Pathology Exam 3

Front 1

The anterior lobe of pituitary is derived from ___ and the posterior lobe is derived from ____

Back 1

Primative oral cavity (Rathke's Pouch); neuroectoderm

Front 2

5 Cell types found in the ant. pituitary and the hormones they secrete

Back 2

1) Somatotroph (50%)- GH
2) Mammatroph (10-20%)- Prolactin
3) Corticotroph (15-20%) - ACTH
4) Gonadotroph (10%) - LH & FSH
5) Thyrotroph (5%) - TSH

Front 3

2 hormones from the posterior pituitary

Back 3

Oxytocin, ADH
- composed of unmyelinated nerve fibers

Front 4

Hyperpituitarism

Back 4

Almost always associated w/ adenoma. May produce symptoms by hormone production or by local mass effects

Front 5

Increased __ hormone has a frequency of __ and causes amenorrhea, infertility, galactorrhea, loss of libido

Back 5

Prolactin, 30%

Front 6

Increased amounts of GH cause what?

Back 6

Gigantism (prepubertal) and acromegaly (adults)
- depends on when the epiphyses closes!

Front 7

Increased amounts of ACTH cause what?

Back 7

Cushing's syndrome

Front 8

Adenomas of __&__ hormone are rare

Back 8

Gonadotropin and thyrotropin

Front 9

Causes of hypopituitarism

Back 9

1) Nonfunctional pituitary adenoma
2) Ischemic necrosis; Sheehan's syndrome (peripartum infarct) needs 75% destruction to be noticed
3) Destruction by surgery, radiation, or adjacent tumor

Front 10

Manifestations of hypopituitarism

Back 10

Dwarfism, amenorrhea/infertility/dec. libido, impotence, lack of sex hairs, no postpartum lactation, hypothyroidism & hypoadrenalism

Front 11

Posterior lobe pathology

Back 11

1) Oxytocin: no significant clinical abnormalities
2) ADH: promotes resorption of free water; diabetes insipidus

Front 12

Diabetes insipidus is caused by pathology of what hormone?

Back 12

ADH

Front 13

Embryo and histo of the thyroid gland

Back 13

- Develops from an invagination of endoderm that arises at the base of the tongue
- Follicles filled w/ colloid and lined by cuboidal follicular cells; C-cells are scattered in the follicles

Front 14

Most common causes of hyperthyroidism (4)

Back 14

1) Grave's disease, #1 cause
2) Ingestion of excessive TH
3) Hyperfunctional multinodular goiter
4) Hyperfunctional thyroid adenoma

Front 15

Clinical manifestations of hyperthyroid

Back 15

Heat intolerance, weight loss + inc. appetite, irritability, muscle weakness, diarrhea, tachycardia, CHF

Front 16

In thyroid storm, patients can die from what?

Back 16

Cardiac arrhythmia

Front 17

Hyperthyroidism is diagnosed by increased __ and decreased __

Back 17

TH, TSH (primary hyperthyroidism)

Front 18

This disease shows diffuse enlargement of the thyroid on gross exam, hyperplasia of follicles w/ lymphoid infiltrates, and increased serum-free TH and decreased serum TSH

Back 18

Grave's Disease

Front 19

Manifestations of Grave's disease

Back 19

- Exophthalmos (40%)
- Skin lesions (pretibial myxedema and scaly thickening of skin over shins)
- Hyperthyroidism
- Autoantibodies of TSH receptor; constantly stimulated
- Female predominance 5:1 in 1-2% of women in US

Front 20

Common causes of hypothyroidism

Back 20

- Destruction by surgery or radiation
- Hashimoto thyroiditis
- Iodine deficiency

Front 21

__ develops in childhood and causes impaired development of skeleton and CNS; rare now due to iodine supplementation

Back 21

Cretinism

Front 22

__ develops in adults; mimics depression; listless w/ cold-intolerance and obesity; enlargement of tongue and course face hair, deepening voice, constipation; accumulation of mucopolysaccharide-rich edema

