Endocrine Flashcards
α-cells in the islets of Langerhans secrete ____
α-cells in the islets of Langerhans secrete glucagon
β-cells in the islets of Langerhans secrete ____ and ____
β-cells in the islets of Langerhans secrete insulin and c-peptide
δ-cells in the islets of Langerhans secrete _____
δ-cells in the islets of Langerhans secrete somatostatin
describe the effect of insulin on potassium
- promotes K+ movement INTO cells
- increases the action of the Na/K/ATPase
- this effect is used in treating life-threatening hyperkalemia by co-administering insulin + glucose
insulin promotes K+ movement (into or out of?) cells by ____
insulin promotes K+ movement into cells by increasing the action of the Na/K ATPase
list the infections associated with secondary DM
CMV
mumps
Coxsackie B virus
which 2 genetic syndromes are associated with secondary DM?
Down syndrome and Turner syndrome
T1DM has an association with HLA-___, ____ & ____
T1DM has an association with HLA-DR3, DR4/DQA1 & DQB1
T1DM is associated with which 4 viruses?
Coxsackie B
Rubella
CMV
mumps
T1DM is characterized by ____ reacting against endogenous ____ due to failure of ____
T1DM is characterized by immune effector cells reacting against endogenous B-cells antigens due to failure of self-tolerance in T-cells
____ antibodies may play a role in T1DM
islet cell antibodies may play a role in T1DM
the risk of T2DM increases with an increase in ____
the risk of T2DM increases with an increase in BMI
distribution of fat also plays a role in development of T2DM; patients with ___ obesity have higher risk of DM than those with ____ obesity
distribution of fat also plays a role in development of T2DM; patients with central obesity have higher risk of DM than those with peripheral obesity
list the 3 ways in which obesity can lead to T2DM
-
production of free fatty acid
- antagonizing insulin action
- lipotoxicity
-
change in adipokines levels
- decrease leptin and adiponectin levels in obesity
-
inflammation
- role of IL-1
- amyloidosis within the islets
describe the presentation of a patient with the type 1 form of the condition seen in the image
- <40 yrs old & skinny (lack of insulin → catabolic state)
- fruity breath (caused by ketones)
- vomiting (ketones irritate area postrema)
- Kussmaul breathing (hyperventilating to compensate for met. acidosis)
describe the OGTT levels in normal, diabetic and pre-diabetic patients
_____ levels give an integrated measure of glucose concentrations over the previous 2-3 months because RBCs ____
glycosylated hemoglobin (HbA1c) levels give an integrated measure of glucose concentrations over the previous 2-3 months because RBCs live for 100 days
____ is the most common precipitating factor for DKA; what are 3 other causes?
missed insulin dose is the most common precipitating factor for DKA
- infection or acute illness
- trauma
- emotional disturbance
the hyperglycemia causes the characteristic ___ and ___ in DKA
the hyperglycemia causes the characteristic osmotic diuresis and dehydration in DKA
describe what is seen in the urine during DKA
positive for sugar and ketones
describe the electrolyte levels seen in DKA
increased K
decreased Na
describe the arterial blood gas levels seen in DKA
low pH (<7.3) with high anion gap metabolic acidosis
low bicarbonate
describe the management of DKA
saline infusion to replace fluid loss
insulin IV in small increments (to reduce glucose slowly)
potassium supplements
_____ occurs in elderly patients with T2DM (instead of DKA)
hyperosmolar hyperglycemia state occurs in elderly patients with T2DM (instead of DKA)
in hyperosmolar hyperglycemic state (HSS), there is usually very high ____ levels causing ____
in hyperosmolar hyperglycemic state (HSS), there is usually very high glucose levels causing dehydration
describe microangiopathic complications in the condition seen in the image
microangiopathic complications:
- affects capillaries, arterioles, small blood vessels
- characterized by thickening of BMs which causes leakiness
- manifestation: nephropathy, retinopathy, neuropathy
the first morphological sign of the condition seen in the image is ___ and ____
the first morphological sign of the condition seen in the image is basement membrane thickening and mesangial expansion
describe the 2 types of the condition seen in the image
-
pre-proliferative retinopathy:
-
microaneurysms: d/t loss of pericytes
- rupture of microaneurysms → dot & blot retinal hemorrhages, hard exudates & cotton wool spots (d/t ischemia → retinal infarct)
-
microaneurysms: d/t loss of pericytes
-
proliferative retinopathy:
- neovascularization (due to VEGF) WITHOUT pericytes → hemorrhage → retinal detachment and blindness
the condition seen in the image occurs when ____ accumulates in tissues
explain this
accumulation of sugar alcohols (polyols) in tissues which do not require insulin for glucose uptake
glucose → sorbitol
sorbitol accumulation causes osmotic effects and depletion of myoinositol, AAs and K+
list the vascular causes of hypopituitarism
Sheehan’s syndrome (post-partum hemorrhage)
severe hypotension
describe macroangiopathic complications of the condition seen in the image
list 4 infections that can cause hypopituitarism
meningitis
TB
syphilis
HIV/AIDS
name 2 systemic conditions that can cause hypopituitarism
sarcoidosis
hemochromatosis
in hypopituitarism
___ is the first hormone to be lost in children;
____ is the first hormone to be lost in adults
and ___ is the last
GH is the first hormone to be lost in children;
LH and FSH is the first hormone to be lost in adults
ACTH is the last
___ is the most common hormone secreted from the condition seen in the image
what are other causes of the most common form of the condition seen in the image?
