Robbins Flashcards
(188 cards)
1
Q
What gene mutations have been identified as causes of familial pituitary adenomas?
A
MEN 1
CDKNIB
PRKARIA
AIP–> develops GH secreting adenoma @ young age
2
Q
Cellular monomorphism, absence of Reticulin network?
A
Pituitary adenoma
3
Q
Macroadenomas in pituitary gland lead to mass effect causing?
A
Visual disturbances
4
Q
What mutation is one of the more come genetic alterations in Pituitary adenomas?
A
GNAS I mutation–> constitutively active Gs protein
5
Q
What is the MC type of hyperfunctioning pituitary adenomas?
A
Prolactinomas
6
Q
What are the consequences of Prolactinomas?
A
Amenorrhea
Galactorrhea
Libido
Infertility
7
Q
Persistent hypersecretion of GH stimulates secretion of what?
A
IGF-I (somatomedin C) from Liver
8
Q
Enlargement of jaw + hands + feet + separation of teeth?
A
Acromegaly from GH excess in adults
**Children get Gigantism
9
Q
What is GH excess associated with causing?
A
Acromegaly/ Gigantism Glucose intolerance DB mellitus Muscle weakness HTN + CHF Arthritis Osteoporosis
10
Q
What type of pituitary adenoma stains Positively with PAS?
A
Corticotroph cell Adenoma (ACTH releasing)
11
Q
Corticotroph cell adenomas can clinically present with?
A
Cushing syndrome
Hyperpigmention due to MSH accompanying ACTH release
12
Q
What is the typical presentation of nonfunctioning pituitary adenomas and Most other pituitary adenomas?
A
Mass effect
Possible Hypopituitarism
13
Q
What are the necessary condition to get clinical signs of Hypopituitarism?
A
75% loss or absence of Pituitary gland
14
Q
Hypopituitarism with evidence of posterior pituitary dysfunction will clinically present as what?
A
Diabetes Insipidus –> almost always Hypothalamic in orgin
15
Q
Sheehan syndrome is?
A
Postpartum Ischemic necrosis of anterior pituitary gland.
16
Q
What happens to Anterior Pituitary gland during pregnancy?
A
Enlarges–> increased size/# of prolactin secreting cells but NOT accompanied by increased Blood supply–> susceptible to necrosis
17
Q
What are some (other than pregnancy) conditions associated with Significant pituitary necrosis?
A
DIC SCD Elevated intracranial pressures Traumatic injury Shock
18
Q
What are some other conditions associated with Anterior pituitary hypo function?
A
Sarcoidosis
TB
Metastasis
19
Q
What are some of the clinical signs/symptoms of Hypopituitarism?
A
Dwarfism (GH) Amenorrhea + infertility in women (GnRH) Decreased Libido, impotence, Loss of pubic hair Hypothyroidism Hypoadrenalism Failure of postpartum lactation Pallor of skin (ACTH/ MSH)
20
Q
Nonapeptide hormone synthesized in the Supraoptic nucleus?
A
ADH
21
Q
What is the most useful screening test for Hyper or hypo thyroidism?
A
TSH
22
Q
Increased Radioactive Iodide uptake is seen in what conditions?
A
Graves
Solitary nodule in toxic adenoma
23
Q
Decreased Radioactive iodide uptake is seen in what condition?
A
Thyroditis
24
Q
MCC of Hypothyroidism?
A
Ww–> Iodine deficiency
Developed worlds–> Autoimmune
25
Hypothyroidism in infant or child?
Cretinism
26
Signs and symptoms of Cretinism?
```
Mental retardation
Short stature
Coarse Facial Features
Protruding tongue
Umbilical Hernia
```
27
Hypothyroidism in adults?
Myxoedema
28
Signs and symptoms of Myxoedema?
```
Mentally sluggish
cold intolerant
Myxoedema--> mucopolysaccharide edema
Broadening and coarsening of facial features
Tongue enlargement
Deepening of VOICE
Constipation
CHF
```
29
Condition associated with acute illness and sever thyroid pain?
