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Flashcards in Endocrine Deck (100):
1

Pituitary Adenoma Sx

Bitemporal Hemianopsia
Hypopituitarism
Headache

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

2

Prolactinoma Sx

Females: Galactorrhea, amenorrhea

Males: Decreased Libido, headache

3

Most common pituitary adenoma

Prolactinoma

4

Tx Prolactinoma

DA inhibitor

Bromocriptine
cabergoline

5

Growth Hormone Adenoma Sx

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

6

Achromegaly COD

Cardiac failure

7

Dx GH adenoma

Elevated GH & IGF-1
No GH suppression with glucose addition

8

ACTH adenoma Sx

Cushing syndrome

9

When do Sx present with hypopituitarism

> 75% of pituitary is lost

10

Causes of hypopituitarism

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

11

Pituitary Apopexy

bleeding into sella tursica

causes hypopituitarism

12

Pregnancy related infarction of pituitary

Sheehan Syndrome

Prituitary doubles in size due to hormone demand

13

Empty Sella Syndrome mechanism

Compression--herniation of arachnoid or CSF destroys pituitary

14

Posterior Pituitary Hormones

ADH
Oxytocin

15

Sx of SIADH

Excessive water

hyponatremia, low serum osmo
mental status changes, seizures

16

Neuromal swelling and crebral edema cause (electrolyte)

Hyponatremia

17

Thyroglossal duct cyst

anterior neck mass due to remnant of the thyroglossla duct

18

Persistent thyroid tissue at base of the tongue

Lingual thyroid

19

metabolic effect of increased TH

Increased basal metabolic rate (Na/K ATPase expression)

Increased ß1 receptors (sympathetics)

20

Clinical Sx of increased TH

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

21

Graves Disease Pathogenesis

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

22

Most common cause of hyperthyroidism

Graves Disease

23

Cause of exophthalmos and pre-tibial myxedema in graves

fibroblast deposition

24

Graves Labs

increased total Free T
Decreased TSH

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