endo path Flashcards
1
Q
cushings etiology
A
increased cortisol d/t
- endogenous corticosteroids
- primary adrenal adenoma, hyperplasia, or carcinoma
- ACTH-secreting pit adenoma (Cushings disease) or pareneoplasitc ACTH secretion
2
Q
endogenous corticosteroids
A
decreased ACTH
b/l adrenal atrophy
MCC
3
Q
primary adrenal adenoma, hyperplasia, or carcinoma
A
decreased ACTH
atrophy of uninvolved adrenal gland
can also present w/pseudohyperaldosteronism
4
Q
ACTH secreting adenoma or paraneoplastic ACTH secretion
A
results in increased ACTH
b/l adrenal hyperplasia
5
Q
cushings findings
A
HTN weight gain moon facies truncal obestiy buffalo hump skin changes osteoporosis hyperglycemia amenorrhea immunosupression
6
Q
Dexamethasone suppression test
A
cushings disease will suppress
ectopic ACTH secretion will not supress
7
Q
CRH stimulation test
A
cushings dis-> increase in ACTH and cortisol
ectopic ACTH secretion -> no increase
8
Q
symptoms of adrenal insufficiency
A
weakness fatigue orthostatic hypotension mm aches weight loss GI sugar and/or salt cravings
9
Q
Dx of adrenal insufficiency
A
measurement of serum electrocluces am cortisol ACTH ACTH stimulation test metyrapone stimulation test
10
Q
metyrapone stimulation test
A
blocks last step of cortisol synthesis
normal response in decreased cortisol and increased ACTH
in adrenal insufficiency ACTH does not increase
11
Q
primary adrenal insufficiency
A
hypotension hyperkalemia metaboic acidosis skin and mucosal hyperpigmentation chronic -> addisons disease
12
Q
causes of addisons
A
autoimmune (MC)
TB
mets
13
Q
Waterhouse-friderichsen syndomre
A
N. menigitidis
14
Q
secondary adrenal insufficiency
A
decreased ACTH
no hyperpigmentation
no hyperkalemia
15
Q
tertiary adrenal insufficiency
A
pt w/chronic exogenous steroid use precipitated by abrupt withdrawal
aldosterone unaffected
16
Q
neuroblastoma
A
MC tumor of adrenal medulla in kids
usually
17
Q
neuroblastoma presentation
A
distended abdomen firm irregular mass that can cross midline (wilms-tumor) opsoclonus-myoclonus sundroem HVA and VMA increased in urine bombesin and neuron-specific enolase _ rarely causes HTN N-myc
18
Q
pheo etiology
A
MC tumor of adrenal medulla in adults
derived from chromaffin cells from neural crest
19
Q
pheo rule of 10’s
A
10% malignant 10% b/l 10% extra-adrenal 10% calcify 10% kids
20
Q
pheo symptoms
A
5 Ps pressure (increased BP) pain (HA) perspiration palpitations pallor
21
Q
pheo associations
A
NF1
VHL
MEN2A and 2B
22
Q
pheo findings
A
increased catecholamines and metanephrines in urine and plasma
23
Q
Tx of pheo
A
irreversilbe alpha antagonists (phenoxybenzamine)
followed by BB prior to tumor resection
if BB first -> HTN crisis
24
Q
hypothyroidism symptoms
A
cold intolerance weight gain, decreased appetite hypoactivity, lethargy, fatigue, weakness constipation decreased reflexes myxedema (facial/periorbital) dry, cool skin, coarse brittle hair bradycardia, dyspnea on exertion
25
hypothyroidism labs
increased TSH (best test)
decreased free T3/4
hypercholesterolemia (d/t decreased LDL R)
26
hyperthyroidism symptoms
```
heat intolerance
weight loss, increased appetite
hyperactivity
diarrhea
increased reflexes
pretibial myxedema
periorbital edema
warm moist skin, fine hair
chest pain, palpitations, arrhythmias (increased number and sensitivity of betaRs)
```
27
hyperthyroidism labs
decreased TSH if primary
increased free or total T3/4
hypocholesterolemia (d/t increased LDL R)
28
hashimotos
```
MCC of hypothyroidism in iodine sufficient regions
anti-thyroid peroxidase
anti-microsomal
anti-thyroglobulin
HLA-DR5
increased risk of Hodgkin lymphoma
```
29
hashimotos presentation
may have transient hyperthyroid stage d/t thyrotoxicosis during follicular rupture
moderately enlarged, non-tender thyroid
30
hashitmotos histo
Hurthle cells
| lymphoid aggregate w/germinal centers
31
congenital hypothyroidism/cretinism
severe fetal hypothyroidism
| thyroid dsygenesis MCC in US
32
findings of congenital hypothyroidism
```
6Ps
pot-bellied
pale
puffy face w/protruding umbilicus
protuberant tongue
poor brain development
```
33
subacute thyroiditis
aka de Quervain
self-limited, often follows flu-like illness
may be hyperthyroid early then hypo
34
subacute thyroiditis histo
granulomatous inflammation
35
subacute thyroiditis findings
increased ESR
jaw pain
early inflammation
very tender thyroid
36
riedel thyroiditis
thyroid replaced by fibrous tissue
mimics anaplastic carcinoma
may be manifestation of IgG4 related systemic disease
fixed, hard, painless goiter
37
IgG4 systemic diseases
autoimmune pancreatitis
retroperitoneal fibrosis
noninfectious aortitis
38
graves
```
MCC of hyperthyroidism
autoAbs stim TSH R
hyperthyroid, diffuse goiter
retro-orbital fibroblasts
dermal fibroblasts (pre-tibial myxedema)
```
39
toxic multinodular goiter
focal patches of hyperfnxing follicular cells, working independently of TSH d/t mutation in TSH R
