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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
What's Cushing disease?
ACTH secreting pituitary adenoma
25
How screening Cushing syndrome?
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
26
What's metyrapone stimulation test?
Metyrapone blocks the last step of cortisol synthesis Block 11deoxycortisol to cortisol Normal ⬆️ACTH
27
Causes of primary adrenal insufficiency ?
Hemorrhage Addison disease ( autoimmune, TB, metastasis) Waterhouse friederichsen syndrome (N. Meningitides)
28
What's the clinical presentation to primary adrenal deficiency(4) ?
Hypotension Hyperkalemia Metabolic acidosis Skin mucosa hyper pigmentation
29
What's the clinical presentation to secundary adrenal deficiency(2) ?
Same whit out Hyperkalemia Hyper pigmentation
30
What's the clinical presentation to tertiary adrenal deficiency) ?
Abrupt whit drawl of steroids
31
Very important features of neuroblastoma
Children
32
Pheocromocitoma 10a rule (5)
10% malignant 10% bilateral 10% extra-adrenal 10% calcify 10% kids
33
Pheocromocitoma associations (4)
neurofibromatosis type 1 (NF-1) von Hippel-Lindau disease (VHL) MEN 2A and 2B. (RET)
34
Treatment of pheocromocitoma ?
FIRST IRREVERSIBLE ALFA ANTAGONIST Phenoxybenzamine SECOND beta blockers
35
What type of cancer is associated whit hashimoto thyroiditis?
Non-Hodking lymphoma
36
Histologic findings hashimoto disease
Hurthle cells
37
Features of Subacute thyroiditis (de Quervain)
Very tender Early hyperthyroidism follow by hypothyroidism Following flu like symptoms
38
What's Riedel thyroiditis?
Fibrous tissue replacement of thyroid Autoimmune pancreatitis Retro peritoneal fibrosis Aortic is no infectious
39
What's toxic multinodular goiter?
Mutation of TSH receptor | Follicles work independently
40
Treatment of thyroid storm?
Propanolol Propylthiouracil prednisolone
41
Surgery complications of thyroidectomy
Hoarseness damage laryngeal recurrent HYPOCALCEMIA Damage N. laryngeal superior
42
What's histologic findings in papillary carcinoma thyroide (4)?
Orphan Annie” eyes) psammoma bodies, RET and BRAF mutations, childhood irradiation.
43
Medullary carcinoma ...
Parafolicular cells C cells | MmE. 2 and 3
44
Signs of hypocalcemia in hypoparatiroidism (2)
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.
45
What's Familial hypocalciuric hypercalcemia?
Not negative fed back from Ca to PTH
46
What's the most common pituitary adenoma?
Prolactinoma benign
47
What's the major risk for cancer in acromegaly ?
Colorectal polyps and cancer
48
Causes of Diabetes insipidus nephrogenic ?
Hypercalcemia Litius Demeclocycline
49
Treatment for diabetes nephrogenic
HCTZ Indomitacine Amiloride Hydration
50
Treatment of SIADH
``` Fluid restriction IV hypertonic saline Conivaptan Tolvaptan Demeclocycline ```
51
What kind of genes are implicated in Type I DM?
HLA-DR3 | HLA-DR4
52
Dif rent histology findings in DM1 Vs. DM2
DM1 islet leukocyte infiltrate | DM2 Islet amyloid polypeptide deposits
53
Symptoms of glucagonoma
Dermatitis Diabetes Depression
54
Key symptom in carcinoid syndrome?
Pellagra (⬇️ niacin) | ⬆️5-HIAA
55
Rule of 1/3 of carcinoid syndrome?
1/3 metastasize 1/3 present with 2nd malignancy | 1/3 are multiple
56
Test to Zollinger-Ellison syndrome?
Gastric levels after secretin hormone | Normally gastrin goes down
57
How Is the different MEN affection?
♦️ 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
58
In kind of patients metformin (biguanide) is contraindicated?
Renal insufficient patients
59
Toxicity by sulfunylurea chlorpropamide gliburide
Hypoglycemia in renal failure Disulfiram like effect in chlorpropamide Hypoglycemia whit glibenclamide
60
Mechanism of action of glitazones , thiazolidinediones
⬆️ insulin sensitivity in peripheral tissue. Binds to PPAR-γ + RXR nuclear transcription regulator ⬆️levels of adiponectine ⬆️GLUT4
61
Side effects of glitazones,thiazolidinediones
Weight gain Edema Heart failure Risk of fractures
62
Function of GLP-1 analogs
Exenatide, Liraglutide. | ⬆️insulin,  ⬇️glucagon release.
