Endocrine

Question 1

MEN 1

Answer 1

• Pituitary adenoma
  
  • Pancreatic endocrine tumor
  • Parathyroid neoplasia

Question 2

MEN 2a

Answer 2

Medullary thyroid cancer
Pheochromocytoma
Parathyroid neoplasia

Question 3

MEN2B

Answer 3

MEDULLARY THYROID CANCER
PHEOCHROMOCYTOMA
NEUROMAS

Question 4

PARATHYROID HORMONES

Answer 4

PTH
VITD
CALCITONIN

Question 5

Hypocalcemia occurs from

Answer 5

Decreased PTH, resistance to PTH, VitD abnormalities, calcium binding

Question 6

Hypercalcemia can be caused by

Answer 6

Hyperthyroidism
Granulomatous disease
Drug induced
Humoral hypercalcemia malignancy (PTHrP, osteoclastic activity)

Question 7

Symptoms of hypercalcemia

Answer 7

Bone brain,fractures
Calcifications
GI abnormalities
Cardiac calcification

Question 8

How to treat hypercalcemia

Answer 8

Calcitonin in severe cases
Glucocorticoids in malignant disorders
Bisphosohates and SERMs

Question 9

Primary hyperparathyroidism can be caused by

Answer 9

Adenoma (one gland is enlarged)
Hyperplasia (all 4 glands)
Carcinoma (invasive)
Paraneoplastic syndrome( PTH like hormone, squamous cell lung and renal cell)

Question 10

Secondary hyperparathyroidism

Answer 10

PTH is constantly elevated due to constant decrease in Ca+

All 4 glands are enlarged
End stage renal disease
Malabsorption or VitD deficiency

Question 11

Diagnosis of hyperparathyroidism

Answer 11

Increased levels of calcium and PTH
Decreased serum phosphorus and increased urinary phosphorus
Symptoms may appear due to elevated calcium and PTH

Question 12

Hypo parathyroidism can be caused by

Answer 12

• Parathyroid gland aplasia (deGeorge)
• Iatrogenic (removed parathyroid to fix hyperparathyroidism)
• Idiopathic: immune destruction of glands

Question 13

Clinical findings seen in hypoparathyroidism

Answer 13

Neuromuscular excitability : sensitive to calcium levels
Bone changes: osteosclerosis and osteomalacia
Calcium in basal ganglia
Cardiac arrhythmias and arrests (conductivity of AP)

Question 14

Chvostek and trousseau phenomena

Answer 14

Pressure on nerve causes spasm

Seen in hypoparathyroidism since spasms/neuromuscular excitability is seen.

Question 15

Adenohypophysis

Answer 15

Anterior pituitary
Releases TP-FLAG
Regulated by hypothalamic releasing factors

Question 16

Neurohypophysis

Answer 16

Posterior pituitary gland

Stores/Secretes oxytocin + ADH(vasopressin)

Question 17

Empty sella

Answer 17

Pituitary is shrunken

Whenever you have alt in production in all pituitary gland hormones sometimes caused by Sheehan’s
Ischemic necrosis

Question 18

anterior decussating fibers are most vulnerable in ____. What kind of VF defect?

Answer 18

Pituitary adenoma

Descending deficit in VF

Question 19

Posteriorly crossing fibers are most vulnerable in ____. What type of VF deficit will be seen?

Answer 19

Craniopharyngioma

Ascending progression in visual field

Question 20

Gonadotroph adenoma

Answer 20

Most common pituitary macro adenoma (non functional)

Mass symptoms, seizures visual complaints, headache, diplopia, CSF rhinorrhea

Question 21

Most common functional pituitary tumor

Answer 21

Prolactinoma

Question 22

Prolactin function?

Answer 22

Inhibits release of GnRH -> which inhibits LH & FSH -> leading to low estrogen, progesterone, testosterone

Question 23

Dopamine inhibits production of ____.

Answer 23

Prolactin
Blocking dopamine due to head injury/drugs will cause prolactin to go crazy and over produce (hyperprolactinemia/diff diagnosis)

Question 24

Symptoms of prolactinoma

Answer 24

Premenopausal: hypogonadotrophic hypogionadism, galactorrhea, abnormal menstruation, menopause symptoms

Post menopause: mass effect symptoms

Males: impotence, infertility, GYNECOMASTIA (breast tissue), mass effect symp

Question 25

How to treat prolactinoma?

Answer 25

Dopamine agonist: block prolactin in functional Adenoma Or surgery

Question 26

Somatotroph adenoma

Answer 26

Pituitary adenoma Hypersecretion of GH-> stimulates hepatic secretion of insulin like growth factors Manifestations: Diabetes + CVD

Question 27

Gigantism + acromegaly

Answer 27

Somatotroph adenoma Hyper secretion of GH prior bone maturity = gigantism After bone maturity = acromegaly -> HTN & abnormal glucose metabolism

Question 28

Corticotroph adenoma

Answer 28

Increased cortisol production by adrenal glands Hypercorticsolism (Cushings)

Question 29

What is Nelson syndrome?

Answer 29

Large destructive adenoma in pituitary after adrenal gland removal. Loss of (-) feed back, low cortisol causes ACTH and CRH to increase and cause massive adenoma. Increased CRH = increased MSH causing hyperpigmentation

Question 30

Thyrotroph adenoma

Answer 30

Pituatary adenoma (TSH is produced there) TSH is not stimulated by TRH or suppressed by exogenous thyroid hormone INCREASED TSH & T3/4 Symptoms of hyperthyroidism