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Flashcards in Endocrinology Deck (128):
1

Connection of thyroid to tongue

thyroglossal duct (foramen cecum= normal remnant)

2

Where thyroid diverticulum arise

primitive pharynx

3

Layers and products of adrenal medulla

Zona glomerulosa: Aldosterone
Zona fasciculata: cortisol
zona reticularis: sex hormones

4

Common tumors of adrenal medulla in adults vs kids

adults: pheo
kids: neurobalstoma (HTN uncommon)

5

Venous drainage of L vs R adrenal gland

L: L adrenal vein, L renal vein, IVC
R: R adrenal vein, IVC

6

Rathke pouch- what does it become

Anterior pituitary

7

Secreted by posterior pituitary

vasopressin, oxytocin

8

secreted by anterior pituitary

FSH, LH, ACTH, TSH (Basophils)
prolactin, GH (Acidophils)

9

a cells of pancrease: secreted and location

glucagon, peripheral

10

b cells of pancreas: secreted and location

insulin, central

11

delta cells of pancreas: secreted and location

somatostatin, interspersed

12

Insulin R is a ___

tyrosine kinase

13

pathways induced by insuline receptor

PI3 kinase, RAS/MAP kinase

14

Gluc transporter in adipose tissue, skeletal muscle

GLUT-4 (insulin dependent)

15

Gluc transpoter in RBC, brain, cornea

GLUT-1 (insulin independent)

16

Gluc transporter in spermatocytes, GI tract

GLUT-5 (Fructose, insulin independent)

17

Gluc transporter in b islet, liver, kidney, SI

GLUT-2 (bidirectional, insulin independent)

18

What inhibits glucagon?

insulin, hyperglycemia, somatostatin

19

what is the action of glucagon?

glyocgenolysis, gluconeogenesis, lipolysis, ketone production

20

Effect of CRH

incr ACTH, MSH, b-endorphin

21

Effect of dopamine on pituitary

decr prolactin

22

Effect of Prolactin on pituitary

decr GnRH

23

Affect of somatostatin on pituitary

decr GH, TSH

24

Effect of TRH on pituitary

Incr TSH, prolactin

25

Effect of GnRH on pituitary

Tonic: supresses HPA
Pulsatile: puberty, fertility
via FSH, LH

26

Bromocriptine

Dopamine agonist, used to inhibit prolactin secretion

27

what stimulates prolactin secretion

dopamine antagonists (antipsychotics), estrogens

28

What 2 factors inhibit GH

glucose, somatostatin

29

What mediates GH effects

IGF-1/somatomedin

30

Which nucleus synthesizes ADH

supraoptic nuclei of hypothalamus

31

What is treatment of central DI

desmopressin (ADH analog)

32

What receptors sense ADH, what to they regulate?

V2- serum osmolarity (primary function)
V1- blood pressure

33

mineralocorticoid, cortisol, sex hormone levels in 17a-hydroxylase deficiency

incr mineralocorticoid, decr cortisol, decr sex hormone levels

34

mineralocorticoid, cortisol, sex hormone levels in 21-hydroxylase deficiency

decr mineralocorticoid, decr cortisol, incr sex hormone levels

35

mineralocorticoid, cortisol, sex hormone levels in 11b-hydroxylase deficiency

decr mineralocorticoid, decr cortisol, incr sex hormone levels; incr BP due to incr 11-deoxycorticosterone

36

Presents as hypertension, hypokalemia, lack secondary sexual development in females

17a hydroxylase deficiency

37

Presents as hypotension, hyperkalemia, incr renin; salt wasting in infants, precocious puberty in children

21 hydroxylase deficiency

38

presents as hypertension with low renin, virilization in females

11b hydroxylase deficiency

39

Functions of cortisol (BIG FIB)

INCR:
Blood pressure
Insuline resistance
Gluconeogensis, lipolysis, proteolysis
DECR:
Fibroblast activity
Inflammatory response
Bone formation

