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148 Cards in this Set
- Front
- Back
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an endocrine gland about the size of a pea, protruding off the hypothalamus at the base of the brain
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pituitary gland or hypophysis
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connects the hypothalmus with the pituitary
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median eminence projects the infundibulum (stalk) connecting the hypothalamus to the pituitary
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secretes 9 hormones that regulate homeostasis
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PITUITARY
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anterior pituitary
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adeno-hypophysis
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posterior pituitary
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neuro-hypophysis
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What does the hypothalamus do in relation to the pituitary
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releases tropic factors to descend down the pituitary stalk to the pituitary gland where they stimulate the release of pituitary hormones.
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While the pituitary gland is known as the 'master' endocrine gland, both of the lobes are under the control of the ___________.
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hypothalamus
*the anterior pituitary receives its signals from the parvocellular neurons and the posterior pituitary receives its signals from magnocellular neurons |
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Hypothalamic hormones are secreted to the ANTERIOR lobe by way of a special ____________ system, called the hypothalamic-hypophysial portal system.
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capillary system = hypothalamic-hypophysial portal system
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pars tuberalis, pars intermedia, and pars distalis
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ANTERIOR pituitary (adenohypophysis)
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The ANTERIOR pituitary develops embryologically from
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RATHKE'S POUCH
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inhibited by hypothalamic Somatostatin.
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SOMATOTROPIN (Growth Hormone/GH)
*anterior pituitary **influenced by hypothalamic release of Growth Hormone Releasing Hormone/GHSR |
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Corticotropin Releasing Hormone (CRH)
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Adrenicorticotropic hormone
*anterior pituitary |
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Thyrotropin Releasing Hormone (TRH)
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Thyroid-stimulating hormone
*anterior pituitary **release under influence of hypothalamic Thyrotropin Releasing Hormone (TRH). |
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also known as 'Luteotropic' hormone (LTH),
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PROLACTIN (PRL)
*anterior pituitary **hypothalamus releases Prolactin Releasing Factors (PRH) |
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2 GONADOTROPINS released by hypothalamus to anterior pituitary
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Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) = both released under influence of Gonadotropin Releasing Hormone (GnRH).
*anterior pituitary |
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"intermedins" as these are released by the pars intermedia which is "the middle part"; adjacent to the posterior pituitary lobe, pars intermedia is a specific part developed from the anterior pituitary lobe.
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Melanocyte-Stimulating Hormones (MSH)
*INTERMEDIATE LOBE pituitary |
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The anterior/adenohypophysis pituitary releases its own hormones when stimulated by a hormone from the hypothalamus.
What does the posterior/neurohypophysis do? |
STORES & then releases...
Oxytocin & ADH/vasopressin *posterior pituitary |
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the majority of which is released from the supraoptic nucleus in the hypothalamus
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ADH/vasopressin
*posterior pituitary storage & release |
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most of which is released from the paraventricular nucleus in the hypothalamus
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Oxytocin
*posterior pituitary storage & release |
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Growth (Excess of HGH can lead to gigantism and acromegaly.)
Blood pressure Some aspects of pregnancy and childbirth including stimulation of uterine contractions during childbirth Breast milk production Sex organ functions in both men and women Thyroid gland function The conversion of food into energy (metabolism) Water and osmolarity regulation in the body Water balance via the control of reabsorption of water by the kidneys Temperature regulation |
Hormones secreted from the pituitary gland control these things
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___________organs are organs whose cells secrete their products, i.e., hormones, into the bloodstream whereas _________ organs such as sweat glands, salivary glands and sebaceous glands secrete their products into a duct system.
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Endocrine (hormones into blood)
Exocrine (products into duct system) |
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Adrenocorticotropic hormone target & effect
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Adrenal gland
Secretion of glucocorticoids *anterior pituitary |
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Beta-endorphin target and & effect
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Dopamine receptors
Block pain perception *anterior pituitary |
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Thyroid-stimulating hormone target & effect
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Thyroid
Secretion of thyroid hormones (ie, prothormone) *anterior pituitary |
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Follicle stimulating hormone target & effect
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Gonads
Growth of reproductive system *anterior pituitary |
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Luteinizing hormone target & effect
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Gonads
SEX hormone production *anterior pituitary |
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Somatotropin/Growth Hormone target & effect
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Liver; Adipose tissue
Promotes growth; lipid and carb metabolism *anterior pituitary |
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Prolactin target & effect
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Ovaries & Mammary glands
Secretion of estrogen/progesterones; Milk production |
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Benign neoplasms of the anterior lobe of the pituitary (adenohypophysis) that are associated with EXCESS secretion of pituitary hormones and corresponding endocrine HYPERfunction.
