Endo Flashcards
(138 cards)
1
Q
derivation of anterior pituitary
A
Rathke’s pouch from oral cavity
2
Q
hormones from posterior pituitary
A
oxytocin and ADH
3
Q
cause of most excess hormones from anterior pituitary
A
adenoma
4
Q
other causes of hyperpituitarism
A
hyperplasia, carcinoma, non-pituitary tumors, disorders of hypothalamus
5
Q
clinical presentation hyperpituitarism
A
signs and symptoms from excessive hormone or mass effect
radiologic abnormalities, bitemporal hemanopsia
elevated intracranial pressure
may cause hypopituitarism from compression
6
Q
radiographic abnormalities of sella turcica
A
sellar expansion, bony erosion, disruption of diaphragma sellae
7
Q
size macroadenoma and microadenoma
A
macro>1cm
miro<1cm
8
Q
invasive adenoma
A
nonencapsulated
9
Q
pituitary apoplexy
A
rapid enlargement due to acute hemorrhage
10
Q
histological difference of adenoma
A
do not have reticulin
11
Q
pituitary stone
A
calcified prolactinoma
12
Q
signs of prolactinoma
A
amenorrhea, galactorrhea, loss of libido, infertility
13
Q
causes of serum prolactinemia
A
pregnancy, nursing, stress
damaged to pituitary stalk or hypothalamus
drugs-phenothiazine, haloperidol (decrease dopamine)
estrogen, renal failure, hypothyroidism
14
Q
treatment prolactinoma
A
bromocriptine (dopamine agonist)
transphenoidal surgery
15
Q
acidophilic adenoma
A
GH
16
Q
signs of GH adenoma
A
gigantism in pre-pubertal child
acromegaly in adults
abnormal glucose tolerance, DM, muscle weakness, HTN, arthritis, osteoporosis, CHF, increased risk of GI cancer
17
Q
genetics GH adenoma
A
gsp mutation of alpha subunit of Gs protein
inhibits GTPase
18
Q
basophilic adenoma
A
corticotroph cell adenoma
19
Q
Cushing disease
A
due to pituitary/hypothalamic disorder
20
Q
Cushing syndrome
A
other causes-iatrogenic, primary adrenal cortex, ectopic ACTH
21
Q
Nelson’s syndrome
A
pituitary corticotroph adenoma due to removal of adrenals for Cushing’s syndrome resulting in a loss of negative feedback
increase ACTH but no cortisol
hyperpigmentation from POMC
22
Q
results of null cell adenoma
A
mass effect and compress remaining pituitary resulting in hypopituitarism
23
Q
gonadotroph adenoma
A
diagnosed in middle age men and women
loss of libido in men
24
Q
hypopituitarism
A
loss of 75% or more of anterior pituitary
25
hypopituitarism from loss of hypothalamus
get loss of ADH too
26
symptoms of hypopituitarism
hypofunction of adrenal cortices, thyroid, and gonads
pallor (decrease MSH)
atrophy of gonads and genitalia leading to amenorrhea, impotence, and loss of libido
loss of axillary and pubic hair
27
nonsecretory pituitary adenoma
enlargement may be gradual or due to acute hemorrhage (pituitary apoplexy)
28
Sheehan's syndrome
postpartum hemorrhage
| most common cause of ischemic necrosis leading to hypopituitarism
29
less susceptible portion of pituitary
posterior pituitary
30
empty sella syndrome
enlarged, empty sella turcica caused by chronic herniation of the subarachnoid space into the sella turcica
obese patients with multiple pregnancies
31
genetic defects causing hypopituitarism
defect in gene encoding pit 1
transcription factor for GH, prolactin, and TSH
resulting protein binds DNA but does not activate target genes
32
diabetes insipidus
lack of ADH
| leads to excessive thirst
33
SIADH
too much ADH
| most common cause is secretion by malignant neoplasms
34
craniopharyngiomas
slow intracranial tumors
enough calcium to see on x-ray
most are suprasellar and occur in children
endocrine deficiencies in children, visual disturbances in adults
35
Cushing disease presentation
primary hypothalamic-pituitary disease
increase ACTH
females in 30-40s
nodular cortical hyperplasia of adrenals
36
primary adrenocortical hyperplasia
most are neoplasms, adenomas or carcinomas
