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Robbins Chapter 19 Endocrine
Terms in this set (92)
Molecules secreted during endocrine signaling
Process whereby the target tissue down regulates the activity of the gland secreting the hormone.
Types of Extra cellular signaling
autocrine, paracrine, endocrine
Location of the pituitary gland
Base of the brain within the sella turcica
Components of the pituitary gland
Anterior and Posterior
Consequence of expanding pituitary lesions
Visual field abnormalities most often in the temporal visual fields
Neurosurgical emergency due to acute hemorrhage of a pituitary adenoma--leads to depressed consciousness.
Arises from excessive secretion of trophic hormones and usually results from an anterior pituitary adenoma.
Deficiency of trophic hormones resulting from ischemic injury, surgery, inflammatory reactions.
Classification of endocrine diseases
Over production ( Hyperpituitarism), under production (hypopituitarism) and mass lesions.
How are pituitary adenomas classified?
Hormones produced, functional or non-functional, familial/genetic, rarely plurihormonal.
Syndrome associated with overproduction of ACTH
Syndromes associated with overproduction of prolactin
Galactorrhea, amenorrhea, sexual dysfunction, and infertility.
Syndrome associated with decreased serum levels of TSH
Syndrome associated with overproduction of growth hormone
Gigantism and Acromegaly
Another name for the anterior pituitary
Gene mutation associated with growth hormone secreting pituitary adenomas and ACTH secreting adenomas.
MENI, CDKNIB, PRKARIA and AIP
Genes identified as causing familial pituitary adenomas
Greater than 1 cm in diameter
Less than 1 cm in diameter
Two distinct morphologic features of most adenomas
Cellular monomorphism and absence of a reticulin network.
Most common type of hyper functioning pituitary adenoma
Neurological symptoms associated with gonadetrophin
vision changes, headaches, diplopia
Generalized increase in body size with disproportionately long arms and legs
Associated with diabetes, muscle weakness, hypertension, arthritis, osteoporosis, and CHF.
TSH secreting adenomas that are a rare cause of hyperthyroidism
Mass Effects and hypopituitarism
Typical presentation with nonfunctioning adenomas
Postpartum necrosis of the anterior pituitary.
Hemorrhage and hypotension in the peripartal period
Clinical manifestations most likely to cause Sheehan syndrome.
Causes of anterior pituitary hypo function
Non-functioning adenomas, ischemic necrosis, ablation of the pituitary by surgery or irradiation, trauma, inflammatory lesions of sarcoidosis or TB and metatastic neoplasms of the pituitary.
Clinical manifestations of anterior pituitary hypofunction
Dwarfism, pallor, amenorrhea, infertility, impotence, hypothyroidism, loss of pubic and axillary hair, and hypoadrenalism and failure of postpartum lactation
Condition resulting from ADH deficiency and characterized by excessive urination resulting from the inability of the kidney to reabsorb water from the urine.
Nephrogenic diabetes insipidus
Caused by renal tubular unresponsiveness to circulating ADH.
Lab values associated with diabetes insipidus
Low specific gravity, increased serum sodium and osmolality
Syndrome of Inappropriate ADH secretion characterized by hyponatremia due to reabsorption of excessive amounts of free water.
Causes of SIDAH
Malignant neoplasms, lung disease, hypothalamic injury, injury to the posterior pituitary
Clinical manifestations of SIADH
Hyponatremia, cerebral edema, neurologic dysfunction
Hormones secreted by the Posterior Pituitary
ADH and Oxytocin
Function of Oxytocin
Stimulates smooth muscle in pregnant uterus and mammary glands during lactation
Urine Specific Gravity Normal Range
Urine Specific Gravity
a measure of the concentration of solutes in the urine. It measures the ratio of urine density compared with water density and provides information on the kidney's ability to concentrate urine.
