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ENDOCRINE Flashcards

0
Q

What are the most common adrenal tumors in adult and children patients?

A

Adult pheocromocitoma

Children neuroblastoma

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1
Q

What hormones are secreted by anterior pituitary?

A 
FSH
LH
ACTH
GH
TSH
MSH
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2
Q

What hormones are secreted in posterior pituitary?

A

ADH

Oxytocin

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3
Q

Explain different Glucose transporter

A 
INSULIN INDEPENDENT
GLUT-1 RBCs brain cornea
GLUT-2 B-cells , liver, kidney, S. Intestine
GLUT-3 Brain
GLUT-5 spermatocyte (fructose)

INSULIN DEPENDENT
GLUT-4 adipose tissue striate muscle

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4
Q

What is the relation between dopamine , prolactine, GnRH ,FSH

A

Dopamine❎ prolactine ❎ GnRH ✅ FSH LH

TRH✅ prolactine

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5
Q

Management of HIV lipodistrophy?

A

Tesamorelin

GHRH analog

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6
Q

What’s the Somatostatin function?

A

⬇️GH

⬇️TSH

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7
Q

What’s the bromocriptine use?

A

Dopamine analog

Used in prolactinoma

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8
Q

What’s the activity of somatomedine C (IGF-1) in glucose?

A

⬆️insulin resistance

DIABETOGENIC

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9
Q

What’s the function of Ghrelin and Leptin?

A

Ghrelin : ⬆️ Hunger
Leptin: satiety hormone
Endocanabinoides desire of fat food

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10
Q

What’s the presentation of deficiency of 17alfa hydroxylase?

A

XY pseudohermafroditism

XX lack of 2 sexual development

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11
Q

What’s the presentation of 21alfa hydroxylase deficiency ?

A

Precocious puberty
XX virilization
⬆️renin activity

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12
Q

What’s the presentation of 11 beta hydroxylase deficiency ?

A

XX virilization

⬇️ Renin activity

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13
Q

What’s the anti inflammatory effects of cortisol?

A 
❎ LKTs , PGs
❎ WBCs adhesion, neutrophilia
❎ Histamine release 
❎ eosinophils
❎ IL-2
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14
Q

What is the relation between pH and calcium?

A

⬆️pH leads to ⬆️calcium bound to albumin

HYPOCALCEMIA

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15
Q

What are the sources of Vit D?

A

Vit D3 🌞
Vit D2🌿

Liver – 25-0H –Kidney—1,25-OH

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16
Q

What’s the PTH function in Ca and PO4?

A

⬆️️️ Ca reabsortion ⬇ PO4 reabsortion
⬆️ macrophage colony stimulate
⬆️ RANK-L ✅ osteoclasts

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17
Q

Relation between PTH and Mg

A

⬇️Mg leads to ⬆️ PTH

⬇️⬇️ Mg leads to ⬇️ PTH

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18
Q

What’s the activity of calcitonin?

A

Opposite of PTH

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19
Q

What’s the consequence of alteration of sex hormone binding globulin levels?

A

Men ⬆️ SHBG leads to gynecomastia

Women⬇️SHBG leads to hirsutism

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20
Q

What’s the function of T3 ( 4Bs)

A

Brain maturation
Bone growth
B-adrenergic effects
Basal metabolic rate

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21
Q

What’s wolf chaickof effect?

A

Too much iodine leads to ❎peroxidase

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22
Q

What’s the function of peroxidase?

A

Oxidation
Organification
Coupling

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23
Q

What’s the function of propiltiuracil and metimazol?

A

Propiltiuracil ❎ peroxidase ❎ 5-deiodinase

Metimazol ❎ peroxidase

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24
Q

What’s Cushing disease?

A

ACTH secreting pituitary adenoma

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25
Q

How screening Cushing syndrome?

A

If ⬇️ACTH do MRI to look for adrenal tumor

If ⬆️ACTH is a ACTH dependent Cushing syndrome
You have to differentiate whit hi dose dexamethasone or CRH stimulation between ectopic or Cushing disease

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26
Q

What’s metyrapone stimulation test?

