Sos- pathology of parathyroid and MEN syndrome Flashcards
is a clone of the same cell over and over
adipose tissue would be pushed out of the way
adenoma
parathyroid tissue
1 parathyroid enlarged=
adenoma
More than 1 parathyroid enlarged=
hyperplasia
parathyroid gland
chief cells of parathyroid gland
secretes PTH and causes increase in blood calcium
parathyroid gland
hyperparathyroidism (causing hypercalcemia)
decrease in PTH and decrease in blood calcium
hypoparathyroidism
contraction of facial muscles after tapping facial nerve (seen in hypocalcemia)
Chvostek sign
induction of carpal pedal spasm seen in hypocalcemia
Trousseau sign
hypocalcemia
Whenever you have calcium that is high, check what
thyroid, parathyroid, and malignancy
hyperfunction of parathyroid cells due to hyperplasia, adenoma, or carcinoma
primary hyperparathyroidism
may be associated with MEN1
high serum calcium
low serum phosphate
primary hyperparathyroidism
due to chronic renal failure
stimulation of parathyroid in response to hypocalcemia
secondary hyperparathyroidism
low to normal serum calcium
high phosphate
secondary hyperparathyroidism
seen in end stage renal failure (from chronic)
following long term physiological stimulation leading to hyperplasia
high serum calcium and phosphate
tertiary hyperparathyroidism
Increased PTH due to the parathyroid gland
The most common cause is a parathyroid adenoma, 80% of cases
Typically one gland
primary hyperparathyroidism
osteitis fibrosa cystica “brown tumor”
primary hyperparathyroidism
found within macrophages (siderophages), breakdown of blood (blood vessel damage)
turning tumor brown color
hemosiderin
having GI issues
bone pain in legs
primary hyperparathyroidism (or MEN1)
parathyroid adenoma
adenoma
on bottom is normal parathyroid
Increased PTH due to a disease other than the parathyroid
Most common cause is chronic renal failure
secondary and tertiary hyperparathyroidism
caused by oversecretion of parathyroid hormone
low phosphate
high PTH and calcium
primary hyperparathyroidism
caused by vitamin D deficiency
high phosphate and PTH
low calcium
secondary hyperparathyroidism
caused by chronic renal failure
high phosphate and calcium
very high PTH
tertiary hyperparathyroidism
common cause of hypercalcemia in elderly
cancer
Most common cause of this is women over the age of 50 after menopause
PTH-independent hypercalcemia
______ carcinoma is common cause of hypercalcemia
squamous cell carcinoma
Rare, decreased PTH due to autoimmune disorders, DiGeorge syndrome and surgical excision
hypoparathyroidism
DiGeorge syndrome
Symptoms of hypoparathyroidism but with an increased PTH level
End organ resistance to PTH, inactive or decreased expression of PTH receptors
GNAS gene mutation coupled to PTH receptor
Short stature, round (full) face, brachydactyly
Pseudohypoparathyroidism
due to PTH receptor deficiency (low serum calcium and normal PTH)
Pseudohypoparathyroidism
Albright’s syndrome (Pseudohypoparathyroidism)
Differ from other hereditary cancer syndromes in that most neoplasia grow in hormone-secreting glands
multiple endocrine neoplasia
Well-defined hormonal syndromes with excess hormone production
Asymptomatic patients can be identified with excess hormone that serve as tumor markers for screening, diagnosis and therapy
multiple endocrine neoplasia
3 P’s
pituitary adenoma, parathyroid hyperplasia, pancreatic tumors
MEN1
parathyroid hyperplasia
medullary thyroid carcinoma
pheochromocytoma
MEN2A
mucosal neuromas
marfanoid body habitus
medullary thyroid carcinoma
pheochromocytoma
MEN2B
MEN1
MEN2
2 theories for this, but pathophysiology is unclear
adrenal gland hemorrhage
First identified as an outcome in children with Neisseria meningitis sepsis
Rare but life-threatening disorder that involves bilateral adrenal hemorrhage
Waterhouse-Friderichsen Syndrome
Following a bacterial or viral infection, an acute clinical presentation including:
Abdominal pain
Fever
Chills
Headache
Nausea and vomiting
Joint and muscle pain
Skin rash
Loss of consciousness
Waterhouse-Friderichsen Syndrome
Develops into disseminated intravascular coagulation (DIC) and shock
Waterhouse-Friderichsen Syndrome
common cause of waterhouse-friderichsen syndrome
meningococcal meningitis
Increased release of cortisol and adrenaline
Adrenocortical hemorrhage
waterhouse-friderichsen syndrome
Septicemia > Endotoxemia > Adrenal hemorrhage (90%) > DIC > Shock
Waterhouse-Friderichsen syndrome
in child, following bacterial or viral infection and has fever
Waterhouse-Friderichsen Syndrome
Waterhouse-Friderichsen Syndrome
