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FA Endo Flashcards

1
Q

Which corticosteroid do you use for dangerous aldosterone deficiency?

A

Fludrocortisone: lots of mineralocorticoid activity

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2
Q

cAMP pathway

A

FLAT ChAMP
FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2 receptor)
MSH
PTH
Also: calcitonin, GHRH, glucagon

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3
Q

cGMP pathway

A

Think vasodilators
ANP, BNP, NO (EDRF)

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4
Q

IP3 pathway

A

GOAT HAG
GnRH
Oxytocin
ADH (V1 receptor)
TRH
Histamine (H1 receptor)
Angiotensin II
Gastrin

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5
Q

Intracellular receptor pathway

A

VETTT CAP
Vitamin D
Estrogen
Testosterone
T3/T4
Cortisol
Aldosterone
Progesterone

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6
Q

Intrinsic tyrosine kinase pathway

A

MAP kinase pathway, think growth factors
Insulin, IGF-1, FGF, PDGF, EGF

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7
Q

Recetor-associated tyrosine kinase pathway

A

JAK/STAT pathway, think acidophils and cytokines
PIGGlET
Prolactin
Immunomodulators (cytokines IL2, IL6, IFN)
GH
G-CSF
Erythropoietin
Thrombopoietin

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8
Q

VIPoma

A

WDHA syndrome: watery diarrhea, hypokalemia, achlorhydria

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9
Q

Somatostatinoma

A

d-cell, a/w DM, steatorrhea, cholelithiasis, hypochlorhydria
Blocks insulin, gastrin, secretin, CCK, and GI motility

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10
Q

Basophilic and Acidiphilic anterior pit hormones

A

Basophils: B-FLAT–FSH, LH, ACTH, TSH
Acidophils: GP–GH, prolactin

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11
Q

Ghrelin

A

Stimulates hunter (orexigenic effect) and GH release (via GH secretagog receptor). Produced by stomach. Increase with sleep loss and Prader-Willi syndrome.
*Ghrelin make you hunghre.

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12
Q

Leptin

A

Satiety hormone, made by adipose tissue, decreased in starvation. Mutation of leptin gene –> congenital obesity. Sleep deprivation decreases production.
*Letin keeps you thin.

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13
Q

Endocannabinoids

A

Stimulate coritcal reward centers– Increase desire for high fat foods.

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14
Q

Cortisol functions

A

BIG FIB
1. Blood pressure: upreg a1 receptor on arterioles (more senstive to NE and E)
2. Insulin resistance
3. Gluconeogenesis, lipolysis, proteolysis
4. Fibroblast (decrease)
5. Inflammatory and Immune: inhibit PLA2, WBC adhesion, histamine release, eosinophils, IL2 production
6. Bone (decrease osteoblast)
***Exogenous cortisol can cause reactivation of TB and candidiasis (blocks IL2)

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15
Q

SHBG in M and W

A

Men: increased SHBG lowers free T –> gynecomastia
Women: decreased SHBG raises free T –> hirsutism
***OCPs, pregnancy both increase SHBG (free E remains same)

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16
Q

T3 functions

A

4B’s: Brain maturation, Bone growth, B-adrenergic effects, BMR increase (incr Na/K ATPase –> increase O2 consumption, RR, body temp)

17
Q

Wolff-Chaikoff effect

A

Excess iodine blocks thyroid peroxidase (temp)–decreased iodine organification and decreased T3/T4.

18
Q

Neuroblastoma

A

Children, Homer-Wright rosettes, neural crest,
Opsoclonus-myoclonus syndrome (dancing eyes-dancing feet)
HVA (dopamine breakdown) and VMA (NE breakdown) in urine
Bombesin and neuron-specific enolase +
N-myc oncogene

19
Q

Hashimoto

A

Anti-thyroid peroxidase, antimicrosomal, antithyroglobulin abs
HLA-DR5 + HLA-B5
Increased risk of B cell marginal zone lymphoma
Hurthle cells (enlarged epithelial cell with abundant eosinophilic granular cytoplasm), lymphoid aggregate with germinal centers.
Type 4 hypersensitivity.