Infectious thyroiditis
| Granulomatous Thyroiditis
30
Disorders manifested by thyroid dysfunction and little inflammation?
Subacute lymphocytic thyroditis (PAINLESS)
| Fibrous [Reidel] Thyroditis
31
2nd MCC of Hypothyroidism characterized by glandular thyroid failure secondary to Autoimmune destruction of thyroid gland?
Hashimoto Thyroditis
32
Pg of Hashimoto thyroiditis?
CD8 mediated cell death
Cytokine mediated cell death-->IFN gamma= macs
Antithyroid Abs mediate cytotoxicity
33
Hashimoto Thyroiditis has what genetic association?
CTLA4--> encodes for Treg cells
34
Biopsy showing widespread infiltration of Lymphocytes, plasma cells, Well developed Germinal Centers?
Hashimoto
35
What are Hurthle or Oxyphil cells?
Follicular cells with:
Abundantly eosinophilic
Granular cytoplasm
Numerous mitochondria
36
Painless enlargement of thyroid, associated with Hypothyroidism in middle age women?
Hashimoto
37
People with Hashimoto are at increased RISK for what?
Non-Hodgkin B cell Lymphoma within Thyroid gland
38
Characterized by Transient Hyperthyroidism and longterm Hypothyroidism?
Hashimoto
39
Patient with Hx of URTi just before onset of Thyroditis?
Subacute Granulomatous Thyroiditis--> Follows viral infections
40
Firm thyroid, intact capsule, and PMN infiltration followed by lymphocytes, macs, plasma cells provoking a granulomatous reaction with giant cells inside Colloid?
Subacute Granulomatous Thyroiditis
41
Thyroid pain in young patient vs. old patient?
Young--> Hashimoto
| Old--> Subacute granulomatous
42
Painless thyroiditis following pregnancy, normal appearing thyroid, lymphocytic infiltration + hyperplastic germinal center formation caused by Autoimmunity?
Subacute Lymphocytic Thyroiditis
43
Autoimmune condition causing Extensive fibrosis of thyroid and neck structures producing a HARD and fixed thyroid mass that may stimulate a neoplasm? Other consequences?
Riedel Thyroiditis--> associated with retroperitoneal fibrosis in some cases
44
Causes Thyrotoxicosis, Ophthalmopathy, Dermopathy (Pretibial Myxedema)?
GRAVES
45
What are some of the genetic association with Graves disease?
HLA-DR3
CLTA4
PTPN22
46
Autoimmune disease characterized by thyroid stimulating Igs, Thyroid growth stimulating Igs, TSH binding inhibitor Igs?
Graves disease
47
What is the Pg of Ophthalamopathy in Graves disease?
1. T cell infiltration
2. Inflammation + swelling of extraocular muscles
3. Glycosaminoglycan (Hyaluronic acid chondroitin sulfate) accumulation
4. Increased Adipocyte #
48
Microscopic appearance of Graves disease?
Diffuse hypertrophy/ hyperplasia
Scalloped colloid in Follicular margins
Germinal center formation
49
Characteristically causes increased blood flow to the thyroid with audible bruits, wide gaze and lid lag patient?
Graves disease
50
Typical characteristics of neoplastic thyroid nodules?
```
Solitary
Younger patient
Males
History of Radiation
NOT "Hot" (take up radioactive Iodine)
```
51
What genetics is associated with thyroid adenomas?
TSH receptor mutations
| GNAS--> allows follicular cells to secrete Thyroid hormone independent of TSH (autonomy)
52
Painless Solitary nodule with Well-defined, Intact capsule, that compresses adjacent thyroid parenchyma?
Adenoma
53
What is the scanning radionuclide description for a thyroid adenoma?
Cold--> less likely to be neoplastic
| **some are HOT--> Toxic and most turn malignant
54
Types of Thyroid Carcinomas in incidence order?