hyperplasia is less common
increased glucocorticoids leading to decreased ACTH
37
ectopic ACTH from tumors
most common cause small cell carcinoma of lung
others-carcinoid tumors, medullary carcinoma of thyroid, pancreatic islet cell tumors
nodular adrenocortical hyperplasia
38
dexamethasome test on ectopic ACTH
does not suppress ACTH production
39
signs and symptoms of hypercortisolism
HTN and weight gain
truncal obesity, moon faces, buffalo hump
atrophy of fast twitch muscle
hyperglycemia, glucosuria, polydipsia
striae on abdomen and osteoporosis
hirsutism, menstrual irregularities, mental disturbances, poor wound healing
40
exogenous steroids on adrenal
atrophy
41
ectopic or endogenous ACTH on adrenal
bilateral nodular adrenocrotical hyperplasia
42
Crooke's hyaline
keratin intermediate filaments
| pituitary changes from endogenous or exogenous glucocorticoids
43
pituitary dexamethasone challenge
at low dose not suppressed but at high dose suppressed
44
primary hyperaldosteronism
due to neoplasm or hyperplasia
| increased aldosterone and decreased renin
45
secondary hyperaldosteronism
due to increase renin activity from CHF, decreased renal perfusion, hypoalbuminemai, or pregnancy
hypertension and hypokalemia
46
treatment of adenomas
surgical correction of hypertension possible
| hyperplasia is treated medically
47
andrenogenital syndromes
causes of virilization
48
congential adrenal hyperpalsia
AR defect in biosynthesis of cortisol
| most common is 21 hydroxylase deficiency
49
21 hydroxylase deficiency
increased androgen activity
| sodium wasting due to lack of mineral-corticoid
50
17 hydroxylase deficiency
androgen deficiency
| some sodium retention and hypertension
51
morphology of congenital adrenal hyperplasia
bilateral nodular adrenal hyperlplasia
| pituitary-hyperplasia of corticostrophs
52
treatment congenital adrenal hyperplasia
suppress ACTH
| at risk of acute adrenal insufficiency
53
autoimmune chronic adrenocortical insufficiency
1/2 restricted to adrenals, rest are plyglandular syndromes
| HLA-B8 and DR3
54
infections that can cause chronic adrenocortical insufficiency
tuberculosis
Histoplasm capsulatum
Coccidiodes immitis
55
metastatic causes of chronic adrenocortical insufficiency
lung and breast most common
| others-GI, melanoma, hematopoietic
56
symptoms of Addisons (chronic adrenocortical insufficiency)
```
weakness and fatigue
anorexia, weight loss, diarrhea
hyperpigmentation
volume depletion and hypotension
hypoglycemia
```
57
adrenocortical insufficiency without pigmentation
pituitary and hypothalamic causes
58
acute adrenal crisis
intractable vomiting, abdominal pain, hypotension, coma, vascular collapse
death if corticosteroids not replaced immediately
59
morphology primary autoimmune adrenocortical insufficiency
irregularly shrunken adrenals with lymphoid infiltate
| medulla preserved
60
morphology secondary autoimmune adrenocortical insufficiency
small, flattened
| atrophied
61
morphology TB and fungus adrenocortical insufficiency
granulomatous inflammation
62
morphology metastatic carcinoma adrenocortical insufficiency
adrenals enlarged, architecture obscured by neoplasm
63
acute adrenocrotical insufficiency
exogenous steroids may develop acute crisis if rapid withdrawal
massive adrenal hemorrhage
64
Waterhouse Friderichsen syndrome
classically from N. meningitidis
| others-pseudomonas, pneumococci, H flu
65
classification of adrenocortical neoplasm
according to clinical findings not morphology
66
morphology adenomas
most nonfunctional
| small (1-2 cm)
67
morphology carcinomas
more likely to be functional
| large, invasive, met by lymphatic and/or bloodstream
68
derivation of adrenal medulla
neural crest
| chromaffin cells
69
pheochromocytoma rule of 10
10% tumor
10% bilateral