Back 22

Myxedema

Front 23

Measure of serum TSH

Back 23

- Increased in primary due to loss of feedback inhibition
- Not increased in cases caused by primary hypothalamic or pituitary disease

Front 24

Hashimoto Thyroiditis

Back 24

- Female predominance
- Most common cause of hypothyroidism
- Some cases preceded by hyperthyroidism
- Autoimmune progressive destruction of parenchyma w/ inflammatory infiltrates (starts as euthyroid); CD4+, CD8+, NK cells
- Patients usually at risk for other autoimmune diseases like B-cell NH lymphoma
- No established risk of development of thyroid neoplasm

Front 25

Most common manifestation of thyroid disease is?

Back 25

Goiters!
- most common clinical features are due to mass effects: cosmetic issues, airway obstruction, dysphagia, compression of vessels

Front 26

Impairment of __synthesis --> __ in serum TSH--> __&__ of follicular cells --> gross enlargement of gland

Back 26

TH; increase; hypertrophy and hyperplasia

Front 27

Hyperfunctional "toxic" goiter

Back 27

In a minority of ppl a "toxic" nodule may develop in a long-standing, non-toxic goiter. Hyperthyroidism

Front 28

Thyroid Neoplasms (and how are they caused)

Back 28

- Common
- Most are non-neoplastic; 1% are carcinomas; nods in young and males are more likely to be neoplastic
- Exposure to radiation in first 2 decades

Front 29

Solitary nodules, grossly separated from normal thyroid by a thin & discrete capsule, microscopically composed of follicles w/ varying amounts of colloid

Back 29

Follicular adenoma

Front 30

Most common cause of thyroid cancers (3-5th decades F>>M), 60-70% multifocal, many have mutations in the RET proto-oncogene

Back 30

Papillary thyroid carcinoma

Front 31

Pathology of papillary thyroid carcinoma

Back 31

- Nuclear clearing, "orphan annie nuclei" !
- papillary projections
- nuclear grooves, inclusions, enlargement
- Indolent lesions have >95% 10 yr survival; poor prog if extra thyroid extension in elderly

Front 32

Accounts for 10-20% of thyroid cancers, areas w/ iodine deficiency, may resemble ademona w/ discrete capsule, must see invasion through the capsule or into a BV

Back 32

Follicular carcinoma

Front 33

Rare, <5%, typically presents as rapid enlargement in a long standing goiter, extremely poor prognosis

Back 33

Anaplastic thyroid carcinoma

Front 34

Uncommon (5%), derived from parafollicular (C) cells, sporadic or familial, always a mutation of RET proto-oncogene, increased serum calcitonin

Back 34

Medullary thyroid carcinoma

Front 35

Embryo and histo of the parathyroid gland

Back 35

- Derived from the 3rd and 4th pharyngeal pouches
- 4 glands, one at each pole of thyroid

Front 36

Chief cells secrete ___& oxyphil cells secrete__

Back 36

PTH and unknown

Front 37

Hyperparathyroidism

Back 37

- Primary or secondary
- PTH activates osteoclasts
- Skeletal changes ( ground glass appearance, Brown tumor)

Front 38

This is caused by adenoma or hyperplasia, more common in women and is often silent, painful bones, weakness & fatigue, osteitis fibrous cystica and osteoporosis, metastatic calcifications

Back 38

Primary hyperparathyroidism

Front 39

Most commonly caused by renal failure and symptoms are dominated by renal disease, renal osteodystrophy

Back 39

Secondary hyperparathyroidism

Front 40

Mechanism of secondary hyperparathyroidism

Back 40

Vitamin D needed for calcium absorption in the gut, vitamin D comes from kidney, when kidney's fail so does production of vitamin D

Front 41

Hypoparathyroidism is found in what disease

Back 41

DiGeorge's syndrome

Front 42

Clinical manifestations of hypoparathyroidism

Back 42

1) Hypocalcemia
2) Increased neuromuscular excitability
3) Cardiac arrhythmias
4) Increased intracranial pressure and seizures

