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Endocrine > Robbins > Flashcards

Robbins Flashcards

1
Q

What gene mutations have been identified as causes of familial pituitary adenomas?

A

MEN 1
CDKNIB
PRKARIA
AIP–> develops GH secreting adenoma @ young age

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2
Q

Cellular monomorphism, absence of Reticulin network?

A

Pituitary adenoma

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3
Q

Macroadenomas in pituitary gland lead to mass effect causing?

A

Visual disturbances

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4
Q

What mutation is one of the more come genetic alterations in Pituitary adenomas?

A

GNAS I mutation–> constitutively active Gs protein

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5
Q

What is the MC type of hyperfunctioning pituitary adenomas?

A

Prolactinomas

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6
Q

What are the consequences of Prolactinomas?

A

Amenorrhea
Galactorrhea
Libido
Infertility

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7
Q

Persistent hypersecretion of GH stimulates secretion of what?

A

IGF-I (somatomedin C) from Liver

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8
Q

Enlargement of jaw + hands + feet + separation of teeth?

A

Acromegaly from GH excess in adults

**Children get Gigantism

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9
Q

What is GH excess associated with causing?

A 
Acromegaly/ Gigantism 
Glucose intolerance 
DB mellitus 
Muscle weakness
HTN + CHF
Arthritis 
Osteoporosis
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10
Q

What type of pituitary adenoma stains Positively with PAS?

A

Corticotroph cell Adenoma (ACTH releasing)

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11
Q

Corticotroph cell adenomas can clinically present with?

A

Cushing syndrome

Hyperpigmention due to MSH accompanying ACTH release

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12
Q

What is the typical presentation of nonfunctioning pituitary adenomas and Most other pituitary adenomas?

A

Mass effect

Possible Hypopituitarism

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13
Q

What are the necessary condition to get clinical signs of Hypopituitarism?

A

75% loss or absence of Pituitary gland

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14
Q

Hypopituitarism with evidence of posterior pituitary dysfunction will clinically present as what?

A

Diabetes Insipidus –> almost always Hypothalamic in orgin

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15
Q

Sheehan syndrome is?

A

Postpartum Ischemic necrosis of anterior pituitary gland.

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16
Q

What happens to Anterior Pituitary gland during pregnancy?

A

Enlarges–> increased size/# of prolactin secreting cells but NOT accompanied by increased Blood supply–> susceptible to necrosis

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17
Q

What are some (other than pregnancy) conditions associated with Significant pituitary necrosis?

A 
DIC
SCD
Elevated intracranial pressures
Traumatic injury 
Shock
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18
Q

What are some other conditions associated with Anterior pituitary hypo function?

A

Sarcoidosis
TB
Metastasis

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19
Q

What are some of the clinical signs/symptoms of Hypopituitarism?

A 
Dwarfism (GH)
Amenorrhea + infertility in women (GnRH)
Decreased Libido, impotence, Loss of pubic hair
Hypothyroidism
Hypoadrenalism
Failure of postpartum lactation
Pallor of skin (ACTH/ MSH)
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20
Q

Nonapeptide hormone synthesized in the Supraoptic nucleus?

A

ADH

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21
Q

What is the most useful screening test for Hyper or hypo thyroidism?

A

TSH

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22
Q

Increased Radioactive Iodide uptake is seen in what conditions?

A

Graves

Solitary nodule in toxic adenoma

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23
Q

Decreased Radioactive iodide uptake is seen in what condition?

A

Thyroditis

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24
Q

MCC of Hypothyroidism?

A

Ww–> Iodine deficiency

Developed worlds–> Autoimmune

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25
Q

Hypothyroidism in infant or child?

A

Cretinism

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26
Q

Signs and symptoms of Cretinism?

A 
Mental retardation 
Short stature
Coarse Facial Features
Protruding tongue
Umbilical Hernia
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27
Q

Hypothyroidism in adults?

A

Myxoedema

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28
Q

Signs and symptoms of Myxoedema?

A 
Mentally sluggish 
cold intolerant 
Myxoedema--> mucopolysaccharide edema 
Broadening and coarsening of facial features
Tongue enlargement 
Deepening of VOICE
Constipation 
CHF
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29
Q

Condition associated with acute illness and sever thyroid pain?

