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DIT Endocrine Flashcards

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1
Q

What hormones use cAMP? mnemonic plus more

A

FLAT ChAMP and glucagon (basophiles use cAMP. think BASE CAMP)

So basophilic anterior pituitary:
FSH (alpha subunit)
LH (alpha subunit)
ACTH
TSH (alpha subunit)
hCG (alpha subunit)
CRH
hCG
ADH (V2)
MSH
PTH

calcitonin, GHRH, glucagon

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2
Q

Inositol triphosphate messenger for? (IP3 from Gq pathway)

A

GOAT HAG

GnRH, Oxytocin, ADH (V1), TRH, Histamine, Angiotensin II, Gastrin

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3
Q

Tyrosine kinase receptors are used by what? Mnemonic?

A

Growth factors and insulin

And acidophiles and cytokines

PIG: prolactin, IL_, GH

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4
Q

What hormones use steroid receptors?

A

Steroids, VITAMIN D, T3 and T4

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5
Q

What hormones have common alpha subunit? What type of receptor do they work on?

A

It is the FLAT without the A + hCG. all work with cAMP (Gs)

LH
FSH
TSH
hCG

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6
Q

What is cabergoline?

A

Dopamine agonist (prolactinoma tx), similar to bromocriptine

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7
Q

What enzyme does cholesterol to pregnenolone?

What activates it?
What inhibits it?

A

Desmolase

ACTH activates it
Ketaconazole blocks it

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8
Q

What is Cushing Disease?

A

Pituitary Adenoma secreting ACTH (causes secondary hypercortisol)

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9
Q

Dexamethasone test. What type of tumor responds?

A

High dexamethasone suppresses ACTH secreting pituitary hormone.

Ectopic ACTH (Small cell lung) won’t respond to dexamethasone b/c its abnormal anyway)

Adrenal tumor just doesn’t need ACTH, so it laughs at dexamethasone test

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10
Q

What causes secondary hyperaldosterone? Lab finding?

A

Low perfusion to kidney causes kidney to perceive low blood volume

HIGH RENIN!!!

Renal artery stenosis
CHF
Low protein state (low oncotic pressure so intravascular volume, so renin response)

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11
Q

Patient has DIC and after septicemia, what is risk for endocrine?

A

Neisseria can case this. It can cause weterhouse friderichsen syndrome and adrenals are just filled with blood and they die.

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12
Q

What findings are different in secondary adrenal insufficiency than primary?

A

No ACTH is made, but renin pathway is fine.

So: normotensive, not hyperkalemic. No hyperpigmentation b/c no POMC action.

but still fatigued, malaised, and feeling like garbage

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13
Q

What happens if you take off glucocorticoids without taper?

A

tertiary adrenal insufficiency b/c negative feedback of cortisol had shut down the hypothal

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14
Q

What are the 3 main causes of Addison’s?

A

Primary adrenal insufficiency:

Autoimmune is most common
Then metastasis
Then tb

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15
Q

What tumors secrete epo?

A

Pheo
RCC
Hemangioblastoma
HCC

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16
Q

Medicaiton to give to pheo patient on their way to OR to have it removed?

A

ALPHA BLOCKER: phenoxybenzamine. (nonselective and irreversible. Phentoalamine is nonselective and reversible and sued for MAO people who eat tyramine)

Then you can give a beta blocker but don’t want unaposed alpha activity

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17
Q

What is the adrenal tumor in children?

A

Adrenal neuroblastoma. Can be anywhere on symp chain and presents as abdominal distension with firm mass.

HVA is present in urine as a dopamine breakdown product.

Less likely to have HTN.

over expression of n-myc

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18
Q

Adrenal neuroblastoma

Oncogene?

Tumor marker

Stain?

Histo?

A

n-myc (transcription factor)

bombesin (NeuroBOMBESInoma)

Neurofilament stain (makes sense)

Homer right pseudorosette

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19
Q

MEN 1, 2A, 2B

A

PPP (diamond)
Pituitary
Pancreas
Parathyroid

PPM (Square)
Parathyroid
Pheo
Medullary thyroid

PMM (triangle)
Pheo
Mucosal neuroma
Medullary thyroid

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20
Q

Where does thyroid come from?

What can happen with problems in migration?

A

From pharynx. ENDODERMAL (gut tissue)

Most common ectopic site is tongue and thyroglossal duct connotes it to tongue

Thyroglossal duct cyst is in middle of the neck and moves with swallowing

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21
Q

Difference in mechanism for propylthiouracil and methimazole?

