Term
| In hyperthyroidism, what is happening to the skeletal muscle and bone? |
|
Definition
| There is increased bone resorption and skeletal muscle atrophy |
|
|
Term
| A thyroid storm most often occurs in whome? |
|
Definition
| people with Graves disease that encounter additional stress (like an infection) |
|
|
Term
| In an iodine uptake test, what is the result for Graves? |
|
Definition
|
|
Term
| What is the classic triad for Graves? |
|
Definition
| there is hyperthyroidism (w/ bruit due to increased blood flow), exophthalmos, and pretibial myxedema |
|
|
Term
| In Graves ophthalmopathy, why is there increased volume of retro-orbital connective tissue? |
|
Definition
| due to mononuclear infiltration, inflammatory edema, and accumulation of extracellular matrix |
|
|
Term
| A person with a protruding tongue, umbilical hernia, and coarse features and is a child is likely displaying the signs of what disease? |
|
Definition
|
|
Term
| In hypothyroidism, what are the TSH, T4, T3 patterns? |
|
Definition
| Both T4 and T3 are decreased while TSH is increased |
|
|
Term
| In which thyroid disease do we find Hurthle cell metaplasia? |
|
Definition
|
|
Term
| What's the most common cause of thyroid pain? |
|
Definition
| granulomatous thyroiditis |
|
|
Term
| In granulomatous thyroiditis, what is the T4/T3/TSH pattern? |
|
Definition
| Initially, you have mild hyperthyroidism, but the radioactive iodine uptake is decreased |
|
|
Term
| In which population are you most likely to find subacute lymphocytic thyroiditis? |
|
Definition
|
|
Term
| Upon microscopy of subacute lymphocytic thyroiditis, what do we often find? |
|
Definition
| lymphocytic infiltration with hyperplastic germinal centers within the thyroid parenchyma and patchy disruption and collapse of thyroid follicles |
|
|
Term
| What is a distinguishing feature of a multinodular goiter from a follicular neoplasm? |
|
Definition
| there is no prominent capsule, so the normal parenchyma is being compressed by the abnormal |
|
|
Term
| What is Plummer Syndrome? |
|
Definition
| when a person develops an autonomous hyperactive nodule (aka toxic multinodular goiter) |
|
|
Term
| For follicular adenoma,what factor distinguishes it from a carcinoma? |
|
Definition
| capsular and/or vascular invasion upon resected specimen |
|
|
Term
| Which type of malignant thyroid neoplasm may present in childhood? |
|
Definition
|
|
Term
| What environment factor increases the risk for a follicular carcinoma? |
|
Definition
|
|
Term
| What type of thyroid cancer accounts for the majority of those associated with radiation? |
|
Definition
| papillary thyroid carcinoma |
|
|
Term
| Upon histologic examination, what is unique in papillary thryoid cancer? |
|
Definition
| so you pale nuclei with grooves and intranuclear inclusions |
|
|
Term
What is the typical prognosis for papillary thyoid carcinoma? |
|
Definition
| excellent/ 10 year survival 95% |
|
|
Term
| In PTC, how does the MAP kinase pathway get activated? |
|
Definition
| Through RET/PTC fusion-> TK activation or point mutations in BRAF gene |
|
|
Term
| On scintigrams, how do follicular carcinomas typically present? |
|
Definition
|
|
Term
| What is the genetic basis for follicular carcinoma? |
|
Definition
| Activation of PI-3/AKT pathway or PAX8: PPARG translocation |
|
|
Term
| What's the origin of medullary thyroid carcinoma? |
|
Definition
| neuroendocrine, derived from parafollicular cells of thyroid |
|
|
Term
| In what setting do familial medullary thyroid carcinomas occur? |
|
Definition
| In setting of MEN2A or 2B/ also look for activating mutations in RET-proto oncogene |
|
|
Term
| Upon microscopic examination of medullary thyroid carcinoma, what do we commonly find? |
|
Definition
| polygonal cell nests/trabeculae/ neuroendocrine cells have "salt and pepper" chromatin |
|
|
Term
| If there is a RET proto-oncogene mutation in MTC, what is not there though? |
|
Definition
| RET/PTC fusion like in PTC |
|
|
Term
| What sort of tumor commonly causes hypothyroidism? |
|
Definition
| non-functioning pituitary adenoma |
|
|
Term
| What percentage of patients with a pituitary adenoma have a MEN1 mutation? |
|
Definition
|
|
Term
| What are the two key histologic features of pituitary adenomas? |
|
Definition
| monomorphism, absence of reticulin supporting network |
|
|
Term
| Hyperprolactinemia between 30 and 200 indicates what cause? |
|
Definition
|
|
Term
| In acromegaly, what happens to the bones? |
|
Definition
| The bone length does not increase, but is increased periosteal thickening |
|
|
Term
| What are Rathke's cleft cysts lined with? |
