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Endocrine Flashcards

1
Q

Pituitary Adenoma Sx

A

Bitemporal Hemianopsia
Hypopituitarism
Headache

Functional Tumors secrete hormones and will have additional Sx related to the hormone

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2
Q

Prolactinoma Sx

A

Females: Galactorrhea, amenorrhea

Males: Decreased Libido, headache

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3
Q

Most common pituitary adenoma

A

Prolactinoma

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4
Q

Tx Prolactinoma

A

DA inhibitor

Bromocriptine
cabergoline

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5
Q

Growth Hormone Adenoma Sx

A

Kids–Gigantism
Adults–achromegaly
2º DI–GH induces gluconeogenesis

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6
Q

Achromegaly COD

A

Cardiac failure

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7
Q

Dx GH adenoma

A

Elevated GH & IGF-1

No GH suppression with glucose addition

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8
Q

ACTH adenoma Sx

A

Cushing syndrome

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9
Q

When do Sx present with hypopituitarism

A

> 75% of pituitary is lost

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10
Q

Causes of hypopituitarism

A

Pituitary adenoma (adults)
Craniopharyngioma (kids)
Sheehan Syndrome
Empty Sella Syndrome

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11
Q

Pituitary Apopexy

A

bleeding into sella tursica

causes hypopituitarism

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12
Q

Pregnancy related infarction of pituitary

A

Sheehan Syndrome

Prituitary doubles in size due to hormone demand

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13
Q

Empty Sella Syndrome mechanism

A

Compression–herniation of arachnoid or CSF destroys pituitary

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14
Q

Posterior Pituitary Hormones

A

ADH

Oxytocin

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15
Q

Sx of SIADH

A

Excessive water

hyponatremia, low serum osmo
mental status changes, seizures

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16
Q

Neuromal swelling and crebral edema cause (electrolyte)

A

Hyponatremia

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17
Q

Thyroglossal duct cyst

A

anterior neck mass due to remnant of the thyroglossla duct

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18
Q

Persistent thyroid tissue at base of the tongue

A

Lingual thyroid

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19
Q

metabolic effect of increased TH

A

Increased basal metabolic rate (Na/K ATPase expression)

Increased ß1 receptors (sympathetics)

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20
Q

Clinical Sx of increased TH

A 
weight loss
heat intolerance and sweating
Tachycardia/arrhythmia
Tremor, ataxia, insomina
diarrhea with malabsorption
oligomenorrhea
hypercalcemia from bone resorption (osteoporosis)
Hypocholesterolemia
Hyperglycemia
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21
Q

Graves Disease Pathogenesis

A

IgG Ab stimulate TSH receptors (type II non-cytotoxic)

