Endo IV Flashcards by Matt Stanton

graves disease

MCC hyperthyroid

antoAbs - IgG - stimulate TSH receptor

diffuse goiter, retroorbital fibroblasts (exophthalmos)

dermal fibroblasts - pretibial myxedema

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toxic multinodular goiter

patch hyperfunctioning follicular cells
-work independent of TSH - mutation in receptor

hot nodule - rarely malignant

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thyroid storm

stress induced catecholamine surge

agitation, delirium, diarrhea, coma, tachyarrhythmia

tx - beta block, PTU, corticosteroids

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jod basedow phenomenon

thyrotoxicosis if pt with iodine deficiency goiter is made iodine replete

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thyroidectomy compliactions

hoarse - recurrent laryngeal n

hyperCa - PTH damage

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papillary carcinoma of thyroid

MC - excellent prognosis

orphan annie nuclei
psammoma bodies
nuclear grooves
lymph invasion

increased with RET and BRAF or child radiation

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psammoma bodies

papillary carcinoma of thyroid
papillary carcinoma of ovary
mesothelioma
meningioma

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lymphoma

with hashimoto thyroiditis

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anaplastic carcinoma of thyroid

undifferentiated
invasive
poor prognosis
older pts

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follicular carcinoma of thyroid

good prognosis

uniform follicles

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medullary carcinoma of thyroid

from parafollicular C cells
-produce calcitonin

sheets cells in of amyloid stroma

heme spread common

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association of medullary carcinoma of thyroid

MEN 2A and 2B - RET mutations

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chvostek sign

tap face - twitch

with hypoCa

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troussea sign

occlude brachial artery
-get twitch

hypoCa

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pseudohypoparathyroidism

albright hereditary osteodystrophy
-unresponse kidney to PTH

hypoCa

short 4/5 digits and short stature

auto dom

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familial hypocalciuric hypercalcemia

defective Ca sensing - parathyroid cells
-PTH cannot be suppressed

mild hyperCa with normal PTH levels

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secondary hyperPTH

D deficiency
renal railure

low Ca and high PTH

PTH independent hyperCa

high Ca

low PTH

primary hyperPTH

parathyroid adenoma or hyperplasia - MC

hyperCa, hypercalciuria (stones), hypoP, increased PTH

stones, bones, groans, psych overtones

stones - hypercalciuria
bone - cystic bone space - brown tumor
groans - weak and constipation
psych overtones - depresion

osteoitis fibrosa cystica

cystic bone space with brown fibrous tissue
-brown tumor

deposited hemosiderin from hemorrhage

with primary hyperPTH

secondary hyperPTH

decreased Ca absorption or increased P

chronic renal disease - low vit D

hypoCa and hyperP in renal failure

renal osteodystrophy

bone lesions
-with secondary or tertiary hyperPTH

due in turn to renal failure

tertiary hyperPTH

refractory hyperPTH
-chronic renal disease

increased PTH and Ca

acromegally

MCC - pituitary adenoma

increased serum IGF-1 - diagnosis

also - fail to suppress serum GH with oral glucose tolerance

pituitary mass on MRI

tx of acromegaly

resection tx - octreotide - somatostatin analog -or pegvisomant - GH receptor antagonist

pegvisomant

GH receptor antagonist

central DI

low ADH high serum osmolarity hyperosmotic volume contraction water deprivation test - greater than 50% increase in urine osmolarity with desmopressin

nephrogenic DI

normal ADH high serum osmolality hyperosmotic volume contraction water deprivation test - no response to desmopressin

causes of SIADH

ectopic ADH - small cel lunng CNS disorder - head trauma pulmonary disease drug - cyclophosphamide

conivaptan

vasopressin antagonist

craniopharyngioma

unsecreting pituitary adenoma

sheehan syndrome

ischemic infarct of pituitary after postpartum bleeding - hypotension

empty sella syndrome

atrophy/compression of pituitary | obese women

pituitary apoplexy

hemorrhage of pituitary gland - existing pituitary adenoma

tx hypopituitarism

hormone replacement therapy | -corticosteroids, T4, sex steroids, GH

DKA

DM I

hyperosmolar coma

DM II

diabetes complications

non-enzymatic glycosylation -small vessel disease kimmelstein wilson nodules - nodular glomerulosclerosis

kimmelstein wilson nodules

non-enzymatic glycosylation - nodular glomerulosclerosis of kidney in diabetes (hyperglycemia)

sorbitol and diabetes

- from hyperglycemia - accumulate in organs with aldose reductase and low sorbitol DH osmotic damage - cataract and neuropathy