Buzz Words Spring Path 2 Endo

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Common pituitary adenoma, MEN-1

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Pituitary Adenoma

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Visual field defect may occur from this by mass effect, enlarged sella turcica, bilateral hemianopsia, HA, N/V

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Macroadenoma

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Most common pituitary tumor, causes hyperprolactinemia, causes amenorrhea, galactorhea, loss of libido, infertility, pituitary stone

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Prolactinoma

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Symptoms of prolactinoma, caused by stress (bodybuilders), DA antagonist drugs, renal failure, brain infarct/trauma

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Non-pituitary Prolactinoma

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Growth hormone producing tumor, 40% have GNAS1, ACIDOPHILIC ADENOMA, has GH/IGF-1 elevation, gigantism/acromegaly

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Somatotroph adenoma

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Hypersecretion of POMC, small basophilic cells, , can lead to cushings syndrome, nelson syndrome

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Corticotroph adnoma

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ACTH from adenoma increasing cortisol, moon face, buffalo hump, amenorrhea, hirsutism, purple striae etc

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Cushings Syndrome

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Pre-existing corticotroph microadenoma enlarges with removal of adrenal glands, leads to adrenal insufficiency and hyperpigmentation in the skin flexures

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Nelson syndrome

Front 9

Inefficient secretion of FSH/LH, causes gonadal hypofunction, FSH immunostain

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Gonadotroph adenoma

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Adenoma that produces TSH and causes secondary hyperthyroidism

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Thyrotroph adenoma

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Local mass effects, no effects of its own (adenoma)

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Nonfunctioning adenoma

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Deficiency of Ant Pit, progressive loss of function (gonadotrophs --> thyrotrophs --> corticotrophs)

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Hypopituitarism

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Sudden hemorrhage into gland, neuro emergency

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Apoplexy

Front 14

Postpartum hemorrhage causes this, ischemic necrosis of Ant Pit, post pit spared

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Sheehan Syndrome

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Most common cause of combined Ant/Pit insufficiency

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Hypothalamic Hypopituitarism

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Mass growth of remnants of Rathke's pouch, benign, can cause hypo/hyperfunction of pituitary

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Craniopharyngioma

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ADH deficiency, causes poyuria/polydipsia/excessive thirst

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Central Diabetes Insipidus

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Eosinophilic Granulomas in the hypothalamus, s/s skull defects, exophthalmos, diabetes insipidus

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Hand-Schuller-Christian Disease

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ADH excess, can be from paraneoplastic syndrome (SmCCa of Lung), S/S hyponatremia, hemodilution

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SIADH

Front 20

Low GH --> proportional dwarfism, delayed sexual development, give GH before growth plate closes

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Pituitary Dwarfism

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Metabolic state caused by high T3/T4, overproduction by thyroid, most common cause of thyrotoxicosis

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Hyperthyroid

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Most common cause of hyperthyroidism, production of AB's that activate TSH receptors

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Graves

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Dilated thyroid follicles, scalloped colloid, HYPERthyroid and goiter + exophthalmos

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Graves

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Mother has graves, TSH stimulated AB's cross placenta, acts on fetal thyroid

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Neonatal thyrotoxicosis

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Abrupt onset of severe hyperthyroidism, acute elevation of catecholamines, tx c immediate B-blockers

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Thyroid storm

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Onset of hyperthyroid in elderly, blunted sx, A FIB

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Apathetic hyperthyroid

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Struma ovarii, exogenous thyroid hormone intake can cause ______?

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Non-hyperthyroid thyrotoxicosis

Front 28

Hypothyroid in fetus from iodine deficiency, thyroid maldevelopment, causes mental retardation, floppy baby, umbilical hernia, coarse facial features

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Cretinism

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Hypothyroidism in older child/adult, slowly decreasing sympathetic output causes symptoms

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Myxedema

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Macrocytic anemia, hyperlipidemia, CK high

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Myxedema

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Autoimmune destruction of the thyroid, HLA-DR5, HLA-DR3, CTLA4, PRPN22, activated auto-reactive CD4+ T cells cause CD8 T cell mediated cell death, cytokine mediated cell dath and AB-dependent cell death

Back 31

Hashimotos Thyroiditis

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Labs have Thyroglobulin AB and Anti-thyroperoxidase AB, increased risk for B-cell MALT lymphoma

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Hashimotos

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Self-limited thyroiditis, transient thyrotoxicosis then hypothyroidism

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Subacute granulomatous thyroiditis

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Shows multinucleated giant cells

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Subacute granulomatous thyroiditis

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HLA-associated thyroiditis, shows transient thyrotoxicosis then hypothyroidism, enlarged non-tender thyroid

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Subacute lymphocytic thyroiditis

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Idiopathic fibrosis of the thyroid

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Reidel Thyroiditis

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Enlargement of thyroid from hyperthyroidism

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Toxic Goiter

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Simple goiter type that has at least >10% of the population affected from low iodine in the soil or giotrogens

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Endemic Simple Goiter

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Simple goiter type that is from iodine deficiency or hereditary enzyme defects

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Sporadic simple gioter

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Develops from longstanding simple goiter, recurrence of hemorrhage --> fibrosis --> calcification --> cyst formation

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Multinodular Goiter

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Hyperfunctional nodule in multinodular goiter --> hyperthyroid

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Plummer syndrome

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Derived from follicular epithelium, solitary, discrete, excellent prognosis, painless mass, small uniform follicles with colloid, no invasion

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Thyroid Adenoma

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Most common thyroid cancer, radiation induced, may invade lymphatics, often asymptomatic

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Papillary Carcinoma

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Branching papillae, empty appearing nuclei, psammoma bodies, asyptomatic, cold on uptake scans

