PATHOLOGY

Endocrine

Click on the -?- to reveal/hide the answer.

Tumors of the adrenal medulla

-?-pheochromocytoma most common tumor of the adrenal medulla in adults; derived from chromaffin cells
-?-neuroblastoma most common tumor of the adrenal medulla in children, but can occur anywhere along the sympathetic chain

Pheochromocytoma: episodic hyperadrenergic symptoms (5 P's)

P -?-Pressure (elevated blood pressure)
P -?-Pain (headache)
P -?-Perspiration
P -?-Palpitations
P -?-Pallor/diaphoresis

Matching: Multiple endocrine neoplasias (MEN)

-?-MEN type III/formerly MEN IIb medullary carcinoma of the thyroid, pheochromocytoma, and oral & intestinal ganglioneuromatosis
-?-MEN type II/Sipple's syndrome medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor, or adeenoma
-?-MEN type 1/Werner's syndrome pancreas, parathyroid, & pituitary tumors; presents with kidney stones & stomach ulcers
MEN type 1/Werner's syndrome MEN type II/Sipple's syndrome MEN type III/formerly MEN IIb

Matching:

-?-hypothyroidism cold intolerance, hypoactivity, weight gian, fatigue, lethargy; ↓ appetite, constipation, weakness, ↓ reflexes, myxedema, dry cool skin, course brittle hair
-?-hyperthyroidism heat intolerance, hyperactivity, weight loss, chest pain/palpiations, arrhythmias, diarrhea, ↑ reflexes, warm, moist skin, & fine hair
-?-Graves disease autoimmune; thyroid-stimulating/TSH receptor antibodies; ophthalmopathy, pretibial myxedema; diffuse goiter; often presents during stress (eg, childbirth)
hypothyroidism hyperthyroidism Graves disease

Matching: Thyroid cancer

-?-follicular carcinoma poor prognosis; uniform follicles
-?-undifferentiated/anaplastic older patients; horrible prognosis
-?-medullary carcinoma from parafollicular "C cells"; produces calcitonin, sheets of cells in amyloid stroma; MEN types II and III
-?-papillary carcinoma most common; good prognosis; "ground-glass" nuclei, psammoma bodies
papillary carcinoma follicular carcinoma medullary carcinoma undifferentiated/anaplastic

Type 1 vs Type 2 diabetes mellitus

Variable Type 1 Type 2
Incidence 15% -?-85%
Insulin necessary in treatment -?-always Sometimes
Age (exceptions commonly occur) <30 -?->40
Associations w/ obesity -?-no yes
Genetic predisposition weak, polygenic -?-strong, polygenic
Association w/ HLA system -?-yes (HLA-DR3 and 4) no
Glucose intolerance severe -?-mild to moderate
Ketoacidosis -?-common rare
β-cell numbers in the islets -?-variable
Serum insulin level -?- variable
Classic symptoms of polyuria, polydipsia, thirst, weight loss common -?-sometimes
Theorized cause -?-viral or immune destruction of β cells ↑ resistance to insulin

Diabetic ketoacidosis

Signs/symptoms? -?-Kussmaul respirations, hyperthermia, nausea/vomiting, abdominal pain, psychosis/dementia, dehydration; fruity breath oder

Lab results? -?-hyperglycemia, ↑ H+, ↓ HCO3- (anion gap metabolic acidosis), ↑ blood ketone levels, leukocytosis

Complications? -?-life-threatening mucormycosis, Rhizopus infection, cerebral edema, cardiac arrhythmias, heart failure

Treatment? -?-fluids, insulin, potassium, glucose if necessary to prevent hypoglycemia

SIADH: Syndrome of inappropriate antidiuretic hormone secretion

  1. -?-excessive water retention
  2. -?-hyponatremia
  3. -?-urine osmolarity > serum osmolarity (note: very low serum sodium levels can lead to seizures - correct slowly)

Hyperparathyroidism: explain differences between primary and secondary

primary: -?-usually an adenoma; hyprecalcemia, hypercalciuria, hypophosphatemia, ↑ PTH, ↑ cAMP in urine; often asymptomatic, or may present with weakness & constipation

secondary: -?-2° hyperplasia due to ↓ srum Ca2+; most often in chronic renal disease; hypocalcemia, hyperphosphatemia, ↑ PTH

Two causes of hypoparathyroidism?

  1. -?-accidental surgical excision (thyroid surgery)
  2. -?-DiGeorge syndrome

Carcinoid syndrome:

rare syndrome caused by carcinoid tumors (neuroendocrine cells), especially those of the -?-small bowel; the tumors secrete high levels of serotonin ( -?-5-HT) that does not get metabolized by the liver due to liver metastases; results in recurrent diarrhea, cutaneous flushing, asthmatic wheezing, and -?-right-sided valvular disease; most common tumor of -?-appendix; ↑ 5-HIAA in urine.

Osteoporosis:

explain differences b/t Type I and Type II
Type I: -?-postmenopausal (10-15 yrs after menopause); ↑ bone resorption due to ↓ estrogen levels; treated with estrogen replacement
Type II: -?-senile osteoporosis; affects men & women >70 yrs
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