Er: Endocrine Pathology

Front 1

what are the 5 cell types that antibodies may attack?

Back 1

1) somatotrophs
2) lactotrophs
3) corticotrophs
4) thyrotrophs
5) gonadotrophs

Front 2

what are the modified glial cells of the neurohypophysis?

Back 2

pituictyes

Front 3

excess secretion of trophic hormones?

Back 3

hyperpituatarism

Front 4

deficiency in secretion of trophic hormones

Back 4

hypopituatarism

Front 5

-radiographic abnormalities of sella turcica
-visual field abnormalities
-elevated intracranial pressure
-pituatary apoplexy
might indicate what effects taking place?

Back 5

local mass effecting pituitary gland

Front 6

with a clinical presentation of increased or decreased ADH levels, what is being effected ?

Back 6

pathology of posterior pituitary gland

Front 7

the most common cause of hyperpituitarism is ____?

Back 7

an adenoma

Front 8

what is the most common adenoma of the pituitary @ 20-30%?

Back 8

Prolactin cell adenoma

Front 9

what is the frequency of occurrence for a GH cell adenoma in pituitary?

Back 9

5%

Front 10

what is the frequency of occurrence for a ACTH cell adenoma in the pituitary?

Back 10

10-15%

Front 11

Gigantism is a result of what type of neoplasm?

Back 11

somatotrophic adenoma

Front 12

generalized increase in body size with diproportionately long arms and legs

Back 12

gigantism

Front 13

gigantism arises when GH levels are elevated due to a ______ adenoma ____ epiphyses calcify

Back 13

somatotrophic
BEFORE

Front 14

if increased levels of GH are present after closure of the epiphyses, the patient may develop?

Back 14

acromegaly

Front 15

growth in ____ is most obvious in :
-skin
-soft tissues
-viscera
-bones of face, hands and feet

Back 15

acromegaly

Front 16

in acromegaly bone density is increased referred to as ____ and occurs most in ___ and ____

Back 16

hyperostosis
spine
hips

Front 17

prognathism is characteristic of what condition ____

Back 17

acromegaly

Front 18

sausage fingers

Back 18

acromegaly

Front 19

what of the following are not characteristics of acromegaly?
1) diabetes mellitus
2) generalized muscle weakness
3) hypertension
4) diabetes insipidus
5) CHF
6) arthritis
7) prostate cancer
8) gonadal dysfunction
9) increased GI cancers

Back 19

Diabetes Insipidus
prostate cancer

Front 20

cardiomegaly and barrel chested-ness may occur in what condition

Back 20

acromegaly

Front 21

macroglossia and hyperplasia of sebaceous and sweat glands are characteristic of _____

Back 21

acromegaly

Front 22

diabetes insipidus may result from a pathology of what?

Back 22

posterior pituitary

Front 23

what is the etiology of diabetes insipidus?

Back 23

deficiency of ADH

Front 24

2 hallmark symptoms of Diabetes Insipidus are?

Back 24

polyuria and polydypsia

Front 25

ADH excess causes resorption of excess amounts of free water resulting in what 3 conditions?

Back 25

1) hyponatremia
2) cerebral edema
3) neurologic dysfunction

Front 26

what are the 2 most common lesions of the neurohypophysis leading to an ADH deficiency?

Back 26

1) idiopathic sporadic mutations (30%)
2) tumors (25%)

Front 27

a hypermetabolic state caused by elevated levels of free T3 and T4

Back 27

thryotoxicosis

Front 28

what is the most common cause of thyrotoxicosis?

Back 28

hyperthyroidism

Front 29

TSH-secreting pituitary adenoma is a cause of _____?

Back 29

thyrotoxicosis

Front 30

diffuse toxic hyperplasia (Grave's)
toxic multinodular goiter
toxic adenoma
are disorders associated with?

Back 30

hyperthyroidism

Front 31

struma ovarii (ovarioan teratomatous thyroid) has been associated with ?

Back 31

hyperthyroidism

Front 32

what part of the nervous system is overactive in hyperthyroidism?

Back 32

sympathetic nervous system

Front 33

increased BMR is characteristic of what condition?

Back 33

hyperthyroidism

Front 34

hyperthyroidism will lead to what in regards to temperature regulation?

Back 34

heat intolerance

Front 35

soft skin
warm
flushed
weight loss
are all characteristic of what path?