A

Metyrapone blocks the last step of cortisol synthesis
Block 11deoxycortisol to cortisol
Normal ⬆️ACTH

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27
Q

Causes of primary adrenal insufficiency ?

A

Hemorrhage
Addison disease ( autoimmune, TB, metastasis)
Waterhouse friederichsen syndrome (N. Meningitides)

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28
Q

What’s the clinical presentation to primary adrenal deficiency(4) ?

A

Hypotension
Hyperkalemia
Metabolic acidosis
Skin mucosa hyper pigmentation

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29
Q

What’s the clinical presentation to secundary adrenal deficiency(2) ?

A

Same whit out
Hyperkalemia
Hyper pigmentation

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30
Q

What’s the clinical presentation to tertiary adrenal deficiency) ?

A

Abrupt whit drawl of steroids

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31
Q

Very important features of neuroblastoma

A

Children

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32
Q

Pheocromocitoma 10a rule (5)

A

10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids

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33
Q

Pheocromocitoma associations (4)

A

neurofibromatosis type 1 (NF-1)
von Hippel-Lindau disease (VHL)
MEN 2A and 2B. (RET)

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34
Q

Treatment of pheocromocitoma ?

A

FIRST IRREVERSIBLE ALFA ANTAGONIST Phenoxybenzamine

SECOND beta blockers

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35
Q

What type of cancer is associated whit hashimoto thyroiditis?

A

Non-Hodking lymphoma

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36
Q

Histologic findings hashimoto disease

A

Hurthle cells

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37
Q

Features of Subacute thyroiditis (de Quervain)

A

Very tender
Early hyperthyroidism follow by hypothyroidism
Following flu like symptoms

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38
Q

What’s Riedel thyroiditis?

A

Fibrous tissue replacement of thyroid
Autoimmune pancreatitis
Retro peritoneal fibrosis
Aortic is no infectious

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39
Q

What’s toxic multinodular goiter?

A

Mutation of TSH receptor

Follicles work independently

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40
Q

Treatment of thyroid storm?

A

Propanolol
Propylthiouracil
prednisolone

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41
Q

Surgery complications of thyroidectomy

A

Hoarseness damage laryngeal recurrent
HYPOCALCEMIA
Damage N. laryngeal superior

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42
Q

What’s histologic findings in papillary carcinoma thyroide (4)?

A

Orphan Annie” eyes)
psammoma bodies,
RET and BRAF mutations,
childhood irradiation.

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43
Q

Medullary carcinoma …

A

Parafolicular cells C cells

MmE. 2 and 3

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44
Q

Signs of hypocalcemia in hypoparatiroidism (2)

A

Chvostek sign—tapping of facial nerve (tap the Cheek) Ž contraction of facial muscles.
Trousseau sign—occlusion of brachial artery with BP cuff (cuff the Triceps) Ž carpal spasm.

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45
Q

What’s Familial hypocalciuric hypercalcemia?

A

Not negative fed back from Ca to PTH

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46
Q

What’s the most common pituitary adenoma?

A

Prolactinoma benign

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47
Q

What’s the major risk for cancer in acromegaly ?

A

Colorectal polyps and cancer

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48
Q

Causes of Diabetes insipidus nephrogenic ?

A

Hypercalcemia
Litius
Demeclocycline

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49
Q

Treatment for diabetes nephrogenic

A

HCTZ
Indomitacine
Amiloride
Hydration

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50
Q

Treatment of SIADH

A 
Fluid restriction
IV hypertonic saline
Conivaptan
Tolvaptan
Demeclocycline
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51
Q

What kind of genes are implicated in Type I DM?

A

HLA-DR3

HLA-DR4

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52
Q

Dif rent histology findings in DM1 Vs. DM2

A

DM1 islet leukocyte infiltrate

DM2 Islet amyloid polypeptide deposits

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53
Q

Symptoms of glucagonoma

A

Dermatitis
Diabetes
Depression

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54
Q

Key symptom in carcinoid syndrome?

