Endocrine Flashcards
Which HLA is associated with T1DM?
DR3 and DR4
How do Beta Blockers cause worsening hyperglycemia in DMs?
BBlocks mask the warning signs of hyperglycemia such as tachycardia.
What step in the steroid hormone mechanism immediately precedes DNA binding within the nucleus?
Conformation change of the hormone-receptor complex
After binding, the conformation change reveals the DNA binding domain and is able to bind the DNA enhancer element
What changes are seen in thyroid hormone levels in a pregnant woman?
Increased thyroid-binding globulin, increased total T4, unchanged free T4
Increased estrogen -> increased synthesis of thyroid binding globulin -> increased total T4 to maintain a normal level of T4
Which GLUT is in the hepatocyte and describe its Affinity, Km, and insulin responsiveness
Glut 2 (liver, pancreatic B cells, renal tubular cells, small intestinal epithelial cells)
Decreased Glucose affinity (prevents saturation at high glucose levels)
Increased Km
Not responsive to insulin
What is the pathology of T2DM?
Decreased uptake of glucose into muscle cells
What is the pathology of T1DM?
Decreased secretion of insulin
A 45 y/o presents with light headedness, back pain, muscle weakness, fatigue. PE - dark buccal mucosa and hypotensive. Pt recently stopped taking his medication. Dx?
Addison dz
Insufficient production of adrenal hormones (cortisol, androgens, aldosterone)
Syx = hyperpigmentation, hypotension, muscle weakness, salt craving
Tx - po hydrocortisone
How do you differentiate addisons from adrenal crisis?
Addisons will have hyperpigmentation
When do you give dehydroepiandrosterone?
androgen replacement therapy
Can be given in addison’s, but withdrawl doesn’t result in hyperpigmentation
A teenager was found unresponsive after reporting that he has been fatigued and drinking lots of water. He is hyponatremic with an anion gap. Normal urine sodium. Dx?
T1DM
Hyperglycemia causes osmotic diuresis
He appears hyponatremic because the hyperglycemia is pulling fluid into the plasma and makes his salt levels look lower than they are
What labs would be seen in DI that would make it unique from T1DM DKA?
ADH deficiency
hypernatremia, hyperosmotic urine.
Risk factor for spontaneous achondroplasia in a fetus with negative family history?
Advanced paternal age
Normal trunk length but short limbs
defect in fibroblast growth receptor 3 - abn cartilage formation.
A 23 y/o male with marfanoid habitus with pectus excavatum presents with being awakened at night by HA, anxiety, and heart palpitations. Dx?
MEN 2B (1P) Pheochromocytoma Medullary thyroid carcinoma Oral or gastrointestinal neuromas Look for neuromas in the oral mucosa and elevated calcitonin level
Pt presents with a thyroid nodule. Bx = hypochromic ground-glass nuclei, intranuclear pseudoinclusions, and nuclear grooves. What else would be seen on histology?
Extracellular, calcified, spherical bodies
Papillary carcinoma of the thyroid is the most common thyroid carcinoma and has the best prognosis
“ground glass” or “Orphan Annie” nuclei, psammoma bodies
Dx thyroid nodules on fine-needle aspiration
What lab findings would be seen in Sheehan syndrome (aka postpartum hypopituitarism)
decreased TSH and ACTH results in decreased thyroxine and cortisol
syx = fatigue, anorexia, poor lactation, loss of pubic and axillary hair.
Order of hormone loss = GH, FSH/LH, ACTH, and TSH
Tx - replace all the deficient hormones
A SLE pt taking prednisone increases risk of what type of syx?
Cushing-like syx - increased infection, cataracts, acne, HTN, hyperglycemia, peptic ulcers, osteoporosis, and psychosis.
Recommend vitamin D
Which type of study has subjects randomly assigned to a sequence of treatments with a washout between the treatment interval? (ie control group undergoes washout and switches to treatment group)
Crossover study
Allows the subjects to serve as their own controls
Drawback - washout may not be long enough
A pt has no change in urine osmolality during water restriction, but they do have an increase in osmolality following vasopressin administration. Dx and where is the damage??
Central DI - low ADH production Nephrogenic would not respond to aDH administration Damage to the hypothalamic nuclei Damage to PP - transiet DI Damage to hypothalamus - permanent DI
Where is ADH synthesized and stored?
Synthesized - paraventricular and supraoptic nuclei of the hypothalamus
Stored - posterior pituitary
Injury to posterior pituitary = transient DI, but if the hypothalamic tract is intact axonal regeneration and hypertrophy will allow adequate ADH realse
Where are the different versions of Vit D synthesized?
7-dehydrocholesterol -> cholecalciferol in the skin
Cholecalciferol -> 25OHvitD in the liver
1,25dihydoxyvitD in the kidney
A pt taking lots of vitamin and mineral supplements presents with stupor and dry mucous membranes. What’s going on?
Hypercalcemia due to excessive vitamin D (muscle wakness, constipation, mental status changes, polyuria/polydypsia)
Also see hypercalcemia in granulomatous dz (sarcoidosis, TB) due to PTH independent conversion due to over expression of 1-alpha-hydroxylase in active macrophages. High vit D synthesis = high intestinal calcium absorption. Similar process is seen in Hodgkin dz
13 yr old presents with difficulty breathing, hoarseness, dysphagia. Large red lingual mass. Bx = normal thyroid follicles with colloid Dx?
Thryoglossal duct
Thyroid gland is derived from evagination of the pharyngeal epithelium and descends to the lower neck.
If migration fails the thyroid can reside anywhere along the thyroglossal duct’s pathway including the tongue (lingual thyroid)
What is the pathology behind Sheehan Syndrome?
Ischemic necrosis