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75 Cards in this Set
- Front
- Back
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Acidophilic pituitary cells
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Somatotrophs
Lactotrophs flat PeG |
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Basophilic pituitary cells
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Corticotrophs
Thyrotrophs Gonadotrophs FLAT peg |
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acute hemorrhage into a pituitary adenoma resulting in rapid enlargement and associated symtpoms
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Pituitary apoplexy
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most common combination pituitary adenoma
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GH and PRL
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size definition of micro/macro pituitary adenomas
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1cm
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peak age incidence of pituitary adenomas
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35 to 60
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gene associated with α subunit of Gs
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GNAS
40% of somatroph adenomas have mutation of GNAS |
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____ _____ is an autosomal dominant disorder of the PRKAR1A (Protein kinase A regulatory subunit 1α) in pituitary/endocrine tumors, resulting in inappropriate activation of cAMP
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Carney Syndrome
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What gene should be tested for in early onset (<35) Acromegaly?
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AIP
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Characteristic features differentiating Pituitary Adenomas from nonneoplastic anterior pituitary parenchyma
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monomorphism
absence of significant reticulin network |
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Characteristic features of Atypical Pituitary Adenomas
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Brisk mitotic activity
Ki-67 (also p53) Aggressive behavior |
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Most common functioning pituitary adenoma
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PRL
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Prolactinoma presentation in females?
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20 to 40
Amenorrhea Galactorrhea Infertility |
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Gross appearance of PRLs
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Acidophilic
Dystrophic calcification → psammoma bodies → pituitary stones |
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Differential Diagnosis of PRLs
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Pregnancy
Nipple Stimulation Dopamine antagonists damage to hypothalamus |
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Treatment of prolactinomas
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Bromocriptine
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Two histological variants of GH adenomas
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Densely granuated - monomorphic and acidophilic, retain GH immuno staining
Sparsely granulated - chromophobic, pleomorphic, loss of GH immuno staining |
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Persistently elevated levels of GH resulting in hepatic secretion of ____, which is the cause of the majority of symptoms
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IGF-1 or somatomedin C
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Presentation of GH adenoma in child
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Gigantism
epiphyses have not closed |
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Presentation of GH adenoma in adult
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Acromegaly
epiphyses have closed |
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typical size of GH adenomas
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very large
symptoms take decades to manifest, allowing growth |
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Associated symptoms of GH adenomas (7)
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Diabetes*
Hypertension* Gonadal dysfunction Arthritis Muscle Weakness CHF Gastrointestinal Cancer |
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Diagnostic test for GH adenomas
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failure to suppress GH production in response to oral load of glucose
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Appearance of ACTH Adenomas
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Small
Basophilic PAS(+) |
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Cushing Disease/Syndrome arises from ACTH Adenomas
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Cushing DISEASE
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Nelson Syndrome
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Development of large destructive adenoma with mass effect after removal of adrenal glands in Cushing Syndrome
loss of inhibition on preexcisting corticotrophic adenoma |
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Common presentation of Gonadotroph Adenomas
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middle aged man or woman with mass effects
tumors are usually inefficient at hormone production |
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Most common pituitary hormone deficiency related to Gonadotroph adenoma
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LH
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Pituitary Carcinomas are rare
what are the two most common variants |
PRL, ACTH
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Hypofunction of the anterior pituitary occurs when approximately __% of the parenchyma is lost or absent
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75%
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Hypopituitarism + posterior pituitary dysfunction (Diabetes Insipidus) indicates
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Hypothalamic disorder
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Hypopituitarism following pregnancy
mechanism? |
Sheehan Syndrome
ant pit can double in size during pregnancy with no ↑ in blood supply |
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Composition of Rathke cleft cysts?
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ciliated cuboidal epithelium with golbet cells with accumulation of proteinaceous fluid
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Common presentation of Empty Sella Syndrome
mechanism |
Obese woman with multiple pregnancies
diaphragm sella defect allows arachnoid matter and CSF to herniate into sella hyperprolactinemia from interruption of hypothalamic signals common |
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Gene associated with Hypopituitarism characterized by deficiences of GH/PRL/TSH
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POU1F1
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LH/FSH deficiency presentation in women?
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amenorrhea and infertility
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LH/FSH deficiency presentation in men?
