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Pathoma > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Pituitary Adenoma Sx

A

Bitemporal Hemianopsia
Hypopituitarism
Headache

Functional Tumors secrete hormones and will have additional Sx related to the hormone

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2
Q

Prolactinoma Sx

A

Females: Galactorrhea, amenorrhea

Males: Decreased Libido, headache

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3
Q

Most common pituitary adenoma

A

Prolactinoma

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4
Q

Tx Prolactinoma

A

DA inhibitor

Bromocriptine
cabergoline

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5
Q

Growth Hormone Adenoma Sx

A

Kids–Gigantism
Adults–achromegaly
2º DI–GH induces gluconeogenesis

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6
Q

Achromegaly COD

A

Cardiac failure

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7
Q

Dx GH adenoma

A

Elevated GH & IGF-1

No GH suppression with glucose addition

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8
Q

ACTH adenoma Sx

A

Cushing syndrome

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9
Q

When do Sx present with hypopituitarism

A

> 75% of pituitary is lost

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10
Q

Causes of hypopituitarism

A

Pituitary adenoma (adults)
Craniopharyngioma (kids)
Sheehan Syndrome
Empty Sella Syndrome

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11
Q

Pituitary Apopexy

A

bleeding into sella tursica

causes hypopituitarism

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12
Q

Pregnancy related infarction of pituitary

A

Sheehan Syndrome

Prituitary doubles in size due to hormone demand

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13
Q

Empty Sella Syndrome mechanism

A

Compression–herniation of arachnoid or CSF destroys pituitary

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14
Q

Posterior Pituitary Hormones

A

ADH

Oxytocin

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15
Q

Sx of SIADH

A

Excessive water

hyponatremia, low serum osmo
mental status changes, seizures

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16
Q

Neuromal swelling and crebral edema cause (electrolyte)

A

Hyponatremia

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17
Q

Thyroglossal duct cyst

A

anterior neck mass due to remnant of the thyroglossla duct

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18
Q

Persistent thyroid tissue at base of the tongue

A

Lingual thyroid

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19
Q

metabolic effect of increased TH

A

Increased basal metabolic rate (Na/K ATPase expression)

Increased ß1 receptors (sympathetics)

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20
Q

Clinical Sx of increased TH

A 
weight loss
heat intolerance and sweating
Tachycardia/arrhythmia
Tremor, ataxia, insomina
diarrhea with malabsorption
oligomenorrhea
hypercalcemia from bone resorption (osteoporosis)
Hypocholesterolemia
Hyperglycemia
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21
Q

Graves Disease Pathogenesis

A

IgG Ab stimulate TSH receptors (type II non-cytotoxic)

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22
Q

Most common cause of hyperthyroidism

A

Graves Disease

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23
Q

Cause of exophthalmos and pre-tibial myxedema in graves

A

fibroblast deposition

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24
Q

Graves Labs

A

increased total Free T

Decreased TSH

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25
Q

Graves Tx

A

ß-Blockers
PTU
Steroids

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26
Q

Multi-nodular Goiter cause

A

Relative Iodine defficiency

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27
Q

Cretinism Cause

A

Hypothyroidism in neonates and infants

Congenital defect in TH production:
Most common Thyroid Peroxidase

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28
Q

Myxedema pathogenesis

A

build up of glycosaminoglycans in skin and soft tissue

Deepening of voice
large tongue

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29
Q

Myxedema Sx

A

Hypercholesterolemia
oligomenorrhea
cold intolerance
bradycardia

Hypothyroid Sx

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30
Q

Hashimoto Thyroiditis

A

Autoimmune destruction of Thyroid

HLA-DR5 mutation association

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31
Q

Hashimoto Labs

A

Increased T4

Decreased TSH

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32
Q

Hashimoto has increased risk of what?

