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Classic Presentations > ENDO > Flashcards

ENDO Flashcards

1
Q

Prolactinoma

Comp?

A

COMP:

- Impingement of optic chiasm -> Bitemporal Hemianopia

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2
Q

NONFUNCTIONAL Pituitary Adenomas

Potential Pres (3)?

A

POTENTIAL PRES:

  • Hypopituitarism (due to compression of normal pituitary tis)
  • Bitemporal Hemianopsia (due to compression of optic chiasm)
  • Headache
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3
Q

Pituitary Adenomas

2 Variations, Comp?

A
  • Functional: Hormone-producing
  • Nonfunctional: Silent. Often produce mass effect.

COMP:
- Islet Cell tumor

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4
Q

Empty Sella Sx

Def’n, Mech (3 steps), Pres (Epi), Imaging?

A

Congenital defect of Sella Turcica.

MECH:
Defective Sella Turcica ->
Herniation of arachnoid + CSF into it ->
Compression / destruction / atrophy of Pituitary.

PRES: Obese Women

IMAGING: Pituitary ABSENT on imaging

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5
Q

Hypopituitarism

Causes (5)?

A

CAUSES:

    • Pituitary Adenoma / Craniopharyngioma
  • Empty Sella Sx
  • Sheehan Sx
  • Brain injury / hem
  • Radiation
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5
Q

Sheehan’s Sx

Def’n, Mech (2 steps), Pres (3)?

A

Postpartum Bleeding -> Hem / Ischemic INFARCT of Pituitary.

MECH:

  • Pituitary doubles in size during pregnancy, however its bl supply does NOT increase significantly.
  • Bl loss during labor -> Pituitary infarct

PRES:

  • Cold Intolerance + Fatigue
  • Absent menses
  • Failure to lactate
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6
Q

Diabetes Insipidus

Mech, Assoc,
Pres (2), Labs (Bl, Urine)?

A

MECH = Lack of ADH (Central) / Lack of response to ADH (Nephrogenic).
Loss of Free H2O

ASSOC:
- Hand-Schuller Christian Dz

PRES:

  • Intense thirst + Polyuria
  • Inability to concentrate urine

LABS:

  • HIGH Serum Osm > 290
  • LOW Urine Osm / Specific Gravity
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7
Q

Central DI

Mech, Causes (4), RX?

A

MECH = LACK of ADH.

CAUSES:

  • Surgery
  • Trauma
  • Histiocytosis X
  • Pituitary tumor

RX: Intranasal Desmopressin (ADH analog)

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8
Q

SIADH

Mech (3 steps), Causes (4), Pres / Labs, RX (2)?

A

MECH:
Excessive ADH secretion ->
Retention of Free H2O ->
↓Aldosterone (body’s response to maintain near-normal volume status).

CAUSES:

  • Small Cell Carcinoma of Lung (ectopic ADH)
  • Pulmonary dz
  • CNS disorders / trauma
  • Cyclophosphamide

PRES: Excessive water retention

  • Hyponatremia (due to↓Aldosterone)
    - > Low Serum Osm
    - > Neuronal swelling + Cerebral Edema

RX:

  • Water restriction
  • Demeclocycline
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8
Q

Nephrogenic DI

Mech, Causes (4), RX (3)?

A

MECH = Lack of renal RESPONSE to ADH.

CAUSES:

  • Hereditary
  • Hypercalcemia
  • Demeclocycline use (ADH antagonist)
  • Lithium use

RX:

  • Amiloride
  • Hydrochlorothiazide
  • Indomethacin
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9
Q

Neuroblastoma

Location, RF (Genetic), Pres, Urine?

A

Can occur anywhere along sympathetic chain.

RF:
- Overexpression of N-myc oncogene (assoc with rapid tumor prog)

PRES: LESS likely to devel Htn compared to Pheochromocytoma

URINE:
-↑HVA (b/d product of dopamine)

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10
Q

Pheochromocytoma

Seen In (4), Pres?

A

SEEN IN:

  • MEN 2
  • All Neurocutaneous Disorders EXCEPT Tuberous Sclerosis*
  • Sturge-Weber Sx
  • Neurofibromatosis Type 1
  • Von Hippel-Lindau Dz

PRES: Symptoms occur in spells- relapse and remit. Are result of catecholamine secretion by tumors.

