Please enable JavaScript.
Coggle requires JavaScript to display documents.
Endocrine pathology, thyroid cancer(甲状腺腫), adrenal insufficiency,…
-
thyroid cancer(甲状腺腫)
follicular carcinoma
-
invades thyroid capsule and vasculature, uniform follicles
-
RAS mutation, PAX8-PPAR-γ translocations
-
papillary carcinoma(乳頭癌)
empty-appearing nuclei with central clearing, psammoma bodies(砂粒小体), nuclear grooves
RET/PTC rearrangement, BRAF mutation
most common, excellent prognosis
-
-
-
-
adrenal insufficiency
-
-
-
-
inability of adrenal gland to generate enough glucocorticoids; weakness, fatigue, orthostatic hypotension(起立性低血圧),,,,etc
treatment: glucocorticoid, mineral corticoid replacement
hypopituitarism
pituitary apoplexy(卒中)
-
-
headache, visual impairment, features of hypopituitarism
Sheehan syndrome
failure of lactate, absent menstruation(月経), cold intolerance
-
-
-
-
nonsecreting pituitary adenoma, craniopharyngioma(頭蓋咽頭腫)
diabetes mellitus
-
-
chronic complication
-
-
large vessel atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene(壊疽), cerebrovascular disease, MI
small vessel disease→retinopathy, glaucoma(緑内障), neuropathy, nephropathy, arteriolosclerosis
-
acute
rarely caused by unopposed secretion of GH and epi, glucocorticoid therapy
polydipsia, polyuria, polyphagia(多食), weight loss, DKA(type1), hyperosmolar hyperglycemic state(type2)
type
type1
-
-
-
-
-
severe glucose intolerance, insulin sensitivity
-
type2
-
-
↑resistance to insulin, progressive pancreatic βcell failure
genetic predisposition is relatively strong, polygenic
-
neuroendocrine tumor
carcinoid tumor
recurrent diarrhea, flushing, asthmatic wheezing, right-sided valvular heart disease
marker; chromogranin A, synaptophysin
by carcinoid tumor, especially metastatic small bowel tumors, which secret high levels of serotonin
treatment: surgical resection, somatostatin analog
-
insulinoma
-
hypoglycemia, Whipple triad (low blood glucose, symptom of hypoglycemia, resolution after normalization)
↓ blood glucose level, ↑C-peptide level
-
glucagonoma
dermatitis, diabetes, DVT, declining weight, depression
-
somatostatinoma
↓secretion of secretin, cholecystokinin, glucagon, indulin, gastrin, GIP
-
neuroblastoma
-
-
-
-
abdominal distension and a firm, irregular mass that can cross the midline
hyperaldosteronism
-
-
increased secretion of aldosterone from adrenal gland; hypertension, ↓ or normal K, metabolic alkalosis
1° hyperaldosteronism does not directly cause edema (aldosterone escape mechanism); 2° hyperaldosteronism impair the escape mechanism
pheochromocytoma(褐色細胞腫)
symptom
epinephrine, norepinephrine, and dopamine→hypertension
-
5P; pressure, pain, perspiration(発汗), palpitation;tachycardis, pallor(蒼白)
treatment
α-antagonist followed by β-blocker, α→β
findings
↑catecholamine, its metabolites in urine and plasma
etiology
-
germline mutation; eg. NF-1, VHL, RET[MEN2A,2B])
-
10% rule(malignant, bilateral, extra-adrenal, calcify, kids)
VIPoma
-
watery diarrhea, hypokalemia, achlorhydria
-
-
Cushing syndrome
-
findings
hypertension, weight gain, moon face, abdominal striae, truncal obesity, buffalo hump, etc
diagnosis
↑24hr urine free cortisol, ↑late night salivary cortisol, inadequate supression on 1mg overnight dexamethasone test
