PATHOLOGY
Endocrine
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Tumors of the adrenal medulla
| -?-pheochromocytoma | most common tumor of the adrenal medulla in adults; derived from chromaffin cells |
| -?-neuroblastoma | most common tumor of the adrenal medulla in children, but can occur anywhere along the sympathetic chain |
Pheochromocytoma: episodic hyperadrenergic symptoms (5 P's)
P -?-Pressure (elevated blood pressure)P -?-Pain (headache)
P -?-Perspiration
P -?-Palpitations
P -?-Pallor/diaphoresis
Matching: Multiple endocrine neoplasias (MEN)
| -?-MEN type III/formerly MEN IIb | medullary carcinoma of the thyroid, pheochromocytoma, and oral & intestinal ganglioneuromatosis |
| -?-MEN type II/Sipple's syndrome | medullary carcinoma of the thyroid, pheochromocytoma, parathyroid tumor, or adeenoma |
| -?-MEN type 1/Werner's syndrome | pancreas, parathyroid, & pituitary tumors; presents with kidney stones & stomach ulcers |
| MEN type 1/Werner's syndrome MEN type II/Sipple's syndrome MEN type III/formerly MEN IIb | |
Matching:
| -?-hypothyroidism | cold intolerance, hypoactivity, weight gian, fatigue, lethargy; ↓ appetite, constipation, weakness, ↓ reflexes, myxedema, dry cool skin, course brittle hair |
| -?-hyperthyroidism | heat intolerance, hyperactivity, weight loss, chest pain/palpiations, arrhythmias, diarrhea, ↑ reflexes, warm, moist skin, & fine hair |
| -?-Graves disease | autoimmune; thyroid-stimulating/TSH receptor antibodies; ophthalmopathy, pretibial myxedema; diffuse goiter; often presents during stress (eg, childbirth) |
| hypothyroidism hyperthyroidism Graves disease | |
Matching: Thyroid cancer
| -?-follicular carcinoma | poor prognosis; uniform follicles |
| -?-undifferentiated/anaplastic | older patients; horrible prognosis |
| -?-medullary carcinoma | from parafollicular "C cells"; produces calcitonin, sheets of cells in amyloid stroma; MEN types II and III |
| -?-papillary carcinoma | most common; good prognosis; "ground-glass" nuclei, psammoma bodies |
| papillary carcinoma follicular carcinoma medullary carcinoma undifferentiated/anaplastic | |
Type 1 vs Type 2 diabetes mellitus
| Variable | Type 1 | Type 2 |
|---|---|---|
| Incidence | 15% | -?-85% |
| Insulin necessary in treatment | -?-always | Sometimes |
| Age (exceptions commonly occur) | <30 | -?->40 |
| Associations w/ obesity | -?-no | yes |
| Genetic predisposition | weak, polygenic | -?-strong, polygenic |
| Association w/ HLA system | -?-yes (HLA-DR3 and 4) | no |
| Glucose intolerance | severe | -?-mild to moderate |
| Ketoacidosis | -?-common | rare |
| β-cell numbers in the islets | ↓ | -?-variable |
| Serum insulin level | -?-↓ | variable |
| Classic symptoms of polyuria, polydipsia, thirst, weight loss | common | -?-sometimes |
| Theorized cause | -?-viral or immune destruction of β cells | ↑ resistance to insulin |
Diabetic ketoacidosis
Signs/symptoms? -?-Kussmaul respirations, hyperthermia, nausea/vomiting, abdominal pain, psychosis/dementia, dehydration; fruity breath oder
Lab results? -?-hyperglycemia, ↑ H+, ↓ HCO3- (anion gap metabolic acidosis), ↑ blood ketone levels, leukocytosis
Complications? -?-life-threatening mucormycosis, Rhizopus infection, cerebral edema, cardiac arrhythmias, heart failure
Treatment? -?-fluids, insulin, potassium, glucose if necessary to prevent hypoglycemia
SIADH: Syndrome of inappropriate antidiuretic hormone secretion
Hyperparathyroidism: explain differences between primary and secondary
primary: -?-usually an adenoma; hyprecalcemia, hypercalciuria, hypophosphatemia, ↑ PTH, ↑ cAMP in urine; often asymptomatic, or may present with weakness & constipation
secondary: -?-2° hyperplasia due to ↓ srum Ca2+; most often in chronic renal disease; hypocalcemia, hyperphosphatemia, ↑ PTH