A

Pellagra (⬇️ niacin)

⬆️5-HIAA

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55
Q

Rule of 1/3 of carcinoid syndrome?

A

1/3 metastasize
1/3 present with 2nd malignancy

1/3 are multiple

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56
Q

Test to Zollinger-Ellison syndrome?

A

Gastric levels after secretin hormone

Normally gastrin goes down

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57
Q

How Is the different MEN affection?

A

♦️ MEN 1 Pituitary ,Parathyroid , Páncreas
⬛️ MEN 2A Parathyroid , pheochromocytoma, medullary thyroid
RET gene Mutation marfanoid habitus
🔺 MEN 2B pheochromocytoma , Neuromas, medulary thyroid
RET gene Mutation marfanoid habitus

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58
Q

In kind of patients metformin (biguanide) is contraindicated?

A

Renal insufficient patients

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59
Q

Toxicity by sulfunylurea chlorpropamide gliburide

A

Hypoglycemia in renal failure
Disulfiram like effect in chlorpropamide
Hypoglycemia whit glibenclamide

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60
Q

Mechanism of action of glitazones , thiazolidinediones

A

⬆️ insulin sensitivity in peripheral tissue.
Binds to PPAR-γ + RXR nuclear transcription regulator
⬆️levels of adiponectine
⬆️GLUT4

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61
Q

Side effects of glitazones,thiazolidinediones

A

Weight gain
Edema
Heart failure
Risk of fractures

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62
Q

Function of GLP-1 analogs

A

Exenatide, Liraglutide.

⬆️insulin,  ⬇️glucagon release.

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63
Q

Action of α-glucosidase inhibitors Acarbose, Miglitol

A

Inhibit intestinal brush-border α-glucosidases.

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64
Q

What drugs is use safely in pregnancy to treat hyperthyroidism?

A

Propylthiuracil

Inhibit oxidation, organification, 5’deiodinase

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65
Q

What’s the uses of somatostatin (octreotide) (5)?

A 
Acromegaly, 
carcinoid syndrome,
 gastrinoma, 
glucagonoma, 
esophageal varices.
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66
Q

What’s the Cushing syndrome(11)?

A 
hypertension
weight gain
moon facies
 truncal obesity
 buffalo hump
 thinning of skin
 striae
 osteoporosis
 hyperglycemia
 amenorrhea
 immunosuppression
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67
Q

What’s cinacalcet?

A

Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ Ž  PTH

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68
Q

How TNF-Alfa, cathecolamines, corticoids , glucagon induces insulin resistance resistance?

A

by phosphorylation of serine or threonine residues of beta subunits of insulin receptor

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69
Q

What’s the function of TSH in thyroid follicles?

A

Stimulation of iodine -sodium symporter

Increases the synthesis of thyroglobulin

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70
Q

Causes of functional hypothalamic amenorrhea (4)

A

Excessive weight loss
Streneus exercise
Chronic illness
Eating disorder

⬇️LEPTINES

Leads to ⬇️ GnRH (⬇️LH,FSH ⬇️ estrogen) amenorrhea bone lose

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71
Q

What’s conn syndrome?

A

Adenoma producing aldosterone

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72
Q

What’s aldosterone escape?

A

When there are too much aldosterone
There hight activity to reabsorb NA and water
BUT!!!! Atrial natriuretic peptide generate sodium excretion

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73
Q

What’s neurophysins?

A

Carriers proteins for Oxytocin (paraventricular) and ADH (supraoptic)

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74
Q

What’s propiomelanocortina?

A

Pre hormone which generate ACTH and MSH

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75
Q

What’s the function of TRH?

A

Stimulates release of TSH and prolactin

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76
Q

What’s the function of sun in Vit D?

A

7-dehydrocholesterol–🌞– cholecalciferol (Vit D3)

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77
Q

What’s the function of Vit D activate?

A

⬆️ bone mineralization
⬆️ Ca and PO3 absorption small intestine
⬆️ Ca and PO3 absorption kidney
⬇️ PTH secretion

78
Q

What’s the function of PTH in kidney related whit Vit D?

