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Pathology 1st aid > Endocrine Path > Flashcards

Endocrine Path Flashcards

1
Q

1 cause of cushing’s syndrome

A

Iatrogenic–exogenous steroids

increased cortisol
decreased ACTH (negative feedback)
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2
Q

Cushing’s syndrome Sx

A 
HTN
hyperglycemia
osteoporosis
Moon Facies
Weight Gain
tuncal obesity
abd. striae, thinning skin
Buffalo hump
immune suppression
amenorrhea
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3
Q

Cushing’s Disease

A

ACTH secreting pituitary adenoma

increased ACTH and Cortisol

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4
Q

Cort stim test with Cortisol levels remaining high after low and high doses of DEX

A

Ectopic ACTH producing tumor

Cortisol producing tumor

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5
Q

Cort stim test with Cortisol levelssuppressed after low and high doses of DEX

A

Normal response

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6
Q

Cort stim test:

Cortisol remains high after low dose and suppressed after high dose DEX

A

ACTh pituitary adenoma

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7
Q

HTN, Hypokalemia, metabolic alkalosis, LOW plasma renin

A

1º Conn’s Syndrome

adrenal hyperplasia or aldosterone secreting adrenal adenoma

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8
Q

HTN, Hypokalemia, metabolic alkalosis, HIGH plasma renin

A

2º Conn’s Syndrome

Renal artery stenosis
CHF
Cirrhosis
Nephrotic Syndrome

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9
Q

Conn’s Tx

A

1º–surgery, spironolactone

2º–spironolactone

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10
Q

Hypotension
hyperkalemia
acidosis
skin hyperpigmentation

A

1º Addison’s Disease

adrenal atrophy and absence of hormone production
all 3 cortical layers but spares medulla
destruction by disease (TB, autoimmune, mets)

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11
Q

DDx 2º from 1º Addison’s Disease

A 
Low aldosterone
low cortisol
no skin hyperpigmentation
no hyperkalemia
decreased ACTH production in pituitary
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12
Q

Post Neisseria meningitidis sepsis
1º adrenal insufficiency due to adrenal hemorrhage
DIC
Endotoxic Shock

A

Waterhouse-Friederichsen Syndrome

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13
Q

Most common tumor in adults of adrenal medulla

A

Pheochromocytoma

Secretes Epi/NE/DA

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14
Q

Pheochromocytoma is composed of what type of cells?

A

Chromaffin cells

derrived from neural crest

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15
Q

Pheochromocytoma Sx

A

Episodic Hyperadrenergic Sx–5 P’s

Pressure (high BP)
Pain (HA)
Perspiration
Palpitation
Pallor
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16
Q

Pheochromocytoma associated with what syndromes?

A

MEN 2A and 2B

Neurofibromatosis Type 1

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17
Q

Pheochromocytoma Tx

A

Phenoxybenzamine (alpha blocker) prior to surgical excision

prevents hypertensive crisis

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18
Q

Pheochromocytoma Lab test

A

Urine VMA

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19
Q

Why is there hyperpigmentation of skin with 1º addison’s?

A

Increased MSH

byproduct of ACTH production from POMC

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20
Q

Most common adrenal medullary tumor in kids

A

Neuroblastoma

less likely to develop HTN
can occur anywhere on sympathetic chain

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21
Q

Lab test for neuroblastoma

A

Elevated HVA in urine (homovanillic Acid)

breakdown product of DA

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22
Q

Neuroblastoma oncogene

A

N-myc overexpression –> rapid tumor progression

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23
Q 
Cold intolerance
weight gain despite decreased appetite
constipation
lower activity and energy
Myxedema (face, periorbital)
bradycardia
A

Hypothyroidism

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24
Q

Hypothyroidism Labs

A

decreased free T4

Increased TSH (1º) 
Decreased in 2º
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25
Q 
Heat intolerance
weight loss, increased appetite
hyperactivity
increased reflexes
diarrhea
pretibial myxedema
warm moist skin/hair
palpitations/arrhythmia
A

Hyperthyroidism

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26
Q

Hyperthyroidism Labs

A 
Decreased TSH (1º)
Increased Free or total T3 and T4
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27
Q

