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Endocrinology > Pathology-Handorf > Flashcards

Pathology-Handorf Flashcards

1
Q

Glandular

A

“acorn”
-an aggregation of cells, specialized to secrete or excrete materials not related to their ordinary metabolic needs
Contrast: tissue, organ, system, compartment
Define: autocrine, paracrine, endocrine

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2
Q

Paracrine

A

adjacent target cell

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3
Q

Autocrine

A

targets sites on same cells

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4
Q

Endocrine

A

distant target cell using blood vessel

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5
Q

Thyroid Development

A
  • thyroid descends along a pathway which creates a virtual (or actual) duct known as the thyroglossal duct
  • ectopic or otherwise pathologic thyroid may be seen anywhere along this pathway in adult life
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6
Q

Lingual Thyroid

A

ECTOPIC THYROID

  • mass in foramen cecum of tongue, most commonly in women
  • dysphagia, dyspnea, dysphonia
  • rare, most common location of functioning ectopic thyroid
  • 70% associated with absence of cervical thyroid
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7
Q

Thyroglossal Duct Cyst

A

ECTOPIC THYROID

  • usually midline, between isthmus of thyroid and hyoid bone
  • usually apparent at birth or in childhood
  • tend to have repeated infection
  • not hormonally active
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8
Q

Substernal Goiter

A

ECTOPIC THYROID

  • often thyroid tissue that has dropped into anterior mediastinum, seen with cervical goiter
  • may be symptomatic (dyspnea, dysphagia, hyperthyroid, hypothyroid) or not
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9
Q

Lateral Aberrant Thyroid

A

ECTOPIC THYROID

  • aberrant thyroid/embryonic rests in lateral neck, sometimes in lymph nodes
  • in adults most likely metastatic follicular thyroid carcinoma
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10
Q

Suprahyoid/Infrahyoid Thyroid

A

ECTOPIC THYROID

  • similar location to thyroglossal duct cyst
  • often hypothyroid (absent cervical thyroid)
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11
Q

Struma Cordis

A

ECTOPIC THYROID

-ectopic thyroid tissue in heart, usually right ventricle

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12
Q

Struma Ovarii

A

ECTOPIC THYROID

  • NOT a product of misplaced ovarian tissue during organogenesis
  • monodermal teratoma of ovary, composed mainly (50%) of adult thyroid tissue
  • may functionally cause thyrotoxicosis
  • adenomas are common, 5% malignant
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13
Q

Hyperthyroidism

A
  • diffuse hyperplasia associated with Graves disease (85% of hyperthyroidism)
  • thyroiditis (early in course)
  • exogenous thyroid hormone administration
  • hyperfunctional multinodular goiter
  • hyperfunctional thyroid adenoma
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14
Q

Graves Disease

A
  • ocular changes due to sympathetic overstimulation of the levator palpebrae superioris and to accumulation of loose connective tissue behind the eyes
  • Exopthalmos
  • Fatigue, weight loss, increased appetite
  • Tachycardia
  • Muscular weakness
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15
Q

Pathophysiology of Graves Disease

A

-immune mediated production of TSH receptor antibodies:
binding of abs to thyroid TSH receptors causes thyroid stimulation without negative feedback
-binding of same abs to other tissue sites causes increased production of glycosamingclycans with resultant tissue effects (exopathalmos/myxedema)

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16
Q

Histopathology of Graves Disease

A
  • thyroid epithelium is hyperplastic “too many cells”
  • heaped up folds of hyperplastic epithelium are present
  • “scalloped” colloid with bubbles, from rapid colloid turnover
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17
Q

Hypothyroidism?

A
  • Thyroiditis
  • Radiation (radioactive iodine, external radiation)
  • Surgical excision of thyroid
  • Developmental anomaly (Cretinism)
  • Interference with thyroid hormone synthesis (I deficiency, lithium)
  • Suprathyroidal (pituitary/hypothalamic lesions)
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18
Q

Types of Thyroditis

A

1) Hashimoto Thyroiditis (Chronis Autoimmune thyroiditis)
2) Subacute (granulomatous)
3) Subacute Lymphocytic (painless)
4) Riedel Thyroiditis
5) Infectious Thyroiditis

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19
Q

Hashimoto Thyroiditis

A

-commonest cause of hypothyroidism in North America, where dietary iodine is sufficient
-autoimmune etiology; T cell defect
-10-20X more women
Hyper-early
Hypo-late
-intense lymphocytic infiltration with tissue destruction and early fibrosis

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20
Q

Subacute (Granulomatous) Thyroiditis

A

“DeQuervain thyroiditis”

  • 3-5X more women
  • peak in summer
21
Q

Subacute Lymphocytic (painless) Thyroiditis

A

-without granulomas or giant cells

22
Q

Riedel Thyroiditis

A
  • unusual disorder of unknown cause
  • characterized by fibrosis of thyroid and other neck structures
  • fibrosis in distant sites (retroperitoneum) may be seen
  • collagen
23
Q

