Endocrine Flashcards
Glactorrhea, amenorrhea, HA, dec libido, vision loss
Prolactinoma - pituitary adenoma
Tx = DA agonist bromocriptine
Gigantism
KIDS, excess GH
Inc GH, IGF-1, lack GH supression by oral glucose
Acromegaly - GH secreting adenoma
- Death = cardiac failure
- Secondary DM d/t GH indices glucose production
- Tx = Octreotide (dec GHRH release)
Post-partum poor lactation & loss of pubic hair
Sheehan syndrome - infarction of pituitary
Polyuria, polydipsia, hyperNa, high serum osmolarity, low urine osmolarity…water deprivation fails to concentrate urine
Central diabetes insipidus
tx = desmopressin
Polyuria, polydipsia, hyperNa, high serum osmolarity, low urine osmolarity…no response to desmopressin
Nephrogenic DI
- lithium, demeclocyline
Tx = HTCZ, indomethacin, amiloride
Low serum Na, osmolarity, mental status change, seizures
SIADH - small cell or cyclophsophamide
HypoNa –> neuronal swelling, cerebral edema
Tx = water restriction, demeclocycline
Inc in BMR & sympathetics in hyperthyroidism
Inc Na/K ATPase
Inc B1 adrenergic
Cholesterol & blood sugar profile in hyperthyroidism
LOW cholesterol
HIGH glucose
Young woman with a diffuse goiter, pre-tibial myexedema, hyperthyroidism, diplopia, eye redness, proptosis, EOM weakness
Grave Disease
IgG Ab to TSH receptor
- in eye and tibia
- Lymphocytes–> inc fibroblasts –> GAGs & edema
Tx = BBs, thioamide, radiation
Scalloping of colloid
Grave disease
High total, free T4, low TSH
Grave disease
Arrhythmia, hyperthermia, vomiting, hypovolemic shock following surgery or childbirth
Thyroid storm
Tx = PTU, BBs, steroids
Pot bellied, puffy face, MR, short stature, enlarged tongue, umbilical hernia
Cretinism
- maternal hypothyroidism, agenesis, iodine deficiency
Congenital defect in TH most commonly involves what enzyme?
Thyroid peroxidase
Most common causes of hypothyroidism
1 = Hasmimoto’s
Iodine deficiency, Lithium, surgical ablation from Grave’s
Dx = Measure TSH*
Hyper –> hypothyroidism, anti-thyroglobulin, anti-microsomal Ab, atrophic follicles
Hashimoto’s
Low T4, high TSH
Hasimoto’s
Chronic inflammation of thyroid w/ germinal centers and Hurthle cells
Hashimoto’s
Hx of Hashimotos presents w/ enlarging thyroid…Dx?
Marginal zone B-cell lymphoma
Hypothyroidism following flu-like illness, tender thyroid, inc ESR
Subacute, granulomatous (De quervain) thyroiditis
#1 = echovirus Coxsackie, measles, mumps, adeno
Mixed cellular infiltrate w/ GIANT cells
Tx = NSAIDs
Young female w/ dyspnea, hypothyroidism, and hard as wood thyroid, extensive fibrosis
Reidal fibrosing thyroiditis
- younger than anaplastic carcinoma
Method to sample thyroid
FNA
Cancerous thyroid Iodine uptake
Cold
Thyroid mass surrounded by dense fibrous capsule
Follicular adenoma
Thyroids carcinomas
- Papillary - RET
- Follicular - RAS
- Medullary - RET
- Anaplastic
Papillary carcinoma of thyroid
Hx ionizing radiation/acne
Orphan annie eye nuclei
Excellent prognosis
Most common thyroid carcinoma
Papillary
Nuclear grooves and white central clearing in the nucleus, concentrically calcified structures in thyroid gland
Papillary carcinoma
- “ground glass,” Orphan Annie eyes, Psamomma bodies
Thyroid mass surrounded by dense fibrous capsule with invasion through capsule
Follicular CARCINOMA
- FNA cannot distinguish
- spread hematogenous NOT LNs like other carcinomas