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Pituitary ADENOMA
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Bitemporal Hemianopsia
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a type of partial blindness where vision is missing in the outer half of both the right and left visual field. It is usually associated with lesions of the optic chiasm, the area where the optic nerves from the right and left eyes cross near the pituitary gland.
(Goliath) |
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A type of brain tumor derived from pituitary gland embryonic tissue
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CRANIOPHARYNGIOMA
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Craniopharyngiomas are also known as (3)
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Rathke pouch tumors, hypophyseal duct tumors, or adamantinomas.
*may lead to bitemporal hemianopsia |
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2 possible causes of visual field defect via pituitary gland
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Pituitary ADENOMA and CRANIOPHARYNGIOMA (Rathke's pouch tumor)
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Condition or Tumor caused by excess secretion of PROLACTIN
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HYPERPROLACTINEMIA or PROLACTINOMA
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Prolactin
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a peptide hormone produced by the anterior pituitary gland primarily associated with lactation and plays a vital role in breast development during pregnancy.
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Effects of too much prolactin in FEMALES
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Hyperprolactinemia/Prolactinoma:
*tumor secretes excess prolactin **amenorrhea, infertility, galactorrhea |
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Effects of too much prolactin in MALES
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Hyperprolactinemia/Prolactinoma
*tumor secretes excess prolactin **absence of libido & impotence |
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Effects of excess somatotropin/GH in CHILDREN
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Before puberty, GIGANTISM:
body grows abnormally longer, with an excess of growth at EPIPHYSES of long bones |
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Effects of excess somatotropin/GH in ADULTS
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Adult: ACROMEGALY:
Soft tissue growth (Lips, ear, nose) Spade-hands Prognathism Visceromegaly (liver, heart and Thyroid) HYPERTENSION DIABETES MELLITUS Headache |
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Effects of excess ACTH (adrenocorticotropic hormone)
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CUSHING'S DISEASE:
**bilateral adrenal involvements |
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MOST COMMON endocrinopathy caused by pituitary adenomas
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HYPERPROLACTINEMIA
F: amenorrhea, galactorrhea, infertility because high levels of blood PRL inhibit surge of LH necessary for ovulation M: down libido, infertility |
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Somatotroph adenoma
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Secrete GH/somatotropin
Pre-epiphyseal closure in kids: GIGANTISM Adults: ACROMEGALY |
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Corticotroph adenoma
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Produce ACTH (adrenocorticotrophic hormone)
Induces excess adrenal cortical hypersecretion = CUSHING'S DISEASE |
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Refers to DEFICIENT secretion of one or more of the pituitary hormones
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HYPOpituitarism
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Deficient gonadotropin secretion
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Hypogonadism
*anterior pituitary GH problem that may or may not cause dwarfism (in African pygmies) and have thyroid involvement |
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Panhypopituitarism caused by ischemic necrosis of the gland, usually due to severe hypotension from POSTPARTUM HEMORRHAGE
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SHEEHAN'S SYNDROME
Feature: Agalactorrhea (failure to lactate) |
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Sheehan's syndrome
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postpartum hemorrage of anterior pituitary gland
Features AGLACTORRHEA (failure to lactate) |
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Empty Sella Syndrome
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radiologic term
describes result of congential defect in DIAPHRAGMA SELLA, which permits transmission of CSF pressure into sella. All hell breaks loose: hyperprolactinemia, oligomenorrhea, anmenorrhea, hypopituitarism, acromegaly, diabetes insipidus, Cushing's syndrome |
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Panhypopituitarism:
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Pituitary necrosis
Pallor (down MSH) Hypothyroidism (down TSH) Failure of lactation (down Prolactin) Adrenal insufficiency (down ACTH) Ovarian fail w/ amenorrhea (down FSH, LH) |
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Insufficient ADH / Antidiuretic hormone/ Vasopressin