S/S of diabetes insipidus
Excessive urination and extreme thirst
Cellular effects of thyroid hormone
Up regulation of carbohydrates and lipid catabolism
Stimulation of protein synthesis
Increase basal metabolic rate
Common S/S associated with hyperthyroidism
Heat intolerance, Warm Flushed skin, Excessive sweating, weight loss, increased appetite, diarrhea,, palpitations, tachycardia, tremors, irritability, wide staring gaze,
Symptoms of hyperthyroidism associated with the elderly
CHF, unexplained weight loss,
Type of hyperthyroidism associated with exophthalmos and goiter and dermopathy
Lab values associated with hyperthyroidism
Decreased TSH, increased T3 and T4
Radiographic scan interpretation for Graves Disease
Increased radioactive iodine uptake in the whole thyroid gland
Radiographic scan interpretation for a solitary nodule in toxic adenoma
increased uptake of radioactive iodine
Radiographic scan interpretation for thyroiditis
decreased uptake of radioactive iodine
Causes of hypothyroidism
Rare gene mutations in PAX8 and FOXEI, dietary deficiency of iodine, congenital goiter, hashimoto thyroiditis, autoimmune disease, surgery, pituitary failure, hypothalamic failure
Most common cause of hypothyroidism in developed countries
Most common cause of hypothyroidism in underdeveloped countries
Dietary deficiency of iodine
Characteristics of Cretinism
Impaired skeletal and central nervous system development, severe mental retardation, short stature, coarse facial features, protruding tongue and umbilical hernia
Hypothyroidism developing in infancy
Hypothyroidism developing in older children and adults
Characteristics of myxedema
Sluggishness, depression, obesity, cold intolerance, constipation, pericardial effusions, heart failure.
Lab values associated with hypothyroidism
Increased TSH and decreased serum T4
Thyroid failure secondary to autoimmune destruction of the thyroid gland
Causal factor of Hashimoto Thyroiditis
Breakdown in self tolerance to thyroid autoantigens
Clinical manifestation of Hashimoto Thyroiditis
Painless enlargement of the thyroid gland that may cause hoarseness and difficulty swallowing.
Patients with Hashimoto Thyroiditis are at increased risk for
B-Cell Non-Hodgkin lymphoma
Subacute granulomatous thyroiditis
Caused by viral infections --most frequently preceded by upper respiratory infections
Clinical features of subacute thyroiditis
neck pain and pain with swallowing, fever, malaise, enlarged thyroid gland, elevated leukocyte lab values and increased ESR rates.
Subacute lymphocytic thyroiditis
Post Partum thyroiditis
Most common cause of endogenous hyperthyroidism
Lab values in Graves Disease
Elevated serum free T4, T3 and decreased serum TSH.
Most common manifestation of thyroid disease
Foods that may contribute to incidence of sporadic goiter
Cabbage, cauliflower, brussels sprouts, turnips
Incidence of goiters in geographic areas where the soil, water and food supply contain little iodine. Used when goiters are present in in more than 10% of the population in a given region.
More common in females and occurs more frequently in young adulthood where is an increase physiologic demand for T4.
Clinical Features of a goiter
enlarged neck mass, airway obstruction, dysphagia, superior vena cava syndrome,
Cells that make up the parathyroid gland
Free ionized serum Calcium
Controls the activity of the parathyroid glands
Tumors of the thyroid glands are a result of
Tumors of the parathyroid glands result from
Excessive secretion of PTH
Two forms of hyperparathyroidism
Primary--overproduction of PTH
Secondary--secondary to chronic renal insufficiency
Most common manifestation of primary hyperparathyroidism
Increase in serum ionized calcium
S/S of primary hyperparathyroidism
Painful bones, positive Trousseau's sign, kidney stones, osteoporosis, gallstones, constipation
Most common cause of secondary hyperparathyroidism
Major causes of hyperparathyroidism
Surgical removal of the thyroid gland, autoimimunity, Dijorge Syndrome
Clinical features of hypoparathyroidism
cardiac arrhythmias, irritability, facial grimacing, seizures, muscle spasm
Diagnosis of diabetes can be due to any one of these
Random blood glucose value greater than 200 mg/dl or higher
Fasting blood glucose value of 126 or higher on more than one occasion
An abnormal oral glucose tolerance test with a glucose value of 200 mg/dl or higher after 2 hours of ingesting 75 g of glucose.
Condition in which the serum fasting glucose value greater than 110 but less than 126 mg/dl.
Type 1 Diabetes
Beta cell destruction leading to insulin deficiency
Type 2 Diabetes
Combination of insulin resistance and beta cell dysfunction
Associated with metabolic syndrome
Failure of target tissues to respond normally to insulin.
Most important factor in the development of insulin resistance
Factors contributing to insulin resistance
Pancreatic neuronendocrine tumors
Islet Cell tumors
Two regions of the Adrenal Glands
Cortex and Medulla
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