Endocrine Flashcards
1
Q
where does the thyroid come from
A
floor of the primitive pharynx
2
Q
what initially connects the thyroid to the tongue
A
the thyroglossal duct
3
Q
what is the normal remnant of the thyroglossal duct
A
foramen cecum
4
Q
most common ectopic thyroid tissue site
A
tongue
5
Q
presentation of a thyroglossal duct cyst
A
anterior mid line neck mass that moves with swallowing or protrusion of the tongue. this is different from a persistent cervical sinus leading to brachial cleft cyst in the lateral neck
6
Q
adrenal cortex is derived from
A
mesoderm
7
Q
adrenal medulla is derived from
A
neural crest
8
Q
most common tumor of adrenal medulla in kids
A
neuroblastoma. rarely causes hypertension
9
Q
most common tumor of adrenal medulla in adults
A
pheochromocytoma
10
Q
where does left adrenal vein drain to
A
left renal vein
11
Q
where does right adrenal vein drain to
A
IVC
12
Q
what is the posterior pituatary derived from
A
neuro-ectoderm
13
Q
what is the anterior pituatary derived from
A
oral ectoderm (rathke’s pouch)
14
Q
what does the posterior pituatary make
A
NOTHING
15
Q
what does the posterior pituatary secrete
A
ADH and oxytocin. these are made in the hypothalamus and shipped to the posterior pituatary via neurophysins.
16
Q
what do the acidophiles in the anterior pituatary make
A
GH and prolactin
17
Q
what 4 hormones have the alpha subunit from the anterior pituitary in common
A
TSH, LH, FSH and Beta HCG
18
Q
position of the cell types in the islets of the endocrine pancreas
A
alpha cells- make glucagon- periphery
beta cells- make insulin- in the center
19
Q
where is pre-pro insulin made
A
in the rough ER
20
Q
what type of insulin is stored in the granules
A
pro insulin
21
Q
what type of insulin gets exocytosed
A
just regular insulin. the proinsulin is cleaved and insulin an C peptide are released
22
Q
what is unique about C peptide
A
it is made in the body but exogenous insulin does not contain this
23
Q
does glucose cross the placenta
A
YES
24
Q
does insulin cross the placenta
A
NO
25
Glut 4
adipose tissue and skeletal muscle. it is the only insulin dependent transporter
26
Glut5
this is for fructose
27
Glut1
this is for RBCs, brain and cornea
28
Glut2
this is bidirectional- beta islet cells, liver, kidney and small intestine.
29
growth hormone relationship to glucose
growth hormones increases insulin release
30
beta blockers and insulin
beta blockers increase insulin
31
how is insulin secreted
glucose is brought into the cells, ATP is generated from glucose metabolism, this closes K+ channels, this depolarizes the cell membrane, this opens voltage gated calcium channels, resulting in Ca influx, this then stimulates exocytosis of insulin.
32
relationship between GnRH and prolactin
prolactin regulates GnRH secretion. high prolactin levels decrease GnRH. inhibits both GnRH synthesis and release
33
what does somatostatin do
decreases GH and TSH
34
what is the relationship between TRH and prolactin
TRH increases both TSH and prolactin
35
dopamine and prolactin
the hypothalamus secretes dopamine and this suppresses prolactin secretion from the anterior pituitary on a normal basis.
36
how does Growth hormone work
by stimulating linear growth and muscle mass trough IGF1 and somatomedin secretion. increases insulin resistance (can cause diabetes).
37
when is growth hormone secretion increased
during exercise and sleep. secretion is inhibited by glucose and somatostatin
38
where is ADH made
in the supra-optic nucleus, released by the posterior pituatary
39
what is the function of ADH
V1- regulates blood pressure and V2- regulates osmolarity by acting on free water. does this in the principal cells of renal collecting duct.
40
what disease has low ADH
diabetes insipidus
41
where is the mutation in nephrogenic diabetes insipidus
in the V2 receptor
42
what is a drug that is an ADH analog
Desmopressin.
