Pathoma material Flashcards
(37 cards)
describe pituitary adenoma and most common type
benign, anterior, functioning makes hormone, non-functioning usually presents with mass effect (bitemporal hemanopsia, hypopituitarism, headache)
Most common is prolactinoma presents as galactorrhea and ammenorrhea in females and decreased libido and headache in males
How would you treat a prolactinoma
Dopamine agonist (bromocriptine or cabergoline)
or surgery for larger lesions
How does growth hormone cell adenoma present differently in children vs adults
Children-increased linear bone growth (epiphysis are not fused)
Adults-Acromegaly (enlarged hands, feet, jaw, visceral organs, and tongue. death from cardiac failure)
Secondary DM is also often present because GH induces liver gluconeogenesis).
How is a GH cell adenoma diagnosed?
How is it treated?
elevated GH and IGF-1. Lack of GH suppression by oral glucose.
Octreotide (SS analog to suppress GH release), GH receptor antagonists, or surgery
When do symptoms arise from anterior hypopituitarism?
What are common causes?
when >75% of the pituitary parenchyma is lost
Pituitary adenomas (adults), craniopharyngioma (children), Sheehan syndrome (pregnancy related infarction of pit gland due to blood loss)
How does Sheehan syndrome present?
poor lactation, loss of pubic hair, and fatigue
What is empty sella syndrome?
Herniation of the arachnoid and CSF into the sella compresses and destroys the pituitary gland. gland is “absent” on imaging
Cause, clinical features, diagnosis, and treatment of central DI
ADH deficiency due to hypothalamic or posterior pituitary pathology
features: polyuria, polydipsia, risk of life threatening dehydration. Hypernatremia and high serum osmolality. Low urine osmolality and specific gravity.
Water deprivation test fails to increase urine osmolality
treat with desmopressin
Cause, clinical features, treatment of SIADH
excessive ADH secretion most often from ectopic production (SCC lung) or CNS trauma, pulmonary infection, or drugs (cyclophosphamide)
features: hyponatremia, low serum osmolality, AMS, seizures
treat by water restriction or demeclocycline (blocks effects of ADH)
increased BMR and SNS activity is due to what in hyperthyroidism?
Increased BMR is due to increased synthesis of Na+/K+ ATPase
Increased SNS activity is due to increased expression of B1-adrenergic receptors
What are the common clinical features of hyperthyroidism
Weight loss w/ increased appetite
Heat intolerance and sweating
Tachycardia with increased cardiac output
Arrhythmia
Tremor, anxiety, insomnia, and heightened emotions
DIARRHEA
oligomenorrhea
bone resporption with hypercalcemia
decreased muscle mass with weakness
HYPOCHOLESTEROLEMIA AND HYPERGLYCEMIA
Causes and clinical features of Grave’s disease?
IgG that mimics TSH and stimulates TSH receptor (type II HS). MOST COMMON CAUSE OF HYPERTHYROID
diffuse goiter, exopthalmos and pretibial myxedema (fibroblasts express TSH receptor)
Histology, Lab findings, and treatment of hyperthyroid?
Irregular follicles with scalloped colloid and chronic inflammation.
increased total and free T4, decreased TSH, hypercholesterolemia, hyperglycemia
treat with Beta-blockers, thioamide, and radioiodine ablation.
How does thyroid storm present and how do you treat it?
arrhythmia, hyperthermia, vomiting, w/ hypovolemic shock
treat with PTU, Beta-blockers, and steroids
Describe Multinodular goiter
enlarged thyroid with nodules due to iodine deficiency. usually non-toxic
What is cretinism and what are causes and features?
hypothyroid in neonates and infants
caused by maternal hypothyroid in early pregnancy, thyroid agenesis, dyshormonogenetic goiter, and iodine deficiency.
features include mental retardation, short stature with skeletal abnormalities, coarse facial features, enlarged tongue, and umbilical hernia.
What is myxedema? causes and features?
hypothyroidism in older children and adults (dough like tissue due to increased glycosaminoglycans)
caused by iodine deficiency, hashimoto’s, drugs like lithium, and surgical removal or ablation of thyroid.
features include DEEPENING of voice and large tongue, weight gain despite normal appetite, slow mental activity, muscle weakness, cold intolerance with decreased sweating, bradycardia with decreased CO (leads to SOB and fatigue), oligomenorrhea, hypercholesterolemia and CONSTIPATION
Cause, features, histology, and associated dz with Hashimoto thyryoiditis
Autoimmune destruction of thyroid gland. HLA-DR5 (HLA-BR8). MOST COMMON CAUSE OF HYPOTHYROID where iodine adequate
initial hyperthyroid from follicle damage then progression to hypo-
Antithyroglobulim and antithyroid peroxidase antibodies
chronic inflammation in the germinal centers and HURTHLE cells (eosinophillic metaplasia of cells lining follicles)
increased risk for Bcell lymphoma
Describe subacute granulomatous (De Quervain) thyroiditis
granulomatous thyroiditis following VIRAL infection.
TENDER thyroid with hyperthyroidism. self limited
Describe Riedel fibrosing thyroiditis
chronic inflammation with extensive fibrosis of thhyroid
hypothyroidism with “HARD as wood” gland. non tender.
fibrosis may extend into local structures like airway. mimics anaplastic carcinoma but riedel is in young people and malignant cells are absent
Describe follicular adenoma
benign follicle proliferation surrounded by capsule
usually non-functional but may secrete thyroid hormone
Describe papillary carcinoma
Malignant follicle proliferation surrounded by a capsule however there will be INVASION THROUGH CAPSULE
hematogenous metastisis
Describe Medullary carcinoma
malignant proliferation of parafollicular C cells. Secretes CALCITONIN–>hypocalcemia. Calcitonin deposits in tumor as amyloid.
MALIGNANT CELLS IN AMYLOID STROMA
Familial MEN 2A and 2B – RET oncogene
Describe Anaplastic carcinoma
undifferentiated malignant thyroid tumor ELDERLY. invasion of local structures resulting in dysphagia or respiratory compromise. poor prognosis.
