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Flashcards in 3/8 endo Deck (129)
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1

How does excess cortisol lead to HTN?

-up-regulates alpha-1 receptors on arterioles.
-has slight mineralocorticoid ability.

2

Dexamethasone suppression test
-low dose suppresses ACTH =
-high dose (8mg) suppresses ACTH =
-no suppression w/high dose (8mg) =

-low dose suppresses ACTH = normal
-high dose suppresses ACTH = pituitary adenoma
-no suppression w/high dose = ectopic ACTH prod.

3

How does excess cortisol lead to osteoporosis?

-cortisol dec. osteoblastic activity

4

CRH stimulation test

-differentiate btwn a pituitary adenoma and ectopic source.
-an ectopic source will not increase cortisol production in response to CRH b/c the pituitary is super suppressed by all the negative feedback of the ectopic ACTH.
-the pituitary adenoma will make even more ACTH and thus cortisol in response to CRH b/c its negative feedback mechanism is obviously fucked up which is a key property thats allowing it to pump out all of this ACTH in the first place.

5

Inoperable Cushings
-Tx:

Ketoconazole

6

Primary or secondary hyperaldo
-Tx:

-surgery (primary) or spironolactone

7

Which bug has been known to destroy the adrenals?

TB

8

Waterhouse-Friderichsen syndrome
-potential causes?

-Neisseria meningitidis septicemia, DIC, and endotoxic shock

9

Resting tone on vasculature?

-sympathetic
-hence neurogenic shock - you lose that sympathetic tone.

10

Neuroblastoma
-originates from what tissue?
-presentation?

-Neural crest cells
-abdominal distension and a firm, irregular mass B that can cross the midline (vs. Wilms tumor, which is smooth and unilateral).
*it does not cause HTN like pheo does.

11

Neuroblastoma
-what is increased in urine?
-associated w/which oncogene?

-Homovanillic acid (HVA) = breakdown product of dopamine.
-N-myc

12

Homovanillic acid (HVA)
-inc urinary levels in what disease?
-HVA is breakdown product of what?

-neuroblastoma
-breakdown product of dopamine.

*dopamine = precursor to catecholamines.

13

Neuroblastoma
-bombesin + or -
-what do you see on histology?

-bombesin + (tumor marker)
-rosettes & classic small, round, blue/purple nuclei.

14

pheochromocytoma
-arise from what cells?
-what color is it usually?

chromaffin cells
-neural crest cells
-brown - the adrenal medulla is usually brown.

15

pheochromocytoma
-rule of 10s

Rule of 10’s:
10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids

*More than 70% of cases of pheochromocytomas
are bilateral when familial.

16

pheochromocytoma
-associated w/which diseases?

-Associated with von Hippel-Lindau disease, MEN 2A and 2B.

17

pheochromocytoma
-Tx:

Irreversible α-antagonists (phenoxybenzamine) and β-blockers followed by tumor resection.
-α-blockade must be achieved before giving
-β-blockers to avoid a hypertensive crisis.

18

Hyperthyroidism
-diarrhea or constipation?
-inc or dec reflexes?

-diarrhea
-inc. reflexes

19

hyperthyroidism
-whats the skin & hair like?
-hypo or hypercholesterolemia?

-Warm, moist skin; fine hair
-Hypocholesterolemia (due to inc. LDL receptor expression). *you're basically burning more fuel.

20

hyperthyroidism
-calcium level?
-blood glucose?

-hypercalcemia (inc. burn resorption).
-hyperglycemia (gluconeo & glycogenolysis going on).

21

dyspnea on exertion
-Sx of hypo or hyperthyroidism

hypothyroidism

22

large fontanels & macroglossia in children.
-hypo or hyperthyroidism?

hypothyroidism

23

Whats the most common cause of myopathy?

hypothyroidism
-myoedema will be present (edema of muscle s/p percussion), inc. creatine kinase, + other hypothyroid Sxs like weight gain, fatigue, etc.
-will present w/myalgia, proximal muscle weakness, & cramping.

24

Abs found in hashimotos thyroiditis

-anti-thyroid peroxidase
-antithyroglobulin antibodies
-anti-microsome

*they do not cause the disease, they are byproducts of the disease.

25

hashimotos
-HLA association?

HLA-DR5
*Pernicious anemia also associated w/HLA-DR5

26

hashimotos
-inc risk of what cancer?

non-Hodgkin lymphoma
-chronic inflammatory states like hashimotos (or sjogrens or h.pylori gastritis) inc. risk of developing a marginal zone lymphoma.

27

Hürthle cells
-which disease?

hashimotos thyroiditis

28

Which hypothyroid states can present w/initial transient hyperthyroid state?

-hashimotos
-Subacute thyroiditis (de Quervain)

29

Long standing hashimoto pt that suddenly has an progressively enlarging thyroid, think what?

B-cell lymphoma

30

Congenital hypothyroidism (cretinism)
-Sxs:

The 6 P’s
Pot-bellied
Pale
Puffy-faced child
Protruding umbilicus
Protuberant tongue
Poor brain development