A

Infectious thyroiditis

Granulomatous Thyroiditis

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30
Q

Disorders manifested by thyroid dysfunction and little inflammation?

A

Subacute lymphocytic thyroditis (PAINLESS)

Fibrous [Reidel] Thyroditis

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31
Q

2nd MCC of Hypothyroidism characterized by glandular thyroid failure secondary to Autoimmune destruction of thyroid gland?

A

Hashimoto Thyroditis

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32
Q

Pg of Hashimoto thyroiditis?

A

CD8 mediated cell death
Cytokine mediated cell death–>IFN gamma= macs
Antithyroid Abs mediate cytotoxicity

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33
Q

Hashimoto Thyroiditis has what genetic association?

A

CTLA4–> encodes for Treg cells

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34
Q

Biopsy showing widespread infiltration of Lymphocytes, plasma cells, Well developed Germinal Centers?

A

Hashimoto

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35
Q

What are Hurthle or Oxyphil cells?

A

Follicular cells with:
Abundantly eosinophilic
Granular cytoplasm
Numerous mitochondria

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36
Q

Painless enlargement of thyroid, associated with Hypothyroidism in middle age women?

A

Hashimoto

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37
Q

People with Hashimoto are at increased RISK for what?

A

Non-Hodgkin B cell Lymphoma within Thyroid gland

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38
Q

Characterized by Transient Hyperthyroidism and longterm Hypothyroidism?

A

Hashimoto

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39
Q

Patient with Hx of URTi just before onset of Thyroditis?

A

Subacute Granulomatous Thyroiditis–> Follows viral infections

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40
Q

Firm thyroid, intact capsule, and PMN infiltration followed by lymphocytes, macs, plasma cells provoking a granulomatous reaction with giant cells inside Colloid?

A

Subacute Granulomatous Thyroiditis

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41
Q

Thyroid pain in young patient vs. old patient?

A

Young–> Hashimoto

Old–> Subacute granulomatous

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42
Q

Painless thyroiditis following pregnancy, normal appearing thyroid, lymphocytic infiltration + hyperplastic germinal center formation caused by Autoimmunity?

A

Subacute Lymphocytic Thyroiditis

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43
Q

Autoimmune condition causing Extensive fibrosis of thyroid and neck structures producing a HARD and fixed thyroid mass that may stimulate a neoplasm? Other consequences?

A

Riedel Thyroiditis–> associated with retroperitoneal fibrosis in some cases

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44
Q

Causes Thyrotoxicosis, Ophthalmopathy, Dermopathy (Pretibial Myxedema)?

A

GRAVES

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45
Q

What are some of the genetic association with Graves disease?

A

HLA-DR3
CLTA4
PTPN22

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46
Q

Autoimmune disease characterized by thyroid stimulating Igs, Thyroid growth stimulating Igs, TSH binding inhibitor Igs?

A

Graves disease

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47
Q

What is the Pg of Ophthalamopathy in Graves disease?

A
  1. T cell infiltration
  2. Inflammation + swelling of extraocular muscles
  3. Glycosaminoglycan (Hyaluronic acid chondroitin sulfate) accumulation
  4. Increased Adipocyte #
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48
Q

Microscopic appearance of Graves disease?

A

Diffuse hypertrophy/ hyperplasia
Scalloped colloid in Follicular margins
Germinal center formation

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49
Q

Characteristically causes increased blood flow to the thyroid with audible bruits, wide gaze and lid lag patient?

A

Graves disease

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50
Q

Typical characteristics of neoplastic thyroid nodules?

A 
Solitary 
Younger patient 
Males
History of Radiation
NOT "Hot" (take up radioactive Iodine)
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51
Q

What genetics is associated with thyroid adenomas?

A

TSH receptor mutations

GNAS–> allows follicular cells to secrete Thyroid hormone independent of TSH (autonomy)

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52
Q

Painless Solitary nodule with Well-defined, Intact capsule, that compresses adjacent thyroid parenchyma?

A

Adenoma

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53
Q

What is the scanning radionuclide description for a thyroid adenoma?

A

Cold–> less likely to be neoplastic

**some are HOT–> Toxic and most turn malignant

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54
Q

Types of Thyroid Carcinomas in incidence order?

