Pathology

Question 1

Nonfunctional tumors often present with mass effect like…

Answer 1

Bitemporal hemianopsia(Due to Optic Chiasm compression)
Hypopituitarism(due to pituitary compression)
Headache

Question 2

What is the most common type ofpituitary adenoma?

Answer 2

Prolactinoma

Question 3

Prolactinoma presents as…

Answer 3

galactorrhea and amenorrhea in Females
decreased libido and headache in males

Question 4

Treatment of Prolactinoma is?

Answer 4

dopamine agonists (e.g., bromocriptine or cabergoline), decreases Prolactin secretion, shrinking tumor
Or
Surgery for larger tumors

Question 5

Symptoms of Growth hormone cell adenoma are?

Answer 5

Gigantism in children(increased linear bone growth (epiphyses are not fused))
Acromegaly in adults
i. Enlarged bones ofhands, feet, and jaw
ii. Growth ofvisceral organs leading to dysfunction (e.g., cardiac failure)
iii. Enlarged tongue

Question 6

Secondary diabetes mellitus is often present in?

Answer 6

Growth hormone cell adenoma because GH causes liver gluconeogenesis.

Question 7

How do you diagnose a Growth hormone cell adenoma?

Answer 7

There is elevated GH and insulin growth factor-1 (IGF-1) levels along with lack ofGH suppression by oral glucose

Question 8

What is the treatment for Growth hormone cell adenoma?

Answer 8

Treatment is octreotide (somatostatin analog that suppresses GH release), GH receptor antagonists, or surgery.

Question 9

ACTH cell adenomas leads to?

Answer 9

Cushing syndrome

Question 10

HYPOPITUITARISM is defined as?

Answer 10

Insufficient production ofhormones by the anterior pituitary gland; symptoms arise when > 75% ofthe pituitary parenchyma is lost.

Question 11

HYPOPITUITARISM can be due to?

Answer 11

1. Pituitary adenomas (adults) or craniopharyngioma (children) - due to mass effect or pituitary apoplexy (bleeding into an adenoma)
2. Sheehan syndrome - pregnancy-related infarction of the pituitary gland
   i. Gland doubles in size during pregnancy, but blood supply does not increase significantly; blood loss during parturition precipitates infarction.

3.Empty sella syndrome-congenital defect of the sella
i. Herniation of the arachnoid and CSF into the sella compresses and destroys the pituitary gland.
ii. Pituitary gland is “absent” (empty sella) on imaging.

Question 12

Symptoms of Sheehan symdromes are?

Answer 12

poor lactation, loss of pubic hair, and fatigue

Question 13

Most common cause of Hyperpituitarism is?

Answer 13

Adenoma

Question 14

Pathogenesis of pituitary adenomas?

Answer 14

•G-protein mutations
•Familial pituitary adenomas
•Mutations of p53

Question 15

What genes cause Familial pituitary adenomas?

Answer 15

MEN1, CDKN1B, PRKAR1A, and AIP(men, apes, couldnt park in 1b amd 1a)

Question 16

What gene cause pituitary carcinomas?

Answer 16

Carcinoma:HRAS( carcinomas harrass)

Question 17

What genes cause Aggressive adenoma?

Answer 17

CyclinD1,Rb,P53

Question 18

Hyperprolactinemia can be due to?

Answer 18

pregnancy
nipple stimulation
response to many types of stress
estrogens
renal failure,
hypothyroidism,
stalk effect.
several classes of drugs like dopamine inhibitory drugs.

Question 19

GH stimulates ….?

Answer 19

the hepatic secretion of insulin-like growth factor I

Question 20

Hypopituitarism accompanied by evidence of posterior pituitary dysfunction in the form of diabetes insipidus is almost always of ….?

Answer 20

hypothalamic origin.

Question 21

What are some clinical manifestations of Hypopituitarism?

Answer 21

 Children can develop growth failure (pituitary dwarfism) due to growth hormone deficiency.
 Gonadotropin (GnRH) deficiency
 Women: amenorrhea and infertility
 Men: decreased libido, impotence, and loss of pubic and axillary hair in men.
 TSH and ACTH deficiencies
 hypothyroidism and hypoadrenalism,
 Prolactin deficiency: lack of post partum lactation
 MSH deficiency: pallor

Question 22

ADH deficiency causes what?

Answer 22

Diabetes insipidus

Question 23

Symptoms of Nephrogenic DI?

Answer 23

• excessive urination(polyuria)
• Serum sodium and osmolality ↑
• thirst and polydipsia

Question 24

How many glands in the Parathyroid gland?

Answer 24

4

Question 25

Describe the parathyroid gland

Answer 25

yellow-brown, ovoid encapsulated nodule

Question 26

the most common endocrine disorder is?

Answer 26

Primary Hyperparathyroidism

Question 27

Hyperparathyroidism is an important cause of?

Answer 27

hypercalcemia

Question 28

Parathyroid adenomas are almost always .....?

Answer 28

solitary

Question 29

Parathyroid adenomas look .....?

Answer 29

well-circumscribed, soft, tan to reddish-brown nodule, and 0.5 to 5.0grams Often on 1/4 of the glands Other glands are normal or shrunk Well defined capsule

Question 30

Pathogenesis of parathyroid adenomas includes:

Answer 30

Cyclin D1 inversions Men1 mutations

Question 31

Parathyroid hyperplasia has....?

Answer 31

Affects are 4 glands Chief cell hyperplasia Stromal fat is inconscipcuous Water clear

Question 32

Parathyroid carcinoma is diagnosed by...?

Answer 32

white, irregular masses invasion of surrounding tissues and metastasis are the only reliable criteria of malignancy Single gland

Question 33

Morphologic changes that occur in other organs due to hyperparathyroidism

Answer 33

1. osteitis fibrosa cystica. 2. Brown tumor(aggregates of osteoclasts) Urinary tract stones (nephrolithiasis) Metastatic calcification secondary to hypercalcemia GI disturbance: peptic ulcer, gall stone

Question 34

Causes of secondary hyperparathyroidism:

Answer 34

• Renal failure (the most common cause) • Inadequate dietary intake of calcium, • steatorrhea, • vitamin D deficiency,

Question 35

causes of hypoparathyroidism:

Answer 35

1. Surgically induced hypoparathyroidism 2. Congenital absence of all glands

Question 36

The major clinical manifestations of hypoparathyroidism are

Answer 36

referable to hypocalcemia • Increased neuromuscular irritability(tingling, muscle spasm carpopedal spasm, tetany) • Cardiac arrhythmia • Increased ICP • seizure

Question 37

Primary Causes of thyrotoxicosis associated with hyperthyroidism:

Answer 37

Diffuse toxic hyperplasia(Grave's disease) Hyperfunctioning multinodal goiter Hyper functioning adenoma

Question 38

Secondary causes of toxicosis associated with hypertbyroidism:

Answer 38

TSH-secreting pituitart adenoma(rare)

Question 39

Causes of thryotoxicosis not associated with hyperthyroidism

Answer 39

Subacute granuloumatous thyroiditis(painful) Subacute lymphocytic thyroiditis(painless) Struma ovarii(ovarian teratoma) Factitious thyrotoxicosis(from exogenous intake of thyroxine)

Question 40

Most common cause of primary hyperthyroidism is?

Answer 40

Grave's disease