63
Action of α-glucosidase inhibitors Acarbose, Miglitol
Inhibit intestinal brush-border α-glucosidases.
64
What drugs is use safely in pregnancy to treat hyperthyroidism?
Propylthiuracil | Inhibit oxidation, organification, 5'deiodinase
65
What's the uses of somatostatin (octreotide) (5)?
``` Acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices. ```
66
What's the Cushing syndrome(11)?
``` hypertension weight gain moon facies truncal obesity buffalo hump thinning of skin striae osteoporosis hyperglycemia amenorrhea immunosuppression ```
67
What's cinacalcet?
Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ Ž  PTH
68
How TNF-Alfa, cathecolamines, corticoids , glucagon induces insulin resistance resistance?
by phosphorylation of serine or threonine residues of beta subunits of insulin receptor
69
What's the function of TSH in thyroid follicles?
Stimulation of iodine -sodium symporter | Increases the synthesis of thyroglobulin
70
Causes of functional hypothalamic amenorrhea (4)
Excessive weight loss Streneus exercise Chronic illness Eating disorder ⬇️LEPTINES Leads to ⬇️ GnRH (⬇️LH,FSH ⬇️ estrogen) amenorrhea bone lose
71
What's conn syndrome?
Adenoma producing aldosterone
72
What's aldosterone escape?
When there are too much aldosterone There hight activity to reabsorb NA and water BUT!!!! Atrial natriuretic peptide generate sodium excretion
73
What's neurophysins?
Carriers proteins for Oxytocin (paraventricular) and ADH (supraoptic)
74
What's propiomelanocortina?
Pre hormone which generate ACTH and MSH
75
What's the function of TRH?
Stimulates release of TSH and prolactin
76
What's the function of sun in Vit D?
7-dehydrocholesterol--🌞-- cholecalciferol (Vit D3)
77
What's the function of Vit D activate?
⬆️ bone mineralization ⬆️ Ca and PO3 absorption small intestine ⬆️ Ca and PO3 absorption kidney ⬇️ PTH secretion
78
What's the function of PTH in kidney related whit Vit D?
✅ 1 Alfa hydroxylase ( synthesis of 1,25 hydroxycholecalciferol )
79
Tumors in von Hippel-Lindau disease(3)
Hemangioblastomas Pheochromocytoma Renal cell carcinoma
80
What's the consequence of androgen abuse in breast and psychiatric field?
💃🏼 breast atrophy 🚶 gynecomastia 💃🏼 depression. Hypo mania 🚶 aggressiveness
81
What's the functions of sexual hormones in the embryonic- fetal development?
Testosterone: internal male genitalia, spermiogenesis, puberty Dihydrotestosterone: external male genitalia , prostate, hair male Estrogen: endometrial, ovarian, breast.
82
Action of 5 Alfa reductase
Testosterone to dihydrotestosterone
83
Diferent 5 Alfa reductase
Type 1 embryo all fetal in testes | Type 2 causes puberty
84
Action of insulins from fast to long
(Glulisine,Lispro,aspart)- regular-NPH-determine- glargine
85
Problem of regular insulin?
Have alternated C and B terminal chains which creating hydrogen bonding delaying its absorption
86
What's copper reduction test in urine?
Detects reducing sugar like FRUCTOSE | good for essential fructosuria diagnostic
87
What's maternal serum quadruple screen?
Alpha veto protein Estriol Beta hCG Inhibin A
88
How is alpha fetoprotein in Down syndrome and Edwards syndrome?
⬇️⬇️AFP IS LOW!!!!!!!
89
Types of 21-hydroxylase deficiency (3)
Severe classic salt wasting Moderate classic non salt wasting Mild non-classic ,delayed
90
What's the treatment of congenital adrenal hyperplasia ?
Low doses of exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of adrenal cortex
91
What's incidentalomas?? 😝😬😅
10% of normal people will present mass-like lesions in brain MRI
92
At what time is best screening Cortisol levels?
At evening because it must be low
93
What's the consequence con glucocorticoids on calcium?
It may be low calcium levels because glucocorticoids supreme PTH
94
What's leuprolide??
GnRH analog Used for prostatic cancer ⬇️testosterone ⬇dihydrotestosterone
95
What's the mechanism of finasteride?
5-alpha reductase inhibitor
96
What vascular, nerve , and muscular structures can be injured in thyroidectomy ?
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
What is the function of internal branch of superior laryngeal nerve?
