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endo Flashcards

1
Q

islet of langerhans organization

A

alpha -> glucagon = peripheral. beta -> insulin = central (insulin inside). delta -> somatostatin = interspersed

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2
Q

zona glomerulosa

A

control: renin-angiotensin system. product: aldosterone

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3
Q

zona fasciculata

A

control: ACTH, CRH. products: cortisol, sex hormones

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4
Q

zona reticularis

A

control: ACTH, CRH. products: sex hormones

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5
Q

adrenal medulla

A

chromaffin cells. control: preganglionic sympathetic fivers. product: catecholamines (epi, NE). pheochromocytoma: most common adult tumor. neuroblastoma: most common in kids - rarely -> HTN.

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6
Q

CRH

A

fxn: inc. ACTH, MSH, beta-endorphin. dec. w/exogenous steroid use

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7
Q

DA

A

fxn: dec. prolactin. DA antagonists can -> galactorrhea due to hyperprolactinemia

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8
Q

GHRH

A

fxn: inc. GH. analog (tesamorelin) used to Tx HIV-associated lipodystrophy

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9
Q

GnRH

A

fxn: inc. FSH, LH. regulated by prolactin. tonic GnRH suppresses HPA axis. pulsatile GnRH -> puberty, fertility

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10
Q

somatostatin

A

fxn: dec. GH, TSH. analogs used to Tx acromegaly

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11
Q

TRH

A

fxn: inc. TSH, prolactin

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12
Q

17alpha-hydroxylase deficiency

A

inc. mineralocorticoids, dec. cortisol, sec. sex hormones, inc. BP, dec. K, dec. androstenedione. presentation: XY: pseudo-hermaphroditism. XX: lack secondary sex development

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13
Q

21-hydroxylase deficiency

A

dec. mineralocorticoids, dec. cortisol, inc. sex hormones, dec. BP, inc. K, inc. renin, inc. 17-hydroxy-progesterone. most common. presents in infancy w/salt wasting or childhood w/precocious puberty. females = virilized.

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14
Q

11beta-hydroxylase deficiency

A

dec. aldosterone, inc. 11-deoxycorticosterone (inc. BP), dec. cortisol, inc. sex hormones, inc. BP, dec. K, dec. renin. XX: virilization

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15
Q

effect of inc. pH on ionized Ca

A

inc. affinity for albumin -> inc. % bound -> hypocalcemia

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16
Q

effects of vit D

A

= cholecalciferol. -> inc. absorption of dietary Ca and PO4 + inc. bone resorption -> inc. available Ca and PO4.

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17
Q

effects of PTH

A

inc. bone resorption of Ca and PO4. inc. kidney reabsorption of Ca in distal convoluted tubule. dec. reabsorption of PO4 in proximal convoluted tubule. inc. 1,25-(OH)2D3 (calcitriol) production by stimulating kidney 1alpha-hydroxylase in proximal convoluted tubule. stimulates osteoblasts to produce RANK-L to stimulate osteoclasts. PTH: Phosphate Trashing Hormone.

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18
Q

PTH regulators

A

+: dec. serum Ca, inc. serum PO4, dec. serum Mg. -: very low serum Mg.

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19
Q

vit D regulators

A

+: PTH, low [Ca], dec. PO4. -: 1,25-(OH)2D3

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20
Q

cAMP hormones

A

FLAT ChAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2-receptor), MSH, PTH, calcitonin, GHRH, glucagon

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21
Q

cGMP hormones

A

vasodilators: ANP, BNP, NO (EDRF)

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22
Q

IP3 hormones

A

GOAT HAG: GnRH, Oxytocin, ADH (V1-receptor), TRH, Histamine (H1-receptor), Angiotensin II, Gastrin

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23
Q

intracellular receptor hormones

A

VETTT CAP: Vit D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone

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24
Q

intrinsic tyrosine kinase hormones

A

MAP kinase pathway: think grown factors: insulin, IGF-1, FGF, PDGF, EGF

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25
Q

receptor-associated tyrosine kinase

A

JAK/STAT pathway: think acidophils and cytokines: PIGGlET: Prolactin, Immunomodulators (e.g. cytokines IL-2, IIL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoietin

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26
Q

sex hormone binding globulin

A

inc. solubility of lipophilic steroid hormones. in men, inc. SHBG -> dec. free testosterone -> gynecomastia. in women, dec. SHBG -> inc. free testosterone -> hirsuitism. OCPs, pregnancy -> inc. SHBG, free estrogen remains unchanged.

