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PATHOLOGY | ENDOCRINE > ENDOCRINE - GOLJAN > Flashcards

ENDOCRINE - GOLJAN Flashcards

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1
Q

suppression tests

A

DMX-dexamethasone-cortisol analogue

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2
Q

low/dose DMX

A

low dose DOES NOT suppress cortisol in Cushing syndrome

high dose DOES suppress ACTH production

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3
Q

which hyper functioning endocrine disorders can be suppressed

A

MOST CAN NOT

but prolactinoma and cushing syndrome can

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4
Q

what tumors affect the hypothalamus

A
  1. pituitary adenoma MC
  2. craniopharyngioma
    * 3. midline hamartoma - not a neoplasm/produces precocious puberty in boys
  3. Langerhans histiocytosis - metastasis
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5
Q

what inflammatory disorder affect the hypothalamus

A

sarcoidosis

meningitis

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6
Q

central DI

A

2ndary hypopituitarism

no ADH from hypothalamus

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7
Q

ADH made in

A

supraoptic and paraventricular nuclei

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8
Q

hyperprolactinemia

A

loss of DA from hypothalamus causes increased prolactin release which leads to GALACTORRHEA

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9
Q

define: true precocious puberty
girls vs guys
major cause

A

due to CNS dysfunction, not peripheral (pseudoprecocious puberty)

guys - puberty before age of 9
girls - puberty before age of 8

midline hamartoma
McCune-Albright syndrome

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10
Q

*Kallmann syndrome

A 
X-linked AR disorder that affects males
embryological defect in migration
anosmia b/c loss of olfactory bulb
and decrease in GnRH from hypothalamus ( less estrogens + androgens )
-underdeveloped genitals
-sterile gonads
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11
Q

pineal gland

  • location
  • production
A

located at the quadrigeminal plate aka tectum
melatonin - sleep/mood/circadian rhythms

http://www.radpod.org/wp-content/uploads/2007/10/quadrigeminal_plate_lipoma.jpg

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12
Q

pineal gland

-disorders

A

dystrophic calcification - beings in childhood
used as a marker for midline shift

tumors:

  • majority are GERM CELL that resemble SEMINOMA
  • teratomas
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13
Q

a pineal gland tumor causes what clinical findings

A
  • PARINAUDs syndrome - inability to perform upward conjugate gaze
  • obstructive hydrocephalus- b/c of aqueduct of sylvius
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14
Q

MC of hypopituitarism is adults

A

nonfunctioning ( null ) pituitary

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15
Q

MC of hypopituitarism in kids

A

*craniopharyngioma

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16
Q

craniopharyngioma is derived from*
located where?
features?
sequela?

A

rathke pouch - SURFACE ECTODERM
above the sella turcica
cystic tumor w/ hemorrhage and calcification
bitemporal hemianopia + CDI

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17
Q

MEN I syndrome

A

parathyroid - hyperPTH
pancreas - zollinger Ellison or insulinoma
pituitary - adenoma

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18
Q

Sheehan postpartum necrosis

A

hypovolemic shock causes infarction of pituitary

loss of prolactin leads to no lactation

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19
Q

located of pituitary in relation to sella turcica

A

below

craniopharyngioma is above

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20
Q

empty sella syndrome

types

A

radiograph shows empty sella turcica

Primary type - anatomic defect. CSF invades space and pushes on pituitary leading to atrophy ** seen in obese woman w HTN