A

✅ 1 Alfa hydroxylase ( synthesis of 1,25 hydroxycholecalciferol )

79
Q

Tumors in von Hippel-Lindau disease(3)

A

Hemangioblastomas
Pheochromocytoma
Renal cell carcinoma

80
Q

What’s the consequence of androgen abuse in breast and psychiatric field?

A

💃🏼 breast atrophy
🚶 gynecomastia

💃🏼 depression. Hypo mania
🚶 aggressiveness

81
Q

What’s the functions of sexual hormones in the embryonic- fetal development?

A

Testosterone: internal male genitalia, spermiogenesis, puberty
Dihydrotestosterone: external male genitalia , prostate, hair male
Estrogen: endometrial, ovarian, breast.

82
Q

Action of 5 Alfa reductase

A

Testosterone to dihydrotestosterone

83
Q

Diferent 5 Alfa reductase

A

Type 1 embryo all fetal in testes

Type 2 causes puberty

84
Q

Action of insulins from fast to long

A

(Glulisine,Lispro,aspart)- regular-NPH-determine- glargine

85
Q

Problem of regular insulin?

A

Have alternated C and B terminal chains which creating hydrogen bonding delaying its absorption

86
Q

What’s copper reduction test in urine?

A

Detects reducing sugar like FRUCTOSE

good for essential fructosuria diagnostic

87
Q

What’s maternal serum quadruple screen?

A

Alpha veto protein
Estriol
Beta hCG
Inhibin A

88
Q

How is alpha fetoprotein in Down syndrome and Edwards syndrome?

A

⬇️⬇️AFP IS LOW!!!!!!!

89
Q

Types of 21-hydroxylase deficiency (3)

A

Severe classic salt wasting
Moderate classic non salt wasting
Mild non-classic ,delayed

90
Q

What’s the treatment of congenital adrenal hyperplasia ?

A

Low doses of exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of adrenal cortex

91
Q

What’s incidentalomas?? 😝😬😅

A

10% of normal people will present mass-like lesions in brain MRI

92
Q

At what time is best screening Cortisol levels?

A

At evening because it must be low

93
Q

What’s the consequence con glucocorticoids on calcium?

A

It may be low calcium levels because glucocorticoids supreme PTH

94
Q

What’s leuprolide??

A

GnRH analog
Used for prostatic cancer
⬇️testosterone
⬇dihydrotestosterone

95
Q

What’s the mechanism of finasteride?

A

5-alpha reductase inhibitor

96
Q

What vascular, nerve , and muscular structures can be injured in thyroidectomy ?

A

In the ligation of superior thyroid artery
External branch of lariangeal superior nerve can be injured
Leading to Denervation of cricothyroid muscle (tense vocal cords)

97
Q

What is the function of internal branch of superior laryngeal nerve?

A

Sensory laryngeal mucosa avoid vocal folds

98
Q

Which activation of receptors increase insulin secretion?

A 
M3 
Glucagon 
Beta 2
Glucagon like peptide 1
Histamine H2
99
Q

Which receptors decrease insulin secretion?

A

Alpha 2

Somatostatin

100
Q

Mechanism of action of sulfunylurea (glibenclamide) and meglitinides?

A

Inhibition of B-cell.potassium ATP Channels

INCREASING INSULIN SECRETION!!!!!!!

101
Q

Mechanism of action of biguanide ( metformin)

A

Stimulate AMPK

decreasing glucose production and insulin resistance

102
Q

Why are important brown adipocytes?

A

They have high number of mitochondrial
They have thermogenien uncoupling protein
Which help to generate heat

103
Q

Why exophthalmos courts in Graves’ disease?

A

Accumulation of glicosaminoglycans in retro-orbital tissue by fibroblast which are stimulated by Th1 cells
Dysfunction of extra ocular muscles can restrict its movement

104
Q

Effects of thiazolidinediones

A 
⬆️ fatty acid uptake
⬆️ adiponectin production
⬆️ insulin sensitivity 
⬇️ TFN-Alfa production 
⬇️ leptin production
105
Q

What’s the mechanism of action of ezetimibe?