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27
Q

T3 fxns

A

4Bs: Brain maturation, Bone grown, Beta-adrenergic effects, Basal metabolism.

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28
Q

wolf-chaikoff effect

A

excess iodine temporarily inhibits thyroid peroxidase -> dec. iodine organification -> dec. T3/T4 production

29
Q

peroxidase

A

enzyme responsible for oxidation and organification of iodide + coupling of monoiodotyrosine (MIT) and di-iodotyrosine (DIT). inhibited by PTU (also inhibits 5’-deiodinase) and methimazole (peroxidase only)

30
Q

neuroblastoma

A

originates from neural crest cells. homer-wright rosettes. occurs anywhere along sympathetic chain. typical presentation: firm, irregular mass, can cross midline (unlike wilms). opsoclonus/myoclonus syndrome (dancing eyes, dancing feet). homovanillic acid and VMA are inc. in urine. bombesin and neuron-specific enolase +. HTN uncommon. overexpression of N-myc.

31
Q

pheochromocytoma rule of 10s

A

10% malignant, 10% b/l, 10% extra-adrenal (bladder wall), 10% calcify, 10% kids

32
Q

pheo Tx

A

irreversible alpha-antagonists (e.g. phenoxybenzamine, to avoid causing HTN crisis) followed by beta-clockers prior to tumor resection.

33
Q

lipids, myxedema in hypo/hyperthyroid

A

hypo: myxedema = facial/periorbital -> deep voice. hypercholesterolemia 2/2 dec. LDL receptor expression. hyper: myxedema = pretibial, periorbital. hypocholesterolemia + hyperglycemia

34
Q

hasimotos

A

HLA-DR5. inc. risk of NH lymphoma (presents w/enlarging thyroid). Abs = markers, not mediators. histo: hurthle cells (pink cytoplasm), lymphoid aggregate w/germinal centers.

35
Q

cretinism

A

6Ps: Pot-bellied, Pale, Puffy-faces, Protruding umbilicus, Protuberant tongue, Poor brain development.

36
Q

riedel thyroiditis

A

thyroid replaced by fibrous tissue -> hypothyroid. fibrosis may extend to local structures (e.g. airway), mimicking anaplastic CA (but in a younger person). manifestation of IgG4-related systemic dz (e.g. autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis). findings: fixed, rock-like, painless goiter

37
Q

graves histo

A

hyperplasia, scalloping of the colloid

38
Q

papillary CA

A

most common, excellent prognosis. “orphan annie eyes” cells (empty-appearing nuclei), psammoma bodies, nuclear grooves. lymphatic invasion = common. inc. risk w/RET and BRAF mutations + childhood irradiation

39
Q

follicular CA

A

hematogenous spread. good prognosis. invades capsule (onlike follicular). uniform follicles. FNA isn’t helpful for Dx: need excision.

40
Q

medullary CA

A

from parafollicular C cells. produces calcitonin, sheets of cells in amyloid stroma. hematogenous spread common. associated w/MEN 2a/b (RET mutuations), warranting prophylactic thyroidectomy

41
Q

peudohypoparathyroidism

A

albright hereditary osteodystrophy: AD. unresponsiveness of kidney to PTH. hypocalcemia, shortened 4th/5th digits, short stature. defect in Gs protein

42
Q

familial hypocalciuric hypercalcemia

A

defective Ca-sensing receptor on parathyroid cells. PTH cannot be suppressed by inc. Ca level -> mild hypercalcemia w/normal to inc. PTH levels

43
Q

osteitis fibrosa cystica

A

cystic bone spaces filled w/brown fibrous tissue = “brown tumor” consisting of deposited hemosiderin from hemorrhages -> bone pain.

44
Q

hyperparathyroid Sx

A

stones, bones, groans, psychiatric overtones: renal stones from hypercalcemia, hypercalciuria, weakness/constipation = groans. depression/seizures.