Papillary
Follicular
Anaplastic
Medullary
55
Genetics associated with Papillary thyroid carcinoma?
MAP kinase activation: RET or NTRKI + BRAF
56
Genetics associated with Follicular thyroid carcinoma?
PI-3K/AKT signaling pathway mutation
57
Genetics associated with Medullary thyroid carcinoma?
MEN-2 and RET oncogene mutations
58
Vast majority of Thyroid cancers are associated with Hx of?
Radiation
59
Cells with finely dispersed chromatin, imparting an optically clear appearance of a Ground glass Nuclei?
Papillary thyroid carcinoma--> "Orphan Annie eye" nuclei
60
Neoplastic growth with cells showing invaginations, pseudoinclusions, concentrically calcified structures (Psammoma bodies) with in papillae?
Papillary thyroid carcinoma--> metastasis to near by lymph nodes 50%
61
Thyroid carcinoma associated with 40-60 yo women in Iodine deficient areas?
Follicular Thyroid carcinoma
62
What is the important difference between follicular adenoma and follicular carcinoma?
Invasion of the CAPSULE or Vessel
63
Solitary Cold nodule, that Hematogenously spreads to Lungs, bone, or liver?
Follicular thyroid carcinoma--> NO LYMPH node metastasis
64
Undifferentiated tumor of thyroid follicular epithelium, in >60yo, aggressive with nearly 100% mortality rate?
Anaplastic carcinoma
65
Bulky mass that typically grows rapidly beyond thyroid capsule into adjacent neck structures, with large pleomorphic giant cells, spindle cells?
Anaplastic carcinoma
66
Neuroendocrine neoplasm derived from parafollicular cells or C cells, secrete Calcitonin, in CHILD is associated with what genetics?
Medullary carcinoma--> MEN 2a or 2b
67
Altered calcitonin molecules in adjacent stroma of medullary carcinoma leads to deposition of what?
AMYLOID
68
Multicentric C cell hyperplasia with amyloid deposition usually presents with what clinical symptoms?
Medullary carcinoma--> Dysphagia or hoarseness
69
Familial medullary carcinoma is associated with what mutation?
RET--> Prophylactic Thyroidectomy
70
Radioactive Iodine uptake shows Homogenous image with HIGH uptake?
Graves
71
Radioactive iodine uptake shows no image or Low uptake?
Subacute thyroiditis
PPT
Pt taking EXCESS thyroid hormone
72
Radioactive Iodine uptake shows Multiple Hot spots with high uptake?
Toxic multinodular goiter
73
Radioactive iodine uptake shows Single High Uptake hot spot with rest of gland suppressed?
Toxic adenoma
74
RAI uptake image shows Single focal COLD spot in otherwise normal gland?
Benign/ colloid cyst
| Bengin/malignant tumor
75
RAI uptake showing patchiness without hotter or colder spots?
Multinodular non-toxic goiter
76
RAI uptake showing diffuse uptake?
Generalized benign Goiter
77
50% of the Adenohypophysis is what type of cells?
Somatotrophs--> Producing GH
78
What % of the adenohypohysis is made up of lactotrophs + Corticotrophs + Thyrotrophs + Gonadotrophs?
Lac--> 20%
Cort--> 20%
Thyro--> 5%
gonad--> 5%
79
Dopamine inhibits the formation or secretion of what hormones?
TSH + Prolactin
80
Stomatostains inhibit the secretion of what hormones?
TSH
| GH
81
What two peptides interact to release prolactin during suckling or stress?
VIP
| PHI
82
Pituitary tumor invading laterally will affect what structures?
Lateral--> Cavernous sinus--> CN III, IV , VI paralysis
83
Pituitary tumor invading superiorly will damage what structure?
Diaphrama sella--> OPTIC CHAISM= Bitemporal hemianopsia
84
Postpartum pituitary necrosis caused by severe blood loss during delivery?