40

What are patients on exogenous cortisol susceptible to? what is mechanism

TB, candidiasis; blocked IL-2 production

41

Regulation of cortisol secretion

CRH produced by hypothalamus, ACTH produced by pituitary

42

Cells that produce PTH

chief cells of parathyroid

43

Effect of PTH on bone

incr resorption of Ca2+, PO43-

44

Effect of PTH on kidney (3)

incr reabsoprtion Ca2+ DCT
decr reabsorption PO43- in PCT
incr production calctriol

45

Effect of Mg on PTH levels

moderate decreae Mg: incr PTH
severe decrease Mg: decr PTH
Causes if hypomagnesemia: diarrhea, aminoglycosides, diuretics, alcohol abuse

46

Effect of incr pH on Ca levels

incr affinity to albumin, symptoms of hypocalcemia

47

Source of calcitonin

Parafollicular C cells of thyroid

48

T3 functions (4 Bs)

Brain maturation
Bone growth (synergize with GH)
B-adrenergic effects (incr B1 on heart)
Basal metabolic rate

49

Cushing disease vs cushing syndrome

Cushing Disease= ACTH secreting pituitary adenoma
Cushing syndrome= incr cortisol (multiple causes)

50

Cushing syndrome with low ACTH, diagnostic test

primary adrenal adenoma, hyperplasia, or carcinoma; MRI to confirm tumor; expect atrophy of uninvolved gland

51

Cushing syndrome with high ACTH, suppression via high dose dexa

Cushing disease, usually pituitary adenoma

52

Cushing syndrome with high ACTH, no suppression via high dose dexa

ectopic ACTH secretion

53

Hypertension, hypokalemia, metabolic acidosis, low renin

primary hyperaldonsteronism

54

Conn syndrome- define

aldosterone-secreting adrenal adenoma

55

Causes of secondary hyper aldost

renal artery stenosis, CHF, cirrhosis, nephrotic syndrome (renal perception of low intravascular volume)

56

treatment of secondary hyperaldost

spironolactone

57

distinguis primary vs secondary hyperaldosterone

primary: low renin
secondary: high renin

58

Addison disease- define

chronic primary adrenal insuffeciency, deficiency of aldosterone and cortisol

59

Hypotension, hyperkalemia, acidosis, hyperpigmentation

Addison disease

60

Primary vs secondary adrenal insufficiency

Secondary: no hyperpigmentation, hyperkalemia (decr pituitary ACTH)

61

Waterhouse-friedrichsen syndrome- describe

acute primary adrenal insufficiency due to hemorrhage

62

causative organism of waterhouse-friedrichsen syndrome

N. meningitidis

63

Oncogene assoc with neuroblastoma

N-myc

64

Neuroblastoma vs Wilms tumor- presentation

Neuroblastoma: firm irregular mass, can cross the midline
Wilms: smooth, unilateral

65

Urine and histology marker for neuroblastoma

Homovanillic acid in urine
Bombesin + with rosettes

66

Syndromes associated with pheo (3)

von Hippel-Lindau, MEN 2A, 2B

67

Treatment for pheo

a antagonist (phenoxybenzamine) before b blocker; resection

68

what cell type makes pheo

chromaffin cell

69

Cholesterol levels in hypothyroidism and mechanism

hypercholesteremia; decr LDL receptor expression

70

Assoc with Hurthle cells

Hashimoto's thyroiditis

71

HLA type assoc with Hashimoto's thyroiditis

HLA-DR5

72

Pot-bellied, pale, protruding umbilicus, protuberant tongue, poor brain function

congenital hypothyroidism (cretinism)

73

Riedel thyroiditis

thyroid is replaced by fibrous tissue; can extend to local structures

74

Tender vs nontender thyroiditis

Tender= de Quervain (usually self-limiting)
Nontender= hashimoto

75

Histologic finding of de Quervain thyroiditis

granulomatous inflammation

76

Cause of toxic multinodular goiter

Mutation in TSH receptor- fxn independent of TSH

77

Jod-Basedow phenomenon

thyrotoxicosis when pt with iodine-deficiency goiter is given iodine

78

Wolf-Chaikoff effect

excess iodine temporarily inhibits thyroid peroxidase

79

Treatment of thyroid storm

propanolol, propylthiouracil, corticosteroids

80

Describe thyroid storm

stress-induced catecholamines-- agitation, delirium, fever, diarrhea, coma, tachyarrythmia

