Endocinology Flashcards
Thyroid hormones
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.
Hyperthyroidism (thyrotoxicosis)
Sxs: abdominal pain, vomiting, weight loss, change in bowel habits.
Hyperthyroidism associated autoimmune disease
pernicious anemia (PA) Celiac and IBD
Hyperthyroidism Upper Digestive Tract
- Dysphagia (compression from goiter) neurohormonal regulation, skeletal myopathy affecting pharynx and upper esophagus.
- Atrophic gastritis (Graves disease; PA) achlorhydria, hypergastrinemia
- Recurrence of Helicobacter pylori
Hyperthyroidism GI motility issues and Lower Digestive tract
- Esophageal contractility increasing velocity of esophageal contractions
- Increase or decrease gastric emptying
- Lactose intolerance.
Hypothyroidism (Hashimoto thyroiditis)
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
Hypothyroidism associated autoimmune disorders
IBD, PA (B12 malabsorption), DM, Celiac, Downs Syndrome
GI disease can affect exogenous thyroid hormone absorption
Hypothyroidism GI Motility
Esophageal motor and LES/goiter: dysphagia and dyspepsia
GER
Delayed gastric emptying
Ileus: SIBO,
Megacolon
Comorbidity with Down’s
Hyperparathyroidism: Hypercalcemia due to increased PTH. DDX
-Sporadic Adenoma
- MEN
Hyperparathyroidism (high calcium) Symptoms:
Gastroparesis: N/V, abdominal pain
PUD (gastric hypersecretion)
Decreased colonic transit: constipation
Pancreatitis: acute and chronic, abdominal pain, steatorrhea
Hypoparathyroidism (Hypocalcemia): Causes:
- Congenital: DiGeorge, 22q11 deletion
- Acquired: Autoimmune polyendocrinopathy syndrome type 1 (AIRE), IPEX, post surgical, radiation destruction
- Infiltrative: Wilson’s disease, hemochromatosis, neoplasm, sarcoidosis
Hypoparathyroidism (Hpyocalcemia)
-Hypomagnesemia/hypermagnesemia
-Low Ca causes decreased cholecystokinin: liver-steatorrhea, poor GB contractility, pancreas: decreased enzyme secretions
Associated with celiac, steatorrhea, Vitamin D deficiency
Cushing’s Disease, Acromegaly (chronic glucocorticoid excess)
- 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
Addison’s disease (Adrenal insufficiency)
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
Adrenal Insufficiency Acute
hypotension, shock weakness, apathy, confusion, anorexia, N/V dehydration, abdominal pain, hyperthermia, hypoglycemia
Adrenal Insufficiency (Addison’s disease) Associated autoimmune
Pernicious anemia (atrophic gastritis and achlorhydria), Celiac disease
Multiple Endocrine Neoplasia Genes
MEN type 1: MEN1
MEN type 2a: RET
MEN type 2b: RET
MEN 1
AD, 10% denovo,
constellation of tumors: parathyroid, pituitary, pancreas, duodenum.
Sxs: hyperparathyroidism (hypercalcemia), and anterior pituitary tumors, and neuroendocrine tumors (Carcinoid).
MEN1 Neuroendocrine tumors
PPoma
Gastrinoma (Zollinger Ellison Syndrome)
Insulinoma
Glucagonoma
Somatostatinoma
VIPoma
MEN 1 anterior pituitary tumors
- Prolactin
- GH
- ACTH
MEN1 does NOT have:
Medullary thyroid carcinoma or Pheochromocytoma
MEN 2A: RET proto oncogene
AD or denovo.
Bilateral medullary thyroid carcinoma
bilateral pheochromocytoma
Primary hyperparathyroidism.
MEN2B
De Novo
Medullary Thyroid Carcinoma (100%)
Pheochromocytoma: 50%
oralcutaneous neuromas.
Thyroid disease is rare.