43
what is elevated in 21 hydroxylase deficiency
androgens. you therefore see salt wasting and precocious puberty in boys and virilization of girls
44
what is elevated in 17 alpha hydroxylase deficiency
increased mineralocorticoids. you see low potassium and increased blood pressure. low androgens means ambiguous genitalia and lack of secondary sex deveopment
45
what is elevated in 11 beta hyroxylase deficiency
increased androgens and weak increased mineralocorticoids. looks like 21 but without the salt wasting. precocious puberty and virilization of girls
46
which andrenal cortex enzyme deficiency leads to increased 17 hydroxy progesterone
21 hydroxylase deficiency
47
what do the adrenal glands look like in enzyme deficiencies
increased or hyperplasia because of increased AcTH simtulation from low cortisol
48
function of cortisol on blood pressure
increases blood pressure by upregulating the lapha 1 receptor on arterioles so that increases sensitivity to epi and nor epi
49
how does cortisol mediate immune response
inhibits leukotriene and prostaglandin production
inhibitrs leukocyte adhesion- neutrophilia
blocks histamine release from mast cells
reduces eosinophils
blocks IL2 so can't activate T cells
50
adrenal gland size with exogenous steroid use
both are small
51
adrenal size with adrenal adenoma or carcinoma that secretes cortisol
the one secreting the stuff is big and the other is small.
52
what causes both adrenal glands to be large
both increased AcTH from a pituatary adenoma and from paraneoplastic syndrome. can distinguish by giving cortisol which will suppress the pituatary adenoma but not the paraneoplastic from like small cell lung cancer.
53
which cells secrete PTH
chief cells of the parathyroid gland
54
function of PTH
increase bone resorption of Ca and phosphorus
increase kidney re-absorption of Ca in distal convoluted tubule and dumping of phosphourus (decreased re-absorption in the proximal convoluted tubule)
increase vitamin D production by stimulating kidney 1-alpha hydroxylase
55
function of RANK-L
this is increased by PTH. it binds to RANK on the osteoblasts which then gets osteoclast stimulation and increased calclium. increases through NfKb ligand
56
common causes low magnesium
diarrhea, aminoglycosides, diuretics, and alcohol use
57
how does pH effect Ca
increase in pH means incrased affinity of albumin for calclium which means effective hypocalcemia. symptoms of low calclium
58
where is D3 from
the sun
59
where is D2 from
vegetables and oral intake
60
how is vitamin D made
first brought in and converted in the liver to 25-OH and then goes to the kidney to make 1,25 OH2
61
function of vitamin D
increases absorption of dietary Ca and phosphorous
| increased bone resorption of calcium and phosphorous
62
what is 24,25 (OH)2
this is an inactive form of D3
63
where is calcitonin made
parafollicular cells- C cells- of the thyroid
64
how do thyroid hormones increase basal metabolic rate
increase the K/Na ATPase function (this increases O2 consumption) and increase beta 1 adrenergic receptors so increase sympathetic activity in the body. also increases glycogenolysis and gluconeogenesis
65
where is most T3 formed
in the tissues of the body- in the target areas
66
Wolff Chaikoff effect
this is when excess iodine temporarily inhibits thyroid peroxidase and this decreases iodine organification and then this ultimately decreases T3/T4 production.
67
thyroxin binding globulin
this binds most T3/T4 in the blood. only free hormone is active
68
birth control pills and thyroid function
birth control pills increase thyroxin binding globulin so decreased thyroid hormone that is free
69
how to convert T4 to T3
5' deiodinase
70
what causes the striae with cushing syndrome
weak collagen and ruptured vessels
71
how does cortisol cause hypertension
increases alpha receptors on vessels- specificlaly arterioles and this leads to increased effect of norepi and hypertension
72
primary hyper-aldosteronism
this is caused by an aldosterone secreting tumor of the adrenal gland or just adrenal hyperplasia. an adenoma is called Conn syndrome. hypertension, hypokalemia, LOW renin, but normal Na because of aldosterone escape. treatment is surgical or spironolactone to decrease aldosterone
73
secondary hyper-aldosteronism
this is when the kidneys sense low volume and INCREASE renin so that they increase aldosterone. often due to renal artery stenosis (fibromuscular dysplasi) or CHF, cirrhosis etc. treatment- spironolactone. remember high renin here unlike primary hyper-aldosteronism
74
conn syndrome
aldosterone secreting adrenal adenoma
75
addison disease
adrenal insufficiency
76
3 causes of addison's disease
```
autoimmune
TB
Metastatic carcinoma (lung cancer loves the adrenal)
```
77
what is addison's disease
basically a deficiency in aldosteron and cortisol such that you get hypotension and hyperkalemia. they also get acidosis and skin and mucosal hyper pigmentation. this is from the increased AcTH that is turned into MSH from POMC. get bilateral adrenal atrophy. spares the medulla.
