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Surgery > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Follicular cells

A

in thyroid

produce and store T3 and T4, thyroglobulin

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2
Q

Parafollicular cells

A

in thyroid
aka C cells
secrete calcitonin

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3
Q

Thyroid Nodule

A

F>M
Features: feeling of choking, difficulty breathing or swallowing
Dx: TSH level, Fine-needle aspiration, US
Tx: low risk = observe 3-6 months, give oral TH
high risk = surgical resection

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4
Q

Graves Disease

A

Cause: ab to TSH receptors
Features: diffuse goiter with hyperthyroidism, exophthalmos, tachycardia, tremor, heat intolerance, weight loss, pretibial myxedema.
Dx: thyroid function tests.
Tx: 1. medical blockade (PTU, methimazole)
2. radioiodine ablation
3. surgical resection
beta blockers ameliorate some effects of TH, used for short term management until surgery

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5
Q

Toxic Adenoma

A

solitary tumor of thyroid causing excessive amounts of TH and hyperthyroidism.
Features: similar to graves disease
Dx: high T3 and T4, suppressed TSH, thyroid normal or small with nodule on exam.
Tx: thyroid lobectomy and isthmectomy

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6
Q

Plummer’s Disease

A

aka toxic multinodular goiter

Tx: total thyroidectomy

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7
Q

Papillary Carcinoma of Thyroid

A

from follicular cells.
most common thyroid malignancy
Features: psammoma bodies (layers of calcium), grow slowly, good prognosis.
Bad prognosis = over 50yr, male, larger than 4cm
Tx: surgery
Metastases = bones and lungs

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8
Q

Follicular Carcinoma of Thyroid

A

second most common thyroid malignancy
from follicular cells.
Features: similar to follicular adenomas but have capsular and vascular invasion, good prognosis.
Tx: surgery

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9
Q

Medullary Carcinoma of Thyroid

A

in parafollicular cells.
20% AD inheritance or MEN2A or 2B
in both thyroid lobes.
50% 10 yr survival
Dx: plasma screening with elevated calcitonin, Ca and Pentagastrin infusion test show increased calcitonin.
Tx: without LN mets = total thyroidectomy and central lymph node dissection
LN mets = radical lymph node dissection

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10
Q

Anaplastic Carcinoma of Thyroid

A

aggressive, undifferentiated
from follicular cells
Bad prognosis
<2yr survival

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11
Q

Lymphoma of Thyroid

A

Features: present as thyroid mass.
Dx: core needle or open biopsy

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12
Q

Primary Hyperparathyroidism

A

Cause: pituitaryr adenoma (prolactinoma), parathyroid hyperplasia, or parathyroid carcinoma
Features: urolithiasis, bone disease, abdominal pain, muscle/joint pains, fatigue/lethargy, depression/psychosis.
“stones, bones, groans, moans, psych overtones”
Dx: elevated PTH, low serum phosphate, normal renal function, hypercalcemia
Adenoma = one large gland
Hyperplasia = all glands large
Tx: acute severe hypercalcemia = large volume saline infusion, furosemide
surgery

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13
Q

Secondary Hyperparathyroidism

A

in renal failure patients.
Cause: phosphate retention and low calcium from renal failure. leads to high PTH, parathyroid hyperplasia, hyperphosphatemia. Also from lack of Vit D
Featuers: bone pian, calcinosis, pruritus
Dx: high PTH, high Cr, hyperphosphatemia
Tx: dialysis, vit D supplement, oral phosphate binders, cinacalcet
renal transplant

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14
Q

Tertiary Hyperparathyroidism

A

secondary hyperparathyroidism with one or more glands that autonomically produce PTH.
Dx: high PTH even after renal transplant, hypercalcemia
Tx: acute severe hypercalcemia = large volume saline infusion, furosemide

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15
Q

Adrenal Cortex

A

3 layers:

  1. zona glomerulosa = mineralocorticoids = aldosterone
  2. zona fasciculata = cortisol
  3. zona reticularis = sex steroids
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16
Q

Aldosterone

A

t1/2 = 15 min
metabolized by liver
regulated by RAS and plasma potassium concentration
causes Na resorption in kidney, K wasting
hypersecretion = Conn’s syndrome

17
Q

Conn’s Syndrome

A

hypersecretion of aldosterone (primary aldosteronism)
cause: adrenal adenoma, diffuse hyperplasia, nodular/adenomatous hyperplasia of adrenal cortex, ACC
Features: hypokalemia, HTN, muscle weakness, metabolic alkalosis, hypomagnesemia, tetany, 2:1 F:M, 30’s - 50 yrs, not suppressed by salt loading.
Dx: elevated serum and urinary aldosterone, suppressed renin, elevated aldosterone-to-renin ratio, sodium loading to rule out secondary cause, CT abdomen, adrenal venous sampling
Tx: unilateral aldosteronoma = spironolactone and then lap adrenalectomy unilateral
bilateral adrenal hyperplasia = spironolactone

18
Q

Cushing Syndrome

A

ACTH-dependent or -independent hypercortisolism
1. ACTH-independent = exogenous steroid use, adenoma, adrenal cortical carcinoma, bilateral adrenal hyperplasia
2. ACTH-dependent = excessive CRH, pituitary adenoma, extrapituitary ACTH-producing tumors
Features: 20-40yrs old, 4:1 F:M, truncal obesity, HTN, diabetes, weakness, purple striae, hirsutism, moon facies, buffalo hump
If due to ectopic ACTH and pituitary tumors then melanotropins are secreted and have increased skin pigmentation.
Dx: urinary free cortisol , late-night salivary cortisol, 1mg dexamethasone suppression test.
then measure plasma ACTH, suppressed = primary adrenal tumor.
increased ACTH => pituitary MRI

19
Q

Cushing Disease

A

pituitary adenoma producing bilateral adrenal cortical hyperplasia.
Features: truncal obesity, HTN, diabetes, weakness, purple striae, hirsutism, moon facies, buffalo hump
Dx: bilateral cortical hyperplasia, pituitary adenoma
Tx: temporary = metyrapone, ketoconazole, aminoglutethimide, radiation.
surgery = transsphenoidal microadenomectomy, if fails then bilateral lap adrenalectomy/radiotherapy/hypophysectoy.
Side effects of bilateral adrenalectomy = Nelson’s syndrome = hyperpigmentation, headaches, exophthalmos, visual field loss.

