Endocrine

Question 1

What is should be suspected if a patient is found to have elevated Calcitonin and mucosal neuromas?

Answer 1

MEN2B

• • Medullary Carcinoma
• • Pheochromocytoma
• • Marfan’s-like Syndrome

Question 2

If a patient is found to have excessive Gastrin levels and hypercalcemia, what might you be suspicious of/

Answer 2

MEN1

• • Parathyroid Carcinoma – Elevated PTH
• • Pancreatic Tumor (Gastrinoma 95%)
• • Pitutary Adenoma (Prolactinoma)

Question 3

If a patient is found to have a pheochromocytoma and elevated calcitonin, what might need evaluation?

Answer 3

Need to evaluate for Parathyroid Tumor

• • MEN2A
• Medullary Carcinoma
• Pheochromocytoma
• Parathyroid Tumor

Question 4

If a male presents with infertility and is very tall on exam, but smaller than average testicles, might might be diagnostic?

Answer 4

Elevated FSH

• • Klinefelter’s Syndrome
• • Testicles no longer work in producing androgens and there is a high Estrogen:Androgen ratio producing gynocomastia
• • reduced spermatogenesis

Question 5

What should be used to reduce LH and FSH secretion from the hypothalamus/pituitary?

Answer 5

Leuprolide — constant, to inhibit GnRH, thus reducing LH/FSH

Question 6

What pharmacologic agents reduces the conversion of Testosterone to DHT for BPH?

Answer 6

Finasteride

— blocks 5-alpha reductase in prostate

Question 7

What agent can be used to block androgen receptors?

Answer 7

Flutamide — however due to negative feedback can cause increased LH/FSH to overcome inhibition, so need to use Leuprolide as well.

Question 8

Why would someone with pituitary adenoma secreting ACTH (ectopic too) cause amenorrhea in a female?

Answer 8

ACTH – induces increased cortisol production in the adrenal fasciculata (hyperplasia), but if untreated with continued ACTH adrenal reticularis will become hyperplastic secreting androgens – inhibiting LH/FSH.

Question 9

If you give a patient a dose of Metyrapone what are you testing?

Answer 9

Metyrapone - inhibits 11-B-hydroxylase in adrenal cortisol synthesis, which SHOULD cause an INCREASE in ACTH production (surge) to produce more cortisol.
– Testing Hypothalamic-Pituitary Axis
If no increase, then failure in hypothalamus to detect a decrease in cortisol

Question 10

What is a distinct finding of Klinefielters?

Answer 10

Elevated FSH

Question 11

If you find a patient to have elevated Acid Phosphatase, what might be occuring within the patient?

Answer 11

Increased osteoclast bone reabsorption

Alk Phosphatase is usually used by osteoblasts to lay down osteoid

Question 12

What is the cause of proptosis in hyperthyroidism?

Answer 12

From infiltration of T-cells which induce a localized inflammatory reaction/cytokine release causing swelling and pushing out of the eyes.

• • can lead to dysfunction of extraoccular muscles as well
• *Treat with Prednisone**

Question 13

What is defective in a Her-2 positive breast cancer?

Answer 13

ERB-B2 gene defect – Tyrosine Kinase Receptor

Her-2/Neu gene

Question 14

Thyroid Disease – Germinal Centers

Answer 14

Hoshimato Thyroiditis

Question 15

What type of thyroid histolgoy causes PAINFUL thyroid?

Answer 15

DeQuervian Thyroiditis

– Mixed Cell Infiltration with Giant Cells

Question 16

What are the differentials when there is extensive fibrosis the thyroid into surrounding tissue?

Answer 16

Riedel’s Thyroiditis – usually younger

Anaplastic Thyroiditis – high mortality and older people

Question 17

What pathology of the thryoid will have cells with empty nuclei and psammona bodies?

Answer 17

Papillary Thyroid Cancer

• • Orphan Annie Eyes
• • Psammona Bodies

Question 18

What is a common side effect of Anti-thryoid medications?

Answer 18

Agranulocytosis

• • Methimazole — tetrogenic
• • Propylthiourical – heptatoxicity