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ABSITE > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Hormones secreted by the posterior pituitary? anterior pituitary?

A

Posterior - ADH, oxytocin; Anterior - ACTH, TSH, GH, LH, FSH, prolactin

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2
Q

post-partum trouble lactating, amenorrhea

A

Sheehan’s syndrome; due to pituitary ischemia following hemorrhage/hypotension during childbirth

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3
Q

adrenal insufficiency after meningitis

A

Waterhouse-Friderichsen syndrome; adrenal gland hemorrhage after meningococcal sepsis

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4
Q

Vascular supply of the adrenal gland?

A

Arterial (3) superior (inferior phrenic), middle (aorta), inferior (renal artery); Left adrenal vein (left renal vein), Right adrenal vein (IVC)

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5
Q

most common metastasis to adrenal gland

A

lung ca

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6
Q

components of the adrenal gland? what do they secrete?

A

cortex and medulla; cortex = GFR (glomerulosa - aldosterone, fasciulata - glucocorticoids, reticularis - androgens/estrogens); medulla = catecholamines

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7
Q

male with precocious puberty (or female with virilization), hyperkalemia, hypotension

A

21-hydroxylase deficiency (90% of congeintal adrenal hyperplasias) – leads to low aldosterone and high testosterone (increased 17-OH progesterone)

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8
Q

male with precocious puberty (or female with virilization), hypertension

A

11-hydroxylase deficiency, leads to salt saving (deoxycortisone acts as mineralcorticoid) and causes hypertension, high testosterone

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9
Q

hypokalemia, hypertension, weakness, polyuria - dx, lab findings

A

hyperaldosteronism (Conn’s syndrome), test w/ salt-load suppression test (urine aldo will stay high in primary), aldosterone:renin ratio >20

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10
Q

primary vs secondary hyperaldosteronism; causes, how to differentiate and tx?

A

primary (renin is low) aldo:renin ratio >20, most often caused by hyperplasia 60%, otherwise adenoma; secondary (renin is high) more common than primary, CHF, renal artery stenosis, liver failure, diuretics, renin tumor – adenoma tx w/ adrenalectomy, hyperplasia tx medical therapy (spironolactone, Ca blocker, K+, otherwise bilateral adrenalectomies)

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11
Q

hypotension, lethargy, hyperkalemia - dx, most common cause

A

hypocortisolism (adrenal insufficiency / Addison’s disease, most often caused by withdrawal of steroids, most common primary cause is autoimmune; decreased cortisol (due to high ACTH) and aldosterone – dx w/ cosyntropin test (give ACTH, measure urine cortisol, should remain low)

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12
Q

high cortisol levels, low ACTH – dx, next steps?

A

cortisol secreting lesion – i.e. adrenal adenoma or more commonly adrenal hyperplasia; adrenalectomy for adenoma, medical therapy first for hyperplasia (spironolactone which inhibits aldosterone)

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13
Q

high cortisol levels, high ACTH – dx, next steps?

A

pituitary adenoma or ectopic source of ACTH (i.e. small cell lung Ca); need to do high dose dexamethsone suppression test – if urine cortisol is suppressed = pituitary adenoma, if urine cortisol is not suppressed = ectopic producer of ACTH

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14
Q

most common non-iatrogenic cause of Cushing’s syndrome? tx?

A

pituitary adenoma – urine cortisol should be suppressed w/ either low or high dose dexamethasone suppression test – tx w/ transphenoidal resection, unrectable tumor treat w/ XRT

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15
Q

2 most common non-iatrogenic cause of Cushing’s syndrome? tx?

A

ectopic ACTH, most commonly from small cell lung ca - cortisol is not suppressed with either low or high dose dexamethasone suppression – tx w/ resection of primary

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16
Q

3 most common non-iatrogenic cause of Cushing’s syndrome? tx?

A

adrenal adenoma, get decreased ACTH, unregulated steroid production, tx w/ adrenalectomy

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17
Q

medication used for residual/recurrent or metastatic adrenocortical carcinoma

A

mitotane; inhibits adrenal cortex, induces adrenal atrophy – has poor response rates

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18
Q

where is epinephrine produced? what about for pheochromocytoma? what enzyme converts norepinephrine to epinephrine?

A

produced in adrenal medulla only; only adrenal pheochromocytomas will produced epinephrine; PMNT (phenylethanolamine N-methyltransferase) - enzyme found only in adrenal medulla

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19
Q

most common location of extra-adrenal pheochromocytoma

A

organ of Zuckerkandl (at aortic bifurcation)

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20
Q

hemodynamic management for pheochromocytoma

A

important to alpha blockade first (usually w/ phenoxybenzamine or terazosin) to avoid hypertensive crisis – then beta block if tachycardic/arrythmia – beta blockade without adequate alpha blockade leads to unopposed alpha stimulation, hypertensive crisis, stroke and heart failure

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21
Q

cell type of pheochromocytoma?