- microfollicles
Low serum Ca, malignant cells in amyloid stroma
Medullary carcinoma
- parafollicular C cells –> calcitonin
- Assoc w/ MEN 2A/B
Medullary carcinoma, pheo, parathyoid adenoma
MEN 2A
- RET mutation
Draw a square
Medullary carcinoma, pheo, mucosal/ganglionueromas, marfanoid habitus
MEN 2B
- RET mutation
Draw a triangle
Elderly, dysphagia, resp compromise, thyroid mass
Anaplastic carcinoma
- highly malignant, poor prognosis
Primary hyperparathyoidism
Adenoma = #1
“Stones, moans, groans & bones”
- Calcium stones
- constipation
- depression
- bone pain - Osteitis fibrosa cystica
- acute pancreatitis*
Inc PTH, Ca, urinary cAMP, alk phos (blast)
Dec phosphate
Primary hyperparathyroidism
- adenoma, hyperplasia
“Stones, moans, groans & bones”
Inc PTH, alk phos, PHOSPHATE
Dec Ca, calcitrol (1,25)
Secondary hyperparathyroidism #1 = chronic renal failure --> dec phos excretion, dec 1,25 --> inc PTH
Inc bone turnover/osteitis fibrosa cystica
Peri-oral numbness, tingling, tetany w/ tapping or blood pressure cuff (Trousseau, Chvostek sign)
Hypoparathyroidism
- DiGeorge, surgical removal
Low PTH, Low Ca
Hypoparathyroidism
Short stature, short 4th, 5th digits, High PTH, Low Ca
Psuedohypoparathyroidism
- end-organ resistance to PTH = Gs defect
Type I DM
T-lymphocyte destruction
HLA-DR3, 4 (MHC I)
Mech of type II DM insulin resistance
Dec # insulin receptors
Hyperosmolar non-ketotic coma
Type II DM
>500 sugar –> diuresis –> hypotension & coma
Leading cause of death among diabetics
CVD/MI
Non-enzymatic glycosylation of renal arterioles
EFFERENT –> hyperfiltration
Microalbuminuria, nephrotic syndrome, Kimmelstiel-wilson nodules
Diffuse sclerosis –> renal failure
Pt presents with kidney stones and stomach ulcers or hypoglycemia, and impotence…Parathyroid hyperplasia, pituitary adenoma, pancreatic neoplasm
MEN 1
- Insulinoma*
- Gastrinoma (ZE)*
- Somatostatinoma - achlorhydria, cholelithiasis, steatorrhea
- VIPoma - watery diarrhea, hypoK
Glomerulosa produces
Aldosterone
Fasiculata produces
Cortisol
Reticularis produces
Sex steroids/testosterone
Moon facies, buffalo hump, truncal obesity, HTN, osteoporosis, immunosuppression, hyperglycemia, striae, amenorrhea
Cushing/hypercortisolism
- inc urine cortisol
- # 1 = steroids
- Adenoma
- ACTH pituitary adenoma
- ACTH small cell
Cushing w/ B/L adrenal atrophy
Steroids
Cushing w/ C/L adrenal atrophy
Primary cortical adenoma
Cushing w/ B/L adrenal enlargement
ACTH secreting pituitary adenoma or Small cell cancer
High dose dexa suppression test –> low cortisol levels
ACTH Pituitary adenoma (vs. small cell)
HyperNa, hypoK (weakness & paresthesia), alkalosis, HTN, Low plasma renin
Hyperaldosteronism (Conn syndrome)
- # 1 = adrenal adenoma
- # 2 = adrenal hyperplasia
- spironolactone bodies
Tx = spironolactone –> surgery
Kid w/ clitoral enlargment, precocious puberty, hypotension, high ACTH, hyperK, hypoNa, B/L adrenal hyperplasia
Congenital adrenal hyperplasia #1 = 21-hydoxylase deficiency
Dx = excess 17-hydroxyprogesterone Tx = ACTH to suppress cortex
Kid w/ clitoral enlargment, precocious puberty, high ACTH, HTN
11-hydroxylase deficiency
Hypotension, HypoNa, HyperK, Hyperpigmentation, V/D, fatigue, weakness, weightloss, acidosis, ACTH 150, cortisol 2, ACTH stimulation fails to inc serum cortisol
1 in US = auto-immune