78
secondary adrenal insuficiency
this is from decreased AcTH. no skin pigmentation in this disease and no hyperkalemia
79
infectious agent assocaited with Waterhouse Friderichsen syndrome
acute primary adrenal insufficiency due to adrenal hemorrhage assocaited with Neisseria meningitidis septicemia, DIC and endotoxic shock. severe hypotension.
80
neuroblastoma
most common tumor of adrenal medulla in CHILDREN
occurs anywhere along sympathetic chain.
abdominal distension and a firm, irrgeular mass that can cross the midline (vs. Wilms tumors that do not cross).
81
how to diagnose neuroblastoma
homovanillic acid (HVA) - a breakdown product of dopamine- found in the urine.
bombesin positive.
associated with overexpression of N-myc oncogene
82
pheochromocytoma
tumor of chromafin cells. brown tumor. most common tumor of adrenal medulla in adults. derived from chromafin cells which arise from neural crest. cyclic hypertension, diarrhea, perspiration, palipitations, headache etc.
83
how to diagnose pheochromocytoma
increased urinary VMA (breakdown product of norepi and epi) and plasma catecholamines are elevated
84
what do patients with a pheo need before surgery
they need an alpha blocker like phenoxybenzamine (irreversible) and beta blockers to prevent any hypertensive issues when the tumor is removed.
85
patient has symptoms of a pheo when they pee?
check the bladder wall. 10% met and they love the bladder wall.
86
what is associated with myxedema (facial/periorbital)
this is associated with HYPOthyroidism. increased glycosaminoglycan in the larynx and throat can cause deepening of the voice.
87
what is associated with pre tibial myxedema
HYPERthyroidism. graves disease. can also see periorbital edema.
88
hyperthyroidism causes... (cholesterol levels)
Hypocholesterolemia.
89
Hashimotos thyroditis
hypothyroidism. anti thyroid peroxidase and anti-thyroglobulin antibodies. enlarged, non tender thyroid
90
genetic association HLA with hashimotos
HLADR5
91
cancer risk with Hashimotos
non hodgkin lymphoma. this is because there is chronic inflammation and formation of germinal centers.
92
hashimoto thyroid levels
may by hyperthyroid early on from toxicosis and rupture of cells and then become hypothyroid
93
histological findings in hashimoto
hurthle cells, lymphoid aggregate with germinal centers
94
congenital hypothyroidism
this is also known as cretinism. this is due to severe maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis iodine deficiency or dyshormonogenic goiter.
95
most common congenital thyroid enzyme deficiency
thryoid peroxidase
96
findings of congenital thyroid deficiency
```
Pot bellies
Pale
Puffy Faced
Protruding umbilicus (hernia)
Protuberant tongue
Poor brain development
```
97
subacute de Quervain thyroditis
self limited hypothyroidism usually after a viral infection (flu like illness). may be hyperthyroid early in the course. classic is TENDER thyroid. this is unique. histology shows granulomas.
98
findings in subacute de Quervains thyroiditis
tender thyroid
elevated ESR
jaw pain,
early inflammation
99
Riedel thyroiditis
disease of young females generally
thyroid replaced by fibrous tissue- become hypothyroid
fibrosis can extend to local structures like airway.
mimics anaplastic carcinoma.
classic is a hard as wood non tender thyroid. IgG systemic disease.
100
what drugs can cause hypothyroidism
lithium
101
multinodular goiter
this is toxic when the cells make thyroid hormone regardless of TSH stimulation. hot nodules are rarely malignant. this is due to a mutation in the TSH receptor.