10% familial
10% malignant
70
signs and symptoms of pheo
hypertension (risk of MI, HF, renal injury, and CVA)
| tachycardia, palpitations, HA, sweating, tremor, sense of apprehension
71
sudden death in pheo
increase catecholamines leading to myocardial instability and ventricualr arrhythmias
72
morphology pheo
hemorrhage, necrotic, cystic
stain with silver stains
benign may have capsular and vascular invasion
73
diagnosis of malignant pheo
by mets exclusively
74
laboratory testing pheo
increased urinary excretion of free catecholamines, VMa, and dopamine
75
origin neuroblastoma
neural crest
| may arise anywhere in sympathetic chain
76
signs and symptoms neuroblastoma less than 2 yrs
protuberant abdomen with abdomenal mass, fever, and weight loss
catecholamines (less likely to cause HTN)
77
signs and symptoms neuroblastoma older
mets leading to hepatomegally, ascites, and bone pain
| catecholamines (less likely to cause HTN)
78
histology neuroblastoma
small, round blue cell tumors
| Homer Wright pseudorosettes
79
laboratory diagnosis neuroblastoma
increase serum catecholamines and VMA and HVA in urine
80
prognosis neuroblastoma depending on genetics
deletion short arm ch1 aggressive
| amplification of N-myc- poor prognosis
81
MEN 1 syndrome
pituitary, parathyroid, pancreatic islet cell tumors (insulin, glucagon, gastrin, somatostatin, VIP)
82
genetic mutation MEN 1
tumor suppressor on ch 11
83
MEN IIa syndrome
medulla-thyroid medullary carcinoma, pheo
medullary carcinoma associated with C-cell hyperplasia
parathyroid disorder
84
genetics MEN IIa
mutation RET on ch 10
85
MEN IIb
thyroid medullary carcinoma and pheo
no parathyroid disorder
associated with neuromas and/or ganglioneuromas
86
genetics MEN IIb
mutation in RET but different mutation than in MEN IIa
87
beta cells islets of langerhans
insulin
88
alpha cells islets of langerhans
glucagon
89
delta cells islets of langerhans
somatostatin (suppresses release of insulin and glucagon)
90
pancreatic polypeptide cells islets of langerhans
pancreatic polypeptide
91
signs and symptoms type 1 DM
polyuria, polydipsia, polyphagia, ketoacidosis
| catbolism leading to weight loss and muscle weakness
92
ketoacidosis in type 1 DM
decrease insulin leads to excessive breakdown of fat
| free fatty acids go to liver and are oxidized by acetyl coA to ketone bodies
93
ketone bodies in ketoacidosis
acetoacetic acid and beta hydroxybuteric acid
94
hyper-osmolar nonketotic coma
severe dehydration from sustained hyperglycemia
absence of ketoacidosis and symptoms
occurs in T2DM
95
release of insulin
biphasic
release from granules when glucose increases
if persists glucose triggers insulin synthesis
96
major anabolic hormone
insulin
97
insulin receptor
tyrosine kinase
98
genetic susceptibility T1DM
class II MHC most important
DR3/4
DQ302/602 linkage
99
protective against diabetes
asparagine 57 on DQ beta chain
100
insulinitis
```
CD8 T lymphocytes with variable CD4T
beta cells destroyed
expression of class II HLA antigens on beta cells (normal is no expression)
```
101
antibodies in T1DM
react to glutamic acid decarboxylase
102
molecular mimicry in T1DM
GAD shares sequence with Coxsackie virus
103
deranged beta-cell secretion of insulin in T2DM
early-disorder of insulin release (blunted first stage)
| later-deficiency of insulin
104
insulin resistance in T2DM
decrease in number of insulin receptors and problems in receptor signaling
105
delay in complications of DM
control to delay complications
| complications mainly due to hyperglycemia
106
nonenzymatic glycosylation
glucose attached to free amino acid of protein w/o enzymes
| traps LDL in vessel walls leading to atherogenesis
107
complications of hyperglycemia in nerves, lens, kidney, blood vessels
