Endocrine Pathology 2 Flashcards
Pseudohypoparathyroidism
Unresponsiveness of kidney to PTH
Hypocalcemia, shortened 4th/5th digits
Autosomal dominant
Short stature
Hypoparathyroidism causes
Accidental surgical excision of Parathyroid glands or autoimmune destruction
Chvostek sign - tap face, leads to face contraction
Trousseau sign - occlusion of brachial artery with BP cuff
Familial hypocalciuric hypercalcemia
Defective calcium sensing receptor of parathyroid cells
PTH cant be suppressed when Ca is high
Primary Hyperparathyroidism
Due to parathyroid adenoma or hyperplasia
Increased PTH, Ca, ALP, cAMP, low phosphate
Osteitis fibrosa cystica - cystic bone spaces filled with brown fibrous tissue
Stones, Bones, groans with psychiatric overtones
Secondary and tertiary hyperparathyroidism
Secondary - chronic renal failure, low calcium, increased PTH, ALP, PO3-
Tertiary - refractory hyperparathyroidism after kidney replacement PTH is still high and so is Calcium as a result
Diabetes Insipidus
Intense thirst and polyuria with inability to concentrate urine due to ADH lack or insensitivity
Central DI tx - intra nasal Desmopressin acetate and hydration
Nephrogenic DI to - HCTZ, indomethacin, amilioride and hydration
SIADH
Excess free water retention, euvolemic hyponatremia with urinary Na secretion, urine osmolality greater than serum osmolality
Body response - Low aldosterone which can lead to cerebral edema, seizures
Correct slowly to prevent demyelination syndrome
Tx- fluid restriction, IV hypertonic saline, conivapatan, demeclocycline
Hypopituitarism
Sheehan syndrome - ischemic infarction of pituitary
Empty sella syndrome - atrophy or compression of pituitary
Pituitary apoplexy - sudden hemorrhage of pituitary gland
Tx by HRT
Diabetes mellitus acute manifestation
Polydypsia, polyuria, polyphagia, weight loss, diabetic keto acidosis in type 1, hyperosmolar coma in type 2.
Diabetic mellitus chronic complications
Non enzymatic glycation
- small vessel disease, retinopathy, glaucoma, neuropathy, nephropathy
- large vessel atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene, MI
Osmotic damage
- sorbitol accumulation in organs with aldosterone reductase, neuropathy, cataracts
Diabetes types and diagnosis
Type 1 - autoimmune destruction of beta cells, juvenile, not associated with obesity, HLA DR3 and HLA DR4, severe glucose intolerance, high insulin sensitivity, islet leukocyte infiltrate, KETOACIDOSIS
Type 2 - strong genetic predisposition, no HLA association, islet amyloid peptide deposits
Dx - fasting serum glucose, oral glucose tolerance test, HbA1c
Diabetes ketoacidosis, symptoms, labs, complications, tx
Due to increased insulin requirements from increased stress
Excess fat breakdown and increased ketogenesis from increased fatty acids ~>ketone bodies (beta hydroxy butyrate >acetoacetate)
Kussmaul respiration, nause/vomiting, abdominal pain, psychosis, fruity breath odor, dehydration
Labs - hyperglycemia, low bicarb, hyperkalemia but total body K depletion
Complications - mucor mycosis, cerebral edema, cardiac arrythmia, HF
Tx - IV Fluids, insulin, K, glucose
Glucagonoma and Insulinoma
Glucagonoma- presents with 4Ds Dermatitis, diabetes, DVT, depression
Insulinoma - decreased blood glucose and increased C peptide. Tx is surgery
Carcinoid syndrome
Metastatic tumor secreting seretonin , rosettes on histology
Recurrent diarrhea, flushing, asthma, right side valvular disease, 5 HIAA in urine, niacin deficiency
Rule of 1/3 - metastasize, present with secondary malignancy, multiple
Zollinger-Ellison syndrome
Gastrin secreting tumor, ulcers, abdominal pain, gastrin remains elevated after secretin administration which should not in healthy patients
