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Pathology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Normal fasting blood glucose values:

A

72-100 mg/dl (4.0-5.7 mmol/L)

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2
Q

Normal Random blood glucose values:

A

<180 mg/dl (10 mmol/L)

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3
Q

Other causes of Diabetes Mellitus

A

1) Pancreatic disease
2) Hormonal antagonists to insulin
3) Drug & chemical induced
4) Genetic syndromes

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4
Q

Hormonal antagonists to insulin

A

1) Cortisol
2) Growth Hormone
3) Catecholamines

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5
Q

Genetic syndromes involved in etiology of Diabetes Mellitus

A

1) Down’s Syndrome

2) Turner’s Syndrome

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6
Q

Type 1 D.M. etiology (general)

A

Most cases: 1) immune mediated destruction of pancreas through autoimmune attack on pancreatic B cells

2) Genetics
3) Environmental factors

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7
Q

Type 1 D.M. etiology (genetic factors)

A

Association with:

1) HLA-DR3
2) HLA-DR4/DQA1
3) DQB1

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8
Q

Type 1 D.M. etiology (environmental factors)

A

Association with viruses:

1) Mumps
2) Coxsackie B4
3) Rubella

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9
Q

Type 2 D.M. etiology (general)

A

caused by combination of B cell failure and insulin resistance

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10
Q

Type 2 D.M. etiology (genetic factors)

A

1) Stronger than type 1 (80% concordance in identical twins)
2) No HLA associations
3) Polygenetic disorder (but environmental factors also involved -> obesity)

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11
Q

More than half of the patients with D.M. II have BMI between what?

A

25-29 kg/m2

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12
Q

What is the RR for DM II for BMI > 35 kg/m2?

A

100 fold than BMI <22 kg/m2

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13
Q

How does obesity lead to DM?

A

Increased production of insulin antagonists, such as fatty acids and TNF by adipose tissue, especially in central obesity.

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14
Q

Pancreatic Pathology in DM. 1

A

1) Selective destruction of insulin-secreting beta cells

2) Insulitis, a chronic inflammatory infiltrate of the islets affecting primarily insulin containing islets

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15
Q

Pancreatic Pathology in DM 2

A

1) Moderate reduction islet tissue

2) Variable degrees deposition of amyloid.

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16
Q

Long term complications of Diabetes Mellitus

A

1) Nephropathy
2) Neuropathy
3) Eye disease
4) Heart disease
5) Stroke
6) Problems of feet

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17
Q

Clinical symptoms of DM (prominent in uncontrolled type 1)

A

1) Polyuria
2) Nocturia
3) Thirst
4) Weight loss
5) Tiredness
6) Blurred vision
7) Vomiting
8) Hyperventilation (Kussmaul breathing)

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18
Q

Why is there polyuria in DM?

A

osmotic diuresis

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19
Q

Why is there thirst in DM?

A

dehydration

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20
Q

Why is there weight loss in DM?

A

Catabolic state

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21
Q

Why is there blurred vision in DM?

A

Dehydration of lens, and of aqueous and vitreous humour

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22
Q

Why is there vomiting in DM?

A

Ketones stimulate the area postrema

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23
Q

Why is there hyperventilation in DM?

A

Respiratory compensation to metabolic acidosis

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24
Q

What are the biochemical signs in DM?

A

1) Hyperglycemia
2) Glycosuria
3) Ketoacidosis
4) Ketonuria
5) Hyperlactemia
6) Hyperlipidemia
7) Hypovolemia
8) Hyperosmolarity

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25
Q

Why is glycosylated hemoglobin a good monitor to manage DM?

A
  • Hemoglobin reacts with glucose non-enzymatically to produce HcA1.
  • HbA1c is the major fraction of glycosylated hemoglobin
  • HbA1c levels give an integrated measure of glucose concentrations over the previous 2-3 months
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26
Q

Acute complications of DM

A

1) Hypoglycemia (diabetes treatment complication)
2) Diabetic ketoacidosis
3) Hyperosmolar nonketotic coma
4) Lactic acidosis

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27
Q

Precipitating factors of Diabetic Ketoacidosis

A

1) Infection or acute illness
2) Trauma
3) Emotional disturbance
4) Missed insulin dose