Difference in toxicity?

A

Propylthiouracil blocks peripheral T4 to T3 and peroxidase (methimazole is just the latter)

PPT is liver toxicity
Methimazole is very teratogenic in first trimester
BOTH can cause agranulocytosis

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22
Q

Patient is having weight loss and anxiety. You do iodine scan and patches of thyroid take up iodine. Dx? pathophys?

A

Toxic multinodular goiter

Mutation in TSH receptor causes parts of thyroid to be acting without signaling. (why nodules are working, and toxic b/c it is functioning)

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23
Q

Tx of thyroid storm?

A

3 P’s Propranalol, propylthiouracil, Prednisolone (corticosteroids)

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24
Q

Hypothyroid with painless goiter?

A

Hashimotos! if autoimmune.

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25
Hashimotos MHC info?
HLA D5 and B5
26
Hashimotos on histo?
Looks like lymph node b/c shrunken follicles and germinal ceneters
27
Rapidly growing thyroid mass in hashimotos, consider what?
B cell lymphoma
28
Difference in histology of hashimoto and de Quervain?
De Quervain is painful and is granulomatous inflammation (after viral infection or even during) Hashimotos is lymphocytic inflammation and painless.
29
Histo of Riedel's? Presentation?
Rock hard mass and hypo thyroid and painless Histo is fibrosis with macrophage and eosinophils
30
What is a big med to think about for causes of hypothyroidism?
Amiodarone Tyrosine kinase inhib, lithium are ohters
31
Histo of papillary carcinoma of thyroid? Risks:
RET and BRAF mutations. (Zach BRAF would be all over annie eye nuclei) Radiation or tobacco can cause it too Orphan Annie Eye nuclei (empty nucleus) and psammoma bodies b/c annie's horse was sandy and thats what psammoma means Good prognosis
32
Follicular carcinoma appearance?
Looks like follicular adenoma but invades capsule. Spreads in blood but still good prognosis
33
Histo of medullary carcinoma? Genes of it? What do you check before you remove this tumor?
Medullary thyroid is C cells and you see amyloid (congo red) RET mutation associated MEN2A and 2B so might have pheo, check this before going into surgery
34
Hard thyroid mass in an old patient?
Anaplastic/undifferentiated carcinoma. Invasive. Bad.
35
What thyroid cancers have tyrosine kinase receptor activation?
Papillary and medullary (tyrosine kinase)
36
What can cause restrictive cardiomyopathy? mnemonic
LEASH ``` Loffler (Endomyocardial fibrosis with eosinophilic) Endocardial fibroealstosis Amyloidosis Sarcoidosis Hemochromatosis ``` Radiation
37
How does glucose cause insulin release?
``` Through GLUT 2 ATP is made from glycolysis ATP sensitive K+ channels close Cell depolarizes Ca++ comes in Exocytosed vesicles with insulin ```
38
Where are GLUT 2 cells?
Beta cells, liver, kidney, small intestine
39
DMI HLA stuff?
HLA DR3-DQ2 and DR4-DQ2
40
What are some small vessel issues with diabetes?
Thicken of basement membrane causes retinopathy (and eventual vessel proliferation), and nephropathy: proteinuria. ACE INHIBITORS HELP Can also cause vascular disease
41
What does osmotic damage hurt in diabetes?
Cells with no sorbitol dehydrogenase Lens, retina, kidney, SCHWANN CELLS ``` Retinopathy Nephropathy VASCULAR disease Motor NEUROPATHY Sensory NEUROPATHY Autonomic NEUROPATHY ```
42
What does diabetic neuropathy feel like?
Can be like pins and needles (its like when your foot falls asleep) Gabapentin and amytriptylin and all sorts of shit for tx
43
What causes DKA? Put it simply
Stress. IE. Things that increase corticosteroids, glucagon, or catecholamine. Cells think they are starving b/c no insulin. Ketones are made while urine is lost and dehydration plus acidosis is bad
44
Major complications of DKA for: Arrythmia K+ levels Infection
Low magnesium and potassium can cause V tach or Torsades K+ serum levels are high b/c acidosis and potassium put into blood, but a lot is peed out so total body potassium is LOWWW need to give potassium as you treat Mucormycosis and rhizopus