102
Jod Basedown phenomenon
thyrotoxicosis is a patient with iodine deficiency goiter is given enough iodine to replenish it
103
what causes graves disease
auto antibodies (IgG) stimulate TSH receptors on thyroid. get a diffuse goiter. these antibodies also stimulate retro-orbital fibroblasts giving pre-tibial myxedema. often presents during stress such as childbirth
104
thyroid storm
complication of hyperthryoid conditions. stress induced catecholamine surge. can see increased alk phos from increased bone turnover. presents with agitation, delirium, fever, diarrhea, coma and tacchyarythmia.
105
treatment of thyroid storm
three Ps
propanalol (beta blocker)
propylthiouracil
Prednisone
106
scalloping of the colloid on histology
this is graves disease.
107
increased thyroid uptake on a scan
this means its probbaly graves or a nodular goiter.
108
decreased thyroid uptake on a scan
this is likely an adenoma or carcinoma.
109
how to biopsy the thyroid
FNA. they will bleed if you do an open biospy. be careful and always do a fine needle aspiration.
110
papillary carcinoma of the thyroid
most common thyroid cancer. empty or white appearing nuclei- orphan annie, psammoma bodies, nuclear grooves. good prognosis. increased risk with REt and BRAF mutations. goes to the cervical nodes but still good prognosis. can be seen in children who have had ionizing radiation.
111
follicular carcinoma of the thyroid
carcinoma if it invades the capsule
| adenoma if it does not invade the capsule
112
medullary carcinoma of the thyroid
from parafollicular C cells, make calcitonin, see sheets of cells in an amyloid stroma.
113
what genetic conditions are associated with medullary carcinoma of the thyroid
MEN2A, MEN2B, ret mutations
114
anaplastic carcinoma of the thyroid
bad diagnosis. older patients. invades local structures. this is different from reidel thyroditis because of the age group. both can cause invasion of local structures and dysphagia
115
what does elevated alk phos tell you
tells you there is osteoblast activity
116
primary hypoerparathyroidism
this is usually from an adenoma. causes hypercalcemia and hypercalciuria and low phosphate. get increased cAMP in the urine (because PTH works via Gs signaling). presents as stones, bones, moans and groans. can cause acute pancreatitis- HY
117
osteitis fibrsoma cystica
secondary to primary hyperparahtyroidism. when the bone gets replaced with fibrous tissue and cystic spaces. causes bone pain
118
secondary hyperparathyroidism
this is from decreased gut absorption of Ca most often from chronic renal disease (reduced vitamin D). high PTH but LOW calclium. high phosphate if it is from renal disease. low phosphate from anything else.
119
renal osteodystrophy
this is bone lesions due to secondary or tertiary hyperparathyroidism due in turn to renal disease. increased phosphate in the blood means it can bind calcium, which lowers free calcium levels
120
tertiary hyperparathyroidism
this is refractory or autonomous PTH production in the presence of chronic renal disease
121
Chovstek sign
tap on the facial nerve and contraction of the muscles. low calcium. often in hypoparathyroidism
122
trousseau sign
occlusion of the brachial artery with BP cuff leading to carpal spasm. this is a sign of low calcium from hypoparathyroidism
123
pseudohypoparathyroidism
also known as albright hereditary osteodystrophy
kidney is not responsive to PTH.
hypocalcemia, shortened 4th and 5th digits (if due to AD mutation in Gs), short stature.
124
shortened 4th and 5th digits, short stature and low calcium
this is pseudohypoparathyroidism. it is from an AD mutation in the G stimulatory protein that is used to signal through PTH. it makes the kidney unresponsive to PTH that is secreted.
125
what is the most common type of pituatary adenoma
prolactinoma
126
treatment for prolactinoma
dopamine agonist like bromocriptine or cabergoline
127
what other symptoms of prolactinoma other than galloctorrhea?
remember that prolactin decreases GnRH so you can get amenorhea in females and decreased libido in men. remember that women get gallactorrhea but men should not because they do not have any lobular units. only have terminal ducts and cant make milk.
