Quiz 7 Review Kristine Krafts, M.D.

Endocrine Pathology Organs Pituitary Thyroid Parathyroids Adrenals Pancreas Diseases Non-neoplastic Too much hormone Too little hormone Neoplastic Benign Malignant

Hyperpituitarism Too much anterior pituitary hormone(s) Most common cause: pituitary adenoma Pituitary symptoms: Asymptomatic at first Endocrine abnormalities Mass effects (like what in particular?*) Many types *Bilateral hemianopsia (bilateral loss of vision in lateral visual fields). From the adenoma compressing the inner portion of the optic nerves (which feed the lateral eye fields).

Hypopituitarism Too little anterior pituitary hormone(s) Causes Pituitary destruction Ischemic necrosis Pituitary apoplexy Symptoms usually insidious (hypothyroidism, adrenal insufficiency…)

Hyperthyroidism A hypermetabolic state caused by increased thyroid hormones. 1°: thyroid problem 2°: pituitary problem 3°: hypothalamic problem

Hyperthyroidism Signs and Symptoms General: weight loss, heat intolerance Cardiac: rapid pulse, arrhythmias Neuromuscular: tremor, emotional lability Skin: warm, moist Gastrointestinal: diarrhea Eye: lid lag Thyroid storm: extreme, dangerous symptoms

Hypothyroidism A hypometabolic state caused by decreased thyroid hormones. 1°: thyroid problem 2°: pituitary problem 3°: hypothalamic problem

Hypothyroidism Signs and Symptoms General: fatigue, weight gain, cold intolerance Cardiac: slow pulse, impaired contraction Nervous: delayed reflexes, lethargy Skin: rough, dry; hair loss (eyebrows) Gastrointestinal: reduced appetite, constipation Myxedema: deepened voice, “edema” Myxedema coma: deteriorating mental status

Endocrine pathology in a nutshell problem up here problem down here

TSH Low Normal High euthyroidism T4

TSH Low Normal High 1° hyper-thyroidism T4

TSH Low Normal High 2° or 3° hyper-thyroidism T4

TSH Low Normal High 1° hypo-thyroidism T4

TSH Low Normal High 2° or 3° hypo-thyroidism T4

TSH Low Normal High subclinical hyper-thyroidism hypo-thyroidism T4

TSH Low Normal High * T4

Hashimoto Thyroiditis Female “Hash” Myxedema Mrs. Potatohead

DeQuervain Thyroiditis Looks scary Really harmless Goes away by itself Rex

Silent Thyroiditis Silent Doesn’t cause problems Bullseye

Fibrosing Thyroiditis Woody Woody

Graves Disease Most common cause of hyperthyroidism in US! Autoimmune: anti-TSH receptor antibodies stimulate thyroid growth Triad: hyperthyroidism, ophthalmopathy, dermopathy

Marty Feldman

no iodine  T4  TSH enzyme defects unknown reasons

trauma hyperplasia simple goiter involution multinodular goiter

Multinodular goiter

hyperfunctioning nodules simple goiter multinodular goiter euthyroid euthyroid hyperfunctioning nodules or hypothyroid

Thyroid adenoma

Incidence of Different Types of Thyroid Carcinoma medullary (5%) anaplastic (<5%) follicular (10%) papillary (80%)

Papillary carcinoma: Orphan Annie nuclei

Papillary carcinoma: psammoma body

You can’t tell! Have to take it out and look carefully at capsule and look for vascular invasion. Invasion means it’s follicular carcinoma. No invasion means it’s an adenoma. Which one is cancer?

Follicular thyroid carcinoma: vascular invasion

Medullary thyroid carcinoma

Anaplastic thyroid carcinoma

Adrenal gland histology Capsule Zona glomerulosa Zona fasiculata Medulla Zona reticularis Adrenal gland histology

Patient with Cushing syndrome

Pheochromocytoma Neoplasm of catecholamine-producing cells Rare cause of hypertension! Urine: catecholamines, VMA and metanephrines The 10% tumor! 10% extra-adrenal (“paraganglioma”) 10% bilateral 10% (or more) familial 10% malignant 10% don’t have hypertension

Neuroblastoma Derived from neural crest cells Relatively common childhood tumor Prognosis better in: Children < 18 months Lower stage tumors Lower grade tumors Hyperdiploid tumors Fewer copies of N-myc

MEN-1 Pitt-uitary adenoma MEN1 gene run-of-the-mill inactive turn off

MEN-2 Cleese-cell hyperplasia bRETon gene one of a kind always turned on