AAW - Endo/Repro Flashcards
carcinoid syndrome
Rare syndrome caused by carcinoid tumors
(neuroendocrine cells), especially metastatic
small bowel tumors, which secrete high levels
of serotonin (5-HT). Not seen if tumor is
limited to GI tract (5-HT undergoes first-pass
metabolism in liver). Results in recurrent
diarrhea, cutaneous flushing, asthmatic
wheezing, and right-sided valvular disease.
increased 5-hydroxyindoleacetic acid (5-HIAA) in
urine, niacin deficiency (pellagra).
Treatment: resection, somatostatin analog (e.g.,
octreotide).
Every now and then, I get really flushed for about 5 minutes and then it goes away and I don’t know what it is!
think carcinoid syndrome
carcinoid tumors now called neuroendocrine tumors i guess
diagnostic test for carcinoid syndrome
5-hydroxyindolacetic acid in urine
salt and pepper chromatic pattern with oval nucleus
neuroendocrine tumor
Adrenal hemorrhage, hypotension, DIC
what syndrome
what bacteria
waterhouse-friederichsen syndrome
Acute 1° adrenal insufficiency due to adrenal hemorrhage associated with Neisseria meningitidis
septicemia, DIC, and endotoxic shock.
exophthalmos, weight loss, palpitations
what is it
how do you diagnose
graves disease - type II hypersensitivity
Most common cause of hyperthyroidism. Autoantibodies (IgG) stimulate TSH receptors on thyroid
(hyperthyroidism, diffuse goiter), retro-orbital fibroblasts (exophthalmos: proptosis, extraocular
muscle swelling B ), and dermal fibroblasts (pretibial myxedema). Often presents during stress
(e.g., childbirth).
ELIZA to look for those antibodies
cervical dysplasia and cacinoma in sity assc with what virus
what are the genetic effects of the virus
HPV 16 and 18, which produce both the E6 gene product
(inhibits p53 suppressor gene) and E7 gene
product (inhibits RB suppressor gene)
p53 normally recruits bax, which knocks out BCL-2 (the molecule that normally stabilizes the mitochondrial membrane) - if mit memb is bad, cytochrome C leaks out and the cell dies
destruction of Rb stops its inhibition of E2F, which moves cells into S phase
all hormones produced by the anterior pituitary (adenohypophysis)
FLAT PiG:
FSH LH ACTH TSH ProlactIn GH
bromocriptine
dopamine agonist
can be used to treat prolactinomas
octreotide
long acting somatostatin analog
treats acromegaly, glucagonoma, somatostatinoma (counter intuitive, but its for sx control), carcinoid syndrome, gastrinoma, esophageal varicies
pegvisomant
GH receptor antagonist
makes you short as a peg
main prolactin inhibitory factor
Tx for prolactinoma
Dopamine acting on D2 receptors
dopamine agonists (bromocriptine or cabergoline) are the Tx for prolactin secreting tumors
function of thyroid peroxidase what blocks it (used for what purpose? SE?)
oxidizes iodide to iodine in the thyroid, which eventually iodinates thyroglobulin tyrosine residues
propylthiouracil, methimazole block it (used for hyperthyroidism (PTU blocks Peripheral conversion (iodinase I), used in Pregnancy (otherwise methimazole is preferred))
SE skin rash, agranulocytosis (rare), aplastic anemia, hepatotox (PTU). Methimazole is a possible teratogen
HLA subtype for hashimoto
autoantibodies for it
increased risk of what cancer
histologic finding
btw, it is the most common cause of hypothyroidism in iodine-sufficient regions
DR5
“i got 5 on it” DR5 because self-medication
(on the hash)
Antimicrosomal, antithyroglobulin, anti-thyroid peroxidase
increased risk of non-hodgkin lymphoma
find Hurthle cells, lymphoid aggregates with germinal centers
Jod-Basedow phenomenon
thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
propylthiouracil
antithyroid
used in thyrotoxicosis, graves disease
tx for thyroid storm
three Ps
beta-blockers (Propanolol), Propylthiouracil, corticosteroids (Prednisone)
methimazole
used to treat thyroid hormone hypersecretion due to Graves’ disease or thyroid storm
inhibit thyroid peroxidase
mifepristone
competitive inhibitor of progestins at progesterone receptors. “morning after pill”
Wolff-Chaikoff
excess iodine temporarily inhibits thyroid peroxidase, get decreased iodine organification, decreased T3/4 production
hashimotos antibodies
antithyroid peroxidase (antimicrosomal), antithyroglobulin antibodies
graves antibodies
anti-TSH receptor (it actually stimulates the receptors)
hurthle cells
hashimotos
lymphoid aggregate with germinal centers in the thyroid
HLA type in hashimotos
HLA-DR5