Endocrine Path

Question 1

Pseudohyperaldosteronism

Answer 1

• Licorice (inhibits 11-beta-HSD type II)

- Liddle’s syndrome (increase Na and decrease K)

Question 2

Secondary Hyperaldosteronism causes

Answer 2

Fibromuscular dysplasia (young women)
Atherosclerosis (men)

Question 3

Hyperaldosteronism doesnt show hypernatremia or edema b/c…

Answer 3

Aldosterone escape via ANP

Question 4

Addison’s disease causes

Answer 4

• Autoimmune (developed countries)
• TB (developing countries)
• Malignancy (esp lung)

Question 5

Tertiary adrenal insufficiency cause

Answer 5

Exogenous steroid use and immediate withdraw

Question 6

Decrease glucocorticoids on insulin requirements

Answer 6

Decreased

Question 7

Neuroblastoma

Answer 7

• Homer-Wright rosettes
• anywhere on sympathetic chain
• firm, irregular mass, crosses midline
• Opsoclonus-myoclonus syndrome (“dancing-eyes-dancing feet”)
• HVA, VMA
• Bombesin and neuron-specific enolase +ve
• Over-express N-myc oncogene

Question 8

Pheochromocytoma rule of 10

Answer 8

10% - malignant, bilateral, extra-adrenal, calcify, kids

Question 9

Pheochromocytoma associated conditions

Answer 9

neurofibromatosis type 1, von Hippel-Lindau disease, MEN 2A and 2B

Question 10

Pheochromocytoma Rx

Answer 10

Phenoxybenzamine ..THEN… B-blocker prior to ressection

Question 11

Hypothyroid heart effect

Answer 11

Mucopolysaccharides deposited b/t fibers causing cardiomyopathy and low voltage EKG

Question 12

Cholesterol levels in hyper-/hypothyroidism

Answer 12

Hyperthyroidism - increased LDL receptor (hypocholesterolemia)
Hypothyroidism - decreased LDL receptor (hypercholesterolemia)

Question 13

Pretibial myxedema

Answer 13

Graves disease

Question 14

Hashimoto thyroiditis

Answer 14

• anti-thyroid peroxidase (anti-microsomal), anti-thyroglobulin
• Risk: non-Hodgkin lymphoma (marginal/B-cell)
• Hurthle Cells
• Non-tender
• germinal centers

Question 15

Congenital hypothyroidism (cretinism)

Answer 15

The 6 P’s (also short w/ coarse facial features)

• Pot-bellied
• Pale
• Puffy-faced child
• Protruding umbilicus
• Protuberant tongue
• Poor brain development

Question 16

Subacute granulomatous thyroiditis (de Quervain)

Answer 16

• High ESR, jaw pain, TENDER thyroid

- often post viral

Question 17

Riedel thyroiditis

Answer 17

• Fibrous replacement of thyroid
• manifestation of IgG4-related systemic disease (autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis)
• fixed, hard (rock-like) painless goiter

Question 18

Lithium on thyroid

Answer 18

hypothyroidism

Question 19

Graves Rx

Answer 19

B-blockers, Thiomide (blocks peroxidase), Radioiodine ablation

Question 20

Toxic multinodular

Answer 20

Focal patches of hyperfunctioning follicular cells working independently of TSH d/t receptor mutation

Question 21

Thyroid storm: COD, Lab, Rx

Answer 21

• tachyarrhythmia
• increased ALP
• 3 P’s: Propanolol, Propylthiouracil, Prednisolone

Question 22

Jod-Basedow phenomenon

Answer 22

thyrotoxicosis if a patient w/ iodine deficiency goiter is made iodine replete

Question 23

Myoedema

Answer 23

found w/ hypothyroid myopathy and d/t slow resorption of Ca by SR (causes focal mounding of muscle following percussion) - also has increased CK

Question 24

Non-toxic multinodular goiter

Answer 24

• d/t relative iodine def

- euthyroid

Question 25

Hyperthyroidism OGTT

Answer 25

rapid rise and rapid fall

Question 26

Papillary carcinoma (thyroid)

Answer 26

- Orphan annie eye nucleus (central clearing) - psammoma bodies - nuclear grooves - Risk w/ RET and BRAF mutations or childhood radiation - Lymphatic invasion common

Question 27

Follicular carcinoma vs follicular adenoma

Answer 27

- Invasion of capsule | - FNA doesnt distinguish!! (no biopsy b/c high blood supply)

Question 28

Spread of follicular carcinoma

Answer 28

hematogenous

Question 29

Medullary carcinoma

Answer 29

- amyloid stroma (calcitonin) - associated with MEN2A, 2B (RET) - hypocalcemia

Question 30

Undifferentiated/anaplastic carcinoma vs Reidel thyroiditis

Answer 30

old vs. young

Question 31

Lymphoma of thyroid?