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Posteriorpituitary/neurohypophysis
Inability to absorb water in distal tubules then cannot concentrate urine Excessive thirst and water intake and excessive urine output (Polydypsia and polyuria) HyperNAtremia = increased serum osmolality (full of salt makes you thirsty as hell) |
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1/4 of central diabetes INSIPIDUS cases are associated with brain tumors, particularly _______________
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CRANIOPHARYNGIOMA
tumor rising above sella turcica, remnant of Rathke's pouch, invades and compresses adj. tissues = bilateral hemianopsia, etc. |
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SIADH
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Syndrome of Inappropriate AntiDiuretic Hormone: HIGH ADH
OAT CELL/small cell carcinoma TOO CONCENTRATED urine - LOW output down serum osmolality Hyponatremia (not enough salt) |
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Congenital HyPOthyroidism
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Cretinism;
Children Irreversible Mental Retardation if not treated Failure of hormone synthesis in pregnancy |
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Clinical features of cretinism
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sluggish apathetic infants
large abdomens UMBILICAL HERNIAS low body temperature PALE Mental retardation Stunted growth (defective osseous maturation) Low T4, T3 High TSH HARSH CRY DUE TO MUCOPOLYSACCHARIDES affecting larynx Need prompt thyroid hormone replacement |
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Hypothyroidism (HASHIMOTO'S THYROIDISM)
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Inadequate secretion of TSH by the pituitary or...
not enough TRH (thyroid releasing hormone) by the hypothalamus = Myxedema madness |
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Clinical signs of manifest hypothyroidism
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tiredness
lethargy sensitivity to cold inability to concentrate hypofunctional organ sys SKIN: myxedema = boggy faces, puffy eyelids, edema of hands and feet, enlarged tongues, Cool, dry, COARSE hair and skin. |
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I mix hash in my auto
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Myxedema
Hashimoto's thyroiditis Autoimmune |
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Autoimmune aspect of Hashimoto's thyroiditis
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circulating antibodies to thyroid antigens = primary hypothyroidism
MAS (multiglandular autoimmune syndrome of men), insulin-dependent diabetes, pernicious anemia, hypoparathyroidism, adrenal atrophy, hypogonadism |
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refers to a thyroid gland enlargement, either nodular or diffuse. Classified according to function
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GOITER
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Nontoxic goiter is also called _______ or _________ goiter.
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COLLOID, MULTINODULAR
enlargement of thyroid without functional, inflammatory or neoplastic alteration |
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euthyroid condition affecting pregnant women and adolescents
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Diffuse euthyroid goiter
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Type of nontoxic goiter affects people over 50
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MULTINODULAR euthyroid goiter
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What happens in non-toxic goiter (diffuse/colloidal/multinodular)?
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euthyroid
Capacity of thyroid to produce thyroid hormone is IMPAIRED so increased TSH LEVELS from ant. pituitary lead to enlargement of gland |
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Rubin's describes it as proteoglycans accumulate in the extracellular matrix and bind water, resulting in a peculiar form of edema. How does Dr.Seva describe it?
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HASHIMOTO'S THYROIDITIS:
Deposition of MUCOPOLYSACCHARIDES in the connective tissue Thyroid is enlarged, rubbery, firm, nodular. Presence of anti-thyroid antibodies Destruction of follicles by INFILTRATION of LYMPHOCYTES Myxedema! madness |
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The clinical consequences of excessive circulating thyroid hormone
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HYPERthyroidism
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3 conditions of HYPERthyroidism:
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1. GRAVE'S DISEASE
2. SUBACUTE thyroiditis 3. RIEDEL'S thyroiditis |
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Describe Grave's disease
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Hypermetabolic state of target tissues
Diffuse goiter Hyperthyroidism Dermopathy (sweating, fine hair, exophthalmos) IgG antibodies** |
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AUTOIMMUNE component of Grave's disease
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IgG ANTIBODIES that bind to TSH receptor on plasma membrane of thyrocytes. They AGONIZE the TSH receptors, increasing thyroid hormone. Hyperplastic, excessively vascular thyroid results.
