Session 6: Endocrine Pathology Flashcards
which gland is responsible for producing the following hormones: GRH, TRH, CRH, PRH, GHRH, Somatostatin?
hypothalmus
which gland is responsible for producing the following hormone: FSH, LH, TSH, ACTH, Prolactin?
Ant. Pit gland
What are the two hormones produced by the posterior pit gland?
ADH and oxytocin
in which ventricle will you find the hypothalamus?
third ventricle
what is the other name for the neurohyphysis?
posterior pit gland
from which gland is the posterior pit gland derived from?
hypothalamus
what is the other name for the adenonyphophysis?
ant pit gland
derived from Rathke’s pouch - anterior pit glad or posterior pit gland?
anterior
more than half of all hypopituitarism in adults is caused by what?
pituitary tumors, usually adenomas
what do symptoms of hypopituitarism often result from?
compression of adjacent tissue by the mass
what is the syndrome that is panhypopituitarism that is caused by ischemic necrosis of the pituitary gland?
sheehan syndrome
what is often the cause of sheehan syndrome?
severe hypotension from postpartum hemorrhage
what is it called when there is hemorrhage and or infarction of the pituitary gland?
pituitary apoplexy
in cases of pituitary apoplexy, half of the cases occur in association with what?
endcrinologically inactive adenomas
what are two common examples of iatrogenic hypopituitarism?
therapeutic radiation or neurosurgical procedures
what is the cause of Laron dwarfism?
mutation in the growth hormone releasing hormone receptor
this is primarily a radiologic term that describes an enlarged sella containing a thin, flattened pituitary at the base.
empty sella syndrome
in terms of the ABC’s of acromegaly - what does A-G stand for?
arthiris, bp elevated, calvaria thickened (thick skull cap), diabetes, enlarged organs, field defect, goiter
in terms of errors with ADH, what is being described: decreased ADH, decreased water reabsorption?
central diabetes insipdus
which of the following is described as being caused by a deficiency of ADH?
central DI
which of the following is described as the kidneys not responding to ADH?
nephrogenic DI
in terms of errors with ADH, what is being described: decreased water reabsorption and increased ADH
nephrogrenic DI
T or F: both CDI and NDI have intense thirst (polydipsia) and loss of diluted urine (polyuria)
TRUE
what is the only significant disease associated with he posterior pit gland?
central diabetes insipidous
T or F: 1/4 of cases of CDI are assoc with brain tumors, particularly craniopharyngioma
TRUE
what is one way to control polyuria in CDI?
powdered vasopressin as snuff
which gland is the largest endocrine organ in the body?
thyroid gland
what is defined as euthyroid (with normal or low thyroid levels) and does NOT have the pt suffering from any form of thyroiditis?
nontoxic goiter
in terms of issues regarding the thyroid gland, how is primary described?
when there is thyroid gland malfunction
in terms of issues regarding the thyroid gland, how is secondary described?
when there is a problem with the hypothalamic-pituitary
nontoxic goiters can be defined as either ___ or ____
nodular or diffuse
in which sex is nontoxic goiter more common?
females
in which two demographics is a diffuse goiter common?
adolescence and pregnancy
the multinodular type of nontoxic goiter is most common in which pt demographic?
pesons older than 50
what is the term that refers to hyperthyroidism that most commonly is due to Grave’s and is caused by inflammation or a multinodular goiter?
“toxic goiter”
which type of goiter is commonly caused by some autoimmune process, sulfonamides, lithium, etc? toxic or nontoxic
nontoxic goiter
what is the term used to describe a goiter that has spread throughout all of the thyroid?
diffused goiter
in nontoxic goiter, what is the capacity of the thyroid gland to produce thyroid hormone?
impaired
in nontoxic goiter, since there is an impairment in the ability to produce thyroid hormone, what happens to the size of the gland?
increases due to increased secretion of TSH which helps to maintain euthyroid state
what is one of the discussed causes of secondary hyperthyroid? (although rare)
TSH secreting tumor
what is the most common cause of hyperthyroidism in young adults?
graves disease
what type of goiter is involved in graves disease?
diffuse
what is the most prevalent autoimmune disease int he US? (esp for pple under 40 y/o)
graves disease
what is known as a skin condition characterized by red, swollen skin, usually on the shins and tops of feet?
dermopathy
describe what happens to the following when a pt has graves: hair, muscles, and menstruation
fine hair, muscle wasting, oligomenorrhea.
True or False: graves disease will cause tremor of the hand
true
what is the most common cause of goistrous hypothyroidism in the US?
chronic autoimmune thyroiditis (hashimoto)
hashimotos’s thyroiditis is defined by having what kind of autoimmune Ab’s?
antimicrosomal Ab
T or F: the course of Hashimoto’s is fast, infiltrate, with germinal centers.
True except for the fact that the course is slow
T or F: you can use radioactive iodine therapy for Graves Disease
True
what is a common cause of secondary hypopituitarism ?
that caused by a pituitary adenoma
which thyroid disorder is a result of antibodies to TBG? Thyroxine Binding Globulin (TBG)
Hashimotos
what are the lab values for hashimotos? (t4 and tsh
low t4 and high tsh
what are the two ab present in hashimotos?
anti tpo ab and anti tbg ab
defective thyroid hormone synthesis is also known as deficiency of what?
iodine
what are the levels associated with iodine deficiency? TH and TSH
low TH and high TSH
what is inadequate thyroid parenchyma function typically associated with?
thyroiditis, surgical resection of the gland or therapeutic administration of radioiodine
what are the tsh and th levels associated with inadequate thyroid parenchyma function?
high tsh low th
is inadequate secretion of tsh by the pit gland or of TRH from the hypothalamus primary or secondary hypothyroidism? what are the hormone levels associated with this?
secondary; low tsh and low th
T or F: long term iodide intake can cause goitrous hypothyroidism.