A

Decrease intestinal absorption of cholesterol

Inhibiting the Niemann-pick C1-like 1(NPC1L1)

106
Q

What’s the action of cholestiramina colesevelam?

A

Bind idle salts in the intestine decreasing their reabsortion
Producing indirect up regulation of 7alfa hydroxylase

107
Q

What’s the action of fibrates?

A

Activate peroxisome prolifator -activated receptor alpha transcription factor stimulating lipoprotein lipase decreasing triglycerides levels

108
Q

Mechanism of action of nicotinic acid

A

Inhibits hepatic tyglicerid acid synthesis

Low VLDL

109
Q

What are aromatase inhibitors for treatment of metastatic breast cancer?

A

Anstrozole
Letrozole
Exemestane

110
Q

Mechanism of action of tamoxifen

A

Antagonist partial agonist of estrogen receptor

Side effects thromboembolism and endometrial cancer

111
Q

Mechanism of action of trastuzumab in breast cancer

A

Inhibit epidermal growth factor

Inhibit HER2/neu

112
Q

Big problems of propiltiuracil on and metimazole

A

propiltiuracil Hepatotoxic
metimazole. Teratogenic

BOTH AGRANULOCYTOSIS!!!!!!!!

113
Q

What kind of antibodies are developed in the use of Propylthiuracil?

A

Anti neutrophil cytoplasmic antibodies ANCA

Anthralgias , glomerulonephritis vasculitis

114
Q

Why aspirin and ibuprofen have to be avoid in hyperthyroidism?

A

Because they displace thyroid.

Hormones from protein binding proteins elevating thyroid hormones

115
Q

Mention the different insulins whit their start working time. Peak and duration

A

LISPRO, ASPART, GLULICINE 15min. 45 min
REGULAR 30 min. 2 hrs
NPH. 2hrs 4-12 hrs. 18hrs
GLARGINE DETEMIR 2hrs 3hrs meseta 24 hrs

116
Q

In the action of ethanol over gluconeogenesis what pathway is impaired?

A

Conversion of lactate to pyruvate
Conversion of malate to oxalacetate
Because ethanol depletes NAD to make NADH

117
Q

What trigger the secretion of cathecolamines in the adrenal medulla?

A

Acetylcholine

Producing 80% epinephrine 20% norepinephrine

118
Q

What stimulators act in the supra renal cortex?

A

Glomerular ALDOSTERONE by ANGIOTENSIN II
Fascicular CORTISOL by ACTH
Reticular TESTOSTERONE ACTH??

119
Q

What’s the action of cortisol opinion cathecolamines?

A

Conversion of norepinephrine to epinephrine

120
Q

Principal features of adrenal crisis?

A

Hypoglycemia
Hyponatremia
Hypoglycemia

121
Q

Gases compensations!!!!

A

metabolic Acidosis : CO2 = 1.5 HCO3 +- 2

metabolic Alkalosis : CO2=. 0.7x🔺HCO3

122
Q

What’s the presentation of panhypopituitarism?

A

⬇️ ACTH
⬇️ FSH
⬇️ LH
⬇️ TSH

123
Q

How contraceptives acts in polycystic ovarian syndrome?

A

Feed back inhibition of LH production

Leads to reduction of testosterone production

124
Q

What’s lingual thyroid?

A

Fails of thyroid migration

Need Qx

125
Q

What signs are very common in GRAVES disease?

A

Prestigious mixedema
Exophthalmos
Periorbial edema
Eye movement limitations

126
Q

Why in hypothyroidism suspect TSH is first evaluated than T3-T4 levels?

A

Because TSH increase first than T4 T3 decrease
TSH is most sensitive

T3 is the last to decline

127
Q

Where is the lesion in permanent central Diabetes insipidus?

A

SUPRAOPTIC NUCLEUS !!!!!

HYPOTALAMUS!!!!!