45
Q

Tx for nephrogenic DI

A

HCTZ, indomethacin, amiloride, hydration

46
Q

causes/Tx for SIADH

A

causes: ectopic ADH, CNS disorders/head trauma, pulm dz, drugs (cyclophosphamide). Tx: fluid restriction, IV hypertonic saline, conivaptan, tolvaptan, demeclocycline

47
Q

histo of DM

A

T1: islet leukocytic infiltrate. T2: islet amyloid polypeptide (IAPP) deposits

48
Q

glucagonoma

A

p/w dermatitis (necrolytic migratory erythema), DM, DVT, and depression

49
Q

carcinoid syndrome

A

1/3 metastasize, 1/3 p/w 2ndary malignancy, 1/3 = multiple. neuroendocrine tumor = most common small intestine malignancy. no Sx if tumor is only in GI b/c of liver metabolism. Sx: recurrent diarrhea, cutaneous flushing, asthmatic wheezing, R-sided valve dz. inc. 5-HIAA in urine, niacin deficiency (pellagra). Tx: resection, somatostatin analog

50
Q

somatostatinoma

A

-> achlorhydria (gastrin inhibition), cholelithiasis + steatorrhea (CCK inhibition)

51
Q

VIPoma

A

excessive vasoactive intestinal peptide -> watery diarrhea, hypokalemia, achlorhydria

52
Q

MEN1

A

AD. 3 Ps: parathyroid tumors, pituitary tumors (prolactin or GH), pancreatic endocrine tumors (SE syndrome, insulinomas, VIPomas, glucagonomas (rare)). associated w/MEN1 gene mutation (menin, = tumor suppressor)

53
Q

MEN2A

A

AD. 2 Ps: parathyroid hyperplasia, pheochromocytoma. inc. risk of medullary thyroid CA. associated w/marfanoid habitus. RET gene mutation (receptor tyrosine kinase)

54
Q

MEN2B

A

1P: pheochromocytoma. inc. risk of medullary thyroid CA. oral/intestinal ganglioneuromatosis (mucosal neuromas). associated w/marfanoid habitus. RET mutation.

55
Q

sulfonylureas

A

1st gen: chlorpropamine, tolbutamide. 2nd gen: glimepiride, pglipizide, glyburide

56
Q

sulfonylurea MoA

A

close K channel in beta-cell membrane -> cell depolarization -> insulin release via inc. Ca influx: stimulates insulin release.

57
Q

glitazones/thiazolidinediones

A

inc. insulin sensitivity in peripheral tissue. binds to PPAR-gamma nuclear transcription regulator. side effects: wt. gain, edema, hepatotoxicity, HF, inc. risk of fractures

58
Q

GLP-1 analogs

A

= exenatide, liraglutide. inc. insulin, dec. glucagon release. side effects: N/V/pancreatitis

59
Q

DPP-4 inhibitors

A

= linagliptin, saxagliptin, sitagliptin. inc. insulin, dec. glucagon release. side effects: mild UTIs/URIs

60
Q

amylin analogs

A

= pramlintide. dec. gastric emptying, dec. glucagon. can be used in T1. side effects: hypoglycemia, nausea, diarrhea.

61
Q

SGLT-2 inhibitors

A

= canagliflozin. block reabsorption of glucose in PCT. side effects: glucosuria, UTIs, yeast infections

62
Q

alpha-glucosidase inhibitors

A

= acarbose, miglitol. inhibit intestinal brush border alpha-glucosidases. delayed carb hydrolysis and glucose absorption -> dec. postprandial hyperglycemia. side effects: GI upset.

63
Q

PTU/methimizole

A

block thyroid peroxidase, inhibiting oxidation of iodide and organification (coupling) of iodine -> inhibition of thyroid hormone synthesis. PTU also blocks 5’-deiodinase -> peripheral conversion of T4 -> T3. no methimizole in pregnancy. side effects: skin rash, agranulocytosis, aplastic anemia, hepatotoxicity (PTU). methimizole = possible teratogen

64
Q

ADH-antagonists

A

conivaptan, tolvaptan. use: SIADH, block ADH at V2 receptor

65
Q

octreotide

A

= somatostatin analog. Tx: acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices.

66
Q

demeclocycline

A

MoA: ADH antagonists (in tetracycline family). Tx: SIADH. toxicity: nephrogenic DI, photosensitivity, abnormalities of bone + teeth

67
Q

glucocorticoids MoA

A

metabolic, catabolic, anti-inflammatory, immunosuppressive effects. inhibits phospholipase A2 and NF-kappaB.

68
Q

cinacalcet

A

MoA: sensitizes Ca-sensing receptor (CaSR) in parathyroid gland to circulating Ca -> dec. PTH. Tx: hypercalcemia due to primary or secondary hyperPTH. toxicity: hypoCa

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