Endocrine - Pathology Flashcards Preview

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Flashcards in Endocrine - Pathology Deck (130)
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1

Symptoms of nonfunctional pituitary adenoma (3)

Mass effects
1. headache
2. bitemporal hemianopsia (compression of optic chiasm)
3. hypopituitarism

2

Most common pituitary adenoma

prolactinoma

3

Prolactinoma: Presentation

Female: galactorrhea, amenorrhea
Males: decreased libido, headache

4

Prolactinoma: Treatment

Dopamine agonists (bromocriptine, cabergoline)
Surgery for larger lesions

5

Growth hormone cell adenoma: Presentation

Children: gigantism (increased linear bone growth because epiphyses are not fused)

Adults: acromegaly

6

Acromegaly: Presentation

Enlarged bones of hands, feet, jaw
Coarse facial features
Growth of visceral organs leading to dysfunction (e.g. cardiac failure)
Enlarged tongue

7

What is often present with GH adenoma?

Secondary diabetes mellitus (induces liver gluconeogenesis)

8

Growth hormone cell adenoma: Diagnosis

Elevated GH/IGF-1
Lack of GH suppression by oral glucose
Pituitary mass on brain MRI

9

Growth hormone cell adenoma: Treatment

Octreotide (somatostatin analog)
GH receptor antagonists
surgery

10

Common cause of death in acromegaly

Heart failure from cardiomyopathy

11

ACTH cell adenoma: Presentation

Cushing syndrome

12

Causes of Hypopituitarism (5)

1. Mass effect or pituitary apoplexy (bleeding): pituitary adenoma in adults and craniopharyngioma in children

2 Sheehan syndrome

3. Empty sella syndrome

4. Brain injury, hemorrhage

5. Radiation

13

Sheehan syndrome: Presentation

Poor lactation, loss of pubic hair, fatigue

14

Sheehan syndrome: Mechanism

Pregnancy-related infarction of pituitary gland

Gland doubles in size during pregnancy but blood supply does not -> blood loss during parturition precipitates infarction

15

Empty sella syndrome: Presentation

absent (empty sella) pituitary gland on imaging

16

Empty sella syndrome: Mechanism

Congenital defect
Herniation of arachnoid and CSF into sella compresses and destroys the pituitary gland

Common in obese women

17

Central diabetes insipidus: Presentation

Polyuria, Polydipsia with riks of life-threatening dehydration; intense thirst

ab: urine specific gravity < 1.006; serum osmolality > 290 mOsm/L
hypernatremia and high serum osmolality

18

Central diabetes insipidus: Mechanism

ADH deficiency (pituitary tumor, trauma, infection, inflammation)

19

Central diabetes insipidus: Diagnosis

Water deprivation test
Urine osmol does not increase, but respond to desmopressin

20

Central diabetes insipidus: Treatmet

Intranasal desmopressin (ADH analog)
Adequate fluid intake

21

Nephrogenic diabetes insipidus: Treatment

HCTZ, indomethacin, amiloride

22

Nephrogenic diabetes insipidus: Mechanism

impaired response to ADH
Mutation or drugs (lithium an demeclocycline)

23

Nephrogenic diabetes insipidus: Presentation

Similar to central diabetes insipidus, but does not respond to desmopressin

24

SIADH: Presentation

Hyponatremia and low serum osmolality
Mental status changes and seizures (neuronal swelling and cerebral edema)

25

SIADH: Causes

Ectopic ADH (small cell lung cancer)
CNS disorder/head trauma
Pulmonary disease
Drugs (cyclophosphamide)

26

SIADH: Treatment

Fluid restriction, IV saline, conivaptan, tolvaptan, demeclocyline

27

Hyperthyroidism: Presentation (12)

1. weight loss despite increased appetite
2. heat intolerance/sweating
3. tachycardia with increased CO
4. arrhythmia (Afib) in elderly
5. tremor, anxiety, insomnia, heightened emotions
6. staring gaze with lid lag
7. diarrhea with malabsorption
8. oligomenorrhea
9. bone resorption with hypercalcemia (osteoporosis)
10. decreased muscle mass with weakness
11. hypocholesterolemia
12. hyperglycemia

28

Graves' disease: Mechanism

Type II hypersensitivity
Autoantibody (IgG) stimulates TSH receptor -> increase syntehsis and release of thyroid hormone

29

Most common cause of hyperthyroidism

Gaves' disease

30

Graves' disease: Risk group

Women of childbearing age (20-40 years)
Often presents during stress (e.g. childbirth)