do not require insulin for glucose to enter cells
| glucose converted to sorbitol, increased influx of water leading to osmotic cell injury
108
morphology islets in T1DM
reduction in number and size of islets
| insulitis
109
morphology islets in T2DM
subtle reduction in beta cell mass and amyloid deposits
110
morphology vascular system DM
accelerated atherosclerosis leading to increased risk of MI
| hyaline arteriosclerosis and diabetic microangiopathy
111
hyaline arteriosclerosis
related to disease duration and degree of HTN
112
diabetic microangiopathy
diffuse thickening of basement membrane (especially capillaries of skin, skeeltal muscle, retinas, renal glomeruli, renal medulla)
concentric hyaline of type IV collagen, makes membranes leaky
113
diabetic nephropathy
second to MI as cause of death
| thickened BM
114
diffuse glomerulosclerosis
diffuse increase in mesangial matrix cell proliferation
thickened capillary BM
nephrotic syndrome, also deen in old age and HTN
115
nodular glomerulosclerosis
nodules at periphery of glomerulus composed of mucopolysaccharides
impede flow of blood of efferent arterioles (tubular ischemia)
Kimmelstiel-Wislon nodules
116
pyelonephritis
acute or chronic inflammation of kidneys beginning in interstitium and affecting tubules
common in diabetics
may lead to acute necrosis of papilla (necrotizing papillitis)
117
nonproliferative diabetic neuropathy
intra-retinal or pre-retinal hemorrhages, retinal exudates, microaneurysms
edema and thickening of retinal capillaries (microangiopathy)
118
proliferative diabetic neuropathy
neovascularization and fibrosis
may lead to blindness
vitreous hemorrhages can form
can pull retina-retinal detachment
119
sorbitol deposition in eye
an lead to glaucoma and cataracts
120
diabetes on the brain
microangiopathy
neuronal degradation
predisposed to CVA and brain hemorrhages
121
diagnosis of diabetes fasting blood glucose
>126 on more than 1 occasion
122
prediabetes on fasting blood glucose
100-126
123
glucose tolerance test diagnosis of diabetes
>200 after 75 gm of glucose
124
islet cell tumors
neuroendocrine origin
125
insulinomas
secrete insulin leading to hypoglycemia
precipitated by fasting or exercise
neuropsych symptoms of nervousness, confusion, stupor
126
morphology insulinoma
usually benign
| look like giant islets
127
differential diagnosis insulinoma
insulin sensitivity
liver disease
inherited glycogenoses
retroperitoneal fibromas or fibrosarcomas
factious-inject with insulin (measure C-peptide)
128
Zollinger-Ellison syndrome
secrete gastrin-extreme gastric acid secretion
| peptic ulcers in unusual locations (jejunum)
129
signs and symptoms Zollinger-Ellison
epigastric pain
| diarrhea
130
morphology Zollinger-Ellison syndrome
may arise in pancreas, peripancreatic region, wall of duodenum
most are malignant
131
laboratory diagnosis Zollinger-Ellison
limited rise in gastric acid secretion by gastrin injection
132
treatment Zollinger Ellison
histamine (H2) blockers and excision of neoplasm
133
pseudohypoparathyroidism type 1
diminished cAMP response resulting in round facies, short stature, short metacarpal and metatarsal bones (Albright Hereditary osteodystrophy)
134
hashimoto
```
HLA DR5
painless enlargement
anti-TSH receptor blocks TSH
Germinal centers
increased risk of B cell lymphomas
```
135
medullary carcinoma of thyroid
```
neuroendocrine tumor
secrete calcitonin
RET protoncogene for MEN IIa/b
may have VIP causing diarrhea
amyloid deposits, polygonal to spindle shaped cells
```
136
Graves
papillae without fibrovascular core
colloid shows scalloping
due to autoantibodies
137
thyroid adenoma
intact capsule but cannot differentiate on FNA so removed
138
papillary carcinoma of thyroid
dense fibrovascular core and psammoma bodies
| orphan annie nucleus