image = pituitary adenoma
- physiological i.e. stress
- drugs:
- antipsychotics decrease dopamine and lead to more prolactin secretion
- OCPs
- renal failure
describe the presentation of the most common form of the condition seen in the image in females vs. males
females: galactorrhea, amenorrhea, anovulation, infertility
males: headache, decreased libido, erectile impotence
the condition seen in the image occurs with ____ secretion after ____
the condition seen in the image occurs with excessive GH secretion after fusion of the epiphysis
the condition seen in the image is part of ___ syndrome
explain other components of this syndrome
the condition seen in the image is part of MEN-1 syndrome
- pituitary adenoma = increased GH potentially
-
pancreatic tumor
- VIPoma, ZE gastrinoma, insulinoma
- parathyroid adenoma/hyperplasia
____ are used as a screening test for the condition seen in the image
IGF-1 levels are used as a screening test for the condition seen in the image
GH acts on the liver to produce IGF-1
IGF-1 is more stable than GH and therefore more important in diagnosis of acromegaly
___ is a test used for definitive diagnosis of the condition seen in the image
what is seen as a positive result in this test?
hyperdynamic testing (OGTT + serial GH levels) is a test used for definitive diagnosis of the condition seen in the image
- in normal patients, decreased GH due to presence of glucose
- acromegaly patients: presence of glucose does NOT inhibit GH (remains high)
____ is the most common cause of death in the condition seen in the image
heart failure is the most common cause of death in the condition seen in the image
due to cardiomegaly + concentric hypertrophy from HTN
in the condition seen in the image, there is hypertension due to ____ which allows ____
in the condition seen in the image, there is hypertension due to upregulation of α receptors which allows permissive action of catecholamines leading to vasoconstriction
in the condition seen in the image, there is hypertrophy of ___ glands leading to ____
in the condition seen in the image, there is hypertrophy of sweat glands leading to body odor & oily skin
list complications of the condition seen in the image
- diabetes (due to insulin resistance from GH)
- obstructive sleep apnea
- osteoarthritis
- carpal tunnel
- heart failure from HTN = MC COD
contrast central vs. nephrogenic DI
-
central = absolute def. of ADH
- genetic, idiopathic, hypothalamic/pituitary stalk lesion
-
nephrogenic = resistance to ADH action
- genetic, metabolic (hypokalemia, hypercalcemia) or lithium
- hypercalcemia causes aquaporin in CD to be insensitive to ADH → decreased urine osmolality → polydipsia & polyuria
list causes of central DI
- genetic
- hypothalamic or high pituitary stalk lesion
- head trauma, tumors, inflammatory disorders
- idiopathic
list metabolic and pharmacologic causes of nephrogenic DI
- metabolic:
- hypercalcemia = causes aquaporin in CD to be insensitive to ADH → decreased urine osmolality → polydipsia & polyuria
- hypokalemia
- drug:
- lithium
give the results for water deprivation test in central vs. nephrogenic DI
SIADH causes an increase in ___ secretion which ultimately causes ___ and leads to ____
SIADH causes an increase in ADH secretion which ultimately causes water retention and leads to hyponatremia
in SIADH, the retention in water can cause ____ which can lead to ____
in SIADH, the retention in water can cause hyponatremia which can lead to cerebral edema, neurological symptoms, coma, and death
list the causes of SIADH
- post-operative
- intra-cranial disease:
- encephalitis, meningitis, head injury
- neoplasms: small cell ca. of the lung
- pulm. disease: pneumonia, TB
- drugs/medications
the organ that is causing the condition seen in the image originates from ____
the organ that is causing the condition seen in the image originates from the floor of the pharynx
the condition seen in the image is the most common cause of ___ in the US and is a type ____ hypersensitivity
the condition seen in the image is the most common cause of hyperthyroidism in the US and is a type II hypersensitivity
describe the image and what condition it is seen in
the follicles are lined by tall columnar epithelial cells that are actively resorbing the colloid in the centers of the follicles, resulting in a “scalloped” appearance of the colloid
in the condition seen in the image, T cells induce B cells to produce ____
in the condition seen in the image, T cells induce B cells to produce IgG antibodies against the TSH receptor (stimulating Abs)
