ENDOCRINE-Pathology Flashcards
1
Q
What is Cushing syndrome?
A
↑ cortisol due to a variety of causes
2
Q
Which are main causes of Cushing syndrome?
A
Exogenous corticosteroids
Primary adrenal adenoma, hyperplasia or carcinoma
ACTH secreting pituitary adenoma; paraneoplastic ACTH secretion
3
Q
1 cause of Cushing syndrome
A
Exogenous corticoesteroids
4
Q
What is the result of Exogenous corticosteroids use?
A
↓ ACTH, bilateral adrenal atrophy
5
Q
In these cases of Chushing syndrome ↓ ACTH, atrophy of uninvolved adrenal gland
A
Primary adrenal adenoma, hyperplasia or carcinoma
6
Q
1º Aldosteronism
A
Conn syndrome
7
Q
How else can Primary adrenal adenoma, hyperplasia or carcinoma present?
A
1º Aldosteronism
8
Q
ACTH secreting pituitary adenoma
A
Cushing disease
9
Q
What is Cushing disease?
A
ACTH secreting pituitary adenoma
10
Q
Example of Paraneoplastic ACTH secretion
A
Small cell lung cancer, bronchial carcinoids
11
Q
Which are the results of Cushing disease and Paraneoplastic ACTH secretion?
A
↑ ACTH, bilateral adrenal hyperplasia
12
Q
Who is the responsible for the majority of endogenous cases of Cushing syndrome?
A
Cushing disease
13
Q
Which are the findings in Cushing syndrome?
A
Hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin changes (thining, striae), osteopororsis, amenorrhea, and immune suppression
14
Q
Which are the screening test for Cushing syndrome?
A
↑ free cortisol on 24 hr urinalysis
Midnight salivary cortisol
Overnight low dose dexamethasone suppression test: Measure serum ACTH
15
Q
If Overnight low dose dexamethasone suppression test Measuring serum ACTH is decreases, what is your suspicious?
A
Adrenal Tumor
16
Q
If Overnight low dose dexamethasone suppression test Measuring serum ACTH is increased, what is your suspicious?
A
Distinguish between Cushing disease and ectopic ACTH secretion
17
Q
What is needed to Distinguish between Cushing disease and ectopic ACTH secretion?
A
High dose (8 mg) dexamethasone suppression test and CRH stimulation test
18
Q
What is expected with High dose (8 mg) dexamethasone in Ectopic secretion? Why?
A
Ectopic secretion will not decrease with dexamethasone because the source is resistant to negative feedback
19
Q
What is expected with CRH stimulation test in Ectopic secretion? Why?
A
Ectopic secretion will not increase with CRH because pituitary ACTH is suppressed
20
Q
When are ACTH levels consider supressed?
A
< 5 pg/ mL
21
Q
When are ACTH levels consider elevated?
A
> 20 pg/ mL
22
Q
What can cause Primary hyperaldosteronism?
A
Adrenal hyperplasia
Adrenal secreting adrenal adenoma
23
Q
What is the Conn syndrome?
A
Aldosterone secreting adrenal adenoma
24
Q
Which are the results of primary hyperaldosteronism?
A
Hypertension
Hypokalemia
Low plasma renin
25
How is the Na+ due to aldosterone escape?
Normal
26
Can edema be present due to Aldosterone escape?
No
27
How can primary Hyperaldosteronism be presented?
May be bilateral or unilateral
28
Which is the treatment for primary Hyperaldosteronism?
Surgery to remove the tumor and/or spironolactone
29
What is spironolactone?
a K+ spairing durietic that acts as Aldosterone antagonist
30
What happens in secondary hyperaldosteronism?
Renal perception of low intravascular volume results in an overactive renin angiotensin system
31
Causes of secondary hyperaldosteronism
Renal artery stenosis, CHF, cirrhosis, or nephrotic syndrome
32
How is renin in secondary Hyperaldosteronism?
High plasma renin
33
Which is the treatment for secondary Hyperaldosteronism?
Spironolactone
34
What is addison disease?
Chronic primary adrenal insufficiency due to adrenal atrophy or destruction by disease
35
Examples of destruction diseases that cause Addison disease
Autoimmune, TB, Metastasis
36
Who are deficient in Addison disease?
Deficiency of aldosterone and cortisol
37
Which are the findings in Addison disease?
Hypotension
Hyperkalemia
Acidosis
Skin and mucosal hyperpigmentation
38
What causes Hypotension in Addison disease?
Hyponatremic volume contraction
39
Which is the reason of skin and mucosal hyperpigmentation?
Due to MSH, a by product of ↑ ACTH production from proopiomelanocortin (POMC)
40
Which are the characteristics of Addison disease?
Adrenal Atrophy and Absence of hormone production
41
In Addison disease who are affected?
Involves all 3 cortical divisions (spares medulla)
42
Characteristic of Secondary adrenal insufficiency
↓ pituitary ACTH production
43
What distinguish Addison disease with Secondary adrenal insufficiency?
Secondary adrenal insufficiency has no skin/ mucosal hyperpigmentation and no hyperkalemia
44
What is the Waterhouse-Friederichsen syndrome?
Acute primary adrenal insufficiency due to adrenal hemorrhage
45
Which are the associated causes to Waterhouse-Friederichsen syndrome?
Neisseria meningitidis septicemia
DIC
Endotoxin shock
46
Most common tumor of the adrenal medulla in children
Neuroblastoma
47
Normal age of apperance of Neuroblastoma
<4 years old
48
From where does Neuroblastoma is originated?
Neural crest cells
49
Where can Neuroblastoma make an apperance?
Anywhere along the sympathetic chain
50
Which is the most common presentation of Neuroblastoma?
Abdominal distention and a firm, irregular mass, that can cross the midline
51
Which is the differential diagnosis of Neuroblastoma?
Wilms tumor, which is smooth and unilateral
52
What lab helps in Neuroblastoma diagnosis?
```
Homovanillic acid (HVA), Increased in urine
Bombesin +
```
53
What is Homovanillic acid (HVA)?
A breakdown product of dopamine
54
How often can a Neuroblastoma generate hypertension?
Less likely to develop hypertension
55
Which oncogen is associated to Neuroblastoma?
Overexpression of N-myc oncogene
56
Most common tumor of the adrenal medulla in adults
Pheochromocytoma
57
From where does pheochromocytoma derives?
From chromaffin cells (arise from neural crest)
58
How else is pheocrhromocytoma known?
Rule of 10's
59
What does the rule of 10's in pheochromocytoma means?
```
10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids
```
60
What does Pheochromocytoma secretes?
Epinephrine, norepinephrine and dopamine
61
What can the secretions of Pheochromocytoma cause?
Episodic hypertension
62
Which diseases are associated to Pheochromocytoma?
von Hippel Lindau disease
| MEN 2A and 2B
63
How does symptoms occur in pheochromocytoma?
In "spells"- relapse and remit
64
Which are the characteristics of episodi hyperadrenergic symptoms caused by pheochromocytoma?
```
5 Ps
Pressure (↑ BP)
Pain (headche)
Perspiration
Palpitations (tachycardia)
Pallor
```
65
Which are the findings in Pheochromocytoma?
```
Urinary VMA (Vanillylmandelic acid )
Plasma catecholamines are ↑
```
66
What is VMA (Vanillylmandelic acid )?
Breakdown products of norepinephrine and epinephrine
67
Which is the treatmenf fot pheocrhromocytoma?
Irreversible α antagonist and β blockers followed by tumor resection
68
Example of Irreversible α antagonist
Phenoxybenzamine
69
When giving pharmacologic treatment for pheochromocytoma, wha do you need to be careful?
α blockade must be achive before giving β blockers to avoid a hypertensive crisis
70
Clinical findings in Hypothyrodism
```
Cold intolerace (↓ heat production)
Weight gain, ↓ appetite
Hypoactivity, lethargy, fatigue, weakness
Constipation
↓ reflexes
Myxedema (facial/ periorbital)
Dry, cool skin; coarse, brittle hair
Bradycardia, dyspnea on exertion
```
71
Which are clinical findings for Hyperthyrodism?
```
Heat intolerance (↑ heat production)
Weight loss, ↑ appetite
Hyperactive
Diarrhea
↑ reflexes
Pretibial myxedema (Graves disease)
Periorbital edema
Warm, moist skin, fine hair
Chest pain palpitations, arrhytmias
```
72
In hyperthyrodism, what causes Chest pain, palpitation, arrhytmia?
