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Flashcards in endo path Deck (78):
1

cushings etiology

increased cortisol d/t
-endogenous corticosteroids
-primary adrenal adenoma, hyperplasia, or carcinoma
-ACTH-secreting pit adenoma (Cushings disease) or pareneoplasitc ACTH secretion

2

endogenous corticosteroids

decreased ACTH
b/l adrenal atrophy
MCC

3

primary adrenal adenoma, hyperplasia, or carcinoma

decreased ACTH
atrophy of uninvolved adrenal gland
can also present w/pseudohyperaldosteronism

4

ACTH secreting adenoma or paraneoplastic ACTH secretion

results in increased ACTH
b/l adrenal hyperplasia

5

cushings findings

HTN
weight gain
moon facies
truncal obestiy
buffalo hump
skin changes
osteoporosis
hyperglycemia
amenorrhea
immunosupression

6

Dexamethasone suppression test

cushings disease will suppress
ectopic ACTH secretion will not supress

7

CRH stimulation test

cushings dis-> increase in ACTH and cortisol
ectopic ACTH secretion -> no increase

8

symptoms of adrenal insufficiency

weakness
fatigue
orthostatic hypotension
mm aches
weight loss
GI
sugar and/or salt cravings

9

Dx of adrenal insufficiency

measurement of serum electrocluces
am cortisol
ACTH
ACTH stimulation test
metyrapone stimulation test

10

metyrapone stimulation test

blocks last step of cortisol synthesis
normal response in decreased cortisol and increased ACTH
in adrenal insufficiency ACTH does not increase

11

primary adrenal insufficiency

hypotension
hyperkalemia
metaboic acidosis
skin and mucosal hyperpigmentation
chronic -> addisons disease

12

causes of addisons

autoimmune (MC)
TB
mets

13

Waterhouse-friderichsen syndomre

N. menigitidis

14

secondary adrenal insufficiency

decreased ACTH
no hyperpigmentation
no hyperkalemia

15

tertiary adrenal insufficiency

pt w/chronic exogenous steroid use precipitated by abrupt withdrawal
aldosterone unaffected

16

neuroblastoma

MC tumor of adrenal medulla in kids
usually

17

neuroblastoma presentation

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

pheo etiology

MC tumor of adrenal medulla in adults
derived from chromaffin cells from neural crest

19

pheo rule of 10's

10% malignant
10% b/l
10% extra-adrenal
10% calcify
10% kids

20

pheo symptoms

5 Ps
pressure (increased BP)
pain (HA)
perspiration
palpitations
pallor

21

pheo associations

NF1
VHL
MEN2A and 2B

22

pheo findings

increased catecholamines and metanephrines in urine and plasma

23

Tx of pheo

irreversilbe alpha antagonists (phenoxybenzamine)
followed by BB prior to tumor resection
if BB first -> HTN crisis

24

hypothyroidism symptoms

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