  • Episodic Htn
  • Tachycardia + Palpitations
  • Sweating
  • Headache
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11
Q

21-hydroxylase Deficiency

Pres (2)?

A

PRES:

  • CONGENITAL adrenal hyperplasia
  • Hypotension
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12
Q

1ry Hyperaldosteronism

Pres (2), Labs (3)?

A

PRES: Uni- or bilateral

  • Htn (↑bl Na + H20 ->↑plasma volume)
  • Metabolic Alkalosis (↑H + K secretion)

LABS:

  • Renin↓(high B.P downregulates renin)
  • Aldosterone↑
  • Na + H2O↑
  • H + K ↓
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13
Q

2ry Hyperaldosteronism

Causes (3), Labs (2)?

A

CAUSES:

  • CHF
  • Renovascular Htn (Nephrotic Sx, Renal art Stenosis, Chronic RF)
  • Cirrhosis

LABS:

  • Renin↑
  • Aldosterone↑
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14
Q

Conn Sx

Pres (2)?

A

PRES:

  • Htn
  • Metabolic Alkalosis (-> Hypokalemia)
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15
Q

Cushing’s Sx

Pres (7), Labs (2), DX (2)?

A

PRES:
- “Moon facies, Truncal obesity, Buffalo hump”
(↑glucose -> ↑insulin -> ↑fat storage)
- Weight gain
- Htn
- Amenorrhea
- Immune suppression
- Skin thinning + striae (impaired collagen syn)
- Osteoporosis, thin extremities + muscle weakness (Cortisol b/d muscle for gluconeogenesis)

LABS:

  • Hyperglycemia
  • Eosinopenia

DX:

  • 24h Urine:↑Cortisol levels
  • Dexamethasone Suppression Test
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16
Q

Addison Disease

Mech, Causes (3), Pres (4: CLUE + 3), Labs (4)?

A

MECH:↑ACTH + MSH production

CAUSES:

  • Autoimmune dz MC in West
  • TB MC in developing world
  • Metastasis (from lung)

PRES: Deficiency of Aldosterone + Cortisol

  • Hypotension (hyponatremic vol contraction)
  • Acidosis (Aldosterone def ->↑H)
  • Fatigue, Vomiting + Diarrhea
  • “Skin hyperpigmentation” (Cortisol def ->↑ACTH -> ↑MSH)

LABS:

  • Aldosterone↓
  • Cortisol↓
  • Na↓
  • H + K↑
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17
Q

Waterhouse-Friderichsen Sx

Causes / Assoc (3)?

A

CAUSES / ASSOC:

  • Neisseria meningitidis septicemia (young children)
  • Endotoxic Shock and Hypotension
  • DIC
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18
Q

Hyperthyroidism

Mech (2), Causes (2)?

A

MECH:

  • ↑BMR (due to↑syn of Na/K ATPase)
  • ↑SNS activity (due to↑expression of b1-receptors)

CAUSES:

  • Struma Ovarii
  • Choriocarcinoma (male + female)
19
Q

Graves Dz

Pres (Epi + Envir + 3), Labs, Histo (2), Comp?

A

PRES: MC in women 20-40

  • Times of stress (ie childbirth)
  • Exophthalmos, Proptosis, Eyelid retraction / Sclera visible
  • Pretibial Myxedema
  • Diffuse Goiter (thyroid hyperplasia + hypertrophy)

LABS:
- ALP↑(due to↑bone turnover)

HISTO:

  • Irregular thyroid follicles
  • Chronic infl

COMP:
- Thyroid Storm

20
Q

Thyroid Storm

Def’n, Pres (4)?

A

Stress-induced CATECHOLAMINE surge leading to death by arrhythmia.

PRES:

  • Arrhythmia
  • Hyperthermia
  • Hypovolemic Shock
  • Vomiting
21
Q

Multinodular Goiter

Mech (4 steps), Causes (2), Comp?

  • Goiters usually non-toxic
  • Hot nodules rarely malignant
A 
MECH:
Mutation in TSH receptor ->
Patches of HYPERfunctioning follicular cells working INDEP of TSH ->
↑release of T3 + T4 ->
Hyperthyroidism.

CAUSES:

  • Iodine def
  • Mutation in TSH receptor

COMP:
- Jod-Basedow Phenomenon: THYROTOXICOSIS if patient with Iodine-def-goiter made Iodine-replete.

23
Q

Hashimoto’s Thyroiditis

HLA, Ab, Pres (2), Clinical Course, Micro Findings (2), Comp?

A

HLA-DR5.

Antimicrosomal Antithyroglobulin antibodies.

PRES:

  • Moderately enlarged NONTENDER thyroid
  • Myxedema

HYPERthyroidism early in course (thyrotoxicosis during follicular rupture) -> Progression to HYPOthyroidism.

FINDINGS:

  • Hurthle cells
  • Chronic infl / lymphocytic infiltrate with germinal centers

COMP:
- NHL

24
Q

Cretinism

Def’n, Pres (4)?

A

Hypothyroidism in neonates and infants.

PRES:

  • Pale, puffy-face, coarse facial features + enlarged tongue
  • Pot-belly with protruding umbilicus / umbilical hernia
  • Short stature + skeletal abnormalities
  • MR
  • Thyroid hormone req for CNS + skeletal devel *
24
Q

Sporadic Cretinism

Causes (3)?

A

CAUSES:

  • Devel failure in thyroid formation (ie from maternal hypothyroidism in early pregnancy)
  • ‘Dyshormonogenetic Goiter’ (congenital defect in T4 production)
  • Thyroid agenesis
25
Q

Subacute (de Quervain’s) Thyroiditis

Def’n, Pres (General + 1), Clinical Course, Labs?

A

Granulomatous thyroiditis.

PRES: Self-limited hypothyroidism following flu / virus.
- Tender thyroid + jaw pain

Can be HYPERthyroid early in course.

LABS:
- ESR ↑

26
Q

Riedel’s Thyroiditis

Def’n, Pres (2), Comp?

A

Chronic infl + extensive fibrosis of thyroid (ie thyroid replaced by fibrous tis).

PRES:

  • Painless goiter
  • Fixed, hard (“rock-like”) thyroid

COMP:
- Fibrosis may extend to nearby structures (ie airways)

27
Q

Thyroid Carcinoma (Papillary Carcinoma)

RF, Pres (2 General), Micro Findings (3), DX (2), Mets, Prognosis?

A

RF:
- Childhood irradiation

PRES:

  • MC as solitary and distinct nodule
  • MC benign

FINDINGS: Enlarged thyroid cells with:

  • “Ground-glass” / “Orphan Annie eyes” nuclei
  • Nuclear grooves
  • Psammoma bodies

DX:

  • I Radioactive Uptake studies (↑uptake = hot nodules,↓uptake = cold nodules)
  • Biopsy by Fine Needle Aspiration

METS: -> Cervical lymph nodes

PROG = Excellent!

28
Q

Anaplastic / Undifferentiated Thyroid Carcinoma

Pres (Epi + 2), Mets, Prognosis?

A

PRES: Older patients

  • Dysphagia
  • Resp compromise

METS: Often invades local structures

PROG = Very poor!

29
Q

Thyroid Lymphoma

Assoc?

A

ASSOC:

- Hashimoto’s Thyroiditis

30
Q

Medullary Thyroid Carcinoma

Def’n, Assoc, Pres, Micro Finding, Prevention?

A

Malignant prolif of parafollicular C cells.

ASSOC: (Familial cases)
- Men 2 (mutations in RET oncogene)

PRES: Calcitonin production (-> Hypocalcemia)

FINDING:
- Amyloid sheets (Calcitonin deposits)

PREV:
- Detection of RET oncogene -> Prophylactic Thyroidectomy

31
Q

Hypoparathyroidism

Causes (2), Pres (2), Phys Findings (2 Signs)?

A

CAUSES:

    • Accidental excision during thyroidectomy
  • Autoimmune destruction / DiGeorge Sx

PRES: Related to HYPOcalcemia

  • Numbness + Tingling
  • Tetany

PHYS FINDINGS:

  • Chvostek’s sign (facial muscles)
  • Trousseau’s sign (carpal)
32
Q

Pseudohypoparathyroidism = Albright’s Hereditary Osteodystrophy

Def’n, Inher, Pres (2)?

A

Kidney UNRESPONSIVENESS to PTH.

AD.

PRES: HYPOcalcemia

  • Short stature
  • Shortened 4th / 5th digits
33
Q

Hyperparathyroidism #1- CAUSES

1ry (3), 2ry, 3ry?

A

CAUSES:

  • 1ry: Hyperplasia, Adenomas, Carcinoma
  • 2ry: HYPOcalcemia of Chronic Kidney Disease / RF
  • 3ry: Chronic Kidney Disease / RF
34
Q

Hyperparathyroidism #2- PRES

1ry (“Stones (2 Renal), Bones and Groans”),
2ry / 3ry (Renal Osteodystrophy MECH (8 steps))?

A

PRES:
1ry:
- “Stones”: Nephrolithiasis (Ca Oxalate stones / Hypercalciuria) +
Nephrocalcinosis (metastatic calc of renal tubules)
- “Bone (pain)”: Osteitis Fibrosa Cystica (Bone resorption ->
fibrosis and cystic spaces)
- “Groans (constipation)”: Peptic Ulcer Dz

 2ry / 3ry: MECH:
 Renal dz / insufficiency -> ↓P excretion ->↑serum P binds free Ca
 ->↓free Ca -> Stim Parathyroids -> ↑PTH 
 -> Bone resorption -> Bone lesions.
36
Q

Hyperparathyroidism #3- LABS / URINE

1ry (incl Urine), 2ry, 3ry?

A

LABS / URINE:
1ry:
- Bl: Ca↑, P↓, ALP↑
- Urine: Ca↑, cAMP ↑

 2ry:
 - Bl: Ca↓, P↑, ALP↑

 3ry:
 - Bl: Ca↑     *** PTH VERY ↑***
37
Q

Parathyroid Hyperplasia (-> 1ry Hyperparathyroidism)

Comp?

A

COMP:

- Islet Cell tumor

38
Q

Chvostek Sign

Pres, Significance?

A

Facial muscle spasm upon tapping.

Significance = Hypocalcemia.

39
Q

Islet Cell Tumor

Assoc (3)?

A

ASSOC: Often a component of:

  • Pituitary Adenomas
  • Parathyroid Hyperplasia
  • Men I
40
Q

Insulinoma

Pres, Labs (3)?

A

PRES:
- Episodic Hypoglycemia with mental status changes, relieved by admin of glucose

LABS:
- Glucose

41
Q

Gastrinoma

Def’n / 2 Locations, Assoc (Potential), Pres?

A

Gastrin-secreting tumor of Pancreas or Duodenum.

ASSOC (Potential):
- Men I

PRES = Zollinger-Ellison Sx

42
Q

Somatostatinoma (Somatostatin-secreting tumor)

Pres, Labs?

A

PRES = Cholelithiasis + Steatorrhea (due to inhib of CCK)

LABS:
- HYPOchlorhydria (due to inhib of Gastrin / production of gastric acid)

43
Q

VIPoma (VIP-secreting tumor)

Mech, Pres, Labs (2)?

A

MECH:↑VIP ->↑intestinal secretions
-> smooth muscle RELAXATION in GI tract

PRES = Watery Diarrhea

LABS:

  • HYPOchlorhydria (due to inhib of Gastrin / production of gastric acid)
  • HYPOkalemia
44
Q

MEN 1 (Wermer’s Sx)

Pres (“3 Ps” Tumors + 2)?

A

PRES:

  • Pituitary tumors (GH or Prolactin)
  • Parathyroid tumors
  • Pancreatic tumors (ENDOCRINE: Z-E Sx, Insulinomas, VIPomas)
  • Stomach ulcers
  • Kidney stones
44
Q

MEN Sx

Inher, Genetics?

A

AD.

ret gene (MEN 2).

46
Q

MEN 2A (Sipple’s Sx)

Pres (2)?

A

PRES:

  • Thyroid AND Parathyroid tumors
  • Pheochromocytoma
47
Q

MEN 2B

Pres (3)?

A

PRES:

  • Medullary Thyroid Carcinoma (secretes Calcitonin)
  • Pheochromocytoma
  • Oral/Intestinal Ganglioneuromatosis
48
Q

McCune-Albright Sx

Path / Genetics, Pres (4: General + 3)?

A

G-protein signaling mutation.

```
PRES:
- Endocrine abnormalities -
- Precocious Puberty
- Cafe-au-Lait spots
- Polyostotic fibrous dysplasia
~~~

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