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44 Cards in this Set

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  • Back
Pituitary Gland

resides within the sella turcica, in the sphenoid bone.
anterior lobe of pituitary gland, makes up 80%

cells divided into 3 groups of equal #: stainable and unstainable cells (CHROMOPHOBE CELLS). The cytoplasmic granules of the stainable cells are called acidophilic or basophilic.

Hormone-producing cells: corticotropes, lactotropes, somatotropes, thyrotropes, gonadotropes.
Posterior lobe of the hypophysis, makes up 20%.

Composed of pituicytes, a type of glial cell without secretory function and unmyelinated nerve fibers containing ADH and oxytocin.
Define hypopituitarism.
THe deficient secretion of 1ore more of the hormones produced by the pituitary.
total failure of pituitary function occurs.
Define pituitary adenomas.
Benign neoplasms of the anterior lobe of the pituitary.

Usually associated with excess secretion of pituitary hormones.

Microadenomas: <10 mm in diameter; don't produce symptoms.

Macroadenomas: >10 mm in diameter; cause both local symptoms + systemic manifestations.
Lactotrope Adenomas
Aka prolactinomas. These are composed of cells that secrete prolactin.

Hyperprolactinemia is the most commo nendocrinopathy that is associated with pitutiary adenomas.
Somatotrope Adenomas
These secrete GH and produce striking bodily changes.

Gigantism, acromegaly
Patients develop coarse facial features, overgrowth of mandible/maxilla with spaces between upper incisor teeth, thickened nose, enlarged hands/feet, increased hat size.

Increased incidence of C-v, cerebrovascular, respiratory deaths.

1/3 have hypertension, diabetes occurs in 20%, hypercalciuria and renal stones in 1/5.
results when a somatotrope adenoma arises in a child or adolescent before the epiphyses close.
Results when a somatotrope adenoma becomes functional after the epiphyses of the long bones have fused and adult height has been achieved.
Corticotrope Adenomas
These secrete corticotrophin, which inturn induces adrenocortical hypersecretion to produce Cushing Disease.
Central diabetes insipidus
Due to deficiency of vasopression (ADH) -- posterior pituitary!!

Inability to concentrate urine (so it very dilute) and consequent chronic water diuresis, thirst, and polydipsia (excessive thirst).
Nontoxic Goiter
This refers to an enlargement of the thyroid that is not associated with functional, inflammatory, or neoplastic alterations = euthryoid (normal thyroid gland).

Simple, colloid, or multinodular goiter.

Women:men = 8:1

Diffuse (early stages) or multinodular (chronic)nontoxic goiters.
Toxic Multinodular goiter
When patients with nontoxic goiter develop hyperthyroidism.
Refers to the clinical manifestations of thyroid hormone deficiency. Can be the consequence of:

defective synthesis of thyroid hormone
inadequate function of thyroid parenchyma
inadequate secretion of TSH by the pituitary or of TRH by the hypothalamus.
Hypothyroidism in Adults
Insidious symptoms: tiredness, lethargy, sensitivity to cold, inability to concentrate.

Skin: proteoglycans accumulate in the ECM, binding water and resulting in a peculiar form of edema called MYXEDEMA.

Boggy facies, puffy eyelids, edema of hands/feets, enlarged tongue, Pale, cool skin.
Myxedema madness
paranoid ideation or depression and severe agitation.
Myxedema heart
dilated heart and a pericardial effusion. heart is flabby and shows interstitial edema and swelling of the myocytes.
Myxedema megacolon:
GI tract of hypothyroidism in adults: constipation due to decreased peristalsis.
Congenital Hypothyroidism.
Girls:boys = 2:1
90% of cases result from thyroid dysgenesis (developmental defects of the thyroid).

Infants are apathetic and sluggish, large abdomen and shows an umbilical hernia, body temp <35C

mental retardation, stunted growth.

if no thyroid hormone replacement therapy --> mentally retarded dwarfs.
Primary hypothyroidism
When the case of thyroid failure is uncertain.

3/4 of patients have circulating anitbodies to thyroid antigens.
Goitrous hypothyroidism
Endemic goiter: goitrous hypothyroidism of dietary iodine deficiency.

Endemic cretinism: congenital hypothyroidism that occurs in areas of endemic goiter.

Goiter induced by antithyroid agents: LITHIUM.
Refers to the clinical conseuqence of excessive circulating thyroid hormone.

Signs/symptoms reflect a hyper-metabolic state of the target tissues.
Graves Disease
An autoimmune disorder that is characteirzed by diffuse goiter, hyperthyroidism, and exophthalmos.
Define thyroiditis.
Refers to a heterogeneous group of inflammatory disorders of the thyroid gland, including those that are caused by autoimmune mechanisms and infectious agents.
Hashimoto Thyroiditis
(Lymphocytic Thyroiditis)
Is an autoimmune disease that is characterized by circulating antibodies to thyroid antigens adn features that are suggestive of cell-mediated immunity to thyroid tissue.

