Phase 1

endocrine disorders

where is the pituitary gland located

sella turcica of sphenoid bone

what is going wrong in SIADH

excessive ADH secretion

what are the effects SIADH

excess absorption of water in kidney collecting ducts

hyponatremia (lethargy, weakness, convulsions, coma) (cerebral edema)

weight gain due to water retention

what produces ADH

supraoptic nucleus of hypothalamus

what produces oxytocin

paraventricular nucleus of the hypothalamus

what is going on in diabetes insipidus

insufficient production of ADH

what are the effects of diabetes insipidus

polyuria

polydipsia (excessive thrist)

what can the pituitary compress when adenoma grows? what can this cause? (2)

optic chiasma = lateral vision is locked out= tunnel vision

pituitary gland itself= hypopituitarism

what is the most common type of functional adenoma of the anterior pituitary?

hyperprolactinemia/prolactinoma

what effects are seen with prolactinomas?

decreased FSH and LH

females: galactorrhea, amenorrhea, infertiliity

males: decreased libido, impotency, sterility

what is the2nd most common pituitary adenoma?

excessive growth hormone

where is somatomedin-C produced?

liver

describe gigantism

excess endochondral and appositional bone growth

describe acromegaly

appositional bone growth, organomegaly, pituitary failure, compression of optic chiasm causing visual symptoms

what is the 3rd most common pituitary adenoma

cushing’s disease

high ACTH and cortisol + low CRH

cushing disease

high somatotropin, low GHRH

gigantism/acromegaly

high prolactin, low FSH and LH

prolactinoma

cushing disease causes what in the adrenal glands

bilateral adrenal hyperplasia

describe nelson’s syndrome

effects caused by removal of adrenal glands (due to cushing’s disease) causing increased MSH and therefore increased pigmentation

describe simmond’s disease

panhypopituitarism (all hormones of pituitary aren’t being produced)

what is simmond’s disease often caused by

sheehan syndrome (post partum pituitary ischemic necrosis)

describe pituitary dwarfism

isolated growth hormone deficiency (person has proportional body, just little growth)

excessive ADH secretion can cause what

SIADH (syndrome of inappropriate ADH)

symptoms of SIADH

weight gain due to water retention

hyponatremia leading to lethargy, weakness, convulsions, and coma

what is the physiological effect of SIADH

excess reabsorption of water in collecting ducts of kidney

insuffienct production of ADH=

diabetes insipidus

effects of diabetes insipidus

poyluria, excessive thirst (polydipsia)

T/F: diabetes insipidus causes polyphagia (excessive hunger)

false

thyroid gland disorders are most common in what population

females

goiter compressing trachea can cause what symptom

difficulty breathing

goiter compressing esophagus can cause what symptom

dysphagia (difficulty swallowing)

goiter compression recurrent laryngeal nerve can cause what symptoms

hoarse voice

high T4/T3, low TRH and TSH

graves disease

what kind of hypersensitivity is graves disease

type 2 (IgG/IgM)

what autoantibody stimulates the thyroid gland in graves disease

LATS (long acting thyroid stimulator)

T/F: graves disease autoantibodies can’t cross the placenta

false, autoantibodies are IgG so CAN causing neonatal hyperthyroidism

what does the goiter look like in graves disease

symmetrical, hyperplastic and diffuse

increased BMR

sweating

heat intolerance

weight loss

increased appetite

diarrhea

tachycardia

arrhythmias

cardiac failure

hypertension

anxiety, irritability, restless, insomnia

thin hair

oligomenorrhea

exophthalmos

lid lag

clincal features of graves disease

describe cretinism

hypothyroidism in childhood

what are the effects of cretinism

delayed physical and mental development

delayed eruption of teeth

large protuberant tongue

protuberant abdomen and umbilical hernia

dry skin and sparse hair

what is cretinism typically caused by

iodine deficiency

cogenital enzyme deficiency

what is myxedema

hypothyroidism in adult

hashimmoto thyroiditis type of hypersensitivity

type IV (T cells)

what autoimmune disorders are commonly associated with hashimotos

systemic sclerosis

RA

ulcerative colitis

SLE

T/F: hashimotos thyroiditis has no involvement with lymph

false

low T4/T3, high TRH and TSH

hashimotos thyroiditis

low BMR

cold intolerance

weight gain

decrease appetite

constipatioin

bradycardia

decreased cardiac output

hypoventilation and hypotension

anovulation, thick coarse hair, retardation, somnolence (sleepiness)

depression

clinical features of hashimotos thyroiditis

describe subacute granulomatous (de quervain) thyroiditis (with clinical features)

acute onset of painful enlargement of thyroid gland with fever, malaise, and muscle aches

