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Flashcards in Endocrine Deck (86)
1

Glactorrhea, amenorrhea, HA, dec libido, vision loss

Prolactinoma - pituitary adenoma

Tx = DA agonist bromocriptine

2

Gigantism

KIDS, excess GH

3

Inc GH, IGF-1, lack GH supression by oral glucose

Acromegaly - GH secreting adenoma
- Death = cardiac failure
- Secondary DM d/t GH indices glucose production
- Tx = Octreotide (dec GHRH release)

4

Post-partum poor lactation & loss of pubic hair

Sheehan syndrome - infarction of pituitary

5

Polyuria, polydipsia, hyperNa, high serum osmolarity, low urine osmolarity...water deprivation fails to concentrate urine

Central diabetes insipidus

tx = desmopressin

6

Polyuria, polydipsia, hyperNa, high serum osmolarity, low urine osmolarity...no response to desmopressin

Nephrogenic DI
- lithium, demeclocyline

Tx = *HTCZ*, indomethacin, amiloride

7

Low serum Na, osmolarity, mental status change, seizures

SIADH - small cell or cyclophsophamide

HypoNa --> neuronal swelling, cerebral edema

Tx = water restriction, demeclocycline

8

Inc in BMR & sympathetics in hyperthyroidism

Inc Na/K ATPase
Inc B1 adrenergic

9

Cholesterol & blood sugar profile in hyperthyroidism

LOW cholesterol

HIGH glucose

10

Young woman with a diffuse goiter, pre-tibial myexedema, hyperthyroidism, diplopia, eye redness, proptosis, EOM weakness

Grave Disease

IgG Ab to TSH receptor
- in eye and tibia
- Lymphocytes--> inc fibroblasts --> GAGs & edema

Tx = BBs, thioamide, radiation

11

Scalloping of colloid

Grave disease

12

High total, free T4, low TSH

Grave disease

13

Arrhythmia, hyperthermia, vomiting, hypovolemic shock following surgery or childbirth

Thyroid storm

Tx = PTU, BBs, steroids

14

Pot bellied, puffy face, MR, short stature, enlarged tongue, umbilical hernia

Cretinism
- maternal hypothyroidism, agenesis, iodine deficiency

15

Congenital defect in TH most commonly involves what enzyme?

Thyroid peroxidase

16

Most common causes of hypothyroidism

#1 = Hasmimoto's

Iodine deficiency, Lithium, surgical ablation from Grave's

Dx = Measure TSH*

17

Hyper --> hypothyroidism, anti-thyroglobulin, anti-microsomal Ab, atrophic follicles

Hashimoto's

18

Low T4, high TSH

Hasimoto's

19

Chronic inflammation of thyroid w/ germinal centers and Hurthle cells

Hashimoto's

20

Hx of Hashimotos presents w/ enlarging thyroid...Dx?

Marginal zone B-cell lymphoma

21

Hypothyroidism following flu-like illness, tender thyroid, inc ESR

Subacute, granulomatous (De quervain) thyroiditis

#1 = echovirus
Coxsackie, measles, mumps, adeno

Mixed cellular infiltrate w/ GIANT cells
Tx = NSAIDs

22

Young female w/ dyspnea, hypothyroidism, and hard as wood thyroid, extensive fibrosis

Reidal fibrosing thyroiditis
- younger than anaplastic carcinoma

23

Method to sample thyroid

FNA

24

Cancerous thyroid Iodine uptake

Cold

25

Thyroid mass surrounded by dense fibrous capsule

Follicular adenoma

26

Thyroids carcinomas

1. Papillary - RET
2. Follicular - RAS
3. Medullary - RET
4. Anaplastic

27

Papillary carcinoma of thyroid

Hx ionizing radiation/acne
Orphan annie eye nuclei
Excellent prognosis

28

Most common thyroid carcinoma

Papillary

29

Nuclear grooves and white central clearing in the nucleus, concentrically calcified structures in thyroid gland

Papillary carcinoma
- "ground glass," Orphan Annie eyes, Psamomma bodies

30

Thyroid mass surrounded by dense fibrous capsule with invasion through capsule

Follicular CARCINOMA
- FNA cannot distinguish
- spread hematogenous NOT LNs like other carcinomas
- microfollicles