Infectious Thyroiditis

A
  • The thyroid is not immune from infection by a variety of systemic agents
  • B/C its highly vascularized (1/4 blood supply)
24
Q

Diffuse and Multinodular Goiter

A
  • diffuse/nontoxic/simple/colloid goiter
    • endemic goiter
    • sporadic
  • multinodular goiter
  • best thought of as a spectrum of diseases with considerable overlap, caused by a # of different etiologies
25
Q

Goiter

A

-chronic enlargement of thyroid gland, not due to neoplasm, occurring endemically in certain locations, especially regions where glaciation occurred and the soil is low in iodine, and sporadically elsewhere

26
Q

Endemic Goiter

A
  • occurs in areas where environment is low in naturally occurring iodine
  • “endemic” if more than 10% of population has goiter
  • diet, genetics play a role
  • starts as diffuse thyroid enlargement, but generally progress (through multiple episodes of regression and enlargement) to multinodular state
27
Q

Function of Pituitary Gland?

A

-critical role in regulation of most other endocrine glands

28
Q

Anterior pituitary?

A
  • more vascularized

- releases GH, PRL, ACTH, FSH, LH, TSH

29
Q

Posterior pituitary?

A
  • less vascularized

- Oxytocin, ADH

30
Q

Most cells of the pituitary gland secrete?

A

GH 40-50%

Prolactin 20-25%

31
Q

Micrograph of Anterior Pituitary

A
  • vasculature is red

- some cells are in clusters

32
Q

Development of Pituitary?

A
  • adenohypophysis
  • neurohypophysis
  • vascular supply
33
Q

Hypopituitarism

A
  • postsurgical
  • postirradiation
  • cysts
  • tumors
  • ischemia/hemorrhage
  • inflammation
  • empty sella syndrome
  • gene defect
34
Q

Most common cause of Hypopituitarism?

A

TUMOR - Benign Adenomas

35
Q

Infarction of Pituitary

A
  • usually involves anterior lobe due to vascular supply

- about 75% of lobe must be lost for symptoms to occur (more endocrine function than we need)

36
Q

Causes of Pituitary Infarction?

A
  • Diabetes Mellitus
  • Intracranial Pressure
  • CVA
  • Hypoperfusion of any cause
  • Sheehan’s Syndrome
  • Pituitary Apoplexy
37
Q

Sheehan’s Syndrome

A
  • in postpartum women, infarct of pituitary due to massive blood loss
  • presents >1 month after birth
  • lack of prolactin/no milk/no periods
38
Q

Inflammatory Lesions of Pituitary

A
  • acute inflammation (sinusitis, osteomyelitis)
  • granulomatous (TB, fungal, sarcoid, idiopathic giant cell granuloma)
  • Lymphocytic (autoimmune)
39
Q

Non-Infections Granulomas of CNS are located where most?

A

-skull/base (pituitary/cranial nerves)

40
Q

Hyperpituitarism

A
  • hyperplasia (big gland, uncommon)
  • pituitary adenoma (most common)
  • ectopic secretion by non-pituitary tumor
  • hypothalmic disorder
41
Q

Pituitary Hyperplasia

A
  • uncommon
  • primary vs secondary
  • nodular or diffuse pattern of gland involvement
  • increase in cell number
  • ex: ACTH hyperplasia in Addison’s disease
42
Q

Pituitary Adenomas

A

-10% of intercranial neoplasms
-30-50 year olds
-usually isolated (can be part of MEN syndrome)
-functional tumors detected eariler
-slow growing
Common Symptoms: headache, compression of optic chasm

43
Q

Pituitary Carcinoma

A
  • very rare
  • middle age
  • isolated, sporatic
44
Q

Types of Pituitary Adenomas

A

1/2 are prolactin

1/4 are GH producing

45
Q

Gross Morphology of Pituitary Adenoma

A
  • typically fragmented due to standard transsphenoidal surgical approach
  • well circumscribed
  • macro vs microadenoma (1cm cut-off)
  • larger lesions may extend into suprasellar region
46
Q

Histopathology of Pituitary Adenoma

A
  • sheet-like growth pattern
  • relative cellular monomorphism
  • loss of typical reticulin fiber network
  • functional status cannot be predicted from routine histologic appearance
  • immunohistochemical stains can be confirmatory
47
Q

Microscopic Pituitary Adenoma

A
  • hypercellular
  • less vascular
  • bigger nuclei
  • no clustering
  • no mitotic figures
48
Q

Diabetes Insipidus

A
  • ADH deficiency
  • excretion of large volume of dilute urine
  • hypernatremia and increased osmolality
  • spontaneous or as a result of various conditions including trauma, tumors, inflammatory disorders, or post surgical
49
Q

SIADH

A
  • ADH excess
  • usually caused by ectopic secretion by tumor (small cell lung cancer)
  • hyponatremia, cerebral edema, neurologic dysfunction

Endocrinology (15 decks)

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