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Endo Repro 2 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Primary hyperparathyroidism

A 
Painful bones (osteoporosis)
Renal stones (neprolithiasis)
Abdominal groans (constipation, gallstones)
Psychic moans (depression, lethargy, siezures)

Causes: adenoma (85-95%)
hyperplasia
carcinoma

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2
Q

Osteitis fibrosis cystica

A

symptom of primary hyperparathyroidism
aka brown tumor, can look like metastatic cancer
osteoclast driven bone destruction, small fractures and hemorrhage

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3
Q

Parathyroid adenoma

A

Most common cause of primary hyperparathyroidism
Affects only 1 parathyroid gland
normal rim of parathyroid tissue

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4
Q

Parathyroid hyperplasia

A

Indicates primary or secondary hyperparathyroidism
affects all 4 glands
no normal rim of parathyroid tissue

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5
Q

Parathyroid carcinoma

A

Causes Primary hyperparathyroidism
metastasis
local invasion
elevated PTH that does not go down after surgery

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6
Q

Hypercalcemia, symptomatic vs asymptomatic

A

asymptomatic → primary hyperparathyroidism

symptomatic → malignancy

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7
Q

Hypercalcemia of malignancy

A

caused from PTHrP, analogue of PTH, released from lung and breast cancers
or lymphomas releasing vitamin D
or just osteolysis from breast/lung cancer

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8
Q

Secondary hyperparathyroidism

A

Renal failure causes ↓Ca++ which triggers ↑ PTH
all 4 glands will undergo hyperplasia
renal osteodystrophy (rugby jersey)
Calciphylaxis → patients may die from sepsis from gangrene

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9
Q

Tertiary hyperparthyroidism

A

prolonged hypocalcemia causes parathyroids to lose regulation and just always release a bunch of PTH

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10
Q

Hypocalcemia

A 
Trosseau sign (BP cuff wrist flexion)
Chvostek sign (CNVII twitching)
prolonged QT interval
Muscle cramps, spasms, tetany
Convuslsions
Numbness and parathesia
Behavioral disturbances
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11
Q

DiGeorge syndrome’s effects on parathyroids

A

parathyroid hypoplasia/aplasia
hypocalcemia
DiGeorge syn: facial abnormalities, cyanosis, infection, tetany

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12
Q

Familial hypocalciuric hypercalcemia

A

LOF mutation of CaSR
↑ PTH
↑ Ca++
↓ renal excretion (hypocalciURIA)

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13
Q

Autosomal dominant hypoPTH

A

GOF mutation of CaSR
↓ PTH
↓ Ca++
↑ renal excretion of Ca++

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14
Q

Pseudohypoparathyroidism

A

hypocalcemia despite ↑↑PTH

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15
Q

Albrights heriditary osteodystrophy

A

short stature
shortened fingers and toes
obesity

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16
Q

Mass effect of pituitary enlargement

A 
headache
confusion
shallow breathing
nausea
papilledema
HTN
bradycardia
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17
Q

Lactotroph adenoma

A

Most common secretory pituitary adenoma
Psammoma bodies, pituitary stone
Women → menstrual irregularities, galactorrhea, diminished libido, infertility, mass effect
Men → decreased libido, decreased sperm count, mass effect

Treatment is dopamine agonists (bromocriptiine and cabergoline) or surgery

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18
Q

Somatotroph adenoma

A

gigantism, acromegaly
↑IGF-1
Glucose tolerance test to confirm
glucose should cause ↓ GH, if it doesn’t then they have adenoma

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19
Q

Cushing syndrome

A 
centripetal obesity
moon face
abdominal thick stria
thin skin
hirsutism
usually caused iatrogenically, glucocorticoid administration
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20
Q

corticotroph adenoma

A 
aka cushing's disease
↑ cortisol
↑ ACTH
cortisol decreases in response to high dose dexamethasone suppression test
USP8 mutations possible
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21
Q

Ectopic ACTH producing tumor

A

paraneoplastic syndrome of small cell carcinoma of the lung, or pancreatic carcinoma
↑ cortisol
↑ ACTH
Cortisol levels do not respond to high dose dexamethasone suppression test

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22
Q

Nelson syndrome

A

A syndrome caused by adrenal removal in the case of corticotroph adenoma.

