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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
What presents w/mild DM, necrolytic migratory erythema and anemia? Frequently in whom?
Alpha-cell tumors (glucagonomas) Peri and postmenopausal women
39
What is Kimmelsteil-Wilson disease?
nodular glomerulosclerosis nodules are PAS (+) They enlarge and obliterate the glomerular tuft
40
What is the 2nd most common cause of deaths in diabetics? Leading cause of what?
Nephropathy ESRD
43
What % of T1DM and T2DM with overt nephropathy will develop ESRD requiring transplant?
75% T1 20% T2
46
What has giant islets w/deposition of amyloid and are usually small ( < 2cm)?
Insulinomas
47
Diabetics have increased susceptibility to what?
Infections --> Tb, pneumonia, pyelonephritis
48
Hyperglycemia along with loss of adipose tissue in the sq fat w/hypertriglyceridemia, acanthosis nigricans, and fat deposition in the liver is what?
Lipoatrophic diabetes
49
Retinopathy in diabetics occurs bc of what? What else may occur?
Overexpression of VEGF Cataract, glaucoma, blindness
52
Enterochromaffin cells make what? Tumor produces what?
Serotonin Carcinoid syndrome
53
In GBM thickening, how is it visualized? What else is thickened? How to see?
EM Tubular BMs, PAS
54
What presents w/DM, cholelithiasis, steatorrhea, and hypochloryhydria?
Somatostatinomas (delta cell tumors)
55
Hyalinosis occurs where in the kidney? Glomerular and arteriolar lesions cause what?
Afferent and efferent glomerular hilar arterioles Ischemia --> Tubular atrophy and interstitial fibrosis
57
Women w/insulin receptor mutations frequently have what?
PCOS | Elevated androgen levels
58
What complication of pyelonephritis is more likely to be seen in diabetics?
Necrotizing papillitis
59
``` What increases w/overall thickening of the GBM? These are (+) for what? ``` What happens as the disease progresses?
Mesangial --> Diffuse mesangial sclerosis PAS + Becomes nodular
60
What ethnicities are more likely to develop diabetes?
Native American African American Hispanics
61
Tx of DKA?
``` Admin insulin (w/some K+) Correct metabolic acidosis Treat underlying cause ```
64
Chronic complications from diabetes are due to what?
Persistent hyperglycemia Insulin resistance Obesity
65
What are the metabolic defects in DM2?
Insulin resistance (dec response of peripheral tissue to insulin) Inadequate insulin secretion (B-cell dysfunction)
67
What is the most frequent pattern of involvement in diabetic neuropathy? Eventually what pattern? What else?
Distal symmetric polyneuropathy of of LE UE in glove and stocking pattern Autonomic neuropathy, footdrop, etc
71
What is hypothesized in the environment causes T1DM?
Viral infections
73
What is the 1st sign of diabetic nephropathy? If untreated what happens? Accompanied by what?
Microalbuminuria (30-300 mg/day) overt nephropathy w/macroalbuminuria (> 300 mg/day) w/ HTN
78
What haplotypes have the highest inherited risk in DM1?
HLA-DR3 or DR4 plus DQ8
81
CF of DKA?
Fatigue, N/V, abdominal pain Fruity breast w/Kussmaul breathing CNS depression and coma
82
Poorly controlled diabetes later in pregnancy causes what in the child?
Large for gestational age newborn | Child at INC risk of developing obesity and diabetes later in life
83
How does glucose enter the cell to begin the process of insulin secretion?
GLUT-2
88
Inadequate insulin secretion in DM2 is due to a combination of what?
Excess FFA - lipotoxicity Chronic hyperglycemia - glucotoxicity Abnormal incretin effect, amyloid deposition w/in islets
89
DM2 pts can present w/what sx?
Fatigue, dizziness, blurred vision
95
What are the autoantigens target that cause failure of self-tolerance in T cells specific for islet antigens in DM1?
Insulin GAD ICA512
97
Impaired glucose tolerance fasting? 2-hour following a 75 gm glucose OGTT? HbA1C?
100-125 140-199 5.7-6.4%
99
Diabetes is diagnosed w/fasting plasma glucose level of what? Random plasma glucose? 2-hour glucose? HbA1C?
> 126 > 200 > 200 > 6.5%
111
A cells make what? Stimulates what? Delta cells make what? Suppresses wha?
Glucagon Stimulates glycogenolysis Somatostatin Suppresses insulin and glucagon
112
D1 cells make what? Induces what? Stimulates what?
VIP Glycogenolysis and hyperglycemia GI fluid secretion and causes secretory diarrhea

Endocrine II AH (6 decks)

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