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Grave's disease factors
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FEMALE (15-40 years of age)
FAMILIAL IgG antibodies NEOVASCULARIZATION BRUIT EXOPHTHALMOS ENLARGED thyroid Nervous! Grave's DERMOPATHY = pretibial edema |
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lab presentation of Grave's
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increased radioactive iodine uptake
elevated T3 and T4 lowered TSH (antibodies are bound to all of them!) |
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Follicular epithelial cells of the thyroid that are affected by chronic autoimmune thyroiditis (Rubin's says it is Hashimoto's thyroiditis)
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ASKANAZY cells
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Also called de Quervain, Granulomatous, or Giant Cell Thyroiditis), this is caused by a viral infection
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SUBACUTE thyroiditis
ergo: FEVER, PAIN, both sexes, ENLARGED CERVICAL NODES |
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Why is de Quervain's/Subacute thyroiditis called granulomatous?
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VIRAL so destruction of follicles allows COLLOID to flow out, causing conspicuous GRANULOMATOUS reaction
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Chronic condition of thyroid of ELDERLY FEMALES
(the Sylvia Browne disease) |
RIEDEL'S thyroiditis
painless painless painless so...rule out cancer STONY HARD DYSPHAGIA DYSPNEA HOARSENESS OF VOICE |
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contrast Diabetes Insipidus vs. SIADH:
1. ADH 2. Urine Output 3. Serum 4. Serum Osmol. 5. Na+ |
1. ADH: DI down, SIADH up
2. Urine output: DI up, SIADH down 3. Serum: DI concentrated, SIADH diluted 4. Serum Osmol.: DI up, SIADH down 5. Na+: DI up (hyperNatremia), SIADH down (hypoNatremia) |
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BOTH diabetes insipidus and diabetes mellitus have ______ urine output.
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HIGH
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Contrast diabetes mellitus to diabetes insipidus
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BOTH have high urine output
DM: high sugar & water = Honey (sugar) DI: Low ADH, tasteless/insipidus |
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Patient A has high TSH and low T3,T4
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HYPOTHYROID
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Patient B has low TSH and high T3,T4
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HYPERTHYROID
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Patient C has High TSH and High T3,T4
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HYPER-PITUITARISM
(pituitary cranking out TSH stimulates thyroid to crank out T3,T4) |
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Why does RIEDEL THYROIDITIS cause hoarseness?
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Gradual onset of PAINLESS goiter in middle aged women.
HARD thyroid mass RECURRENT LARYNGEAL N. pressure (hoarseness) TRACHEAL compression (stridor) ESOPHAGEAL compression (dysphagia) |
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Subacute thyroiditis (de Quervain, Granulomatous or Giant Cell Thyroiditis) is caused by a ___________________.
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VIRAL INFECTION
*de Quervain/granulomatous/giant cell/SUBACUTE thyroiditis |
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Why does the serum osmolality increase in diabetes insipidus?
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Blood plasma becomes CONCENTRATED because polyuria. When serum (solution) is concentrated,HYPERNATREMIA occurs. HIGH SERUM OSMOLALTIY
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BOTH Diabetes Mellitus and Diabetes Insipidus have __________ & _____________, but only Diabetes Mellitus has __________.
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BOTH: polyuria & polydypsia
D. MELLITUS: polyphagia |
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What are the only two things HYPERthyroidism has LESS of than hypothyroidism?
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TSH (low) & edema (none)
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Has ELEVATED TSH, no finger or tongue tremor and no exophthalmos
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Hypooothyroid
Antibodies in Hashimoto's hypothyroiditis block thyroid function. Results in striking accumulations of lymphocytes. (Graves' has ANTI- TSH RECePTOR antibodies that agonize/elevate thyroid function) |
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ALL neoplasms of the thyroid are hard, stony and __________.
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Painless.
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REIDEL thyroiditis causes ________ of the thyroid
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fibrosis = Reidel's = hoarseness, painless goiter
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Benign clonal neoplasm showing follicular differentiation. Most common thyroid tumor. Euthyroid patients as a solitary "cold" nodule.