Front 43

Causes of hypoparathyroidism

Back 43

Removal, congenital absence, autoimmune

Front 44

Embryo and histo of the pancreas

Back 44

- Arises from endoderm of the foregut
-Islets of Langerhan (endocrine) interspersed among the acinar group of cells (exocrine)

Front 45

Cell types of the pancreas

Back 45

Beta (70%)- Insulin
Alpha (20%) - Glucagon
Delta (10%) - Somatostatin
PP (1-2%) - Pancreatic polypeptide

Front 46

Diabetes Mellitus

Back 46

- Group of metabolic disorders resulting in hyperglycemia due to defects in insulin secretion
- Leading cause of end-stage renal disease, blindness, and amputations
- Involves kindeys, eyes, nerves, BV

Front 47

___ is caused by severe insulin deficiency while ___is caused by insulin resistance and inadequate response to insulin by beta cells

Back 47

Type 1, type 2

Front 48

Presenting symptoms of type 1 diabetes

Back 48

Polyuria, polydipsia, polyphagia w/ weight loss, ketoacidosis (due to fat usage as energy, excess ketones in blood, decreased pH) which can lead to a diabetic coma

Front 49

Presenting symptoms of type 2 diabetes

Back 49

Usually present after 40, polyuria and polydipsia, diagnosis by blood or urine test, enhanced susceptibility of infections

Front 50

Type I diabetes

Back 50

- Absolute lack of insulin secondary to autoimmune destruction of beta cells
- Genetic susceptibility + autoimmune factors + environmental factors
- Abrupt onset
- Requires insulin for survival

Front 51

Type II diabetes

Back 51

- Collection of multiple genetic defects, each contributing its own predisposing risks modified by environment
- Insulin resistance
- Beta cell dysfunction results in inadequate insulin secretion in the face of insulin resistance and hyperglycemia

Front 52

Disposing factors of type 2 diabetes

Back 52

OBESITY(80%, 60% w/ glucose intolerance,adipose is antagonistic to insulin, obese kids=>obese adults), pregnancy, stress

Front 53

Manifestations of DM in pancreas

Back 53

- Reduction of the number and size of islets
- Heavy inflammatory infiltrate
- Amyloid deposition

Front 54

Vascular manifestation of DM

Back 54

- Responsible for 80% DM-related deaths
- Severe and accel. atherosclerosis
- MI
- Gangrene of lower extremities is 100-fold increased
- Thickened membrane in small BV

Front 55

Kidney's of DM

Back 55

1) Glomerular lesions
- diffuse glomerulosclerosis, 90% of diabetics in 10 yrs (not DM specific)
- microangiopathy around glomerular caps and matrix deposition
- proteinuria, total renal failure
2) Nodular glomerulosclerosis
- 35%; DM specific
- ball-like matrix deposition
- total renal failure
- renal atherosclerosis
- pylenonephritis

Front 56

Eye manifestations of DM

Back 56

- 4th leading cause of blindness
- Microangiopathy and microaneurysms
- Retinal detachment and vision loss

Front 57

T/F patients w/ type 2 diabetes die more often than people w/ type 1

Back 57

False, type 1 die by MI, renal failures, cerebrovascular disease, atherosclerosis, infection

Front 58

Insulinoma (Insulin Secreting Islet Cell Tumor)

Back 58

- Beta cell tumor, hyperinsulinism, most are ademonas
- Hypoglycemia quickly occurs from fasting or exercise
- Many asymptomatic, 5-10% malignant
- Nervousness, confusion, stupor
Surgical excision

Front 59

Gastrinoma

Back 59

- Arise in duodenum, peripancreatic tissues, or pancreas
- Gastric acid hyper secretion
- 90-95% of recalcitrant ulcers
- Zollinger-Ellison Syndrome