A

B Cell Lymphoma

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33
Q

Hashimoto Histology

A

Chronic Inflammation
Germinal Centers
HURTHLE Cells (eiosinophilic metaplasia of cells that line follicle)

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34
Q

Bx of thyroid neoplasias

A

Fine needle aspiration (FNA)

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35
Q

Hot Nodule (thyroid)

A

Graves

Nodular goiter

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36
Q

Cold Nodule (thyroid)

A

adenoma

CA

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37
Q

Types of Thyroid Tumors

A 
Follicular adenoma
Papillary CA
Follicular CA
Medullary CA
Anaplastic CA
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38
Q

Benign proliferation of follicles surrounded by fibrous capsule

A

Follicular adenoma

may secrete TH but usually non-fxn

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39
Q

Most common thyroid CA (80%

A

Papillary CA

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40
Q

Orphan Annie eyes and nuclear groves

Thyroid CA

A

Papillary CA

papillae lined by cells with clear cytosol

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41
Q

Malignant proliferation of follicles surrounded by fibrous capsule

hematogenous spread

A

Follicular CA

42
Q

how to Bx Follicular CA

A

need to Bx entire capsule

43
Q

Malignant proliferation of parafollicular C cells in thyroid

Amyloid deposits in tumor (calcinin)

Sheets of malignant cells in an amyloid stroma

A

Medullary CA

44
Q

C Cells fxn

A

Secrete calcitonin

Lowers serum Ca via renal excretion
leads to hypocalcemia if secreted by medullary CA

45
Q

Medullary CA associated with:

A

MEN-2A and 2B

Mutation of RET oncogene–prophylactic thyroidectomy if detected

46
Q

Undifferentiated malignant CA of thyroid
Elderly pt.
invasion to local stxrs

A

Anaplastic CA

poor prognosis

47
Q

Secretes PTH

A

Chief cells

regulate free Ca in serum

48
Q

PTH mechanism

A

Activates osteoblasts which activate osteoclasts –> releasing Ca/Pi

Increases small bowel abs. of Ca via Vit. D activation in kidney

Increases renal resorption of Ca and Pi excretion

49
Q

most common cause of 1º hyperparathyroidism

A

Parathyroid adenoma

50
Q

Sx of Hyperparathyroidism

A 
Nephrolithiasis
Nephrocalcinosis
CNS disturbances
Constipation
PUD
Acute pancreatitis
Osteitis fibrosa cystica
51
Q

Osteitis fibrosa cystica

A

resorption of bone leading to fibrosis and cystic spaces

52
Q

Hyperparathyroidsim labs

A

inc. PTH, Ca, Alkaline Phosphate, urinary cAMP

Dec. Phosphate

53
Q

2º hyperparathyroidism #1 cause

A

renal insufficiency

54
Q

2º hyperparathyroidism Sx

A

Decreased Pi excretion

increased serum Pi–binds free Ca, PTH, Alkaline Phosphate

dec. Ca

55
Q

Effects of Insulin

A

Increased Glycogen synth, protein synth, ligogenesis

Increased glucose uptake via GLUT4 in sk. mm., adipose

56
Q

Alpha and Beta pancreatic cells

A

Alpha–glucagon

Beta–insulin

57
Q

Glucagon Effects

A

opposite of insulin–inc. glucose blood levels

glycogenolysis and lipolysis increased

58
Q

Type I DM associated with HLA:

A

HLA-DR3 and DR4

59
Q

Pathophys of Type I DM

A

Autoimmune destruction of ß cells by T lymphocytes
(Type II cytotoxic)

Insulin Defficiency

60
Q

Pathopysh of DKA

A

Stress causes increase in Epi –> increased lipolysis

Free FA converted to Ketones –> hyperglycemia, anion gap met. acidosis, hyperkalemia

61
Q

Ketones seen in DKA

A

ß-hydroxybutyric acid

Acetoacetic acid

62
Q

Type II DM

A

End organ resistance to insulin

63
Q

Type II DM histology

A

Amyloid deposition in islets of langerhans

64
Q

Dx type II DM

A

Random Glucose > 200
Fasting Glucose > 126
Glucose Tolerance Test > 200 (2 hrs after)

65
Q

Type II DM Tx

A

Weight Loss**
Rx–
Exogenous insulin

66
Q

Type I DM Tx

A

Insulin

67
Q

Hyperosmolar non-ketotic coma

A

Type II DM

leads to life threatening diuresis, Hypotension, coma

Ketones absent due to low insulin circulation

68
Q

Non-Enzymatic Glycosylation effects on lg/med vessels

A
  1. Cardiovascular disease

2. Peripheral Vascular disease

69
Q

Non-enzymatic glycosylation effects on small vessels

A

Renal arterioles –> glomerulosclerosis

Efferent arterioles preferential involvement –> nephrotic syndrome

70
Q

Kimmelstiel-Wilson Nodules

A

characteristic of nephrotic syndrome from DM

71
Q

Osmotic Damage due to DM

A

Glucose enters schwann cells, pericytes of retinal blood vessels, lens –> creates osmotic gradient

blindness, peripheral neropathy, impotence, cataracts

72
Q

MEN I

A

Parathyroid Hyperplasia
Pituitary adenoma
Tumor of Islet cells (pancreas)

