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Endocrine Flashcards

1
Q

Causes of decreased Mg

A

Diarrhea, Aminoglycosides, Diuretics, Alcohol abuse

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2
Q

Control of blood flow to parathyroids?

A

Cervical sympathetic ganglia control blood flow to parathyroids

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3
Q

How does PTH activate osteoclasts?

A

PTH binds osteoblasts and causes increased production of macrophage colony stimulating factor and RANK-L –> RANK-L binds RANK receptor on osteoclasts to stimulate them and increase Ca

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4
Q

Where are parafollicular cells derived from?

A

Neural crest

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5
Q

Which endocrine hormones signal through cAMP?

FLATChAMP

A

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calcitonin, GHRH, Glucagon

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6
Q

Which endocrine hormones signal through cGMP?

Vasodilators

A

ANP, BNP, NO (EDRF)

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7
Q

Which endocrine hormones signal through IP3?

GOAT HAG

A

GnRH, Oxytocin, ADH (V1), TRH, Histamine (H1), Angiotensin II, Gastrin

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8
Q

Which endocrine hormones signal through intracellular receptors? VETTT CAP

A

Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone

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9
Q

Which endocrine hormones signal though intrinsic tyrosine kinase?

A

Insulin, IGF-1, FGF, PDFG, EGF (think growth factors)

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10
Q

Which endocrine hormones signal through receptor-associated tyrosine kinase?
PIGG(L)ET

A

Prolactin, Immunomodulators (IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoietin

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11
Q

Functions of T3 hormone (4 B’s)

A

Brain maturation
Bone growth (synergism with GH)
B-adrenergic effects (increased B1 receptors in heart = CO, HR, SV, contractility)
Basal metabolic rate increases (via increased Na/K ATPase activity –> increases O2 consumption, RR, body temp)

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12
Q

Mechanism of Propylthiouracil

Mechanism of Methimazole

A

Propylthiouracil inhibits peroxidase (oxidation and organification of iodide, coupling of MIT and DIT) and 5-deiodinase (converts T3 to T4)
Methimazole inhibits peroxidase only

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13
Q

What is the Wolff-Chaikoff effect?

A

Excess iodine temporarily inhibits thyroid peroxidase –> decreases iodine organification and T3/T4 production
-The reason Iodine can be used to treat hyperthyroidism

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14
Q

What is metyrapone stimulation used for?

A

Metyrapone blocks the last step of cortisol synthesis (11 deoxycortisol –> cortisol)
Normal response is a decrease in cortisol and compensatory increase in ACTH but in adrenal insufficiency ACTH remains decreased after test

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15
Q

What do you see in urine of patient with neuroblastoma?

A 
Homovanillic acid (HVA) - breakdown product of dopamine
Vainllylmandelic acid (VMA) - breakdown product of NE
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16
Q

Stains for neuroblastoma

A

Bombesin and neuron-specific enolase positive

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17
Q

EPO secreting tumors

A

Renal cell carcinoma
Hepatocellular carcinoma
Pheochromocytoma
Hemangioblastoma

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18
Q

Rule of 10s for pheochromocytoma

A 
10% malignant
10% bilateral
10% extra-renal (bladder wall)
10% calcify
10% kids
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19
Q

Associations of pheochromocytoma

A

Neurofibromatosis type 1
Von Hippel Lindau
MEN 2A and 2B

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20
Q

Urine of patient with Pheochromocytoma

A

Increased catecholamines and metanephrines in urine and plasma (vanillylmandelic acid)

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21
Q

Treatment for pheochromocytoma

A

IRREVERSIBLE alpha antagonist - Phenoxybenzamine followed by beta blocker prior to tumor resection

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22
Q

Increased CK from myopathy (w/o myoedema)

A

Hypothyroidism

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23
Q

Lab findings in hypothyroidism

A

Increased TSH
Decreased free T3 and T4
Hypercholesterolemia (from decreased LDL receptor expression)

