foramen cecum is remnant of
thyroglossal duct
layers of adrenal cortex (outer to inner) and what they make
GFR:
glomerulosa - aldosterone
fasciculata - cortisol
reticularis - sex hormones
MC tumor of adrenal medulla in kids vs adults
kids - neuroblastoma
adults - pheo
alpha subunit is common to what hormones
TSH, LH, FSH, hCG
tissues w/ insulin dependent glucose uptake
BRICK L
brain, RBCs, intestine, cornea, kidney, liver
GLUT1, GLUT2, GLUT4 - how do they work and where found
1 - insulin independent. RBCs, brain
2 - bidirectional. beta islet cells, liver, kidney, small intestine
4 - insulin dependent. adipose, skeletal muscle
adrenergic stimulation/inhibitors of insulin release
beta 2 agonists stimulate insulin release
alpha 2 agonists dec insulin release
link btwn hypothyroidism and hyperPRL
TRH stimulates PRL release - not significant at physiologic levels, but when TRH is elevated in hypothyroid, can cause hyperPRL
somatostatin neg regulates what 2 hormones?
GH, TSH
2 types of drugs that stimulate PRL secretion
DA antagonists (like antipsychotics) estrogens
antimicrobial drug that can cause adrenal insuff
ketoconazole
17alpha hydroxylase def, 21 hydroxylase def, 11beta hydroxylase def - all of these are what type of disorder? what are hormone levels in each one? which is most common?
congenital adrenal hyperplasias
17alpha - inc aldo, dec cortisol, dec androgens
21 - dec aldo, dec cortisol, inc androgens
11beta - dec aldo (but inc 11-deoxycorticosterone - another mineralocorticoid), dec cortisol, inc androgens
21 is most common
fns of cortisol
maintain BP (esp alpha 1 receptors) dec bone formation anti inflammatory inc insulin resistance inc gluconeogenesis, lipolysis, proteolysis inhibit fibroblasts
Mg effect on PTH secretion
dec Mg > inc PTH
severely dec Mg > dec PTH
what cells make calcitonin?
parafollicular cells in thyroid (C cells)
4 main fns of T3
4 Bs - brain maturation bone growth beta adrenergic effects basal metabolic rate (inc)
Wolff Chaikoff effect
excess iodine temporarily inhibits TPO > dec T3/4 synth
MCC cushing’s syndrome
exogenous steroids
aldosterone secrecting adrenal adenoma called
Conn’s syndrome
2 findings that are present in primary but not secondary adrenal insufficiency
primary has skin hyperpigmentation and hyperkalemia, secondary doesnt
Waterhouse Friderichsen syndrome
acute primary adrenal insufficiency caused by N. meningitidis septicemia, DIC and endotoxic shock
type of cell that makes up pheo
chromaffin cell
tx of pheo
first, irreversible alpha antagonists to prevent HTN crisis
next beta blockers to slow HR
then can surgically remove
marker indicating presence of neuroblastoma
urine HVA (homovanillic acid - breakdown product of DA)
findings in cretinism
5 Ps - pot belly pale puffy face protruding umbilicus protuberant tongue
granulomatous inflammation in thyroid
subacute thryoiditis (de Quervain’s)
fibrosis of thyroid
Reidel’s thyroiditis - painless, hypothyroid
pathophys of toxic multinodular goiter
patches of hyperfunctioning follicular cells working independently of TSH > inc release of T3/4
Jod Basedow phenomenon
thyrotoxicosis if pt w/ iodine def goiter is made iodine replete
cause of death from thyroid storm
arrhythmia
really bad kind of thyroid CA
anaplastic
MC type of thyroid CA
papillary
which type of thyroid CA makes calcitonin?
medullary - from parafollicular cells
bone dz assoc w/ hyperPTH
osteitis fibrosa cystica - cystic bone spaces filled w/ brown fibrous tissue
Albright’s hereditary osteodystrophy
pseudohypoPTH
AD
kidney unresponsive to PTH
hypoCa, shortened 4/5th digits, short stature
MC type of pituitary adenoma
prolactinoma
Sheehan’s syndrome
postpartum infarct of pituitary causing panhypopituitarism
Kimmelsteil wilson nodules
deposits in nodular glomerulosclerosis assoc w/ diabetic nephropathy
Kussmaul respirations assoc w/
DKA
carcinoid syndrome
carcinoid tumor “after” the liver (not confined to GI) secretes 5HT - paroxysms of diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular dz
inheritance pattern of MEN syndromes
AD
gene assoc w/ MEN2a/b
ret
MEN 1 manifestations
parathyroid tumors
pituitary tumors
pancreatic endocrine tumors
MEN 2a manifestations
medullary thyroid CA
pheo
parathyroid tumors
MEN 2b manifestations
medullary thyroid CA
pheo
oral/intestinal ganglioneuromatosis, marfanoid habitus
AEs of metformin
GI upset
lactic acidosis **
AEs of first gen sulfonylureas
disulfiram like effects
pramlintide - mech, use
amylin analog (dec glucagon secretion) type 1 and 2 DM
-gliptin drugs - what is the mechanism / use
DPP4 inhib - stop incretin degradation to increase insulin and dec glucagon
used in T2DM
2 drugs used to reduce production of thyroid hormone
propylthiouracil and methimazole
demeclocycline - mech, use
ADH antagonist
used in SIADH