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Endocrine II AH > Endocrine Pancreas - Guerin > Flashcards

Endocrine Pancreas - Guerin Flashcards

1
Q

Inactivating mutation in what genes can cause sporadic PanNETs?

A

ATRX

DAXX

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3
Q

What is the classic triad of DM1?

When severe?

A

Polyuria, polydipsia, polyphagia

DKA

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4
Q

DKA is usually associated with the release of what? What are its actions?

What is the glucose level?

Hyperglycemia causes what?

A

Epinephrine, blocks insulin and stimulates glucagon

250-600

Osmotic diuresis and dehydration

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7
Q

Women w/presentational diabetes that become pregnancy have children with increased risk of what?

A

Stillbirth

Congenital malformations

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8
Q

Where do ZEs arise?

What % metastasize?

25% arise from what syndrome?

A

Duodenum and pancreas

50%

MEN-1

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9
Q

Ulcers found in the jejunum and that are unresponsive to therapy with 50% having diarrhea may indicate what problem?

A

ZE syndrome

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10
Q

What are the major ketone bodies?

A

acetoacetic acid

B-hydroxybutyric acid

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12
Q

What tumor produces hypoglycemic episodes, confusion, stupor, and is precipitated by fasting or exercise?

A

Insulinoma - benign, most common

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13
Q

Polymorphisms in what genes causes T1DM?

What autoimmune regulators?

A

CTLA4, PTPN22

AIRE –> APS1

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15
Q

Fibrin caps and capsular drops are what?

A

Nodular glomerulosclerosis

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16
Q

Why is ketoacidosis lower in type 2 DM?

A

Higher portal v insulin levels prevent unrestricted hepatic FA oxidation

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17
Q

What is the major macrovascular complication and most common cause of death in diabetics?

A

MI from Coronary a. atherosclerosis

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18
Q

What effect does insulin have on adipose tissue?

A

Inc glucose uptake
Inc lipogenesis
Dec lipolysis

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19
Q

What genes are assoc. w/pancreatic neuroendocrine tumors?

A

MEN1

Loss-of-fx in PTEN and TSC2

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23
Q

What inhibitor of fibrinolysis that acts as a procoagulant is increased in diabetics?

A

PAI-1

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24
Q

What are the 3 lesions associated w/diabetic nephropathy?

A

Glomerular
Renal vascular –> arteriolosclerosis
Pyelonephritis

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29
Q

What presents w/watery diarrhea, hypokalemia, achlorhydria?

A

VIPoma (WDHA syndrome)

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31
Q

What causes hyperosmolar hyperosmotic syndrome (HHS) in T2DM?

Occurs most often in whom?

A

Severe dehydration

Old and disabled by stroke or infection

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32
Q

Describe the pathogenesis of DKA starting with insulin deficiency

A

Stimulates lipase -> breakdown of adipose stores -> Inc FFA, they are esterifed in the liver into fatty acyl CoA, in the mitochondria it is oxidized to produce ketone bodies

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33
Q

What is the major feature of diabetic microangiopathy?

Leads to what?

A

Diffuse thickening of BM making them more leaky to protein

Diabetic nephropathy, retinopathy, neuropathy

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34
Q

What are the effects of insulin resistance in the liver?

Skeletal m.?

Fat?

A

Failure to inhibit gluconeogenesis

Failure of glucose uptake and glycogen synthesis after a meal

Failure to inhibit activation of lipase –> excess circulating FFA

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35
Q

What is the most common acute metabolic complication in diabetes?

From what?

A

Hypoglycemia

Missing a meal, exercise, excess insulin admin

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36
Q

What genetic abnormality is most important in Pathogenesis in T1DM?

A

HLA Gene on chromosome 6

37
Q

What is the hallmark of diabetic macrovascular disease?

A

Accelerated atherosclerosis involving the aorta and large and medium sized arteries

38
Q

What presents w/mild DM, necrolytic migratory erythema and anemia?

Frequently in whom?

A

Alpha-cell tumors (glucagonomas)

Peri and postmenopausal women

39
Q

What is Kimmelsteil-Wilson disease?

A

nodular glomerulosclerosis
nodules are PAS (+)
They enlarge and obliterate the glomerular tuft

40
Q

What is the 2nd most common cause of deaths in diabetics?

Leading cause of what?

A

Nephropathy

ESRD

43
Q

What % of T1DM and T2DM with overt nephropathy will develop ESRD requiring transplant?

A

75% T1

20% T2

46
Q

What has giant islets w/deposition of amyloid and are usually small ( < 2cm)?