A

chromaffin cells (neural crest)

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22
Q

embryologic origin of thyroid gland? parathyroid glands?

A

thyroid from 1st and 2nd pharyngeal arches, superior parathyroid from 4th pharyngeal pouch, inferior parathyroid from 3rd pharyngeal pouch (Parathyroid from the Pouch)

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23
Q

what is the arterial and venous blood supply to the thyroid and where do they branch from

A

superior thyroid artery (1st branch of external carotid artery), inferior thyroid artery (off thyrocervical trunk / subclavian artery, supplies both parathyroids), Ima artery (arises from inominate/aorta to isthmus, 1% of pts); superior and middle thyroid vein (drain to internal jugular vein), inferior thyroid vein (drains into inominate vein)

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24
Q

what is the significance of the superior laryngeal nerve?

A

vagus branch, provides motor to cricothyroid muscle, lateral to thyroid lobes close to superior thyroid artery, injury results in loss of projection and easy voice fatigability

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25
Q

what is the general course of the recurrent laryngeal nerve?

A

runs posterior to thyroid lobe in the tracheoesophageal groove, often close to inferior thyroid artery, left RLN goes around aorta, right RLN goes around inominate artery

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26
Q

FNA of thyroid nodule shows follicular cells: dx/tx?

A

5-10% chance of malignancy, cannot differentiate between follicular cell adenoma, follicular cell hyperplasia, and follicular cell ca on FNA; tx w/ lobectomy vs total thyroidectomy

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27
Q

mechanism of propylthiouracil, methimazole? important side effects? use in pregnancy?

A

inhibits peroxidases and prevents iodine-tyrosine coupling – PTU is safe with pregnancy; both can cause aplastic anemia and agranulocytosis

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28
Q

most common type of thyroid ca, most common metastasis

A

papillary thyroid ca, rare mets to lung

29
Q

general indication for total thyroidectomy?

A

for follicular/papillary bilateral lesions, multicentricity, history of XRT, positive margins, tumors >1 cm – total thyroidectomy w/ central neck node dissection for medullary thyroid cancer

30
Q

FNA of thyroid nodule w/ amyloid deposits

A

medullary thyroid ca

31
Q

1st manifestation of MEN2a (and MEN2b)

A

diarrhea/flushing from hyper-calcitonin medullary thyroid ca

32
Q

cell type of medullary thyroid ca?

A

parafollicular C cells

33
Q

which thyroid cancers respond to radioactive iodine?

A

papillary and follicular thyroid ca only

34
Q

explain bethesda classification for FNA, malignancy risk, and recommendation

A

1-6, 1 is non-diagnostic (repeat FNA), 2 is benign (0-3% risk), 3 is atypia/follicular cell of undetermined significance (5-15% risk, repeat FNA), 4 follicular neoplasm (15-30%, at least lobectomy), 5 suspicious (60-75%, at least lobectomy), 6 is malignant (at least lobectomy)

35
Q

most common ectopic location of inferior parathyroid gland

A

thymus - inferior more likely to be ectopic than superior

36
Q

indications for parathyroidectomy in primary hyperthyroidism

A

symptoms of hypercalcemia, asymptomatic with serum Ca > 1 above normal, renal involvement / kidney stones, osteoporosis, age <50

37
Q

secondary vs tertiary hyperparathyroidism: mechanism? tx?

A

secondary -> renal failure -> phosphate retention and decreased vitamin D -> hypocalcemia -> hyperparathyroidism, tx w/ Ca supplements, vitamin D, phos binders – in tertiary hyperparathyroidism renal disease corrected w/ transplant however parathyroid glands are hyperplastic and overproduce PTH, tx w/ subtotal (3 1/2 gland) or total parathyroidectomy w/ autoimplantation

38
Q

increased serum Ca, decreased urine Ca, normal PTH - dx, tx?

A

familial hypercalcemic hypocalciuria, caused by defect in PTH receptor in distal convoluted tubule of kidney, causes increased reabsorption of Ca; tx nothing

39
Q

most common site of mets for parathyroid ca?

A

lung

40
Q

what is MEN1, which is most common symptom, what do you treat first

A

MEN1 = PPP; Menin gene, parathyroid hyperplasia (1st symptomatic w/ urinary symptoms), pituitary adenoma (prolactinoma), pancreatic islet cell tumors (gastrinoma, 50% multiple, 50% malignant) correct hyperparathyroidism first

41
Q

what is MEN2a, which is most common symptom, what do you treat first

A

MEN2a = PPM; RET protooncogene, parathyroid hyperplasia, pheochromocytoma (often bilateral), medullary Ca of thyroid (diarrhea most common 1st symptom, often bilaterally, #1 cause of death) – need to correct pheochromocytoma first

42
Q

what is MEN2b, which is most common symptom, what do you treat first

A

MEN2b = PMM; RET protooncogene; pheochromocytoma, medullary Ca of thyroid (same as MEN2a, 1st symptom diarrhea, often bilateral, MCC of death), mucosal neuromas / Marfan’s habitus

43
Q

most common cause of hypercalcemia? outpatient? hospital?