31

Low serum Ca, malignant cells in amyloid stroma

Medullary carcinoma
- parafollicular C cells --> calcitonin
- Assoc w/ MEN 2A/B

32

Medullary carcinoma, pheo, parathyoid adenoma

MEN 2A
- RET mutation

Draw a square

33

Medullary carcinoma, pheo, mucosal/ganglionueromas, marfanoid habitus

MEN 2B
- RET mutation

Draw a triangle

34

Elderly, dysphagia, resp compromise, thyroid mass

Anaplastic carcinoma
- highly malignant, poor prognosis

35

Primary hyperparathyoidism

Adenoma = #1

"Stones, moans, groans & bones"
- Calcium stones
- constipation
- depression
- bone pain - Osteitis fibrosa cystica
*acute pancreatitis*

36

Inc PTH, Ca, urinary cAMP, alk phos (blast)
Dec phosphate

Primary hyperparathyroidism
- adenoma, hyperplasia

"Stones, moans, groans & bones"

37

Inc PTH, alk phos, PHOSPHATE
Dec Ca, calcitrol (1,25)

Secondary hyperparathyroidism
#1 = chronic renal failure --> dec phos excretion, dec 1,25 --> inc PTH

Inc bone turnover/osteitis fibrosa cystica

38

Peri-oral numbness, tingling, tetany w/ tapping or blood pressure cuff (Trousseau, Chvostek sign)

Hypoparathyroidism
- DiGeorge, surgical removal

39

Low PTH, Low Ca

Hypoparathyroidism

40

Short stature, short 4th, 5th digits, High PTH, Low Ca

Psuedohypoparathyroidism
- end-organ resistance to PTH = Gs defect

41

Type I DM

T-lymphocyte destruction
HLA-DR3, 4 (MHC I)

42

Mech of type II DM insulin resistance

Dec # insulin receptors

43

Hyperosmolar non-ketotic coma

Type II DM
>500 sugar --> diuresis --> hypotension & coma

44

Leading cause of death among diabetics

CVD/MI

45

Non-enzymatic glycosylation of renal arterioles

EFFERENT --> hyperfiltration
Microalbuminuria, nephrotic syndrome, Kimmelstiel-wilson nodules

Diffuse sclerosis --> renal failure

46

Pt presents with kidney stones and stomach ulcers or hypoglycemia, and impotence...Parathyroid hyperplasia, pituitary adenoma, pancreatic neoplasm

MEN 1

1. Insulinoma*
2. Gastrinoma (ZE)*
3. Somatostatinoma - achlorhydria, cholelithiasis, steatorrhea
4. VIPoma - watery diarrhea, hypoK

47

Glomerulosa produces

Aldosterone

48

Fasiculata produces

Cortisol

49

Reticularis produces

Sex steroids/testosterone

50

Moon facies, buffalo hump, truncal obesity, HTN, osteoporosis, immunosuppression, hyperglycemia, striae, amenorrhea

Cushing/hypercortisolism
- inc urine cortisol

1. #1 = steroids
2. Adenoma
3. ACTH pituitary adenoma
4. ACTH small cell

51

Cushing w/ B/L adrenal atrophy

Steroids

52

Cushing w/ C/L adrenal atrophy

Primary cortical adenoma

53

Cushing w/ B/L adrenal enlargement

ACTH secreting pituitary adenoma or Small cell cancer

54

High dose dexa suppression test --> low cortisol levels

ACTH Pituitary adenoma (vs. small cell)

55

HyperNa, hypoK (weakness & paresthesia), alkalosis, HTN, Low plasma renin

Hyperaldosteronism (Conn syndrome)
- #1 = adrenal adenoma
- #2 = adrenal hyperplasia
- spironolactone bodies

Tx = spironolactone --> surgery

56

Kid w/ clitoral enlargment, precocious puberty, hypotension, high ACTH, hyperK, hypoNa, B/L adrenal hyperplasia

Congenital adrenal hyperplasia
#1 = 21-hydoxylase deficiency

Dx = excess 17-hydroxyprogesterone
Tx = ACTH to suppress cortex

57

Kid w/ clitoral enlargment, precocious puberty, high ACTH, HTN

11-hydroxylase deficiency

58

Hypotension, HypoNa, HyperK, Hyperpigmentation, V/D, fatigue, weakness, weightloss, acidosis, ACTH 150, cortisol 2, ACTH stimulation fails to inc serum cortisol