A

Papillary
Follicular
Anaplastic
Medullary

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55
Q

Genetics associated with Papillary thyroid carcinoma?

A

MAP kinase activation: RET or NTRKI + BRAF

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56
Q

Genetics associated with Follicular thyroid carcinoma?

A

PI-3K/AKT signaling pathway mutation

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57
Q

Genetics associated with Medullary thyroid carcinoma?

A

MEN-2 and RET oncogene mutations

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58
Q

Vast majority of Thyroid cancers are associated with Hx of?

A

Radiation

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59
Q

Cells with finely dispersed chromatin, imparting an optically clear appearance of a Ground glass Nuclei?

A

Papillary thyroid carcinoma–> “Orphan Annie eye” nuclei

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60
Q

Neoplastic growth with cells showing invaginations, pseudoinclusions, concentrically calcified structures (Psammoma bodies) with in papillae?

A

Papillary thyroid carcinoma–> metastasis to near by lymph nodes 50%

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61
Q

Thyroid carcinoma associated with 40-60 yo women in Iodine deficient areas?

A

Follicular Thyroid carcinoma

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62
Q

What is the important difference between follicular adenoma and follicular carcinoma?

A

Invasion of the CAPSULE or Vessel

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63
Q

Solitary Cold nodule, that Hematogenously spreads to Lungs, bone, or liver?

A

Follicular thyroid carcinoma–> NO LYMPH node metastasis

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64
Q

Undifferentiated tumor of thyroid follicular epithelium, in >60yo, aggressive with nearly 100% mortality rate?

A

Anaplastic carcinoma

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65
Q

Bulky mass that typically grows rapidly beyond thyroid capsule into adjacent neck structures, with large pleomorphic giant cells, spindle cells?

A

Anaplastic carcinoma

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66
Q

Neuroendocrine neoplasm derived from parafollicular cells or C cells, secrete Calcitonin, in CHILD is associated with what genetics?

A

Medullary carcinoma–> MEN 2a or 2b

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67
Q

Altered calcitonin molecules in adjacent stroma of medullary carcinoma leads to deposition of what?

A

AMYLOID

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68
Q

Multicentric C cell hyperplasia with amyloid deposition usually presents with what clinical symptoms?

A

Medullary carcinoma–> Dysphagia or hoarseness

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69
Q

Familial medullary carcinoma is associated with what mutation?

A

RET–> Prophylactic Thyroidectomy

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70
Q

Radioactive Iodine uptake shows Homogenous image with HIGH uptake?

A

Graves

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71
Q

Radioactive iodine uptake shows no image or Low uptake?

A

Subacute thyroiditis
PPT
Pt taking EXCESS thyroid hormone

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72
Q

Radioactive Iodine uptake shows Multiple Hot spots with high uptake?

A

Toxic multinodular goiter

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73
Q

Radioactive iodine uptake shows Single High Uptake hot spot with rest of gland suppressed?

A

Toxic adenoma

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74
Q

RAI uptake image shows Single focal COLD spot in otherwise normal gland?

A

Benign/ colloid cyst

Bengin/malignant tumor

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75
Q

RAI uptake showing patchiness without hotter or colder spots?

A

Multinodular non-toxic goiter

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76
Q

RAI uptake showing diffuse uptake?

A

Generalized benign Goiter

77
Q

50% of the Adenohypophysis is what type of cells?

A

Somatotrophs–> Producing GH

78
Q

What % of the adenohypohysis is made up of lactotrophs + Corticotrophs + Thyrotrophs + Gonadotrophs?

A

Lac–> 20%
Cort–> 20%
Thyro–> 5%
gonad–> 5%

79
Q

Dopamine inhibits the formation or secretion of what hormones?

A

TSH + Prolactin

80
Q

Stomatostains inhibit the secretion of what hormones?

81
Q

What two peptides interact to release prolactin during suckling or stress?

82
Q

Pituitary tumor invading laterally will affect what structures?

A

Lateral–> Cavernous sinus–> CN III, IV , VI paralysis

83
Q

Pituitary tumor invading superiorly will damage what structure?

A

Diaphrama sella–> OPTIC CHAISM= Bitemporal hemianopsia

84
Q

Postpartum pituitary necrosis caused by severe blood loss during delivery?

