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Endo II > Pituitary and thyroid > Flashcards

Pituitary and thyroid Flashcards

(112 cards)

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1
Q

PIT-1

A

TF which regulates differentiation of
somatotrophs
mammosomatotrophs
lactotrophs

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2
Q

SF-1 and GATA-2

A

TFs which regulates differentiation of gonadotrophs

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3
Q

What is most common cause of hyperpituitarism of ant pit

A

pituitary adenoma

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4
Q

what is the peak incidence of pituitary adenomas

A

35-60

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5
Q

genetic abnormaliites of pituitary adenomas

A

GPCR mutations -> GNAS

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6
Q

GNAS

A

codes for Galpha subunit

these mutation are also present in corticotroph adenomas

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7
Q

morphology of pituitary adenoma

A
  • well circumscribed and soft (d/t lack of reticulin)
  • if breaks thru diaphgragma sella its invasive
  • CELLULAR MONOMORPHISM AND LOSS OF RETICULIN distinguished from nonneoplastic surrounding cells
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8
Q

Mass Effect signs

A
  • radiographic abnromaliites of sella turcia
  • bitemporal hemianopsia
  • elevated intracranial pressure
  • acute hemorrhage into adenoma leading to pituitary apoplexy
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9
Q

lactotroph adenoma

A

prolactin secreting

most frequent type of fnx pituitary adenoma

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10
Q

sparsely granulated lactotroph adenomas

A

most common

chromophobic cells w/juxtanuclear PIT-1

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11
Q

densely granulated lactotroph adenomas

A

diffuse cytoplasmic PIT-1

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12
Q

other morphological features of lactotroph adenomas

A

psammoma bodies or calcification of entire tumor

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13
Q

symptoms of lactotroph adenoma

A

amenorrhea
galactorrhea
loss of libido and fertility

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14
Q

other causes of pathologic prolactinemia

A 
truama to pituitary stalk
DR2 antagonists
any mass in suprasellar compartment
renal failure
hypothyroidism
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15
Q

Tx of prolactinemia

A

surgery

bromocriptine

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16
Q

somatotroph adenomas

A

GH secreting

2nd most common type of fnx pituitary adenoma

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17
Q

densely granulated somatotroph adenomas

A

monomorphic acidophillic cells

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18
Q

mammosomatotroph

A

bihormonal: GH and prolactin

usually dense granulated variant

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19
Q

acromegaly

A

bone density may increase in spine and hips

sausage fingers

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20
Q

other issues associated with GH excess

A 
gonadal dysfunction
DM
mm weakness
HTN
arthritis
CHF
GI CA
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21
Q

Dx of somatotroph adenoma

A

elevated GH and IGF1

FAILURE OF GLUCOSE load to suppress GH

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22
Q

corticotroph adenomas

A

excess ACTH -> adrenal hypersection of cortisol -> cushings disease

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23
Q

corticotroph adenomas morphology

A

stain with PAS due to CHO in POMC

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24
Q

Nelson syndrome

A

large destructive adenomas develop post adrenal gland removal
do not present until mass effect bc cannot become symptomatic

