Endo Review Flashcards
1
Q
Where is the location of secretion of growth hormone?
A
anterior pituitary
2
Q
Where is the location of secretion of thyroid hormone?
A
thyroid gland
3
Q
Where is the location of secretion of glucocorticoids?
A
adrenal cortex (zona fasciculata)
4
Q
Where is the location of secretion of progesterone?
A
ovaries and placenta in pregnancy
5
Q
Where is the location of secretion of prolactin?
A
anterior pituitary
6
Q
Where is the location of secretion of oxytocin?
A
hypothalamus (paraventricular nucleus)
7
Q
Where is the location of secretin of atrial natriuretic hormone?
A
atria of the heart
8
Q
Where is the location of secretion of glucagon?
A
alpha cells of the pancreas
9
Q
Where is the location of secretion of testosterone?
A
made in the zone reticularis of the adrenal cortex; secreted in testes (men) and ovaries (women)
10
Q
Where is the location of secretion of FSH?
A
Anterior pituitary
11
Q
Where is the location of secretion of ADH?
A
Hypothalamus (supraoptic nucleus)
12
Q
Where is the location of secretion of calcitonin?
A
parafollicular C cells of thyroid
13
Q
Where is the location of secretion of TSH?
A
Anterior pituitary
14
Q
Where is the location of secretion of epinephrine and norepinephrine?
A
Adrenal medulla (chromaffin cells)
15
Q
Where is the location of secretion of insulin?
A
beta cells of the pancreas
16
Q
Where is the location of secretion of estradiol?
A
ovaries
17
Q
Where is the location of secretion of estriol?
A
placenta
18
Q
Where is the location of secretion of estrone?
A
fat cells
19
Q
Where is the location of secretion of estrogen in males?
A
testes and adipocytes
20
Q
Where is the location of secretion of PTH?
A
parathyroid glands
21
Q
Where is the location of secretion of somatostatin?
A
delta cells of pancreas
22
Q
Where is the location of secretion of LH?
A
anterior pituitary
23
Q
Where is the location of secretion of mineralocorticoids?
A
zona glomerulosa of adrenal cortex
24
Q
Where is the location of secretion of ACTH?
A
Anterior pituitary
25
What clinical finding would you expect to find in a man with high sec hormone binding globulin?
decreased free testosterone -> gynecomastia or ED
26
What clinical finding would you expect to find in a woman with low sex hormone binding globulin?
increased free testosterone -> hirsutism, acne, deep voice, and irregular periods
27
Sheehan syndrome
postpartum hemorrhage leading to underperfusion of the pituitary gland
pituitary necrosis and hypopituitarism
presentation
- galactorrhea due to a deficiency in prolactin
- amenorrhea after delivery
- secondary hypothyroidism leading to fatigue, cold intolerance and weight gane
- hyponatremia (rare)
28
Which hormones share a common alpha subunit?
LH, FSH, TSH, hCG
29
What is the most common presentation of hyperprolactinemia in a female patient?
- premenopausal - hypogonadism, infertility, oligo/amenorrhea
- postmenopausal -> asymptomatic
- galactorrhea
30
What are some of the possible clinical features of acromegaly?
```
large tongue
increased spacing of teeth
large hands and feet
deep voice
coarsening of facial features
impaired glucose tolerance/diabetes
```
31
What are the symptoms of 21-alpha-hydroxylase deficiency?
- increased progesterone, increased androgens, decreased cortisol, decreased mineralocorticoids
- hypotension -> salt wasting
- masculinization
- electrolyte abnormalities
32
What are they symptoms of 11-beta-hydroxylase deficiency?
- increased DOC, increased androgens, decreased cortisol
- HTN d/t increased DOC (has mineralocorticoid action)
- masculinization
33
What food substance is an essential starting point in the synthesis of adrenal steroids?
cholesterol
34
What effect does cortisol have on bone formation and immune system functioning?
decreases both
35
What are the potential side effects of glucocorticoid use?
BAM, CUSHINGOID
- buffalo hump
- amenorrhea
- moon facies
- crazy
- ulcers
- skin changes
- HTN
- infection
- necrosis of femoral head
- glaucoma
- osteoporosis
- immune suppression
- diabetes
36
What are the most common causes of Cushing syndrome?
1. exogenous steroid use
2. ACTH-producing small cell lung cancer
3. Cushing Dz
4. adrenal adenoma
37
What are the clinical manifestations of Addisons disease? What is the cause?
- Addison disease is caused by autoimmune destruction of the adrenal glands -> decreased aldosterone, cortisol
- hyponatremia, hyperkalemia, hypotension, fatigue, skin hyperpigmentation, anorexia, weight loss
38
Most common cause of primary hyperaldosteronism?
B/L adrenal hyperplasia
39
Medical treatment for hyperaldosteronism?
aldosterone antagonist (spironolactone)
40
Adrenal disease associated with skin hyperpigmentation
Addison disease
41
HTN, hypokalemia, metabolic alkalosis
Conn syndrome
42
What tumor locations are associated with the three different types of multiple endocrine neoplasia?
MEN 1 - parathyroid adenoma, pancreas, pituitary
MEN 2A - pheochromocytoma, parathyroid hyperplasia, medullary thyroid
MEN 2B - pheochromocytoma, medullary thyroid, mucosal neuromas (and marfinoid body habitus)
43
What might a lab detect int he urine of a patient with pheochromocytoma?
increased metanephrines and normetanephrine in the plasma; increased VMA in the urine
44
Most common tumor of the adrenal gland
benign non-functioning adenoma
45
Most common tumor of the adrenal medulla in adults
pheochromocytoma
46
Most common tumor of the adrenal medulla in children
neuroblastoma
47
medical treatment for pheochromocytomas
resection; alpha blocker (nonselective)
48
What is the most common location for ectopic thyroid tissue?
tongue
49
How would pregnancy affect serum third hormone levels?