TRUE - b/ cit prevents the thyroid from producing/synthesizing thyroid hormones itself - it should also be noted that iodine deficiency is also part of the etiology of goistrous hypothyroidism
T or F: endemic goiters often cause hyperthyroidism
FALSE
what is the procedure used to determine if the growth or nodule within the thyroid is malignant?
FNA (fine needle aspiration)
the action of PTH on the kidney together with hypercalcemia does what to the phosphate levels in the blood?
leads to hypophoatemia
what step (binding of some ions) is necessary for the activation of the 7 bit k dependent clotting factors with the aid of platelets ?
binding of calcium ions (which is why you would place chelating agent to hind the calcium so it does NOT clot in the bag)
what level of calcium will lead to the following: spasms, tetany, increased excitability of nerve, cardiac dysfunction.
HYPO
what level of calcium will lead to the following: inhibits neurons and muscle cells and may cause heart arrrhythmias
hyper
what does hyperparathyroidism do to your muslces? your bones?
causes atrophy and will lead to osteitis fibrosa cyctica
secondary parathyroid hyperplasia is typically seen in which patient population?
chronic renal failure or even those who are vit d deficiency - also be on the look for those with intestinal malabsorption and renal tubular acidosis
this is defined as abnormal hypersecretion of PTH, producing hypercalcemia and hyperphosphatemia.
primary hyperparathyroidism (the primary problem is that the PTH is being hypersecreted which is then leading to an increase in calcium)
what is the main difference between primary and secondary hyperparathyroidism?
in secondary there is an increase in PTH due to low calcium whereas with primary the increase in PTH is NOT caused by this - it’s independent of it.
adrenal gland destruction leading to adrenal cortical insufficiency is called what?
primary adrenal cortical insufficiency
what is defined as secondary adrenal cortical insufficiency?
pit or hypo dysfunction with decreased acth production
what is the other (third) way that leads to adrenal cortical insufficiency
chronic corticosteriod therapy
what is the other term for primary adrenal insufficiency?
Addison Disease
symptoms of acute adrenal insufficiency are mainly due to which deficiency?
mineralcorticoid (as opposed to glucocorticoids - so more aldosterone and NOT cortisol)
what is the most common cause of acute adrenal insufficiency?
abrupt withdrawal of corticosteriod therapy in pts with adrenal atrophy
what is the difference between Cushing syndrome and Conn syndrome?
cushing is hypercortisolism while conn is hyperaldosteronism
what is the difference between cushing disease and cushing syndrome?
syndrome is hypercortisolism for any reason where as disease is due specifically for excessive secretion of acth by pit tumors.
T or F: hyperproduction of corticosteriods by adrenal tumors is more common than excess secretion of acth by pit tumors?
FALSE: excess secretion of acth by pit tumors is 5x more common
what is the most common cause of cushing syndrome in the USA?
chronic corticosteroid administration to treat immune and inflammatory disorders
T or F: the second most common cause of cushing syndrome in the USA is a paraneoplastic effect assoc with non pit cancers that inappropriately produce acth
TRUE
what are the acth and cortisol levels for cushing’s disease?
increase both
what are the cortisol levels and acth levels for adrenal hyperneoplasia?
high cortisol. low acth
what accounts for most cases of acth dependent hyperadrenalism?
ectopic acth production by a malignant tumor (inappropriate secretion of corticotropin releasing hormone by tumors arising outside of the hypothalamus)
what is the main cause of acth independent adrenal hyper function?
adrenal tumors (adenomas)
T or F: adenomas of the adrenal cortex are uncommon
TRUE
what is known as primary hyperaldosteronism?
conn’s
what is it called when you have an increase in aldosterone (due to a tumor) which leads to low renin?
conn’s syndrome
what are the renin and aldosterone levels associated with secondary hyperaldosteronism?
high aldosterone and renin (remember, secondary is basically anything that causes the kidneys to perceive low intravascular volume)
what acid base state is the result of hyperaldosteronism?
metabolic alkalosis
what is the major form of treatment for hyperaldosteronism?
spironolactone (K+ sparere and aldosterone inhibitor)
what is the result of pigmentation for patients with addison’s disease?
hyperpigmentation
what is the reason behind hyperpigmentation with addison’s?
This occurs because melanocyte-stimulating hormone (MSH) and adrenocorticotropic hormone (ACTH) share the same precursor molecule, Pro-opiomelanocortin (POMC).
what is the most common tumor of the adrenal medulla in adults? and what is the treatment?
pheochromocytoma - treat with non selective alpha blockers
pheochromocytomas are catecholmamine secreting tumors originating from which cells?
chromaffin cells
if pheohromocytomas originate from an extra adrenal site, what are they called?
paragangliomas
this is a prototypic paraganglioma arising at the carotid bifurcation. it tends to form a palpable mass in the neck
carotid body tumor
this is an embryonal malignant tumor of neural crest origin that is composed of neoplastic neuroblast and originates int eh adrenal medulla, paravertebral sympatheic ganglia and sympathetic paraganglia?
neuroblastoma
this accounts for half of all cancers diagnosed in the first month of life?
neuroblastoma
what happens to osmotic BP with high blood glucose?
increases
which of the types of DM has the much higher percentage associated with genetics?
type II
what are the levels of beta cell mass associated with each type of DM?
type I is reduced type II is normal or slightly reduced