A

Insulinomas

47
Q

Diabetics have increased susceptibility to what?

A

Infections –> Tb, pneumonia, pyelonephritis

48
Q

Hyperglycemia along with loss of adipose tissue in the sq fat w/hypertriglyceridemia, acanthosis nigricans, and fat deposition in the liver is what?

A

Lipoatrophic diabetes

49
Q

Retinopathy in diabetics occurs bc of what?

What else may occur?

A

Overexpression of VEGF

Cataract, glaucoma, blindness

52
Q

Enterochromaffin cells make what?

Tumor produces what?

A

Serotonin

Carcinoid syndrome

53
Q

In GBM thickening, how is it visualized?

What else is thickened? How to see?

A

EM

Tubular BMs, PAS

54
Q

What presents w/DM, cholelithiasis, steatorrhea, and hypochloryhydria?

A

Somatostatinomas (delta cell tumors)

55
Q

Hyalinosis occurs where in the kidney?

Glomerular and arteriolar lesions cause what?

A

Afferent and efferent glomerular hilar arterioles

Ischemia –> Tubular atrophy and interstitial fibrosis

57
Q

Women w/insulin receptor mutations frequently have what?

A

PCOS

Elevated androgen levels

58
Q

What complication of pyelonephritis is more likely to be seen in diabetics?

A

Necrotizing papillitis

59
Q 
What increases w/overall thickening of the GBM?
These are (+) for what?

What happens as the disease progresses?

A

Mesangial –> Diffuse mesangial sclerosis
PAS +

Becomes nodular

60
Q

What ethnicities are more likely to develop diabetes?

A

Native American
African American
Hispanics

61
Q

Tx of DKA?

A 
Admin insulin (w/some K+)
Correct metabolic acidosis
Treat underlying cause
64
Q

Chronic complications from diabetes are due to what?

A

Persistent hyperglycemia
Insulin resistance
Obesity

65
Q

What are the metabolic defects in DM2?

A

Insulin resistance (dec response of peripheral tissue to insulin)

Inadequate insulin secretion (B-cell dysfunction)

67
Q

What is the most frequent pattern of involvement in diabetic neuropathy?

Eventually what pattern?

What else?

A

Distal symmetric polyneuropathy of of LE

UE in glove and stocking pattern

Autonomic neuropathy, footdrop, etc

71
Q

What is hypothesized in the environment causes T1DM?

A

Viral infections

73
Q

What is the 1st sign of diabetic nephropathy?

If untreated what happens? Accompanied by what?

A

Microalbuminuria (30-300 mg/day)

overt nephropathy w/macroalbuminuria (> 300 mg/day) w/ HTN

78
Q

What haplotypes have the highest inherited risk in DM1?

A

HLA-DR3 or DR4 plus DQ8

81
Q

CF of DKA?

A

Fatigue, N/V, abdominal pain
Fruity breast w/Kussmaul breathing
CNS depression and coma

82
Q

Poorly controlled diabetes later in pregnancy causes what in the child?

A

Large for gestational age newborn

Child at INC risk of developing obesity and diabetes later in life

83
Q

How does glucose enter the cell to begin the process of insulin secretion?

A

GLUT-2

88
Q

Inadequate insulin secretion in DM2 is due to a combination of what?

A

Excess FFA - lipotoxicity
Chronic hyperglycemia - glucotoxicity
Abnormal incretin effect, amyloid deposition w/in islets

89
Q

DM2 pts can present w/what sx?

A

Fatigue, dizziness, blurred vision

95
Q

What are the autoantigens target that cause failure of self-tolerance in T cells specific for islet antigens in DM1?

A

Insulin
GAD
ICA512

97
Q

Impaired glucose tolerance fasting?

2-hour following a 75 gm glucose OGTT?

HbA1C?

A

100-125

140-199

5.7-6.4%

99
Q

Diabetes is diagnosed w/fasting plasma glucose level of what?

Random plasma glucose?

2-hour glucose?

HbA1C?

A

> 126

> 200

> 200

> 6.5%

111
Q

A cells make what? Stimulates what?

Delta cells make what? Suppresses wha?

A

Glucagon
Stimulates glycogenolysis

Somatostatin
Suppresses insulin and glucagon

112
Q

D1 cells make what?

Induces what?

Stimulates what?

A

VIP

Glycogenolysis and hyperglycemia

GI fluid secretion and causes secretory diarrhea

Endocrine II AH (6 decks)

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