A

Sheehan syndrome

85
Q

Intrapituitary hemorrhage caused by Growing tumor causing vascular necrosis leading to Hypopituitarism?

A

Pituitary Apoplexy

86
Q

What is the only hormone that will increase due to a damage to the Infindibulum/ or pituitary stalk resulting in lack of Hypothalamic hormone delivery?

A

Prolactin–> Decreased Dopamine inhibition

87
Q

Pt with hypotension, wgt loss, aches, loss of axillary hair and low adrogens/ cortisol has what type of deficiency?

A

Hypadrenalsim–> LOW ACTH

88
Q

Male with impotence and infertility can have what hormonal problems>?

A

High Prolactin

Low Testosterone

89
Q

Women with amenorrhea and infertility can have what type of hormone imbalance?

A

High Prolactin

Low estrogen

90
Q

Dynamic test involving insulin induced Hypoglycemia is testing for what hormones?

A 
GH
ACTH--> Cortisol
PRL
Glucagon
Catecholamines
ADH
91
Q

Dynamic test involving infusion of arginine stimulates what hormone secretion?

92
Q

A sleep study would be done to determine of which hormones?

A

GH
PRL
ACTH + Cortisol

93
Q

Normal blood glucose range?

94
Q

Criteria for Dx of Diabetes mellitus?

A

Random glucose= 200mg/dL or MORE
Fasting= 126mg/dL or MORE
OGTT= 200 or MORE after 2 hrs

95
Q

Type 1 Diabetes mellitus?

A

Autoimmune destruction of Beta cells causing Absolute deficiency of Insulin (10%)

96
Q

Type 2 Diabetes mellitus?

A

Peripheral resistance + relative insulin deficiency

80-90%

97
Q

Type 1 DB most commonly develops when?

A

Childhood and manifests @ Puberty

98
Q

Hyperglycemia and ketosis occur when in T1DB?

A

Late in course after more than 90% of beta cells are Dead

99
Q

What is the fundamental immune abnormality in T1DB?

A

Failure of self-tolerance in T cells

100
Q

Production of autoantibodies against insulin + glutamic acid decarboxylase and necrosis of beta cells with Lymphocytic infiltration is a feature of what?

101
Q

What are the genetic risks associated with T1DB?

A 
HLA-D--> MHC class II on 6p21
HLA-DR3/DR4
102
Q

What are some of the environmental factors that can lead to T1DB?

A

Mumps
Rubella
Coxsackie B viruses

103
Q

What is insulin resistance?

A

Failure of target cells to respond to normal levels of insulin

104
Q

Visceral obesity + insulin resistance + Glucose intolerance + CV risks (HTN or Abnormal lipids)?

A

Metabolic syndrome

105
Q

Intracellular High triglyceride and products of FA metabolism are potent inhibitors of what?

A

Inhibit Insulin Signaling and result in INSULIN RESISTANCE-> link btwn Obesity and T2DB

106
Q

What is present in 90% of the islets in a long Standing T2DB?

A

Amyloid replacing islet cells

107
Q

What are the monogenic Diabetes?

A

Loss of function mutation w/in 1 gene
Younger–> MODY
Neonates–> mitochondrial DNA mutation (maternally inherited DB + bilateral blindness)

108
Q

What are the 3 distinct metabolic pathways involved in the pathogenesis of longterm complications?

A
  1. Accelerated AGE formation
  2. Activation of PKC-> thickens Basement mem
  3. disturb polyol pathway-> dec. glutathione
109
Q

How do AGEs form?

A

Non enzymatic rxn btwn Intracellular glucose precursors and AMino groups

110
Q

What is the Pg of AGE mediated damage in Diabetes?

A

AGE-RAGE signaling:
Increases pro-inflammatory cytokines + GFs
Generates ROS
Increases Procoagulant activity
Proliferation of vascular smooth muscle/ ECM

111
Q

How does increased AGE formation lead to increased risk for CV disease?

A

AGEs cross link ECM proteins and trap proteins and LDL–> accelerating Atherosclerosis

112
Q

What is the Pg of PKC activation induced damage in Diabetes?

A

PKC–> activates VEGF and TGF beta= increased deposition of ECM and basement membrane material

113
Q

Which tissues Do NOT require Insulin to Transport Glucose?

