- Episodic hypoglycemia and mental status changes that improve with glucose - Have low glucose, high insulin, and high C peptide (indicating endogenous insulin production) - Treat with surgical resection

- Inhibits gastrin (results in acholhydria) and CCK which promotes contraction of the gall bladder (can lead to stone and steanorrhea)

Endocrine Flashcards by Elizabeth Ludwig

Glucagonoma

Tumor of the pancreatic a cells

4 Ds: dermatitis (necrolytic migratory erythema); diabetes (hyperglycemia), DVT, and depression

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Insulinoma

Episodic hypoglycemia and mental status changes that improve with glucose
Have low glucose, high insulin, and high C peptide (indicating endogenous insulin production)
Treat with surgical resection

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Gatrinoma / Zollinger Ellision syndrome

Gastrin producing tumor of pancreas of duodenum that results in treatment resistant peptic ulcers that can extend into jejunum
Sx: abdominal pain, diarrhea (malabsorption)
Test: exogenous secretin (S cells secreted in duodenum to decrease gastric acid sectretion) does not decrease gastrin levels
Associated with MEN 1

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Somatistatinoma

Inhibits gastrin (results in acholhydria) and CCK which promotes contraction of the gall bladder (can lead to stone and steanorrhea)

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VIPoma

Vasoactive peptide inhibits gastric acid secretion

Watery diarrhea, hypokalemia, and acholorhydria (WDHA syndrome - Watery Diarrhea, Hypokalemia, Acholorhydria)

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Which structure connects the thyroid gland with the tongue?

thyroglossal duct

reminent in adult is the foramen cecum, a divot at the merge pt of the 3 parts of the tongue

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How can you differentiate a thyroglossal duct cyst from a branchial cleft cyst?

TGD cyst is midline and motile (will move with swallowing), comes from patent thryoglossal duct
Branchial cleft cyst is lateral and derives from persistent cervical sinus

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What are parafollicular cells in the thyroid dervied from and what cancer do they cause?

neuroendocrine cells
secrete calcitonin
cause medullary thyroid cancer (v aggressive)

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What are the name of the carrier proteins that transport posterior pituitary hormones from the hypothalamus?

Neurophysins

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GLUT 1

Non insulin dependent

Brain, cornea, RBCs

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GLUT 2

liver, kidney, small intestine, beta islet cells
bi-directional
High Vmax, high Km

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GLUT 3

Brain

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GLUT 4

Insulin dependent (insulin upregulates their presence on cell surface)
Muscle and adipose
Low Km (high affinity), low Vmax

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GLUT 5

fructose transporter

Spermatocytes, GI tract

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What is another name for IGF-1?

Somatomedin C

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What are the common causes of hypomagnesemia?

Diarrhea
Diuretics
Alcohol Abuse
Aminoglycosides (gentamycin, etc)

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What are the effect(s) of magnesium on PTH?

1) Mild hypomagnesemia causes increase in PTH secretion

2) Gross hypomag causes decrease in PTH secretion

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Which hormones use Gas receptors?

FSH, LH, ACTH, TSH [FLAT]
CRH, GHRH
PTH, calcitonin
MSH
ADH (V2)
hCG

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What hormones signal through cGMP?

ANP, BNP, NO (EDRF)

Think vasodilation

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What hormones signal through Gq?

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

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What hormones signal via an intracellular receptor?

Cortisol, aldosterone, T3/T4, progesterone, estrogen, vitamin D

What hormones signal through an intrinsic tyrosine kinase receptor?

Insulin, IGF-1, FGF, PDGF, EGF

What hormones signal through a receptor associated tyrosine kinase?

Prolactin, Immunomodulators (IL2, IL6, etc), GH, G-CSF, EPO, TPO

Effects of Sex Hormone Binding Globulin Levels on Men and women

Increase SHBG in men decreases free testosterone, gynocomastia
Decreases in SHBG in women increase free testosterone, cause hirrsuitism
Increase SHBG (women) due to pregnancy or OPCs do nothing, free estrogen levels unchanged

What are the classic signs associated with a neuroblastoma?

kid

Differences between neuroblastoma and willms tumor?

NB irregular, crosses midline | Wilms: renal tissue, smooth, never crosses midline, slightly older kids >4

What are pheos associated with?

MEN2A, MEN2B, neurofibromatosis type 1, von Hippel Lindau

What is the rule of pheos?

``` Rule of 10% Malignant Kids Calcify Extra-renal Bilateral ```

What is the pathonomonic presentation of congenital hypothyroidism?

``` "Cretinism" : 6 Ps, seen in kids Pot bellied Protruding umbilicus Pale Puffy faced Proturberant tongue Poor brain development ```

What are the pathnomonic cells seen in Hashimotos thyroiditis?

Hurthle cells

What is the pathonomonic finding of the histology in Graves disease?

Scalloping of the colloid

What are the pathonomonic findings in Papillary carcinoma (histology)?

Orphan annie eyed nuclei Nuclear creases/ grooves Psommoma bodies (RET and BRAF mutation, kids radiation for acne)

What is unique about follicular carcinoma?

Hematogenous spread

What vitamin deficiency is associated with carcinoid tumors?

Niacin (B3) pellagra | Dermatitis, Diarrhea, Dementia

What breakdown product do you find in the urine in a patient with a carcinoid tumor?

5-HIAA (5-hydroxyindoleacetic acid)

What is the rule of 1/3 associated with carcinoid tumors?

1/3 metastisize 1/3 present with a second malignancy 1/3 are multiple Most common malignancy in the small intestine

What is the progression of kidney pathology in DM?

mesangial expansion --> nodular glomerulosclerosis (KW nodules) + with thick basement membranes

What is tolbultamide and what is its main side effect?

first generation sulfonalurea (chlorpropamide) | Disulfram like reaction

Neuroblastoma key pts

MCC adrenal tumor in children N-Myc Homer Wright Rosettes Firm, irregular mass that can cross the midline Opthoclonus, myoclonus; HVA/VMA in urine, Bombesin, endolase + ,

Important disease that are AR inherited?

CF, phenylketonuria, thalasemia, sickle cell, lysosomal storage disease, infant polycystic kidney disease, and hemochromatosis

What is the mode of inheritance of the MEN diseases?

HLA DR3 associations

DM1, Graves, Hashimotos, SLE

HLA DR4 associations

Rheumatoid arthritis, DM1

HLA DR5 associations

Hashimotos, pernicious anemia

What is the pathophysiology associated with bone pain due to primary hyperparthyroidism?

osteitis fibrosis cystica lytic bone lesions filled with brown fibrosis from hemmorhage and hemosiderin pick up by macrophages often seen in the jaw

What is the most common cause of hypopit in kids?

craniopharyngeoma

What cardiac abnormalities are associated with carcinoid tumors?

RIGHT SIDED HEART LESIONS | Tricuspid regurg, pulmonic stenosis

What are the common symptoms of hypoglycemia?

Lethargy, syncope, diplopia

Which cancers is bombesin a marker for?

Neuroblastoma; small cell lung cancer; gastric carcinoma, pancreatic carcinoma

From what cell line does a tumor that stains positive for Bombesin, neuron specific enolase, and chromogranin come from?

NEURAL CREST CELLS

What does the RET gene code for?

Tyrosine kinase receptors