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Endocrine > Pathology > Flashcards

Pathology Flashcards

0
Q

Secondary hyperaldosteronism

A

Renal perception of low volume leading to overactive RAAS system
Due to renal artery stenosis,chronic renal failure , CHF, cirrhosis, nephrotic syndrome

RX spironolactone
HIGH renin,

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1
Q

Conns syndrome

A

Aldosterone secreting adrenal adenoma (1’ hyperaldosteronism)

HTN, normal Na+ (due to aldosterone escape and ANP), hypokalemia, metabolic alkalosis (high HCO3), LOW renin

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2
Q

Addison’s disease most common cause…..

A

Autoimmune

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3
Q

Addison’s disease

A

Chronic 1’ adrenal insufficiency due to adrenal atrophy or destruction by disease (autoimmune, TB, metastasis)

Deficiency in aldosterone, cortisol—leads to hypotension (hyponatremic volume contraction), hyperkalemia, metabolic acidosis, skin hyperpigmentation due to increased ACTH from POMC and excess MSH

Adrenal atrophy and absence of hormone production
All 3 cortical layers involved (spares medulla)

Labs: low Na, high K, low Cl, low HCO3

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4
Q

Addison’s disease caused by secondary adrenal insufficiency differences

A

Low ACTH which leads to no hyperpigmentation no hyperkalemia

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5
Q

Waterhouse Friderichens syndrome

A

Acute primary adrenal insufficiency due to adrenal hemorrhage as coated with Neisseria meningitidis septicemia, DIC, Endotoxic shock

Only meningitis species to have petechial rash present**

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6
Q

Exogenous causes of Cushing’s

A

Steroids (low ACTH)

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7
Q

Endogenous causes of Cushing’s

A 
Pituitary adenoma (high ACTH)
Ectopic ACTH (high ACTH think small cell lung or bronchial carcinoids)
Adrenal adenoma (low ACTH)
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8
Q

Suppressed low and high doses of dex test

A

Normal response

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9
Q

Suppressed with high dose of DEX and stays elevated with low dose of DEX

A

ACTH pituitary adenoma

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10
Q

Elevated with low and high DEX test

A

Cortisol producing tumor or ECTOPIC ACTH producing tumor

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11
Q

Pheochromocytoma associated with….

A

NF type I, MEN 2a and 2b

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12
Q

RX for pheochromocytoma

A

Phenoxybenzamine and beta blockers first , then can remove tumor surgically

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13
Q

5Ps of pheochromocytoma

A 
Pressure
Pain
Perspiration
Palpitations
Pallor
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14
Q

Tests for pheochromocytoma

A

Elevated VMA in urine

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15
Q

Rule of 10s for pheochromocytoma

A 
10% are........
Malignant
Bilateral
Extra-adrenal
Calcify
Kids
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16
Q

Pheochromocytoma vs neuroblastoma

A

Pheochromocytoma is in adults, happens in episodes, most are benign

Neuroblastomas are in kids, constant, most are malignant

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17
Q

Neuroblastoma

A

Elevated HVA in urine (breakdown of dopamine)

Overexpression of n-myc

Less likely to develop HTN

Can occur anywhere along the sympathetic chain

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18
Q

Signs of hypothyroidism

A 
Cold 
Wt gain, low appetite
Hypoactivity, lethargy, fatigue, weakness 
Constipation
Decreased reflexes
Myxedema 
Dry cool skin, coarse brittle hair
Bradycardia, DOE
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19
Q

Labs of hypothyroidism

A

High TSH ( if 1’ )
Low free T4
High creatinine kinase

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20
Q

Hyperthyroidism symptoms

A 
Hot
Wt loss, high appetite
Hyperactivity
Diarrhea
Increased reflexes
Pretibial myxedema (graves)
Warm, moist skin , fine hair
Increased beta adrenergic
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21
Q

Labs for hyperthyroidism

A

Low TSH (if primary)
High free or total T4
High free or total T3

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22
Q

Hashimoto’s thyroiditis

A

Most common cause of Hypothyroidism
Autoimmune (antithyroglobulin antibodies)
HLA-DR5
Increased risk for Hodgkin’s lymphoma

Histo: hurthle cells, lymphocytic infiltrate with germinal centers

Findings: enlarged, nontender thyroid, normal ESR

May be hyperthyroid early in course if thyroid ruptures

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23
Q

Cretinism

A

Severe fetal hypothyroidism
Endemic type happens when low dietary iodine
Sporadic form caused by defect in T4 formation or developmental failure in thyroid formation

5 Ps
Pot bellied
Pale
Puffy faced child
Protruding umbilicus
Protuberant tongue
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24
Q

Subacute thyroiditis (de Quervains)

A

Self limiting following flu illness

Very TENDER thyroid
HIGH ESR, jaw pain, inflammation
Histo: Granulomatous inflammation, cellular infiltration with giant cells

Can be hyperthyroid early in cousre

25
Q

Riedel’s thyroiditis

A

PAINLESS, goiter, fixed, rock like

Thyroid replaced with fibrous tissue

Manifestation of IgG4 related systemic dz

26
Q

Other causes of hypothyroidism

A 
Congenital hypothyroidism
Iodine deficiency
Goitrogens
Wolf-Chaikoff effect
Painless thyroiditis
27
Q

