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43 Cards in this Set
- Front
- Back
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lecture 28
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*Pituitary Gland*
-Size 1 cm in greatest dimension -Weight ~0.5 gm -Located at base of brain within the ... -Attached by a stalk to the hypothalamus -Known as the "... gland" *Plays a critical role in regulation of other glands -Up to ~25% of people have small pituitary tumors at autopsy -Only 14/100,000 have clinically significant tumors |
sella turcica
master |
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*Pituitary Gland Development*
Anterior pituitary (adenohypophysis) compromises ~80% of the pituitary gland -derived from ... which is an extension of the oral cavity -has a ... vascular system through which releasing hormones arrive from the hypothalamus Posterior pituitary (neurohypophysis) compromises ~20% of the pituitary gland -derived from outpouchings of floor of the ... ventricle -consists of modified glial cells and axonal processes extending from nerve cell bodies in the ... and ... nuclei of the hypothalamus |
Rathke's pouch
portal 3rd supraoptic and paraventricular |
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*Pituitary Hormones*
Anterior pituitary -Somatotrophs --> ... -Thyrotrophs --> ... -Corticotrophs --> ... -Gonadotrophs --> ... Posterior pituitary (hormones made in hypothalamus and stored in posterior pituitary) -... and ... |
Prolactin and Growth hormone (GH)
Thyroid-stimulating Hormone (TSH) Adrenocorticotrophic Hormone (ACTH) Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH) -Antidiuretic Hormone (ADH) and Oxytocin |
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look at slide 9 (lecture 28)
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What happens to pituitary hormone output when there is loss of hypothalamic input ?
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Prolactin increases, all other pituitary hormones decrease
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*Pituitary Adenomas*
Most common cause of hyperpituitarism is an ... arising in the adenohypophysis These adenomas may be -... *associated with hormone excess with clinical manifestations -... *no overt hormone excess or clinical manifestations Classified based on hormones produced by the tumor cells -used ... stains to identify the hormones |
adenoma
Functional Silent histochemical |
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look at slide 16 (lecture 28)
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What is the most common type of pituitary adenoma?
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prolactinoma
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*Prolactinomas*
Most common type of pituitary adenoma ~40% -Elevated ... levels Symptoms -Galactorrhea -Amenorrhea -Infertility -Impotence -... libido -Headache -Vision changes |
prolactin
Decreased |
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*Prolactinomas*
DDX -Other causes of elevated prolactin *...thyroidism *Drugs (haloperidol, trifluoperazine, metoclopramide) *Other pituitary tumors -may block ... flow Treatment -Drugs: ..., ... *effective in ~80% of patients -Surgery *... - most common approach *craniotomy - larger more extensive tumors -Radiation therapy (newer option) *... |
Hypo
dopamine bromocriptine, cabergoline transsphenoidal gamma knife |
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*Growth Hormone Producing Pituitary Adenomas* - Clinical Features
Children & Adolescents (prior to fusion of growth plates) -... - tall stature, long extremities Adults -... *enlargement of facial features, hands and feet, heart disease, hypertension, arthritis, carpel tunnel syndrome, amenorrhea, and impotence |
Gigantism
Acromegaly |
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look at slide 24
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*... *
-Sudden hemorrhage into the pituitary gland often occurring in a pituitary adenoma -Patent presents with sudden onset of severe headache, diplopia, hypopituitarism -Can lead to cardiovascular collapse, loss of consciousness, sudden death -This is a ... EMERGENCY! |
Pituitary Apoplexy
SURGICAL |
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*... *
-During pregnancy the anterior pituitary enlarges to twice normal size -The pituitary blood supply DOES NOT increase resulting in relative ... -Any reduction in blood supply caused by obstetric hemorrhage or shock may result in ... -The ... pituitary is typically not affected because it has a direct arterial blood supply |
Sheehan Syndrome
anoxia infarction posterior |
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*... *
Primary -defect in the diaphragma sella that allows arachnoid mater and cerebrospinal fluid to herniate into the sella and compress the pituitary Secondary -a mass (such as a pituitary adenoma) enlarges the sella but is then either surgically removed or undergoes spontaneous necrosis |
Empty Sella Syndrome
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lecture 29
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look at slide 3-4 (lecture 29)
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...: general term for an enlarged thyroid gland
Latin “guttar” (throat) Etiology: defective ... synthesis – worldwide is most commonly due to ... -Results in rise in ... *Leads to hypertrophy and hyperplasia of thyroid follicular cells *Thyroid enlarges *Compensatory increase in mass helps overcome the hormone deficiency so that most are ... -May have problems due to mass effect |
Goiter
T4 iodine deficiency TSH euthyroid |
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Simple Goiter (diffuse nontoxic goiter):
Thyroid is enlarged without nodule formation ... |
Euthyroid
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... – substances that interfere w/ thyroid hormone synthesis. They stimulate goiter.
