endo Flashcards
increased cortisol, decreased ACTH and B/L adrenal atrophy?
exogenous steroid use –> Cushing syndrome
increased cortisol, decreased ACTH, unilateral adrenal atrophy?
1ary adrenal adenoma, hyperplasia, or carcinoma
** can also present with pseudohyperaldo
increased cortisol, increased ACTH, B/L adrenal hyperplasia?
ACTH-secreting adenoma = Cushing disease
or ectopic ACTH - e.g. paraneoplastic
diagnostic method for hypercortisolism?
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
weakness, fatigue, orthostasis, muscle aches, weight loss, GI disturbances, sugar/salt cravings?
adrenal insufficiency
dx of adrenal insufficiency?
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
hypotension, hyperkalemia, metabolic acidosis, skin and mucosal hyperpigmentation?
primary adrenal insufficiency
(MCC in West = autoimmune)
** hyperpigmentation 2/2 MSH = byproduct of increased ACTH production
Waterhouse Friedrichsen?
acute 1ary adrenal insufficiency from adrenal hemorrhage
2/2 septicemia (usually N meningitidis), DIC, endotoxic shock
adrenal insufficiency w/o hyperpigmentation or hyperkalemia?
secondary adrenal insufficiency
from decreased pituitary ACTH secretion
aldosterone preserved
kid with abdominal distension and firm irregular mass that crosses midline?
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
dancing eyes, dancing feet?
opsoclonus-myoclonus
seen in neuroblastoma
rule of 10s in pheo?
10% malignant 10% B/L 10% extra adrenal 10% calcify 10% kids
what cells do pheos come from?
chromaffin cells - neural crest origin
changes in cholesterol in thyroid dz?
hypothyroid –> increased cholesterol 2/2 decreased LDL receptor expression
hyperthyroid –> decreased cholesterol 2/2 increased LDL receptor expression
thyroid biopsy: Hurthle cells, lymphoid aggregate with germinal centers?
Hashimoto
HLA DR5 assoc
thyroid non-tender
** increased risk of NHL
pot bellied baby with pale skin, puffy face, protruding umbilicus and tongue?
congenital hypothyroidism = cretinism
2/2 maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis, iodine deficiency, dyshormogenetic goiter
MCC in US = thyroid dysgenesis
tender thyroid, jaw pain following flu-like illness?
subacute thyroiditis = de Quervain
increased ESR
** biopsy: granulomatous inflammation
fixed, rock hard, painless goiter?
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
Wolff-Chaikoff effect?
downregulation of thyroid gland in response to increased iodide
pathogenesis of toxic multinodular goiter?
mutation of TSH receptor –> hyperfunctioning follicular cells
cause of death in thyroid storm?
tachyarrhythmia
tx of thyroid storm?
BBs
PTU
steroids
Jod Basedow phenomenon?
thyrotoxicosis following iodine repletion in pt with iodine-deficiency goiter
thyroid biopsy: Orphan Annie eyes, psammoma bodies, nuclear grooves?
papillary thyroid carcinoma - MC, good prog
increased risk with RET and BRAF mutations, hx of childhood irradiation
** lymphatic invasion common
thyroid biopsy: uniform follicles, thyroid capsule invasion?
follicular carcinoma
good prognosis
thyroid biopsy: sheets of cells in amyloid stroma?
medullary carcinoma - from parafollicular “C cells”
assoc with MEN2A and 2B
produces calcitonin
** hematogenous spread common
thyroid cancer in older patients?
undifferentiated/anaplastic
** invades local structures
hypocalcemia, shortened 4th/5th digits, short stature?
pseudohypoparathyroidism = Albright hereditary osteodystrophy
AD
kidney unresponsive to PTH
familial hypocalciuric hypercalcemia?
defective Ca-sensing rcptr on parathyroid cells
–> mild hypercalcemia, normal to increased PTH levels
MCC of 1ary hyperparathyroidism?
parathyroid adenoma or hyperplasia
findings in 1ary hyperparathyroidism?
hyperCa hypercalciuria --> stones hypoPh increased PTH increased ALP increased cAMP in urine
findings in 2ary hyperparathyroidism?
hypoCa
hyperPh
increased PTH
increased ALP
cancer risk in acromegaly?
increased risk of colorectal polyps/cancer
MCC of death in acromegaly?
HF
causes of nephrogenic DI?
hereditary - ADH receptor mutation
hypercalcemia
lithium
demeclocycline (ADH antag)
tx of central DI?
intranasal desmopressin acetate
tx of nephrogenic DI?
HCTZ
indomethacin
amiloride
causes of SIADH?
paraneoplastic - SCLC
CNS/trauma
pulmonary disease
cyclophosphamide
tx of SIADH?
fluid restriction IV hypertonic saline (be caaaaareful!) ADH antag (conivaptan, tolvaptan, demeclocyline)
empty sella syndrome?
atrophy or compression of pituitary
common in obese women
MCC of death in diabetes?
MI
DM1 vs DM2: genetic predisposition?
DM1 - weaker
DM2 - stronger
why don’t type 2 DM pts usually get DKA?
endogenous insulin usually prevents lipolysis
dermatitis, hyperglycemia, DVTs, depression?
glucagonoma
- necrolytic migratory erythema
recurrent diarrhea, cutaneous flushing, asthmatic wheezing?
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
MEN 1?
MEN1 mutation - menin = tumor suppressor
parathyroid tumors
pituitary tumors
pancreatic endocrine tumors (Zollinger Ellison, insulinoma, VIPoma, glucagonoma)
MEN 2A?
RET mutation (tyr kinase)
parathyroid hyperplasia
pheo
medullary thyroid carcinoma
MEN 2B?
RET mutation (tyr kinase)
pheo
medullary thyroid carcinoma
marfanoid habitus
mucosal neuromas - oral/intestinal