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FOLLICULAR ADENOMA of the thyroid = BENIGN colloid
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MOST COMMON thyroid cancer
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PAPILLARY thyroid carcinoma (PTC)
*from x-rays to the neck |
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Papillary thyroid carcinoma (PTC) is most common thyroid cancer. Etiology?
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PAPILLARY = x-ray therapy to neck
PSAMMOMA BODIES |
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Which thyroid neoplasm/carcinoma is FAMILIAL?
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MEDULLARY = familial
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What are the microscopic features of PAPILLARY thyroid carcinoma?
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PTC:
1. PSAMMOMA BODIES (calcospherites) 2. GROUND GLASS NUCLEI (clear) |
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Rarely fatal, this thyroid cancer is uncommon in the US. It CANNOT identified by FNA (fine needle aspiration)
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FOLLICULAR = cannot be diagnosed by FNA
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Thyroid carcinoma derived from C-cells
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MEDULLARY = C-cells (Calcitonin), familial.
PARAFOLLICULAR C-CELLS of thyroid (marker of oncoming medullary cancer is C-cell hyperplasia, found in MEN 2A & 2B) |
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Medullary thyroid carcinoma (MTC) culprits
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familial parafollicular C-cells (calcitonin)
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ANAPLASTIC means
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undifferentiated
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ANAPLASTIC (undifferentiated) thyroid carcinoma is usually __________
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ANAPLASTIC = fatal, highly malignant
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postpartum failure of lactation due to hemmorhage of pituitary (due to trying to control bleeding from placental detachment)
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SHEEHAN'S SYNDROME (Infarction of pituitary in prolactin area)
Hypopituitarism |
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Defect of diaphragma sellae (clinoid process) resting on pituitary causing hyPOpituitism
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Empty Diaphragma Sella
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Medical Rx for hypothyroidism
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Thyroxine (thyroid hormone)
raises T3,T4 |
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Patient C has high TSH and high T3,T4. What is condition and treatment?
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hyperpituitism from TUMOR so surgery
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Evil "It" clownface microscope slide
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Anaplastic carcinoma of thyroid
(p479, Rubin's pathology essentials) |
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MEN
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Multiple Endocrine Neoplasia: MEN syndromes 1 and 2
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MEN 1
*triple P |
M.E.N. 1 = WERNER'S triple P SYNDROME:
Pituitary adenoma (up TSH, up T3,T4) Parathyroid adenoma (same as MEN 2) Pancreatic Islets neoplasm |
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triple P
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MEN 1 = WERNER'S triple P SYNDROME:
Pituitary adenoma Parathyroid adenoma Pancreatic islets neoplasm |
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MEN 2
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MEN 2 = SIPPLE'S syndrome has 2 P's and an M:
Medullary carcinoma of thyroid (parafollicular C-cells) Pheochromocytoma of adrenal (catecholamine secreting tumor of adrenal medulla) = HYPERTENSION Parathyroid adenoma (same as MEN 1) |
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has 2 P's and an M
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SiPPle's syndroMe:
1 > Medullary carcinoma of thyroid (Calcitonin) 2 > Pheochromocytoma (catecholamine secreting chromaffin cells of adrenal medulla) 3 > Pituitary adenoma (elevated TSH & T3,T4) |
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Pity Pan's Parrot
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MEN 1/Werner's syndrome: triple P
Pituitary - Pancreatic islets - Parathyroid |
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why is a pheochromocytoma of the adrenal medulla (think MEN 2) considered a neuroendocrine tumor?
MEN 2 will make you MENTAL |
Located on the adrenal medulla, the site of catecholamine production via chromaffin cells: Norepinephrine and Epinephrine
Mostly NE: palpitations, anxiety, skin crawling, headaches, elevated heart rate, weight loss. Yuck. |
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3 layers of adrenal CORTEX from inside our HORMONES:
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(inner is medulla)
1. Sex hormones 2. Cortisol 3. Aldosterone |
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Congenital Adrenal Hyperplasia, what happens to adrenal?
