Endo

Question 1

30% of all pituitary adenomas

Females = Amenorrhea, galactorrhea, infertility
Males = vague sxs (decreased libido)

What is it? Tx?

Answer 1

Lactotropic adenoma (prolactinoma)

Tx = Bromocriptine (surgery for large tumors/failed pharm)

(smaller than 10mm = microadenoma)

Question 2

Somatotropic adenoma (growth hormone)… Has two different presentations based off puberty. what are they?

Tx = surgical excision, BONE CHANGES ARE PERMANENT

Answer 2

pre puberty = Gigantism (growth of long bones = ~8ft tall)

Post puberty = acromegaly (growth of hands/feet/face/jaw)

Question 3

Complication of post puberty somatotropic adenomas?

Answer 3

Internal organ enlargemetn… cardoresp comps may cause death

Question 4

Cushing from over stimulation of adnreal cortex results from?

Answer 4

Corticotropic adenoma (ACTH)

Question 5

Causes of hypopituitarism?

which is rare, btw

Answer 5

Congenital (primary empty sella syndrome, dwarfism, hypogonadism)

Tumors (decreases circulation/destroys pituitary gland)

Circulatory disturabances (Sheehan’s syndrome)

Trauma (head injury/trauma)

Question 6

Postpartum ischemia

Massive hemorrhage/HOTN from childbirth

(Similar process to acute renal tubule necrosis)

Answer 6

Sheehan syndrome

can cause hypopituitarism

Question 7

COLD INTOLERANCE

HOTN

General weakness

Poor appetite

Answer 7

SSx of hypopituitarism

Cold intolerance/HOTN being the key dffierentiator

Question 8

Damage to hypothalamus, pituitary stalk, tumors, trauma

-> insufficient ADH

Ssx?

Answer 8

Diabetes inspidus

Polyuria
Polydipsia
BUT NO polyphagia

(Water restriction does not affect urine output)

Tx = vasopressin

Question 9

Most common cause of hyperthyroidism?

Clinical features/

Answer 9

Graves Dz (autoimmune)

Ssx appear slowly

Restlessness/nervousness
Tremors/excessive sweating
Heart palpitation
*High t3/t4
*LOW TSH

Tx = I131, surgical excision

Question 10

Typical Graves dz pt?

Characterized by?

Answer 10

20-40 y/o woman

Thyrotoxicosis
Exophthalmos
Dermopathy - pretibial myxedema - dough like skin that doesn’t pit (<4%)

Question 11

Most common hypothyroidism

Answer 11

Hashimoto’s

Autimmune dz associated with other dz (Sjogrens)

Females are 10x more likely

Question 12

Other less common forms of hypothyroidism

Answer 12

Thyroidectomy

Iodine deficiency (rare… cretinism/goiter)

Question 13

Features of hypothyroidism

Answer 13

SLOWING OF ALL METABOLIC PROCESSES

Low T3/T4 (HIGH TSH)

Sleepiness/cold sensitivity/constipation/ wt gain

TX = synthetic thyroid supps

Question 14

Iodine deficiency presents with?

Must r/o cancer when seeing this sign

Answer 14

Nodular goiter

Hypothyroid symptoms

Normal to low thyroid hormones (HIGH TSH)

Tx = incomplete thyroidectomy

Question 15

Common benign tumor usually presenting as solitary nodule

Can’t be differentiated from normal tissue on I123 scan
Diagnosis by biopsy

Answer 15

Follicular adenoma

Question 16

Most common malignant thyroid nodule

Inactive

Does not take up I123 on scan (“cold nodule”)

Biopsy -> partial/total thyroidectomy

Answer 16

Papillary thyroid carcinoma

Question 17

15% of malignant thyroid tumors

Hot nodule (seen on I123 scan)

Susceptible to I131 ablation

Answer 17

Follicular thyroid carcinoma

Question 18

Increased secretion of PTH

Most commonly from?

Answer 18

Hyperparathyrdiism usually from benign parathyroid adenoma

(usually asymptomatic; however severe cases may lead to pathological fxs of bones/kidney stone formation)

Labs = high Ca, low PO

Question 19

Labs = low Ca, high PO

Muscle spasms/cramps

Chvostek’s sign (facial twitching from tapping)

Trousseau’s sign (wrist flex from BP cuff)

Answer 19

Hypoparathyroidism (rare)

Question 20

Hypercortisolism?

Causes?

Answer 20

Cushing’s
1. Pituitary adenoma = too much ACTH Cushing’s Dz (MC)

2. Adrenocortical tumor = too much corticosteroids = Cushing’s syndrome
3. Exogenous glucocorticoids = Prolonged tx of autoimmune d/o

Question 21

Central truncal obesity

Moon faces

BUffalo hump

Facial redness

Cutaneous striae

Facial hair/thinning/acne

Answer 21

Cushings

Question 22

Tx for Cushing’s?

Answer 22

Excision of tumor

Medical suppression of endocrine system

OR if due to exogenous steroids, taper/cease steroids

Question 23

Chronic adrenocortical inufficiency

Answer 23

Addison’s dz

Progressive destruction of adrenal cortex

Question 24

Slow insidious onset

Progressive weakness/fatigue

BRONZING hyperpigmentation (stimulated melanocytes)

Answer 24

Addison’s

Tx = life long corticosteroid supplements

Question 25

ACTH test administration should trigger corticosteroid release…
If no response, suspect?

Answer 25

Addison’s

Question 26

Catecholamine secretion tumor

Rare neoplasm of adrenal medulla

Strong familial association w/ MEN (multiple endocrine neoplasia)

Answer 26

Pheochromocytoma

Question 27

Classic triad =

HA
Diaphoresis
Tachycardia

Answer 27

Pheochromocytoma

ABRUPT onset of HTN

Question 28

Many people w/ pheochromocytoma don’t have classic triad. Other ssx?

Answer 28

Tachycardia, palpitations, tremor, apprehension

Question 29

What labs will be elevated in pheochromocytoma?

Answer 29

Epi/norepinephrine elevated

24-HOur Vanillylmandelic acid (VMA) test will be elevated

(VMA = epi/norepinephrine metabolite)

Question 30

Tx for pheochromocytoma?

Answer 30

Surgical resection (excellent prog)

Question 31

Developmental malignancy of neonates/children <5

Large abd tumor frequently found by parents

Elevated VMA urine test!

Answer 31

Neuroblastoma

tx = combo of surgery, rad, chemo

(Early detection = 90% cure)

Question 32

Cushing’s disease AKA….

3 most common causes?

Answer 32

… hyper cortisolism tied to ACTH

1. Pituitary adenoma- produce excess ACTH (70% of cases) = DISEASE
2. Adrenocortical tumor = excess corticosteroids = SYNDROME
3. Exogenous glucocorticoids- prolonged steroid tx of AI d/o