Back 35

hyperthyroidism

Front 36

cardiac manifestations due to hyperthyroidism may include:
- increased CO
- tachycardia
-?
-cardiomegaly
-arrhytmias
-?

Back 36

palpitations
CHF

Front 37

tremor
hyperactivity
emotional lability
anxiety
inability to concentrate
insomnia
muscle weakness
characterize what aspect of hyperthyroidism?

Back 37

neuromuscular manifestations

Front 38

ocular changes:
-wide, staring gaze
-lid lag
associated with?

Back 38

hyperthyroidism

Front 39

ocular changes:
-increased fibrous CT behind the eyes leading to exopthalamus is associated with?

Back 39

Grave's Disease

Front 40

how might hyperthyroidism affect the GI tract?

Back 40

sympathetic hyperstimulation:
hypermotile GI
malabsorption
diarrhea

Front 41

how does hyperthyroidism affect the bone system?

Back 41

increased resorption and thus fragility

Front 42

an abrupt onset of severe hyperthyroidism and is a medical emergency as some untreated pts. die of cardiac arhythmias

Back 42

thryoid storm

Front 43

what type of dental care is contraindicated for hyperthyroid patients?

Back 43

elective care

Front 44

normal thyroid state is referred to as?

Back 44

euthyroid

Front 45

what type of drug substance ought to be avoided for use with hyperthyroid pts.?

Back 45

epinephrine

Front 46

-autoimmune disorder
-antibodies vs. TSH receptor mainly
-thryoid peroxisomes
-thyroglobulin

Back 46

Grave's Disease

Front 47

Graves diseases occurs at the age range of ______ and affects what gender the most?

Back 47

20-40 yrs
7:1 Women

Front 48

what are genetic markers for Grave's disease?

Back 48

HLA-B8
DR3
CTLA-4

Front 49

most common cause of endogenous hyperthyroidism?

Back 49

Graves disease

Front 50

Top 3 clinical findings of Graves disease?

Back 50

1) hyperthyroidism
2) infiltrative opthalmopathy w/ exopthalmos

3) localized infiltrative dermopathy (pretibial myxedema)

Front 51

what pathology is caused by any structural and functional derangement that interferes with the production of adequate levels of thyroid hormone?

Back 51

hypothyroidism

Front 52

what are the locations for defect in :
1) Primary?
2) Secondary?
3) Tertiary?

Back 52

primary - thyroid gland
secondary - pituitary
tertiary - hypothalamus

Front 53

which of the following is NOT as cause of hypothryoidism:
1) surgical or radiation induced ablation
2) thyroid hyperplasia
3) thyroid agenesis
4) Hashimoto's thyroiditis
5) drugs treating hyperthyroidism

Back 53

thyroid hyperplasia
--- ought to be thyroid hypoplasia

Front 54

which of the following are NOT causes of primary hypothyroidism?
1) genetic defects of thyroid metabolism
2) genetic defects in thyroid hormone receptor
3) iodine overdose

Back 54

iodine overdose is incorrect

iodine deficiency is correct

Front 55

TSH deficiency would indicate?

Back 55

secondary hypothyroidism

Front 56

TRH deficiency would indicate?

Back 56

tertiary hypothyroidism

Front 57

hypothyroidism apparent in children is termed?

Back 57

cretinism

Front 58

hypothyroidism apparent in adults is termed?

Back 58

myxedema

Front 59

what are couple drugs that may lead to decreased thyroid hormone synthesis leading to hypothyroidism

Back 59

lithium
iodides

Front 60

severe mental retardation
short stature
coarse facial features
protruding tongue
umbilical hernia

Back 60

cretinism

Front 61

initial symptoms of :
generalized fatigue
apathy
mental sluggishness
slowed speech and intellectual fxn

Back 61

Gull Disease ( Myxedema)

Front 62

listless
cold intolerance
obesity
reduced CO
decreased sympathetic activity = constipation and less sweating

Back 62

myxedema ( gull disease)

Front 63

what causes the coarse facial features of skin, subcutaneous tissue in viscera
-deepening of voice
-enlargement of tongue?

Back 63

accumulation of glycosaminoglycas and hyaluronic acid in Myxedema

Front 64

what is the prevalence of Hashimoto's Thyroiditis?

Back 64

Females 10:1
45-65 yrs. old

Front 65

An increased incidence of Hashimoto's is seen in patients with what 2 chromosomal syndromes?