Sensory laryngeal mucosa avoid vocal folds
98
Which activation of receptors increase insulin secretion?
``` M3 Glucagon Beta 2 Glucagon like peptide 1 Histamine H2 ```
99
Which receptors decrease insulin secretion?
Alpha 2 | Somatostatin
100
Mechanism of action of sulfunylurea (glibenclamide) and meglitinides?
Inhibition of B-cell.potassium ATP Channels | INCREASING INSULIN SECRETION!!!!!!!
101
Mechanism of action of biguanide ( metformin)
Stimulate AMPK | decreasing glucose production and insulin resistance
102
Why are important brown adipocytes?
They have high number of mitochondrial They have thermogenien uncoupling protein Which help to generate heat
103
Why exophthalmos courts in Graves' disease?
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
Effects of thiazolidinediones
``` ⬆️ fatty acid uptake ⬆️ adiponectin production ⬆️ insulin sensitivity ⬇️ TFN-Alfa production ⬇️ leptin production ```
105
What's the mechanism of action of ezetimibe?
Decrease intestinal absorption of cholesterol | Inhibiting the Niemann-pick C1-like 1(NPC1L1)
106
What's the action of cholestiramina colesevelam?
Bind idle salts in the intestine decreasing their reabsortion Producing indirect up regulation of 7alfa hydroxylase
107
What's the action of fibrates?
Activate peroxisome prolifator -activated receptor alpha transcription factor stimulating lipoprotein lipase decreasing triglycerides levels
108
Mechanism of action of nicotinic acid
Inhibits hepatic tyglicerid acid synthesis | Low VLDL
109
What are aromatase inhibitors for treatment of metastatic breast cancer?
Anstrozole Letrozole Exemestane
110
Mechanism of action of tamoxifen
Antagonist partial agonist of estrogen receptor | Side effects thromboembolism and endometrial cancer
111
Mechanism of action of trastuzumab in breast cancer
Inhibit epidermal growth factor | Inhibit HER2/neu
112
Big problems of propiltiuracil on and metimazole
propiltiuracil Hepatotoxic metimazole. Teratogenic BOTH AGRANULOCYTOSIS!!!!!!!!
113
What kind of antibodies are developed in the use of Propylthiuracil?
Anti neutrophil cytoplasmic antibodies ANCA | Anthralgias , glomerulonephritis vasculitis
114
Why aspirin and ibuprofen have to be avoid in hyperthyroidism?
Because they displace thyroid. | Hormones from protein binding proteins elevating thyroid hormones
115
Mention the different insulins whit their start working time. Peak and duration
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
In the action of ethanol over gluconeogenesis what pathway is impaired?
Conversion of lactate to pyruvate Conversion of malate to oxalacetate Because ethanol depletes NAD to make NADH
117
What trigger the secretion of cathecolamines in the adrenal medulla?
Acetylcholine | Producing 80% epinephrine 20% norepinephrine
118
What stimulators act in the supra renal cortex?
Glomerular ALDOSTERONE by ANGIOTENSIN II Fascicular CORTISOL by ACTH Reticular TESTOSTERONE ACTH??
119
What's the action of cortisol opinion cathecolamines?
Conversion of norepinephrine to epinephrine
120
Principal features of adrenal crisis?
Hypoglycemia Hyponatremia Hypoglycemia
121
Gases compensations!!!!
metabolic Acidosis : CO2 = 1.5 HCO3 +- 2 | metabolic Alkalosis : CO2=. 0.7x🔺HCO3
122
What's the presentation of panhypopituitarism?
⬇️ ACTH ⬇️ FSH ⬇️ LH ⬇️ TSH
123
How contraceptives acts in polycystic ovarian syndrome?
Feed back inhibition of LH production | Leads to reduction of testosterone production
124
What's lingual thyroid?
Fails of thyroid migration | Need Qx
125
What signs are very common in GRAVES disease?
Prestigious mixedema Exophthalmos Periorbial edema Eye movement limitations
126
Why in hypothyroidism suspect TSH is first evaluated than T3-T4 levels?
Because TSH increase first than T4 T3 decrease TSH is most sensitive T3 is the last to decline
127
Where is the lesion in permanent central Diabetes insipidus?
SUPRAOPTIC NUCLEUS !!!!! | HYPOTALAMUS!!!!!
128
Mention two drugs from MIGLITINIDE hypoglycemiant group which inhibit K ATP channels
REPAGLINIDE!!!! | NATEGLINIDE !!!
129
Cell target , and function of LH And FSH?
