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Patho Test 2 - Endocrine Disorders
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81
Anatomy
Graduate
06/20/2016

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Term
Primary
Definition
Type of endocrine failure where Problem is with the end organ (thyroid, adrenals, gonads)
Term
Secondary
Definition
Type of endocrine failure where Problem is with the pituitary
Term
Tertiary
Definition
Type of endocrine failure where Problem is with the hypothalamus
Term
Releasing/inhibiting factors
Vasopressin/Oxytocin
Definition
What does the hypothalamus secrete?
Term
ACTH (adrenocorticotropic hormone)
TSH (thyroid stimulating hormone)
FSH/LH (gonadotropins)
Prolactin
Somatotropin (Growth Hormone)
Definition
What does the anterior pituitary secrete?
Term
Growth Hormone
Definition
Protein hormone produced by specific pituitary cells: somatotropes
Facilitates growth via insulin-like growth factor I (IGF-I)
Stress-reactive functions via glucose metabolism
Term
Dwarfism
Nothing (the decline is normal)
Definition
Growth hormone deficiency in childhood?
What about adulthood?
Term
Giantism/gigantism
Acromegaly
Definition
Growth hormone excess in childhood?
What about adulthood?
Term
Acromegaly
Definition
Most commonly due to pituitary tumor

Excess GH in adults leads to:
Diabetes
Cardiac enlargement
Soft tissue swelling including:
Increasing head size
Increasing shoe size
Term
Exogenous growth hormone
Definition
Treatment for GH deficiency
Term
Surgery: excise pituitary tumor
Medications:
Drugs which block GH release (somatostatin***)
Drugs which block GH receptors
Definition
Treatment for GH excess
Term
Prolactin
Definition
Protein hormone produced by lactotropes
Term
Growth hormone releasing hormone (GHRH) to stimulate
Inhibition by somatostain
Definition
How does the hypothalamus control GH?
Term
Lactation failure

Galactorrhea
Suppression of gonadal function
Definition
Prolactin deficiency leads to what?
Prolactin excess leads to what?
Term
Dopamine agonists: Cabergoline (Dostinex) is the best drug for this
Definition
What is the best treatment for hyperprolactinemia? What is the best drug for this?
Term
Production & release inhibited by dopamine***
Release stimulated by TRF (thyrotropin-releasing factor)
Definition
Production and release of prolactin inhibited by what?
Stimulated by what?
Term
Cushing’s Syndrome
Definition
Signs and symptoms due to excess secretion of cortisol by the adrenal gland
Term
On top of the kidneys
Definition
Where are the adrenal glands located?
Term
Medulla and cortex
Definition
What are the two parts of the adrenal gland?
Term
Secretes epinephrine & norepinephrine
(part of the sympathetic nervous system)
Definition
What is the function of the medulla part of the adrenal gland?
Term
Secretes steroids of three types
Definition
What is the function of the cortex part of the adrenal gland?
Term
Glucocorticoid (cortisol)
Androgens (androstenedione, DHEA-S)
Mineralocorticoids (aldosterone)
Definition
What are the three types of steroids secreted by the adrenal gland?
Term
Pituitary secretes ACTH which…