Answer 31

Hashimoto's

Question 32

Albright hereditary osteodystrophy

Answer 32

Pseudohypoparathyroidism - unresponsiveness of kidney to PTH - shortened 4th/5th digits, short stature - Gs prot mutation (GNAS1) - AD - Diagnose w/ PTH --> no increase in urinary cAMP or PO4 - Cafe-late spots, endocrine abnorm (precocious puberty)

Question 33

Familial hypocalciuric hypercalcemia

Answer 33

- Defective CaSR on parathyroid cells | - mild hypercalcemia w/ normal/increased PTH

Question 34

Factitious hypercalcemia

Answer 34

Hypergammablobinemia (increased Ca binding)

Question 35

QT interval: hyercalcemia/hypocalcemia

Answer 35

``` shortened QT (hyper) prolonged QT (hypo) ```

Question 36

Primary hyperparathyroism

Answer 36

Stones, Bones, Groans and psychiatric overtones

Question 37

Cystic bone spaces filled with brown fibrous tissue (deposited hemosiderin from hemmorages)

Answer 37

Osteitis fibrosa cystica

Question 38

Bone lesions from 2 * or 3* hyperparathyroidism due to renal disease

Answer 38

Renal osteodystrophy

Question 39

Pituitary apoplexy

Answer 39

hemmorage into preexisting pituitary adenoma

Question 40

Acromegaly Rx (alt. to surgery)

Answer 40

Octreotide (somatostatin analog) | Pegvisomant (GH-R antagonist)

Question 41

urine specific gravity of DI

Question 42

Hyperosmotic volume contraction

Answer 42

DI or proffuse sweating

Question 43

Nephrogenic DI causes

Answer 43

Hereditary, hypercalcemia, lithium, demeclocycline (ADH antagonist)

Question 44

Nephrogenic DI Rx

Answer 44

Hydrochlorothiazide indomethacin - PG's inhibit vassopressin action on kidney amiloride hydration

Question 45

SIADH

Answer 45

- euvolemic hyponatremia with continued Na excretion (d/t decreased aldosterone levels) - urine osmolarity > plasma - cerebral edema and seizures

Question 46

SIADH Rx

Answer 46

- Fluid restriction - IV hypertonic saline - Conivapton - Tolvaptan - Demeclocycline

Question 47

Most common COD in diabetics

Answer 47

MI

Question 48

Requirements for sorbitol accumulation

Answer 48

- Aldose reductase and decreased/absent sorbitol dehydrogenase - Schwann cells, retina, kidneys, lens

Question 49

DKA K+ status

Answer 49

Hyperkalemia but decreased total body stores

Question 50

Best glucose test for diabetes

Answer 50

1 - FBG | 2 - GTT (for Gestational or cystic fibrosis related diabetes or those with Sx but normal FBG)

Question 51

Glucagonoma

Answer 51

- Dermatitis (necrolytic migratory erythema) - Diabetes - DVT - Depression

Question 52

Somogyi effect

Answer 52

rebound hyperglycemia d/t counter reg hormones in response to hypoglycemia

Question 53

Whipple triad

Answer 53

low blood glucose, hypoglycemia Sx's, improvement with glucose - seen in Insulinoma

Question 54

Carcinoid rule of 1/3's

Answer 54

1/3 metastasize 1/3 present w/ 2nd malignancy 1/3 are multiple (most common malignancy of small intestine)

Question 55

Positive secretin stimulation test? - associations? - hints?

Answer 55

Zollinger-Ellison syndrome (gastrinoma) = gastrin levels remain raised - MEN1 - Distal (eg. jeujenal ulcers)

Question 56

Somatostatinoma

Answer 56

- Achlorhydria (inhibits gastrin) | - Cholelithiasis and steatorrhea (inhibits CCK)

Question 57

VIPoma

Answer 57

``` WDHA synd (watery diarrhea, hypokalemia, achlorhydria) - Rx. somatostatin ```

Question 58

MEN1 (AD)

Answer 58

Pituitary (prolactin, GH) Parathyroid Pancreatic endocrine tumors (ZE, insulinoma, VIPoma, glucagonoma) [MEN1 gene - menin=tumor supressor]

Question 59

MEN2A (AD)

Answer 59

Parathyroid hyperplasia Pheochromocytoma Medullary thyroid carcinoma (calcitonin) [RET gene - receptor tyrosine kinase]

Question 60

MEN2B (AD)

Answer 60

``` Pheochromocytoma Medullary thyroid carcinoma Oral/intestinal ganglioneuromatosis (mucosal neuromas) [RET gene - receptor tyrosine kinase] marfanoid habitus ```