45
Who gets hyperosmolar hyperglycemic state? How is it different than DKA?
There is some insulin in DMII, so there is not the ketoacidosis. Instead there is extreme hyperglycemia (>800) Pateints are confused, delierus and severe dehydration. maybe coma Tx: potassium and IV insulin
46
Tx of DKA?
Treat acidosis. Keep giving insulin anion gap normalizes (may need to add glucose) Potassium for intracellular stores IV fluid
47
Biguanides mechanism: Tox?
Less gluconeogenesis in liver, lower LDL and triglycerides. GI upset: diarrhea (limiting use early on) LACTIC ACIDOSIS: can't give it in renal failure. (CAREFUL with IV contrast)
48
Sulfonylureas suffix? Mechanism? Tox?
Prefix: glyburide, glimepiride, glipizide. Secretagogues Close K+ channel in Beta cells so cells depolarize and trigger insulin release by Ca++ influx Hypoglycemia and weight gain, can be long lasting effects.
49
Thiazolidinediones are what drugs? Mehanims? Tox?
glitazones Increase sensitivity to insulin in peripheral tissue. PPAR-gamma receptor. Hepatotoxic. Inclease fluid retension: Worsen CHF
50
What are DPP-4 inhibitors?
Gliptins. Mechanism: Inhibit DPP-IV which would break down GLP-1 which is released as you eat which increases insulin release and blocks glucagon. Prolongs incretin actions Increase insulin release, less glucagon release
51
What are the GLP-1 analogues?
Exenatide, and Liraglutide they are incretin analogues so more insulin release and less glucagon release N/V and also pancreatitis Exeneatide is an analog of exendin, a hormone in the Gila monster which allows them to eat once a week! neat!
52
What is the amylin analog action?
Satiety and decreased emptying and less glucagon
53
What are the alpha glucosidase inhibitors?
Acarbose and miglitol Inhibit intestina alpha glucosidase so less sugar absorption. GI issues
54
Leptin is from what? What does it signal?
From adipocytes Inhib Lateral hypothal (stop being hungry) Stim ventromedial hypothal (signal youa re satisfied)
55
2 main causes of lipodystrophy?
``` Leptin deficiency HIV medications (protease inhibitors) ``` Cushing can cause it too
56
Without knowing numbers, what are the criteria for metabolic syndrome? 3 star
3 of the 5 ``` Waist circumference triglycerides HDL BP Fasting serum glucose ```
57
Weight loss meds?
Orlistat (pancreatic lipase inhib) | Phentermine
58
PTH affect on bone? Kidney?
Hits osteoblasts which make more RANK-L which hit RANK of osteoclast so more bone turnover More reabsorption of Ca in DCT of kidney Less reabsorption of phosphate in PCT Moare 1,25 OH production by stimulating kidney 1 alpha hydroxylase
59
Other than low calcium, what signals affect PTH release?
Low magnesium increases PTH release. VERY LOW or prolonged decreases PTH, weird. Low magnesium caused by: diarrhea (duh, not absorbed), too much pee (diuretics and booze), amino glycosides)
60
3 functions of Vit d?
dietary absorption of Ca++ Dietary absorption of phosphate More bone resoprtion so more Ca and phosphate
61
What malignancies can cause hypercalcemia?
``` SQUAMOUS CELL (especially lung) Renal cell (makes sense b/c vit D) Breast mets Multiple myeloma b/c osteolytic factors Parathyroid adenoma (duh) ```
62
What are labs for secondary hyperparathyroidism?
Low calcium high phosphate high parathyroid High alkaline phosphatase (duh) (b/c renal can't make 1-25 OH Vit D so high PTH. Also renal failure means can't excrete phosphate so high phosphate)
63
Mnemonic for hypercalcemia?
• MD PIMPS ME * Malignancy (MM and squamous) * Diuretics * Parathyroid (hyperparathyroidism) * Idiopathic * Megadose of vitamin D * Paget disease * Sarcoidosis * Milk-alkali syndrome * Endocrine (thyrotoxicosis)
64
What is pseudohypoparathyroidism? What are findings?
Low calcium b/c AUTOSOMAL DOMINANT unresponsiveness of kidney to PTH so hypocalcemia and shorteend 4th/5th digits. Short stature. OSTEOITIS FIBROSIS CYSTICA b/c PTH causes RANKL to be made by osteoblasts and bones are destroyed by osteoclasts Albrithgt hereditary osteodystropghy

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