OPT Endocrine
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| feedback inhibition | increased activity of target tissue down regulates secreting gland
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| pituitary gland | bean-shaped gland at base of brain, connected to hypothalamus
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| adenohypophysis | anterior lobe of the pituitary; secretes FSH, LH, ACTH, TSH, PRL, GH
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| neurohypophysis | posterior lobe of the pituitary; secretes {ADH} and {oxytocin}
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| 1. visual field abnormalities 2. elevated intracranial pressure | symptoms of pituitary mass effects:
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| prolactinoma | most common type of hyper functioning pituitary adenoma; amenorrhea, lactation, infertility
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| growth hormone-producing adenomas | excess GH causes {gigantism} before epiphyses close and {acromegaly} if after closure; neoplasms of somatotrophs
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| Cushing syndrome | neoplasm of corticotroph cells that make ACTH causes hypercortisolism
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| gonadotroph adenoma | neoplasm of excess LH or FSH
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| thyrotroph adenomas | neoplasm of excess TSH
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| hypopituitarism | usually acquired diseases intrinsic to the pituitary
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| nonfunctioning pituitary adenomas | neoplasms that mostly exhibit mass effects
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| ischemic necrosis of the anterior pituitary | most commonly seen in {Sheehan syndrome} after pregnancy
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| ablation of pituitary by surgery or radiation | pituitary hypo function from inflammatory conditions
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| pituitary dwarfism | ablation of pituitary gland can cause a GH deficiency in children and they fail to grow
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| posterior pituitary syndromes | clinically important syndromes that involve ADH that is usually released when decreased water concentration in plasma
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| diabetes insipidus | ADH deficiency causes excessive urination because kidney does not resorb water; polydipsia and polyuria
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| central diabetes insipidus | type of diabetes insipidus from ADH deficiency
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| nephrogenic diabetes insipidus | type of diabetes insipidus from renal tubular unresponsiveness but normal ADH levels
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| syndrome of inappropriate ADH secretion (SIADH) | excess ADH production so resorption of excessive water; most commonly from ectopic ADH secretion from tumors and head trauma
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| thyroid | net result of hormones is to increase basal metabolic rate
-disorders can be excess (hyperthyroidism), deficiency (hypothyroidism) and mass lesions
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| hyperthyroidism | most common cause of thyrotoxicosis; hyper metabolic state from elevated T3 and T4
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| thyroid storm | abrupt onset of hyperthyroidism; medical emergency
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| primary hyperthyroidism | decreased levels of TSH but increased T3 and T4 levels
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| Graves disease | most common cause of endogenous hyperthyroidism; an autoimmune disorder
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| 1. thyrotoxicosis 2. ophthalmopathy 3. dermopathy | triad of Grave's disease
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| exophthalmos | abnormal protrusion of the eyeballs
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| pretibial myxedema | scaly thickening and orange peel texture seen in Grave's disease, especially on shins
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| hypothyroidism | deficient production of thyroid hormones
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| cretinism | hypothyroidism in childhood from lack of iodine; kids have skeletal and CNS issues
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| myxedema | hypothyroidism in older children and adults; apathy, mental sluggishness, obesity
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| primary hypothyroidism | serum TSH increased because of loss of feedback inhibition from thyroid
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| chronic lymphocytic (Hashimoto) thyroiditis | most common cause of hypothyroid disease in areas of the world where iodine is in sufficient quantities
-autoimmune destruction of thyroid cells and replacement by lymphocytic cells
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| 1. cytokine-mediated cell death 2. CD8 cytotoxic T-cell mediated cell death 3. antithyroid antibodies | thyrocyte death in Hashimoto's by:
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| hashitoxicosis | hypothyroidism preceded by transient thyrotoxicosis from disruption of thyroid follicles
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| diffuse and multinodular goiter | enlargement of thyroid from impaired synthesis of thyroid hormones from lack of iodine
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| superior vena cava syndrome | goiter that compresses vessels in neck and upper thorax
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| 1. activation of proto-oncogene RET by chromosomal rearrangement 2. germline mutations | unique to thyroid cancers:
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| papillary carcinoma | most common type of thyroid neoplasm from radiation exposure; chromosomal rearrangement of {RET proto-oncogene} resulting in {RET/PTC fusion protein}
-{NTRK1 and BRAF mutations activate MAP kinase pathway}
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| follicular carcinoma | thyroid neoplasm from iodine deficiency
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| medullary carcinoma | most cases are sporadic but some found in MEN 2A and B; caused by {germline RET mutations