-
-
neuroendocrine tumors
eg. carcinoid, gastrinoma, insulinoma, glucagonoma, amall cell carcinoma, etc
-
-
thyroidism
hyperthyroidism
thyrotoxic myopathy, osteoporosis
oligomenorrhea, amenorrhea, gynecomastia(女性化乳房), ↓libido, infertility
-
-
-
tachycardia, palpitation(動悸), dyspnea(呼吸困難)
warm, moist skin, fine hair, onycholysis(爪甲炎), pretibial myxedema(粘液水腫) in Graves disease
↓TSH (if1°), ↑free T3,T4, ↓LDL, HDL, totalcholesterol
heat intolerance, ↑sweating, weight loss
hypothyroidism
-
myopathy (proximal), carpal tunnel syndrome, myoedema
-
menorrhagia(月経過多), oligomenorrhea, ↓libido, infertility
dry cool skin, coarse, brittle hair, diffuse alopecia(脱毛症), brittle nails, puffy face, edema
-
cold intolerance, ↓sweating, weight gain, hyponatremia
-
↑TSH (if 1°), ↓free T3 and T4, hypercholesterolemia
details
hypothyroidism
Hashimoto thyroiditis
-
associated with HLA-DR3, ↑risk of non-Hodgkin lymphoma
-
-
-
-
-
Riedel thyroiditis
-
fixed, hard, pain-less goiter
fibrous tissue with inflammatory infiltrate, fibrosis extend to local structure, mimicking anaplastic carcinoma
other causes
iodine deficiency, goitrogen, Wolff-Chaikoff effect
hyperthyroidism
-
thyroid storm(甲状腺クリーゼ)
β-blocker, proyplthiouracil, corticosteroid, potassium iodine
agitation, delirium, fever, diarrhea, coma, tachycardia
hyperthyroidism is incompletely treated/untreated→significantly worsens in the setting of acute stress (eg. infection, trauma, surgery)
Graves disease
-
-
thyroid-stimulating immunoglobulin (IgG; type2)stimulates TSH receptors on thyroid and dermal fibroblast
-
-
-
-
parathyroid disease
hypoparathyroidism
-
-
tetany, hypocalcemia, hyperphosphatemia, Chovostek sign, Trousseau sign
-
hyperparathyroidism
secondary parathyroidism
-
hypocalcemia, hyperphosphatemia
due to ↓Ca²⁺ absorption, ↑PO₄³⁻
-
-
-
-
ADH
-
diabetes insipidus
central DI
-
-
pituitary tumor, autoimmune, trauma, surgery, ischemic encephalopathy, idiopathic
treatment: desmopressin, hydration
nephrogenic DI
-
minimal change in urine osmolality, even after administration of ADH analog
hereditary, 2° to hypercalcemia, hypokalemia, lithium, demeclocycline
treatment: HCTZ, indomethacin, amiloride, hydration, dietary salt restriction, avoidance of offending agent
intense thirst and polyuria, due to lack of ADH or response to ADH
urine specific gravity<1.006, serum osmolality>290mOsm/kg, hyperosmotic volume contraction
-
cause of goiter
smooth/diffuse
Graves disease, Hashimoto thyroiditis, iodine deficiency, TSH secreting pituitary adenoma
nodular
toxic multinodular goiter, thyroid adenoma, thyroid cancer, thyroid cyst
Nelson syndrome
enlargement of ACTH secreting pituitary adenoma after bilateral adrenalectomy for refractory Cushing disease
hyperpigmentation, headache, bitemporal hemianopia(両耳側性半盲)
GH
acromegaly(先端巨大症)
large tongue, deep voice, large hand and feet, coarsening of facial feature, frontal bossing(前頭隆起), diaphoresis(発汗), hypertension
↑ serum IGF-1, failure to supress GH in oral glucose tolerance test; pituitary mass
-
treatment: resection; octreotide, pegvisomant, dopamine agonist
Laron syndrome
defective hormone receptor→↓linear growth, ↑GH, ↓IGF-1