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Flashcards in Exam 2 - other endocrine diseases Deck (70):
1

anatomically (parathyroid?) derived from

3rd and 4th pharyngeal pouches

2

Parathyroid hormone function

*** maintains ionized serum calcium levels

-inc renal calcium reabsorb
- dec renal phosphorus reabsorb
-inc intestinal calcium and phosphorus reabsorb
-dec bicarbonate reabsorb

-inc 1-alpha hydroxylase synthesis in kidney (increases calcitriol synthesis)

3

Parathyoid hormone (stim and suppressed by)

stim:
-hypocalcemia
-hyperphosphatemia

suppressed by:
-hypercalcemia
-hypophosphatemia

4

Calcium (total serum vs free-ionized)

-total serum bound to albumin

-free-ionized is metabolically active and is a negative feedback on PTH

5

What happens if calcium is decreased?

tetany:
-partial depolarization of nerves and muscles
-carpopedal spasm
-Chvostek sign: facial twitch with facial nerve tap

6

Hypoalbuminemia is what?

-decreased total calcium
-normally free, ionized calcium

7

What is hypoparathyroidism?

-a hypofunction of the parathyroid glands resulting in hypocalcemia

8

What are the causes of hypoparathyroidism?

-Autoimmune (most common)
-previous thyroid surgery
-DiGeorge syndrome (failure of 3rd and 4th pharyngeal pouches to develop)
-hypomagnesemia (Mg needed for cAMP, which is required for PTH use)

9

Hypoparathyroidism: clinical findings

-tetany
-basal ganglia calcification (inc phosphorus drives calcium into brain)
-cataracts
-Candida assocation

10

Hypoparathyroidism: labs and treatment

labs:
-dec calcium and PTH (parathyroid hormone)
-inc phosphorus

Treatment:
-calcium, vid D3, teriparatide

11

Primary hyperparathyroidism

-***most common nonmalignant cause of hypercalcemia

-postmenopausal women
-asymptomatic in 50%
- MEN I and IIa association

12

Primary hyperparathyroidism: Adenoma

-***single adenoma
-usually right inferior gland
-sheets of chief cells (no intervening adipose)
-atrophy in rest of gland
-hypercalcemia decrease PTH secretion from tissue

13

Primary hyperparathyroidism: Primary hyperplasia

-*** all four glands
-chief cell hyperplasia

14

Primary hyperparathyroidism: clinical findings

*-"Stones, bones, groans, and psychic overtones"
(due to hypercalcemia)

15

Primary hyperparathyroidism: LABS and treatment

Labs:
***- inc PTH
***- inc calcium
***- dec phosphorus

treatment: surgery to remove, treat the hypercalcemia

***Hypercalcemia from malignancy normally has a dec PTH!

16

What is Secondary Hyperparathyroidism?

-hyperplasia of all four glands
***physiological compensation for hypocalcemia

17

Secondary Hyperparathyroidism: Labs

Labs:
-dec calcium
-inc PTH

-may eventually normalize labs (tertiary hyperparathyroidism, autonomous glands)

18

Normal thyroid A&P

-contains largest store of hormones out of all endocrine glands

19

Thyroid hormone function

-***controls BMR
-turnover of hormones
-cell regen
-growth and maturation of tissue
-receptor synthesis

20

Thyroid labs look at

-total serum T4
-TSH
-(a specific) Iodine uptake
-thyroglobulin

21

Total serum T4 and TBG

-total serum t4 is free t4 and TBG-bound T4

TBG (thyroid binding globulin)
-produced in liver
-production inc by estrogen

22

Thyroid stimulating hormone (TSH)

-screen for dysfunction
-***produced in anterior pituitary
-increased with inc TRH
-inc with low T3 and T4
-dec with high T3 and T4

23

123Iodine uptake

-measures synthetic activity in thyroid
-iodide needed in thyroid hormone synthesis
-inc uptake = inc T4 synthesis
-dec uptake = gland inactivity/inflammation

24

Lingual thyroid

-failed decent of thyroid (remains at base of tongue)
-clinical find: dysphagia, mass lesion
-Diag: 123-I uptake
-Treat: thyroxine suppression, ablation, surgery