20
Q

Congential hypothyroidism (cretinism)

A

D/t maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis (MCC), iodine deficiency, dyshormonnogenetic goiter.
6 Ps: Pot-bellied, Pale, Puffy-faced, Protruding umbilicus, Protuberant tongue, Poor brain development.

21
Q

Subacute thyroiditis de Quervain

A

After viral flu infection. Transient hyperthyroid first.
Granulomatous inflammation. Increased ESR, jaw pain, early inflammation, TENDER. HLA-B35

22
Q

Reidel thyroiditis

A

Thyroid replaced by fibrous tissue that can extend into local structures–like anaplastic carcinoma!
IgG4-related systemic disease (autoimmune pancreatitis, retoperitoneal fibrosis)
Hard rock like painless goiter

23
Q

Graves

A

IgG stimulate TSH receptors, retro-orbital fibroblasts, and dermal fibroblasts. Can present during stress (childbirth).
HLA-DR3 and HLA-B8
Scalloped colloids
Tx = b-blocker, thiomide, radioiodine ablation

24
Q

Toxic multinodular goiter

A

Focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation on TSH receptor. Increases release of T3/T4. Hot nodules rarely malignant!

25
Q

Thyroid storm (surgery or shock)

A

Stress-induced catecholamine surge is a serious complication of thyrotoxicosis due to disease and other hyperthyroid d/o. Presents with agitation, delirium, fever, diarrhea, coma, tachyarrhythmia (cause of death).
Increase ALP (increased bone turover).
Tx = 3Ps = propranolol, PTU, prenisolone

26
Q

Jod-basedow phenomenon

A

Thyrotoxicosis if patient with iodine deficiency goiter is made iodine replete.

27
Q

Papillary carinoma

A

Orphan annie (empty appearing nuclei with central clearing), psammoma bodies, nuclear grooves. Lymphatic invasion. Increased risk with RET and BRAF, childhood radiation.

28
Q

Follicular carcinoma

A

RAS, invades thyroid capsule, uniform follicles, vascular spread!!!

29
Q

Medullary carcinoma

A

RET, from parafollicular C cells, makes calcitonin, sheets of cells in amyloid stroma. MEN2A and 2B. Screen for pheo!!!

30
Q

Undifferentiated/anaplastic carcinoma

A

Older patients, invade local structure, very poor prognosis. Dysphagia, respiratory compromise, poor prognosis.
P53

31
Q

Pseudohypoparathyroidism

A

Albright hereditary osteodystrophy: unresponsiveness of kidney to PTH.
Hypocalcemia, shortened 4-5th digits, short stature. AD. Defect in Gs.

32
Q

Familial hypocalciuric hypercalcemia

A

Defective Ca sensing receptor on PTH cells. PTH can’t be suppressed! Mild hypercalcemia with normal to increased PTH levels.
Asx, modest, lifelong

33
Q

DI treatment

A
  1. Central: desmopressin, hydration
  2. Nephrogenic: HCTZ, indomethacin (NSAIDs block renal PGs), amiloride, hydration
    Remember–DM lacks insulin like DI lacks ADH!
34
Q

Glucogonoma

A

Pancreatic a cell tumor.
D’s: dermatitis (necrolytic migratory erythema), diabetes (hyperglycemia), DVT, depression

35
Q

Isulinoma

A

Whipple triad: low BG, sx of hypoglycemia (lethargy, syncope, diplopia), resolution of sx after glucose normalized.
*Low BG and high C-peptide.
Surgical resection.

36
Q

Carcinoid syndrome

A

Neuroendocrine cells (chromogranin+) (often mets small bowel tumor)
Secrete 5HT. Not seen if limited to GI (liver metabolizes).
Recurrent diarrhea, cutaneous flushing, asthmatic wheezing, R-sided valvular disease. 5HIAA in urine, niacin deficiency (pellagra).
BFDR = bronchospasm, flushing, diarrhea, R-sided HF/murmur

37
Q

Zollinger-Ellison

A

Gastrinoma of pancreas or duodenum. Recurrent ulcers in duodenum/jejunum.
+ secretin stimulation test.
MEN1
Increased parietal cells, decreased G cells in stomach.

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