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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
Adrenal Cortex - Hormones
Glucocorticoids Mineralocorticoids Sex Steroids
26
Adrenal Medulla - Hormones
Catecholamines
27
Glucocorticoids
Cortisol Effects: catabolic hormone, principally carbohydrates Anti-inflammatory, immunosuppressive, inhibit bone formation, calcium absorption
28
Mineralcorticoids
Aldosterone | Sodium and water retention, potassium excretion
29
Sex Steroids (Androgens)
Major source for androgens in females and in males with nonfunctional testes
30
Catecholamines
Epinephrine or Norepinephrine
31
Cushing's Syndrome - Causes
EXCESS: Glucocortiocids Cause: steroid therapy, hyperpalsia or functioning adenoma, Cushing's Disease, or ectopic ACTH secretion
32
Cushing's Syndrome - Clinical Effects
``` 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
Hyperaldosteronism
EXCESS: Mineralocorticoids Excess sodium - hypertension, hypokalemia Causes: Aldosterone secreting adenoma (Conn's Syndrome), Adrenal hyperplasia, activation of renin-angiotensin system
34
Adrenogenital Syndromes
EXCESS: secretion of androgens Effects: virilization Causes: ACTH hypersecretion, adrenal cortical adenoma/carcinoma, congenital adrenal hyperplasia (21 hydroxylase deficiency)
35
Adrenal Cortical Adenoma
Solitary, nonfunctional | Most common benign
36
Adrenal Cortical Carcinoma
Uncommon Metastasis - 70-90% of cases, liver, lung Malignancy - vascular invasion, size/weight, pleomorphism, tumor necrosis, weight loss
37
Chronic Primary Adrenal Insufficiency | Addison's Disease
Destruction of adrenal cortex Causes: autoimmune, infection, metastatic malignancy Clinical: fatigue, weakness, GI (nausea, vomiting, weight loss, diarrhea), hyponatremia, hyperkalemia, volume depletion, hyperpigmentation
38
Acute Adrenocortical Insufficiency
EMERGENCY Intractable vomiting, abdominal pain, hypotension, vascular collapse, coma Cause: sudden withdrawal of steroid, adrenal hemorrhage, Addisonian crisis
39
Pheochromocytoma
Chromaffin cell - adrenal medulla Secrete catecholamines - hypertension 10% tumor: bilateral, malignant, extra-adrenal, children
40
Parathyroid Glands
4 glands on posterior thyroid From 3-4 pharyngeal arch Secrete PTH
41
PTH
-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
Hyperparathyroidism
Primary: hyperplasia, neoplasia, hypercalcemia, hypophosphatemia Effects: painful bones, renal stones, abdominal groans, psychic moans, wakens, hypotonia Secondary: chronic renal failure
43
Parathyroid Hyperplasia
15-20% of cases | All 4 glands enlarged similarly
44
Parathyroid Adenoma
80% of cases | One gland enlarge - three normal or atrophic
45
Parathyroid Carcinoma
Rare PTH massively elevated Diagnostic: invasion, fibrosis, mitosis
46
Decreased PTH
Malignancy - associated hypercalcemia Hypoparathyroidism - hypocalcemia and hyperphosphatemia, surgical removal of parathyroid glands, effect: hypertonia, arrhythmias
47
Thyroid Gland Hormones
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
Thyroid Binding Gloubulin
Protein transport, binds T4 and T3 - inactive
49
Thyroglobulin
Storage form of thyroid hormone, colloid
50
Thyroid Hormone Effects
Increase basal metabolic rate: carbohydrate and lipid catabolism, stimulate protein synthesis, glucose absorption Increase cardiac output Growth effects
51
Hyperthyroidism Effects
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
Hyperthyroidism Causes
Primary: Graves disease, toxic goiter, thyroiditis, factitious Secondary: TSH secreting adenoma
53
Hyperthyroidism Diagnosis
Decreased TSH, Increased T4
54
RAIU
Diffuse increase - Graves disease Focal/nodular - Toxic goiter/adenoma Decreased uptake - Thyroiditis, factitious
55
Graves Disease
Hyperthyroidism Young to middle age women Autoimmune Clinical: hyperthyroidism, ophthalmopathy, dermopathy Treatment: thyroidectomy, radioactive iodine, beta blockers, antithyroid drugs
56
Thyroid Storm
ACUTE, SEVERE hyperthyroidism - Medical Emergency - arrhythmia Complication of Graves disease Marked elevated T4
57
Hypothyroidism
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
Hypothyroidism Causes
``` Therapeutic ablation Hashimoto's thyroiditis Iodine deficiency Dyshormonogenetic goiter Drugs Hypopituitarism ```
59
Hypothyroidism Diagnosis and Treatment
Increased TSH, Decreased T4 | Thyroxine
60
Chronic Lymphocytic Thyroiditis
Autoimmune - destruction of thyroid Middle age to elderly women Diffuse enlargement of gland, lymphocytic infiltration Diagnosis: antithyroid antibodies Complications: lymphoma, papillary carcinoma
61
DeQuervain's Thyroiditis
Viral infection Pain Euthyroid - resolves in several weeks
62
Fibrosing (Riedels)
Destruction by fibrous tissue Hard mass Autoimmune
63
Nodular Hyperplasia "Goiter"
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
Follicular Adenoma
Most common thyroid tumor Nonfunctional Solitary nodule, thin fibrous capsule Histology: microfollicular, normofollicular, macrofollicular
65
Follicular Carcinoma
5-15% of thyroid malignancies Metastases - bloodborne RAS mutation Similar to adenoma - with invasion
66
Hurthle Cell Tumors
Follicular tumor with oncocytic features More cytoplasm in the cell 20% of follicular carcinoma
67
Papillary Carcinoma
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
Cystic Papillary Carcinoma
10% of all PCT | Node metastases may be cystic
69
Undifferentiated (Anaplastic) Carcinoma
Malignant - rapid growth, wide invasion Squamous, sarcomatoid or giant cell Poor prognosis
70
Medullary Carcinoma (MCT)
Tumor of parafollicular cells (C cells) Sporadic - 70-80% of cases, solitary Familial - younger age group - MEN, multiple Histology: follicular, papillary, amyloid, calcitonin
71
Thyroid Lymphoma
Lymphocytic thyroiditis Large B cell lymphomas Rapid enlargement of thyroid
72
Multiple Endocrine Neoplasms (MEN)
Tumors or hyperplasia in multiple endocrine organs Autosomal dominant Chromosomal abnormality Younger age, multifocal, preceded by hyperplasia
73
Fine Needle Aspiration Biopsy
``` Medical Nodules (50-70%) - benign, thyroiditis, conservative follow up Surgical Nodules (20-25%) - malignancies, follicular, hurthle cell, surgical removal ```
74
Thyroid FNA Diagnostic Categories
Benign: thyroid nodule, thyroiditis, cyst Intermediate: follicular/hurthle cell neoplasm Malignant: usually PCT Nondiagnostic: hyopcellular, obscured by blood
75
Benign Thyroid Nodule
Most common FNA Nodular hyperplasia, macrofollicular Abundant colloid, small number of benign follicular cells
76
Follicular Neoplasm
Numerus benign appearing follicular cells, microfollicular, little colloid

Pathology (4 decks)

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