Endocrine Pathology

What might be the root of problems, clinically

too much or too little hormone

what are pituitary gland pathologies?

Hyperpituitarism

what are thyroid gland pathologies?

HHPTT

-hyperthyroidism (Graves & multinodular)

-hypothyroidism

-papillary thyroid carcinoma

-thyroid adenoma

-thyroglossal duct cyst

what are parathyroid gland pathologies?

-Primary hyperparathyroidism

-Secondary hyperparathyroidism

what are adrenal gland pathologies?

-Hypercortisolism (Cushing syndrome)

-Adrenal insufficiency (Addison disease)

-Pheochromocytoma

what are pancreas pathologies?

type I and II diabetes

what are the immune mediated diseases?

Graves disease

Hashimoto thyroiditis

Type I diabetes mellitus

what are neoplastic endocrine pathologies?

-pituitary adenoma

-thyroid adenoma

-papillary thyroid carcinoma

-pheochromocytoma

what are developmental endocrine pathologies?

thyroglossal duct cyst

what are metabolic endocrine pathologies?

-Adrenal insufficiency (Addison's disease)

-Hypercortisolism (Cushing syndrome)

-Hyperpituitarism

-Hyperthyroidism

-Hypothyroidism

-Multinodular goiter

-Primary hyperparathyroidism

-Secondary hyperparathyroidism

-Type II diabetes mellitus

what might be the root of problems pathalogically

a problem between the hypothalamus and pituitary

a problem between the pituitary and end organ

The Pituitary is the "_____ gland". The anterior pituitary is controlled by the _____

master; hypothalamus

most endocrine problems occur in the ___ pituitary. What hormones are produced here?

anterior

GH, prolactin, TSH, FSH, LH, ACTH

what are the target organs of growth hormones and the effects?

liver and adipose tissue

stim growth, metabolism of carbs and fats

what are the target organs of prolactin and the effects?

mammary glands

milk prod

what are the target organs of thyroid stimulating hormone and the effects?

thyroid

secretion of thyroid hormones

what are the target organs of follicle stimulating hormone and the effects?

ovaries and testes

regulating reproductive function

what are the target organs of luteinizing hormone and the effects?

ovaries and testes

production of sex hormones

what are the target organs of Adrenocorticotropic hormone and the effects?

adrenal gland

secretion of glucocorticoids

what hormones secreted by the posterior pituitary?

ADH and oxytocin

what is hyperpituitarism? what is the most common cause, and what is the clinical presentation

too much anterior pituitary hormone

pituitary adenoma

endocrine abnormalities

What category does pituitary adenoma belong to? Benign or mallignant?

neoplasia

benign

what are the demographics of pituitary adenoma?

any age, incidence increases with age

what are the clinical presentations of pituitary adenoma?

headaches, vision problems, functional or nonfunctional, silent

how is pituitary adenoma dx? tx?

what is functional pituitary adenoma?

too much hormone is produced

what is nonfunctional pituitary adenoma?

no hormone produced

what is silent pituitary adenoma

normal amount of hormone produced

what is the most common cause of hyperpituitarism?

functional pituitary adenoma

what is the most common hormone overproduced in pituitary adenoma and the effect?

growth hormone; gigantism and acromegaly

occurs pre-puberty characterized by generalized increase in body size and results in disproportionately long limbs

gigantism

occurs post-puberty, growth of soft tissue, skin, viscera, results in enlarged bones of face, hands, and feet, increased spacing between mandibular teeth from mandibular growth

acromegaly- exress GH produced in adults

Which of the following hormones is secreted by the anterior pituitary gland?

a. Oxytocin

b. Antidiuretic hormone (ADH)

c. Growth hormone (GH)

d. Epinephrine

Growth hormone (GH)

Which condition results from excess growth hormone production in adults?

Acromegaly

what is the primary function of thyroid hormones?

control metabolic rate

if the problem is in the pituitary gland, it is considered ____

secondary

if the problem is in the thyroid gland, it is considered

primary

lab tests will show a _____ in TSH in primary hyperthyroidism

decrease

lab tests will show ____ T3 and T4 in primary hyperthyroidism

increase

in secondary hyperthyroidism lab tests will show a ____ in T3 and T4 and a ___ in TSH

increase; increase

in primary hypothyroidism lab tests will show a ____ in T3 and T4 and a ____ in TSH

decrease; increase

in secondary hypothyroidism lab tests will show a ____ in T3 and T4 and a ____ in TSH

decrease; decrease

excess thyroid hormone productiondefinition of hyperthyroidism

definition of hyperthyroidism

what are the most common causes of hyperthyroidism?

graves disease and multinodular goiter

clinical presentation of hyperthyroidism

weight loss

tachycardia

heat intolerance

tramor

anxiety

thyroid storm

what is thyroid storm?

abrupt onset of severe hyperthyroidism

medical emergency (cardiac arrhythmias may be fatal)

how is hyperthyroidism dx?

elevated circulating T3 and T4

what category is graves disease in?

immune-mediated

what causes graves disease?

autoimmune; autoantibodies against the TSH receptor result in increased thyroid hormones and proliferation of thyroid follicles

what disease is the most common cause of hyperthyroidism?

graves disease

demographics of graves disease?

more common in women, 20-40 year age range

what is the clinical presentation of graves disease?

symptoms of hyperthyroidism

exophthalmos

enlarged thyroid gland

dermopathy

thyroid storm possible

what is dermopathy? What disease is it associated with?

scaly thickening and induration of skin of the shins; Grave's disease

how is Graves disease dx? tx?

