Endo IV Flashcards
graves disease
MCC hyperthyroid
antoAbs - IgG - stimulate TSH receptor
diffuse goiter, retroorbital fibroblasts (exophthalmos)
dermal fibroblasts - pretibial myxedema
toxic multinodular goiter
patch hyperfunctioning follicular cells
-work independent of TSH - mutation in receptor
hot nodule - rarely malignant
thyroid storm
stress induced catecholamine surge
agitation, delirium, diarrhea, coma, tachyarrhythmia
tx - beta block, PTU, corticosteroids
jod basedow phenomenon
thyrotoxicosis if pt with iodine deficiency goiter is made iodine replete
thyroidectomy compliactions
hoarse - recurrent laryngeal n
hyperCa - PTH damage
papillary carcinoma of thyroid
MC - excellent prognosis
orphan annie nuclei
psammoma bodies
nuclear grooves
lymph invasion
increased with RET and BRAF or child radiation
psammoma bodies
papillary carcinoma of thyroid
papillary carcinoma of ovary
mesothelioma
meningioma
lymphoma
with hashimoto thyroiditis
anaplastic carcinoma of thyroid
undifferentiated
invasive
poor prognosis
older pts
follicular carcinoma of thyroid
good prognosis
uniform follicles
medullary carcinoma of thyroid
from parafollicular C cells
-produce calcitonin
sheets cells in of amyloid stroma
heme spread common
association of medullary carcinoma of thyroid
MEN 2A and 2B - RET mutations
chvostek sign
tap face - twitch
with hypoCa
troussea sign
occlude brachial artery
-get twitch
hypoCa
pseudohypoparathyroidism
albright hereditary osteodystrophy
-unresponse kidney to PTH
hypoCa
short 4/5 digits and short stature
auto dom
familial hypocalciuric hypercalcemia
defective Ca sensing - parathyroid cells
-PTH cannot be suppressed
mild hyperCa with normal PTH levels
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