in the condition seen in the image, the thyroid gland is (smaller or larger?) due to diffuse ____ and hyperplasia of ____
in the condition seen in the image, the thyroid gland is larger due to diffuse hypertrophy and hyperplasia of follicular epithelial cell
in the condition seen in the image, the lumen is lined by ____ instead of the normal ___ and the colloid within the follicular lumen is _____
in the condition seen in the image, the lumen is lined by columnar cells instead of the normal cuboidal cells and the colloid within the follicular lumen is pale with scalloped margins
in the condition seen in the image, there is ____ uptake
in the condition seen in the image, there is radioactive iodine uptake
describe blood levels in the condition seen in the image
increased TSI (thyroid stimulating Ig), T3 and T4
decreased TSH (bc free T3 downregulates TRH receptors in the AP to decrease TSH release)
list the triad of symptoms that are specific to the condition seen in the image
- finger clubbing (thyroid acropachy)
- ophthalmopathy (exopthalmos b/c fibroblasts have TSH receptors and pushes the eye forward)
- pretibial myxedema (non-pitting edema b/c fibroblasts have TSH receptors → GAGs)
the most common cause of death in the condition seen in the image is ____
the most common cause of death in the condition seen in the image is arrhythmias
describe the cholesterol and glucose levels in the condition seen in the image
HYPOcholesterolemia (increased LDL receptors from T3/T4 = increased removal from blood)
HYPERglycemia (T3/T4 cause gluconeogenesis and glycogenolysis)
describe “thyroid storm” in relation to the condition seen in the image
stress causes elevated catecholamines and massive hormone excess → arrhythmias, hyperthermia, vomiting, hypovolemic shock
list the clinical features associated with the condition seen in the image
describe the image and the condition it is seen in
the thyroid parenchyma contains a dense lymphocytic infiltrate with germinal centers; residual thyroid follicles lined by deeply eosinophilic Hurthle cells are also seen
the condition seen in the image is the most common cause of ____ and is caused by a type ___ hypersensitivity
the condition seen in the image is the most common cause of hypothyroidism and is caused by a type IV hypersensitivity
the condition seen in the image is characterized by chronic inflammation with ___ & ____metaplasia (which are atrophic thyroid follicles filled with ___)
the condition seen in the image is characterized by chronic inflammation with germinal centers & Hurthle cell metaplasia (which are atrophic thyroid follicles filled with eosinophilic granular cytoplasm)
describe serum levels of T3, T4, TRH and TSH of the condition seen in the image
decreased T3 and T4
increased TRH and TSH
in the condition seen in the image, ___ is increased which leads to increased ___
explain this effect on men vs. women
in the condition seen in the image, TRH is increased which leads to increased prolactin
females: amenorrhea, galactorrhea, infertility (bc no LH surge)
males: gynecomastia, decreased libido, infertility
list the 2 antibodies found in the condition seen in the image
anti-thyroglobulin
anti-microsomal antibodies (aka anti-thyroid peroxidase)
the condition seen in the image is associated with which tumor?
monoclonality of germinal center → non-Hodgkin’s B cell lymphoma
describe how the condition seen in the image can affect the vascular system
atherosclerotic plaques → MI, stroke, peripheral vascular disease
the condition seen in the image is characterized by generalized ____ due to accumulation of ____
the condition seen in the image is characterized by generalized myxedema due to accumulation of GAGs
describe the cholesterol levels in the condition seen in the image
hypercholesterolemia due to lack of thyroid hormones which causes a decrease in LDL receptors
the condition seen in the image causes generalized ____ which can compress the ___ nerve leading to ____
the condition seen in the image causes generalized myxedema which can compress the median nerve leading to carpal tunnel syndrome
____ is characterized by high TSH levels and normal FT4/FT3 levels in an asymptomatic individual
sub-clinical hypothyroidism is characterized by high TSH levels and normal FT4/FT3 levels in an asymptomatic individual
sub-clinical hypothyroidism is characterized by high ___ levels and normal ____ levels in an asymptomatic individual
sub-clinical hypothyroidism is characterized by high TSH levels and normal FT4/FT3 levels in an asymptomatic individual
patient has the following levels:
high TSH
normal FT3/FT4
what else is associated with the condition the patient has?