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28
Q

Most common cause of hypopituitarism

A

Pituitary adenoma

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29
Q

Tumors which cause hypopituitarism

A

1) Adenoma
2) Craniopharyngioma
3) Cerebral and secondary tumors

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30
Q

Vascular causes of hypopituitarism

A

1) Sheehan’s syndrome

2) Severe hypotension

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31
Q

Infectious causes of hypopituitarism

A

1) Meningitis
2) T.B.
3) Syphilis
4) HIV/AIDS

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32
Q

Hypothalamic disorders which cause hypopituitarism

A

1) Tumors
2) Functional disorders
3) Isolated deficiency of GHRH
4) Isolated deficiency of LH/FSH-RH (GnRH secretion)

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33
Q

Iatrogenic causes of hypopituitarism

A

1) Irradiation

2) hypophysectomy

34
Q

Miscellaneous causes of hypopituitarism

A

1) Sarcoidosis

2) Hemochromotosis

35
Q

Pattern of hormone deficiency of the anterior pituitary

A

1) LH
2) GH
3) FSH
4) ACTH
5) TSH

36
Q

Which hormone is maintained in anterior pituitary hormone deficiency?

A

Vasopressin

37
Q

Drugs that cause nephrogenic D.I.

A

Lithium

38
Q

Metabolic causes of D.I.

A

1) Hypokalemia

2) Hypercalcemia

39
Q

SIADH will cause?

A

Water retention and hyponatremia

40
Q

Presentation of SIADH

A

1) Hyponatremia can be asymptomatic or assoc with nonspecific symptoms
2) Severe hyponatremia, specially if there is rapid fall in serum sodium, can cause neurological symptoms, coma and death.

41
Q

Causes of SIADH

A

1) Post operative
2) Intra-cranial disease: encephalitis, meningitis, head injury
3) Neoplasms: small cell carcinoma of the lung
4) Pulmonary disease: pneumonia, tuberculosis
5) Drugs/medications

42
Q

Possible mechanisms of non-thyoridal illness (NTI)

A

1) Decreased peripheral conversion of T4 to T3
2) Abnormality of binding protein
3) Effects of circulating inflammatory mediators on metabolism of thyroid hormones

43
Q

Characterization of papillary carcinoma of the thyroid gland

A
  • presence of papillae

- tend to spread to local lymph nodes

44
Q

Characterization of follicular carcinoma of thyroid gland

A
  • Well differentiated follicles, which can be difficult to differentiate from normal thyroid tissue
  • Invade the capsules and spread into blood vessels
45
Q

Disorders that stem from overactivity of adrenal cortex

A

1) Cushing’s syndrome

2) Hyperaldosteronism

46
Q

What are the clinical features of Addison’s disease?

A

1) Tiredness
2) Weakness
3) Anorexia
4) Apathy
5) Abdominal pain
6) hyperpigmentation
7) postural hypotension

47
Q

What precipitates an adrenal crisis?

A

Infection in a patient with adrenocortical insufficiency.

48
Q

What characterizes an adrenal crisis?

A

1) Circulatory shock
2) Volume depletion
3) Anorexia
4) Nausea
5) Vomiting

49
Q

What is secondary adrenocortical insufficiency due to?

A

Pituitary disorders

50
Q

Describe the serum presentation of a person with Addison’s disease

A 
Plasma sodium - low
Postassium - high
Serum bicarbonate - low
Urea - high
Morning cortisol - low or normal
51
Q

What is the levels of ACTH in Addison’s Disease?

A

High

52
Q

How do we manage patients with Addisons?

A

replace glucocorticoids and mineralocorticoids

53
Q

Describe the renin activity and aldosterone levels in pt with Addisons

A

Renin - high

Aldosterone - low

54
Q

What is the best test for Addisons?

A

Morning cortisol

55
Q

What is a specific test for Addisons?

A

Short synacthen test: administration of ACTH analogues to assess the residual capacity of the adrenal glands.

56
Q

What are the causes of Hyperadrenalism : Cushing’s syndrome

A

1) Exogenous steroids
2) Pituitary dependent
3) Adrenal adenoma
4) Ectopic ACTH

57
Q

What are the clinical features of hyperadrenalism: Cushing’s syndrome

A

1) Moon facies, truncal obesity, buffalo hump
2) Hypertension
3) Thin limbs and muscular weakness
4) Purple striae, fragile skin
5) Impaired glucose tolerance
6) Psychiatric disturbances
7) Menstrual disturbances, hirsutism

58
Q

How does one diagnose Cushing’s Syndrome?

