Parathyroid and Pancreas (Endocrine System) Flashcards Preview

SP16- Gen Path Exam 3 > Parathyroid and Pancreas (Endocrine System) > Flashcards

Flashcards in Parathyroid and Pancreas (Endocrine System) Deck (73)
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1
Q

How many parathyroid glands are there? Where are they located?

A

four

on the posterior surface of the thyroid gland

2
Q

The parathyroid glands are mostly composed of ____ cells.

A

chief

3
Q

What is the function of the parathyroid’s chief cells?

A

to secrete parathyroid hormone

4
Q

Parathyroid Hormone is an important regulator of blood ______ levels.

A

calcium

5
Q

True or False: In addition to chief cells, the parathyroid glands contain chlorophyll cells.

A

False (that’s plants!), parathyroid = OXYPHIL cells

6
Q

True or False: The parathyroid glands are stimulated by the pituitary gland and hypothalamus.

A

FALSE, no they are not

parathyroid glands are stimulated by decreases in blood calcium levels

7
Q

What is the net effect of PTH?

A

increased level of blood calcium

feedback inhibition of further PTH secretion

8
Q

How does PTH increase the level of blood calcium (what are the actions of PTH)?

A

increase renal tubular REABSORPTION of calcium
increase urinary phosphate EXCRETION
increase OSTEOCLASTIC activity
increase renal CONVERSION of vit.D into its active form
(vitamin D increases GI calcium absorption)

9
Q

Hyperparathyroidism is an important cause of ______. Explain.

A

Hypercalcemia

= excess secretion of PTH = excessive increase in free calcium without feedback regulation

10
Q

What are the two types of hyperparathyroidism?

A

Primary

Secondary

11
Q

What is the difference between Primary and Secondary Hyperparathyroidism?

A

Primary = autonomous/spontaneous overproduction of PTH

Secondary = low blood calcium triggers the parathyroid to excrete PTH = too much is excreted due to hyperplasia of the gland = usually occurs in patients with chronic renal failure (bad kidneys can’t convert vitamin D to its active form and calcium is not well-absorbed in GI)

12
Q

Is Primary Hyperparathyroidism more common in males or females?

A

females (4:1)

13
Q

Primary Hyperparathyroidism is usually the result of parathyroid _________ or an ________.

A

hyperplasia (multiglandular)

adenoma (solitary)

14
Q

What are the classic clinical features of Primary Hyperparathyroidism?

A

“Painful Bones, Stones, Abdominal Groans, and Psychic Moans”

Bones: increased PTH increases osteoclasts
Stones: increased PTH increases renal calcium abs.
Abdominal: constipation, gall stones, peptic ulcers
Psychic: seizures, lethargy, depression

15
Q

What are the two common dental radiographic signs of Primary Hyperparathyroidism?

A
  1. Ground Glass appearance of alveolar bone

2. Generalized loss of lamina dura

16
Q

What type of tumor can be found in the mouth of a patient with primary hyperparathyroidism?

A

brown tumor

brown due to hemosiderin pigmentation; it is not neoplastic!

17
Q

Secondary Hyperparathyroidism is usually due to _______ which leads to increased amounts of ______ in the blood.

A

renal failure

phosphate (hyperphosphatemia)

18
Q

What does “excess phosphate in the blood” stimulate?

A

stimulates PTH production because serum calcium decreases

what will PTH lead to??? excretion of phosphate in the urine and increased free calcium

19
Q

Renal failure causes excessive secretion of PTH by the parathyroid glands because:

  1. phosphate isn’t excreted through the urine
  2. ______________________________
A

damaged kidneys can’t produce Vitamin D

no vitamin D = less absorption of Calcium
less calcium = more secretion of PTH

20
Q

True or False: A patient with Secondary Hyperparathyroidism will have normal calcium levels.

A

True

kidneys suck at doing their job = PTH increases = more calcium is pulled from bone, GI, and renal tubes to COMPENSATE

21
Q

True or False: The “bones, stones, groans” are more severe in secondary hyperparathyroidism.

A

False: Primary has more severe symptoms bc secondary is dominated by symptoms of kidney failure

22
Q

How does Secondary Hyperparathyroidism manifest in the oral cavity?

A

Renal Osteodystrophy- bony mass of the palate due to increased levels of PTH

(the mass is bony and fibrotic with lots of osteoclasts)

23
Q

How is Hyperparathyroidism treated? What is the prognosis?

A
  • surgical removal of the hyperplastic parathyroid glands
  • kidney transplant if applicable

Prognosis: GOOD (guarded if secondary + kidney failure)

24
Q

True or False: Hypoparathyroidism is very common.

A

False

25
Q

What are the possible causes of hypoparathyroidism?

A
  • surgically induced via excision of thyroid tissue
  • congenital absence (Di George)
  • Autoimmune
26
Q

How does hypoparathyroidism affect calcium levels?

A

decreased serum calcium

27
Q

How does hypoparathyroidism affect the heart and neuromusculature?

A
  1. causes heart arrythmias

2. increases neuromuscular excitability (think of spasms related to decreased calcium and this makes sense)

28
Q

True or False: Hypoparathyroidism may increase intracranial pressure and seizures.

A

True

29
Q

True or False: The Pancreas has both endocrine and exocrine functions.

A

True

exocrine: secretes into ducts
endocrine: secretes into blood

30
Q

The EXOcrine pancreas makes ______.

A

gastric enzymes

31
Q

What are the “cell clusters” that make up the ENDOcrine pancreas?

A

Islets of Langerhans

32
Q

Islets of Langerhans are microscopic clusters of cells that include the four cells types: ____, ____, ___, and ___.