LH---leyding cells --- TESTOSTERONE !!! | FSH--- Sertoli cells ---- INHIBIN B and sex -hormone binding globulin !!!
130
Why granulomatous diseases have hypercalcemia as well?
Macrophages activated have ⬆️ expression of 1 - alpha- hydroxylase Which activate Vit -D
131
Where IGF-1 is released by GH estimulation?
LIVER!!!! By JAK kinase- STAT pathway
132
How are the two principal hormones in Laron dwarfism ?
⬆️ GH ⬇️ IGF-1 Defect in the GH receptor
133
What kind of proteins are GLUT???
Carrier mediated transporters!!!!
134
What is Familial Hypocaliuric Hypercalcemia? And what kind of receptor is implied?
Calcium-sensing receptors (CaSR) in parathyroids and kidney are impaired Transmembrane -G- protein coupled receptor
135
What substances have transmembrane receptors which recruit Janus - Kinase?
Growth Hormone Prolactine Erythropoietin
136
What is the pathognomonic histologic sign of gaucher disease?
Lipid-laden macrophages "Wrinkled tissue paper" Pancitopenia Hepatomegaly
137
When you see rouleaux formation? (RBCs like poker chips)
MULTIPLE MYELOMA!!!!!
138
Explain the water deprivation and vasopressin injection test in polyuria & polydipsia. (4)
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
Treatment of Nephrogenic DI?(2)
Thiazides : hypovolemia leads to ⬆️Na absorption in Proximal tubule Indomethacin: ⬇️ prostaglandines which inhibit ADH
140
Symptoms of excess of somatostatin (5)
``` Abdominal pain Gallbladder stones Constipation Hyperglycemia Steatorrhea ```
141
Clinical features of Glucagoma (3)
Necrolitic migratory erythema (bronze-colored central area) Diabetes mellitus GI symptoms
142
Features of ZINC deficiency (6)
``` ERITHEMATOUS SKIN LESSION AROUND ORIFICES Hypogonadism Azoospermia Hair loss Impaired taste Night blindness Impaired wound healing ```
143
Mechanism of action of Metformin
Non-Competitive inhibitor of mithocondrial glycerol-3- phosphate dehydrogenase ⬇️hepatic glucose synthesis
144
Effect of estrogens on Thyroid hormon?
⬆️ thyroxin-binding globulin ⬆️T4 pool EUTHYROID
145
What is pseudohypoparathyroidism?
Renal resistance to PTH
146
Findings in secundary hyperparathyroidism
⬇️Ca ⬇️PO4 ⬆️ PTH
147
Mental side effect of corticoids use?
Corticosteroid-induced psychosis
148
Clinical Sings of hypocalcemia
TROUSSEAU | CHVOSTEK
149
Signs of Hypercalcemia(3)
Constipation Polyuria/polydipsia Muscle weakness
150
Gene mutation in medullary thyroid tumors
Activating mutation of RET Porto-oncogene
151
MOTEL PASS cells from neural crestfallen cells
``` Melanocytes Odontoblasts Tracheal cartilage Enterochromaffin cells Laryngeal cartilage ``` Parafollicular cells Adrenal medulla Spinal membrane Spiral membrane
152
Clinical findings in VIPoma
Watery diarrhea Hypokalemia Impaired gastric acid secretion
153
What physical finding has a Big relation whit insulin resistance?
WAIST CIRCUMFERENCE MEN >102 cms WOMEN > 88 cms
154
What cholesterol alterations are related whit Diabetes?
⬆️Triglicerides | ⬇️HDL
155
Explain the 4 groups of antiandrogenic drugs
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
How it the body water and osmolarity in SIADH?
Euvolemic- Hyponatermic
157
Cuses of myopathy
``` Glucocorticoid ↔️ CK Polymialgia rheumatica↔️ CK Inflammatory ⬆️CK Statin ⬆️CK Hypothyroid ⬆️CK ```
158
What is metabolic syndrome?
``` ⬆️ triglycerides ⬇️ HDL Central obesity ⬆️ Arterial Pressure ⬆️ glucose ```
159
Explain the three Multiple Endocrine Neoplasia
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
How is seen medullary thyroid cancer?
nests or Sheets of polygonal or spindle-shaped cells with extra cellular amyloid deposits (Congo red positive)
161
If there is a section of pituitary stalk what hormone elevates?
PROLACTIN!! Because dopamine CANNOT inhibit the prolactin secretion
162
How hyperphsophatemia in the chronic renal failure can cause hypocalcemia?