25

Thyroglossal duct cyst

-cystic midline mass
-near hyoid bone
-Treatment: surgery (remove hyoid or prox duct)

26

Acute thyroiditis

****BACTERIAL (usually staph aureus

clin: fever, tender, cervical adenopathy, initial thyrotoxicosis, dec 123-I uptake

Treat: penicillin or ampicillin

27

Sub-acute granulomatous thyroiditis

****VIRAL (mumps, coxsackievirus)

clin:
-PAINFUL* thyroid gland
-most common cause is preceding URI

-Self-limiting

28

Hashimoto thyroiditis

-autoimmune
-***most common cause of hypothyroidism

-pathogenesis: cytotoxic T cells destroy gland, dec THS, macrophages destroy tissue

29

Cretinism

-hypothyroidism in infancy

Cause: maternal hypothyroidism, iodine deficiency

clin: mental retardation, inc wt, short stature

30

Myxedema coma

-extreme hypothyroidism
-mortality 20-50%

31

Thyrotoxicosis (what is it)

-thyroid hormone excess regardless of cause

-could be due to graves, thyroiditis, inc exogenous hormone intake, plummer disease, thyroid storm

32

Thyrotoxicosis (constitutional signs and cardiac findings)

constitutional:
-wt loss, anxiety, tremor, lid stare

cardiac:
-sinus tachycardia, inc risk for a-fib, systolic hypertension

33

Thyrotoxicosis lab findings

-dec TSH
-inc T4*
-123-I depends on disease (inc or dec)
-hyperglycemia, hyper calcemia, hypocholesterolemia, lymphocytosis

34

Hyperthryoidism (gen)

-hormone excess due to inc synthesis

-graves
-plummer disease

35

Graves disease

-most common cause of hyperthyroidism and thyrotoxicosis
-autoimmune

-production of antibodies that compete with TSH
-Thyromegaly (symmetrical, nontender)

36

Graves: clinical findings

-*Exophthalmos, proptosis (eye bulge)
-antibodies to TSH receptor can cross placenta
-pretibial myxedema
-thyroid acropachy (digital swelling/clubbing, nails lifted)

37

Apathetic hyperthyroidism

-Graves disease inelderly

38

Graves disease: treatment

-beta blockers (dec adrenergic affects)
-thioamides (dec hormone synthesis)
-radioactive ablation of thyroid with 131-I (if other treatments fail)

39

Plummer disease

-aka toxic multinodular goiter
-1+ nodules become TSH-indep

*no exophthalmos
*no pretibial myxedema

Treatment: surgery

40

Thyroid storm

-too much hormone
-cause: anything that causes too much hormone
-treat: stuff to dec hormone levels

41

Euthyroid sick syndrome

-abnormal T3 and T4 but gland appears to be functioning normally

-pathophysiology: conversion of T3/T4 is messed up so stuff is messed up

42

Nontoxic goiter (types and general what is it)

=thyroid enlargement from excess colloid

types
-Endemic (****iodide deficiency = most common)

-Sporadic (Goitrogens, enzyme deficiceny, puberty, pregnancy)

43

Nontoxic goiter: pathology and treatment

-deficiency of thyroid hormone
-hyperplasia and hypertrophy
-gland involution due to failure to sustain systhesis
-diffuse thryomegaly -> multinodular goiter

Treatment: levothyroxine or surgery

44

Nontoxic goiter: complications

-hemorrhage into cysts
-jugular vein compression (pemberton sign)
-could become toxic
-hoarseness
-dyspnea

45

Solitary thyroid nodule

-usually cold
-risk of malignancy inc with hx of radiation
-diag: FNA and labs
-Treat: benign = watch it, malignant = removal

46

Follicular adenoma

-most common benign tumor
-complete capsule
-solitary cold nodule
-10% malignant transformation

47

Papillary adenocarcinoma (general)

-most common endocrine cancer
-most common thyroid cancer
-F > M
-2nd and 3rd decades
-radiation exposure association

48

Papillary adenocarcinoma: Pathology

-multifocal
-papillary fronds in follicles
-*psammoma bodies
-*orphan annie nuclei
-appear empty