Stimulates the adrenal cortex to produce cortisol

Cortisol inhibits ACTH secretion
Definition
Describe the negative feedback loop of the pituitary and adrenal gland
Term
Iatrogenic (pharmacologic)
Secondary Adrenal Hyperplasia
Primary adrenal hyperplasia
Definition
What are the three causes of Cushing's syndrome?
Term
An ACTH secreting tumor of the pituitary causes the adrenal cortex to produce more cortisol than normal
Definition
Describe secondary adrenal hyperplasia
Term
Enhances glucose production
Improves resistance to stress (raises blood pressure and causes more glucose to be available)
Hematopoietic/Immunologic (lowers lymphocyte and monocyte levels)
Definition
What does cortisol do?
Term
Weight Gain (Central Obesity)
Hyperglycemia
Impaired Healing
Bone Loss/Osteoporosis
Edema
Peptic Ulcers
Euphoria/hallucinations
Definition
Adverse effects of cortisol
Term
Benign microadenomas
Definition
The vast majority of pituitary tumors are what?
Term
Prolactin (most common)
ACTH
Growth hormone
Definition
What are the three secretory types of pituitary tumors?
Term
produce thyroid hormones
Definition
Main task of the thyroid
Term
T3: triodothyroinine
Amino acid tyrosine with 3 iodine groups
Is the main functional hormone
Definition
What is T3 and what does it do?
Term
T4: tetraiodothyroinine, thyroxine
Amino acid tyrosine with 4 iodine groups
T4 is converted to T3 in peripheral tissues
Pharmacologic preferred form, easier to administer (once per day vs. 3 times per day/ less expensive)
Definition
What is T4 and what does it do?
Term
Virtually all tissues (Especially concentrated in brain, heart, muscle, kidneys, gonads)

Activated receptors increase…
Energy utilization
Protein synthesis
Sensitivity to other hormones
Definition
Where are T3 receptors located and what do they do?
Term
Thyrotropin-releasing hormone (TRH) or factor (TRF)
Definition
Stimulates the release of TSH and prolactin
Term
Thyrotropin, Thyroid stimulating hormone (TSH)
Definition
Stimulates the thyroid to produce T3 & T4
Term
Endemic Goiter
Caused by low dietary iodide availability***
Definition
What is the most common type of goiter and where is it located?
Term
exposure to ionizing radiation***
Definition
What is the main risk factor of thyroid cancer?
Term
Palpable, non-tender nodule***

Other symptoms only for large tumors:
Neck discomfort
Trouble with swallowing (dysphagia)
Hoarseness: injury to recurrent laryngeal nerve
Definition
Thyroid Cancer Symptoms
Term
FNA – Fine needle aspiration biopsy
Definition
How do you diagnose thyroid cancer?
Term
Papillary

Follicular

Medullary

Anaplastic
Definition
Four Main Types of Thyroid Cancer
Term
Papillary
Definition
What is the Most common & most benign form of thyroid cancer?
Term
Surgical excision (thyroidectomy)

Radioactive iodine for metastatic disease

Lifelong thyroid hormone replacement
Thyroxine
Definition
Treatment of thyroid cancer
Term
Excellent (>90% 5 year survival) for:
Papillary, follicular & medullary if tumor limited to the thyroid at diagnosis

Poor for anaplastic thyroid cancer
One year survival: 10%
Five year survival: 5%
Definition
Prognosis for thyroid cancer
Term
Graves’ Disease
Toxic nodular goiter
Definition
What are the two main types of hyperthyroidism?
Term
TSH very low or non-detectable***
T4 level very high
Sometimes auto-immune disorder tests are positive
Definition
How does a laboratory confirm hyperthyroidism?
Term
Restlessness
Insomnia
Tremor
Weight loss
Heat intolerance
Weakness
Fatigue
Muscle cramps
Menstrual irregularities
Definition
Hyperthyroid Symptoms
Term
Graves’ Disease
Definition
Most common type (60-80%) of hyperthyroidism
Term
Graves’ Disease
Definition
Results from auto-antibodies that bind to and activate TSH receptors
Term
8:1
Definition
Female to male ratio of Graves' Disease
Term
Exophthalmos***
(Protrusion of eyes)
Definition
Unique Symptom for Graves’
Term
Control symptoms

Prevent thyroid storm ***
Lower blood levels of T3 and T4 with anti-thyroid drugs