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decreased libido
impotence loss of pubic/axillary hair |
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Presentation of Diabetes Insipidus (central)
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Thirst, polydipsia
Polyuria Hypernatremia response to exogenous ADH |
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Presentation of SIADH
MCC |
hyponatremia
hypercalcemia mental status changes small cell of lung |
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Origin of Craniopharyngiomas
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Rathke's pouch
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Common variant of craniopharyngioma in children 5 to 15
morphologic features? |
Adamantinomatous
dystrophic calcification palisading squamous epithelium "machine oil" cholesterol rich brown-yellow fluid |
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Craniopharyngioma variant seen in elderly (65+)
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Papillary
lack keratin, calcification, palisading |
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bone effects of hyperthyroidism
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increases resorption, leading to osteoporosis in chronic situations
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Apathetic Hyperthyroidism
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In elderly with multiple comorbidities, diagnosis suspected by unexplained weight loss of worsening cardiovascular disease
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MOST effective screening tool for Hyperthyroid
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(low) TSH
confirm with serum (high) T4 levels |
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normal rise in TSH following TRH administration excludes
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Secondary Hyperthyroidism
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Iodine uptake values
Grave's |
Diffusely increased in whole gland
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Iodine uptake values
Toxic Adenoma |
Increased uptake in solitary nodule
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Iodine uptake values
Thyroiditis |
decreased uptake
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Control of acute hyperthyroid symtpoms
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ß blocker
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TSH/T4-T3 values
Primary Hyperthyroid |
↓TSH
↑T4/T3 |
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TSH/T4-T3 values
Primary Hypothyroid |
↑TSH
↓T4/T3 |
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sex prevalence of hypothyroid
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women 10:1
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MCC Congenital Hypothyroidism
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iodine deficiency
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Iodine "Organification"
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binding of iodide to tyrosine residues in the storage protein (thyroglobulin)
defect → hypothyroidism (one of many causes) |
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MCC Dyshormonogenetic Goiter (hypothyroidism)
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mutations in thyroid peroxidase
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Hypothyroidism + Sensorineural deafness
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Pendred Syndrome
SLC26A4 defect |
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Thyroid Hormone Resistance Syndrome
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Autosomal dominant
↑T4/T3 ↑TSH but no thyroid effectiveness |
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Common causes of acquired hypothyroidism
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Radiation
Accidental surgical removal Hyperthyroid Treatments - radioiodine, methimazole, propylthiouracil Lithium, p-aminosalicylic acid |
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Classic manifestations of hypothyroidism
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Cretinism
Myxedema |
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MCC Hypothyroid in iodine-sufficient regions
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Autoimmune (Hashimoto's)
will be goitrous, possibly associated with APS |
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Common features of Cretinism
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severe MR
short stature coarse facial hair protruding tongue umbilical hernia |
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Cause of Cretinism (esp severe)
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Iodine deficiency in utero, severity correlates with earlier onset during pregnancy
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Regions where cretinism is common
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High altitude areas
Himalayas China Africa |
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Most sensitive screening tool for Myxedema/Hypothyroidism
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TSH levels
↑ in primary T4 is decreased regardless of etiology |
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Painless enlargement of thyroid gland bilaterally in middle aged woman with hypothyroidism, PREceded by episode of hyperthyroidism
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Hashimoto's
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Morphology of Hashimoto's
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Diffuse bilateral painless enlargement
Pale, yellow-tan, firm appearance "Hurtle Cells" - eosinic cells lining follicles Germinal centers and lymphocytic infiltrate Interstitial Fibrosis |
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Genetic predispositions to Hashimotos (40% concordance in monozygotic twins)
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CTLA4 loss
PTPN22 loss |
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Older female, transient hyperthyroid leading to hypothyroid with pale enlarged goiter
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Hashimoto's
autoimmune infiltration of lymphocytes |
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Pathogenic difference between Hashimoto's and Subacute/DeQuervain
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Hashimotos is autoimmune and self-perpetuating
DeQuervain/Subacute is viral caused and limited |
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Morphologic difference between Hashimoto's and DeQuervain/Subacute
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Hashimoto's has germinal centers, subacute has Giant cells and granulomas
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Clinical Presentation of DeQuervain/Subacute
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PAINFUL thyroid
2-6 weeks hyperthyroid Diminished Radioiodine uptake ↑T4/T3, ↓TSH |
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Subacute Lymphocytic (Painless) Thyroiditis
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painless hyperthyroidism post-pregnancy with presence of thyroid autoABs and germinal centers but no fibrosis or hurthle cells
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major difference in outcome between Hashimoto's and Subacute Lymphocytic Thyroiditis
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subacute patients will be euthyroid within 1 year
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extensive fibrosis of Thyroid extending to surround structures
associated findings? |
Reidel Thyroiditis
retroperitoneal fibrosis leading to ureter blockade |