Front 60

Zollinger-Ellison Syndrome

Back 60

Pancreatic islet cell tumor, hyper secretion of gastric acid and severe peptic ulcers. 60% are malignant and surgery is needed

Front 61

Zona __secretes mineralcorticoids (aldosterone), zona ___secretes glucocorticoids (cotisol), and zona ___ secretes sex hormones (estrogen/androgen)

Back 61

Glomerulosa, fasciculata, reticularis
*adrenal cortex

Front 62

Adrenal medulla (origin, cell type, hormone)

Back 62

Has a neural origin, chromatin cells, source of catecholamines (epinephrine)

Front 63

Hypercortisolism (Cushing's disease)

Back 63

- Excessive exogenous glucocorticoids
- Primary adrenal hyperplasia or neoplasm
- Primary pituitary source: ACTH oversecretion, Cushing disease, skin pigmentation
- Ectopic ACTH secretion by neoplasm, eg lung

Front 64

Signs and symptoms of Cushing's disease

Back 64

- Hypertension
- Weight gain_ "Moon facies" buffalo bump
- Muscle weakness
- Osteoporosis
- Increased risk for infection
- Menstral irregularities, hirsutism, mental disturbances

Front 65

Characterized by sodium retention and potassium excretion, hypertension and hypokalemia

Back 65

Hyperaldosteronism

Front 66

Primary Hyperaldosteronism

Back 66

- Very rare
- Hyperplasia, neoplasm, idiopathic
- Decreased levels of plasma renin

Front 67

Secondary Hyperaldosteronism

Back 67

- Aldosterone release in response to activation of renin-angiotensin system
- Increased levels of plasma renin

Front 68

Hypoadrenalism

Back 68

- Primary or secondary (decreased stimulation of adrenals from ACTH deficiency)
- Don't appear until at least 90% of adrenal gland has been destroyed
- Manifestations: weakness, fatigue, GI disturbances

Front 69

In patients maintained on exogenous corticosteroids, rapid withdrawal of steroids or failure to increase steroids in response to an acute stress can precipitate an adrenal crisis

Back 69

Acute adrenocortical insufficiency

Front 70

Acute adrenocortical insufficiency

Back 70

- Manifestations: vomiting, ab pain, hypotension, coma, death
- Can also be caused by adrenal hemorrhage or stress in a patient w/ existing Addinson's

Front 71

Causes of Addinson's disease

Back 71

- Autoimmune destruction of steroid- producing cells (most common 60-70%)
- TB
- AIDS
- Metastatic disease

Front 72

Addinson's Disease

Back 72

- Progressive destruction of the adrenal cortex
- Serum ACTH may be elevated=> skin & mucosal pigmentation
- Destruction of cortex prevents response to ACTH

Front 73

Potassium retention, sodium loss, hyperkalemia, hypoatremia, volume depletion, and hypotension are seen in what disease?

Back 73

Addinson's disease

Front 74

Any disorder of the hypothalamus or pituitary that reduces output of ACTH

Back 74

Secondary chronic adrenocortical insufficiency
- symptoms similar to Addinson's but no skin/mucosal pigmentation

Front 75

2 types of adrenal neoplasms

Back 75

1- Pheochromocytoma
2- Multiple endocrine neoplasia (MEN) syndrome

Front 76

Pheochromocytoma

Back 76

- Neoplasm of chromatin cells, F>M, 30-60 yo
- Hypertension, tachycardia, tremor, headache
- Large polygonal cells w/ variable pleomorphism

Front 77

Rule of 10's

Back 77

Bilateral, extra-adrenal, malignant, familial syndromes

Front 78

MEN 2B Manifestations

Back 78

- Notable for oral manifestations
- Mucosal neuromas (tongue, labial commisure)
- Large, blubbery lips
- Marfoid body habitus

Front 79

Tumors involved in types 1, 2A, 2B MEN syndrome

Back 79

1- Medullary thyroid carcinoma
2- Pheochromocytoma
3- Parathyroid
4- Pituitary
5- Pancreas
* RET proto-oncogene