A

Beta Cells
Alpha Cells
Delta Cells
PP Cells

33
Q

What do Beta cells produce?

A

insulin

-allows glucose to be stored after meals

34
Q

What do Alpha cells produce?

A

glucagon

  • mobilizes carbs from the liver when needed
  • promotes glycogenolysis and gluconeogenesis
35
Q

What do Delta cells produce?

A

somatostatin

-suppresses both insulin and glucagon/regulates glucose levels

36
Q

What do PP cells produce?

A

the pancreatic polypeptide VIP

-exerts effects on the GI system

37
Q

_______ is a group of metabolic disorders resulting in hyperglycemia (excess blood glucose levels)

A

Diabetes Mellitus

38
Q

Type ___ Diabetes is the deficient production of insulin; Type ____ Diabetes is the defective response to insulin.

A
1 = production
2 = response
39
Q

Diabetes Mellitus is the leading cause of _____, _____, and ______ in the United States.

A

End Stage Renal Disease (ESRD)
Blindness
Lower Limb Amputation

40
Q

What percent of the US population is affected by Diabetes?

A

7% (over 20 million people)

41
Q

What is considered the normal blood glucose level? What is the diagnostic “fasting glucose level” for diabetes? What is the diagnostic “random glucose level” for diabetes?

A

Normal: 70 to 120 mg/dL
DM Fasting: 126 mg/dL or higher
DM Random: 200 mg/dL or higher

42
Q

Diagnosing diabetes requires (1) random blood glucose level greater than 200 mg/dL, OR (2) fasting glucose above 126 mg/dL on more than one occasion, OR (3)_______

A

an abnormal glucose tolerance test

43
Q

Glucose homeostasis depends on what three processes?

A
  • Gluconeogenesis
  • Glucose uptake by tissues
  • Actions of insulin and glucagon
44
Q

Insulin increases the rate of _____ transport into certain _____ of the body.

A

glucose

cells

45
Q

What causes the absolute deficiency in insulin production that is seen with DM Type 1?

A

beta cells of the pancreas get destroyed by self-reactive T cells and auto-antibodies (chronic autoimmune)

46
Q

When is Type 1 DM typically diagnosed?

A

before age 20 (patients usually have a normal weight)

47
Q

True or False: Both types of DM are characterized by a decrease in blood insulin.

A

False:
Type 1 = decreased insulin in the blood
Type 2 = increased or normal insulin in the blood

48
Q

Auto-antibodies are detectable in the blood of ____% of patients.

A

70-80%

49
Q

Symptoms of DM Type 1 appear when ____% of beta cells have been destroyed.

A

90

50
Q

What are the four common symptoms of DM Type 1?

A

Polydipsia (increased thirst/fluid intake)
Polyuria (increased urination)
Polyphagia (increased food intake/hunger)
Ketoacidosis (excessive fat breakdown/ketones in blood)

51
Q

True or False: Insulin therapy is critical to survival of DM Type 1 patients.

A

True

52
Q

Why is the prognosis of DM Type 1 considered “guarded”?

A

there are many complications involved

53
Q

True or False: DM Type 2 is an autoimmune disease.

A

False

54
Q

DM Type 2 can be the result of ______ or ______.

A
insulin resistance (target tissues don't respond)
decreased insulin secretion (inadequate for that patient)
55
Q

Type 2 diabetes is usually diagnosed after age ____.

A

40

56
Q

Which form of diabetes does NOT typically show clinical signs of ketoacidosis?

A

type 2 does NOT

57
Q

What is the typically treatment regimen for Type 2 diabetes?

A
  • weight loss and diet modification
  • oral hypoglycemic drugs
  • insulin
58
Q

True or False: DM Type 2 patients are more likely to die from the disease thatn Type 1.

A

False, Type 1 more likely to die from disease

59
Q

Which form of DM is more common?

A

Type 2: 90%

Type 1: 10%

60
Q

How does diabetes manifest in the pancreas?

A
  • destruction of islets
  • heavy inflammatory infiltrate
  • amyloid accumulation (protein fragments)
61
Q

__________ associated with diabetes is responsible for 80% of DM-related deaths.

A

Vasculopathy

62
Q

Describe “microangiopathy” as it pertains to diabetes.

A

thickening of the basement membrane, especially around small blood vessels (seen with PAS stain)

63
Q

Diabetic _______ is the second leading cause of death.

A

nephropathy

64
Q

Glomerular lesions that result from diabetes will be _____ or _____, both forms may lead to total renal failure.

A

diffuse glomerulosclerosis

nodular glomerulosclerosis

65
Q

Which form of glomerulosclerosis is specific to diabetes?

A

Nodular (long-term diabetes only)

66
Q

True or False: Diffuse Glomerulosclerosis is specific to diabetes.

A

False, it affects 90% of diabetics but is not specific to that disease

67
Q

True or False: Diabetes retinopathy is the fourth leading cause of blindness.

A

True, microangiopathy and microaneurysms lead to retinal detachment and vision loss

68
Q

Diabetic neuropathy can affect the _____ or _____ nerves.

A

peripheral sensorimotor nerves

autonomic nerves

69
Q

Diabetics have an enhanced susceptibility to _______.

A

Skin infections (TB, pneumonia, pyelonephritis, etc)

70
Q

Islet Cell Tumors may be _____ or ______.

A

Functional

Non-functional

71
Q

Most Islet Cell Tumors are from the _______.

A

exocrine pancreas

72
Q

True or False: Islet Cell Tumors are common.

A

False

73
Q

What is Zollinger-Ellison Syndrome?

A

a condition in which a gastrin-secreting tumor (gastrinoma) of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers