endo

Question 1

increased cortisol, decreased ACTH and B/L adrenal atrophy?

Answer 1

exogenous steroid use –> Cushing syndrome

Question 2

increased cortisol, decreased ACTH, unilateral adrenal atrophy?

Answer 2

1ary adrenal adenoma, hyperplasia, or carcinoma

** can also present with pseudohyperaldo

Question 3

increased cortisol, increased ACTH, B/L adrenal hyperplasia?

Answer 3

ACTH-secreting adenoma = Cushing disease

or ectopic ACTH - e.g. paraneoplastic

Question 4

diagnostic method for hypercortisolism?

Answer 4

1) serum ACTH - if low, adrenal tumor –> MRI
2) if high –> high dose dex suppression and CRH stim tests

• • adequate dex suppression and increase in ACTH/cortisol with CRH –> Cushing disease
• • no suppression and no change in ACTH/cortisol with CRH –> ectopic ACTH

Question 5

weakness, fatigue, orthostasis, muscle aches, weight loss, GI disturbances, sugar/salt cravings?

Answer 5

adrenal insufficiency

Question 6

dx of adrenal insufficiency?

Answer 6

serum electrolytes, serum cortisol and ACHT, ACTH stim test

** metyrapone stim test (blocks 11deoxycortisol –> cortisol) - normal response = decreased cortisol and increased ACTH; if ACTH remains low then dx = adrenal insuff

Question 7

hypotension, hyperkalemia, metabolic acidosis, skin and mucosal hyperpigmentation?

Answer 7

primary adrenal insufficiency
(MCC in West = autoimmune)

** hyperpigmentation 2/2 MSH = byproduct of increased ACTH production

Question 8

Waterhouse Friedrichsen?

Answer 8

acute 1ary adrenal insufficiency from adrenal hemorrhage

2/2 septicemia (usually N meningitidis), DIC, endotoxic shock

Question 9

adrenal insufficiency w/o hyperpigmentation or hyperkalemia?

Answer 9

secondary adrenal insufficiency
from decreased pituitary ACTH secretion
aldosterone preserved

Question 10

kid with abdominal distension and firm irregular mass that crosses midline?

Answer 10

neuroblastoma - adrenal medulla (from neural crest cells)
HVA and MVA in urine
bombesin and neuron specific enolase +
overexpression of N-myc oncogene

** Homer-Wright rosettes on biopsy

Question 11

dancing eyes, dancing feet?

Answer 11

opsoclonus-myoclonus

seen in neuroblastoma

Question 12

rule of 10s in pheo?

Answer 12

10% malignant
10% B/L
10% extra adrenal
10% calcify
10% kids

Question 13

what cells do pheos come from?

Answer 13

chromaffin cells - neural crest origin

Question 14

changes in cholesterol in thyroid dz?

Answer 14

hypothyroid –> increased cholesterol 2/2 decreased LDL receptor expression
hyperthyroid –> decreased cholesterol 2/2 increased LDL receptor expression

Question 15

thyroid biopsy: Hurthle cells, lymphoid aggregate with germinal centers?

Answer 15

Hashimoto
HLA DR5 assoc
thyroid non-tender

** increased risk of NHL

Question 16

pot bellied baby with pale skin, puffy face, protruding umbilicus and tongue?

Answer 16

congenital hypothyroidism = cretinism

2/2 maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis, iodine deficiency, dyshormogenetic goiter
MCC in US = thyroid dysgenesis

Question 17

tender thyroid, jaw pain following flu-like illness?

Answer 17

subacute thyroiditis = de Quervain
increased ESR

** biopsy: granulomatous inflammation

Question 18

fixed, rock hard, painless goiter?

Answer 18

Riedel thyroiditis
replacement of thyroid by fibrous tissue; may extend to local structures

** 2/2 IgG4-related dz - e.g. autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis

Question 19

Wolff-Chaikoff effect?

Answer 19

downregulation of thyroid gland in response to increased iodide

Question 20

pathogenesis of toxic multinodular goiter?

Answer 20

mutation of TSH receptor –> hyperfunctioning follicular cells

Question 21

cause of death in thyroid storm?

Answer 21

tachyarrhythmia

Question 22

tx of thyroid storm?

Answer 22

BBs
PTU
steroids

Question 23

Jod Basedow phenomenon?

Answer 23

thyrotoxicosis following iodine repletion in pt with iodine-deficiency goiter

Question 24

thyroid biopsy: Orphan Annie eyes, psammoma bodies, nuclear grooves?

Answer 24

papillary thyroid carcinoma - MC, good prog
increased risk with RET and BRAF mutations, hx of childhood irradiation

** lymphatic invasion common

Question 25

thyroid biopsy: uniform follicles, thyroid capsule invasion?

Answer 25

follicular carcinoma | good prognosis

Question 26

thyroid biopsy: sheets of cells in amyloid stroma?

Answer 26

medullary carcinoma - from parafollicular "C cells" assoc with MEN2A and 2B produces calcitonin ** hematogenous spread common

Question 27

thyroid cancer in older patients?

Answer 27

undifferentiated/anaplastic ** invades local structures

Question 28

hypocalcemia, shortened 4th/5th digits, short stature?

Answer 28

pseudohypoparathyroidism = Albright hereditary osteodystrophy AD kidney unresponsive to PTH

Question 29

familial hypocalciuric hypercalcemia?

Answer 29

defective Ca-sensing rcptr on parathyroid cells | --> mild hypercalcemia, normal to increased PTH levels

Question 30

MCC of 1ary hyperparathyroidism?

Answer 30

parathyroid adenoma or hyperplasia

Question 31

findings in 1ary hyperparathyroidism?

Answer 31

``` hyperCa hypercalciuria --> stones hypoPh increased PTH increased ALP increased cAMP in urine ```

Question 32

findings in 2ary hyperparathyroidism?

Answer 32

hypoCa hyperPh increased PTH increased ALP

Question 33

cancer risk in acromegaly?

Answer 33

increased risk of colorectal polyps/cancer

Question 34

MCC of death in acromegaly?

Answer 34

HF

Question 35

causes of nephrogenic DI?

Answer 35

hereditary - ADH receptor mutation hypercalcemia lithium demeclocycline (ADH antag)

Question 36

tx of central DI?

Answer 36

intranasal desmopressin acetate

Question 37

tx of nephrogenic DI?

Answer 37

HCTZ indomethacin amiloride

Question 38

causes of SIADH?

Answer 38

paraneoplastic - SCLC CNS/trauma pulmonary disease cyclophosphamide

Question 39

tx of SIADH?

Answer 39

``` fluid restriction IV hypertonic saline (be caaaaareful!) ADH antag (conivaptan, tolvaptan, demeclocyline) ```

Question 40

empty sella syndrome?

Answer 40

atrophy or compression of pituitary | common in obese women

Question 41

MCC of death in diabetes?

Answer 41

MI

Question 42

DM1 vs DM2: genetic predisposition?

Answer 42

DM1 - weaker | DM2 - stronger

Question 43

why don't type 2 DM pts usually get DKA?

Answer 43

endogenous insulin usually prevents lipolysis

Question 44

dermatitis, hyperglycemia, DVTs, depression?

Answer 44

glucagonoma | - necrolytic migratory erythema

Question 45

recurrent diarrhea, cutaneous flushing, asthmatic wheezing?

Answer 45

carcinoid syndrome - MC malignancy in SI only get sx if mets - if in GI tract, 5HT metabolized in liver dx: 5HIAA in urine, niacin deficiency ** causes R sided valvular heart disease

Question 46

MEN 1?

Answer 46

MEN1 mutation - menin = tumor suppressor parathyroid tumors pituitary tumors pancreatic endocrine tumors (Zollinger Ellison, insulinoma, VIPoma, glucagonoma)

Question 47

MEN 2A?

Answer 47

RET mutation (tyr kinase) parathyroid hyperplasia pheo medullary thyroid carcinoma

Question 48

MEN 2B?

Answer 48

RET mutation (tyr kinase) pheo medullary thyroid carcinoma marfanoid habitus mucosal neuromas - oral/intestinal