Toxic multinodlar goiter

A

Focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation in TSH receptor

Increased release of T3 and T4
Hot nodules rarely malignant

Jod-Basedow phenomenon– thyrotoxiosis if PT with iodine deficiency goiter is made iodine replete

28
Q

Graves Disease

A

Autoimmune hyperthyroidism with thyroid stimulating immunoglobulins

Proptosis, EOM swelling
Pretibial myxedema*******
Increased connective tissue deposition (dermatan sulfate like in MVP)
Diffuse goiter
Presents during stress
29
Q

Thyroid storm

A

Stress induced catecholamine surge leading to death by arrhythmia
Serious complication of graves and hyperthyroid dz
May see high ALP due to hi bone turnover

30
Q

Papillary carcinoma

A

Most common
Great prognosis
Orphans Annie eyes (empty appearing nuclei)
Psammoma bodies
Nuclear grooves
Increased risk with childhood irradiation

31
Q

Follicular carcinoma

A

Good prognosis

Uniform follicles

32
Q

Medullary carcinoma

A

From para follicular C cells–produces calcitonin
Sheets of cells in amyloid stroma (stains Congo red)
RET mutation
MEN 2a and 2b

33
Q

Undifferentiated / anaplastic

A

Older patients , poor prognosis

34
Q

Lymphoma

A

Associated with Hashimoto’s thyroiditis

35
Q

Thyroidectomy beware of…..

A

Superior laryngeal n. which innervates cricothyroid m.

36
Q

Osteitis fibrosa cystica

A

Cystic bones spaces filled with brown fibrous tissue

1’ hyperparathyroidism
Stones bones and groans

37
Q

Secondary parathyroidism

A

Chronic renal disease
Low gut Ca absorption and increased PO4
Can’t activate vitamin D
Hypocalcemia, Hyperphosphatemia in chronic renal failure
Increased alkaline phosphatase, increased PTH

38
Q

Renal osteodystophy

A

One lesions due to 2’ or 3’ hyperparathyroidism due to renal disease

39
Q

Hypoparathyroidism causes

A

Thyroid surgery
Autoimmune
DiGeroge syndrome

Findings: hypocalcemia and tetany

40
Q

Chvotstek’s sign

A

Tapping of facial n. —-contraction of facial mm.

41
Q

Trousseaus sign

A

Occlusion of brachial a. With BP cuff—–carpal spasm

42
Q

Pseudohypoparathyroidism

A

Albrights hereditary osteodystophy —AD kidney unresponsive to PTH

Hypocalcemia, shortened 4th and 5th digit , short stature

43
Q

SIADH causes

A

Ectopic ADH (small cell lung CA)
CNS disorders/head trauma
Pulmonary diseases
Drugs (cyclophosphamide)

44
Q

Bodies response to SIADH

A

Aldosterone secretion DECREASES to maintain near normal volume status despite the hyponatremia

Euvolemic Hyponatremia (normal ECF volume)

45
Q

Causes of nephrogenic DI

A

2’ to Hypercalcemia, lithium, demeclocycline (ADH inhibitor)

46
Q

Central DI RX

A

Desmospressin

47
Q

Nephrogenic DI RX

A

HCTZ, indomethacin, amiloride

48
Q

Pituitary apoplexy

A

Hemorrhage of pituitary gland—can develop CV collapse bc lack of ACTH leading to low cortisol levels

Presents similar to subarachnoid hemorrhage accept vision changes

49
Q

Sheehans syndrome

A

Ischemic infarct of pituitary following postpartum bleeding: usually presents with failure to lactate

50
Q

Treatments for prolactinoma

A

Bromocriptine / cabergline (dopamine agonists)

51
Q

Diabetes Mellitus Type I HLA System

A

HLA-DR 3&4

52
Q

Islet leukocytic infiltrate

A

DM type 1

53
Q

Islet amyloid (AIAPP) deposit

A

DM type 2

54
Q

Carcinoid syndrome symptoms

A

Diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease (endocardial thickening with fibrosis), niacin deficiency (tryptophan used up), high 5-HIAA in urine

RX: octreotide

55
Q

Carcinoid rule of 1/3s

A

1/3……
Metastasize
Present with second malignancy
Multiple

Most common tumor of appendix

56
Q

Zollinger-Ellison syndrome

A

Gastric secreting tumor of pancreas or duodenum

Stomach shows rural thickening with acid hypersecretion

RECURRENT ULCERS

MEN type 1

57
Q

MEN 1

A

Parathyroid tumors
Pituitary tumors
Pancreatic tumors (ZE syndrome, insulin/VIP/glucagonomas)

Presents with kidney stones and stomach ulcers

58
Q

MEN 2a

A

Medullary thyroid carcinoma (secretes calcitonin)
Pheochromocytoma
Parathyroid tumors

RET gene

59
Q

MEN 2b

A

Medullary thyroid carcinoma (calcitonin)
Pheochromocytoma
Oral/intestinal ganglioneuromatosis (Marfanoid habitus)

RET gene

60
Q

MEN syndrome inheritance

A

Autosomal dominance

Endocrine (5 decks)

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