128
Q

Mention two drugs from MIGLITINIDE hypoglycemiant group which inhibit K ATP channels

A

REPAGLINIDE!!!!

NATEGLINIDE !!!

129
Q

Cell target , and function of LH And FSH?

A

LH—leyding cells — TESTOSTERONE !!!

FSH— Sertoli cells —- INHIBIN B and sex -hormone binding globulin !!!

130
Q

Why granulomatous diseases have hypercalcemia as well?

A

Macrophages activated have ⬆️ expression of 1 - alpha- hydroxylase
Which activate Vit -D

131
Q

Where IGF-1 is released by GH estimulation?

A

LIVER!!!!

By JAK kinase- STAT pathway

132
Q

How are the two principal hormones in Laron dwarfism ?

A

⬆️ GH
⬇️ IGF-1

Defect in the GH receptor

133
Q

What kind of proteins are GLUT???

A

Carrier mediated transporters!!!!

134
Q

What is Familial Hypocaliuric Hypercalcemia? And what kind of receptor is implied?

A

Calcium-sensing receptors (CaSR) in parathyroids and kidney are impaired

Transmembrane -G- protein coupled receptor

135
Q

What substances have transmembrane receptors which recruit Janus - Kinase?

A

Growth Hormone
Prolactine
Erythropoietin

136
Q

What is the pathognomonic histologic sign of gaucher disease?

A

Lipid-laden macrophages
“Wrinkled tissue paper”

Pancitopenia
Hepatomegaly

137
Q

When you see rouleaux formation? (RBCs like poker chips)

A

MULTIPLE MYELOMA!!!!!

138
Q

Explain the water deprivation and vasopressin injection test in polyuria & polydipsia. (4)

A

NORMAL ↔️Na. ⬆️ U. Osm.🚫💧↔️ U. Osm. ADH

CENTRAL D. INSIPIDUS ⬆️Na ↔️U. Osm.🚫💧⬆️⬆️U. Osm. ADH

NEPRHOGENIC D. INSIPIDUS⬆️Na ↔️U. Osm.🚫💧↔️U. Osm. ADH

  1. POLYDIPSIA ⬇️Na ⬆️U. Osm.🚫💧↔️U. Osm. ADH
139
Q

Treatment of Nephrogenic DI?(2)

A

Thiazides : hypovolemia leads to ⬆️Na absorption in Proximal tubule

Indomethacin: ⬇️ prostaglandines which inhibit ADH

140
Q

Symptoms of excess of somatostatin (5)

A 
Abdominal pain
Gallbladder stones
Constipation
Hyperglycemia
Steatorrhea
141
Q

Clinical features of Glucagoma (3)

A

Necrolitic migratory erythema (bronze-colored central area)
Diabetes mellitus
GI symptoms

142
Q

Features of ZINC deficiency (6)

A 
ERITHEMATOUS SKIN LESSION AROUND ORIFICES 
Hypogonadism
Azoospermia
Hair loss
Impaired taste
Night blindness
Impaired wound healing
143
Q

Mechanism of action of Metformin

A

Non-Competitive inhibitor of mithocondrial glycerol-3- phosphate dehydrogenase
⬇️hepatic glucose synthesis

144
Q

Effect of estrogens on Thyroid hormon?

A

⬆️ thyroxin-binding globulin
⬆️T4 pool

EUTHYROID

145
Q

What is pseudohypoparathyroidism?

A

Renal resistance to PTH

146
Q

Findings in secundary hyperparathyroidism

A

⬇️Ca
⬇️PO4
⬆️ PTH

147
Q

Mental side effect of corticoids use?

