Somatotroph) Adenoma

A

Growth disturbances (gigantism, acromegaly), diabetes like metabolic effects

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18
Q

Gigantism

A

Growth hormone - excess before closure of epiphysis

Increase in size and limb length

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19
Q

Acromegaly

A

Growth hormone - excess after closure of epiphysis

Coarsening of facial features and hands

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20
Q

Corticotroph Adenoma

A

Cushing’s Disease

Hyperpigmentation (increase in MSH, with ACTH)

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21
Q

Posterior Pituitary

A

Antidiuretic Hormone - promotes water retention

Oxytocin - uterine and breast smooth muscle

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22
Q

Diabetes Insipidus

A

Decreased or absent ADH secretion

Clinical: polyuria, polydipsia, dilute urine, life-threatening dehydration

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23
Q

Syndrome of Inappropriate ADH Secretion (SIADH)

A

Increased ADH due to tumor - small cell carcinoma of lung

Kidneys retain too much water - hyponatremia, cerebral edema

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24
Q

Panhypopituitarism

A

Deficiency of all anterior pituitary hormones
Causes: neoplasms, ischemic necrosis, iatrogenic
Effects: TSH and ACTH deficiency

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25
Q

Adrenal Cortex - Hormones

A

Glucocorticoids
Mineralocorticoids
Sex Steroids

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26
Q

Adrenal Medulla - Hormones

A

Catecholamines

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27
Q

Glucocorticoids

A

Cortisol
Effects: catabolic hormone, principally carbohydrates
Anti-inflammatory, immunosuppressive, inhibit bone formation, calcium absorption

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28
Q

Mineralcorticoids

A

Aldosterone

Sodium and water retention, potassium excretion

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29
Q

Sex Steroids (Androgens)

A

Major source for androgens in females and in males with nonfunctional testes

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30
Q

Catecholamines

A

Epinephrine or Norepinephrine

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31
Q

Cushing’s Syndrome - Causes

A

EXCESS: Glucocortiocids
Cause: steroid therapy, hyperpalsia or functioning adenoma, Cushing’s Disease, or ectopic ACTH secretion

32
Q

Cushing’s Syndrome - Clinical Effects

A 
Impaired glucose tolerance/diabetes
Weight gain/hypertension
Axial redistribution of fat: Moon facies, Buffalo hump, truncal obesity
Bone Resorption
Skin fragility
Susceptibility to infection
Virilization
Mental disturbances
Skin Pigmentation
33
Q

Hyperaldosteronism

A

EXCESS: Mineralocorticoids
Excess sodium - hypertension, hypokalemia
Causes: Aldosterone secreting adenoma (Conn’s Syndrome), Adrenal hyperplasia, activation of renin-angiotensin system

34
Q

Adrenogenital Syndromes

A

EXCESS: secretion of androgens
Effects: virilization
Causes: ACTH hypersecretion, adrenal cortical adenoma/carcinoma, congenital adrenal hyperplasia (21 hydroxylase deficiency)

35
Q

Adrenal Cortical Adenoma

A

Solitary, nonfunctional

Most common benign

36
Q

Adrenal Cortical Carcinoma

A

Uncommon
Metastasis - 70-90% of cases, liver, lung
Malignancy - vascular invasion, size/weight, pleomorphism, tumor necrosis, weight loss

37
Q

Chronic Primary Adrenal Insufficiency

Addison’s Disease

A

Destruction of adrenal cortex
Causes: autoimmune, infection, metastatic malignancy
Clinical: fatigue, weakness, GI (nausea, vomiting, weight loss, diarrhea), hyponatremia, hyperkalemia, volume depletion, hyperpigmentation

38
Q

Acute Adrenocortical Insufficiency

A

EMERGENCY
Intractable vomiting, abdominal pain, hypotension, vascular collapse, coma
Cause: sudden withdrawal of steroid, adrenal hemorrhage, Addisonian crisis

39
Q

Pheochromocytoma

A

Chromaffin cell - adrenal medulla
Secrete catecholamines - hypertension
10% tumor: bilateral, malignant, extra-adrenal, children

40
Q

Parathyroid Glands

A

4 glands on posterior thyroid
From 3-4 pharyngeal arch
Secrete PTH

41
Q

PTH

A

-Polypeptide
-Increase serum calcium, decrease serum phosphate - increases osteoclast activity, promotes calcium retention and absorption, renal phosphate excretion, renal activation of vitamin D
Secretion stimulated by low levels of Ca

42
Q

Hyperparathyroidism

A

Primary: hyperplasia, neoplasia, hypercalcemia, hypophosphatemia
Effects: painful bones, renal stones, abdominal groans, psychic moans, wakens, hypotonia
Secondary: chronic renal failure

43
Q

Parathyroid Hyperplasia

A

15-20% of cases

All 4 glands enlarged similarly

44
Q

Parathyroid Adenoma

A

80% of cases

One gland enlarge - three normal or atrophic

45
Q

Parathyroid Carcinoma

A

Rare
PTH massively elevated
Diagnostic: invasion, fibrosis, mitosis

46
Q

Decreased PTH

A

Malignancy - associated hypercalcemia
Hypoparathyroidism - hypocalcemia and hyperphosphatemia, surgical removal of parathyroid glands, effect: hypertonia, arrhythmias

47
Q

Thyroid Gland Hormones

A

Thyroxine (T4) - main thyroid hormone in blood
Tri-iodothyronine (T3) - more active than T4
Calcitonin - parafollicular cells, regulates calcium metabolism (inhibits osteoclast, promotes calcium uptake)