A

Nerves
Lens
Kidneys
Blood vessels

114
Q

What is the Pg of Polyol pathway disturbance in Diabetic mediated damage?

A

In cells that dont require insulin for Glucose transport–> Hyperglycemia= increased Sorbitol= Fructose= Decreased NADPH (which is needed for Glutathione reduction)

115
Q

What enzyme converts Glucose to Sorbitol inside Nerves, lens, Kidneys, blood vessels?

A

Aldose reductase

116
Q

What is the underlying reason for Diabetic Neuropathy?

A

Hyperglycemia causing damage via Oxidative stress due to decreased Glutathione

117
Q

What is observed in Nondiabetic newborns of Diabetic mothers?

A

Increased # and size of Islets due to Hyperglycemia–> causes Hypoglycemia @ birth

118
Q

Vascular complications of Diabetes?

A 
Accelerated Atherosclerosis 
Gangrene of lower extremities 
Hyalin arteriolosclerosis
Diffuse BM thickening 
Leaky capillaries
119
Q

What is diabetic microangiopahty?

A

Diffuse thickening of BM of capillaries b concentric layers of hyaline material (type IV collagen)
Underlies: DB nephropathy + Retinopathy + neuropathy

120
Q

What are the renal complications of Diabetes?

A

Capillary BM thickening (entire length)
Diffuse mesangial sclerosis (>10 years)
Nodular glomerulosclerosis (ONLY DB) (Kim-wilson)
Renal arteriolosclerosis (afferent + efferent)
Papillary necrosis

121
Q

Ocular complications of Diabetes?

A

Retinopathy (MC)
Cataracts
Glaucoma

122
Q

Pg of nonProliferating retinopathy in DB pts?

A

Intraretinal: hemorrhage, exudates, microaneurysms + edema and retinal cap thickening
** Microaneurysms in retinal choroidal capillaries are seen as RED DOTS

123
Q

What is Pg of proliferative retinopathy in DB pts?

A

process of Neovascularization and Fibrosis

**blindness–> retinal detachment

124
Q

Clinical features of Diabetes?

A

Polyuria
Polydipsia
Polyphagia (increased appetite) w. wgt loss
Lack/ depletion of Glycogen storage
Catabolic state with abnormal Glucose + Fat + protein metabolism

125
Q

What factors lead to DKA type 1?

A

Dehydration from osmotic diuresis
Lipoprotein lipase activation= increase FAA
Ketogenesis

126
Q

What leads to hyperosmolar nonketotic coma in T2DB?

A

Severe dehydration without signs of Ketoacidosis causing CNS compromise

127
Q

What are the pathological features of T1DB?

A

Autoimmune “insulitis”
Beta cell depletion
Islet atrophy/ necrosis

128
Q

What are the pathological features of T2Db?

A

Early: inflammation
Late: Amyloid
Mild Beta cell depletion

129
Q

Sporadic attacks of Hypoglycemia, confusion, stupor, loss of consciousness fixed with feeding, Increased C-peptide is seen in what?

A

Insulinoma

130
Q

What are the pathological characteristics of Insulinomas?

A

Giant islets with AMYLOID DEPOSITION

131
Q

Pt with Diarrhea, multiple duodenal and jeujenal ulcers Dx?

A

Zollinger-Ellision syndrome

GASTRINOMA

132
Q

What are symptoms associated with Male hyperprolactinomas?

A

decreased Libido
Impotence
Infertility

133
Q

Female symptoms of Hyperprolactinomas?

A 
Anovulation
Amenorrhea
Galactorrhea
Infertility
Osteopenia
134
Q

What static test can be done to determine Hyperprolactinoma?

A

Measure baseline PRL: 100-200ng/ml

normal= <16-20

135
Q

What are some Dynamic tests that can be done for Dx of hyperprolactinoma?

A

Sleep study–> Loss of nocturnal rise (sustained elevation)
TRH–> PRL increases by 50% or less
Dopamine blocker–> Blunted response

136
Q

What hormonal excess would cause Bilateral adrenal hyperplasia + increased Skin pigmentation?

A

Excess ACTH

137
Q

Salt retention (HTN), Insulin resistance (hyperglycemia) , Buffalo hump, Decreased skin collagen (easily bruised), and proximal myopathy is caused by excess of what hormone?