examples: excess calcium, cabbage, cauliflower, brussel sprouts, turnips, cassava |
goitrogens
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Multinodular Goiter
-Thyroid is irregularly enlarged with nodule formation -Typically ... -Females ... Males -Late in the course may develop hyperthyroidism *... multinodular goiter (... syndrome) -Microscopic *Nodules with varying sizes *May see calcification, hemorrhage, cyst formation, scarring |
euthyroid
> Toxic Plummer |
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What is the most common cause of hypothyroidism in the US?
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iatrogenic hypothyroidism
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*Iatrogenic Hypothyroidism*
-Most common cause of hypothyroidism in United States -Due to ... or ... -Rx: ... |
radioactive iodine or thyroidectomy
Levothyroxine |
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What are the 4 types of thyroiditis? (inflammation of the thyroid)
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Hashimoto’s, subacute, silent, fibrosing thyroiditis
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...:
-Commonest cause of noniatrogenic hypothyroidism in US! -F>>M, 10-20:1 ratio -Age 45-65 -... destruction of gland -Painless goiter -Genetic component *..., Turner syndrome, HLA-DR3, HLA-DR5 -Gross: pale and enlarged thyroid with some nodularity, tends to become ... with time -Micro: ... inflammation with germinal centers, areas with follicles lined by cells with pink granular cytoplasm (... cells) |
Hashimoto’s thyroiditis
Autoimmune Trisomy 21 atrophic lymphocytic Hurthle |
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Hashimoto’s Thyroiditis:
Autoantibodies (non-stimulatory) -anti-... (specific for Hashimoto’s and Graves’ disease) -anti-... (previously called antimicrosomal antibody, sensitive but not specific as 20% of adult women without disease have these antibodies) - anti-... (less sensitive but similar specificity as anti-thryoid peroxidase -anti-iodine transporter (rare) May be associated with other autoimmune diseases -Type I diabetes, lupus, rheumatoid arthritis, Sjogren syndrome, myasthenia gravis Increased risk of developing ... |
TSH
thyroid peroxidase thyroglobulin B-cell non-Hodgkin lymphomas |
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look at slide 23 (lecture 29)
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*... *
-AKA DeQuervain thyroiditis -AKA granulomatous thyroiditis -Second most common form of thyroiditis -Females>Males, 3-5:1 -Age 30-50 -Recent ... -Gross: ... firm enlarged thyroid -Micro: early-... and destruction of follicles with colloid depletion; later-... surround follicles and engulf colloid; late-... -Cause of transient hyperthyroidism -Self-limiting (rx NSAIDS, Steroids) |
Subacute Thyroiditis
URI (upper respiratory infx) Tender neutrophils noncaseating granulomas fibrosis |
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*... *
Common autoimmune disease! Females:Males ~7:1 Ages 20-40 Triad -Hyperthyroidism (causes ~60% of cases) -Ophthalmopathy -Dermopathy -> pretibial myxedema Anti-... receptor antibodies -Stimulate thyroid growth -Cause ... release -React with retro-orbital tissues, skin of legs |
Graves Disease
TSH T4 |
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Graves disease:
Gross: symmetric diffusely enlarged thyroid, has a red cut surface (prominent ...) Micro: hyperplastic follicles with ... colloid, papillae |
vascularity
scalloped |
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look at slide 35 (lecture 29)
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*Thyroid Neoplasms*
Most neoplasms present as nodules -Nodules are common (4-7% of population) -Most nodules are ... (90-95%) |
benign
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*... *
-Common! -Most are derived from follicular epithelium and are called follicular adenomas -Most patients are ... (some are hyperthyroid –... adenomas) -Radioactive iodine uptake: most adenomas are “...” -Toxic adenomas are “...” -Need to excise *Must see the whole tumor (including capsule ) to make sure it’s not a cancer (cancer will invade outside of capsule of thyroid) |
Thyroid Adenoma
euthyroid toxic cold hot |
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What are the 4 types of thyroid cancer?