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Papillary Carcinoma

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Increased incidence with dietary iodine deficiency, invasion THROUGH capsule, no psammoma bodies, painless mass, appears cold on uptake scans

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Follicular Carcinoma

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Neuroendocrine tumor of parafollicular C cells, sporadic, MEN mutation, acellular amyloid in stroma, multiple foci, pale grey / tan, may have hemorrhage / necrosis

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Medullary Carcinoma

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Highly aggressive thyroid neoplasm, 100% mortality, older pts, highly anaplastic cells, rapidly enlarging neck mass, compresses and invades neck structures

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Anaplastic carcinoma

Front 48

Production of excess PTH, hypercalcemia, hypercalcuria, high serum Alk Phos, hypophosphatemia, osteitis fibrosa cystica

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Primary Hyperparathyroid

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Short QT, calcifications, osteoporosis, fracture, mostly asymptomatic

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Primary Hyperparathyroid

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Most common cause of primary HyperPTH, solitary lesion, composed of chief cells

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Parathyroid Adenoma

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MEN 1

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Parathyroid hyperplasia

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MEN 2

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Causes parathyroid hyperplasia and / or thyroid medullary carcinoma

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FHH

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Familial hypocalcuric hypercalcemia

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Compensatory parathyroid hyperplasia in response to dec serum Ca, leads to hyperCa and hyperPO and high PTH from renal disease, inadequate Ca intake, vit D deficiency

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Secondary hyperparathyroid

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Causes renal osteodystrophy

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Secondary hyperparathyroid

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Persistent parathyroid hyperfunction, occurs despite correction

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Tertiary hyperparathyroid

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22q11 deletion

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DiGeorge syndrome

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APS1

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Autoimmune polyendocrine syndrome type 1

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AD, maternal mutation of GNAS1

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Pseudohypoparathyroidism

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Albright hereditary osteodystrophy, hypoCa, hyperPTH, shortened 4th/5th metatarsal/metacarpals, short stature, hypocalcemia

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Pseudohypoparathyroidism

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Administration of glucocorticoids (ingesting cortisol) --> bilateral cortical atrophy

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Cushings from the high ingestion of cortisol
Exogenous

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Primary hypersecretion of ACTH from pituitary adenoma --> bilateral adrenocortical hyperplasia

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Pituitary Cushing's Disease

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ACTH production from paraneoplastic source (lung SmCCa)

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Ectopic Cushings

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Hypersecretion of cortisol, independent of ACTH, unilateral neoplasm

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Adrenal Hypersecretion

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Chronic excess aldosterone secretion from single aldosterone secreting adenoma (Conn's syndrome), hypokalemia, HTN, low renin

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Primary Hyperaldosteronism

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Enzyme deficiency diverts corticoid precursors into androgen production, cortex is wide/brown, adrenals are large, tx c exogenous glucocorticoids (supress ACTH)

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21a hydroxylase deficiency

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Total lack of 21a hydroxylase, virilization occurs, aldosterone not sufficient for salt reabsorption

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Salt wasting 21a hydroxylase deficiency

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Partial lack of 21a hydroxylase, genital ambiguity occuts, aldosterone sufficient for salt reabsorption

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Simple virilizing 21a hydroxylase deficiency

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Asymptomatic 21a hydroxylase deficiency, most common of the 3 types

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Non classic 21a hydroxylase deficiency

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Massive destruction of adrenals, from overwhelming septicmia (Neisseria) --> hypotension + DIC --> bilateral adrenal hemorrhage

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Waterson-friderichsen syndrome

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Primary chronic adrenocortical insufficiency

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Addisons disease

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>60% of cases of addisons, irregularly shrunken adrenal glands

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Autoimmune adrenocortical insufficiency

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Autoimmune disease affecting multiple glands

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Autoimmune polyendocrine syndrome

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Granulomatous inflammatory enlargement and destruction of the adrenals

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Infectious Adrenocortical insufficiency (TB)

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Normal adrenal architecture disrupted by neoplastic infiltration

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Metastatic adrenocortical insufficiency

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Adrenal insufficiency resulting from insufficient ACTH, no hyperpigmentation, adrenals respond if ACTH is increased

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Secondary adrenocortical insufficiency

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Non-functional, found incidentally, well circumscribed, nodular lesion (KNOW IMAGE, GIANT GROWTH IN ADRENAL GLAND)

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Adrenal adenoma

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Highly malignant, invades adrenal vein, vena cava, lymphatics

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Adrenocortical carcinoma

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Uncommon neoplasms of chromaffin cells, catecholamines synthesized, released, electron dense granules on EM

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Pheochromocytoma

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10% MEN ass'd, 10% extra-adrenal, 10% malignant, 10% seen in kids, 10% bilateral

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Pheochromocytoma

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Increased urinary catecholamines, VMA, abrupt onset

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Pheochromocytoma

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Tumor of carotid body or jugulotympanic body

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Paraganglioma

Front 83

When compared to sporadic tumors, these tumors arise earlier, more aggressive, more multifocal

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MEN Syndromes

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Wermer syndrome, mutation of gene that encodes MENIN, Diamond (PTH's, Pituitary, Pancreas), HyperPTH, Prolactinemia, gastrinoma / insulinoma

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MEN 1

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Sipple syndrome, ass'd c bilateral pheo, mutation of RET, SQUARE (PTH's, Adrenals)

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MEN 2A

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Similar to MEN 2A, still mutation of RET, includes neurogangliomas of skin and mucosa

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MEN 2B

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Variant of MEN 2A, most cases sporadic, ass'd c RET

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Familial Medullary Thyroid Cancer