Sheehan syndrome
85
Intrapituitary hemorrhage caused by Growing tumor causing vascular necrosis leading to Hypopituitarism?
Pituitary Apoplexy
86
What is the only hormone that will increase due to a damage to the Infindibulum/ or pituitary stalk resulting in lack of Hypothalamic hormone delivery?
Prolactin--> Decreased Dopamine inhibition
87
Pt with hypotension, wgt loss, aches, loss of axillary hair and low adrogens/ cortisol has what type of deficiency?
Hypadrenalsim--> LOW ACTH
88
Male with impotence and infertility can have what hormonal problems>?
High Prolactin
| Low Testosterone
89
Women with amenorrhea and infertility can have what type of hormone imbalance?
High Prolactin
| Low estrogen
90
Dynamic test involving insulin induced Hypoglycemia is testing for what hormones?
```
GH
ACTH--> Cortisol
PRL
Glucagon
Catecholamines
ADH
```
91
Dynamic test involving infusion of arginine stimulates what hormone secretion?
GH
92
A sleep study would be done to determine of which hormones?
GH
PRL
ACTH + Cortisol
93
Normal blood glucose range?
70-120
94
Criteria for Dx of Diabetes mellitus?
Random glucose= 200mg/dL or MORE
Fasting= 126mg/dL or MORE
OGTT= 200 or MORE after 2 hrs
95
Type 1 Diabetes mellitus?
Autoimmune destruction of Beta cells causing Absolute deficiency of Insulin (10%)
96
Type 2 Diabetes mellitus?
Peripheral resistance + relative insulin deficiency
| 80-90%
97
Type 1 DB most commonly develops when?
Childhood and manifests @ Puberty
98
Hyperglycemia and ketosis occur when in T1DB?
Late in course after more than 90% of beta cells are Dead
99
What is the fundamental immune abnormality in T1DB?
Failure of self-tolerance in T cells
100
Production of autoantibodies against insulin + glutamic acid decarboxylase and necrosis of beta cells with Lymphocytic infiltration is a feature of what?
T1DB
101
What are the genetic risks associated with T1DB?
```
HLA-D--> MHC class II on 6p21
HLA-DR3/DR4
```
102
What are some of the environmental factors that can lead to T1DB?
Mumps
Rubella
Coxsackie B viruses
103
What is insulin resistance?
Failure of target cells to respond to normal levels of insulin
104
Visceral obesity + insulin resistance + Glucose intolerance + CV risks (HTN or Abnormal lipids)?
Metabolic syndrome
105
Intracellular High triglyceride and products of FA metabolism are potent inhibitors of what?
Inhibit Insulin Signaling and result in INSULIN RESISTANCE-> link btwn Obesity and T2DB
106
What is present in 90% of the islets in a long Standing T2DB?
Amyloid replacing islet cells
107
What are the monogenic Diabetes?
Loss of function mutation w/in 1 gene
Younger--> MODY
Neonates--> mitochondrial DNA mutation (maternally inherited DB + bilateral blindness)
108
What are the 3 distinct metabolic pathways involved in the pathogenesis of longterm complications?
1. Accelerated AGE formation
2. Activation of PKC-> thickens Basement mem
3. disturb polyol pathway-> dec. glutathione
109
How do AGEs form?
Non enzymatic rxn btwn Intracellular glucose precursors and AMino groups
110
What is the Pg of AGE mediated damage in Diabetes?
AGE-RAGE signaling:
Increases pro-inflammatory cytokines + GFs
Generates ROS
Increases Procoagulant activity
Proliferation of vascular smooth muscle/ ECM
111
How does increased AGE formation lead to increased risk for CV disease?
AGEs cross link ECM proteins and trap proteins and LDL--> accelerating Atherosclerosis
112
What is the Pg of PKC activation induced damage in Diabetes?
PKC--> activates VEGF and TGF beta= increased deposition of ECM and basement membrane material
113
Which tissues Do NOT require Insulin to Transport Glucose?