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All 3 layers of CORTEX suffer hyperplasia:
Increased Aldosterone, Increased Na+ = Increased Blood Pressure 1. Less cortisol 2. More testosterone 3. Less hydroxylase enzymes 4. More ACTH 5 NO odor (secondary sex characteristics) 6. More MSH (melanocyte stim) so...ambiguous genitalia leads to Male: No odor for a boy less than 10 is unusual. Precocious puberty. Female: Hirsuitism, Hair receeds, Laryngeal masculine voice, Increased muscles, Decreased breast, Increased clitoris, Amenorrhea, Hyperpigmentation |
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If the adrenals are BILATERALLY affected, think ________ adenoma.
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PITUITARY = bilateral affect
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Increased ACTH affects all 3 layers of CORTEX of adrenal glands because of __________________.
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negative feedback
If a person has enough hydroxylase enzymes, the normal increase in ACTH leads to normal increase in cortex... but without hydroxylase enzymes 11,21 & 17, ACTH stimulates the cortex and LOWERS cortisol while ELEVATES aldosterone |
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What happens when the bilateral adrenals get too much ACTH and do not have hydroxylase enzymes 11, 21 & 17 because there is a pituitary adenoma (congenital adrenal hyperplasia)?
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CONGENITAL ADRENAL HYPERPLASIA results in ACTH stimulates cortex:
1. lowers CORTISOL 2. elevates ALDOSTERONE |
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An increase in _______ and increase in ________ = high BP
Due to CONGENITAL ADRENAL HYPERPLASIA. |
Aldosterone + Na+ = high BP (hypernatremia = hypertension)
*congenital adrenal hyperplasia is a DEFECT IN HYDROXYLASE ENZYMES 11, 21 or 17 necessary to control ACTH from getting TOO high int the ****CORTEX**** CAH: less cortisol, more aldosterone affects males and females: Amenorrhea + virilization of females Precocious odorless young boys Ambiguous genitalia both sexes |
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Werner's mp3
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MEN 1 triple P:
Multiple endocrine Neoplasia 1. Pituitary adenoma 2. Parathyroid adenoma 3. Pancreatic islets neoplasm |
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____ of adrenal medulla does not cause any disease, but tumor of adrenal medulla causes ____________: increased catecholamines.
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loss of medulla causes no disease.
TUMOR of MEDULLA = increase in Norepinephrine and Epinephrine...PHEOCHROMOCYTOMA (inc. catecholamines) |
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Congenital Adrenal Hyperplasia does not affect the adrenal medulla. So what?
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So adrenal medulla is where NE and E come from. Losing the medulla doesn't cause a disease but in CAH, all the affects are bilateral adrenal cortex only.
A tumor of the medulla, on the other hand, will affect NE and E levels (pheochromocytoma of MEN 2/Sipple's) |
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CUSHING's syndrome:
Primary vs. Secondary |
Primary: adrenal adenoma (high ACTH). Surgery.
Secondary: either... 1. Cushing's DISEASE (not syndrome) of excess bilateral ACTH adrenal hyperplasia. ABDOMINAL STRIAE. (collagen to glucose) 2. SI-ADH (Syndrome of Inappropriately HIGH ADH) so hypoNa+tremia due to small/oat cell carcinoma. Cannot get rid of salt because ADH is sooo damn high, it tells the body to keep it. Urine becomes very concentrated, high osmolality, low salt. Diluted serum because salt keeps pulling all the water into the blood stream. |
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level of TSH in cretinism?
Levels of T3 & T4 in cretinism? |
TSH is HIGH because the pituitary is okay but...
T3 & T4 are low because the thyroid didn't develop properly due to failure of hormone synthesis in pregnancy. Irreversible mental retardation, Umbilical hernia, Harsh cry/mucopolysaccharides. HYPOthyroidism in children is fine TSH but no thyroid output of T3 or T4. |
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Clinical feature of 2* Cushing's disease due to (excess ______) bilateral adrenal cortex HYPERPLASIA:
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excess ACTH
Clinical Feature: ABDOMINAL STRIAE where body is breaking down abdominal collagen to make glucose. Too much adrenocorticotrophic hormone because of a tumor on the pituitary = bilateral adrenal affect on cortex CORTISOL |
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Describe MEN 2
(like cocaine and inherited cancer all in one!) |
SIPPLE's SUCKS:
1. PARATHYROID ADENOMA: (High Ca+, Low PO4 because tumor secreting PTH/parathormone saying, "Where's the Calcium?") Stone/Bone/Moan/Groan/Get 911 on the phone! is hyperparathyroidism 2. PHEOCHROMOCYTOMA of adrenal MEDULLA: causes crazy increase in NE and Ep (blood catecholamines), increase in thyroid, BP, and urine metabolites. Ugh. Like being on cocaine all the time. 3. MEDULLARY carcinoma of the THYROID - familial. Ground glass/clear nuclei glazed over (get it?), Psammoma bodies/calcospherites, due to PARAFOLLICULAR C-CELLS (calcintonin) neoplasia |
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Parathyroid function?