20
Q

Adrenal Adenoma

A

number one cause of primary adrenal hypercoritsolism (Cushing syndrome)
Features: increased cortisol, decreased ACTH, atrophy of remaining ipsilateral adrenals and contralateral adrenals.
Tx: lap unilateral adrenalectomy, perioperative steroids, postop perdnisone until normal adrenal function

21
Q

Adrenal Cortical Carcinoma

A

causes Cushing syndrome
Features: peak incidence 30-50yrs, L>R, F>M, hormone hypersecretion, poor prognosis, large (>6cm), friable, necrotic center and hemorrhage, stippled calcifications, extension through adrenal vein into renal vein or IMV, virilizing/feminizing, aldosterone secreting
Dx: CT
Tx: open unilateral adrenalectomy

22
Q

Primary Adrenal Hyperplasia

A

causes Cushing syndrome
both sides hyperplastic
either:
1. PPNAD = primary pigmented nodular adrenocortical disease
2. AIMAH = ACTH-independent macronodular adrenal hyperplasia
Tx: bilateral adrenalectomy laparascopically

23
Q

Bilateral adenomas

A

cortisol secreting

Tx: bilat cortical-sparing lap adrenalectomy

24
Q

Incidentaloma

A

arenal mass discovered on CT, MRI, or US.
80% non-functioning, 5% subclinical Cushing syndrome,5% pheochromocytoma
Dx: dexamethosone suppression test, plasma metanephrines, adrenal biopsy if a met
Tx: f/u radiographic testing 3-6 months then 1-2 yrs and hormonal disturbance evals
pheos should be resected

25
Q

Pheochromocytoma

A

arise from adrenal medulla
Features: produces NE and/or Epi, episodic HTN, palpitations, HA, sweating, sense of impending doom
associated with von HIppel-Lindau, von Recklinghausen’s disease, Sturge-Weber syndrme.
Dx: urine metanephrine, plasma metanephrine and normetanephrine, CT or MRI
Tx: phenoxybenzamine or alpha-methyltyrosine then beta blocker 10 days prior to surgery. remove by lap adrenalectomy or cytoreductive resection

26
Q

MEN1

A

autosomal dominant
gene encoding menin on chromosome 11
1. parathyroid hyperplasia (most common)
mean age 25yr, affects all glands, hypercalcemia, weakness/fatigue/irritability/depression, urolithiasis, hypercalciuria, PUD, pancreatitis, decreased bone density, bone pain/fracture
Dx: serum calcium and PTH, sestamibi radionuclide scan
Tx: full or partial parathyroidectomy, cervical thymus removal
2. pancreatic islet cell
starts after age 40yr
secrete insulin/gastrin/glucagon, VIP. somatostatin, GRF.
most common nonfunctioning is PP (pancreatic polypeptide), most common functioning is gastrin
Tx: control with medications, surgery for insulinoma
3. pituitary tumor
prolactinoma
sometimes carcinoid tumor or lipoma

27
Q

Gastrinoma

A

cause Zollinger Ellison syndrome
proximal pancreas and duodenal wall
Features: elevated gastric acid >100, basal output >15 causing severe PUD, secretory diarrhea, esophagitis
Dx: secretin stimulation test with gastrin >200

28
Q

Insulinoma

A

Features: drowsiness, seizures, coma, weight gain
Dx: supervised fast with triad of 1. neuroglycopenic symptoms, 2. glucose 5 within 72 hours of fast, elevated c-peptide and proinsulin levels

29
Q

Glucagonoma

A

Features: hyperglycemia, cachexia, anemia, necrolytic migratory erythema (red, scaling, pruritic, migratory rash)
Dx: elevated glucagon levels

30
Q

VIPoma

A

Features: profuse watery diarrhea, severe hypokalemia, hypochlorhydria
Dx: excluded by stool volume <700, confirmed by elevated VIP levels

31
Q

Somatostatinoma

A

Features: cholelithiasis, hyperglycemia, weight loss, steatorrhea
Dx: elevated somatostatin levels

32
Q

GRFoma

A

Features: acromegaly
Dx: elevated GRF

33
Q

Prolactinoma

A

secretes prolactin
Features: irregular menses, galactorrhea, infertility, impotence, bitemporal hemianopsia
Dx: elevated prolactin, CT or MRI
Tx: bromocriptine, resection via transsphenoidal route or craniotomy

34
Q

MEN 2A

A 
autosomal dominant
1. primary hyperparathyroidism
2. pheochromocytoma
3. medullary thyroid carcinoma
death from MTC
35
Q

Medullary Thyroid Carcinoma

A

mutated RET protooncogene
occurs in C cells of thyroid
Prevention: RET positive should undergo total thyroidectomy before age 6
Mets to lung, liver, and bone

36
Q

MEN 2B

A
  1. pheochromocytoma
  2. medullary thyroid carcinoma
  3. marfinoid habitus/prognathism, puffy lips, bumpy tongue, hyperflexible joints, ganglioneuromas
    RET positive
    early metastases from MTC
    Tx: total thyroidectomy by age 6 months

Surgery (11 decks)

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