81

Mutations associated with papillary thyroid carcinoma

RET, BRAF

82

Assoc with "orphan annie" eye nuclei

papillary thyroid carcinoma

83

Follicular adenoma vs follicular carcinoma

follicular carcinoma invades thyroid capsule

84

Amyloid stroma assoc with

medullary thyroid carcinoma

85

Syndromes associated with medullary carcinoma

MEN 2A, MEN 2B

86

Osteitis fibrosa cystica

cystic bone spaces filled with brown fibrous tissue, assoc with hyperparathyroidism

87

Hypercalcemia, hypercalciuria, hypophosphatemia, Incr ALP, incr cAMP in urine

hyperparathyroidism

88

Renal osteodystrophy

bone lesion due to secondary or tertiary hyperparathyroidism

89

Cause of secondary, tertiary hyperparathyroidism

chronic renal disease

90

Albright hereditary osteodystrophy

psuedohypoparathyroidism; AD, kidney unresponsive to PTH; hypocalcemia, shorthened 4th, 5th digit, short stature

91

Chvostek sign

tapping of facial nerve induces contraction of facial muscle; indicates hyocalcemia

92

Trousseau sign

carpal spasm when brachial arterl occulded; indicates hypocalcemia

93

Treatment of prolactinoma

bromocriptine, cabergoline (dopamine agonist)

94

Pegvisomant

growth hormone receptor antagonist

95

GH response to oral glucose challenge

should suppress, will not suppress in acromegaly

96

Intense thirst and polyuria, inability to concentrate urine

diabetes insipidus

97

Demeclocycline

ADH antagonist

98

Destinguish central vs nephrogenic DI

ADH levels (decr in central)
Water restriction test (no response in nephrogenic)
Vasopressiin administration (no response in nephrogenic)

99

treatment of central DI

intranasal DDAVP

100

treatment of nephrogenic DI

HCTZ, indomethacin, amiloride

101

Causes of SIADH (3)

Small cell lung cancer, CNS, pulmonary disease

102

what drug can cause SIADH

cyclophosphamide

103

Treatment of SIADH

fluid restriction, IV hypertonic saline, conivaptan, tolvaptan, demeclocycline

104

Define SIADH

excess water retention, dilutional hyponatremia, urine osmolarity> serum osmolarity

105

Sheehan syndrome

ischemic infarct of pituitary (esp ant pituitary) after postpoartum bleeding

106

Kimmelstiel-Wilson nodules

assoc with diabetic nephropathy

107

Most common cause of death in diabetic

MI

108

Small vessel disease in diabetics

retinopathy, glaucoma, nephropathy

109

Large vessel disease in diabetics

atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene

110

Osmotic damage in diabetics

neuropathy, cataracts

111

HLA types associated with Type 1 diabetes

HLA-DR3, DR4

112

Histologic finding T1 DM

Islet leukocytic infiltrate

113

Histologic finding T2 DM

islet amyloid polypeptide deposits

114

Kussmaul respirations, n/v, abdominal pain, delirium, dehydration

DKA

115

Lethargy, syncope, diplopia

whipple triad; insulinoma

116

Infection associated with DKA

mucormycosis (Rhizopus)

117

MEN syndrome associated with marfanoid habitus

MEN 2B

118

MEN syndrome associated with pancreatic endocrine tumors

MEN 1

119

Also called Wermer syndrome

MEN 1

120

MEN associated with pituitary tumors

MEN 1

121

Also called Sipple syndrome

MEN 2A

122

MEN syndrome associated with mucosal neuromas

MEN 2B

123

MEN syndromes associated with medullary thyroid carcinoma

MEN 2A, 2B

124

MEN syndromes associated with parathyroid tumor/hyperplasia

MEN 1, 2A

125

MEN syndromes associated with Pheo

MEN 2A, 2B

126

Treatment of carcinoid syndrome

resection, somatostatin analog

127

Diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease

carcinoid syndrome

128

Assoc with incr 17-OH progesterone

21a-hydroxylase deficiency