A

Corticosteroid-induced psychosis

148
Q

Clinical Sings of hypocalcemia

A

TROUSSEAU

CHVOSTEK

149
Q

Signs of Hypercalcemia(3)

A

Constipation
Polyuria/polydipsia
Muscle weakness

150
Q

Gene mutation in medullary thyroid tumors

A

Activating mutation of RET Porto-oncogene

151
Q

MOTEL PASS cells from neural crestfallen cells

A 
Melanocytes
Odontoblasts 
Tracheal cartilage
Enterochromaffin cells
Laryngeal cartilage

Parafollicular cells
Adrenal medulla
Spinal membrane
Spiral membrane

152
Q

Clinical findings in VIPoma

A

Watery diarrhea
Hypokalemia
Impaired gastric acid secretion

153
Q

What physical finding has a Big relation whit insulin resistance?

A

WAIST CIRCUMFERENCE

MEN >102 cms

WOMEN > 88 cms

154
Q

What cholesterol alterations are related whit Diabetes?

A

⬆️Triglicerides

⬇️HDL

155
Q

Explain the 4 groups of antiandrogenic drugs

A

GnRH agonist (leuprolide) inhibit LH release by pituitary
Spironolactone inhibit testosterone synthesis by Leydig cells
5alpha reductase inhibitor finasteride 🚫conversions of DHT
FLUTAMIDE,CYPROTERONE,SPIRONOLACTONE 🚫androgen receptor in target organ eg. Testes

156
Q

How it the body water and osmolarity in SIADH?

A

Euvolemic- Hyponatermic

157
Q

Cuses of myopathy

A 
Glucocorticoid ↔️ CK
Polymialgia rheumatica↔️ CK 
Inflammatory  ⬆️CK
Statin ⬆️CK
Hypothyroid  ⬆️CK
158
Q

What is metabolic syndrome?

A 
⬆️ triglycerides 
⬇️ HDL
Central obesity 
⬆️ Arterial Pressure 
⬆️ glucose
159
Q

Explain the three Multiple Endocrine Neoplasia

A

MEN1 🔹3P’s Parathyroids, Pituitary, Pancreas
MEN2A ▪️ 2P’s Parathyroids, Pheochromocytoma, Medullar thyroid ❎RET protooncogen
MEN2B 🔺1P Pheochromocytoma, Medullar Thyroid, mucosa neurons , marfanoi ❎RET protooncogen

160
Q

How is seen medullary thyroid cancer?

A

nests or Sheets of polygonal or spindle-shaped cells with extra cellular amyloid deposits (Congo red positive)

161
Q

If there is a section of pituitary stalk what hormone elevates?

A

PROLACTIN!!

Because dopamine CANNOT inhibit the prolactin secretion

162
Q

How hyperphsophatemia in the chronic renal failure can cause hypocalcemia?

A

Calcium-phosphatum exceeds solubility so calcium precipitates

163
Q

clinical features of primary parathyroidism (parathyroid adenoma) (4)

A

bone pain
renal stones
GI disturbances
psychiatric disorders

164
Q

what are the radiologic findings in primary hyperparathyroidism?(3)

A

subperiosteal erosions
granular “salt and pepper skull”
osteolytic cysts in the long bones

165
Q

Metalloprotease that cleaves and I actives BNP, glucagon, oxytocin, radykinin …

A

NEPRILYSIN!!!!!

166
Q

What type of channel is potassium channel in beta cells?

A

ATP ase channel

167
Q

How insulins is released from beta cells?

A 
Glucose enters trough GLUT-2 
Glucose generates ATP
ATP close K channel depolarizing   The cell
Ca enters to the cell 
Insulin release
168
Q

What oral hypoglycemics have high incidence in hypoglycemia?(2)

A

SULFUNYLUREAS!!!!

Gliburide
Glimepiride

169
Q

Mechanism of action of FOSCARNET and indication?

A

Pyrophosphate analog DO NOT require viral enzymes

🚫 DNA polymerase (herpesvirus)
🚫 Reverse transcriptase (HIV)

Herpesvirus acyclovir resistant

170
Q

After 12 hours of fasting which organ is important to gluconeogenesis?

A

KIDNEY!!!

Epinephrine acts in renal cortex

171
Q

Hormone responsible for insulin resistance in the second and third trimester of pregnancy?

A

HUMAN PLACENTAL LACTOGEN

Chorionic somatotropin

172
Q

How different doses of dexamethasone can differentiate between Cushing disease and Cushing syndrome?

