Endocrine - Pathology (Part 1) Flashcards Preview

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Flashcards in Endocrine - Pathology (Part 1) Deck (80)
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1

A 30-year-old male comes to you with the presentation shown. What is the likely diagnosis?

Cushing's disease, which constitutes 70% of cases of Cushing's syndrome

2

A biopsy of a thyroid cancer is shown here. What type of thyroid cancer is this?

Papillary carcinoma

3

Fundoscopic exam of a patient with longstanding diabetes mellitus reveals the image shown. What is the diagnosis?

Diabetic retinopathy; characterized by hemorrhages, exudates, microaneurysms, and vessel proliferation

4

A patient with Cushings syndrome has an increased adrenocorticotropic hormone level; what are two mechanisms of increased adrenocorticotropic hormone production?

Overproduction of adrenocorticotropic hormone by the pituitary and overproduction of adrenocorticotropic hormone by an ectopic site (such as in small-cell lung cancer)

5

A patient with Cushings syndrome has a decreased adrenocorticotropic hormone level; what are two mechanisms of increased cortisol production with low adrenocorticotropic hormone levels?

Overproduction of cortisol by the adrenal cortex or administration of exogenous cortisol

6

A patient is diagnosed with small-cell carcinoma of the lung leading to Cushings syndrome. Will this patients adrenocorticotropic hormone level be high or low?

High

7

A patient is diagnosed with primary adrenal cortical hyperplasia. Will this patients adrenocorticotropic hormone level be high or low?

Low

8

What is the effect of long-term steroid administration on adrenocorticotropic hormone?

Suppression of the hypothalamic-pituitary-adrenal axis causing low adrenocorticotropic hormone levels

9

What is Cushings disease?

An adrenocorticotropic hormone-hypersecreting primary pituitary adenoma

10

What are the results of a low dose dexamethasone suppression test in a healthy person?

Decreased cortisol level; dexamethasone decreases adrenocorticotropic hormone secretion by negative feedback leading to decreased cortisol levels

11

What results would you expect after a dexamethasone suppression test in the setting of an adrenocorticotropic hormone-producing pituitary tumor?

With low-dose dexamethasone, we would expect high cortisol levels (no suppression); with high doses of dexamethasone, we would expect suppression and thus low adrenocorticotropic hormone and cortisol levels

12

Would cortisol levels be high or low after a high-dose dexamethasone suppression test in a patient with an ectopic adrenocorticotropic hormone-producing tumor?

High; the secretory activity of this tumor is independent of negative feedback

13

Would cortisol levels be high or low after a high-dose dexamethasone suppression test in a patient with a cortisol-producing tumor?

High; the secretory activity of this tumor is independent of negative feedback

14

What findings are indicative of Cushings syndrome?

Hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin changes, osteoporosis, amenorrhea, and immune suppression

15

Why are patients who are taking chronic steroids more susceptible to infection?

Associated immune suppression

16

When are cortisol levels drawn for the dexamethasone suppression test and why?

In the morning; this is when cortisol levels should be at the highest

17

Which diuretic is used as a treatment for hyperaldosteronism?

Spironolactone, a K+-sparing diuretic that works as an aldosterone antagonist

18

What is the cause of Conns syndrome?

An aldosterone-secreting tumor

19

A patient has hypertension, hypokalemia, metabolic alkalosis, and a low plasma renin level; what is the likely diagnosis?

Conns syndrome

20

A patient has hypertension, hypokalemia, metabolic alkalosis, and a high plasma renin level; what is the likely diagnosis?

Secondary hyperaldosteronism

21

Name five causes of secondary hyperaldosteronism.

Renal artery stenosis, chronic renal failure, congestive heart failure, cirrhosis, and nephrotic syndrome

22

Why is secondary hyperaldosteronism associated with high plasma renin levels?

All the causes of secondary hyperaldosteronism cause the kidney to perceive a low intravascular volume state, causing up-regulation of the renin-angiotensin pathway

23

Which hormones are deficient in patients with Addisons disease?

Cortisol and aldosterone

24

What pathologic findings would be expected in the adrenal glands of a patient with Addisons disease?

Adrenal Atrophy affecting All three cortical divisions and Absence of hormone production

25

Name three findings associated with Addisons disease (primary adrenal insufficiency).

Hypotension, skin hyperpigmentation, hyperkalemia

26

Is primary or secondary hypoaldosteronism associated with skin hyperpigmentation?

Primary

27

Is low adrenocorticotropic hormone production associated with primary or secondary hypoaldosteronism?

Secondary

28

Why is skin pigmentation a finding of Addisons?

In Addisons, there is increased adrenocorticotropic hormone; proopiomelanocortin is the precursor of adrenocorticotropic hormone and melanocyte-stimulating hormone; melanocyte-stimulating hormone leads to skin hyperpigmentation

29

How is primary adrenal insufficiency distinguished from secondary adrenal insufficiency?

Secondary adrenal insufficiency has decreased adrenocorticotropic hormone, no skin hyperpigmentation, and no hyperkalemia

30

What processes can cause primary adrenal insufficiency?

Atrophy or destruction by autoimmune disease, tuberculosis infection, or metastatic malignancy