Addison - chronic PRIMARY adrenal insufficiency
- likely to develop w/ DM-1, Hashimoto’s, Graves, Addison
#1 developing = TB
Mets from Lung cancer
EPISODIC HTN, HA, palpiations, tach, sweating, inc urine VMA
Pheo (5Ps) - pressure, pain, perspiration, palpitations, pallor
Tx = excision + alpha blocker phenoxybenzamine to prevent HTN crisis
Episodic HTN with urination
Bladder wall pheo
Syndromes assoc w/ Pheo
MEN 2A,B
Von-Hippel Lindau - hemoangio of cerebellum
NF-1
XY Male appears as a female, HTN, hypoK
17-alpha hydroxylase deficiency
PTH fxns
Goal = INC serum Ca
- Inc RANKL on blasts –> stim clasts
- Dec phos abs (Phos Trashing Hormone)
- Inc 1,25 by inc 1-alpha hydroxylase
Endocrine hormones using IP3
GOAT - GnRH, Oxytocin, ADH (V1), TRH
Most use cAMP including calcitonin, glucagon
Endocrine hormones using TK/MAP kinase –> RAS
Think growth factors
Insulin, IGF-1, FGF, PDGF
Sex hormone binding globuin inc in men & dec in women
Inc in Men –> Dec T –> gynecomastia
Dec in Women –> Inc T –> hirsuitism
Wolff-Cahikoff effect
Excess iodine inhibits TPO –> dec T3/4
HyperNa, hypoK, alkalosis, HTN, High plasma renin
Hyperaldosteronism (Conn syndrome)
- Secondary = atherosclerosis, RA stenosis
Hypotension, HypoNa, V/D, fatigue, weakness, weightloss, ACTH 20, Cortisol 2, ACTH stimulation inc cortisol
Secondary adrenal insufficiency
#1 = STOP MEDS Pituitary insufficiency
Neuroblastoma
Adrenal medulla tumor in KIDS*
Anywhere along sympathetic chain
High DA –> HVA in urine
Less HTN
Over expression of N-myc
Hypothyroidism + deafness
Pendred syndrome
- AR deficiency in Na/I co-transport
Huge goiter, patchy radio-I uptake, raise arms and get red in the face. hitology shows distended follicles lined by flattened epithelium w/ fibrosis and hemorrhage
Toxic multinodular goiter
Inc Ca with low PTH
PTH-independent hyperCa
- Ca ingestion, cancer
Diabetic with high morning blood sugar…next step?
2AM BG
Dawn effect = high/normal glucose
- cortisol, epi stimulate release from liver –> high BG d/t low insulin
Somogyi effect = low glucose
- night hypoglycemia –> nocturnal release
Pt presents with LRQ pain, diarrhea, flushing, asthmatic wheezing and right heart vavle disease.
Carcinoid syndrome - most common tumor of the appendix
High 5-HIAA in urine
Tx = Octreotide
Drug acts by closing K+ channel –> insulin release only in type II DM
Sulfonylureas
- Tolbutamide, Glyburide, Glipizide
Drug acts by dec gluconeogenesis and inc sensitivity to insulin
Metformin (Biguanides)
- glinides have less hypoglycemia
1st line drug to type II DM
Metformin (Biguanides)
Diabetes drug that causes lactic acidosis
Metformin (Biguanides)
Drug acts by binding PPAR-gamma to inc insulin sensitivity in peripheral tissue
Thiazolidinediones
-HEPATOTOXIC, HF, Fx, Bladder cancer
Drug inhibits alpha glucosidases to dec post-prandial hyperglycemia
Acarbose & Miglitol
Drug inhibits DDP4 degredation of GLP-1
Piptidyl-Peptidase Inhibitors
- Sitagliptan, Saxipliptan
MOA of PTU, methimazole
Blocks TPO = blocks organifiation
PTU also blocks 5-deiodinase = block peripheral T4–>T3
ADH antagonist used in SIADH
Demeclocycline
Endocrine hormones using JAK/STAT
PiG - Prolactin, GH, cytokines
Necrolyic migratory erythema with blisters in areas of friction, weight loss, diarrhea, diabetes, high blood sugar
Glucagonoma
- Tx = octreotide
