Endocrine Keys Flashcards
Ventral Medial hypothalamus
regulates the sensation of satiety
if a lesion is present the patient will likely be massive (Very MASSIVE)
Ventral Lateral hypothalamus
regulates the sensation of hunger
if a lesion is present the patient will likely be lean (Very LEAN)
Dorsomedial nucleus of hypothalamus
Regulates
1. Feeding
2. Drinking
3. Body weight
4. Circadian rhythm
Preoptic nucleus synthesizes
GnRH
Preoptic nucleus role =
Regulation of both temperature and sleep
Arcuate nucleus mediates responses from
metabolic hormones
1. Leptin
2. Ghrelin
3. Insulin
Arcuate nucleus will affect functions relating to
- Metabolism
- Feeding
- Reproduction
What are the main physiologic conditions that activate the RAAS pathway are
- Decreased blood pressure
- Increased sympathetic tone
- Decreased NaCl delivery to macula densa cells
ANP and BNP effects on RAAS =
- downregulate the RAAS
- increasing cGMP –> increased glomerular vasodilation
- increasing the GFR due to increased VD
34F presents with
1. nausea
2. emesis
3. lethargy
4. confusion
5. altered mental status
6. seizures
SIADH = hyponatremia sx
A patient taking Amphotericin B
with new-onset
1. polydipsia
2. polyuria
3. elevated ADH
Should be tx w/
Pt has Peripheral/nephrogenic diabetes insipidus
Tx = Thiazide, amiloride, and indomethacin
Pseudohyponatremia =
Pt w/ a serum osmolality of 285 mOsm/kg and low Na+ serum levels (below 130)
This is because of increased oncotic = hyperproteinuria or hyperlipidemia
hypertonic hyponatremia =
SUGAR in the blood
Larynx supplied by X = SCAR
Superior laryngeal nerve
Cricothyroid
All other muscles
Recurrent laryngeal nerve
1week M
1. hypoplastic mandible
2. low-set ears
3. bifid uvula
4. cleft palate
5. decreased soft-tissue attenuation in the right anterior mediastinum
Congenital defeat?
DiGeorge syndrome 22.11.2 microdeletion
neural crest fails to migrate into the derivative pharyngeal/bronchial pouches
1st and 2nd pouches = Thyroid
3rd = inferior parathyroid + thymus
4th = superior parathyroid
1week M
Poor feeding
lethargy
unusual muscle movements
decreased soft-tissue attenuation in right anterior mediastinum
DiGeorge Syndrome
hypocalcemia = increased neuromuscular excitability
W/o the 3rd & 4th pouches the pt is not able to produce PTH which helps to increase blood Ca++ levels
The left inferior thyroid artery branches off from which of the following arteries?
Left Subclavian
Note
Right side = Brachiocephalic –> Common Carotid + Subclavian
32F
tx w/ BB for hyperthyroidism
how is this helpful
BB = blocks 5-deiodinase = decreases T4–>T3 conversion
34F
takes GC how does this affect the thyroid
If pt has graves = decreased Ab production
decreases T4 –> T3 peripherally
Which drugs decreases the peripheral conversion of T4-T3
Amiodarone + PTU + BB + GC
Wolff-Chaikoff effect = excess amounts of iodine
tx would be
Lugol’s iodine
this is given in situations where there is acute radiation exposure
30F
HTN
Low renin
electrolytes changes?
Low renin = high aldosterone (Primary hyperaldosterone = Conn disease)
decreased serum K+
decrease pH = increased serum Bicarb
normal - high serum Na+
4M
growth spurt
body odor
pigmented hair at the base of the penis
dx & tx
decreased 21-hydroxylase –> increased 17-hydroxylase = increased androgens
Tx: blocking ACTH
61F
hypoechoic thyroid nodule
increased central blood flow
Clusters of cells w/ large overlapping nuclei
despersed chromatin
intranuclear inclusion bodies & grooves
increase BF = cancerous
Papillary Carcinoma
Orphan Annie eye nuclei
Pseudoinclusion
Laminated Ca++ deposits = Psammoma bodies
81F
mass that has grown 3x in size rapidly
experiencing hoarseness
pleomorphic cells
irregular giant and spindle cells
Anaplastic thyroid carcinoma
TP53 mutation
Follicular adenoma vs carcinoma
carcinoma = vascular or capsular invasion
RAS mutation
uniform follicles
Hypocalcemia
sheets of polygonal cells
amyloid stroma
Medullary Carcinoma
MEN2A/B RET mutation
Block G____ will increase Insulin levels
Blocking Gi = increase insulin levels
28F
non-tender goiter
gave birth 3 wks ago
experiencing excessive sweating + palpitations
HTN
low free T4 and high TSH
Postpartum thyroiditis in its transient phase TH can be high
Autoimmune destruction = lymphocyte-mediated thyroid follicular damage –> early release of TH
Anti-thyroid peroxidase antibodies
40M
increased gastrin levels
prominent gastric folds + multiple ulcers in duodenum + proximal jejunum
History or Family would include?
Dx: Zollinger-Ellison syndrome
associated with MEN1
MEN1 = 3 P’s (Pituitary tumors + Pancreatic endocrine tumors + Parathyroid adenoma)
Parathyroid adenoma = increased PTH = increase Ca+ =
constipation + muscle twitching + stones
Tamoxifen
SERM that can tx gynecomastia
Danazol
synthetic androgen that acts a partial agonist at androgen receptors
Rx that can cause Gynecomastia
GnRH agonist
Ketoconazole = 17a-hydroxylase/17,20 lyase inhibitor
5a reductase inhibitors = decrease DHT –> increased testosterone –> increased estrogen
Spironolactone = 17a-hydroxylase/17,20 lyase inhibitor
Bicalutamide = testosterone receptor antagonist
14M
Painless nodules on lips & tongue
Long & thin
Joint laxity
Oral inspection = small, soft, flesh-colored papules
TSH normal
Dx
Marfanoid habitus = caused by Medullary thyroid cancer which is associated with MEN2B
The left superior thyroid artery branches off from which of the following arteries?
Left external carotid
Note: right = Braciocephalic –> subclavian + (common carotid –> External carotid)
Recent viral infection
Painful thyroid
low T3/T4 levels
High TSH
De Quervian thyroiditis = Granulomatous inflammation, multinucleated giant cells, and foamy histiocytes are classically present on histology
Low T3/T4
immobile thyroid gland
hoarseness
Riedel Thyroiditis
IgG4 systemic disease –> fibrous tissue replacing thyroid tissue + inflammatory infiltrates
Decrease T3
Normal T4
High TSH
Increase IL-6
Euthyroid Sick Snydrome
Toxic multinodular goiter is associated with
focal patches of hyperfunctioning cells that work independently of TSH (commonly due to mutated, constitutively activated TSH receptors), leading to elevated T3 and T4 levels.
Hürthle cells arise from the thyroid follicular epithelium and are seen on histologic slides along with
lymphoid aggregates with germinal centers in patients with Hashimoto’s thyroiditis