|
Definition
| ciliated cuboidal epithelium, goblet cells, and cells of the anterior pituitary |
|
|
Term
| Which patients are most likely to get an empty sella syndrome? |
|
Definition
| patients who are obese and a history of multiple pregnancies |
|
|
Term
| What are craniopharyngiomas derived from and what structure is affected? |
|
Definition
| derived from remnants of Rathke pouch (odontogenic epithelium) and they affect hypothalamic function |
|
|
Term
| What is the age distribution for a craniopharyngioma? |
|
Definition
| bimodal (5-15 and then >60) |
|
|
Term
| Characterize the histology of the craniopharyngioma? |
|
Definition
| stratified squamous epithelium embedded in spongy reticulum/palisading of squamous cells at edges |
|
|
Term
| If yound a cystic tumor containing viscous fluid and cholesterol flecks, what's your dx? |
|
Definition
|
|
Term
| What are most pinealomas? |
|
Definition
|
|
Term
| What are the three primary cell populations in the parathyroid? |
|
Definition
| chief cells (pale basophilic cytoplasm), water clear cells (contain a lot glycogen) and oxyphil cells (chief cells + mitochondria) |
|
|
Term
| Symptomatic hypercalcemia is indicative of what? |
|
Definition
|
|
Term
| What is the most common reason for primary hyperparathyroidism? |
|
Definition
|
|
Term
| T or F- MEN1 changes are seen in some sporadic parathyroid tumors |
|
Definition
|
|
Term
| T or F- MEN 2A changes are seen in some sporadic parathyroid tumors |
|
Definition
|
|
Term
| What is the primary reason for familial hypocalciuric hypercalcemia? |
|
Definition
| inactivating mutaions in parathyroid calcium-sensing receptor gene on Chromosome 3q |
|
|
Term
| Parathyroid adenoma is composed primarily of what cells? |
|
Definition
| uniform polygonal chief cells |
|
|
Term
| What percent of pheochromocytomas are not associated with hypertension? |
|
Definition
|
|
Term
| MTC, Marfanoid Habitus, Mucocutaneous ganglioneuromas are associated with what syndrome |
|
Definition
|
|
Term
| With both MEN IIa and IIb, what neoplasms are common? |
|
Definition
| pheochromocytoma and medullary carcinoma of thyroid |
|
|
Term
| Describe the histology of pheochromocytoma? |
|
Definition
| polygonal/spindle cells clustered with sustentacular cells in Nests of Zellballen/ with salt-pepper chromatin |
|
|
Term
| What lab markers are used to diagnose pheochromocytoma? |
|
Definition
|
|
Term
| What's the primary cause of hyperaldosteronism? |
|
Definition
|
|
Term
|
Definition
| aldosterone-secreting adrenal cortical adenoma |
|
|
Term
| In secondary hyperaldosteronism, what happens to the renin level? |
|
Definition
|
|
Term
| How do we treat primary adrenal hyperplasia leading to aldosteronism? |
|
Definition
| we admire a K+ sparing diuretic like spironolactone |
|
|
Term
| What hormone is responsible for regulating adrenal androgen formation? |
|
Definition
|
|
Term
| Are adrenocortical neoplasms associated with virilization more likely to be androgen-secreting carcinomas or adenomas? |
|
Definition
|
|
Term
| 90% of cases of adrenal virilism are due to what? |
|
Definition
| 21 hydroxylase deficiency |
|
|
Term
| TSH is structurally similar to what other hormone? |
|
Definition
|
|
Term
| In salt-wasting syndrome, what's a clear sign of female virilization? |
|
Definition
| clitoral enlargement (phallic like) |
|
|
Term
| What does 11 hydroxylase deficiency lead to ? |
|
Definition
| excessive androgen production causing virilization, hypertension (due to buildup of 11-DOC) and hypokalemia |
|
|
Term
| How is Waterhouse-Friederichsen syndrome characterized? |
|
Definition
| rapidly developing hypotension, DIC, adrenal hemorrhage |
|
|
Term
| When are the clinical manifestations of Addison disease seen? |
|
Definition
| when 90% of the cortical cells are destroyed |
|
|
Term
| What are the two main types of autoimmune adrenalitis and what is the difference between them |
|
Definition
| APS1 and 2/ APS 1 has mucocutaneous changes while APS 2 doesn't (accounts for 60-70% of Addison cases) |
|
|
Term
| What feature of primary adrenocortical insufficiency is not present in secondary? |
|
Definition
|
|
Term
| What is the only way to detect adrenal malignancy? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What three organs are affected in MEN1? |
|
Definition
| parathyroid, pituitary, and pancreas |
|
|
Term
| What's the pathogenesis behind MEN 2A? |
|
Definition
| germ-line mutations of RET proto-oncogene on chromosome 10q11.2--> leading to constitutive activation of RET receptor |
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