Back 65

Turner's Syndrome (monosomy)
Down's Syndrome (trisomy)

Front 66

the overriding feature of Hashimoto's is the progressive depletion of thyroid epithelial cells by ____

Back 66

mononuclear cell infiltrate (lympocyte)
fibrosis

Front 67

clinically presents with a painless enlargement of the thyroid and some degree of hypothyroidism

Back 67

Hashimoto's Thyroiditis

Front 68

patients with Hashimoto's are at an increased risk for Type I Diabetes and what type of diseases?

Back 68

autoimmune (SLE, Sjogren's

Front 69

what is the most common manifestation of thyroid disease?

Back 69

goiter (thyroid enlargement)

Front 70

diffuse and multinodular goiters are most often caused by?

Back 70

dietary iodine deficiency

Front 71

due to the feedback mechanism, what results from decreased synthesis of thyroid hormone due to goiter nodules?

Back 71

compensation rise in TSH release

Front 72

the physical enlargement of diffuse and multinodular goiters can results in what?

Back 72

airwary obstruction
dysphagia
compression of neck vaculature

Front 73

patients with thyroid nodules are at risk for developing neoplasms.
benign are?
malignant?

Back 73

adenomas
carcinomas

Front 74

what is the most common type of thyroid carcinoma?

Back 74

papillary carcinoma

Front 75

neoplasm of thyroid associate with MEN syndrome?

Back 75

medullary carcinoma of thyroid

Front 76

neuroendocrine neoplasms derived from the parafollicular C cells of thyroid?

Back 76

Medullary Carcinoma of Thyroid

Front 77

are medullary carcinomas hereditary?

Back 77

no
= either sporadic
=MEN syndrome related (2B)

Front 78

what is the genetic defect that gives rise to MEN-2B syndrome

Back 78

substitution in the RET gene

Front 79

MEN-2B patients may develop medullary carcinomas and ______

Back 79

pheochromocytomas

Front 80

neuromas or ganglionneuromas of skin
oral mucosa, eyes and GI tract
-marfanoid habitus

Back 80

MEN-2B syndrome

Front 81

why might those with medullary carcinomas have increased blood pressure?

Back 81

chromaffin cells of adrenal medulla release excessive epinephrine

Front 82

what is more common?
hyperparathyroidism or hypoparathyroidism?

Back 82

hyperparathyroidism

Front 83

primary hyperparathyroidism is associated with what characteristics?

Back 83

-autonomous/spontneous overproduction of PTH

Front 84

secondary/tertiary hyperparathyroidism is usually associated with what ?

Back 84

renal insufficiency

Front 85

-one of the most common endocrine disorders
-causes hypercalcemia in women
-women affected 3:1 over men

Back 85

primary hyperparathyroidism

Front 86

what are the top 3 causes of prathyroid lesions underlying hyperfunction :?

Back 86

1) adenoma 75-80%
2) hyperplasia 10-15%
3) carcinoma < 5%

Front 87

95% of primary hyperparathyroidism cases occur how?

Back 87

sporadically

Front 88

primary hyperparathyroidism present in 2 ways?

Back 88

1) asymptomatic discovered in chemistry profile

2) symptomatic with classic signs

Front 89

the signs and symptoms of primary hyperparathyroidism are due mainly to these 2 features of the disease?

Back 89

1) increased PTH
2) hypercalcemia

Front 90

'painful bones, renal stones, abdominal groans, psychic moans w/ fatigue overtones'

Back 90

Primary Hyperparathyroidism

Front 91

bone disease features of primary hyperparathyroidsim:
1)
2)
3) pathology fractures

Back 91

1) osteoporosis
2) osteitis fibrosa
3) pathology fractures

Front 92

renal stones in primary hyperparathyroidism causing :
1) pain
2) obstructive uropthy
3) chronic renal insufficiency
4) polyuria
5) secondary polydipsia
are called ____

Back 92

nephrolithiasis

Front 93

the features of primary hyperparathyroidism affecting the GI are:
1) constipation
2) nausea
3)
4) pancreatitis
5)

Back 93

3) peptic ulcers
5) gallstones

Front 94

CNS manifestations of primary hyperparathyroidism:
1)
2) lethargy
3) seizures

Back 94

1) depression

Front 95

2 Neuromuscular manifestations in primary hyperparathyroidism?

Back 95

1) weakness
2) fatigue

Front 96

1 Cardiac manifestation in primary hyperparathyroidism?

Back 96

1) aortic/mitral valve calcifications

Front 97

5 Dental manifestations of primary hyperparathyroidism?
1) loss of LD
2)
3) osteoporosis
4)
5) osteitis fibrosa cystica

Back 97

2) ground glass appearance
4) brown tumor

Front 98

any condition associate with chronic depression in serum calcium level because low calcium leads to overactivity of putative glands?