Most common cause of hypothyroidism

A

Hashimoto’s

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28
Q

Hashimoto’s Thyroiditis Pathophys

A

autoimmune disease against thyroid

moderately enlarged, NONTENDER thyroid

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29
Q

Hashimoto’s Thyroiditis histo

A

Hurthle Cells

lymphocytic infiltrate with germinal centers

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30
Q

HLA marker associated with Hashimoto’s

A

HLA-DR5

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31
Q 
Severe Fetal hypothyroidism
Pot-Bellied
Pale
Puffy Faced kid
protruding umbilicus
Protuberant tongue
A

Cretinism

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32
Q

Types of Cretinsim

A

Endemic goiter–dietary Iodine deficiency

Sporadic Cretinsim–defect in T4 formation or dev. failure of thyroid

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33
Q

Self-limited hypothyroidism following flu infection
VERY TENDER thyroid
increased ESR, jaw pain
granulomatous inflammation

A

De Quervain’s Subacute thyroiditis

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34
Q

Thyroid replaced by fibrous tissue
hypothyroidism
PAINLESS, rock-hard goiter

A

Riedel’s Thyroiditis

manifestation of IgG related systemic disease

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35
Q

Wolf Cheikoff Effect

A

Hypothyroidism due to ingestion of excessive Iodine

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36
Q

Focal patches of hyperfunctioning follicular cells working independently of TSH

Hot nodule

Increased T3 and T4

A

Toxic Multinodular Goiter

Mutation of TSH-R

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37
Q

Jod-Basedow Phenomenon

A

Thyrotoxicosis when iodine defficient patient is made iodine replete

38
Q

Graves Disease pathophys

A

Autoimmune hyperthyroidism

Ab that stimulate TSH receptors

39
Q

Pretibial Myxedema and exophthalmos seen with Graves–mechanism

A

increase in CT deposition

40
Q

Stress induced thyroid storm
Death by Arrhythmia

increased ALP

A

Thyroid Storm

41
Q 
Thyroid mass
Empty appearing nuclei (orphan annie eyes)
psammoma bodies 
nuclear grooves
Excellent prognosis
A

Papillary CA of thyroid

42
Q

Risk of Papillary CA

A

Childhood irradiation

43
Q

Calcitonin Producing mass on thyroid

sheets of cells in amyloid stroma

A

Medullary CA of Thyroid

44
Q

Cancer associated with Hashimoto’s

A

Lymphoma

45
Q

Medullary CA of thyroid cell type

A

C Cells

secrete calcitonin

46
Q

Undifferentiated mass on thyroid
poor prognosis
old pt.

A

Anaplastic

47
Q

Mass on Thyroid with uniform follicles

good prognosis

A

Follicular CA

48
Q

1 tumor on thyroid

A

Papillary CA of Thyroid

49
Q

1 cause of primary hyperparathyroidism

A

adenoma

50
Q

Osteitis Fibrosa Cystica

A

cystic bone spaces filled with brown fibrous tissue –> bone pain

51
Q

Sx of Hyperparathyroidism

A

Hypercalcemia –> Stones, bones, and groans

Renal stones
constipation (GI)
bone pain

52
Q

1º hyperparathyroidism labs

A

Increased PTH, Alk Phos, and urine cAMP

53
Q

2º hyperparathyroidism causes

A

Chronic Renal disease –> decreased Vit. D

decreased Ca reabsorption from gut and increased Pi

54
Q

2º hyperparathyroidism labs

A

Hypocalcemia
hyper Pi
increased Alk. phos
Increased PTH

55
Q

3º hyperparathyroidism

A

Refractory (autonomous) hyperparathyroidism due to chronic kidney disease

very very high PTH
elevated Ca

56
Q

Hypoparathyroidism causes

A

Accidental surgical excision (thyroid surgery)
Autoimmune destruction
DiGeorge Syndrome

57
Q

hypoparathyroidsim Sx

A

Hypo Ca
tetany
Chvostek’s sign
Trousseau’s Sign

58
Q

Chvostek’s sign

A

Tap on facial nerve and get spasm of face

hypo Ca sign

59
Q

Trousseau’s Sign

A

Occlusion of brachial a. with BP cuff –> carpal spasm

hypo Ca sign

60
Q

Pseudohypoparathyroidsim

A

Albright’s hereditary ostrodystrophy

AD kidney unresponsive to PTH

Short stature, short 4/5 digits, hypocalcemia

61
Q

Most common pituitary adenoma

A

Prolactinoma

62
Q

Sx of prolactinoma

A

amenorrhea
galctorrhea
low libido
infertility (low GnRH)

