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Endocrine Flashcards

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1
Q

Glactorrhea, amenorrhea, HA, dec libido, vision loss

A

Prolactinoma - pituitary adenoma

Tx = DA agonist bromocriptine

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2
Q

Gigantism

A

KIDS, excess GH

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3
Q

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

A

Acromegaly - GH secreting adenoma

  • Death = cardiac failure
  • Secondary DM d/t GH indices glucose production
  • Tx = Octreotide (dec GHRH release)
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4
Q

Post-partum poor lactation & loss of pubic hair

A

Sheehan syndrome - infarction of pituitary

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5
Q

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

A

Central diabetes insipidus

tx = desmopressin

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6
Q

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

A

Nephrogenic DI
- lithium, demeclocyline

Tx = HTCZ, indomethacin, amiloride

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7
Q

Low serum Na, osmolarity, mental status change, seizures

A

SIADH - small cell or cyclophsophamide

HypoNa –> neuronal swelling, cerebral edema

Tx = water restriction, demeclocycline

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8
Q

Inc in BMR & sympathetics in hyperthyroidism

A

Inc Na/K ATPase

Inc B1 adrenergic

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9
Q

Cholesterol & blood sugar profile in hyperthyroidism

A

LOW cholesterol

HIGH glucose

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10
Q

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

A

Grave Disease

IgG Ab to TSH receptor

  • in eye and tibia
  • Lymphocytes–> inc fibroblasts –> GAGs & edema

Tx = BBs, thioamide, radiation

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11
Q

Scalloping of colloid

A

Grave disease

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12
Q

High total, free T4, low TSH

A

Grave disease

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13
Q

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

A

Thyroid storm

Tx = PTU, BBs, steroids

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14
Q

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

A

Cretinism

- maternal hypothyroidism, agenesis, iodine deficiency

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15
Q

Congenital defect in TH most commonly involves what enzyme?

A

Thyroid peroxidase

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16
Q

Most common causes of hypothyroidism

A

1 = Hasmimoto’s

Iodine deficiency, Lithium, surgical ablation from Grave’s

Dx = Measure TSH*

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17
Q

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

A

Hashimoto’s

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18
Q

Low T4, high TSH

A

Hasimoto’s

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19
Q

Chronic inflammation of thyroid w/ germinal centers and Hurthle cells

A

Hashimoto’s

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20
Q

Hx of Hashimotos presents w/ enlarging thyroid…Dx?

A

Marginal zone B-cell lymphoma

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21
Q

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

A

Subacute, granulomatous (De quervain) thyroiditis

#1 = echovirus
Coxsackie, measles, mumps, adeno

Mixed cellular infiltrate w/ GIANT cells
Tx = NSAIDs

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22
Q

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

A

Reidal fibrosing thyroiditis

- younger than anaplastic carcinoma

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23
Q

Method to sample thyroid

A

FNA

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24
Q

Cancerous thyroid Iodine uptake

A

Cold

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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

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