↑ Number and sensitivity of β adrenergic receptors
73
Lab findings in Hypothyroidism
↑ TSH
↓ free T3 and T4
Hypercholesterolemia
74
Which lab test is sensitive for primary hipothyroidism?
↑ TSH
75
Why Hypercholesterolemia is a finding in Hypotyhyroidism?
Due to ↓ LDL receptor expression
76
In Primary hyperthyroidism which are the lab findings?
↓ TSH
↑ free T3 and T4
Hypocholesterolemia
77
Why Hypocholesterolemia is a finding in Hypotyhyroidism?
Due to ↑ LDL receptor expression
78
Most common cause of hypothyroidism in iodine sufficient regions
Hashimoto thyroiditis
79
How is Hashimoto thyroiditis consdier?
Autoimmune disorder
80
Antibodies foun in Hashimoto thyroiditis
Antithyroid peroxidase, anthythyroglobulin antibodies
81
Broad-antigen serotype related to Hashimoto thyroiditis
HLA-DR5
82
Which cancer is associated to Hashimoto thyroiditis?
↑ risk for Non Hodgkin lymphoma
83
How is Hashimoto thyroiditis at the begining?
May be thyrotoxicosis during follicular rupture
84
Histologic findings in Hashimoto thyroiditis
Hurthle cells
85
What are the hurtle cells?
Lymphoid aggregate with germinal centers
86
Findings in Hashimoto thyroiditis
Moderately enlarged, nontender thyroid
87
Causes of Congenital hypothyroidism
```
Maternal hypothyrodism
Thyroid agenesis
Thyroid dysgenesis
Iodine deficiency
Dyshormonogenic goiter
```
88
This is a another name for Congenital hypothyroidism
Cretinism
89
Most common cause of Congenital hypthyroidism in US
Thyroid dysgenesis
90
Clinical findings in Congenital hypothyroidism
```
6 Ps
Pot bellied
Pale
Puffy faced child
Protruding umbilicus
Protuberant tongue
Poor brain development
```
91
Causes of Hypothyroidism
```
Hashimoto thyroidtis
Congenital hypothyroidism
Subacute thyroiditis
Riedel thyroiditis
Iodine Deficiency
Goitrogens
Woll Chaikoff effect
Painless thyroiditis
```
92
Another name for Subacute Thyroiditis
de Quervain
93
Self limited hypothyroidism often following a flu like illness
Subacute Thyroiditis (de Quervain)
94
How is the evolution of Subacute Thyroiditis?
May be hyperthyroid early in cpurse then becomes hypothyroidism
95
Hystology of Subacute Thyroiditis (de Quervain)
Granulomatous inflammation
96
Findings in Subacute Thyroiditis (de Quervain)
↑ ESR (erythrocyte sedimentation rate), jaw pain, early inflammation, very tender thyroid (de Quervain is associated with pain)
97
What happens in Riedel Thyroiditis?
Thyroid replaced by fibrous tissue (hypothyroid)
98
How much can the Riede thyroiditis can extent?
Fibrosis may extend to local structures (eg airway) mimicking anaplastic carcinoma
99
How is Riedel Thyroiditis consider?
A manifestation of IgG4 related systemic disease
100
Findings of Riedel Thyroiditis
Fixed, hard (rock like), and painless
101
Other causes of hypothyroidism
Iodine deficiency, goitrogens, Wolff Chaikoff effect, painless thyroiditis
102
Disease that curse with Hyperthyroidism
Toxic multinodular goiter
Graves disease
Thyroid storm
103
What happens in Toxic multinodular goiter?
Focal patches of hyperfunctioning follicular cells working independently of TSH due to mutations in TSH receptor
104
Which secretion is affected in Toxic multinodular goiter?
↑ release of T3 and T4
105
Normaly how are hot nodules of Toxic multinodular goiter consider?
Rarely malignat
106
What is the Jod Basedow phenomenom?
Thyrotoxicosis if a patient with iodine deficiency goiter is made iodine repleted
107
Which disease is related to Jod Basedow phenomenom?
Toxic multinodular goiter
108
Most comon cause of Hyperthyroidism
Graves disease
109
Which are the causes of clinical manifestation of Graves disease?