DX: elevated circualting T3 and T4, decreased levels of circulating TSH

TX: anti-thyroid medication, radioactive iodine, surgery

What is the category of multinodular goiter?

metabolic

what causes multinodular goiter?

-decrease in thyroid hormone(dietary iodine deficiency) leads to increased serum TSH (hypertrophy and hyperplasia of thyroid follicles) and can result in increased thyroid hormone over time

what is the most common manifestation of thyroid disease characterized by an enlargement of the thyroid gland?

multinodular goiter

multinodular goiter is most common in _____

women

what is the clinical presentation of multinucleated goiter?

-enlarged thyroid gland

-can cause symptoms of hyperthyroidism over time

how is multinodular goiter dx? tx?

DX: ultrasound

biopsy

thyroid function tests

TX: radioactive iodine,

surgery

deficiency in thyroid hormone production is called...

hypothyroidism

what is the most common causes of hypothyroidism?

Hashimoto thyroiditis

iodine deficiency

what is then clinical presentation of hypothyroidism?

fatigue

weight gain

cold intolerance

dry skin

constipation

how is hypothyroidism dx?

low circulating T3 and T4

Hashimoto category

immune-mediated

what is the cause of hashimotos thyroiditis?

autoimmune, auto-antibodies against thyroid antigens cause progressive destruction of thyroid epithelial cells and a chronic inflammatory response

what are the auto-antibodies against thyroid antigens?

Thyroid peroxidase (TPO) antibodies

Thyroglobulin (Tg) antibodies

demographics of hashimoto

genetic component, middle-aged women

clinical presentation of hashimoto

painless thyroid enlargement - usually diffuse and symmetric

symptoms of hypothyroidism

how is hashimoto dx?

biopsy

thyroid function tests

detection of auto-antibodies

what autoantibodies used in hashimoto testing/ detection?

anti-thyroglobulin

anti-thyroid peroxidase antibody

how is hashimoto tx?

thyroid hormone replacement therapy

thyroid adenoma category?

neoplastic

what causes thyroid adenoma?

benign tumor of the thyroid arising form follicular cells

demographics of thyroid adenoma

more common in women

30-50 years

what is the clinical presentation of thyroid adenoma?

-painless thyroid nodule

-may have symptoms of hyperthyroidism

-may be euthyroid

how is thyroid adenoma dx? tx?

DX: ultrasound

biopsy

thyroid function tests

TX: monitor, surgery

papillary thyroid carcinoma category

neplastic

what is the papillary thyroid carcinoma?

thyroid mallignancy

what is the clinical presentation of papillary thyroid carcinoma?

painless thyroid mass

may have lymphadenopathy

how is papillary thyroid carcinoma dx? tx?

DX: ultrasound, 4biopsy

TX: surgery, good prognosis

thyroglossal duct cyst category

developmental

thyroglossal duct cyst etiology

congenital cyst remnants of thyroglossal duct

demographics of thyroglossal duct cyst

present from birth and apparent in children and young adults

how is thyroglossal duct cyst dx? tx?

DX: imaging

TX: excision

what is the function of parathyroid hormone?

regulates calcium and phosphate levels, plays a crucial role in bone metabolism

primary hyperparathyroidism category

metabolic

primary hyperparathyroidism etiology

overproduction of PTH most commonly due to parathyroid adenoma

demographics of primary hyperparathyroidism

most common in women and older adults

clinical presentation of primary hyperparathyroidism?

hypercalcemia

kidney stones

bone pain

frequent urination

depression and confusion

how is primary hyperparathyroidism dx? tx?

DX: high serum calcium

high parathyroid hormone

low serum phosphate

TX: SURGICAL REMOVAL OF ADENOMA

secondary hyperparathyroidism category

metabolic

secondary hyperparathyroidism eitiology

chronic low calcium levels most often secondary to chronic kidney disease.

This results in overproduction of PTH by parathyroid

caused less commonly by vitamin D deficiency or malabsorption

secondary hyperparathyroidism demographics

patients with chronic kidney disease

what is the clinical presentation of secondary hyperparathyroidism?

decreased bone mineralization - renal osteodystrophy

calciphylaxis

what is calciphylaxis?

calcification of blood vessels secondary to hypophasphatemia

how is secondary hyperparathyroidism dx? tx?

DX:

-low or normal serum calcium levels

-high serum PTH and phosphate levels

-vitamin D levels may be low

TX: treat underlying cause

what is the primary function of parathyroid hormone?

maintain calcium homeostasis

secondary hyperparathyroidism is most commonly associated with which condition?

chronic kidney disease

what is produced in the adrenal cortex?

glucocorticoids

mineral corticoids

androgens