BOTH HAVE ⬆️ACTH

A

Cushing disease (pituitary adenoma)Need high doses to suppress cortisol

Cushing syndrome (lung cancer) High doses cannot suppress cortisol

173
Q

where T3r como from?

A

come from T4!!!!!

174
Q

Action of desmolase?

A 
Cholesterol to pregnenolone
If lack is Incompatible whit life
❎aldosterone 
❎cortisol
❎ testosterone
175
Q

Mechanism of action of alpha-metiltyrosine? Drug use in the management of pheochromocytoma?

A

Inhibit tyrosine hydroxylase (tyrosine to DOPA)

176
Q

3 most importatn predisposing factors for hypoglicemia in type 1 diabetes patient?

A
  1. excesive insulin dose
  2. inadequated food intake
  3. excercise
176
Q

Type 1 DM increase what autoimmune endocrine disease?(2)

A

Hashimoto thyroiditis

Autoimmune adrenalitis

177
Q

How lack of ACTH leads to low levels of epinephrine?

A

ACTH stimulates cortisol which in turn increase the phenthanolamine-N-methyltransferase (PNMT) which in turns converts Norepinephrine to Epinephrine in the medulla adrenal.

177
Q

How hypoaldosteronism afect acid-base equilibrium?

A

⬇️H excretion leads to ⬇️HCO3 metabolic acidosis normal gap because
⬆️CL absortion trying to compensate

⬇️Na
⬆kalemia

180
Q

Sid effect of metformin and population in high risk? (1.3)

A

⬆️ LACTIC ACIDOSIS

renal failure
Hepatic failure
CHF

181
Q

Side effects of Niacin?(4)

A

Flushing
Hyperglycemia
Hepatotoxicity
Acute gouty arthritis (⬇️acid Uric renal excretion)

182
Q

Histologic characteristics of papillary thyroid carcinoma?(4)

A

Overlapping nuclei containing finely disperse chromatin
Orphan Annie eye
Intranuclear inclusions and groves
Psammoma bodies

183
Q

Urinary labs which shows early stage of Diabetic Nephropathy?

A

ALBUMIN IN URINE

184
Q

How is microscopically seen Hashimoto Thyroiditis (MCC hypothyroidism in U.S.)

A

Mononuclear infiltrate (Lymphocytes, plasma cells) with germinal centers and Hurthle cells

185
Q

What’s Riedel Thyroiditis?

A

Fibrosis of the thyroid gland extending into the surrounding structures

186
Q

How is microscopically seen subacute (Quervain) thyroiditis?

A

Mixed cellular infiltration with occasional multi-nucleated Giant cells

187
Q

What’s LEPTIN and how it works?

A

Hormone produce by adipocytes acting in hypothalamus
Decrease appetite by :
1.🚫neuropeptide Y (appetite stimulant)
2. ⬆️POMC ⏩ alpha-MSH (🚫food intake)

LEPTIN RESISTANCE ⏩ OBESITY!!!!

188
Q

How aromatase inhibitors decrease the risk of gallstones?

A

Aromatase converts estrogen from androgens

Estrogens ⬆️cholesterol synthesis

189
Q

Two important theories of DM 2?

A

Insulin recistance

⬇️ insulin secretion (islet amyloid deposition toxic consequences)

190
Q

What’s metyrapone and its use?

A

Metyrapone blocks 11-beta-hydroxylase ( 11-deoxycortisol➡️cortisol)

Evaluate the integrity of hypothalamic-Pituitary -adrenal axis

Normal ⬆️11 deoxycortisol. And ⬆️ urinary 17-hydroxycorticosteroid
⬆️ ACTH (🚫feedback inhibition)

191
Q

What’s adiponectin?

A

Cytokine secreted by fat tissue
⬆️ insulin sensitivity
⬆️ fatty acid oxidation

192
Q

Net result of somatostatin over serum glucose?

A

Hypoglicemia because blocks glucagon more than insuline

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