subacute granulomatous (de queervain) thyroiditis is commonly of _____ origin

viral

describe riedel thyroiditis

rare chronic condition characterized by dense fibrosis of thyroid gland

T/F: riedel thyroiditis will cause entire thyroid gland to be non functional

false, unaffected nodules will still function

what do you call the thyroid when it has undergone the metaplasia to dense hyalinized fibrous tissue

woody thyroid

in what other areas of the body might you see effects of reidel thyroiditis

retroperitoneum, mediastinum, orbit

painless goiter

difficulty swallowing

difficulty breathing

hoarse voice

clinical features of riedel thyroiditis

most common neoplasm of thyroid gland

follicular adenoma

describe follicular adenoma

well circumscribed painless nodule

follicular adenoma is benign or malignant

benign

most thyroid carcinomas are caused by mutations in what cells

follicular cells

most common type of thyroid carcinoma

papillary carcinoma

describe neoplasm of papillary carcinoma

well differentiated

non-functional

papillary carcinomas are often caused by what

exposure ot irradiation

T/F: papillary carcinoma has lymph node infiltration

true

what are psammoma bodies

laminated calcium spheres found in histology slide of papillary carcinoma

describe follicular carcinoma of thyroid

well differentiated

gain of function RAS mutation

T/F: follicular carcinoma has lymph node infiltration

false

describe anaplastic carcinoma of thyroid

undifferentiated

mutation in suppressor T53 gene (escapes apoptosis)

rapidly growing

T/F: anaplastic carcinoma has lymph node infiltration

true, and blood

what common carcinomas of thyroid gland often cause death within a year

anaplastic carcinoma

describe medullary carcinoma of thyroid gland

RET gene mutation affecting parafollicular/C cells

produces calcitonin

mass in neck

dysphagia

hoarseness

hypocalcemia

clinical features of medullary carcinoma

primary hyperparathyroidism AKA

von recklinghausen’s disease of parathyroid glands

physiological effects of primary hyperparathyroidism

high PTH causing hypercalcemia, resorption of bone, reabsorption of Ca2+ from kidney and absorption in intestines

bone pain (bones)

urolithiasis (stones)

intestinal cramps (groans)

confusion (moans)

osteitis fibrosa cystica

metastatic calcification

clinical features of primary hyperparathyroidism

describe secondary hyperparathyroidism

high PTH due to low blood calcium

causes of secondary hyperparathyroidism

renal failure, decreased vit D synthesis

paraneoplastic syndrome

effects of secondary hyperparathyroidism

renal osteodystrophy

partial depolarization of nerves/muscles —> spasms

tetany, convulsion

hypoparathyroidism

causes of hypoparathyroidism

digeorge

iatrogenic/idiopathic

high PTH, hypocalcemia

pseduohypoparathyroidism

what causes pseduohypoparathyroidism

genetic disease causing insensitivity of receptor for PTH

pseduohypoparathyroidism can cause what clinical problem (name)

albright’s hereditary osteodystrophy

obese with short stature, short neck

mental retardation (calcificaiton of basal ganglia)

brachydactyly (4th and 5th fingers)

can’t calficy bone but calcifies tissue

albight’s hereditary osteodystrophy

what do you call a primary adenocortical deficiency causing decreased cortisol, increased ACTH and CRH

Addison’s disease

waht are common causes of addisons disease

autoimmune, idiopathic

what are these symptoms describing?

weakness

hypoglycemia

muscle carmps

hair loss

weight loss

hypotension

pigmentation of skin around folds of skin, areola, and genitalia

addisons disease

what is an adrenal crisis

acute effect of lowered cortisol due to stress (trauma, infection, surgery)

what is Waterhouse Friderichsen syndrome

bilateral hemorrhage into adrenal glands with sepitcemia especially due to meningococcal meningitis

adrenogenital syndrome is a congenital problem of what?

21-hydroxylase deficiency

a deficiency in 21- hydroxylase in adrenogenital syndrome results in

decreased glucocorticoid, mineralcorticoid metabolism, shunting cholesterol metabolism to androgen production

what are these symptoms of

female patient

ambiguous external genitalia with hypertrophic clitoris

hirsutism

acne

oligomenorrhea

balding

decreased breast size

adrenogenital syndrome

what are these symptoms of

male patient

enlarged genitalia (infant hercules)

accelerated growth/sexual maturation

adrenogenital syndrome

what is conn syndrome caused by

aldosterone producing adenoma

what are these symptoms describing

hypertension due to increased circulatory volume

hypokalemia causing weakness

impaired renal concentration and polyuria

low plasma renin activity

conn syndrome