Thyroid excision or destruction
Definition
Hyperthyroidism Treatment
Term
Use drugs that block beta adrenergic (sympathetic) receptors: “beta blockers”
Definition
Controlling Symptoms of hyperthyroidism
Term
Requires thyroid excision or ablation (destruction)!***
Definition
Definitively curing hyperthyroidism requires what?
Term
failure of the thyroid gland
Definition
What is primary hypothyroidism?
Term
failure of pituitary to release normal amounts of TSH
Definition
What is secondary hypothyroidism?
Term
Primary (99+% of all cases)
Definition
What is the most common type of hypothyroidism?
Term
Very high TSH ***
Low T4
Definition
How would a laboratory confirm hypothyroidism?
Term
Poor memory
Inability to concentrate
Hair loss
Weight gain
Cold intolerance
Weakness
Fatigue
Dry skin
Menstrual irregularities
Definition
Hypothyroid Symptoms
Term
Iatrogenic
Hashimoto’s thyroiditis
Drug induced (uncommon)
Dietary iodide deficiency (uncommon)
Definition
Four Causes of hypothyroidism
Term
Hashimoto’s Thyroiditis
Definition
Fairly common (1-4/1,000) type of hypothyroidism resulting from an autoimmune disorder
Term
First Choice: Thyroxine (T4) Daily

Adjust Dose by Symptoms and TSH levels

Age Factor:
Low & Slow for >65 y/o
Dose typically 75% of young adults
Definition
Hypothyroidism Treatment
Term
Parathyroid Glands
Definition
Produce parathyroid hormone (PTH)
Term
Parathyroid Hormone
Definition
Increases osteoclastic activity in bone

Increases calcium reabsorption in the kidneys

Stimulates the synthesis of vitamin D
Increases calcium absorption in the small intestine
Term
Calcium***
Definition
So the Parathyroids Are All About…
Term
Osteoclasts
Osteoblasts
Definition
What releases calcium in bone?
What stores it?
Term
Low calcium
High phosphorus
Low PTH
Definition
How does a laboratory diagnose hypoparathyroidism?
Term
PTH secreting parathyroid adenoma
Definition
What usually causes primary Hyperparathroidism
Term
Hypercalcemia
High levels of PTH
Low levels of phosphorus
Diagnostic imaging may be needed
Definition
Diagnosis of primary Hyperparathroidism
Term
Surgical excision of adenoma or of the glands (for hyperplasia)

Medications to prevent further bone reabsorption (bisphophonates)

Vitamin D analog if needed post-operatively
Definition
Treatment of primary Hyperparathroidism
Term
Seen frequently with chronic renal disease

Main problem is falling vitamin D production

Falling Ca++ levels stimulate the parathyroids to secrete PTH
Definition
Secondary Hyperparathyroidism cause
Term
High PTH level

Variable calcium & phosphorus levels

In setting of renal failure
Definition
Diagnosis of Secondary Hyperparathyroidism
Term
Definition
Disorder characterized by chronic hyperglycemia which is caused by… Relative or absolute deficiency of insulin OR a deficiency of insulin action (“insulin resistance”) Results in “Glucose Intolerance”
Term
Islets of Langerhans (Beta cells specifically)
Definition
In the pancreas, what produces insulin?
Term
Islets of Langerhans (Alpha cells specifically)
Definition
In the pancreas, what produces glucagon?
Term
Inhibits Catabolic Actions
Inhibits glycogen breakdown
Inhibits amino acids & fatty acid breakdown into ketones

Promotes Anabolic Actions
Promotes glycogen production & storage
Promotes triglyceride synthesis in fat cells
Promotes protein synthesis in muscle cells
Definition
Insulin Actions
Term
Glucagon
Definition
What is virtually the opposite of insulin?
Term
Type I diabetes
Definition
Autoimmune disorder
Rapid loss of beta cells
Trigger may be virus or toxin
Term
Type II diabetes
Definition
Very slow loss of beta cells
Genetic predisposition
Obesity
Term
The “three P’s”:
Polydipsia
Polyuria
Polyphagia
Definition
Symptoms of Diabetes
Term
Significant hyperglycemia (>300 mg/dl) causes…

Keto acids (acetoacetate, B-hydroxybutyrate) to accumulate which results in acidosis (ph 6.8 – 7.3)
Definition
Describe Diabetic Ketoacidosis
Term
Most commonly used: Metformin (Glucophage)
Definition
Most commonly used drug for reducing lnsulin resistance in type II diabetes
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