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22
Q

Most common cause of hyperthyroidism

A

Graves Disease

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23
Q

Cause of exophthalmos and pre-tibial myxedema in graves

A

fibroblast deposition

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24
Q

Graves Labs

A

increased total Free T

Decreased TSH

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25
Graves Tx
ß-Blockers PTU Steroids
26
Multi-nodular Goiter cause
Relative Iodine defficiency
27
Cretinism Cause
Hypothyroidism in neonates and infants Congenital defect in TH production: Most common Thyroid Peroxidase
28
Myxedema pathogenesis
build up of glycosaminoglycans in skin and soft tissue Deepening of voice large tongue
29
Myxedema Sx
Hypercholesterolemia oligomenorrhea cold intolerance bradycardia Hypothyroid Sx
30
Hashimoto Thyroiditis
Autoimmune destruction of Thyroid | HLA-DR5 mutation association
31
Hashimoto Labs
Increased T4 | Decreased TSH
32
Hashimoto has increased risk of what?
B Cell Lymphoma
33
Hashimoto Histology
Chronic Inflammation Germinal Centers HURTHLE Cells (eiosinophilic metaplasia of cells that line follicle)
34
Bx of thyroid neoplasias
Fine needle aspiration (FNA)
35
Hot Nodule (thyroid)
Graves | Nodular goiter
36
Cold Nodule (thyroid)
adenoma | CA
37
Types of Thyroid Tumors
``` Follicular adenoma Papillary CA Follicular CA Medullary CA Anaplastic CA ```
38
Benign proliferation of follicles surrounded by fibrous capsule
Follicular adenoma may secrete TH but usually non-fxn
39
Most common thyroid CA (80%
Papillary CA
40
Orphan Annie eyes and nuclear groves | Thyroid CA
Papillary CA papillae lined by cells with clear cytosol
41
Malignant proliferation of follicles surrounded by fibrous capsule hematogenous spread
Follicular CA
42
how to Bx Follicular CA
need to Bx entire capsule
43
Malignant proliferation of parafollicular C cells in thyroid Amyloid deposits in tumor (calcinin) Sheets of malignant cells in an amyloid stroma
Medullary CA
44
C Cells fxn
Secrete calcitonin Lowers serum Ca via renal excretion leads to hypocalcemia if secreted by medullary CA
45
Medullary CA associated with:
MEN-2A and 2B Mutation of RET oncogene--prophylactic thyroidectomy if detected
46
Undifferentiated malignant CA of thyroid Elderly pt. invasion to local stxrs
Anaplastic CA poor prognosis
47
Secretes PTH
Chief cells regulate free Ca in serum
48
PTH mechanism
Activates osteoblasts which activate osteoclasts --> releasing Ca/Pi Increases small bowel abs. of Ca via Vit. D activation in kidney Increases renal resorption of Ca and Pi excretion
49
most common cause of 1º hyperparathyroidism
Parathyroid adenoma
50
Sx of Hyperparathyroidism
``` Nephrolithiasis Nephrocalcinosis CNS disturbances Constipation PUD Acute pancreatitis Osteitis fibrosa cystica ```
51
Osteitis fibrosa cystica
resorption of bone leading to fibrosis and cystic spaces
52
Hyperparathyroidsim labs
inc. PTH, Ca, Alkaline Phosphate, urinary cAMP Dec. Phosphate
53
2º hyperparathyroidism #1 cause
renal insufficiency
54
2º hyperparathyroidism Sx
Decreased Pi excretion increased serum Pi--binds free Ca, PTH, Alkaline Phosphate dec. Ca
55
Effects of Insulin
Increased Glycogen synth, protein synth, ligogenesis Increased glucose uptake via GLUT4 in sk. mm., adipose
56
Alpha and Beta pancreatic cells
Alpha--glucagon | Beta--insulin
57
Glucagon Effects
opposite of insulin--inc. glucose blood levels glycogenolysis and lipolysis increased
58
Type I DM associated with HLA:
HLA-DR3 and DR4
59
Pathophys of Type I DM
Autoimmune destruction of ß cells by T lymphocytes (Type II cytotoxic) Insulin Defficiency
60
Pathopysh of DKA
Stress causes increase in Epi --> increased lipolysis Free FA converted to Ketones --> hyperglycemia, anion gap met. acidosis, hyperkalemia
61
Ketones seen in DKA
ß-hydroxybutyric acid | Acetoacetic acid
62
Type II DM