-invade lymph tissue
-metastasis to lungs and nodes

49

Papillary adenocarcinoma: diag, treat, prog

diag: FNA
treat: thyroidectomy, 123-I radiotherapy, thyroid hormone replacement
prog: >95% 5 year survival

50

Follicular carcinoma

-most common solid cold nodule thyroid cancer (F>M)
-pathology: encapsulated or invasive. Vessels invaded by neoplastic follicles
-lung and bone metastasis (lymph node uncommon)
-Treatment (same as others: remove, radio, replacement)

51

Medullary carcinoma

-Produces ACTH
-types (80% sporadic, 20% familiar - MEN IIa/IIb)

patho: C-cell hyperplasia, tumors from parafollicular C cells

diag: FNA, serum calcitonin (converted to amyloid)

Treat: thyroidectomy, genetic screening

52

MEN IIa

-medullary carcinoma
-primary hyperparathyroidism
-pheochromocytoma

53

MEN IIb

-medullary carcinoma
-mucosal neuromas
-pheochromocytoma
-marfin-like habitus

54

Primary B-cell malignant lymphoma

-mostly due to Hashimoto's

55

Anaplastic thyroid cancer

-elderly women
-risk: multinodular goiter, hx of follicular CA
-rapid progression, fatal
-Treat: palliation (decompress trachea), radiation/chemo

56

Adrenal cortex hormones: layers superficial to deep***

-zona glomerulosa: "salty"
-zona fasciculta: "sweet"
-zona raticularis: "sex"

superficial to deep

57

Adrenal medulla hormones: origin and produces

Origin: *** neural crest
Produces: ***EPI and NE
Produces metabolic end produces of catecholamines also? metanephrine, vanillylmandelic acid

58

Causes of Acute adrenocortical insufficiency

-***adrupt withdrawal of steroids
-Waterhouse-Friderichsen syndrome
-anticoagulation therapy

59

Waterhouse-Friderichsen syndrome

-Associated with ***Neisseria meningitidis sepsis

-Endotoxic shock

-***bilateral adrenal hemorrhage

60

Addison disease

-**Chronic adrenal insufficiency. (mineral and glucocorticoid deficiency)
-**low cortisol

Causes: ***autoimmune most common

Clin findings: sodium loss, ACTH stimulated melanocytes =hyperpigmentation)

61

Addison disease: labs

-short and prolonged ACTH stim test
-Metyrapone test: **inc ACTH
-**inc plasma ACTH

62

Congenital adrenal hyperplasia

-aka adrenogenital syndrome
-genetic disorder
-Patho:
**** hypocortisolism
*** increase ACTH
clinical findings: ambiguous genital, quicker puberty

-screen for 17-OH progesterone****

63

Disease differentiation: cortisol levels (high vs low)

too low = addison
too high = cushing

64

Cushing syndrome: causes

-***prolonged corticosteroid therapy (most common!)
-pituitary adenoma
-adrenal stuff
-ectopic cushing

65

Cushing syndrome: clinical findings

-weight gain. moon facies, buffalo hump
-muscle weakness. cortisol breaks down muscle
-diastolic hypertension
-osteoporosis
-Hirsutism (hair from increased androgens)
-purple striae (skin thing cuz cortisol weakens collagen)

66

Cushing syndrome: Labs

-urine: inc free cortisol
-***dexamethasone suppression test (low and high dose. differentiate between types)

-hyperglycemia
-metabolic alkalosis
-hypokalemia

67

Neuroblastoma

-Malignant tumor
***postganglionic sympathetic neurons
*** most common in the adrenal medulla

-kids under 5yrs. 3rd most common cancer in kids

68

Neuroblastoma Pathology

-malig neuroblasts
-small cell tuor
-Homer-Wright rosettes
-Neurosecretory granules

69

Neuroblastoma clinical findings

opsoclonus-myoclonus syndrome

palpable ab mass
diastolic HTN
inc urine VMA and HVA

70

Neuroblastoma: diag, treat, prog, metastasis

diag: urine, imaging
treat: surgery, radiation/chemo
prog: younger when dx the better
metastasis: skin and bones