ACTH has no adrenals to act on, but nothing is suppressing ACTH secretion

Hyperpigmentation remains, because ACTH → MSH

Tumor keeps on growing so mass effect may occur

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23
Q

Gonadotroph adenoma

A

asymptomatic until tumor is large enough to cause mass effect

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24
Q

GNAS mutations

A

Gs loses GTPase activity making GTP always active, and cascade always turned on

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25
Craniopharyngioma
Causes hypopituitarism kids → adamantinomatous, growth retardation adults → papillary, intracranial pressure derived from rathke's pouch remnants
26
Things that cause hypopituitarism
pituitary gets squashed, has ischemia, or hemorrhaged
27
Empty sella syndrome
CSF leaks and squished pituitary | Pituitary expands, infarcts, and then necrotizes, leaving empty sella
28
Sheehan syndrome
postpartum necrosis of ant pituitary from ischemia or infarction
29
Diabetes insipidus Central vs nephrogenis
``` ↓ ADH (AVP) ↑ water excretion hyperosmolarity hypernatremia polyuria which is dilute ↑ thirst ``` Central: DDAVP adminstration fixes it Nephrogenic: DDAVP administration does nothing
30
SIADH
``` ↑ ADH concentrated low volume urine hyponatremia hypernatriuria mental status changes, muscle weakness, siezures ↑ thirst ``` Caused from small cell carcinoma of the lung, brain trauma, drugs
31
Paraneoplastic syndromes associated with small cell carcinoma
Cushing syndrome (↑ ACTH) SIADH (↑ ADH)
32
Thyroid storm
Fever Tachycardia diarrhea jaundice Common causes: pregnancy/postpartum hemithyroidectomy amiodarone
33
Grave's disease
Triad: hyperthyroidism with gland enlargement exophthalmos pretibial myxedema (edema of shins with scaly skin) ↑ T3/4 ↓ TSH ↑ TSI (thyroid stimulating Ig, mimics TSH)
34
Cretinism
``` congenital hypothyroidism seen in children mental and growth retardation coarse facial features umbilical hernias caused from lack of iodine in pregnancy ```
35
Myxedema
``` hypothyroidism in adults mental and physical sluggishness weight gain cold intolerance brittle hair, nales coarse skin ↓ CO hypercholesterolemia ```
36
Hashimoto thyroiditis
Autoimmune hypothyroidism antibodies against thyroglobulin and thyroid peroxidase (TPO) lymphocytes diffuse, painless enlargment of thyroid with Hurthle cell metaplasia looks like lymph node is taking over thyroid tissue initial hyperthyroid, then chronic hypothyroid ↑hTg-Ab ↑hTPO-Ab ↑TSHR-Ab
37
Subacute lymphocytic thyroiditis
Post partum hypothyroid | painless
38
Subacute granulomatous thyroiditis
aka deQuervain thyroiditis post viral infection (mumps usually) painful
39
Reidel thyroiditis
thyroid fibrosis cement-like Ig4-related disease fibrosis, lymphocytes and plasma cells
40
Diffuse nontoxic goiter
Endemic goiter → iodine deficiency Also caused from cassava root and excess broccoli, cauliflower, cabbage and radish ingestion symptoms due to mass effect more common in younger patients
41
Multinodular goiter
some nodules can be neoplastic strikingly large Cold and hot nodules more likely benign Cold → more concern for malignancy than hot
42
Papillary thyroid carcinoma (PTC)
Psammoma bodies RET-PTC BRAF Orphan Annie Eye nuclei
43
Follicular PTC
``` PAX8/PPARG RAS PTEN mushroom invasion of capsule angio-invasion ```
44
Anaplastic carcinoma
elderly highly aggressive, less than 1 year to live TP53 mutation
45
Medullary thyroid carcinoma
``` Neuroendocrine tumor derived from C-cells (which secrete calcitonin) Blue cells amyloid (Acal) C-cell hyperplasia RET mutations ```
46
Release of insulin pathway
``` Glucose enters pancreatic Beta cell through GLUT-2 channel ↑ ATP ATP blocks K+ channel membrane depolarization Ca++ channel opens influx of Ca++ insulin released ```
47
Incretins
Increase insulin release inhibit glucagon release include GLP-1 and GIP
48
Prediabetes and diabetes test values
A1C 5.7-6.4% FPG 100-125 OGTT 140-199 A1C over 6.5% FPG over 126 OGTT over 200 RPG over 200