138
Q

Hirsutism, oligomenorrhea (dec LH/FSH), Acne, impotence. What hormonal excess is responsible?

A

Adrenal Androgens

139
Q

MEN 2A consists of what neoplastic disorders?

A

Pheochromocytoma
Hyperparathyroidism
Medullary carcinoma of Thyroid

140
Q

MEN 2B consists of what neoplastic disorders?

A

Pheochromocytoma
Multiple mucosal neuromas
Medullary Carcinoma of thyroid

141
Q

What is the triad of symptoms for Pheochromocytoma?

A

Paroxysmal: Headache, Diaphoresis, Palpitations

142
Q

What are the clinical signs of Hyperaldosteronism?

A

Increased Na reabsorption
HTN
Hypokalemia–> Cramps + weakness

143
Q

What are the MCC of death in DB patients?

A
  1. MI
  2. Renal failure
  3. Infections
144
Q

What is the link between Obesity and Insulin resistance?

A

Visceral Fat–> release toxic FFAs + reduced adiponectin through PPAR gamma receptor actions

145
Q

What are the long term complications of diabetes and their Pg?

A 
Blood vessel, Renal, nerves, eye damage: 
Formation of AGEs
Activation of PKC
Sorbitol formation in Polyol pathway
ALL LEADING TO OXIDATIVE STRESS
146
Q

What is the role of FFAs in Diabetic complications?

A 
Excess FFAs leads:
ROS formation 
Apoptosis of Islet cells
Increased Inflammatory cytokines 
Increased VLDL production by liver
Decreased Adiponectin release by Adipocytes
147
Q

Thyroid nodule with finger like projections of epithelium surrounded by fibrovascular core, calcified spheres, “optically” clear nuclei?

A

Papillary Thyroid Carcinoma

148
Q

HLA-DR5 increases the risk for what kind of Thyroid pathology?

A

AI THYRODITIS (hashimoto)

149
Q

What stimulates PTH release?

A

Levels of FREE IONIZED calcium in the bloodstream

150
Q

What is the most MCC of hyperparathyroidism?

A

Sporadic parathyroid adenoma

151
Q

What is the pathology of Familial hypocalciuric hypercalcemia?

A

Inactivating mutation of the Calcium-sensing receptors on Parathyroid cells

152
Q

What are the two genetic abnormalities associated with Parathyroid adenomas?

A

MEN 1

Cyclin D1 mutations

153
Q

What is the typical morphology and how does that relate to all four of the glands?

A

Adenomas–> Solitary nodule + SINGLE GLAND

3 other glands–> SHRUNKEN due to feedback inhibition by elevated serum calcium

154
Q

Causes erosion of bone matrix and mobilization of calcium salts @ metaphysics, increased new bone formation containing Abundant Fibrous tissue + hemorrhage?

A

Osteitis fibrosa Cystica–> Parathyroid carcinoma

155
Q

Parathyroid carcinoma with aggregating osteoclast, reactive giant cells, hemorrhagic debris?

A

BROWN TUMOR

156
Q

What are some of the systemic wide complications of Parathyroid carcinoma induced hypercalcemia?

A

Nephrolithiasis
Nephrocalcinosis
Metastatic calcification (stomach, lungs, myocardium, blood vessels)

157
Q

Hypercalcemia with accompanying low PTH can be caused by?

A

Malignancies (SCLC + Breast)
Vitamin D toxicity
Thiazide diuretics
Sarcoidosis (granulomatous diseases)

158
Q

Patient with bone pain, constipation, depression, and weakness will have elevated?

159
Q

Signs and symptoms of Hyperparathyroidism?

A

GI–> Constipation, pancreatitis
CNS–> depression, seizures
Muscular–> Weakness
Polyuria

160
Q

What is the MCC of 2nd hyperparathyroidism>

A

Renal failure

161
Q

Causes tingling, muscle spasms, facial grimacing, sustained carpopedal spasms, arrhythmias, seizures due to increased intracranial pressure?

A

Hypoparathyroidism

162
Q

MEN 1?

A 
Parathyroid tumor (hypercalcemia)
Pancreatic tumor (Gastrinoma, insulinoma)
Pituitary adenoma (Prolactinoma, ACTH)
163
Q

MEN 2a?