Nerves
Lens
Kidneys
Blood vessels
114
What is the Pg of Polyol pathway disturbance in Diabetic mediated damage?
In cells that dont require insulin for Glucose transport--> Hyperglycemia= increased Sorbitol= Fructose= Decreased NADPH (which is needed for Glutathione reduction)
115
What enzyme converts Glucose to Sorbitol inside Nerves, lens, Kidneys, blood vessels?
Aldose reductase
116
What is the underlying reason for Diabetic Neuropathy?
Hyperglycemia causing damage via Oxidative stress due to decreased Glutathione
117
What is observed in Nondiabetic newborns of Diabetic mothers?
Increased # and size of Islets due to Hyperglycemia--> causes Hypoglycemia @ birth
118
Vascular complications of Diabetes?
```
Accelerated Atherosclerosis
Gangrene of lower extremities
Hyalin arteriolosclerosis
Diffuse BM thickening
Leaky capillaries
```
119
What is diabetic microangiopahty?
Diffuse thickening of BM of capillaries b concentric layers of hyaline material (type IV collagen)
Underlies: DB nephropathy + Retinopathy + neuropathy
120
What are the renal complications of Diabetes?
Capillary BM thickening (entire length)
Diffuse mesangial sclerosis (>10 years)
Nodular glomerulosclerosis (ONLY DB) (Kim-wilson)
Renal arteriolosclerosis (afferent + efferent)
Papillary necrosis
121
Ocular complications of Diabetes?
Retinopathy (MC)
Cataracts
Glaucoma
122
Pg of nonProliferating retinopathy in DB pts?
Intraretinal: hemorrhage, exudates, microaneurysms + edema and retinal cap thickening
** Microaneurysms in retinal choroidal capillaries are seen as RED DOTS
123
What is Pg of proliferative retinopathy in DB pts?
process of Neovascularization and Fibrosis
| **blindness--> retinal detachment
124
Clinical features of Diabetes?
Polyuria
Polydipsia
Polyphagia (increased appetite) w. wgt loss
Lack/ depletion of Glycogen storage
Catabolic state with abnormal Glucose + Fat + protein metabolism
125
What factors lead to DKA type 1?
Dehydration from osmotic diuresis
Lipoprotein lipase activation= increase FAA
Ketogenesis
126
What leads to hyperosmolar nonketotic coma in T2DB?
Severe dehydration without signs of Ketoacidosis causing CNS compromise
127
What are the pathological features of T1DB?
Autoimmune "insulitis"
Beta cell depletion
Islet atrophy/ necrosis
128
What are the pathological features of T2Db?
Early: inflammation
Late: Amyloid
Mild Beta cell depletion
129
Sporadic attacks of Hypoglycemia, confusion, stupor, loss of consciousness fixed with feeding, Increased C-peptide is seen in what?
Insulinoma
130
What are the pathological characteristics of Insulinomas?
Giant islets with AMYLOID DEPOSITION
131
Pt with Diarrhea, multiple duodenal and jeujenal ulcers Dx?
Zollinger-Ellision syndrome
| GASTRINOMA
132
What are symptoms associated with Male hyperprolactinomas?
decreased Libido
Impotence
Infertility
133
Female symptoms of Hyperprolactinomas?
```
Anovulation
Amenorrhea
Galactorrhea
Infertility
Osteopenia
```
134
What static test can be done to determine Hyperprolactinoma?
Measure baseline PRL: 100-200ng/ml
| normal= <16-20
135
What are some Dynamic tests that can be done for Dx of hyperprolactinoma?
Sleep study--> Loss of nocturnal rise (sustained elevation)
TRH--> PRL increases by 50% or less
Dopamine blocker--> Blunted response
136
What hormonal excess would cause Bilateral adrenal hyperplasia + increased Skin pigmentation?
Excess ACTH
137
Salt retention (HTN), Insulin resistance (hyperglycemia) , Buffalo hump, Decreased skin collagen (easily bruised), and proximal myopathy is caused by excess of what hormone?