associated with endothelial dysfunction → atheroma
patient has the following levels:
high TSH
normal FT3/FT4
the condition the patient has can convert into ___ especially if ___ are present
the condition the patient has can convert into hypothyroidism especially if anti-thyroid antibodies are present
the condition seen in the image is caused by a mutation in ____
the condition seen in the image is caused by a mutation in KRAS
in the condition seen in the image, there is ___ metaplasia
in the condition seen in the image, there is Hurtle cell metaplasia
complications of the condition seen in the image occurs from ____ and can compress which 3 structures?
complications of the condition seen in the image occurs from mass effect and can compress:
- left recurrent laryngeal nerve → hoarseness
- trachea → dyspnea
- esophagus → dysphagia
the condition in the image is benign solely because the ____ is intact
the condition in the image is benign solely because the capsule is intact
the most important risk factor for the condition seen in the image is ____
the most important risk factor for the condition seen in the image is iodine deficiency
the condition seen in the image occurs due to a mutation in ____
the condition seen in the image occurs due to a mutation in KRAS (since its a progression of follicular adenoma, which also has KRAS mutation)
in the condition seen in the image, there is invasion of ____ as well as ____
in the condition seen in the image, there is invasion of capsule as well as hemorrhage
the condition seen in the image spreads ____
the condition seen in the image spreads hematogenously (to liver, lungs, bone)
the most important predisposing factor for the condition seen in the image is _____
the most important predisposing factor for the condition seen in the image is long-standing ionizing radiation
the condition seen in the image is caused by a mutation in ____
the condition seen in the image is caused by a mutation in BRAF
the condition seen in the image has ____ projections with ___ core and ____ bodies
the condition seen in the image has papillary projections with fibrovascular core and psamomma bodies
the condition seen in the image is lined by cells with ____ nuclei
the condition seen in the image is lined by cells with clear “Orphan Annie eye” nuclei
the complications of the condition seen in the image are due to ____
the complications of the condition seen in the image are due to mass effect
the condition seen in the image occurs due to a mutation in ____ which is a ____ gene
the condition seen in the image occurs due to a mutation in RET which is a proto-oncogene
in the condition seen in the image, there are malignant ___ cells secreting ____
in the condition seen in the image, there are malignant parafollicular (C cells) cells secreting localized amyloid
____ is a tumor marker for the condition seen in the image and is used to measure ____
calcitonin is a tumor marker for the condition seen in the image and is used to measure recurrence/response to therapy
explain how the condition seen in the image can be part of MEN2A
MEN2A = 2 P’s, 1 M
- MEN2A consists of:
- medullary carcinoma of the thyroid
- parathyroid adenoma/hyperplasia
- pheochromocytoma
explain how the condition seen in the image can be part of MEN2B
MEN2B = 3 Ms, 1 P
- MEN2B:
- medullary carcinoma of thyroid
- marfinoid habitus
- mucosal neuromas
- pheochromocytoma
MEN2A and MEN2B are caused by mutations in ____
MEN2A and MEN2B are caused by mutations in RET
the condition seen in the image secretes which 3 hormones in its paraneoplastic syndrome?
MAVS
Medullary carcinoma
ACTH
VIP
S erotonin
on biopsy of the condition seen in the image, there are _____
on biopsy of the condition seen in the image, there are sheets of malignant cells in amyloid stroma
____ carcinoma of the thyroid are ___ tumors
anaplastic carcinoma of the thyroid are undifferentiated tumors
describe the hormones synthesized by the different layers of the adrenal cortex
the most common cause of Addison’s disease is ____
the most common cause of Addison’s disease is autoimmune disease
list the infections that can lead to adrenocortical insufficiency (Addison’s disease)
- TB
- AIDS
- meningitis → Waterhouse-Fredericksen syndrome, which causes hemorrhage and destruction of the adrenal glands
describe the short Synacthen test
- administration of ACTH analogues to assess the residual capacity of the adrenal gland
- within 15-30 min of ACTH infusion, the normal adrenal cortex releases 2-5 times its basal plasma cortisol output
- failure of response confirms a diagnosis of primary adrenal insuff.