49
Type 1 diabetes
``` Autoimmune disease due to failure of T-cell self tolerance HLA DR/DQ on chromosome 6 Classic triad polyphagia (hunger) polyuria polydipsia ``` ``` increased thirst and frequent urination extreme hunger weight loss fatigue irritability fruity smelling breath ```
50
Type 2 diabetes
Insulin resistance Beta cell exhaustion identified on screening or vision changes
51
Mature onset diabetes of the young
Type 2 DM, mutation resulting in loss of glucokinase, so beta cells do not breakdown glucose which would normally trigger insulin release
52
Diabetic ketoacidosis
``` T1DM Triad of hyperglycemia Ketonemia Metabolic acidosis ``` Symptoms of Nausea/vomitting, tachycardia, Kussmaul respirations Treat with insulin, hydration, and potassium
53
Hyperglycemic hyperosmotic syndrome (HHS)
``` T2DM prolonged insulin deficiency glucose over 600 severe dehydration hyperosmolality → coma, death impaired renal function no ketones ```
54
Diabetic nephropathy
glomerular sclerosis causing leak of large molecules into urine, such as protein mesangial matrix accumulation → Kimmelstiel wilson disease urine albumin creatinine ratio (UACR) is the gold standard test ↑ albumin in urine as it progresses
55
Insulinoma
small pancreatic tumor of beta cells Amyloid
56
Gastrinoma
aka zollinger ellison syndrome G cell tumor → ↑gastrin ↑ HCl leading to ulceration, which do not respond to therapy Can cause perforation → free air in abdomen
57
Somatostatinoma
``` diabetes, cholelithiasis, steatorrhea Somatostatin is inhibitory so think.... reduced insuling reduced gallbladder motility reduced exocrine pancreatic secretions ```
58
Glucagonoma
mild diabetes necrolytic migratory erythema in groin and lower extremities → skin rash with erythema and necrotic patches and crusted erosions 4 D's → diabetes, dermatitis, depression, DVT
59
VIPoma
``` WDHA syndrome - Watery Diarrhea - Hypokalemia - Achlorhydria may also have flushing ```
60
Primary adrenal adenoma
Cushings syndrome ↑ cortisol ↓ ACTH so ACTH independent
61
Conn's syndrome
Primary hyperaldosteronism HTN Hypokalemia Hypomagnesemia
62
Secondary hyperaldosteronism
``` HTN Hypokalemia Hypomagnesemia Caused from activation of Renin-angiotensin-aldosterone system, hypovolemia decreased renal perfusion renin secreting tumor pregnancy ```
63
Aldosterone-secreting adenoma
Spironolactone bodies
64
Congenital Adrenal Hyperplasia
``` Autosomal recessive defective enzyme, often 21-hydroxylase prevents production of aldosterone and cortisol but allows production of sex hormones salt wasting aka hyponatremia hyperkalemia hypotension virilization of females at birth ```
65
Primary Acute Adrenocortical insufficiency
3 causes Adrenal crisis rapid withdrawl of steroids massive adrenal hemorrhage (waterhouse friderichsen syndrome) ``` Hypotenstion hyponatremia hyperkalemia abdominal pain fever nausea/vomitting hypoglycemia ```
66
Primary chronic adrenocortical insufficiency
``` aka Addison's disease malaise and fatigue anorexia and weight loss joint pain hyperpigmentation of the skin ```
67
Autoimmune polyendocrine syndrome type 1
``` Adrenalitis parathyroiditis hypogonadism pernicious anemia candidiasis ectodermal dystrophy (teeth and nails) ```
68
Autoimmune polyendocrine syndrome type 2
adrenalitis thyroiditis T1DM
69
Adrenal carcinoma
much larger than adrenal adenoma compression of adjacent structures
70
Pheochromocytoma
``` tumor of adrenal medulla ↑ NE classic triad headache palpitations diaphoresis ```
71
MEN1
germline mutation of tumor suppressor gene MEN1 3 P's Pituitary adenoma Pancreatic endocrine tumor Primary hyperparathryoidism
72
MEN2A
Germline GOF mutation in RET 2 P's, 1 M Parathryoid hyperplasia Pheochromocytoma Medullary thyroid carcinoma
73
MEN2B
Germline GOF mutation in RET 1 P, 2 M's Pheochromocytoma Medullary thyroid carcinoma Mucosal neuromas

Endo Repro 2 (2 decks)

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