Quiz7ReviewKris.neKra1s,M.D.

Organs

PituitaryThyroidParathyroidsAdrenalsPancreas

Diseases

Non-neoplas.cToomuchhormoneTooliFlehormone

Neoplas.cBenignMalignant

EndocrinePathology

•  Toomuchanteriorpituitaryhormone(s)

•  Mostcommoncause:pituitaryadenoma

•  Pituitarysymptoms:•  Asymptoma.catfirst•  Endocrineabnormali.es•  Masseffects(likewhatinpar.cular?*)

•  Manytypes

Hyperpituitarism

•  TooliFleanteriorpituitaryhormone(s)

•  Causes•  Pituitarydestruc.on•  Ischemicnecrosis•  Pituitaryapoplexy

•  Symptomsusuallyinsidious(hypothyroidism,adrenalinsufficiency…)

Hypopituitarism

Hyperthyroidism

Ahypermetabolicstatecausedbyincreasedthyroidhormones.

1°:thyroidproblem2°:pituitaryproblem3°:hypothalamicproblem

General:weightloss,heatintolerance

Cardiac:rapidpulse,arrhythmias

Neuromuscular:tremor,emo.onallability

Skin:warm,moist

Gastrointes.nal:diarrhea

Eye:lidlag

Thyroidstorm:extreme,dangeroussymptoms

HyperthyroidismSignsandSymptoms

Hypothyroidism

Ahypometabolicstatecausedbydecreasedthyroidhormones.

1°:thyroidproblem2°:pituitaryproblem3°:hypothalamicproblem

General:fa.gue,weightgain,coldintolerance

Cardiac:slowpulse,impairedcontrac.on

Nervous:delayedreflexes,lethargy

Skin:rough,dry;hairloss(eyebrows)

Gastrointes.nal:reducedappe.te,cons.pa.on

Myxedema:deepenedvoice,“edema”

Myxedemacoma:deteriora.ngmentalstatus

HypothyroidismSignsandSymptoms

Endocrinepathologyinanutshell

problemuphere

problemdownhere

Low Normal High

Low

Normal euthyroidism

High

TSH

T4

Low Normal High

Low

Normal

High1°

hyper-thyroidism

T4

TSH

Low Normal High

Low

Normal

High2°or3°hyper-

thyroidism

T4

TSH

Low Normal High

Low1°

hypo-thyroidism

Normal

High

T4

TSH

Low Normal High

Low2°or3°hypo-

thyroidism

Normal

High

T4

TSH

Low Normal High

Low

Normalsubclinicalhyper-

thyroidism

subclinicalhypo-

thyroidism

High

T4

TSH

Low Normal High

Low *

Normal

High *

T4

TSH

Female

“Hash”

Myxedema

HashimotoThyroidi.s

Mrs.Potatohead

Looksscary

Reallyharmless

Goesawaybyitself

DeQuervainThyroidi.s

Rex

SilentThyroidi.s

Bullseye

SilentDoesn’tcauseproblems

FibrosingThyroidi.s

Woody

Woody

•  MostcommoncauseofhyperthyroidisminUS!

•  Autoimmune:an.-TSHreceptoran.bodiess.mulatethyroidgrowth

•  Triad:hyperthyroidism,ophthalmopathy,dermopathy

GravesDisease

MartyFeldman

noiodine

enzymedefects

↓T4 ↑TSH

unknownreasons

hyperplasia

involu.on

trauma

simple goiter

multinodular goiter

Mul.nodulargoiter

simple goiter multinodular goiter

euthyroid euthyroidhyperfunc.oningnodules

orhypothyroid

Thyroidadenoma

papillary(80%)

follicular(10%)

anaplas.c(<5%)

IncidenceofDifferentTypesofThyroidCarcinoma

medullary(5%)

Papillarycarcinoma:OrphanAnnienuclei

Papillarycarcinoma:psammomabody

Whichoneiscancer?

Follicularthyroidcarcinoma:vascularinvasion

Medullarythyroidcarcinoma

Anaplas.cthyroidcarcinoma

Capsule

Zona glomerulosa

Zona fasiculata

Zona reticularis

Adrenalglandhistology

Medulla

Pa.entwithCushingsyndrome

•  Neoplasmofcatecholamine-producingcells

•  Rarecauseofhypertension!

•  Urine:catecholamines,VMAandmetanephrines

•  The10%tumor!•  10%extra-adrenal(“paraganglioma”)•  10%bilateral•  10%(ormore)familial•  10%malignant•  10%don’thavehypertension

Pheochromocytoma

•  Derivedfromneuralcrestcells

•  Rela.velycommonchildhoodtumor

•  PrognosisbeFerin:•  Children<18months•  Lowerstagetumors•  Lowergradetumors•  Hyperdiploidtumors•  FewercopiesofN-myc

Neuroblastoma

MEN-1PiF-uitaryadenoma

MEN1generun-of-the-millinac.veturnoff

MEN-2Cleese-cellhyperplasia

bRETongeneoneofakindalwaysturnedon