Back 98

Secondary hyperparathyroidism

Front 99

what are the 3 types of corticosteroids produced by the adrenal gland?

Back 99

1) glucocorticoids
2) mineralcorticoids
3) androgens / estrogen

Front 100

hypercortisolism or elevated glucocorticosteroids= ?

Back 100

Cushing Syndrome

Front 101

what is the most common cause of Cushing syndrome?

Back 101

exogenous (drug-induced) Cushing syndrome

Front 102

what are the 4 means of acquiring Cushing syndrome?

Back 102

1) ACTH releasing tumor in pituitary
2) adrenal gland adenoma/ nodular hyperplasia in zona fasciculata
3) paraneoplastic cushings from cancer of lung or other releasing ACTH
4) iatrogenic/drug-induced = atrophy of gland

Front 103

corticotropin =

Back 103

ACTH

Front 104

early indications of Cushings include which 2 common symptoms?

Back 104

weight gain
hypertension

Front 105

over time, those with Cushing present with these 3 common appearances?

Back 105

1) buffalo hump
2) moon facies
3) truncal obesity

Front 106

which type of muscle atrophy leads to proximal limb weakness?

Back 106

fast twitch (type 2) - white

Front 107

stimulation of gluconeogenesis leading to hyperglycemia, glucosuria and polydpsia in Cushing's may lead to ?

Back 107

secondary diabetes mellitus

Front 108

what are the effects of Cushings on the skin and bone

Back 108

skin = thin, fragile, bruisable gb/c of protein catabolism (ie. collagen)

bone = osteoporosis b/c bone resorption

Front 109

what effects do excess glucocorticoids have in leading to recurrent infections?

Back 109

suppress immune system

Front 110

hirsutism

Back 110

excessive hair growth related to Cushing

Front 111

mental disturbances of Cushings?

Back 111

mood swings
depression
psychosis

Front 112

what oral manifestations may present from Cushings?

Back 112

Pituatary Cushings due to a ACTH secreting tumor may lead to mucosal pigmentation

Front 113

what ought to be monitored in Cushings as a dental precaution?

Back 113

1) steroid level
2) antibiotic coverage?
3) monitor healing

Front 114

consequences that ought to be considered by the dentists in treating pts. with Cushings?

Back 114

1) increased susceptibility to infxn
2) poor/delayed healing
3) depression

Front 115

most common feature of Cushings?

Back 115

central obesity

Front 116

what are the 3 categories of Adrenal Insufficiency?

Back 116

1) primary acute
2) primary chronic
3) secondary AI

Front 117

which type of adrenal insufficiency is indicative by:
-adrenal crisis
-Waterhouse-Fideichsen syndrome

Back 117

primary Acute AI

Front 118

what type of adrenal insufficiency is associated with Addison Disease

Back 118

primary Chronic AI

Front 119

over 90% of the causes of Addison Disease are caused by these 4?
1) AIDS
2)?
3) tuberculosis
4)?

Back 119

2) autoimmune adrenalitis
4) metastatic cancers

Front 120

what is the most common cause of Addison Disease?

Back 120

autoimmune adrenalitis ( 60-70%)

Front 121

initial manifestations of Addison Disease are 2 in number?

Back 121

progressive weakness
easily fatigued

Front 122

GI effects of Addison are :
-anorexia
-nausea
-vomiting
-?
-?

Back 122

weight loss
diarrhea

Front 123

where is the hyperpigmentation due to Addison disease?

Back 123

skin
oral mucosa
* sun exposed areas/pressure points

Front 124

hyperkalemia
hyponatremia
blood volume depletion --> hypotension
hypoglycemia
---- are all due to what feature of Addison Disease

Back 124

decreased mineralicorticoid activity

Front 125

what may trigger a acute adrenal crisis leading to :
vomiting
ab pain
hypotension
coma
vascular collapse
possible death

Back 125

1) infection
2) trauma
3) surgery

Front 126

what are some dental considerations for those with Addison Disease

Back 126

- coping under stress
- hypotension (postural)
-hypoglycemic syncope
- monitor steroid therapy