In regions where supplies of iodine are adequate, Hashimoto thyroiditis is the most common cause of goitrous hypothyroidism.
Subacute Thyroiditis
(Granulomatous or Giant Cell Thyroiditis)
An infrequent, self-limited viral infection of the thyroid that is characterized by granulomatous inflammation.

Typically occurs after upper respiratory tract infections.
Riedel Thyroiditis
A rare disease that is characterized by dense fibrosis of the thyroid.

Involves extrathyroidal soft tissues.
Usually results from decreased secretion of parathyroid hormone and occasionally from end-organ sensitivity to the hormone.

Most common cause: inadvertent surgical resection of the parathyroids.

Primary hyperparathyroidism
Is the syndrome caused by excessive secretion of PTH as a result of intrinsic parathyroid disease.

Parathyroid Adenoma = 80%
Primary Parathyroid Hyperplasia = 15%
Parathyroid Carcinoma = 1%

Hypercalcemia and hypophosphatemia
-osteitis fibrosa cystica
-renal colic
-mental changes
-peptic ulcer disease
-chronic pancreatitis
Secondary hyperparathyroidism
Refers to excess secretion of PTH as a response to chronic hypocalcemia.

Encountered in patients with chronic renail failure.

Renal osteodystrophy: osseous manifestations
Congenital Adrenal Hyperplasia
CAH is a syndrome in which deficient synthesis of corticosteroids results in the unopposed action of corticotropin, and hence, adrenal hyperplasia.

>90% of the cases represent an inborn deficiency of 21-hydroxylase, or P450c2I
Simple Virilizing CAH
Female infants: pseudohermaphroditism (sexual ambiguity), fused labia, enlarged clitoris, urogenital sinus.

Male infants: no abnormalities of sexual rogans; sexual precocity (maturity), closure of epiphyses and stunted growth.

Adult women: infertile
Adult men: may or may not be fertile.
Salt-Wasting CAH
Synthesis of aldosterone impaired --> hyponatremia, hyperkalemia, dehydration, hypotension, increased renin secretion.
Adrenocortical Insufficiency
Deficient production of adrenocortical hormones can result from:
-destruction of the adrenal gland
-dysfunction of the pituitary or hypothalamus
-intake of corticosteroids as treatment for chronic inflammatory diseases.
Addison Disease
aka Primary Chronic Adrenal Insufficiency

A fatal, wasting disorder that is caused by failure of adrenocortical secretion.

Autoimmune adrenalitis is responsible for 75% of cases.

>90% of the adrenal gland must be destroyed before symptoms appear.

Weakness, weight loss, GI symptoms, HYPOTENSION (RULE), electrolyte disturbances, hyperpigmentation, marked personality changes.
Acute Adrenal Insufficiency (Adrenal crisis)
A life-threatening medical emergency that reflects a sudden loss of adrenocortical function.

occurs in 3 settings:
1. abrupt withdrawal of of corticosteroid therapy
2. the stress of infection or surgery.
3. waterhouse-friderichsen syndrome: acute, bilateral, hemorrhagic infarction of the adrenal cortex.
Adrenal Hyperfunction
excess secretion of corticosteroids occurs in the context of adrenal hyperplasia or neoplasia.

2 forms:
hypercortisolism = cushing syndrome
hyperaldosteronism = conn syndrome.
Cushing disease
aka Corticotropin-DEPENDENT adrenal hyperfunction

With few exceptions, adrenal hyperplasia is secondary to chronic stimulation by corticotropin.

Women 5x>males

bilateral, DIFFUSE (75%) or NODULAR (25) hyperplasia of the adrenal glands.
Cushing disease results from 1 of the following:
1. primary hypersecretion of corticotropin by the pituitary

2. ectopic production of corticotropin by a nonpituitary tumor (cancer of lung).

3. inappropriate secretion of CRH (corticotropin-releasing hormone).
Corticotropin-Independent Adrenal Hyperfunction.
A functional neoplasm of the adrenal cortex is a well-documented cause of Cushing syndrome.

-adrenal adenoma: encapsulated, firm, yellow mass; exhibit clear, lipid-laden cells that are arranged in sheets/nests.
Most common cause of Cushing syndrome
long-term administration of corticosteroids.

corticosteroid treatment of a vairety of immnologic and inflammatory diseases
Clinical features of cushing syndrome
obesity: moon face, buffalo hump (neck), trunk, abdomen.

skin is atrophic and there is loss of subcutaneous fat.

icnreased bone resorption --> osteoporosis.


Females show increased facial hair, acne, oligomenorrhea.
Men: erectile dysfunction and decreased libido.

Hyperinsulinemia, diabetes mellitus

Psychological: irritability, emotional lability, depression, paranoia.
Conn Syndrome
aka Primary Aldosteronism.

Conn syndrome, which is characterized by hypertension and hypokalemia, is produced by inappropriate secretion of aldosterone by an adrenal adenoma or hyperplastic adrenal glands.