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Pathology 1st aid > Endocrine Path > Flashcards

Endocrine Path Flashcards

1
Q

1 cause of cushing’s syndrome

A

Iatrogenic–exogenous steroids

increased cortisol
decreased ACTH (negative feedback)
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2
Q

Cushing’s syndrome Sx

A 
HTN
hyperglycemia
osteoporosis
Moon Facies
Weight Gain
tuncal obesity
abd. striae, thinning skin
Buffalo hump
immune suppression
amenorrhea
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3
Q

Cushing’s Disease

A

ACTH secreting pituitary adenoma

increased ACTH and Cortisol

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4
Q

Cort stim test with Cortisol levels remaining high after low and high doses of DEX

A

Ectopic ACTH producing tumor

Cortisol producing tumor

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5
Q

Cort stim test with Cortisol levelssuppressed after low and high doses of DEX

A

Normal response

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6
Q

Cort stim test:

Cortisol remains high after low dose and suppressed after high dose DEX

A

ACTh pituitary adenoma

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7
Q

HTN, Hypokalemia, metabolic alkalosis, LOW plasma renin

A

1º Conn’s Syndrome

adrenal hyperplasia or aldosterone secreting adrenal adenoma

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8
Q

HTN, Hypokalemia, metabolic alkalosis, HIGH plasma renin

A

2º Conn’s Syndrome

Renal artery stenosis
CHF
Cirrhosis
Nephrotic Syndrome

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9
Q

Conn’s Tx

A

1º–surgery, spironolactone

2º–spironolactone

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10
Q

Hypotension
hyperkalemia
acidosis
skin hyperpigmentation

A

1º Addison’s Disease

adrenal atrophy and absence of hormone production
all 3 cortical layers but spares medulla
destruction by disease (TB, autoimmune, mets)

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11
Q

DDx 2º from 1º Addison’s Disease

A 
Low aldosterone
low cortisol
no skin hyperpigmentation
no hyperkalemia
decreased ACTH production in pituitary
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12
Q

Post Neisseria meningitidis sepsis
1º adrenal insufficiency due to adrenal hemorrhage
DIC
Endotoxic Shock

A

Waterhouse-Friederichsen Syndrome

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13
Q

Most common tumor in adults of adrenal medulla

A

Pheochromocytoma

Secretes Epi/NE/DA

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14
Q

Pheochromocytoma is composed of what type of cells?

A

Chromaffin cells

derrived from neural crest

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15
Q

Pheochromocytoma Sx

A

Episodic Hyperadrenergic Sx–5 P’s

Pressure (high BP)
Pain (HA)
Perspiration
Palpitation
Pallor
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16
Q

Pheochromocytoma associated with what syndromes?

A

MEN 2A and 2B

Neurofibromatosis Type 1

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17
Q

Pheochromocytoma Tx

A

Phenoxybenzamine (alpha blocker) prior to surgical excision

prevents hypertensive crisis

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18
Q

Pheochromocytoma Lab test

A

Urine VMA

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19
Q

Why is there hyperpigmentation of skin with 1º addison’s?

A

Increased MSH

byproduct of ACTH production from POMC

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20
Q

Most common adrenal medullary tumor in kids

A

Neuroblastoma

less likely to develop HTN
can occur anywhere on sympathetic chain

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21
Q

Lab test for neuroblastoma

A

Elevated HVA in urine (homovanillic Acid)

breakdown product of DA

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22
Q

Neuroblastoma oncogene

A

N-myc overexpression –> rapid tumor progression

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23
Q 
Cold intolerance
weight gain despite decreased appetite
constipation
lower activity and energy
Myxedema (face, periorbital)
bradycardia
A