- increased total binding globulin (body thinks free T4 and T3 are low)
- increased total T4
- TSH may be decreased
50
What are the causes of congenital hypothyroidism? How can it be prevented?
- complete genesis, hypoplasia, or ectopic location
- thyroid-related enzyme deficiency
- dysfunctional hormone production, transportion
- TSH resistance
- transfer of anti-thyroid meds or Abs from mother
- iodine-deficient diet in mom during pregnancy
Prevention: add iodine to diet of pregnant moms; identify congenital hypothyroidism early
51
A 35 year old woman has a diffuse painless goiter and hypothyroidism. What is the most likely diagnosis, and what are the most likely relative values of TSH and thyroid hormone?
Hashimoto
| Increased TSH, decreased thyroid hormones
52
How does hypothyroidism affect cholesterol levels?
hypothyroidism will cause elevations of LDL and total cholesterol
53
A 35-year old woman has a diffuse goiter and hyperthyroidism. What are the most likely relative laboratory values of TSH and thyroid hormones?
(Graves Dz)
- decreased TSH
- increased TSI
- increased T3, T4
54
What is the most likely diagnosis with an extremely tender thyroid gland?
subacute thyroiditis (de Quervain)
55
What is the most likely diagnosis with pretibial myxedema?
Graves
56
What is the most likely diagnosis with pride in recent weight loss in a medical professional?
thyroid hormone abuse
57
What is the most likely diagnosis with palpation of a single thyroid nodule?
thyroid adenoma (toxic)
58
What is the most likely diagnosis with palpation of multiple thyroid nodules?
toxic multi nodular goiter
59
What is the most likely diagnosis in hyperthyroidism with a recent study using IV contrast (iodine)?
Jod-Basedown phenomenon
60
What is the most likely diagnosis with eye changes: proptosis, edema, injection?
Graves Dz
61
What is the most likely diagnosis with hyperthyroidism and with a history of thyroidectomy or radio ablation of thyroid?
too much exogenous thyroid hormone
62
What type of thyroid cancer is associated with activation of receptor tyrosine kinases?
papillary and medullary
63
What type of thyroid cancer is associated with Hashimoto thyroiditis as a risk factor?
B cell lymphoma
64
What type of thyroid cancer arises from parafollicualr C cells?
medullary
65
What type of thyroid cancer is associated with RAS mutation or PAX8-PPARgamma-1 rearrangement?
follicular
66
What type of thyroid cancer is associated with rearrangements in RET oncogene?
papillary and medullary
67
What type of thyroid cancer is associated with a mutation in the BRAF gene?
papillary
68
What nerve can be easily damaged in thyroid surgery and lead to hoarseness?
recurrent laryngeal nerve
69
What is the most common thyroid cancer?
papillary
70
Enlarged thyroid cells with ground-glass nuclei
follicular thyroid cancer
71
most likely electrolyte abnormality with perineal tingling perioral paresthesias, and recent thyroidectomy?
hypocalcemia
72
How is hemoglobin glycosylated in diabetes mellitus to form HgbA1C?
non enzymatic glycosylation
73
Which type of diabetes is associated with HLA-DR3 and HLA-DR4?
T1DM
74
In which tissues will you find GLUT-2 receptors?
beta cells, liver, kidney, small intestine
75
Which tissues depend on insulin for glucose?
GLUT4 transporters - skeletal muscle and adipose tissue
76
What are three important component of DKA management? HHS management?
DKA - fluids, insulin drip, fix electrolytes (especially potassium); goal is to close the anion gap
HHS - fluids and insulin; goal is to fix serum osmolarity
77
What the common precipitating factors for DKA?
```
missed insulin
new Dx
stress -> infection
dehydration
MI/trauma
alcohol/drug abuse
```
78
What are the five categories of criteria for the diagnosis of metabolic syndrome?
1. waist circumference >40 (M); >35 (F)
2. triglycerides >150
3. HDL <40 (M); <50 (F)
4. BP >130/85
5. fasting glucose >/=100mg/dL
79
What liver disease is associated with obesity?
NASH
80
At what BMI is a patient considered obese?
>29.9
81
What are the three functions of vitamin D?
1. increase dietary absorption of Ca2+
2. increase dietary absorption of phosphate
3. increase bone turnover
82
How does PTH affect Ca2+? Pi?
increase Ca2+, decrease Pi
increase bone resorption
increase renal reabsorption of Ca2+
83
What cell type produces PTH? What cell type produces calcitonin?
PTH -> chief cells of parathyroid
| Calcitonin -> parafollicular C cells of the thyroid
84
What are two signs of hypocalcemia?
Chvostek and Trousseau
85
What are the two most important causes of primary hyperparathyroidism?
1. PTH adenoma
| 2. PTH hyperplasia
86
What are some possible causes of hypocalcemia?
1. decreased vitD intake/deficiency
2. hypoparathyroidism (surgery, autoimmune, DiGeorge)
3. acute pancreatitis
87
Most common cause of hypercalcemia?
primary hyperparathyroidism
88
Most common cause of primary hyperparathyroidism?
parathyroid adenoma
89
Most common cause of secondary hyperparathyroidism?
chronic renal failure
90
Most common cause of hypoparathyroidism
parathyroid removal