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PTH = PARATHORMONE
(Where's the Calcium?) Tells osteoclasts to release Ca+ from bone and tells enterocytes to up intake from food - this screws Vitamin D) |
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HYPER-PARATHYROID-ISM
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PTH/Parathormone too much!
a. Primary is due to PARATHYROID ADENOMA b. Secondary is due to CHRONIC RENAL FAILURE *High serum Ca+ due to PTH saying, "Where's the Ca+?" *Low Phosphate due to PTH stimulating aldosterone and telling body to keep dumping phosphate-containing URINE. |
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stone - bone - moan - groan -get 911 on the phone!
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Clinical features of HYPER-parathyroidism:
Stone = LISTHESIS kidney due to renal fail (2*) + high Ca+ levels Bone = brittle due to high PTH telling osteoclasts to release Ca+ Moan = depressed. Who the f*** wouldn't be? Groan = Constipated due to high Ca+ Get 911 on the phone! = CARDIAC ARRYTHMIA as ASYSTOLE |
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HYPO parathyroid ism
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*parathormone is responsible for Ca+ levels.
HypoPTH means low serum Ca+. clincial features: PERIORAL TINGLING into hands/feet & TETANY CHVOSTEK'S SIGN: twitching CN VII Facial at tragus TROUSSEAU'S SIGN: stored parathormone in arms causes carpopedal spasm. Has scar over extensor group. Etiology: neck surgery to remove goiter on thyroid also accidentally removed parathyroids. Now now PTH. Idopathic also - sudden, no cause. |
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Cushing's syndrome (3)
Conn's syndrome Addison's crisis or disease CAH Pheochromocytoma |
ADRENAL problems
3CPAs Cushing's Conn's Congenital Adrenal Hyperplasia Addisons's Pheochromocytoma (medulla tumor) |
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Adrenal:
CUSHING'S |
Increased CORTISOL
Etiology: 1* adenoma (surgery) 2* oat cell carcinoma (SI-ADH) or Cushing's syndrome (high ACTH and bilateral adrenal involvement) Clinical features: MOON face, WEB neck, TRUNCAL obesity with thin extremities, Muscle wasting, psychiatric!! Female: hirsuitism, acne, infertility, amenorrhea Both sexes: INFECTION, HYPERTENSION, D. MELLITUS |
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Which layer of cortex does Cushing's affect?
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Zona Fasiculata (Cortisol/glucocorticoids)
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Adrenal:
CONN's syndrome Big Al gave Connie a headache and sent her blood pressure through da' roof! |
PRIMARY Big Al Dosterone problem from the Zona Glomerulosa
Big Al Dosterone just keeps coming due to an aldosterone-secreting neoplasm HIGH BP + low potassium (Al is kicking out K+ and keeping salty girls so hypoK+alemia and high BP/hyperNa+tremia result) |
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Adrenal:
ADDISON's crisis & disease due to adrenal INSUFFICIENCY: |
Addison's doesn't have enough cortisol + aldosterone.
ACUTE - Addison's CRISIS CHRONIC - Addison's DISEASE |
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ADDISON'S CRISIS
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*iatrogenic! ACUTE insufficiency of Al Dosterone and Cortisol from overuse of PREDNISONE
Synthetic steroids replace your own = SHOCK |
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ADDISON'S DISEASE
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CHRONIC lack of cortisol and aldosterone
AUTOIMMUNE (vs. acute that was perscription steroid induced) CF: hyperpigmentation (MSH), HYPOtension (no jump juice), HYPERK+ because no Al kicking out potassium bums in distal tubule, HYPONa+ because of same Al not pulling out salty girls for himself, Cardiac ARRHYTHYMIA |
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Cushing's syndrome 2* as Cushing's disease just causes hirsuitism, acne, infertility and DM, Infection, hypertension and menstrual disorders in females.