Autoantibodies (IgG) stimulate TSH receptors on thyroid
Retroorbital fibroblasts
Dermal fibroblasts
110
Clinical manifestations of Graves disease
Hyperthyrodism, diffuse goiter (Autoantibodies (IgG) stimulate TSH receptors on thyroid)
Exophthalmos: proptosis, extraocular muscle swelling (Retroorbital fibroblasts)
Pretibial Mixedema (Dermal fibroblasts)
111
When is Graves disease often presented?
During Stress (eg. Childbirth)
112
What is the Thyroid storm?
Stress induced catecholamine surge seen as a serious complication of Graves disease and other hyperthyroid disorders
113
Which is a cause of death in Thyroid storm?
Tachyarrhytmia
114
How is Thyroid storm presented?
Agitation, delirium, fever, diarrhea, coma, and tachyarrhytmia
115
How is Alkaline Phosphatase in Thyroid storm? Why?
↑ ALP due to bone turnover
116
How do you treat a Thyroid storm?
3 Ps
β blockers ( Propanolol)
Propylthiouracil
Corticoesteroids (Prednisone)
117
When is Thyroidectomy indicated?
Treatment option fot Thyroid cancers and hyperthyrodism
118
These could be complications of Thyroidectomy
Hoarseness (Due to recurrent laryngeal nerve damage)
Hypocalcemia (due to removal of parathyroid glands)
transection of inferiori thyroid artery
119
Most common thyroid cancer
Papillary carcinoma
120
Which is the prognosis of Thyroid papillary carcinoma?
Excelent prognosis
121
Histologic findings in Thyroid papillary carcinoma
Empty appearing nuclei ("Orphan Annie" eyes)
Psamoma eyes
Nuclear grooves
122
When is increased the risk for Thyroid papillary carcinoma?
With RET ad BRAF mutations
| Childhood irradiation
123
What are the Orphan Annie eyes histologic findings?
Empty appearing nuclei in Thyroid papillary carcinoma
124
Most common thyroid cancers
```
Papillary carcinoma
Follicular carcinoma
Medullary carcinoma
Undifferentiated/ Anaplastic carcinoma
Lymphoma
```
125
How is the prognosis of Thyroid follicular carcinoma?
Good prognosis
126
Which are differential characteristics of Thyroid follicular carcinoma and Thyroid follicular adenoma?
Invades thyroid capsule, uniform follicles
127
From which cells does Thyroid Medullary carcinoma comes from?
From parafollicular "C cells"
128
What does Thyroid Medullary carcinoma produce?
Produces calcitonin
129
Hystologic findings for Thyroid Medullary carcinoma
Sheets of cells in an amyloid stroma
130
Which gen mutations are associated to Medullary carcinoma?
MEN 2A and 2B (RET mutations)
131
Who are at higher risk for Thyroid Anaplastic Carcinoma?
Older patients
132
How else is Anaplastic carcinoma known?
Undifferentiated
133
Hystoligic characteristics of Thyroid Anaplastic carcinoma
Invades local structures
134
Prognosis of Thyroid Anaplastic carcinoma
Very poor prognosis
135
Thyroid Lymphoma is associated to this disease
Hashimoto Thyroiditis
136
How is Hyperparathyroidism classified?
Primary
Secondary
Tertiary
137
Which is the common cause of primary hyperparathyroidism?
Ussually an adenoma
138
Labs found in primary hyperparathyroidism
```
Hypercalcemia
Hypercalciuria
Hypophosphatemia
↑ PTH
↑ ALP
↑ cAMP in urine
```
139
Which are the symptoms of primary hyperparathyroidism?
Most often asymptomatic
May present with weakness and constipation ("groans"), abdominal/flank pain (kidney stones, acute pancreatitis), depression
140
Which disease is associated with primary hyperparathyroidism?
Osteitis fibrosa cystica
141
What is Osteitis fibrosa cystica?
Cystic bone spaces filled with brown fibrous tissue
142
What happens in secondary hyperparathyroidism?
Secondary hyperplasia due to ↓ gut Ca2+ absorption and ↑ PO4 3-
143
When is more often to see secondary hyperparathyroidism?
In chronic renal disease
144
What does chronic renal disease causes in secondary hyperparathyroidism?