A

1) Exclude exogenous glucocorticoids
2) Perform one of the following tests to confirm hypercortisolism:
- 24 hour urinary free cortisol (common)
- 1 mg overnight DST (Dexamethasone suppression test)
- Late night salivary cortisol: new test

59
Q

Describe the overnight Dexamethasone suppression test for Cushing’s syndrome.

A

Involves taking a small dose of a cortisol-like drug called dexamethasone (1 mg) at 11 p.m. and having blood drawn for cortisol the following morning.

Normal individuals typically have very low levels of cortisol in these samples (s disease.

60
Q

Physiological causes of hyperprolactinemia

A

Stress

61
Q

Drugs that cause hyperprolactinemia

A

1) Anti-psychotics
2) Oral Contraceptive Pill
3) Antidopamine

62
Q

What are the associations with MEN2A

A

1) Medullary Thyroid Cancer
2) Pheochromocytoma
3) Parathyroid Adenoma

63
Q

What are the associations with MEN2B

A

1) Medullary Thyroid Cancer
2) Marfanoid habitus/mucosal neuroma
3) Pheochromocytoma

64
Q

What is characteristic of Papillary Carcinoma of the thyroid gland?

A

1) Presence of papillae
2) Orphan Annie eye nuclei
3) Spread via lymphatics

65
Q

What is characteristic of Follicular Carcinoma of the Thyroid gland?

A

1) Well differentiated
2) Encapsulated
3) Hematogenous spread
4) Can only be diagnosed via visualization of capsular invasion. (Tissue biopsy, not aspiration)
5) Hurthle cells

66
Q

Mutation of medullary carcinoma of the thyroid

A

RET

67
Q

Age of presentation of Medullary Carcinoma of the thyroid?

A

Sporadic and Inherited are above 50, except MEN syndrome assoc, which is an early presentation.

68
Q

What is the difference between Cushing’s Syndrome and Cushing’s Disease?

A

Disease is due to pituitary adenoma

Syndrome is ectopic ACTH caused by non-pituitary tumor (i.e. small cell carcinoma of lung)

69
Q

First functional change in Diabetic Nephropathy

A

Hyperfiltration

70
Q

First morphological change in Diabetic Nephropathy

A

Basement membrane thickening and mesangial expansion.

-subsequentyl nodular deposits and diffuse glomerulosclerosis

71
Q

What is associated with established Diabetic Nephropathy?

A

Proteinuria (urinary albumin >300 mg/day)

72
Q

Diabetic Neuropathy causes:

A

1) Pain
2) Impotence
3) Orthostatic hypotension
4) Muscle atrophy
5) Weakness

73
Q

Two main causes of hypercalcemia:

A

1) Hyperparathyroidism

2) Malignant diseases

74
Q

Other causes of Hypercalcemia

A

1) Excessive vitamin D: Vit. D intoxication
2) Granulomas (tuberculosis, lymphoma, sarcoidosis) because they activate vitamin D
3) High bone turnover
- thyrotoxicosis
- Paget’s disease

75
Q

What are the clinical features of hypercalcemia on the renal system?

A

– Polyuria and thirst
– Stones
– Nephrocalcinosis; deposition of calcium crystals in kidney
– May lead to renal failure

76
Q

What are the associations with Primary Adrenal Insufficiency (Addisons)

A

Autoimmunity of other organs such as:

1) Thyroid disease
2) Premature ovarian failure
3) DM 1

77
Q

Secondary Adrenal Insufficiency is NOT associated with:

A

1) Hyperpigmentation

2) Electrolyte balances

78
Q

Adrenal crisis is characterized by:

A

1) Circulatory shock
2) Volume Depletion
3) Anorexia
4) Nausea
5) Vomiting

79
Q

The low dose (2mg/day for 2 days) DST is given to rule out hypercortisolism due to what?

A

1) Alcoholism
2) Depression
3) Obesity

80
Q

Conn’s syndrome (hyperaldosteronism) causes what? Leading to what?

A

Causes: Na retention

Leading to:

1) hypertension
2) hypokalemia
3) metabolic alkalosis

81
Q

Secondary Hyperaldosteronism is caused by what? In response to what?

A
  • Overactivity of the RAS system

In response to: dec in blood volume due to:

1) Liver cirhossis
2) Heart failure
3) Nephrotic syndrome

or, dec renal blood flow due to hypertension

Pathology (2 decks)

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