Lecture 9 - Endocrine Pathology and Hepatobiliary Flashcards
(27 cards)
What are the other names for the anterior and posterior pituitary gland?
Ant. = Adenohypophysis
Post. = Neurohypophysis
What are the 5 types of hormones secreted by the ANTERIOR pituitary and what do they produce?
What are the 2 from the POSTERIOR pituitary?
**1) Somatotrophs
* Produces growth hormone
2) Lactotrophs
* Produces prolactin
*****3) Corticotrophs
* Produces adrenocorticotrophic hormone
**4) Thyrotrophs
* Produces thyroid simulating hormone
5) Gonadotrophs
* Produces follicle stimulating hormone and luteinizing
hormone
_________________________________________
**1) Antidiuretic hormone
* (ADH, Vasopressin)
2) Oxytocin
Hyperpituitarism vs hypopituitarism
BOTH diseases of ANTERIOR LOBE
Hypopituitarism
a. Destructive lesions/processes –ischemia,
radiation, inflammation, neoplasms
* Hyperpituitarism
a. Functional adenoma within anterior lobe
b. Local mass effects –enlargement of sella turcica,
visual field abnormalities, increased intracranial
pressure
Hypopituitarism is a sequelae of what diseases?
- Pituitary Adenomas
- Radiation Treatment
- Neurosurgery
- Sheehan Syndrome
- Ischemic necrosis of pituitary gland
Hyperpituitarism is a sequelae of what diseases?
- Pituitary Adenomas (benign)
- Pituitary Hyperplasia
- Pituitary Carcinomas (malignant)
- Hypothalamic disorders
What are some clinical manifestations of hypopituitarism?
Pituitary Dwarfism
* Amenorrhea & Infertility
* Libido & Impotence
* Postpartum lactation failure
* Hypothyroidism
* Hypoadrenalism
What are some clinical manifestations of hyperpituitarism?
- Gigantism
- Acromegaly
- Cushing disease
Gigantism vs Acromegaly
GIGANTISM/Hyperpituitarism
* Primary tumor
* Excess growth hormone (GH)
- Adenoma of anterior pituitary
- 2nd most common
* Affects all “growing tissues”
* Gigantism- BEFORE growth plate closure
SIDE EFFECTS: Generalized
overgrowth (3 standard deviations), Headaches, Chronic fatigue, Arthritis, osteoporosis, Muscle weakness, Hypertension, Congestive heart
ACROMEGALY
* Late diagnosis
- AFTER growth plate closure
* Poor vision; photophobia
* Enlarged skull, hands, feet, ribs
* Soft tissue, viscera
* Enlarged maxilla, mandible, nasal and frontal bones, maxillary sinus
* Intraoral:
-Diastemas
-Malocclusion
-Macroglossia
-Enlarged lips
-Sleep apnea
What are diseases of the POSTERIOR pituitary gland?
- Diabetes Insipidus (Central)
- Polyuria
- Dilute urine
- Polydipsia
- Secretions of Inappropriately High
Levels of ADH (SIADH)- Hyponatremia
- Cerebral edema
- Neurologic dysfuction
- Total Body Water
Blood volume normal
No peripheral edema
__________ is stored in the thyroid (bound to _________) used to make ______ (primary product) and _______. T3 is converted to T4 in the __________
Iodide
Thyroglobulin
T4
T3
Liver
TRH is the activator for the production of _______ which is the activator for the production of ___________
TSH
T3 and T4
What glands are responsible for thyroid function?
Hypothalamus
Pituitary
Thyroid
What hormones are metabolically active? What percentage of these make up the body?
Free hormones - not bound to thyroxine binding proteins
Free T4 = 0.03% total T4
Free T3 = 0.3% total T3
How is the production of T4 and T3 by TSH controlled in the body?
Negative Feedback loop
Primary vs Secondary HYPOthyroidism
- Primary
- Intrinsic abnormality in the thyroid
- Surgery
- Radiotherapy
- Autoimmune
- Secondary
- Pituitary failure
What are the two types of hypothyroidism?
MYXEDEMA
* Adult
* Generalized fatigue
* Apathy
* Mental sluggishness
* Listless
* Cold intolerance
* Overweight
CRETINISM
* Childhood
* Impaired skeletal development
* Severe mental retardation
* Short stature
* Course facial features
* Delayed tooth eruption
What are the levels of TSH and T3/T4 in someone with Hypothyroidism?
What about with HYPERthyroidism?
HYPO: TSH levels are HIGH in Primary
- Levels are LOW in secondary
T4 levels are LOW
PERMANENTLY
HYPER: TSH levels LOW
T3/T4 levels HIGH
What is the most common cause of hypothyroidism in areas where there is sufficient Iodide levels? What is the common cause for HYPERthyroidism?
Hypo = Hashimotos Thyroiditis
- Autoimmune
Hyper = Grave’s Disease (BIG ASS EYES)
What are the symptoms of someone with Hyperthyroidism/Grave’s Disease?
- Tachycardia
- Increased appetite
- Weight loss
- Exophthalmos
- Intolerance to heat
What is the sequence of events of an Endemic Goiter?
1) Diet deficient in iodine
2) Decreased output of T3 & T4 by thyroid
3) Pituitary responds by secreting TSH
4) Thyroid hyperplasia
What is the most common malignancy we see in the thyroid gland?
Papillary Carcinoma (75-85%)
What is a Brown Tumor associated with?
Primary Hyperparathyroidism
What is a good way to remember what happens in patients with hyperparathyroidism?
Stones (kidney, gall, etc.), Bones (brown tumor), Moans (psychic moans, depression, etc.) & Groans (abdominal groans/peptic ulcers)
What is secreted from each layer of the adrenal gland cortex?
- Zona Glomerulosa
- Aldosterone
- Regulated by angiotensin II
- Zona Fasiculata
- Glucocorticoids (cortisol)
- Regulated by ACTH (biofeedback)
- Zona Reticularis
- Androgens
- No feedback with ACTH
Medulla releases EPI and NE