in patients with adrenal insufficiency (Addison’s), there is high ___ activity due to low ____ levels
in patients with adrenal insufficiency (Addison’s), there is high renin activity due to low aldosterone levels
an anterior pituitary adenoma can cause the condition seen in the image and (does or does not?) respond to feedback from high dose ____
an anterior pituitary adenoma can cause the condition seen in the image and DOES respond to feedback from high dose dexamethosone
ectopic ACTH can cause the condition seen in the image and (does or does not?) respond to feedback from high dose ____
ectopic ACTH can cause the condition seen in the image and DOES NOT respond to feedback from high dose dexamethosone
the condition seen in the image can be caused by unilateral adrenal cortical adenoma and causes ____ atrophy of adrenal gland
the condition seen in the image can be caused by unilateral adrenal cortical adenoma and causes contralateral atrophy of adrenal gland
low-dose dexamethosone test separates ____ from _____
low-dose dexamethosone test separates pseudo-Cushing’s (obese patients, drugs, stress, alcohol) from true Cushing’s
true Cushing’s = increased urinary cortisol b/c low dose DOES NOT suppress it
high-dose dexamethasone is used to differentiate between ___ and ___, where ____ is suppressed by the high dose
high-dose dexamethasone is used to differentiate between anterior pituitary adenoma and ectopic ACTH production, where anterior pituitary adenoma (Cushing’s Disease) is suppressed by the high dose
the condition seen in the image causes ____ of fat which can lead to which 3 characteristic feature?
the condition seen in the image causes redistribution of fat which can lead to:
-moon facies
-truncal obesity
-buffalo hump
the condition seen in the image causes HTN b/c cortisol is a weak ____ and also upregulates ____
the condition seen in the image causes HTN b/c cortisol is a weak mineralocorticoid (acts like aldosterone) and also upregulates α-1 receptors
the most common cause of death in the condition seen in the image is ____
the most common cause of death in the condition seen in the image is MI & arrythmias (due to atherosclerosis and HTN)
____ is the 2nd most common cause of death in the condition seen in the image
recurrent infections (b/c cortisol is an immunosuppressant) is the 2nd most common cause of death in the condition seen in the image
describe the image
the neoplastic cells are vacuolated because of the presence of intracytoplasmic lipid
the condition seen in the image can lead to ___ because cortisol is a catabolic hormone
the condition seen in the image can lead to osteoporosis → pathologic fractures because cortisol is a catabolic hormone
the most common presentation of the condition seen in the image is ____
the most common presentation of the condition seen in the image is asymptomatic (non-functional)
the condition seen in the image can cause Cushing syndrome if it arises from zona ____
the condition seen in the image can cause Cushing syndrome if it arises from zona fasciculata
the condition seen in the image can cause primary hyperaldosteronism, which is also called ____, if it arises from zona ____
the condition seen in the image can cause primary hyperaldosteronism, which is also called Conn syndrome, if it arises from zona glomerulosa
the ____ test can be used to diagnose hyperaldosteronism
the fludrocortisone suppression test can be used to diagnose hyperaldosteronism
a screening test for hyperaldosteronism is an increased ___ to ___ ratio
a screening test for hyperaldosteronism is an increased aldosterone:renin ratio
describe 21-hydroxylase def.
describe 11B-hydroxylase def.
describe 17a-hydroxylase def.
describe the image
characteristic nests of cells with abundant cytoplasm
bizarre cell is seen in the center of the image
the condition seen in the image is a tumor of ___ (___ cells)
the condition seen in the image is a tumor of adrenal medulla (chromaffin cells)
the condition seen in the image can be part of which 4 conditions?
MEN2A
MEN2B
Von-Hippel-Lindau syndrome (w/ RCC)
Neurofibromatosis
describe the presentation of the condition seen in the image
episodic HTN, anxiety, palpitations, headache, excessive sweating, cardiac arrhythmias
the most common cause of death in the condition seen in the image is caused by _____
the most common cause of death in the condition seen in the image is caused by cardiac arrhythmias
for the condition seen in the image:
____ testing is more sensitive
____ is more specific
for the condition seen in the image:
plasma metanephrine testing is more sensitive
24-hour urinary catecholamines and metanephrines is more specific
____ is reserved for biochemically confirmed cases in which CT scanning or MRI does not show a tumor
MIBG scintigraphy (metaoidobenzylduanidine) is reserved for biochemically confirmed cases in which CT scanning or MRI does not show a tumor
