quiz 7 review - dentalstudentpathology.files.wordpress.com · quiz 7 review kris.ne kras, m.d....
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Quiz7ReviewKris.neKra1s,M.D.
Organs
PituitaryThyroidParathyroidsAdrenalsPancreas
Diseases
Non-neoplas.cToomuchhormoneTooliFlehormone
Neoplas.cBenignMalignant
EndocrinePathology
• Toomuchanteriorpituitaryhormone(s)
• Mostcommoncause:pituitaryadenoma
• Pituitarysymptoms:• Asymptoma.catfirst• Endocrineabnormali.es• Masseffects(likewhatinpar.cular?*)
• Manytypes
Hyperpituitarism
• TooliFleanteriorpituitaryhormone(s)
• Causes• Pituitarydestruc.on• Ischemicnecrosis• Pituitaryapoplexy
• Symptomsusuallyinsidious(hypothyroidism,adrenalinsufficiency…)
Hypopituitarism
Hyperthyroidism
Ahypermetabolicstatecausedbyincreasedthyroidhormones.
1°:thyroidproblem2°:pituitaryproblem3°:hypothalamicproblem
General:weightloss,heatintolerance
Cardiac:rapidpulse,arrhythmias
Neuromuscular:tremor,emo.onallability
Skin:warm,moist
Gastrointes.nal:diarrhea
Eye:lidlag
Thyroidstorm:extreme,dangeroussymptoms
HyperthyroidismSignsandSymptoms
Hypothyroidism
Ahypometabolicstatecausedbydecreasedthyroidhormones.
1°:thyroidproblem2°:pituitaryproblem3°:hypothalamicproblem
General:fa.gue,weightgain,coldintolerance
Cardiac:slowpulse,impairedcontrac.on
Nervous:delayedreflexes,lethargy
Skin:rough,dry;hairloss(eyebrows)
Gastrointes.nal:reducedappe.te,cons.pa.on
Myxedema:deepenedvoice,“edema”
Myxedemacoma:deteriora.ngmentalstatus
HypothyroidismSignsandSymptoms
Endocrinepathologyinanutshell
problemuphere
problemdownhere
Low Normal High
Low
Normal euthyroidism
High
TSH
T4
Low Normal High
Low
Normal
High1°
hyper-thyroidism
T4
TSH
Low Normal High
Low
Normal
High2°or3°hyper-
thyroidism
T4
TSH
Low Normal High
Low1°
hypo-thyroidism
Normal
High
T4
TSH
Low Normal High
Low2°or3°hypo-
thyroidism
Normal
High
T4
TSH
Low Normal High
Low
Normalsubclinicalhyper-
thyroidism
subclinicalhypo-
thyroidism
High
T4
TSH
Low Normal High
Low *
Normal
High *
T4
TSH
Female
“Hash”
Myxedema
HashimotoThyroidi.s
Mrs.Potatohead
Looksscary
Reallyharmless
Goesawaybyitself
DeQuervainThyroidi.s
Rex
SilentThyroidi.s
Bullseye
SilentDoesn’tcauseproblems
FibrosingThyroidi.s
Woody
Woody
• MostcommoncauseofhyperthyroidisminUS!
• Autoimmune:an.-TSHreceptoran.bodiess.mulatethyroidgrowth
• Triad:hyperthyroidism,ophthalmopathy,dermopathy
GravesDisease
MartyFeldman
noiodine
enzymedefects
↓T4 ↑TSH
unknownreasons
hyperplasia
involu.on
trauma
simple goiter
multinodular goiter
Mul.nodulargoiter
simple goiter multinodular goiter
euthyroid euthyroidhyperfunc.oningnodules
orhypothyroid
Thyroidadenoma
papillary(80%)
follicular(10%)
anaplas.c(<5%)
IncidenceofDifferentTypesofThyroidCarcinoma
medullary(5%)
Papillarycarcinoma:OrphanAnnienuclei
Papillarycarcinoma:psammomabody
Whichoneiscancer?
Follicularthyroidcarcinoma:vascularinvasion
Medullarythyroidcarcinoma
Anaplas.cthyroidcarcinoma
Capsule
Zona glomerulosa
Zona fasiculata
Zona reticularis
Adrenalglandhistology
Medulla
Pa.entwithCushingsyndrome
• Neoplasmofcatecholamine-producingcells
• Rarecauseofhypertension!
• Urine:catecholamines,VMAandmetanephrines
• The10%tumor!• 10%extra-adrenal(“paraganglioma”)• 10%bilateral• 10%(ormore)familial• 10%malignant• 10%don’thavehypertension
Pheochromocytoma
• Derivedfromneuralcrestcells
• Rela.velycommonchildhoodtumor
• PrognosisbeFerin:• Children<18months• Lowerstagetumors• Lowergradetumors• Hyperdiploidtumors• FewercopiesofN-myc
Neuroblastoma
MEN-1PiF-uitaryadenoma
MEN1generun-of-the-millinac.veturnoff
MEN-2Cleese-cellhyperplasia
bRETongeneoneofakindalwaysturnedon