Endocinology

Question 1

Thyroid hormones

Answer 1

T3 and T4 are transported by proteins controlled and secreted by the liver.
T3 and T4 drive digestive functions.
T3: nuclear transcription factor which drives transcription and translation impacting all cells.

Question 2

Hyperthyroidism (thyrotoxicosis)

Answer 2

Sxs: abdominal pain, vomiting, weight loss, change in bowel habits.

Question 3

Hyperthyroidism associated autoimmune disease

Answer 3

pernicious anemia (PA) Celiac and IBD

Question 4

Hyperthyroidism Upper Digestive Tract

Answer 4

• Dysphagia (compression from goiter) neurohormonal regulation, skeletal myopathy affecting pharynx and upper esophagus.
• Atrophic gastritis (Graves disease; PA) achlorhydria, hypergastrinemia
• Recurrence of Helicobacter pylori

Question 5

Hyperthyroidism GI motility issues and Lower Digestive tract

Answer 5

• Esophageal contractility increasing velocity of esophageal contractions
• Increase or decrease gastric emptying
• Lactose intolerance.

Question 6

Hypothyroidism (Hashimoto thyroiditis)

Answer 6

Sxs: anorexia, N/V, abdominal pain, constipation.
- weight gain (myxedema),
-anemia: menorrhagia, pernicious anemia/achlorhydria
-ascites (high protein content)-responds to hormone treatment.
-GI bleeding
- Interferon induced hypothyroidism

Question 7

Hypothyroidism associated autoimmune disorders

Answer 7

IBD, PA (B12 malabsorption), DM, Celiac, Downs Syndrome
GI disease can affect exogenous thyroid hormone absorption

Question 8

Hypothyroidism GI Motility

Answer 8

Esophageal motor and LES/goiter: dysphagia and dyspepsia
GER
Delayed gastric emptying
Ileus: SIBO,
Megacolon
Comorbidity with Down’s

Question 9

Hyperparathyroidism: Hypercalcemia due to increased PTH. DDX

Answer 9

-Sporadic Adenoma
- MEN

Question 10

Hyperparathyroidism (high calcium) Symptoms:

Answer 10

Gastroparesis: N/V, abdominal pain
PUD (gastric hypersecretion)
Decreased colonic transit: constipation
Pancreatitis: acute and chronic, abdominal pain, steatorrhea

Question 11

Hypoparathyroidism (Hypocalcemia): Causes:

Answer 11

• Congenital: DiGeorge, 22q11 deletion
• Acquired: Autoimmune polyendocrinopathy syndrome type 1 (AIRE), IPEX, post surgical, radiation destruction
• Infiltrative: Wilson’s disease, hemochromatosis, neoplasm, sarcoidosis

Question 12

Hypoparathyroidism (Hpyocalcemia)

Answer 12

-Hypomagnesemia/hypermagnesemia
-Low Ca causes decreased cholecystokinin: liver-steatorrhea, poor GB contractility, pancreas: decreased enzyme secretions
Associated with celiac, steatorrhea, Vitamin D deficiency

Question 13

Cushing’s Disease, Acromegaly (chronic glucocorticoid excess)

Answer 13

• Cushingoid facies, failure of longitudinal growth, hirsutism, muscle weakness, acne, striae, hypertension
• Increased serum ACTH and Cortisol level: gastric ulceration (NSAIDs).
• Increased serum growth hormone level: colorectal polyps and cancer
• GI issues of DM

Question 14

Addison’s disease (Adrenal insufficiency)

Answer 14

Nausea, vomiting, anorexia, diarrhea, abdominal pain. Symptoms can mimic cyclic vomiting syndrome. Chronic: weakness, fatigue, anorexia, weight loss, hypotension and hyperpigmentation.
Enterocyte dysfunction: diarrhea, malabsorption, FTT

Question 15

Adrenal Insufficiency Acute

Answer 15

hypotension, shock weakness, apathy, confusion, anorexia, N/V dehydration, abdominal pain, hyperthermia, hypoglycemia

Question 16

Adrenal Insufficiency (Addison’s disease) Associated autoimmune

Answer 16

Pernicious anemia (atrophic gastritis and achlorhydria), Celiac disease

Question 17

Multiple Endocrine Neoplasia Genes

Answer 17

MEN type 1: MEN1
MEN type 2a: RET
MEN type 2b: RET

Question 18

MEN 1

Answer 18

AD, 10% denovo,
constellation of tumors: parathyroid, pituitary, pancreas, duodenum.
Sxs: hyperparathyroidism (hypercalcemia), and anterior pituitary tumors, and neuroendocrine tumors (Carcinoid).

Question 19

MEN1 Neuroendocrine tumors

Answer 19

PPoma
Gastrinoma (Zollinger Ellison Syndrome)
Insulinoma
Glucagonoma
Somatostatinoma
VIPoma

Question 20

MEN 1 anterior pituitary tumors

Answer 20

• Prolactin
• GH
• ACTH

Question 21

MEN1 does NOT have:

Answer 21

Medullary thyroid carcinoma or Pheochromocytoma

Question 22

MEN 2A: RET proto oncogene

Answer 22

AD or denovo.
Bilateral medullary thyroid carcinoma
bilateral pheochromocytoma
Primary hyperparathyroidism.

Question 23

MEN2B

Answer 23

De Novo
Medullary Thyroid Carcinoma (100%)
Pheochromocytoma: 50%
oralcutaneous neuromas.
Thyroid disease is rare.