A

most common cause in outpatient setting is hyperparathyroidism, in a hospitalized pt most commonly due to cancer that produce PTHrP (small cell lung ca, breast ca)

44
Q

mechanism of grave’s disease

A

IgG antibodies to TSH / thyrotropin receptors

45
Q

most common cause of primary hyperaldosteronism? tx?

A

idiopathic bilateral adrenal hyperplasia (60%), tx is medical w/ spironolactone

46
Q

most important factor in thyroid cancer? how does it affect staging?

A

age. if age <55, cancer either stage 1 (no distant mets) or stage 2 (distant mets) – lymph node status, tumor size do not matter. for age >55, tumor size, nodes and mets TNM system

47
Q

most common primary tumor to metastasize to thyroid gland?

A

renal cell carcinoma&raquo_space;> lung > breast > esophageal

48
Q

Rate limiting step of catecholamine synthesis?

A

L tyrosine to L dopa by tyrosine hydroxylase

49
Q

Hurthle cell vs follicular cell carcinomas?

A

Hurthle cell <10% of thyroid cancers, subtype of follicular; needs vascular/capsular invasion, eosinophilic cells packed w/ mitochondria derived from oncocytic/xyphilic cells of the thyroid, often multifocal, bilateral, more likely to metastasize to local nodes/distant sites, higher mortality – not effectively treated w/ iodine

50
Q

spread of follicular cell thyroid ca

A

hematogenous

51
Q

indications for post op radioactive iodine following total thyroidectomy?

A

large tumor >4 cvm, extrathyroidal extension of the tumor regardless of size, LN metastasis, and high risk features (Tall cell / columnar cells)

52
Q

treatment of hypercalcemic crisis

A

IV crystalloids, bisphosphonates/calcitonin, dialysis

53
Q

primary thyroid lymphoma is associated with…

A

hashimoto thyroiditis

54
Q

most common ectopic location of superior parathyroid gland

A

retro/paraesophageal - inferior more likely to be ectopic than superior

55
Q

Best screening test / highest sensitivity test for pheochromocytomna

A

PLASMA metanephrines

56
Q

what is pseudohypoparathyroidism?

A

inesnsitivity to PTH - characterized by elevated PTH but hypocalcemia and hyperphosphatemia

57
Q

best test to monitor recurrent disease after total thyroidectomy and post op iodine ablation of follicular ca?

A

serum thyroglobulin levels, if elevated check 131I scan

58
Q

malignancy associated with thyroglossal duct cyst

A

papillary thyroid ca - if discovered incidentally after cyst resection, pt should undergo total thyroidectomy

59
Q

paramedian or abducted position of vocal cord

A

recurrent laryngeal nerve injury - paramedian position leads to weak voice, abducted position leads to hoarse voice and ineffective cough

60
Q

pathophys of familial hypocalciuric hypercalcemia

A

mutation in CASR (calcium receptor) of parathyroid/kidney, lack of calcium signal increases PTH level, which increases renal calcium reabsorption

61
Q

most common cause of primary adrenal insufficiency in the US? in the world?

A

autoimmune adrenal atrophy, worldwide tuberculosis

62
Q

most common cause of secondary adrenal insufficiency

A

exogenous glucocorticoid therapy > bilateral adrenal resection > pituitary tumors

63
Q

most common cause of cushing syndrome? 2nd most common?

A

exogenous corticosteroid administration > ACTH producing pituitary adenoma

64
Q

challenges to lap right adrenalectomy (3)

A
  1. need to retract liver, 2. need to mobilize duo 3. short/posteriorly located adrenal that drains into IVC, posing risk of injury to IVC
65
Q

most accurate test for hyperthyroidism?

A

TSH – should have suppressed/low TSH in hyperthyroid states

66
Q

direct effects of PTH

A

acts on bone (stimulates osteclasts, suppress osteoblast), acts on kidney at DCT (inhibits phosphate/bicarb reabsorption) and promote hydroxylation of 25-vitD to 1-25 vitD

67
Q

what promotes intestinal calcium reabsorption?

A

1-25 hydroxyvitamin D

68
Q

what is a “lateral aberrant thyroid”

A

ectopic thyroid tissue found in neck, typically represents metastatic thyroid cancer within a lymph node, most often its papillary type

69
Q

what is hungry bone syndrome

A

prolonged hypocalcemia

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