Endocrine Pathology

Front 1

What are etiologies of Cushing’s syndrome? Is ACTH always elevated?

Back 1

increased cortisol due to: 1. Cushing’s disease (primary pituitary adenoma) increased ACTH 2. Primary adrenal (hyperplasia/neoplasia) decreased ACTH 3. Ectopic ACTH production (ie- small cell lung ca) increased ACTH 4. Iatrogenic, decreased ACTH

Front 2

Describe the clinical picture of Cushings.

Back 2

HTN, wt gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin change (thinning, striae), osteoporosis, immune suppression

Front 3

T/F Conn’s syndrome is secondary hyperaldosteronism.

Back 3

False. Conn’s syndrome is primary hyperaldosteronism, caused by an aldosterone-secreting tumor. Results in HTN, hypokalemia, metabolic alkalosis, low plasma renin.

Front 4

Which hyperaldosteronism is associated with high plasma renin?

Back 4

Secondary hyperaldosteronism. It is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome. Kidney perception of low intravascular volume results in an overactive renin-angiotensin sysem.

Front 5

What is the tx for hyperaldosteronism?

Back 5

Spironolactone, a diuretic that works by acting as a aldosterone antagonist.

Front 6

What characterizes addison’s disease? (which hormones are elevated or deficient)? Is it associated with HTN or hypotension?

Back 6

Primary deficiency of aldosterone and cortisol due to adrenal atrophy, causing hypotension and skin hyperpigmentation. Adrenal atrophy, absence of hormone production, involves all 3 cortical divisions.

Front 7

T/F In primary insufficiency decreased pituitary ACTH production is characterized by skin hyperpigmentation.

Back 7

False: increased ACTH causes MSH activity & hyperpigmentation

Front 8

T/F Neuroblastoma is the most common tumor of adrenal medulla in adults.

Back 8

False. Pheochromocytoma is the most common tumor of adrenal medulla in adults. It is derived from chromaffin cells (arise from neural crest). It is associated with neurofibromatosis MEN types II and III.

Front 9

Where does neuroblastoma occur?

Back 9

Neuroblastoma is the most common tumor of adrenal medulla in children. It can occur anywhere along the sympathetic chain.

Front 10

Pheochromocytoma: secrete combination of two molecules

Back 10

epinephrine and norepinephrine

Front 11

Pheochromocytoma: epidemiology (rule of 10's)

Back 11

10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcify, 10% kids, 10% familial

Front 12

Pheochromocytoma: symptoms - 5 P's

Back 12

(elevated blood) Pressure, Pain (headache), Perspiration, Palpitations, Pallor/diaphoresis --> relapsing and remittant

Front 13

Pheochromocytoma: elevations in two lab values

Back 13

urinary VMA and serum catecholamines

Front 14

Pheochromocytoma: association with two other endocrine diseases

Back 14

MEN II and III

Front 15

Pheochromocytoma: treatment

Back 15

alpha-antagonists

Front 16

Multiple Endocrine Neoplasia type I (Wermer's syndrome) - 3 P's

Back 16

Pancreas, Pituitary, and Parathyroid tumors

Front 17

Multiple Endocrine Neoplasia type II (Sipple's syndrome)

Back 17

medullary carcinoma of thyroid, pheochromocytoma, parathyroid tumor, or adenoma

Front 18

Multiple Endocrine Neoplasia type III

Back 18

medullary carcinoma of thyroid, pheochromocytoma, oral/intestinal ganglioneuromatosis

Front 19

Hypothyroidism or hyperthyroidism myxedema is prominent in which one

Back 19

hypothyroidism

Front 20

Hypothyroidism or hyperthyroidism chest pain, palpitations, arrhythmias

Back 20

hyperthyroidism

Front 21

TSH is (increased/decreased) in primary hyperthyroidism? In primary hypothyroidism?

Back 21

hyper - decreased, hypo - increased

Front 22

Graves' disease involves autoantibodies with what mechanism of action?

Back 22

stimulation of TSH receptors

Front 23

three symptoms of Graves'

Back 23

ophthalmopathy, pretibial myxedema, diffuse goiter

Front 24

Graves' is a type __ hypersensitivity

Back 24

type II

Front 25

Hashimoto's thyroiditis: thyroid is (enlarged/not enlarged) and (tender/nontender)

Back 25

enlarged, nontender

Front 26

Hashimoto's thyroiditis: autoimmune antibodies directed against ---

Back 26

microsomes

Front 27

Hashimoto's thyroiditis: histology shows (type of cell) infiltrate

Back 27

lymphocytes (with germinal centers)

Front 28

Subacute thyroiditis (de Quervain's): self-limited (hyper/hypo)thyroidism following ---

Back 28

hypothyroidism following flu-like illness

Front 29

Subacute thyroiditis (de Quervain's): symptoms include

Back 29

jaw pain, tender thyroid gland, early hyperthyroidism

Front 30

Thyroid cancer: most common, good prognosis, "ground glass" nuclei, psammoma bodies

Back 30

papillary carcinoma

Front 31

Thyroid cancer: poor prognosis, uniform follicles

Back 31

follicular carcinoma

Front 32

Thyroid cancer: calcitonin producing (C cells), sheets of cells

Back 32

medullary carcinoma (MEN II and III)

Front 33

Thyroid cancer: older patients, horrible prognosis

Back 33

undifferentiated/anaplastic

Front 34

Cretinism: caused by a lack of dietary --- or defect in --- formation

Back 34

iodine (endemic), T4 (sporadic)

Front 35

Cretinism: symptoms include

Back 35

pot-belly, paleness, puffy face, protuberant tongue, protruding umbilicus

Front 36

Acromegaly: caused by excess --- in adults

Back 36

growth hormone

Front 37

Acromegaly: symptoms include

Back 37

large furrowed tongue, deep voice, large hands and feet, coarse facial features

Front 38

Acromegaly: in children, leads to ---

Back 38

gigantism