Cortisol
138
Hirsutism, oligomenorrhea (dec LH/FSH), Acne, impotence. What hormonal excess is responsible?
Adrenal Androgens
139
MEN 2A consists of what neoplastic disorders?
Pheochromocytoma
Hyperparathyroidism
Medullary carcinoma of Thyroid
140
MEN 2B consists of what neoplastic disorders?
Pheochromocytoma
Multiple mucosal neuromas
Medullary Carcinoma of thyroid
141
What is the triad of symptoms for Pheochromocytoma?
Paroxysmal: Headache, Diaphoresis, Palpitations
142
What are the clinical signs of Hyperaldosteronism?
Increased Na reabsorption
HTN
Hypokalemia--> Cramps + weakness
143
What are the MCC of death in DB patients?
1. MI
2. Renal failure
3. Infections
144
What is the link between Obesity and Insulin resistance?
Visceral Fat--> release toxic FFAs + reduced adiponectin through PPAR gamma receptor actions
145
What are the long term complications of diabetes and their Pg?
```
Blood vessel, Renal, nerves, eye damage:
Formation of AGEs
Activation of PKC
Sorbitol formation in Polyol pathway
ALL LEADING TO OXIDATIVE STRESS
```
146
What is the role of FFAs in Diabetic complications?
```
Excess FFAs leads:
ROS formation
Apoptosis of Islet cells
Increased Inflammatory cytokines
Increased VLDL production by liver
Decreased Adiponectin release by Adipocytes
```
147
Thyroid nodule with finger like projections of epithelium surrounded by fibrovascular core, calcified spheres, "optically" clear nuclei?
Papillary Thyroid Carcinoma
148
HLA-DR5 increases the risk for what kind of Thyroid pathology?
AI THYRODITIS (hashimoto)
149
What stimulates PTH release?
Levels of FREE IONIZED calcium in the bloodstream
150
What is the most MCC of hyperparathyroidism?
Sporadic parathyroid adenoma
151
What is the pathology of Familial hypocalciuric hypercalcemia?
Inactivating mutation of the Calcium-sensing receptors on Parathyroid cells
152
What are the two genetic abnormalities associated with Parathyroid adenomas?
MEN 1
| Cyclin D1 mutations
153
What is the typical morphology and how does that relate to all four of the glands?
Adenomas--> Solitary nodule + SINGLE GLAND
| 3 other glands--> SHRUNKEN due to feedback inhibition by elevated serum calcium
154
Causes erosion of bone matrix and mobilization of calcium salts @ metaphysics, increased new bone formation containing Abundant Fibrous tissue + hemorrhage?
Osteitis fibrosa Cystica--> Parathyroid carcinoma
155
Parathyroid carcinoma with aggregating osteoclast, reactive giant cells, hemorrhagic debris?
BROWN TUMOR
156
What are some of the systemic wide complications of Parathyroid carcinoma induced hypercalcemia?
Nephrolithiasis
Nephrocalcinosis
Metastatic calcification (stomach, lungs, myocardium, blood vessels)
157
Hypercalcemia with accompanying low PTH can be caused by?
Malignancies (SCLC + Breast)
Vitamin D toxicity
Thiazide diuretics
Sarcoidosis (granulomatous diseases)
158
Patient with bone pain, constipation, depression, and weakness will have elevated?
Calcium
159
Signs and symptoms of Hyperparathyroidism?
GI--> Constipation, pancreatitis
CNS--> depression, seizures
Muscular--> Weakness
Polyuria
160
What is the MCC of 2nd hyperparathyroidism>
Renal failure
161
Causes tingling, muscle spasms, facial grimacing, sustained carpopedal spasms, arrhythmias, seizures due to increased intracranial pressure?
Hypoparathyroidism
162
MEN 1?