Hypothyroidism

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24
Q

Hypothyroidism Labs

A

decreased free T4

Increased TSH (1º) 
Decreased in 2º
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25
``` Heat intolerance weight loss, increased appetite hyperactivity increased reflexes diarrhea pretibial myxedema warm moist skin/hair palpitations/arrhythmia ```
Hyperthyroidism
26
Hyperthyroidism Labs
``` Decreased TSH (1º) Increased Free or total T3 and T4 ```
27
Most common cause of hypothyroidism
Hashimoto's
28
Hashimoto's Thyroiditis Pathophys
autoimmune disease against thyroid moderately enlarged, NONTENDER thyroid
29
Hashimoto's Thyroiditis histo
Hurthle Cells | lymphocytic infiltrate with germinal centers
30
HLA marker associated with Hashimoto's
HLA-DR5
31
``` Severe Fetal hypothyroidism Pot-Bellied Pale Puffy Faced kid protruding umbilicus Protuberant tongue ```
Cretinism
32
Types of Cretinsim
Endemic goiter--dietary Iodine deficiency Sporadic Cretinsim--defect in T4 formation or dev. failure of thyroid
33
Self-limited hypothyroidism following flu infection VERY TENDER thyroid increased ESR, jaw pain granulomatous inflammation
De Quervain's Subacute thyroiditis
34
Thyroid replaced by fibrous tissue hypothyroidism PAINLESS, rock-hard goiter
Riedel's Thyroiditis manifestation of IgG related systemic disease
35
Wolf Cheikoff Effect
Hypothyroidism due to ingestion of excessive Iodine
36
Focal patches of hyperfunctioning follicular cells working independently of TSH Hot nodule Increased T3 and T4
Toxic Multinodular Goiter Mutation of TSH-R
37
Jod-Basedow Phenomenon
Thyrotoxicosis when iodine defficient patient is made iodine replete
38
Graves Disease pathophys
Autoimmune hyperthyroidism | Ab that stimulate TSH receptors
39
Pretibial Myxedema and exophthalmos seen with Graves--mechanism
increase in CT deposition
40
Stress induced thyroid storm Death by Arrhythmia increased ALP
Thyroid Storm
41
``` Thyroid mass Empty appearing nuclei (orphan annie eyes) psammoma bodies nuclear grooves Excellent prognosis ```
Papillary CA of thyroid
42
Risk of Papillary CA
Childhood irradiation
43
Calcitonin Producing mass on thyroid | sheets of cells in amyloid stroma
Medullary CA of Thyroid
44
Cancer associated with Hashimoto's
Lymphoma
45
Medullary CA of thyroid cell type
C Cells secrete calcitonin
46
Undifferentiated mass on thyroid poor prognosis old pt.
Anaplastic
47
Mass on Thyroid with uniform follicles | good prognosis
Follicular CA
48
#1 tumor on thyroid
Papillary CA of Thyroid
49
#1 cause of primary hyperparathyroidism
adenoma
50
Osteitis Fibrosa Cystica
cystic bone spaces filled with brown fibrous tissue --> bone pain
51
Sx of Hyperparathyroidism
Hypercalcemia --> Stones, bones, and groans Renal stones constipation (GI) bone pain
52
1º hyperparathyroidism labs
Increased PTH, Alk Phos, and urine cAMP
53
2º hyperparathyroidism causes
Chronic Renal disease --> decreased Vit. D decreased Ca reabsorption from gut and increased Pi
54
2º hyperparathyroidism labs
Hypocalcemia hyper Pi increased Alk. phos Increased PTH
55
3º hyperparathyroidism
Refractory (autonomous) hyperparathyroidism due to chronic kidney disease very very high PTH elevated Ca
56
Hypoparathyroidism causes
Accidental surgical excision (thyroid surgery) Autoimmune destruction DiGeorge Syndrome
57
hypoparathyroidsim Sx
Hypo Ca tetany Chvostek's sign Trousseau's Sign
58
Chvostek's sign
