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38 Cards in this Set

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What are the hormones of the posterior pituitary?
ADH (vasopressin) and oxytocin
Pituitary adenoma:
- Most common cause of hyperpituitarism.
- Classified based on the hormones that are produced.
- PRL, GH, and ACTH are the most common.
- Microadenomas are found in 25% of autopsies.
What is this mass?
What are the three most common mutations seen in pituitary adenomas?
- G protein mutations: commonly secrete somatostatin and cortisol, but infrequently anything else.
- Mutation on chromesome 11q3 causes multiple endocrine neoplasia (MEN-1), but only causes 3% of adenomas.
- RAS and MYC are seen in the most aggressive tumors.
Adenomas that are this large infrequently have a hormone secretion.
What hormone does this pituitary adenoma secrete?
What are the major clinical characterisitics of a prolactinoma?
- 30% of functioning pituitary adenomas (the most common type).
- More common in women.
- Presents with a classic triad: amenorrhea, galactorrhea, and infertility.
- 25% of women with amenorrhea present with prolactinoma.
- Diagnosis: PRL levels of less than 20 ng/Dl will exclude.
- Treatment: Bromocriptine a dopamine recetor agonist.
What are the major clinical charactersistics of a somatotroph cell adenoma?
- Second most common functioning pituitary adenoma.
- Tumors can be basophilic or chromatophobic.
- Symptoms: If before full growth, giagantism, if after, acromegaly.
- Diagnosis: Elevated GH and IGF-1, GH release not supprsed by the glucose load, and imaging studies.
Treatment: Surgery.
What are the major clinical characterisitics of a corticotroph cell adenoma?
- Tumors are often basophilic, but sometimes chromophobic.
- Exccess ACTH production leads to hypercortisolism (Cushing disease).
- Nelson syndrome is a large adenoma that occurs after an adrenalectomy.
What are the major clinical characterisitics of a gonadotroph?
- Difficult to diagnose because it secretes variably and without clinical effect.
- Middle aged patients may experience headaches and visual disturbances.
What is the most rare pituitary adenoma?
Thyrotrophs only make up 1% of the pituitary adenomas.
How much of the pituitary must be lost before symptoms emerge?
75%
What are the common causes of hypopituitarism?
- Mass lesions
- Surgery in the area
- Pituitary apoplexy (hemorrhage into an adenoma)
- Ischemic necrosis of pituitary
- Sheehan syndrome: Post-partum necrosis of the pituitary
- Empty sella syndrome
- Genetic defects: Rare
- Lesions of the hypothalamus
What are the subtypes of diabetes insipidus?
- Too little ADH is secreted, or the ADH that is secreted is ineffectual.
- Neurogenic: Too little is secreted.
- Nephrogenic: The kidney fails to respond.
- Primary polydipsia: Abnormal thirst causes too much water intake.
- Gestational: Increased metablism of vasopressin causes deficiency.
- Symptoms: Polyuria, polydipsia, hypernatrimia, enuresis.
What are the causes of diabetes insupidus?
Familal mutations, tumors, pituitary surgery.
What are two causes of the syndrome of inappropriate ADH syndrome?
- Abnormal regulation of ADH secretion with high levels of ADH.
- Ectopic secretion of ADH by a malignant tumor (small cell carcinoma most commonly).
What are the major clinical characteristics of syndrome of inappropriate ADH?
- Weakness and general deteriation.
- Confusion and seizures.
- Nausea and vomiting.
- Hyponatremia is the only abnormal lab value.
What are the characterisitics of a carniopharyngioma?
- Derived from the remnants of Rathke's pouch.
- Slow growing
- Occurs in the hypothalamic region and cause growth defect, visual disturbance, and diabetes insipidus.
- Bimodal age distrubance.
What is the most common cause of hypopituitarism in children?
Craniopharyngoma
Craniopharyngoma:
- Remanants of Rathke's pouch
- Characterisitic cyst formation with epithelial cells present
- Difficult to eradicate, but good prognosis.
What is this pathology?
What locations are common for ectopic thyroid tissue and which area is the most common?
Ectopic tissue can be found anywhere along the thyroglossal duct, but is most usually found in the lingual region.
What is the most common congenital throid anomaly?
Thyroid cysts:
- Remnant of the thyroglossal duct.
- Does not cause any pathology.
These are thyroid cysts and they are not associated with any pathology.
What are the complications from the pathology viewed here?
What is a diffuse (simple/colloid) nontoxic goiter?
A form of goiter that involves the entire thyroid gland and cuases it to become non-functional.
What is a multinodular goiter?
Recurrent episodes of hyperplasia because of a diffuse goiter results in formation of a multinodular goiter. This is also due to varying sensitivity of the follicular epithelium.
What is a toxic goiter?
Describes a goiter that produces thyroid hormone.
What is thyroiditis?
Inflammation of the thyroid gland caused by many issues.
This is a nodular goiter:
- Common worldwide because of iodine defciencies in developing nations
- Uneven enlargement of the thyroid gland
- Possible that nodules are hot
What is this pathology?
What is thyrotoxicosis?
The clinical finding of an increasing metabolic state because of incrasing circulating levels of T3 and T4.
What is hyperthyroidism?
Similar to thyrotoxicosis, but causes thyroid dysfunction secondary to a primary thyroid disorder.
What is subclinical hyperthyroidism?
Low TSH associated with normal levels of T3 and T4.
What is thyroid ophthalmopathy (exopthalmos)?
This is an accumulation of loose connective tissue in the posterior orbit causing the prominent protuberence of the eyes in Grave's disease.
What is a thyroid storm?
Abrubt onset of severe thyrotoxicosis.
What are the major clinical characterisitics of thyrotoxicosis?
- Increased BMR.
- Cardiac symptoms (tachycardia)
- Weight loss
- Heat intolerance
- Nervousnous
- Ten times more common in women.
- Goiter more likely in younger patients.
What are four basic causes of sustained thyrotoxicosis?
- Primary: Overactivity of the thyroid, by far the most common.
- Secondary: Excessive thyroid stimulating hormone.
- Tertiary: Caused by hypothalamic disorders.
- Exogenous: Caused by taking thyroid hormones.
What are the causes of transient thyrotoxicosis?
(1.) Subacute granulomatous thyroidosis
(2.) Subacute lymphocytic thyroiditis
(3.) Hashimoto thyroiditis
What are causes of primary hyperthyroidism?
(1.) Graves disease
(2.) Toxic multinodular goiter
(3.) Toxic adenoma
(4.) Drug-induced goiter
(5.) Amiodarone: Antiarrythmic agent that has hyperthyroidism as a side effect.
(6.) Iodides: Used in prescription drugs.
(7.) Lithium induced hypothyroidism onccurs in depression patients.
What are the causes of secondary hyperthyroidism?
- Autonomous TSH secerting pituitary hormone.
- Ectopic TSH production is associated with small cell carcinoma.
- Agonist effect of HCG, a complication of molar pregnancy.
- Mutation of pituitary hormone beta receptor: resistance of thyroid hormone to shut down TSH secretion.
What are the causes tertiary hyperthyroidism?
- Hypothalamic induced TSH via TRH (rare).
What are two causes of exogenous hyperthyroidism?
- Iatrogenic: Excessive administration of thyroxine by physicians.
- Factitious thyrotoxicosis: result of patient self administering excessive doses of thyrotoxicosis.