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25
pleurihormonal
very rare and usually aggressive
26
gonadotroph adenomas
secrete hormones inefficiently and variably usually discovered d/t mass effect FSH usually dominantly secreted hormone usually express SF-1 and GATA-2
27
thyrotroph adenomas
rare
28
non-fnx pituitary adeomas
aka silent or null-cell | most common type of pituitary adenoma
29
pituitary carcinomas
rare presence of craniospinal or systemic mets most are functional: prolactin and ACTH most common
30
when does hypopituitarism become symptomatic
when 75% of parenchyma is lost
31
Where is the likely pathology in neurogenic DI
hypothalmus
32
what is the most common cause of neurogenic DI
trauma
33
Pituitary apoplexy
sudden hemorrhage into pituitary gland sudden onset of HA and diploplia CV collapse, loss of conciousness, sudden death neurosurgical emergency
34
sheehan syndrome
aka postparum necrosis of ant pit most common cause of ant pit necrosis pit enlarges during preg without increased blood supply, if blood loss occurs during labor ant pit at risk
35
other causes of pit necrosis
``` DIC Sickle cell elevated intracranial pressure trumatic injury shock ```
36
Rathke cleft cyst
lined by ciliated cuboidal epi w/occaision goblet and ant pit cells proteinacious fluid
37
empty sella syndrome
any condition or Tx that destryoys all or part of pit gland | radiation or surgery
38
hypothalamic lesion
DI tumors inflammatory disorder and infections (TB and sarcoidosis) genetic defects (PIT-1)
39
Post pit syndromes
DI | SIADH
40
SIADH
most common cause is SSC of lung | can also be caused by drugs
41
hypothalamic suprasellar tumros
may induce hypo or hyper fnx of ant pit, DI, or combos | gliomas and craniopharyngiomas most common
42
craniopharyngiomas
``` arise from vestigial remnants of Rathke pouch biomodal: 5-15 and 65 HA and visual disturbances WNT and beta catenin mutationa excellent prognosis ```
43
morphology of craniopharyngiomas
most commonly cystic and mulitloculates
44
2 variants of craniopharyngiomas
adamantinomatous | papillary
45
adamantinomatous craniopharyngiomas
kids calcification (psomma bodies) cysts of machine oil fluid
46
papillary craniopharyngiomas
adults | calcifications and cysts rare
47
parafollicular cells
aka C cells in thyroid secrete calcitonin
48
3 most common causes of thyrotoxicosis
Diffuse hyperplasia associated with graves (85%) hyperfunctional multinodular goiter hyperfunctional thyroid adenoma
49
Thyrotoxicosis and BMR
increased skin warm, soft, flushed heat intolerance and sweating weigh loss despite increased appetite
50
Thyrotoxicosis and heart
``` earliest and most consistent features elevated contractility and CO tachy, palps, cardiomegaly arrhythimia (a-fib) in older patients CHF ```
51
Thyrotoxic cardiomyopathy
left ventricular dysfunction -> decreased CO
52
Thyrotoxicosis and NS
``` tremor hyperactivity emotional lability anxiety inability to concentrate insomnia mm weakness and decreased mm mass ```
53
Thyrotoxicosis and eyes
wide staring gaze with lid lag | exopthalmus only in graves
54
Thyrotoxicosis and skeleton
over stimulation of bone resorption -> osteoporosis
55
Thyroid storm
``` abrupt onset of severe Thyrotoxicosis most common in graves febrile and tachy medical emergency b/c arrhythmias fatal predisposing factors: infection, surgery, stress, cessation of meds ```
56
apathetic hyperthyroidism
older adults and various co-morbidities blunt features of excess TH
57
Tx of Thyrotoxicosis
``` beta blockers thionamide iodine radioiodine ablation surgery ```
58
congenital hypothyroidism
worldwide d/t endemic iodine deficiency
59
autoimmune hypothyroidsim
most common in developed countries | almost all are hashimotos
60
Abs against thyroid
antimicrosomal antithyroid peroxidase antithyroglobulin
61
drugs which can induce hypothyroidsim
methimazole PTU lithium p-aminosalcylic acid
62
myxedema
``` hypothyroidism in developing in older child or adult slowing of physical and mental activity listless, cold intolderant, overweight constipation, decreased sweating reduced CO -> SOB atherogenic profile deepening of voice, non pitting edema ```
63
histo of myxedema
glycosaminglycans and hyaluronic acid in skin
64
Dx of myxedema
TSH
65
hashimotos thyroiditis
women 45-65 CTLA4 and PTPN22 (regulate T cells) progressive apoptosis or thyroid epi replaced by mononuclear cells and fibrosis
66
morphology of hashimotos
diffusely enlarged, with intact capsule and pall surface extensive mononuclear infiltrates with germinal centers Hurthle cells fibrosis does NOT extend beyond capsule
67
hashitoxicosis
transient thyrotoxicosis d/t disruption of thyroid follicles and release of TH
68
hashimotos at risk for what CA
extranodal marginal zone B cell lymphomas in thyroid
69
subacute lymphocytic thyroiditis
postpartum thyroiditis is in this category autoimmune (Abs) lymphocytic infiltrates w/large germinal centers unlike hasimotos NO fibrosis or Hurthle cells
70
granulomatous thyroiditis
``` aka dequervain thyroiditis 40-50 tirggered by viral infection, Hx of URI painful u/l or b/l enlarged firm thyroid with intact capsule that may adhere to surrounding structures multinucleated giant cells lasts 2-6 weeks elevated TH, decreased TSH radioactive I uptake diminished ```