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24
Q

Granulomatous inflammation of thyroid

A

Subacute thyroiditis (de Quervain)

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25
Tender thyroid
Subacute thyroiditis (de Quervain)
26
Thyroid replaced by fibrous tissue
Riedel thyroiditis
27
IgG4 related systemic disease manifestations
Autoimmune pancreatitis Retroperitoneal fibrosis Non-infectious atrocities Riedel thyroiditis
28
Rock like painless goiter
Riedel thyroiditis
29
Treatment for Thyroid storm
Propranolol Propylthiouracil Prednisolone
30
Ovarian tumor that presents as hyperthyroidism
Struma ovarii teratoma
31
How do beta blockers treat thyrotoxicosis?
Decreased peripheral conversion of T4 --> T3 by inhibiting iodithyronine deiodinase and block beta adrenergic receptors --> decrease HR and agitation
32
Complications of thyroid surgery
Hoarseness (recurrent laryngeal nerve damaged) Hypocalcemia (removal of parathyroid glands) Transection of recurrent and superior laryngeal nerves (during ligation of inferior thyroid artery and superior laryngeal artery)
33
Large cells with overlapping nuclei containing finely dispersed chromatin (empty nuclei with central clearing)
Orphan annie nuclei
34
Orphan annie nuclei and psammoma bodies
Papillary carcinoma of thyroid
35
Difference between follicular adenoma and follicular carcinoma
Carcinoma invades thyroid capsule | FNA can't distinguish
36
Tumor that produces Calcitonin
Medullary carcinoma of thyroid
37
How does medullary carcinoma of thyroid spread?
Hematogenous spread
38
Cancer associated with Hashimoto thyroiditis
Lymphoma (rapidly enlarging neck mass)
39
Albright hereditary osteodystrophy
Pseudohypoparathyroidism = unresponsiveness of kidney to PTH Hypocalcemia, shortened 4th/5th digits, short stature PTH levels are high
40
Familial hypocalciuric hypercalcemia
Defective Ca sensing receptor on parathyroid cells | PTH cannot be suppressed by increased Ca level --> mild hypercalcemia with normal to increased PTH levels
41
Calcium levels in acute pancreatitis
Hypocalcemia - Ca precipitates out of abdomen
42
Lab findings in primary hyperparathyroidism
``` Increased PTH Hypercalcemia Hypercalciuria Hypophosphatemia Increased ALP (sign of osteoblast activity) Increased cAMP in urine ```
43
Chronic renal failure labs
Hypocalcemia Hyperphosphatemia (can't excrete it) Increased PTH
44
Lamellar bone structure resembling mosaic pattern
Pagets
45
Osteoid matrix accumulation around trabeculae
Vit D deficiency
46
Spongiosa filling medullary canals with no mature trabeculae
Osteopetrosis
47
Trabecular thinning with few connections
Osteoporosis
48
Treatment for prolactinoma
(Dopamine agonists) Bromocriptine Cabergoline
49
GH effects on glucose
GH decreases glucose uptake | Can cause secondary diabetes
50
Most common cause of death in Acromegaly
Heart failure
51
Treatment for Acromegaly
Removal of pituitary adenoma Octreotide (somatostatin analog) Pegvisomant (growth hormone receptor antagonist)
52
Diagnosis of Diabetes Insipidus
Urine specific gravity 290 mOsm/kg | Hyperosomotic volume contraction
53
Treatment of Central DI
Intranasal desmopressin acetate | Hydration
54
Treatment of Nephrogenic DI
HCTZ, Indomethacin, Amiloride | Hydration
55
How does body respond to water retention in SIADH?
Body responds with decreased aldosterone (hyponatremia) to maintain near-normal volume status
56
Causes of SIADH
Trauma to head/CNS disorders Ectopic ADH (small cell lung cancer) Pulmonary disease Drugs (Cyclophosphamide)
57