Addison - chronic PRIMARY adrenal insufficiency

#1 in US = auto-immune
- likely to develop w/ DM-1, Hashimoto's, Graves, Addison
#1 developing = TB
***Mets from Lung cancer***

59

EPISODIC HTN, HA, palpiations, tach, sweating, inc urine VMA

Pheo (5Ps) - pressure, pain, perspiration, palpitations, pallor

Tx = excision + alpha blocker phenoxybenzamine to prevent HTN crisis

60

Episodic HTN with urination

Bladder wall pheo

61

Syndromes assoc w/ Pheo

MEN 2A,B
Von-Hippel Lindau - hemoangio of cerebellum
NF-1

62

XY Male appears as a female, HTN, hypoK

17-alpha hydroxylase deficiency

63

PTH fxns

Goal = INC serum Ca

1. Inc RANKL on blasts --> stim clasts
2. Dec phos abs (Phos Trashing Hormone)
3. Inc 1,25 by inc 1-alpha hydroxylase

64

Endocrine hormones using IP3

GOAT - GnRH, Oxytocin, ADH (V1), TRH

Most use cAMP including calcitonin, glucagon

65

Endocrine hormones using TK/MAP kinase --> RAS

Think growth factors

Insulin, IGF-1, FGF, PDGF

66

Sex hormone binding globuin inc in men & dec in women

Inc in Men --> Dec T --> gynecomastia

Dec in Women --> Inc T --> hirsuitism

67

Wolff-Cahikoff effect

Excess iodine inhibits TPO --> dec T3/4

68

HyperNa, hypoK, alkalosis, HTN, High plasma renin

Hyperaldosteronism (Conn syndrome)
- Secondary = atherosclerosis, RA stenosis

69

Hypotension, HypoNa, V/D, fatigue, weakness, weightloss, ACTH 20, Cortisol 2, ACTH stimulation inc cortisol

Secondary adrenal insufficiency

#1 = STOP MEDS
Pituitary insufficiency

70

Neuroblastoma

Adrenal medulla tumor in KIDS*

Anywhere along sympathetic chain
High DA --> HVA in urine
Less HTN
Over expression of N-myc

71

Hypothyroidism + deafness

Pendred syndrome
- AR deficiency in Na/I co-transport

72

Huge goiter, patchy radio-I uptake, raise arms and get red in the face. hitology shows distended follicles lined by flattened epithelium w/ fibrosis and hemorrhage

Toxic multinodular goiter

73

Inc Ca with low PTH

PTH-independent hyperCa
- Ca ingestion, cancer

74

Diabetic with high morning blood sugar...next step?

2AM BG

Dawn effect = high/normal glucose
- cortisol, epi stimulate release from liver --> high BG d/t low insulin

Somogyi effect = low glucose
- night hypoglycemia --> nocturnal release

75

Pt presents with LRQ pain, diarrhea, flushing, asthmatic wheezing and right heart vavle disease.

Carcinoid syndrome - most common tumor of the appendix

High 5-HIAA in urine
Tx = Octreotide

76

Drug acts by closing K+ channel --> insulin release only in type II DM

Sulfonylureas
- Tolbutamide, Glyburide, Glipizide

77

Drug acts by dec gluconeogenesis and inc sensitivity to insulin

Metformin (Biguanides)
- glinides have less hypoglycemia

78

1st line drug to type II DM

Metformin (Biguanides)

79

Diabetes drug that causes lactic acidosis

Metformin (Biguanides)

80

Drug acts by binding PPAR-gamma to inc insulin sensitivity in peripheral tissue

Thiazolidinediones

-HEPATOTOXIC, HF, Fx, Bladder cancer

81

Drug inhibits alpha glucosidases to dec post-prandial hyperglycemia

Acarbose & Miglitol

82

Drug inhibits DDP4 degredation of GLP-1

Piptidyl-Peptidase Inhibitors
- Sitagliptan, Saxipliptan

83

MOA of PTU, methimazole

Blocks TPO = blocks organifiation

PTU also blocks 5-deiodinase = block peripheral T4-->T3

84

ADH antagonist used in SIADH

Demeclocycline

85

Endocrine hormones using JAK/STAT

PiG - Prolactin, GH, cytokines

86

Necrolyic migratory erythema with blisters in areas of friction, weight loss, diarrhea, diabetes, high blood sugar

Glucagonoma
- Tx = octreotide