Calcium-phosphatum exceeds solubility so calcium precipitates
163
clinical features of primary parathyroidism (parathyroid adenoma) (4)
bone pain renal stones GI disturbances psychiatric disorders
164
what are the radiologic findings in primary hyperparathyroidism?(3)
subperiosteal erosions granular "salt and pepper skull" osteolytic cysts in the long bones
165
Metalloprotease that cleaves and I actives BNP, glucagon, oxytocin, radykinin ...
NEPRILYSIN!!!!!
166
What type of channel is potassium channel in beta cells?
ATP ase channel
167
How insulins is released from beta cells?
``` Glucose enters trough GLUT-2 Glucose generates ATP ATP close K channel depolarizing The cell Ca enters to the cell Insulin release ```
168
What oral hypoglycemics have high incidence in hypoglycemia?(2)
SULFUNYLUREAS!!!! Gliburide Glimepiride
169
Mechanism of action of FOSCARNET and indication?
Pyrophosphate analog DO NOT require viral enzymes 🚫 DNA polymerase (herpesvirus) 🚫 Reverse transcriptase (HIV) Herpesvirus acyclovir resistant
170
After 12 hours of fasting which organ is important to gluconeogenesis?
KIDNEY!!! Epinephrine acts in renal cortex
171
Hormone responsible for insulin resistance in the second and third trimester of pregnancy?
HUMAN PLACENTAL LACTOGEN | Chorionic somatotropin
172
How different doses of dexamethasone can differentiate between Cushing disease and Cushing syndrome? BOTH HAVE ⬆️ACTH
Cushing disease (pituitary adenoma)Need high doses to suppress cortisol Cushing syndrome (lung cancer) High doses cannot suppress cortisol
173
where T3r como from?
come from T4!!!!!
174
Action of desmolase?
``` Cholesterol to pregnenolone If lack is Incompatible whit life ❎aldosterone ❎cortisol ❎ testosterone ```
175
Mechanism of action of alpha-metiltyrosine? Drug use in the management of pheochromocytoma?
Inhibit tyrosine hydroxylase (tyrosine to DOPA)
176
3 most importatn predisposing factors for hypoglicemia in type 1 diabetes patient?
1. excesive insulin dose 2. inadequated food intake 3. excercise
176
Type 1 DM increase what autoimmune endocrine disease?(2)
Hashimoto thyroiditis | Autoimmune adrenalitis
177
How lack of ACTH leads to low levels of epinephrine?
ACTH stimulates cortisol which in turn increase the phenthanolamine-N-methyltransferase (PNMT) which in turns converts Norepinephrine to Epinephrine in the medulla adrenal.
177
How hypoaldosteronism afect acid-base equilibrium?
⬇️H excretion leads to ⬇️HCO3 metabolic acidosis normal gap because ⬆️CL absortion trying to compensate ⬇️Na ⬆kalemia
180
Sid effect of metformin and population in high risk? (1.3)
⬆️ LACTIC ACIDOSIS renal failure Hepatic failure CHF
181
Side effects of Niacin?(4)
Flushing Hyperglycemia Hepatotoxicity Acute gouty arthritis (⬇️acid Uric renal excretion)
182
Histologic characteristics of papillary thyroid carcinoma?(4)
Overlapping nuclei containing finely disperse chromatin Orphan Annie eye Intranuclear inclusions and groves Psammoma bodies
183
Urinary labs which shows early stage of Diabetic Nephropathy?
ALBUMIN IN URINE
184
How is microscopically seen Hashimoto Thyroiditis (MCC hypothyroidism in U.S.)
Mononuclear infiltrate (Lymphocytes, plasma cells) with germinal centers and Hurthle cells
185
What's Riedel Thyroiditis?
Fibrosis of the thyroid gland extending into the surrounding structures
186
How is microscopically seen subacute (Quervain) thyroiditis?
Mixed cellular infiltration with occasional multi-nucleated Giant cells
187
What's LEPTIN and how it works?
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
How aromatase inhibitors decrease the risk of gallstones?
Aromatase converts estrogen from androgens Estrogens ⬆️cholesterol synthesis
189
Two important theories of DM 2?
Insulin recistance | ⬇️ insulin secretion (islet amyloid deposition toxic consequences)
190
What's metyrapone and its use?
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
What's adiponectin?
Cytokine secreted by fat tissue ⬆️ insulin sensitivity ⬆️ fatty acid oxidation
192
Net result of somatostatin over serum glucose?
Hypoglicemia because blocks glucagon more than insuline

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