Endo Review Slides Flashcards by Shirley G

Tumor with remnants of Rathke’s
pouch

Craniopharyngioma

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Increase in Urine osmolality, Decrease
plasma osmolality

SIADH

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Decrease in urine osmolality, increase
in plasma osmolality

Diabetes insipidus

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galactorrhea, amenorrhea, bitemporal
hemianopia

Craniopharyngioma

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Defect in diaphragm of the sella that
allows CSF to enter the sells and
compress the pituitary

Empty Sella syndrome

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Childbirth with PPH followed by
Amenorrhea, hypoglycemia,
hyponatremia, hypotension and
bradycardia

Sheehan syndrome

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Brown yellow motor oil
like fluid, Suprasellar
calcifications on MRI

Craniopharyngioma

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Diffuse thyromegaly
Increased TSH , decreased T3 / T4

Hashimoto thyroiditis

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Post viral infection, painful thyroid, mixed
inflammatory infiltrate with giant cells, reduced
radio iodine uptak

Subacute granulomatous thyroiditis (
De Quverain)

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Tall columnar follicular epithelium, pale scalloped
colloid, papillae without fibrovascular core,
Antibody against TSH receptor

Graves disease

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Antibody against thyroid peroxidase, lymphocytic
infiltrate, germinal follicles hurthle cells

Hashimoto thyroiditis

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Papillae, psammoma bodies, lymph node deposit

Papillary carcinoma

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decreased TSH
Decreased T3 / T4, Increased rT3

Euthyroid sick syndrome

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Iodine excess in patient with endemic goiter
causing hyperthyroidism

Jod-Basedow phenomenon

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A 45-year-old male presents to the office complaining that his wedding ring
no longer seems to fit, and some of his hats seem to be too small. He also
complains of headache, as well as some visual disturbances. What would be
the initial test of choice be for this patient to screen for the likely diagnosis?

Insulin like growth factor-1- Acromegaly
Glucose suppression test – No GH suppression

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Young child with features of Diabetes insipidus and cystic suprasellar mass

Craniopharyngioma - remnants of Rathke pouch, surface ectodermal structure

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Which of the following panels represents subclinical hypothyroidism?

A. Low TSH, Normal T4, Normal T3
B. High TSH, Low T4, low T3
C. High TSH, Normal T4, Normal T3
D. Normal TSH, Low T4, Low T3

C. High TSH, Normal T4, Normal T3

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Multiple endocrine neoplasia type 1 is a rare autosomal dominant disorder characterized by a predisposition to tumors most commonly in what 3 areas of the body

Parathyroid, pancreas and pituitary – 3P’s

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What screening test should be done annually for diabetic patients to screen for early signs of diabetic nephropathy?

Urinary Albumin ( Spot urinary albumin : creatinine ratio) : >30 mg/g

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A 46-year-old female presents to the emergency department because she feels like her heart is beating out of her chest and is complaining of persistent headache. On examination she is diaphoretic, has a pulse of 120/min and blood pressure of 160/80 mm Hg. He lab test show her plasma metanephrines to be significantly elevated. A CT of the head, abdomen and pelvis are performed and a adrenal mass
in discovered. For a likely diagnosis in this patient, where would this mass most commonly be located

Adrenal medulla ( derived from neural crest) - Pheochromocytoma

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RET mutation,MEN2A, MEN2B

Medullary thyroid
carcinoma

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Psammoma bodies, ground glass nucleus,
nuclear grooves, Intranuclear
pseudoinclusions

Papillary thyroid
carcinom

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Pleomorphic giant cells, sarcomatoid
spindle cells, poor prognosis

Anaplastic thyroid
carcinoma

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Loss-of-function mutations in PTEN,
PAX8/PPARG fusion, PI3K/AKT signaling
pathway

Follicular thyroid
carcinoma

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Solid encapsulated nodule

Follicular adenoma

Activation of the MAP kinase pathway, mutations in BRAF. Rearrangements in genes that encode the receptor tyrosine kinases RET and NTRK1

Papillary thyroid carcinoma

P53 mutations

Anaplastic thyroid carcinoma

Medullary thyroid carcinoma, Pheochromocytoma, Ganglioneuroma, Marfanoid habitus

MEN 2B

Thymic & parathyroid hypoplasia, hypocalcemia

Digeorge syndrome

Medullary thyroid carcinoma, Pheochromocytoma, parathyroid hyperplasia

MEN 2A

Parathyroid hyperplasia, pancreatic endocrine tumor, pituitary adenoma

MEN 1

CATCH -22 Cardiac abnormalities, Abnormal facies, Thymic absence / abnormality, T cell abnormality, Cleft palate, Hypocalcemia, Chromosome 22

Digeorge syndrome

17-alpha hydroxylase deficiency

low cortisol, androgens, and estrogens, increased mineralocorticoids

New born, Metabolic acidosis, hyponatremia, hyperkalemia, hypotension

Congenital adrenal hyperplasia- 21 hydroxylase deficienc

Zell ballen pattern- nested, neurosecretory granules, urine VMA, urine metanephrine,

Pheochromocytoma 10% tumor, RET, NF1, VHL, SDH

Canary yellow tumor with spironolactone bodies

Conn Syndrome Hypertension, hypokalemia, metabolic alkalosis- tetany

T Cell Infiltrate, Insulitis

Type I DM

Amyloid deposit, apoptosis & pressure atrophy of islet cells.