Bitemporal hemianopsia (optic chiasm)

63
Q

Prolactinoma Tx

A

DA agonists–bromocriptine & cabergoline

64
Q

Excessive GH in adults and kids

A

acomegaly–adults

gigantism–kids

65
Q

Achromegaly Dx

A

High IGF-1, GH

No GH suppression with glucose suppression test

pituitary mass on MRI

66
Q

Dx of DI

A

Water deprivation test does not increase urine osmo

Desmopressin response–central
not response–nephrogenic

67
Q

DI Tx

A

Fluid intake

Central–nasal ADH (desmopressin)

Nephrogenic–hydrochlorothiazide, indomethacin, or amiloride

68
Q

Sheehan Syndrome

A

Hypopituitarism due to post partum bleeding (could occur at end of preg)

Hypertrophy of pituitary with no ∆ in vascular supply

failure to lactate

69
Q

Empty Sella Syndrome

A

atrophy or compression of pituitary

idiopathic
obese women

70
Q

Hypopituitary causes

A 
Non-secreting pituitary adenoma
craniopharyngioma
Sheehan's Syndrome
Empty Sella
Brain injury
Hemorrhage
Radiation
71
Q

Hypopituitarism Tx

A

Substituinon Tx

Corticosteroids
Thyroxine
Sex steroids
human growth factor

72
Q

Concentrated urine

dilute blood–relative hyponatremia

A

SIADH

73
Q

SIADH Tx

A

Fluid restriction
IV saline
Tolvaptan/conivaptan–Vasopressin Rec. antagonist
demeclocycline

74
Q

Kimmelsteil Wilson Nodules

A

DM buzz word for non-enxymatic glycosylation in kidney vasculature

75
Q

DM Type 1 HLA associated

A

HLA-DR3 and DR4

76
Q

Histology of DM Type 1 vs. Type 2

A
  1. Islet leukocytic infiltrate

2. Islet amyloid deposition (AIAPP)

77
Q

DKA pathophys

A

Stress –> excessive fat breakdown –> ketogenesis from free FA –> Ketone bodies

78
Q

Most common Ketone bodies in DKA

A

ß-hydroxybutyrate > acetoacetate

79
Q

Hyperkalemia with DKA

A

Serum levels are high but overall hypokalemia due to intracellular depletion from insulin

80
Q

DKA complications

A 
mucor
Rhizopus infection
cerebral edema
cardiac arrhythmias
heart failure
81
Q

Tx DKA

A

Fluids
Insulin
K+–replete intracellular
glucose–if necessary to prevent hypoglycemia

82
Q

Recurrent Diarrhea, Cutaneous flushing,asthmatic wheezing, right sided valvular disease

Elevated 5HT

A

Carcinoid Syndrome

83
Q

Carcinoid Syndrome Cause

A

Carcinoid tumors OUTSIDE of GI

If in GI–Liver will filter out 5HT due to first pass

84
Q

Carcinoid Tumor cells

A

Neuroendocrine cells

85
Q

Carcinoid Syndrome Tx

A

Somatostatin anologue–octreotide

86
Q 
Gastrin secreting tumor of pancreas or duodenum
rugal thickening of stomach
stomach acid hypersecretion
Recurrent ulcers (down to ileum)
MEN Type 1
A

Zollinger Ellison Syndrome

87
Q

MEN Type 1 (Wermer’s Syndrome)

A

Parathyroid Tumors
Pituitary Tumors
Pancreati Endocrine Tumors (ZE Syndrome)

Kidney stones, stomach ulcers

“3 P’s”

88
Q

MEN 2A (Sipple Syndrome)

A

Pheochromocytoma
Parathyroid Tumor
Medullary Thyroid Tumor–Calcitonin

“2 P’s”

89
Q

MEN 2B

A

Pheochromocytoma
Medullary Thyroid CA
Oral/intestinal ganglioneuromatosis–associated marfanoid habits

“1 P”

90
Q

Gene mutation associated with MEN 2A and 2B

A

ret gene mutation

91
Q

Inheritance patter of MEN syndromes

A

Autosomal Dominant

Pathology 1st aid (11 decks)

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