A

Medullary carcinoma Thyroid (Calcitonin)
Pheochromocytoma
Parathyroid tumor

164
Q

MEN 2b?

A

Medullary carcinoma Thyroid (calcitonin)
Pheochromocytoma
Marfans/ Mucosal Neuromas

165
Q

Zollinger-Ellison Syndrome?

A

Gastrinoma–> Duodenal ulcers

Insulinoma–> Hypoglycemia

166
Q

MCC of hypercortisolism?

A

Exogenous administration of Steroids

167
Q

MCC of Endogenous hypercortisolism?

A
  1. ACTH producing pituitary adenoma->
    (Cushing’s disease)
  2. Adrenal neoplasm (ACTH independent)
  3. Ectopic ACTH producing tumors (Oat cell)
168
Q

Hypercortisolism + Bilateral cortical atrophy?

A

Exogenous Steroid induced

169
Q

Hypercortisolism + diffuse hyperplasia?

A

Endogenous–> ACTH producing tumor or adrenal tumor

170
Q

Solitary aldosterone secreting tumor?

A

Conn’s syndrome

171
Q 
Solitary adrenal nodule w: 
Well circumscribed 
Eosinophilic cells w. laminated cytoplasmic inclusions
Not suppressing  ACTH
NO contralateral gland atrophy?
A

Aldosterone secreting tumor

172
Q

Child with ambiguous genitalia, vomiting, dehydration, and salt wasting?

A

21 hydroxylase deficiency

173
Q

MCC of Acute adrenocortical insufficiency?

A

Waterhouse-Friderichsen syndrome
Sudden withdrawal of Longterm corticosteroids
Stress in Pt with underlying chronic adrenal insuff

174
Q

MCC of chronic adrenocortical insufficiency?

A 
Autoimmune adrenalitis (addisons)
TB
AIDS
Metastatic disease
Systemic Amyloidosis 
Sarcoidosis
175
Q

Pt develops sepsis and suffers adrenal insufficiency due to hemorrhage into adrenal cortex, what is the MCC?

A 
Waterhouse-Friderichsen--> 
1, Nisseria meningitidis 
2.P aeruginosa  
3.pneumococci 
4.H, flu
176
Q

Adrenal insufficiency commonly seen in postoperative patients on anticoagulants, DIC or sepsis patients, and Pregnancy?

A

Waterhouse-Fredrichsen syndrome

177
Q

What the MCC of progressive destruction of adrenal cortex?

A

Addisons disease

178
Q

What is 90% of Addisons disease attributed to?

A

Autoimmune adrenalitis (60-70%)
TB
AIDS
Metastatic cancer

179
Q

Autoimmune adrenalitis is associated with what genetic defect?

A

APS1–> AIRE mutation (chromosome 21)
**Causes: chronic mucocutaneous candidiasis
Skin, dental, nail abnormalities

180
Q

What is the AIRE protein involved in?

A

Antigen presentation to Thymus and elimination of Tcells specific for these antigens

181
Q

Early adulthood adrenal insufficiency, autoimmune thyroditis, Type 1 diabetes is associated with what genetics?

A

APS2–> AIRE mutation

182
Q

MC source of metastatic adrenal neoplasia?

A

Lungs

Breasts

183
Q

Adrenal insufficiency characterized by small, flat yellow adrenal glands and loss of cortical cell cytoplasmic lipids?

A

Secondary hypoadrenalism

184
Q

Adrenal insufficiency characterized by irregularly shrunken glands, collapsed CT network and lymphoid infiltrates?

A

Primary autoimmune adrenalitis

185
Q

Adrenal insufficiency characterized by granulomatous reaction?

A

TB or Fungal (Histo or Coccidio)

186
Q

When does adrenal insufficiency manifest clinically?

A

at least 90% of the cortex has been compromised

187
Q

MC complaints are anorexia, N/V, wgt loss, diarrhea, darkened skin?

A

primary Adrenal defect

188
Q

Adrenal nodule characterized by yellow-brown color, endocrine atypic (pelomorphism), vacuolated cells, MC seen in?

A

Adrenal Adenoma

MC–> aldosterone producing

Endocrine (4 decks)

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