Treatment of SIADH
``` Fluid restriction IV hypertonic saline Conivaptan - ADH antagonist Tolvaptan - ADH antagonist Demeclocycline - ADH antagonist ```
58
What is pituitary apoplexy?
Sudden hemorrhage of pituitary gland - often in presence of existing pituitary adenoma
59
Secondary diabetes
Due to unopposed secretion of GH and epinephrine
60
Complications of diabetes mellitus
1. Nonenzymatic glycation: a. small vessel disease causes retinopathy, glaucoma, neuropathy, nephropathy and b. large vessel disease atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene 2. Osmotic damage: sorbitol accumulation in organs with aldose reductase and absent orbital dehydrogenase --> neuropathy and cataracts
61
What is Kussmaul breathing?
The body's way of compensation for metabolic acidosis; trying to breathe off CO2 - happens in Diabetic ketoacidosis; rapid deep breathing
62
Why is there hyperkalemia in DKA?
H+/K+ exchanger is trying to pull H+ into cells because of metabolic acidosis --> then Kidney compensates and gets rid of K+ so total body K+ will be low
63
Why does hyperosmolar coma happen in type 2 DM instead of DKA?
There is some insulin in Type 2 so the insulin prevent lipolysis, B oxidation and ketone production
64
a. Histology of Type 1 DM | b. Histology of Type 2 DM
a. Islet leukocytic infiltrate | b. Islet amyloid polypeptide (IAPP) deposits
65
Precipitating factors of DKA
Increased insulin requirements due to stress (infection)
66
Complications of DKA
Mucormycosis Cerebral edema Cardiac arrhythmias Heart failure
67
Dermatitis, Diabetes, DVT, Depression and Anemia
Glucagonoma
68
Treatment of hypoglycemia
In medical setting - IV glucose | In emergency non-medical setting - IM glucagon
69
Necrolytic Migratory Erythema
Seen in Glucagonoma Erythematous papules, plaques on face/perineum/extremities Lesions enlarge and coalesce leaving a bronze colored, central indurated area with blistering/scaling
70
5-Hydroxyindoleacetic acid (5-HIAA) in urine
Carcinoid syndrome
71
MEN 1
``` Parathyroid tumors (100%) Pituitary tumors (prolactin or GH) Pancreatic endocrine tumors (ZE, insulinoma, VIPomas, glucagonomas) ```
72
MEN 2A
Parathyroid hyperplasia (20%) Pheochromocytoma (45%) Medullary thyroid carcinoma (secretes calcitonin) Associated with marfanoid habitus (mutation in RET gene)
73
MEN 2B
Pheochromocytoma Medullary thyroid carcinoma Oral/intestinal ganglioneuromatosis (Mucosal neuromas) Associated with Marfanoid habits (mutation in RET gene)
74
Septicemia, DIC, adrenal hemorrhage, petechial rash
Waterhouse-Friderichsen syndrome from N. meningitidis
75
Derivatives of neural crest cells
``` Chromatin cells Parafollicular cells of thyroid Schwann cells Autonomic nervous system Dorsal root and celiac ganglia Melanocytes Cranial nerves Pia and arachnoid Odontoblasts Skull bones Aorticopulmonary septum ```
76
N-myc oncogene overexpression and homer-wright rosettes
Neuroblastoma
77
Drugs that cause hypothyroidism
Lithium - inhibits uptake and organification of iodine by thyroid gland and inhibits peripheral conversion of T4 to T3 Amiodarone
78
Plasma antimicrosomal (antiperoxidase) antibodies and lymphocytic infiltrate
Hashimoto's thyroiditis
79
Gestational diabetes predisposes newborns to what?
Macrosomia Hypoglycemia Respiratory distress syndrome (Insulin inhibits surfactant synthesis)
80
What is Whipple's triad?
Hypoglycemia Symptoms that are attributed to hypoglycemia Resolution of symptoms with eating

Step 1 AB (29 decks)

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