increased release of T3/4
hot nodules are rarely malignant
40
thyroid storm
stress-induced catecholamine surge
serious complication of thyrotoxicosis
agitation, delirium, fever, diarrhea, coma, tacharrythmia (COD)
increased ALP d/t bone turnover
41
Tx of thyroid storm
3 Ps
Propanolol (or other BB)
PTU
Prednisolone (or other corticosteroids)
42
Jod-Basedow phenomenon
thyrotoxicosis after iodine deficient goiter given iodine
43
papillary carcinoma
```
MC thyroid CA
excellent prognosis
orphan annie eyes
psammoma bodies
nuclear grooves
lymphatic invasion common
```
44
orphan annie eyes
empty appearing nuclei w/central celaring
| diagnostic of papillary carcinoma
45
papillary carcinoma risks
childhood radiation
RET
BRAF
46
follicular carcinoma
good prognosis
invases thyroid capsule (unlike follicular adenoma)
uniform follicles
47
medullary carcinoma
parafollicular C-cells
produces calcitonin
sheets of cells in amyloid stroma
hematogeneous spread
48
medullary carcinoma assocaitions
MEN 2A, 2B -> RET mutations
49
undifferentiated anaplastic carcinoma
older pts
invades local structures
poor prognosis
50
lymphoma
associated w/hashimotos
| hodgkin type
51
hypoparathyroidism signs
chvostek sign- tapping of cheek (facial nn) -> contractions of facial mm
trousseau sign- occulusion of brachial a w/BP cuff -> carpal spasm
52
psudohyperparathyroidism
```
albright hereditary osteodystophy
unresponsiveness of kidney to PTH
hypocalcemia
shortened 4th and 5th digits
short stature
AD
```
53
familial hypocalciuric hypercalcemia
defective Ca sensingR on parathyroid
| PTH cannot be suppressed by increased Ca -> mild hypercalcemia w/normal to increased PTH
54
primary hyperparathyroidism
stones, bones, groans, and psychiatric overtones
usually d/t parathyroid adenoma or hyperplasia
hypercalcemia, hypercalciuria (stones)
hypophosphatemia
increased PTH
increased ALP, cAMP, in urine
asymptomatic
may present w/constipation and/or derpession
55
osteitis fibrosa cystica
cystic bone spaces filled w/brown fibrous tissue and hemosiderin (brown tumor)
painful
complication of primary hyperparathyroidism
56
secondary hyperparathyroidism
d/t decreased Ca and/or increased phos
MCC chronic renal disease
hypocalcemia, hyperphosphatemia
increased ALP, PTH
57
renal osteodystrophy
bone lesions d/t a secondary or tertiary hyperparathyroidsim that is d/t renal disease
58
tertiary hyperparathyroidism
refractory/autonomous hyperparathyroidism from chronic renal disease
very increased PTH
increased Ca
59
pituitary adenoma
MC is prolactinoma (bengin)
| Tx bromocriptine or cabergoline
60
acromegaly
excessive GH in adults, usually d/t pit adenoma
large tongue w/deep furrows
imparied glucose tolerance
increased risk of colorectal polyps and CA
61
acromegaly Dx
increased serum IGF-1
failure to suppress serum GH with oral glucose tolerance test
pit mass on MRI
62
acromegaly Tx
surgery
octreotide (somatostatin analog)
pegvisomant (GHR antagonist)
63
SIADH
euvolemic hyponatremia (d/t decreased aldosterone)
urine osm>blood
very low Na -> cerebral edema and seizures
correct slowly
64
what happenes if you correct hyponatremia too quickly
osmotic demyelination syndrome/central pontine meylinolysis
65
causes of SIADH
ectopic ADH (small cell lung CA)
CNS disorders/head trauma
pulmonary disease
drugs (cyclophosphamide)
66
Tx of SIADH
```
fluid restriction
IV hypertonic saline
conivaptan
tolvaptan
demeclocycline
```
67
hypopituitarism causes
```
nonsecreting pit adenoma
craniopharyngioma
sheehan syndrome
empty sella syndroem
pit apoplexy
brain injury
radiation
```
68
glucagonoma
```
alpha cell tumor
dermatitis (necrolytic migratory erythema)
DM
DVT
depression
```
69
insulinoma
beta cell tumor
hypoglycemia
whipple triad
70
whipple triad
low blood glucose
hypoglycemia
resolution of symptoms w/glucose
71
carcinoid syndroem
rare, but MCC malignancy of small intestine
usually small bowel tumors secreting 5-HT
non seen if tumor limited to GI
recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right valvular disease
increased 5-HIAA in urine
niacin deficiency
72
carcinoid Tx
surgery
| somatostatin analog- octreotide
73
carcinoid rule of thirds
1/3 mets
1/3 present w/secondary malignancy
1/3 are multiple
74
zollinger-ellison syndrome
```
Gastrin-secreting tumor of pancreas or duodenum
acid hypersecretion -> recurrent ulcers
pain, diarrhea
+ secretin stimulation test
MEN1
```
75
secretin stimulation test
gastrin levels remain elevated after administration of secretin
76
MEN1
```
Parathyroid
Pituitary tumors (prolactin or GH)
Pancreatic endocrine (ZE, insulinomas, VIPomas, glucagonomas)
MEN1 gene (tumor supressor)
```
77
MEN 2A
```
Parathyroid
Pheo
Medullary thyroid carcinoma (secretes calcitonin)
Marfanoid
RET gene (TKR)
```
78
MEN 2B
```
Pheo
medullary thyroid carcinoma (secretes calcitonin)
oral/intestinal ganglioneuromatosis
marfanoid
mutation in RET
```