Tap on facial nerve and get spasm of face hypo Ca sign
59
Trousseau's Sign
Occlusion of brachial a. with BP cuff --> carpal spasm hypo Ca sign
60
Pseudohypoparathyroidsim
Albright's hereditary ostrodystrophy AD kidney unresponsive to PTH Short stature, short 4/5 digits, hypocalcemia
61
Most common pituitary adenoma
Prolactinoma
62
Sx of prolactinoma
amenorrhea galctorrhea low libido infertility (low GnRH) Bitemporal hemianopsia (optic chiasm)
63
Prolactinoma Tx
DA agonists--bromocriptine & cabergoline
64
Excessive GH in adults and kids
acomegaly--adults | gigantism--kids
65
Achromegaly Dx
High IGF-1, GH No GH suppression with glucose suppression test pituitary mass on MRI
66
Dx of DI
Water deprivation test does not increase urine osmo Desmopressin response--central not response--nephrogenic
67
DI Tx
Fluid intake Central--nasal ADH (desmopressin) Nephrogenic--hydrochlorothiazide, indomethacin, or amiloride
68
Sheehan Syndrome
Hypopituitarism due to post partum bleeding (could occur at end of preg) Hypertrophy of pituitary with no ∆ in vascular supply failure to lactate
69
Empty Sella Syndrome
atrophy or compression of pituitary idiopathic obese women
70
Hypopituitary causes
``` Non-secreting pituitary adenoma craniopharyngioma Sheehan's Syndrome Empty Sella Brain injury Hemorrhage Radiation ```
71
Hypopituitarism Tx
Substituinon Tx Corticosteroids Thyroxine Sex steroids human growth factor
72
Concentrated urine | dilute blood--relative hyponatremia
SIADH
73
SIADH Tx
Fluid restriction IV saline Tolvaptan/conivaptan--Vasopressin Rec. antagonist demeclocycline
74
Kimmelsteil Wilson Nodules
DM buzz word for non-enxymatic glycosylation in kidney vasculature
75
DM Type 1 HLA associated
HLA-DR3 and DR4
76
Histology of DM Type 1 vs. Type 2
1. Islet leukocytic infiltrate | 2. Islet amyloid deposition (AIAPP)
77
DKA pathophys
Stress --> excessive fat breakdown --> ketogenesis from free FA --> Ketone bodies
78
Most common Ketone bodies in DKA
ß-hydroxybutyrate > acetoacetate
79
Hyperkalemia with DKA
Serum levels are high but overall hypokalemia due to intracellular depletion from insulin
80
DKA complications
``` mucor Rhizopus infection cerebral edema cardiac arrhythmias heart failure ```
81
Tx DKA
Fluids Insulin K+--replete intracellular glucose--if necessary to prevent hypoglycemia
82
Recurrent Diarrhea, Cutaneous flushing,asthmatic wheezing, right sided valvular disease Elevated 5HT
Carcinoid Syndrome
83
Carcinoid Syndrome Cause
Carcinoid tumors OUTSIDE of GI If in GI--Liver will filter out 5HT due to first pass
84
Carcinoid Tumor cells
Neuroendocrine cells
85
Carcinoid Syndrome Tx
Somatostatin anologue--octreotide
86
``` Gastrin secreting tumor of pancreas or duodenum rugal thickening of stomach stomach acid hypersecretion Recurrent ulcers (down to ileum) MEN Type 1 ```
Zollinger Ellison Syndrome
87
MEN Type 1 (Wermer's Syndrome)
Parathyroid Tumors Pituitary Tumors Pancreati Endocrine Tumors (ZE Syndrome) Kidney stones, stomach ulcers "3 P's"
88
MEN 2A (Sipple Syndrome)
Pheochromocytoma Parathyroid Tumor Medullary Thyroid Tumor--Calcitonin "2 P's"
89
MEN 2B
Pheochromocytoma Medullary Thyroid CA Oral/intestinal ganglioneuromatosis--associated marfanoid habits "1 P"
90
Gene mutation associated with MEN 2A and 2B
ret gene mutation
91
Inheritance patter of MEN syndromes
Autosomal Dominant

Pathology 1st aid (11 decks)

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