128
excess GH in children
gigantism
129
excess GH in adults
acromegaly
130
most common cause of death from excess GH
cardiac failure
131
insulin and GH relationship
too much GH causes insulin resistance. nrmally oral glucose can reduce GH secretion
132
how to medically treat acromegaly
octreotide- this blocks the response to growth hormone releasing hormone
pegvismant- growth hormone receptor blocker
133
what is missing in diabetes insipidus
to little ADH
134
how to treat central diabetes insipidus
intranasal DDAVP and hydration
135
how to treat nephrgenic diabetic insipidus
HCTZ, indomethacin, amiloride, hydration
136
causes of siADH
ectopic ADH from small cell lung cancer, CNS disorders/head trauma, pulmonary disease, drugs like cycloposphamide
137
classic finding in siADH
urine osmolarity > serum osmolarity
138
dangerous complications of siADH
seizures and cerebral edema from the hyponatremia. must correct this slowly because need t prevent central pontine myelinolysis.
139
treatment of siADH
no water, democlocycline (ADH blocker)
140
two drugs that can cause nephrogenic diabetes insipidus
lithium and democlocycine
141
pituitary tumor in children
craniopharyngioma
142
sheehan syndrome
this is ischemic infarct to the pituatary usually following post partum bleeding- patients prevent with no lactation and important- LOSS OF PUBIC HAIR
143
genetic HLA association with type 1 diabetes
HLA DR3 and HLA DR4
144
complications of diabetes
non enzymatic glycosylation of the large vessels- atherosclerosis, small vessels- hyline arteriolosclerosis esp in the kidney and of hemoglobin- Ha1c elevation.
also get osmotic damage to the schwann cells and pericytes in the retina. the lens also accumulates sugar causing cataracts
145
what is classic finding in the kidney with diabetes
arteriolosclerosis of kidney. increased efferent involvement. nephrotic syndrome- sclerosis of the mesangium= kimmel steil wilson nodules
146
aldose ruductase
this turns glucose into sorbitol. sorbital dehydrogenase is not in every tissue to reduce the sorbital. this happens in the lens, pericytes, schwann cells. neuropathy and cataracts.
147
does type 1 or type 2 diabetes have a stronger genetic predominance
type 2
148
which diabetes causes hyper-osmolar non ketotic coma
type 2
149
which type of diabetes causes DKA
type 1 only!
150
how does obesity increase diabetes
decreases the number of insulin receptors on adipose tissue and skeletal muscle. this makes the tissue more resistant to insulin
151
which type of diabetes shows islet leukocyte infiltrate
type 1
152
which type of diabetes shows islet amyloid polypeptide (IAPP) deposits
type 2
153
what are kussmal respirations
rapid, deep breathing seen in DKA
154
potassium situation in DKA
they have hyperkalemia but this is because there is no insulin to put any into the cells and the reality is that the cells intracellularly are severely depleted of K+
155
treatment of DKA
fluids, insulin and K+ to replete the intracellular stores. if necessary give glucose to prevent hypoglycemia
156
lab findings in DKA
hyperglycemia, increased H+, decreased bicarb, (anion gap metabolic acidosis). increase ketones, hyperkalemia
157
whipple triad of episodic CNS symptoms with insulinoma
lethargy, syncope, and diplopia
158
somatstatinoma
this means too much stomatostatin.
decreased gastrin, decreased CCK
leads to low acid, gallstones, steatorrhea
159
VIPoma
this causes watery diarrhea, decreased K+, decreased gastric acid
160
gastrinoma
this is a gastrin secreting tumor of the pancreas or duodenum. causes too much acid to be secreted- zollinger ellison syndrome. recurrent ulcers in distal duodenum and jejunum. presents with abdominal pain, diarrhea. can be seen in MEN1
161
MEN1
parathyroid
pituatary adenoma
pancreatic endocrine tumor (gastirnoma, insulinoma, VIPoma, glucagonoma)
can present with kidney stones and stomach ulcers
162
MEN2a
parathyroid
phoechromocytoma
medullary carcinoma of the thyroid
163
MEN2b
pheochromocytoma
medullary carcinoma of the thyroid
oral or intestinal ganglineuromatosis- neuromas
associated with marfinoid habitus
164
what gene is assocaited with Men2a and 2b
ret gene