End organ resistance to insulin
63
Type II DM histology
Amyloid deposition in islets of langerhans
64
Dx type II DM
Random Glucose > 200 Fasting Glucose > 126 Glucose Tolerance Test > 200 (2 hrs after)
65
Type II DM Tx
Weight Loss** Rx-- Exogenous insulin
66
Type I DM Tx
Insulin
67
Hyperosmolar non-ketotic coma
Type II DM leads to life threatening diuresis, Hypotension, coma Ketones absent due to low insulin circulation
68
Non-Enzymatic Glycosylation effects on lg/med vessels
1. Cardiovascular disease | 2. Peripheral Vascular disease
69
Non-enzymatic glycosylation effects on small vessels
Renal arterioles --> glomerulosclerosis Efferent arterioles preferential involvement --> nephrotic syndrome
70
Kimmelstiel-Wilson Nodules
characteristic of nephrotic syndrome from DM
71
Osmotic Damage due to DM
Glucose enters schwann cells, pericytes of retinal blood vessels, lens --> creates osmotic gradient blindness, peripheral neropathy, impotence, cataracts
72
MEN I
Parathyroid Hyperplasia Pituitary adenoma Tumor of Islet cells (pancreas)
73
Islet Tumor Types
VIPoma Gastrinoma Somatostatinoma Insulinoma
74
Tumor on pancreas | low serum glucose, high insulin, C-peptide
Insulinoma
75
Cholelithiasis Steatorrhea Achlorhydria mass on pancreas
Somatostatinoma Steatorrhea--inh. of CCK Achlor--inh. of gastrin
76
PUD with ulcers extending into ileum | pancreatic mass
Gastrinoma Zollinger-Ellison Syndrome
77
Watery Diarrhea hypokalemia achlorhydria pancreatic mass
VIPoma
78
Layers and secretions of Adrenal Cx
Glomerulosa--Mineralocoritcoids (Aldosterone) Fasciculata--Glucocorticoids (cortisol) Reticularis--Sex Steroids (testosterone) "It gets sweeter as you go deeper"
79
``` Muscle weakness Moon facies buffalo hump truncal obesity abdominal striae HTN Osteoporosis Multiple infxns ```
Cushing Syndrome--hypercortisolism
80
Dx Cushing Sundrome
24 hr. urine cortisol
81
Causes of Cushing
Exogenous corticosteroids--neg. feedback of ACTH 1º adrenal adenoma ACTH-secreting pituitary adenoma Paraneoplastic Syndrome (Small cell CA of lung, RCC)
82
Bilateral adrenal hyperplasia
Paraneoplastic Syndrome (small cell CA of Lung, RCC)
83
Tx of Cushing Syndrome
High dose Dexamethazone--suppresses ACTH production produced by pituitary but NOT SCC of Lung
84
Conn Syndrome
Hyperaldosteronism HTN, Hypernatremia, hypokalemia, metabolic alkalosis
85
Most common cause of Conn syndrome
Adrenal Adenoma
86
High Aldosterone Low renin Dx?
1º aldosteronism
87
High Aldosterone | High Renin
2º Aldosteronism CHF, renovascular HTN
88
Most common Cause of congenital adrenal hyperplasia
21-hydroxylase defficiency Req. for production of aldosterone and corticosteroids
89
21-hydroxylase deficiency effects
increased sex hormone production because no ALD or corticosteroids are produced
90
17-Hydroxylase deficiency
Increased Aldosterone decreased Sex hormones, glucocorticoids
91
Waterhouse-Friderichsen Syndrome
N. meningitidis infection hemorrhagic necrosis of adrenal glands --> adrenal insufficiency DIC
92
Addison Disease
Adrenal Insufficiency ``` Hypotension hyponatremia hypovolemia hyperkalemia weakness hyperpigmentation vomiting diarrhea ```
93
Why is there hyperpigmentation in Addison Disease?
Increased ACTH by-products stimulate melanocytes --> pigment production
94
Addison Disease Causes
1. autoimmune (US) 2. TB (developing countries) 3. Metastatic CA
95
Tumor of Chromaffin Cells
Pheochromocytoma Increased Epi/NE
96
Sx of Pheochromocytoma
Episodic HTN, sweating, palpitations, HA, Tachycardia
97
Pheochromocytoma Dx
Increased serum metanephrines Increased 24 hr. urine metanephrines vanillylmandelic Acid
98
Pheochromocytoma Tx
Phenoxybenzamine (irrev. alpha blocker)
99
Pheochromocytoma associated with
MEN 2A and 2B VHL Neurofibromatosis Type I
100
Pheochromocytoma Rule of 10's
10% bilateral, familial, malignant, outside adrenal medulla

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