Type 2 DM

Watery diarrhea, hypokalemia, achlorhydria

Vipoma

Increased gastric acid, multiple peptic ulcers

Gastrinoma

Increased blood glucose, mass in epigastrium, coalescing erythematous plaques with central areas of brown induration. crusting and scaling of the borders, Anemia

Glucagonoma

decreased blood glucose, mass in the pancreas

Insulinoma

Increased C peptide, differentiates injected insulin

Insulinoma

HLA DR3, DR4

Type I DM

VIP- major GI relaxant hormone

Vipoma

Zollinger Ellison syndrome

Gastrinoma

A patient with history of type I diabetes presents tachycardia, weakness, altered mental status, and fruity order of breath . A bedside finger stick test done reveals a blood glucose of 560 mg/dl. Urine is positive for ketones. On physical examination you note deep, rapid, and labored breathing. These respirations are a compensatory mechanism for what acid base disorder that is likely to be present in this patient

High Anion gap Metabolic acidosis Causes-: DKA, Lactic acidosis, Uremia, Renal failure, Methanol, Propylene glycol, Isoniazid (INH), Salicylates. electrolyte disturbances : Lack of insulin shifts intracellular potassium to extracellular fluid Acidosis also shifts I.C K+ to E.C K+ Osmotic diuresis also causes K+ and Na+ loss in urine

A 37-year-old female presents to the office today complaining of persistent fatigue, combined with nausea, generalized abdominal pain, and a brownish discoloration of her hands, elbows, and knees. Labs are ordered and reveal elevated serum potassium levels, and a blood glucose of 63 mg/dl. What is the most likely diagnosis in this patient?.

Addison disease Would the ACTH levels in the patient be elevated or decreased ACTH elevated

A 36-year-old female presents to the office complaining of fatigue, constantly feeling cold, dry skin, and weight gain. If the thyroid hormone levels were drawn in this patient, what would be the levels of TSH and free T4 likely to reveal?

Elevated TSH and decreased Free T4

A 42-year-old male presents today to the office for routine labs. The results show an elevated TSH level. Free T4 levels are within normal limits. The patient is otherwise healthy and asymptomatic fully what diagnosis should be suspected in this patient?

Subclinical hypothyroidism

Physical examination is performed on a newborn female due to abnormalities detected at birth. The newborn has dry skin, swelling around the eyes, enlargement of the tongue, and an umbilical hernia palpated on examination. What nutritional deficiency should be suspected in the mother of the newborn?

Iodine deficiency- cretinism

A 47-year-old woman presents to the office two weeks post-op after having a thyroidectomy performed. She complaints of muscle cramping, muscle spasms as well as tingling sensation in her extremities. An ECG performed shows prolongation of QT interval. What is the most likely cause of her symptoms?

Hypocalcemia- hypoparathyroidism

37-year-old female presents to the office today because she has not had her periods in four months. She is not sexually active and denies any chance of pregnancy. She also complains of headache a milky discharge from her breast. What is the most likely diagnosis

Prolactinoma

A patient with Cushing's disease after administration of high dose dexamethasone would likely have what response in their serum cortisol levels?

Suppression of serum cortisol

A patient with nephrogenic diabetes insipidus will likely have what response in urine output after a desmopressin(ADH)stimulation test is performed

No change - continued production of large amounts of dilute urine

Most common cause for Cushing syndrome?

Long term high dose use of glucocorticoids

A patient with secondary hypothyroidism you will have an abnormality in which part the hypothalamic-pituitary-thyroid axis

Pituitary gland

A 37-year-old female presents to the office complaining that she is having trouble losing weight despite following a strict diet and exercising daily. On physical examination you note central obesity, thin extremities, oily skin, and striae across her abdomen. A screening test to check for excessive what hormone should be done in this patient

Cortisol

What is the most common type of thyroid cancer. What is the most aggressive type of thyroid cancer ?

Papillary thyroid cancer - most common Anaplastic thyroid carcinoma - most aggressive

A 27-year-old female with history of bipolar disorder presents to the office complaining of fatigue , constipation, and weight gain. Lab tests are ordered, and it is determined that she is biochemically hypothyroid. What medication is this patient likely taking that led to her diagnosis of hypothyroidism?.

Lithium Others: iodides, para-amino salicylic acid

A 40 year old man presents to the office with polyuria and polydipsia. He has a family history of diabetes and he wants to be tested to see if he is a diabetic. He last ate 4 hours ago and his blood glucose in the office was 156mg/dl. HbA1C comes back and reveals a result of 6.3. A 2-hour of glucose tolerance test revealed a blood glucose of 212mg/dl. Which of these lab tests satisfies a diagnosis of diabetes in this patient?

2-hour of glucose tolerance test : 212mg/dl