73
Q

Islet Tumor Types

A

VIPoma
Gastrinoma
Somatostatinoma
Insulinoma

74
Q

Tumor on pancreas

low serum glucose, high insulin, C-peptide

A

Insulinoma

75
Q

Cholelithiasis
Steatorrhea
Achlorhydria
mass on pancreas

A

Somatostatinoma

Steatorrhea–inh. of CCK
Achlor–inh. of gastrin

76
Q

PUD with ulcers extending into ileum

pancreatic mass

A

Gastrinoma

Zollinger-Ellison Syndrome

77
Q

Watery Diarrhea
hypokalemia
achlorhydria
pancreatic mass

A

VIPoma

78
Q

Layers and secretions of Adrenal Cx

A

Glomerulosa–Mineralocoritcoids (Aldosterone)
Fasciculata–Glucocorticoids (cortisol)
Reticularis–Sex Steroids (testosterone)

“It gets sweeter as you go deeper”

79
Q 
Muscle weakness
Moon facies
buffalo hump
truncal obesity
abdominal striae
HTN
Osteoporosis
Multiple infxns
A

Cushing Syndrome–hypercortisolism

80
Q

Dx Cushing Sundrome

A

24 hr. urine cortisol

81
Q

Causes of Cushing

A

Exogenous corticosteroids–neg. feedback of ACTH
1º adrenal adenoma
ACTH-secreting pituitary adenoma
Paraneoplastic Syndrome (Small cell CA of lung, RCC)

82
Q

Bilateral adrenal hyperplasia

A

Paraneoplastic Syndrome (small cell CA of Lung, RCC)

83
Q

Tx of Cushing Syndrome

A

High dose Dexamethazone–suppresses ACTH production produced by pituitary but NOT SCC of Lung

84
Q

Conn Syndrome

A

Hyperaldosteronism

HTN, Hypernatremia, hypokalemia, metabolic alkalosis

85
Q

Most common cause of Conn syndrome

A

Adrenal Adenoma

86
Q

High Aldosterone
Low renin

Dx?

A

1º aldosteronism

87
Q

High Aldosterone

High Renin

A

2º Aldosteronism

CHF, renovascular HTN

88
Q

Most common Cause of congenital adrenal hyperplasia

A

21-hydroxylase defficiency

Req. for production of aldosterone and corticosteroids

89
Q

21-hydroxylase deficiency effects

A

increased sex hormone production because no ALD or corticosteroids are produced

90
Q

17-Hydroxylase deficiency

A

Increased Aldosterone

decreased Sex hormones, glucocorticoids

91
Q

Waterhouse-Friderichsen Syndrome

A

N. meningitidis infection
hemorrhagic necrosis of adrenal glands –> adrenal insufficiency
DIC

92
Q

Addison Disease

A

Adrenal Insufficiency

Hypotension
hyponatremia 
hypovolemia
hyperkalemia
weakness
hyperpigmentation
vomiting 
diarrhea
93
Q

Why is there hyperpigmentation in Addison Disease?

A

Increased ACTH by-products stimulate melanocytes –> pigment production

94
Q

Addison Disease Causes

A
  1. autoimmune (US)
  2. TB (developing countries)
  3. Metastatic CA
95
Q

Tumor of Chromaffin Cells

A

Pheochromocytoma

Increased Epi/NE

96
Q

Sx of Pheochromocytoma

A

Episodic HTN, sweating, palpitations, HA, Tachycardia

97
Q

Pheochromocytoma Dx

A

Increased serum metanephrines
Increased 24 hr. urine metanephrines
vanillylmandelic Acid

98
Q

Pheochromocytoma Tx

A

Phenoxybenzamine (irrev. alpha blocker)

99
Q

Pheochromocytoma associated with

A

MEN 2A and 2B
VHL
Neurofibromatosis Type I

100
Q

Pheochromocytoma Rule of 10’s

A

10% bilateral, familial, malignant, outside adrenal medulla

Pathoma (3 decks)

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