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Papillary, follicular, medullary and anaplastic thyroid carcinoma
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*... Thyroid Carcinoma*
-Most common (80% of malignant thyroid tumors) -Females > Males -Age 30-50 -Risk factor: ... exposure -Uncommon familial syndromes such as familial adenomatous polyposis, Gardner’s syndrome, and Cowden’s disease may be associated with thyroid papillary tumors in about 5% of cases |
Papillary
radiation |
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*Papillary Carcinoma: The ... Tumor*
-Has nuclei that resemble Orphan Annie’s eyes -Good prognosis: 20 year survival is ~90% |
Little Orphan Annie
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*Papillary Thyroid Carcinoma*
Micro -Papillary pattern -... “Orphan Annie” nuclei -Nuclear grooves -Intranuclear cytoplasmic ... ... spread Surgical treatment Use ... for metastases |
Clear
inclusions Lymphatic I-131 |
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... Thyroid Carcinoma:
-10-20% of thyroid cancers (2nd most common) -Females>males -Age 40-60 -Must differentiate from ... (do surgery) -Prognosis dependent on extent at diagnosis *If confined to thyroid at presentation then 10 year survival ~90% -Hematogenous metastases common *Bone, liver, lungs (spread by blood) *Associated with poor survival |
Follicular
follicular adenoma |
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Follicular Thyroid Carcinoma:
Gross -usually single encapsulated nodule, focally ...; variable fibrosis and calcification; larger lesions often infiltrate surrounding structures Microscopic -uniform small follicles containing colloid often resembling normal thyroid, need convincing evidence of ... of adjacent thyroid parenchyma, capsule (complete penetration) or blood vessels (medium sized veins or larger vessels in or beyond the capsule) in order to make diagnosis of cancer Treatment : surgery and RAI, postop give thyroid hormone to suppress ..., which may stimulate it to grow |
hemorrhagic
invasion TSH |
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... Thyroid Carcinoma:
-~5% of thyroid cancers -Neuroendocrine tumor *derived from ... cells (parafollicular cells) which secrete ... -75% are sporadic (... patients) -25% are familial (... patients) and associated with MEN (multiple endocrine neoplasia) syndrome 2A or 2B -Treatment: ... -... prognosis than papillary or follicular carcinoma *5 yr survival ~85% |
Medullary
C calcitonin older younger thyroidectomy Worse |
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Medullary Thyroid Carcinoma:
Gross -single or multiple nodules -typically ... -Solid, gray-tan-yellow, firm Micro -round, polygonal or spindle cells in nests, cords or follicles - defined by sharply outlined fibrous bands - stroma has ... deposits |
nonencapsulated
amyloid |
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*... Thyroid Carcinoma*
-Rare, less than 5% of thyroid cancers -Females:Males ~3:1 -Mean age 65 -Bulky, fast-growing -Often ... at diagnosis -Very bad prognosis – mortality rate approaches 100%, no effective therapy |
Anaplastic
metastatic |