```
Parathyroid tumor (hypercalcemia)
Pancreatic tumor (Gastrinoma, insulinoma)
Pituitary adenoma (Prolactinoma, ACTH)
```
163
MEN 2a?
Medullary carcinoma Thyroid (Calcitonin)
Pheochromocytoma
Parathyroid tumor
164
MEN 2b?
Medullary carcinoma Thyroid (calcitonin)
Pheochromocytoma
Marfans/ Mucosal Neuromas
165
Zollinger-Ellison Syndrome?
Gastrinoma--> Duodenal ulcers
| Insulinoma--> Hypoglycemia
166
MCC of hypercortisolism?
Exogenous administration of Steroids
167
MCC of Endogenous hypercortisolism?
1. ACTH producing pituitary adenoma->
(Cushing's disease)
2. Adrenal neoplasm (ACTH independent)
3. Ectopic ACTH producing tumors (Oat cell)
168
Hypercortisolism + Bilateral cortical atrophy?
Exogenous Steroid induced
169
Hypercortisolism + diffuse hyperplasia?
Endogenous--> ACTH producing tumor or adrenal tumor
170
Solitary aldosterone secreting tumor?
Conn's syndrome
171
```
Solitary adrenal nodule w:
Well circumscribed
Eosinophilic cells w. laminated cytoplasmic inclusions
Not suppressing ACTH
NO contralateral gland atrophy?
```
Aldosterone secreting tumor
172
Child with ambiguous genitalia, vomiting, dehydration, and salt wasting?
21 hydroxylase deficiency
173
MCC of Acute adrenocortical insufficiency?
Waterhouse-Friderichsen syndrome
Sudden withdrawal of Longterm corticosteroids
Stress in Pt with underlying chronic adrenal insuff
174
MCC of chronic adrenocortical insufficiency?
```
Autoimmune adrenalitis (addisons)
TB
AIDS
Metastatic disease
Systemic Amyloidosis
Sarcoidosis
```
175
Pt develops sepsis and suffers adrenal insufficiency due to hemorrhage into adrenal cortex, what is the MCC?
```
Waterhouse-Friderichsen-->
1, Nisseria meningitidis
2.P aeruginosa
3.pneumococci
4.H, flu
```
176
Adrenal insufficiency commonly seen in postoperative patients on anticoagulants, DIC or sepsis patients, and Pregnancy?
Waterhouse-Fredrichsen syndrome
177
What the MCC of progressive destruction of adrenal cortex?
Addisons disease
178
What is 90% of Addisons disease attributed to?
Autoimmune adrenalitis (60-70%)
TB
AIDS
Metastatic cancer
179
Autoimmune adrenalitis is associated with what genetic defect?
APS1--> AIRE mutation (chromosome 21)
**Causes: chronic mucocutaneous candidiasis
Skin, dental, nail abnormalities
180
What is the AIRE protein involved in?
Antigen presentation to Thymus and elimination of Tcells specific for these antigens
181
Early adulthood adrenal insufficiency, autoimmune thyroditis, Type 1 diabetes is associated with what genetics?
APS2--> AIRE mutation
182
MC source of metastatic adrenal neoplasia?
Lungs
| Breasts
183
Adrenal insufficiency characterized by small, flat yellow adrenal glands and loss of cortical cell cytoplasmic lipids?
Secondary hypoadrenalism
184
Adrenal insufficiency characterized by irregularly shrunken glands, collapsed CT network and lymphoid infiltrates?
Primary autoimmune adrenalitis
185
Adrenal insufficiency characterized by granulomatous reaction?
TB or Fungal (Histo or Coccidio)
186
When does adrenal insufficiency manifest clinically?
at least 90% of the cortex has been compromised
187
MC complaints are anorexia, N/V, wgt loss, diarrhea, darkened skin?
primary Adrenal defect
188
Adrenal nodule characterized by yellow-brown color, endocrine atypic (pelomorphism), vacuolated cells, MC seen in?
Adrenal Adenoma
| MC--> aldosterone producing