48
Q

Thyroid Binding Gloubulin

A

Protein transport, binds T4 and T3 - inactive

49
Q

Thyroglobulin

A

Storage form of thyroid hormone, colloid

50
Q

Thyroid Hormone Effects

A

Increase basal metabolic rate: carbohydrate and lipid catabolism, stimulate protein synthesis, glucose absorption
Increase cardiac output
Growth effects

51
Q

Hyperthyroidism Effects

A

General: heat intolerance, weight loss, increased appetite
Cardiac: palpitation/tachycardia, arrythmias
GI: hypermotility, malabsorption, diarrhea
Skin: warm, moist skin, sweating
Neuromuscular: nervousness, irritability, tremor, muscle weakness

52
Q

Hyperthyroidism Causes

A

Primary: Graves disease, toxic goiter, thyroiditis, factitious
Secondary: TSH secreting adenoma

53
Q

Hyperthyroidism Diagnosis

A

Decreased TSH, Increased T4

54
Q

RAIU

A

Diffuse increase - Graves disease
Focal/nodular - Toxic goiter/adenoma
Decreased uptake - Thyroiditis, factitious

55
Q

Graves Disease

A

Hyperthyroidism
Young to middle age women
Autoimmune
Clinical: hyperthyroidism, ophthalmopathy, dermopathy
Treatment: thyroidectomy, radioactive iodine, beta blockers, antithyroid drugs

56
Q

Thyroid Storm

A

ACUTE, SEVERE hyperthyroidism - Medical Emergency - arrhythmia
Complication of Graves disease
Marked elevated T4

57
Q

Hypothyroidism

A

General: cold intolerance, listlessness, weight gain
Cardiac: bradycardia, pericardial effusion
Skin: dry skin, decreased sweating, brittle hair, myxedema
Neuromuscular: slow reflexes
GI: decreased motility/constipation

58
Q

Hypothyroidism Causes

A 
Therapeutic ablation
Hashimoto's thyroiditis
Iodine deficiency
Dyshormonogenetic goiter
Drugs
Hypopituitarism
59
Q

Hypothyroidism Diagnosis and Treatment

A

Increased TSH, Decreased T4

Thyroxine

60
Q

Chronic Lymphocytic Thyroiditis

A

Autoimmune - destruction of thyroid
Middle age to elderly women
Diffuse enlargement of gland, lymphocytic infiltration
Diagnosis: antithyroid antibodies
Complications: lymphoma, papillary carcinoma

61
Q

DeQuervain’s Thyroiditis

A

Viral infection
Pain
Euthyroid - resolves in several weeks

62
Q

Fibrosing (Riedels)

A

Destruction by fibrous tissue
Hard mass
Autoimmune

63
Q

Nodular Hyperplasia “Goiter”

A

Endemic - iodine deficiency
Sporadic - most common cause of thyroid enlargement
Morphology - marked variation and size, nodules without fibrous capsule
Secondary changes: hemorrhage, fibrosis, calcification, cystic degeneration

64
Q

Follicular Adenoma

A

Most common thyroid tumor
Nonfunctional
Solitary nodule, thin fibrous capsule
Histology: microfollicular, normofollicular, macrofollicular

65
Q

Follicular Carcinoma

A

5-15% of thyroid malignancies
Metastases - bloodborne
RAS mutation
Similar to adenoma - with invasion

66
Q

Hurthle Cell Tumors

A

Follicular tumor with oncocytic features
More cytoplasm in the cell
20% of follicular carcinoma

67
Q

Papillary Carcinoma

A

65-80% of all thyroid cancers
Ill defined, unencapsulated
Spread: local spread, cervical lymph nodes, distant uncommon
Histology: papillary architecture, nuclear abnormalities (Orphan Annie, nuclear grooves, intranuclear cystoplasmic inclusions), Psammona bodies, Oncogenes - BRAF

68
Q

Cystic Papillary Carcinoma

A

10% of all PCT

Node metastases may be cystic

69
Q

Undifferentiated (Anaplastic) Carcinoma

A

Malignant - rapid growth, wide invasion
Squamous, sarcomatoid or giant cell
Poor prognosis

70
Q

Medullary Carcinoma (MCT)

A

Tumor of parafollicular cells (C cells)
Sporadic - 70-80% of cases, solitary
Familial - younger age group - MEN, multiple
Histology: follicular, papillary, amyloid, calcitonin

71
Q

Thyroid Lymphoma

A

Lymphocytic thyroiditis
Large B cell lymphomas
Rapid enlargement of thyroid

72
Q

Multiple Endocrine Neoplasms (MEN)

A

Tumors or hyperplasia in multiple endocrine organs
Autosomal dominant
Chromosomal abnormality
Younger age, multifocal, preceded by hyperplasia

73
Q

Fine Needle Aspiration Biopsy

A 
Medical Nodules (50-70%) - benign, thyroiditis, conservative follow up
Surgical Nodules (20-25%) - malignancies, follicular, hurthle cell, surgical removal
74
Q

Thyroid FNA Diagnostic Categories

A

Benign: thyroid nodule, thyroiditis, cyst
Intermediate: follicular/hurthle cell neoplasm
Malignant: usually PCT
Nondiagnostic: hyopcellular, obscured by blood

75
Q

Benign Thyroid Nodule

A

Most common FNA
Nodular hyperplasia, macrofollicular
Abundant colloid, small number of benign follicular cells

76
Q

Follicular Neoplasm

A

Numerus benign appearing follicular cells, microfollicular, little colloid

Pathology (4 decks)

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