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| anaplastic carcinoma | one of the most aggressive human cancers; in older patients with history of goiter
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| parathyroid glands | 4 glands at corners of thyroid; composed of {chief cells} and {oxyphil cells} that secrete parathyroid hormone
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| parathyroid hormone | hormone that is controlled by free calcium levels in the bloodstream, not the pituitary
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| 1. increase osteoclast activity 2. convert Vit. D to active form 3. increase Ca reabsorption in kidneys | 3 ways PTH increases calcium levels
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| hyperparathyroidism | on radiograph, bone looks like {ground (frosted) glass} and is osteoporotic
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| osteitis fibrosa cystica | replacement of resorbed bone by fibrous tissue with cysts; from hyperparathyroidism
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| brown tumors of hyperparathyroidism | aggregates of osteoclasts, giant cells and hemorrhagic debris
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| metastatic calcification | can be secondary to hypercalcemia
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| primary hyperparathyroidism | one of the most common endocrine disorders; causes {hypercalcemia} and often brought on by a parathyroid adenoma
-painful bones, renal stones, abdominal groans and psychic moans
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| secondary hyperparathyroidism | chronic calcium depression, usually from {renal failure}
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| renal osteodystrophy | bone abnormalities seen in patients with renal failure and hyperparathyroidism
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| tertiary hyperparathyroidism | parathyroid activity becomes autonomous and excessive
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| hypoparathyroidism | much less common than hyperparathyroidism; hypocalcemia, muscle spasms, dental abnormalities
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| DiGeorge syndrome | congenitally missing parathyroid glands that causes symptoms of hypoparathyroidism
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| adrenal gland | paired organs with cortex and medulla; makes glucocorticoids, mineralocorticoids and sex steroids
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| adrenal medulla | contains chromaffin cells that make catecholamines, mainly epinephrine
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| 1. hypercortisolism (Cushing syndrome) 2. hyperaldosteronism 3. adrenogenital syndromes | 3 clinical syndromes of adrenocortical hyperfunction (hyperadrenalism)
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| Cushing syndrome (hypercortisolism) | any elevation of glucocorticoids; buffalo hump, moon faces, truncal obesity, hypertension and weight gain
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| primary adrenocortical hyperplasia or neoplasm | autonomous adrenal function independent of the levels of ACTH
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| primary hypothalamic-pituitary disease aka Cushing disease | over-secretion of ACTH with increased skin pigmentation
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| secretion of ectopic ACTH by non-pituitary neoplasms | small-cell lung carcinomas can have this effect
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| hyperaldosteronism | excess aldosterone causes sodium retention and potassium excretion--leads to hypertension and hypokalemia
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| secondary hyperaldosteronism | accompanied by increased levels or renin
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| primary hyperaldosteronism / Conn's syndrome | caused by an aldosterone-producing neoplasm with low renin levels
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| congenital adrenal hyperplasia (CAH) | recessive defect in an enzyme for adrenal steroid biosynthesis with an increase in ACTH; type of adrenogenital syndrome
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| 21-hydroxylase deficiency | most common enzymatic defect in CAH; required for cortisol and aldosterone
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| adrenal insufficiency | only apparent if 90% compromised; can be acute, chronic, or secondary insufficiency
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| Waterhouse-Friderichsen syndrome | massive adrenal hemorrhage secondary to sepsis that can cause acute adrenal insufficiency
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| chronic adrenocortical insufficiency (Addison Disease) | progressive destruction of adrenal cortex with increase in ACTH and pigmentation
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| 1. autoimmune adrenalitis 2. tuberculosis 3. acquired immune deficiency syndrome (AIDS) 4. metastatic cancers | causes of chronic adrenocortical insufficiency
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| secondary adrenocortical insufficiency | any disorder that reduces ACTH production; aldosterone levels and pigmentation remain normal
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| adrenal adenomas | benign adrenal tumors with little consequence
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| adrenocortical carcinoma | rare adrenal tumors that are very metastatic (most tumors in adrenal cortex are not primary tumors)
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| pheochromocytoma | neoplasms of chromaffin cells that release catecholamines, hypertension; uses rule of 10's (10% outside adrenal gland, 10% bilateral, 10% malignant)
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| multiple endocrine neoplasia syndromes | group of dominantly inherited diseases resulting in proliferative lesions of endocrine glands
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| MEN 2 | both Type 2A and 2B have gain-of-function mutations of RET proto-oncogene
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| multiple endocrine neoplasia 2A | involve the thyroid (medullary carcinoma of the thyroid), adrenal medulla (adrenal pheochromocytomas) and parathyroid gland
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| multiple endocrine neoplasia 2B | distinct germline mutation of one amino acid; like MEN 2A but no parathyroid symptoms
-also get {mucosal neuromas} and {ganglioneuromas}
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