What does CONGENITAL ADRENAL HYPERPLASIA do? |
*Lack of hydroxylase enzymes 11, 21 or 17 that control levels of ADH.
Person gets SI-ADH. Bilateral enlargement/hyperplasia of adrenals Females: ambiguous genitalia, amenorrhea and virilization Males: precocious, odorless little boys under 10 CAH increases all three layers of adrenal cortex so HyperNa+/hypertension, too |
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Adrenal:
ADENOMA of MEDULLA |
MEDULLA tumor is called a PHEOCHROMOCYTOMA...
increases NE * E (catecholamines) INCREASES thyroid, BP, urine metabolites |
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People with Addison's disease crave _______.
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SALT
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Is an increase in blood sugar only considered diabetes? Why or why not?
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NO. An increase is not considered diabetes mellitus because the sugar should first be increased in the blood. For diabetes, blood will show HYPERGLYCEMIA and inadequate action of insulin on tissues
d/t low levels of circulating insulin OR insulin resistance |
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2 possible causes for blurring of vision?
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Pituitary adenoma & Diabetes Mellitus
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2 places a pheochromocytoma can be and why?
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PHEOCHROMOCYTOMAS
CHROMAFFIN cells embryonically give rise to sympathetic chain ganglia, and they also live in adrenal medulla. Tumor could be either place. Can be adrenal adenoma, MEN 2 (Sipple's sucks - it's still a medullary adenoma) or Hyperthyroid until you test it. The tumor can either be on the sympathetic chain ganglia of neck or on adrenal medulla and still it is a pheochromocytoma (high thyroid, BP, urine metabolites of NE * E) |
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Cushing's primary vs. Cushing's secondary levels
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***** All have high GC/C*****
Uni tumor primary Cushings = low ACTH Bi hyperplasia d/t pituitary malfunction is high ACTH Oat cell cancer bilateral SI-ADH (high ADH, no pee) |
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Addison's disease levels
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Worn out, no juice -pituitary sending it but cortex not giving it up.
high ACTH down GC/C down A/MC melanocyte up |
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Diabetes Mellitus I
Ketoacidosis or Hypoglycemic coma |
YOUNG
Sugar needs to leave blood vessels of intestines and get to liver portal vein but cannot. Circulating insulin levels LOW DUE TO ANTIBODIES AGAINST BETA CELLS. Extremely low insulin. Treatment is shots or pump. KETOACIDOSIS or HYPOGLYCEMIC COMA |
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Ketoacidosis or Hypoglycemic coma
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DM I
Young Insulin levels low d/t antibodies against BETA cells |
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ketoacidosis and hypoglycemic coma descriptions
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DM -I:
*crazy sugar excess KETOACIDOSIS *insulin shots push sugar into liver. If patient forgets to eat at proper time, all sugar drained from brain then HYPOGLYCEMIC COMA |
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Clinical features of DM
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DM -I (young people, antibodies to beta cells, no insulin)
DM- II (people over 50+, insulin resistance in tissues) Osmotic diuresis EXTREME urine output THIRST WEIGHT LOSS INFECTION OF UROGENITAL VISION BLURRY |
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Hyperosmotic non-ketotic coma is an acute complication of
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DM-II (over 50+, insulin resistance in tissues)
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Why does chronic DM change the blood vessel structure?
Changes to EYE, KIDNEY, MEDIUM & LARGE BLOOD VESSELS, AUTONOMIC? |
SUGAR stays in blood vessels all the time!
Causes microvasculature changes: EYE - blot hemorrhages, cotton wool spots of retina, blindness, cataracts KIDNEY - MOST COMMON CAUSE OF KIDNEY FAILURE IS DIABETES MELLITUS. Proteinuria. MEDIUM & LARGE BLOOD VESSELS- Silent myocardial infarction, Nervous system poly or mononeuropathy AUTONOMIC - males have impotence, atonic bladder (loss of bladder tone because urine is trapped) |
