Ch 26: Endocrine Disorders

Question 1

Sheehan syndrome refers to hypopituitarism caused by….

It is characterized by….

Answer 1

….postpartum pituitary necrosis, usually following severe postpartum uterine hemorrhage.

…postpartum amenorrhea and inability to lactate.

Question 2

What 2 drugs are first-line treatment for hyperthyroidism (Grave’s disease)?

Answer 2

methimazole and propylthiouracil

Question 3

What are the essential of diagnosis for pheochromocytoma?

Answer 3

1. ) “Attacks” of headaches, perspiration, palpitations, anxiety. Multisystem crisis.
2. ) Hypertension, frequently sustained, but often paroyxsmal, especially during surgery or delivery.
3. ) Elevated urinary plasma free metanephrines. Normal serum T4 and TSH.
4. ) Frequent germline mutations.

Question 4

Both pheochromocytomas and non-head-neck paragangliomas are tumors of the…

Answer 4

….sympathetic nervous system.

Question 5

Paragangliomas are also called…

…arise from ___________ ___________, often metatastasize, and secrete norepinephrine OR are ____________.

Answer 5

….”extra-adrenal pheochromocytomas”….

sympathetic paraganglia

nonsecretory

Question 6

Pheochromocytomas and paragangliomas may be located…

Answer 6

…in either or both adrenals or anywhere along the sympathetic nervous chain, and sometimes in the mediastinum, heart, or bladder.

Question 7

What % of hypertension cases are caused by pheochromocytoma?

Answer 7

0.4%

Question 8

Pheochromocytomas account for about _% of adrenal incidentalomas.

Answer 8

4%

Question 9

The yearly incidence is _ to _ new cases per million population.

Answer 9

2 to 4

Question 10

Nonsecretory paragangliomas arise in the head or neck, particularly in the…

Answer 10

….carotid body, jugular-tympanic region, or vagal body.

Question 11

Pheochromocytomas develop in about 20% of patients with ___ ______-______ (___) disease type 2 (hemangiomas of the retina, cerebellum, brainstem, and spinal cord; hyperparathyroidism; pancreatic cysts; endolymphatic sac tumors; cystadenomas of the adnexa or epididymis; pancreatic neuroendocrine tumors; renal cysts, adenomas, and carcinomas).

Answer 11

von Hippel–Lindau (VHL)

Question 12

Pheochromocytomas that arise in patients with VHL secrete exclusively….

Answer 12

….norepinephrine and its metabolite normetanephrine.

Question 13

Multiple endocrine neoplasia (MEN) 2 is associated with…

Answer 13

…..pheochromocytomas, hyperparathyroidism, cutaneous lichen amyloidosis, and medullary thyroid carcinoma.

Question 14

Pheochromocytomas can be lethal unless they are diagnosed and treated appropriately. Catastrophic hypertensive crisis and fatal cardiac arrhythmias can occur spontaneously or may be triggered by…

Answer 14

…needle biopsy or manipulation of the mass, intravenous contrast dye or glucagon injection, vaginal delivery, trauma, anesthesia, or surgery (both unrelated to the tumor or for its removal).

Question 15

[pheochromocytomas]

________, bending, _______, or emotional stress can trigger paroxysms.

Answer 15

Exercise, lifting

Question 16

[pheochromocytomas]

What drugs can precipitate attacks?

Answer 16

fluoxetine and other SSRIs
monoamine oxidase inhibitors (MAOIs)
caffeine
nicotine
decongestants
amphetamines
cocaine
ionic intravenous contrast
epinephrine

Question 17

Bladder paragangliomas may present with paroxysms during….

Answer 17

…micturition.

Question 18

[pheochromocytomas]

List the symptoms of paroxysms in order of frequency of occurrence.

Answer 18

hypertension (90%)
severe headache (80%)
perspiration (70%)
palpitations (60%)
other symptoms may include anxiety (50%), and
a sense of impending doom, or tremor