1. Quiz 7 Review Kristine Krafts, M.D.

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

3. 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).

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

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

7. 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

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

9. 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

10. Endocrine pathology in a nutshell
problem up here
problem down here

11. TSH
Low
Normal
High
euthyroidism T4

12. TSH
Low
Normal
High 1°
hyper-thyroidism T4

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

14. TSH
Low
Normal
High 1°
hypo-thyroidism T4

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

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

17. TSH
Low
Normal
High * T4

18. Hashimoto Thyroiditis
Female
“Hash”
Myxedema
Mrs. Potatohead

19. DeQuervain Thyroiditis
Looks scary
Really harmless
Goes away by itself
Rex

20. Silent Thyroiditis
Silent
Doesn’t cause problems
Bullseye

21. Fibrosing Thyroiditis
Woody
Woody

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

23. Marty Feldman

24. no iodine
 T4
 TSH
enzyme defects
unknown reasons

25. trauma
hyperplasia
simple goiter
involution
multinodular goiter

26. Multinodular goiter

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

28. Thyroid adenoma

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

30. Papillary carcinoma: Orphan Annie nuclei

31. Papillary carcinoma: psammoma body

32. 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?

33. Follicular thyroid carcinoma: vascular invasion

34. Medullary thyroid carcinoma

35. Anaplastic thyroid carcinoma

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

37. Patient with Cushing syndrome

39. 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

40. 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

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

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