Secondary type - regression in size due to trauma, radiation, etc

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21
Q

what happens to pituitary during pregnancy

A

increases double in size due to prolactin synthesis

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22
Q

how does progesterone relate to prolactin

A

inhibits release of prolactin

seen during pregnancy

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23
Q

autoimmune destruction of pituitary gland seen in women

A

lymphocytic hypophysitis

seen during or after pregnancy

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24
Q

oxytocin produced primarily where

function

A

paraventricular nucleus

uterine contractions + milk ejection

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25
MC pituitary tumor
prolactinoma
26
prolactinoma can also secrete
GH
27
clinical features of prolactinoma | women vs men
WOMEN - 2ndary amenorrhea b/c prolactin inhibits GnRH which decreases FSH/LH - NO galactorrhea present MEN - loss of libido b/c of less LH ( less testosterone ) - decrease estrogen and progesterone
28
prolactinoma tx
bromocriptine or cabergoline | surgery if microadenoma <10mm
29
effects of GH
1. stimulate gluconeogenesis and AA uptake in muscles 2. cause increase in IGF-1 production 3. antinatriuretic action (retains sodium)
30
*functions of IGF-1
stimulate bone (lateral, linear) cartilage and soft tissue growth
31
MCC of death in acromegaly
dilated cardiomyopathy
32
big clinical features of acromegaly
1. DM - hyperglycemia from increased gluconeogenesis 2. HTN - GH retains Na+ / hyperglycemia causes increased insulin which acts on mineralocorticoid rec. 3. macroglossia
33
*steps in thyroid hormone synthesis
* everything is mediated by TSH / w/o it = atrophy 1. iodide is trapped 2. thyroid peroxidase mediates oxidation of iodide to iodine ( inhibited by propylthiouracil ) 3. organification a. iodine + tyrosine = MIT ( monoiodotyrosine ) b. MIT + DIT = T3 c. DIT + DIT = T4 4. hormones stored as colloid 5. proteolysis by lysosomal proteases 6. released and bind to TBG
34
thyroid hormone synthesizes what 2 things
1. Beta adrenergic receptors for catecholamines | 2. LDL receptors
35
interrelation between total serum T4, FT4, and TSH
* if TSH increases, then total serum T4 increases \ and vice versa
36
how does estrogen affect TSH
1. increases TSH production by the liver 2. increases TBG which binds with free T4 3. thyroid makes more T4 to compensate for loss total serum T4 is increased FT4 is normal = normal TSH
37
what causes a decrease is TSH
anabolic steroids + nephrotic syndrome total serum T4 is decreased, because lower TBG but FT4 and TSH remain normal
38
``` TBG normal + FT4/FT3 increased TBG normal + FT4/FT3 decreased TBG decreased + FT4/FT3 normal TBG increased + FT4/FT3 normal ******************************************* ```
graves disease or thyroiditis hypothyroidism anabolic steroids or nephrotic syndrome estrogen and during pregnancy
39
what is used to measure synthetic activity of the thyroid gland
123 Iodine uptake
40
marker for thyroid cancer
thyroglobulin
41
* decreased uptake of 123 I
1. inactivity of thyroid gland ( patient taking thyroid hormone - decreases TSH ) 2. inflammation of gland ( acute, subacute, chronic thyroiditis - interferes w normal function of gland )
42
* increased uptake of 123 I
indicates increased synthesis of T4 | graves disease and toxic nodular goiter
43
" cold " thyroid nodule
decreased 123 I uptake | cyst, adenoma, cancer
44
" hot " thyroid nodule
toxic nodule goiter
45
decreased serum TSH is seen in
thyrotoxicosis hypothalamic dysfunction hypopituitarism
46
mass at the base of the tongue
lingual thyroid
47
cystic midline mass
thyroglossal duct cyst
48
* different types of THYROIDITIS
1. acute thyroiditis 2. subacute granulomatous thyroiditis 3. hashimoto thyroiditis 4. Riedel thyroiditis 5. subacute painless lymphocytic thyroiditis
49
describe : ACUTE THYROIDITIS
``` bacterial infection fever painful tender gland increased T4, decreased TSH adenopathy is present decreased 123 I uptake tx is penicillin or ampicillin ```
50
describe : subacute granulomatous thyroiditis
``` MCC painful thyroid* viral infection usually follows URI women 40-50 no fever of adenopathy decreased T4, increased TSH decreased 123 I uptake self limiting ```
51
HLA subtypes for Hashimoto thyroiditis
HLA-Dr3 + Dr5
52
type of HSR in Hashimoto thyroiditis
mainly type 4 - cytotoxic T and helper T destroy parenchyma | also type 2- antibodies against TSH receptor
53
what autoantibodies are in Hashimoto thyroiditis*
anti-microsomal and anti-thyroglobulin
54
morphology seen in Hashimoto thyroiditis
enlarged, gray gland | lymphocytic infiltrate with prominent germinal follicles
55
Hashimoto has increased risk for *
primary B-cell malignant lymphoma of thyroid
56
describe : Riedel thyroiditis
"Riedel REPLACES thyroid with fibrous tissue" | and surrounding tissue
57
hypothyroid disorder seen POSTPARTUM*
subacute painless lymphocytic thyroiditis
58
describe : subacute painless lymphocytic thyroiditis
``` autoimmune destruction postpartum NO germinal follicles slightly enlarged and painless antimicrosomal antibodies can progress to primary hypothyroidism ```
59
hypothyroidism in infancy or early childhood
cretinism
60
brain requires which thyroid hormone for maturation
thyroxine during 1st year of life *
61
what is MYXEDEMA COMA
causes include : - idiopathic / cold exposure - infection - sedatives/opiates clinical features include : - stupor *hypothermia - hypoglycemia, hypocortisolism - bradycardia, hypoventilation
62
define : thyrotoxicosis
increase in hormones regardless of cause
63
HLA subtypes of GRAVES disease
HLA- Dr3 + B8
64
etiology of GRAVES disease
female dominant!
65
GRAVES disease HSR
type 2 | IgG autoantibodies against TSH receptor
66
autoantibodies in GRAVES disease
anti-microsomal and anti-thyroglobulin
67
unique features in GRAVES disease
pretibial myxedema, thyroid acropachy, exophthalmos
68
define thyroid acropachy *
digital swelling and clubbing of fingers | separating of nail bed from nails - onycholysis
69
describe : toxic multinodular goiter
one or more HOT nodules - TSH independent | LACKS exophthalmos and pretibial myxedema
70
GRAVES disease in the elderly AKA
apathetic hyperthyroidism - thyromegaly - AFib + CHF - muscle weakness

PATHOLOGY | ENDOCRINE (2 decks)

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