Endocrine Flashcards
40 or 50yo with thyroid cancer, palpatations, HTN, anxiety, sweating and other sympathetic symptoms. W/U shows adrenal mass (pheochromocytoma, should be thinking of MEN syndrome at this point). What is pre-op treatment?
Alpha and beta blockade
Research lab studying insulin resistant DM: what biochemical assay would they be working on? Inhibition of which biochemical agent would be associated with insulin-resistance in DM?
Tyrosine kinases
Patient in 60s, smoker, shows up to ER with vomiting, HA, and malaise. CT shows nodule in lung (lung cancer) and labs show high Ca2+, low ALP, low phosphorous. Where is the primary function for these lab studies?
Small cell lung cancer most likely; none of the endocrine organs effected but bones and tubules are affected
54yo woman with DM, osteoporosis, and HTN who gains a bunch of weight and gets ascites. Imaging studies show mass adjacent to right kidney. Neither low or high dose dexamethasone changes cortisol levels (dexamethasone suppression test). What does she have?
Adrenal adenoma
Woman in 50s has no real physical findings except exophthalmos. She receives drug treatment but develops GI issues, fever and infection. What medication was she given?
Propothouracil for Grave’s disease
A patient with chronic renal disease and osteodystrophy (hyperactive osteoclast activity). Which of the following hormones plays a role?
PTH
A 65yo male with SCLC is given democycline to treat ectopic ADH production which leads to large amounts of dilute urine production. Patient is told to hold all fluids for 12 hours. However the patient continues to produce dilute urine, ADH levels are markedly elevated, serum hyperosmolality and serum hyponatremia are prominent. Which of the following is most likely?
a. Not DM, not SIADH, not primary hyperaldosteronism
b. Medication-induced diabetes insipidus
19yo college student is vomiting, photophobia, fever, malaise, leg pain rash (basically septic). Gram stain shows G- diplococci. He then develops vomiting, flank pain, and abdominal pain. What is causing this?
Hemorragic change in adrenal glands (Waterhouse-Friedrich syndrome)
Kid born with organomegaly, large tongue, Wilm’s tumor, omphalocele, pits in back of ear. What does she have?
Beckman-Wiedmann syndrome
5yo kid with excessive hunger, thirst, high levels of glucose/ketones in urine (he’s in DKA). What’s the association?
HLA-DR: autoimmune
How do steroid hormones work?
Generally transform hormone receptor complex, generally located in nucleus
Older guy with DM symptoms and symptoms of BPH (stream issues, trouble starting and stopping, enlarged prostate on DRE etc.
Glandular and stromal hyperplasia of prostate (not an endocrine disorder)
Patient with thyroidectomy for Grave’s disease. She has facial spasm with tap on cheek, QT prolongation, low calcium, low PTH, high phosphorous. What happened?
Hypocalcemia secondary to hypoparathyroidism from removal of PTH glands during surgery
Patient is a diabetic and loses vision in both eyes (DM shouldn’t lose simultaneous, acute vision in both eyes). Mass identified in brain; biopsy reveals GH-producing adenoma. What type of cell composes this mass?
Acidophilic cells
Patient with DM and HTN shows up with a HbA1c of 8.5%, SOB, dizziness, and chest pain. What drug were they most likely given that induced these symptoms?
Beta-blocker (propranolol)
Patient with intracranial tumor, plasma ADH is normal, urine flow is 10ml/min, and serum osmolality is 290 (Nephrogenic DI). Which of the following osmolarity values should resemble condition?
Either 100 or 1000
28yo patient with hypothyroidism, diarrhea, palpatations, tachycardia and fatigue. Hypothyroidism presents with lethargy, hyperthyroidism causes BMR to become fast than it should –> fatigue.
Cause = overmedication for hypothyroidism (levothyroxine)
25yo female with galactorrhea, visual changes, loss of libido and mass in sella turcica. Which of the following functions is most likely to be preserved?
Salt retention
She likely has a prolactinoma)
24yo with galactorrhea; PMH of duodenal ulcers and hypercalcemia; FHx has wide variety of tumors in pancrease, pituitary, etc. Which of the following inheritance patterns is most likely?
Autosomal dominant (MEN syndrome)
Researcher wants to know how thyroid hormone works
TSH tends to access Na/K/ATPase
History of pheochromocytome (chromaffin cells in adrenal medulla)
Will secrete NE
Young woman who stops menstruating, has N/V/weakness, 160/100 BP, low serum potassium of 2. Condition affects 2 adrenal hormones and leaves 1 hormone intact. Which are/hormone is intact?
Amenorrhea –> anti-androgenic effects
Low serum K –> aldosterone affected
Cortisol is intact so glomerulosa is intact
Autoimmune disorder of adrenal gland: given symptoms we must recognize, given patient with multiple masses in uterus and adrenal gland. She does not have leiomyomas. Clinical manifestation of adrenocortical carcinoma
Adenocortical mass: stain with inhibin
Sort of a trick question because adrenal cortical tumors, especially carcinomas, share inhibin positivity just like granulosa cells.
Patient with hyperthyroidism (basically has Hashimoto), anxiety, weight loss, pretibial myxedema. Given series of etiologies for this (radiation, auto-antibodies, etc)
Test of choice is anti-TSH (auto AB for TSH)
Hypercalcemia: always look at PTH or kidney.
Patient with hypercalcemia, dry mouth and thyroid nodule (MEN-type presentation); outside of conventional parayhtoid PTH hormone, the only ting that will cause hypercalcemia is valcitonin vs amyloid deposition
Medullary cancer of thyroid
Where do adrenal veins drain into?
IVC
EKG: endocrine pathology associated with a couple different manifestations
Prologed QT with hypercalcemia
u wave associated with long-standing steroid use (cortisol)
Papillary cancer of thyroid
Know linkage to radiation (radiology techs prior to protective measures, treatment of ance with radiation)
DM type II: remember that there are certain drugs which can cause hydrolysis of sugars at the brush border, know drugs, their actions, their symptoms
Acarbose
Recognize different tumors in pituitary gland and their different manifestations; GH overproduction and gigantism
GH-producing adenoma
Patient with chronic fracture, weight gain, compression fractures, polyuria, polydipsia.
Cortisol causes these diabetes like S/S fractures, etc (reason for hesitancy in treating elderly with long-term steroids)
Patients with a bunch of autoimmune disorders, DM etc
If GI symptoms also, celiac disease; linkage between celiac and DM
High TSH, low total and free T4: probably older patient with fatigue, weakness, weight gain, constipation, cold-insensitivity, etc
Has hypothyroidism
MEN
Autosomal dominant
End terminal PTH produced where?
May have patient with high PTH and high calcium (either symptoms or lab values) –where is hormone produced?
End terminal PTH is mostly produced by chief cells > oxaphilic cells
How do you treat GH tumors?
Somatostatin therapy
Pancreatic vascular blood distribution; islet cell tumors
Gastroduodenal and SMA could be problematic in surgery
DM: diabetic nerve pain has lots of new drugs; what is the abnormality in the peripheral neuropathy?
Pacinian corpuscle
How does PTH work in the kidney?
Decreased reabsorption of sodium, increased excretion of phosphate
Guy with UC on chronic steroid therapy and suddenly develops what symptoms of steroid use?
Can develop DM
Know Kimmelstiel-Wilson histology and DM
Nodular glomerulosclerosis in kidney