71
graves
most common cause of endogenous hyperthyroidism | peak 20-40
72
graves triad
hyperthyroidism with diffuse enlargement of gland exopthalamus pretibial myexedema
73
Ab in graves
TSI- thyroid stimulating immunoglobulin
74
Pathogenesis of graves
linked to CTLA4 and PTPN22 and HLA-DR3
75
morphology of graves
-symmetrically enlarged with diffuse hypertrophy and hyperplasia of follicular epi cells -soft meaty appearance resembling mm small papillae project into lumen, but NO fibrovascular core T cell and B cell infiltratates germinal centers colloid scalloped
76
Tx of graves
``` beta blockers thionamides PTU radioiodine ablation thyroidectomy ```
77
what is TH in most goiters
euthyroid
78
diffuse nontoxic/simple goiter
aka colloid goiter 2 categories: endemic sporadic
79
endemic diffuse nontoxic/simple goiter
10%+ of pop must be affected mountainous areas can be d/t goitrogens
80
sporadic
less frequent the endemic | mostly idiopathic
81
goiterogens
``` cabbage, cauliflower, brussel sprouts, turnips cassava root (thiocyanate) ```
82
phases of goiter
hyperplastic: symmetrically enlarged | colloid involution: when I is again available
83
multinodular goiter
virtually all long standing simole goiters progress to multinodular produce most extreme thyroid enlargements polyclonal and monoclonal nodules can be complicated by follicular rupture, hemorrhages, cysts scarring, calcification
84
multinodular goiter morphology
pressure on midline structures intrathroacic/plunging goiter: grows behind sternum brown gelantinous colloid
85
mass effects of multinodular goiter
airway obstruction dysphagia compression of large vessels SVC syndrome
86
plummer syndrome
less common presentation of goiter hyperthyroidism (toxic) exopthalmus and dermopathy of graves absent
87
determining malignancy in thyroid
- solitary nodules more likely to be neoplastic - nodules in young more likely to be neoplastic - noduels in males more likely to be neoplastic - Hx of radiation more likely malignant - fnx noduels more likely benign
88
thyroid adenomas
from follicualr epi usually not forerunners to carcinomas most are non functional
89
common mutations in thyroid adenomas
gain of fnx in TSHR or GRAS | these are RARE in follicular carcinomas
90
rare mutatuion in thyroid adenomas
RAD or pIK3CA mutation PAX8-PPARG fusion these ARE shared with follicualr carcinomas
91
morphology of thyroid adenomas
solitary spherical, encapsulated lesion areas of hemorrhage, fibrosis, cystic changes common HALLMARK is well formed capsule integrity of capsule is only way to determine if it is truly benign
92
Dx of thyroid adenomas
surgical removal for capsule integrity determination
93
prognosis of thyroid adenomas
excellent | do not recur
94
thyroid carcinomas
uncommon in kids M=F types: papillary, follicular, anaplastic, medullary
95
which thyroid carcinomas arise from follicular epi
papillary follicular anaplastic mutation in TK -> RAS -> MAPK pathway
96
papillary carcinomas
most common 85% 25-50 usually have radiation Hx
97
mutations in papillary carcinomas
gain of fnx in RET, NTRK1, or BRAF
98
RET mutations
part of MAP kinase pathway RET/PTC fusion more common in radiation NOT seen in follicular adenomas or carcinomas
99
BRAF
in MAP pathwya adverse prognosis NOT seen in follicular adenomas or carcinomas
100
morphology of papillary carcinomas
GRAY WHITE areas of fibrosis and cysts papillae have fibrovascular stalk nuclei of OPTICAL CLEARING (ground glass or orphan Annie nuclei) psudoinclusions in nuclei of invading cytoplasm psammoma bodies in papillay (never seen in follicular or medullary CA) LYMPH invasion, but NOT blood METS to cervical nodes
101
Dx of papillary carcinomas
on cellular findings alone | excellent prognosis
102
follicular carcinomas
more common in areas with I deficiency | 40-60
103
mutation in follicular carcinoma
- RAS or PI3K/AKT TK pathway - loss of fnx in PTEN - PAX8-PPARG fusion
104
morphology of follicular carcinoma
``` usually well circumscribed but may rupture capsule gray-tan-pink central fibrosis and calcification hurthle cells NO psammoma bodies Dx with capsular invasion ```
105
spread of follicular carcinoma
lymph rarely involved, but common thru blood with mets to bone, liver, and lungs
106
Tx of follicular carcinoma
total thyroidectomy radioactive iodine ablation TH to suppress TSH
107
anaplastic carcinomas
aggressive 100% mortality 65 25% previous Hx of thyroid CA 25% concurrent CA in adjacent cells
108
anaplastic carcinomas mutations
TP53 | beta catenin
109
anaplastic carcinomas morphology
lots of cell types (giant, spindle, mised, foci of papillary or follicular differentiation)
110
medullary carcinoma
neuroendocrine neoplasm derived from parafollicular C cells secrete calcitonin can also secrete serotonin, ACTH, VIP
111
familial causes of medullary carcinoma
MEN-2 | germline RET mutations (not translocations)
112
morphology of medullary carcinoma
``` sporadic solitary, familial mulitple necrosis and hemorrhage AMYLOID CALCITONIN adjacent C cell hyperplasia -> MEN2 ```

Endo II (15 decks)

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