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Flashcards in Pathoma Review Deck (42)
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1

Cushing Disease at it's most basic is

Excess Cortisol

2

What are the Clinical FIndings of Cushings disease and how do they relate to the physiology of Cortisol

- Muscle Weakness: Cortisol breaks down proteins to be used in gluconeogenesis. Remember, it is catabolic and its main goal is to keep glucose in the blood to keep you alive. It will do anything to make sure this happens.
- Moon Fascies, Buffalo Hump, Truncal Obesity: This is due to the relocation of fat. As blood glucose increases, so does insulin. Insulin increases fat storage
- Abdominal Striae: Cortisol inhibits Collagen synthesis, you get thin skin
- Hypertension: Cortisol has a direct effect on vasoconstriction by upregulating Alpha 2 receptors
-Osteoporosis
- Inmmune suppression: Three methods 1) Inhibit phospholipase A2 which means you get no arachidonic acid metabolites which make prostaglandin 2) Inhibit IL-2 3) Inhibit Histamine Release

MMAHOI

3

Causes of Cushings

1) corticosteroids: These basically are cortisol. ACTH will be low, therefore both adrenals will hypertrophy
2) Adrenal adenoma, carcinoma or hyperplasia: ACTH will be low. Uninvolved gland will atrophy
3) Pituitary adenoma: ACTH will be high. HIGH DOSE DEXAMETHASONE WILL SUPPRESS IT.
4) Paraneoplastic ACTH secretion
HIGH DOSE DEX WON"T TOUCH IT

4

Hyperaldosteronism presentation

Hypernatremia (actually it is usually normal because the ADH increases water reabsorption so sodium concentration doesn't get too far out of whack)
Hypokalemia
Metabolic acidosis_ loss of H

Will also see hypertension due to plasma volume increase

5

Primary hyperaldosteronism will have LOW RENIN

Usually caused by adrenal adenoma

6

Secondary hyperaldosteronism will show HIGH RENIN

This is most likely due to volume loss or CHF

7

Congenital adrenal hyperplasia

EXCESS SEX steroids

8

Most common cause of congenital adrenal hyperplasia is:

deficiency in 21-hydroxylase. This is the enzyme needed to convert Pregnenolone to Mineralocorticoid and Glucocorticoid. WHen its gone, everything is shunted into sex steroids

9

Why do you get congenital adrenal hyperplasia?

Because without cortisol being made, ACTH secretion skyrockets and we know that whenever ACTH touches the Adrenals, they grow.

10

Clinical features of congenital adrenal hyperplasia?

- Lack of ADH = no salt, high k, hypotension
- Life threatening hypotension due to lack of cortisol
- Precocious puberty in males, clitoral enlargement in females.

11

Acute lack of adrenal hormones

Waterhouse Friedrichsen syndrome

12

What happens in WFS?

Necrosis of the adrenal glands due to DIC.

13

What causes WFS?

N. Meningitidis usually

14

What is the cause of death in WFS

Hypotension----NO CORTISOL

15

What is Addison's disease

Chronic insufficiency of the Adrenal glands

16

Most common cause of Addison's in the US

Autoimmune

17

Most common cause of addison's in the developing wor;d

TB

18

What color are tumors of the Adrenal Medulla

Brown.....you will see a yellow capsule surrounding a tumor in the adrenal medulla and that is the cortex. Yellow because of Cortisol

19

mulitnodulat goiter is generally caused by

Iodine deficiency

20

Are multinodular goiters usually toxic? Toxic meaning they secrete Thyroid hormone without TSH stimulation

No. Usually Euthyroid (non-toxic). Rarely they become TSH independent leading to hyperthyroidism. These are called toxic goiters

21

What is the cause of the pre-tibial myxedema and exopthalmos in Graves Disease?

Fibroblasts behind the orbit and overlying the shin express TSH receptors. When stimulated they produce glycosaminoglycans which leads to inflammation and edema. The edema is non-pitting, very dough like because there isn't much water in it/

22

What is Cretinism?

Hypothyroidism in neonates and infants

23

Cretinism is cahracterized by

mental retardation, short stature, enlarged tongue, umbilical hernia

24

Hyporthyroidism in adults

Myxedema

25

Hyporthyroidism in kids

Cretinism

26

What are the clinical features of Myxedema due to

Decrease in Basal Metabolic Rate and decreases SNS activity

27

Clinical signs and symptoms of myxedema

1) myxedema- glycosaminoglycan buildup resulting in deep voice and large
2) Weight gain
3) slowing of mental activity
4) muscle weakness
5) cold intolerance
6) bradycardia
7) hypercholesterolemia
8) constipation

28

Hyperthyroidism at the beginning of hashimotos

follicle damage

29

Type 1 diabetes is an autoimmune disease associated with what?

T cell mediated destruction of beta cells

30

Which HLA types of Type 1 associated with

HLA-DR3 and HLA-DR4