Causes hypovitaminosis D → ↓ Ca2+ absorption
145
Effects of secondary hyperparathyroidism
Hypocalcemia
Hyperphosphatemia in chronic renal failure (vs hypophosphatemia with most other causes)
↑ ALP, ↑ PTH
146
Refractory (autonomous) hyperparathyroidism
Tertiary hyperparathyroidism
147
Which is the cause of Tertiary hyperparathyroidism?
Resulting from chronic renal disease
148
Findings on Tertiary hyperparathyroidism
↑↑ PTH, ↑ Ca2+
149
What is and who causes Renal osteodystrophy?
Bone lesions due to 2º or 3º hyperparathyroidism due in turn to renal disease
150
Causes of Hypoparathyroidism
Accidental surgical excision of parathyroid glands
Autoimmune destruction
DiGeorge syndrome
151
Findings in Hypoparathyroidism
Hypocalcemia
| Tetany
152
Which signs could be found in Hypoparathyroidism?
Chvosek sign
| Trousseau sign
153
What is the Chvosteck sign?
Tapping of facial nerve (tap the Cheek) → contraction of facial muscles
154
What is the Trousseau sign?
Occlusion of brachial artery with BP cuff → carpal spasm
155
Alternative name for Pseudohypoparathyroidism
Albright hereditary osteodystrophy
156
Genetic adquiring pattern of Albright hereditary osteodystrophy
Autosomal dominant
157
What happens in Pseudohypoparathyroidism?
Autosomal dominant unresponsiveness of kidney to PTH
158
What happens in Albright hereditary osteodystrophy?
Autosomal dominant unresponsiveness of kidney to PTH
159
Findings of Albright hereditary osteodystrophy
Hypocalcemia
Shortened 4th/5th digits
Short stature
160
Pathology that curses with Low serum calcium and high PTH levels
Secondary hyperparathyroidism
161
Causes of Secondary hyperparathyroidism
Vitamin D deficiciency
| Chronic renal failure
162
Low levels of PTH and Low levels of calcium
Hypoparathyroidism
163
Which levels of PTH are consider low?
<10 pg/ mL
164
High levels of both PTH and calcium
Primary hyperparathyroidism
165
Causes of primary hyperparathyroidism
Hyperplasia
Adenoma
Carcinoma
166
Low levels of PTH but high levels of Calcium
PTH independent hypercalcemia
167
Causes of PTH independent hypercalcemia
Excess Ca2+ ingestion
| Cancer
168
Which is the most common pituitary adenoma?
Prolactinoma (benign)
169
How are pituitary adenoma classified?
```
Functional (hormone producing)
Non functional (silent)
```
170
How are nonfunctional Adenomas presented?
With mass effect (bitemporal hemianopia, hypopituitarism, headache)
171
How is prolactinoma presented?
Amenorrhea
Galactorrhea
Low libido
Infertility
172
How is somatotropic adenoma presented?
Acromegaly
173
Treatment for prolactinoma
Dopamine agonist
174
Dopamine agonists
Bromocriptine or Cabergoline
175
What is acromegaly?
Excess GH in adults
176
Which is the typical cause of Acromegaly?
Pituitary adenoma
177
Findings in Acromegaly
Large tongue with deep furrows, deeps voice, large hands and feet, coarse facial features, impaired glucose tolerance (insulin resistance)
178
Which is the most common cause of death in gigantism patients?
Cardiac failure
179
Characteristics of GH increased in children
Gigantism (↑ linear bone growth)
180
Characteristics of Diabetes insipidus
Characterized by intense thrist and polyuria inability to concentrate urine due to lack of ADH
181
Which are the possible causes of Diabetes insipidus?
Central or nephrogenic
182
Etiology of central Diabetes Insipidus
Pituitary Tumor, autoimmune, trauma, surgery, ischemic encephalopaty, idiopathic
183
How is ADH in Central Diabetes Insipidus?
↓ ADH
184
Findings in Central Diabetes insipidus
Urine specific gravity 290 mOsm/L
| Hyperosmotic volume contraction
185
How is Central Diabetes insipidus diagnose?
Water restriction test> 50% ↑ in urine osmolarity
186
Treatment for Central Diabetes Insipidus
```
Intranasal DDAVP (Desmopressin)
Hydration
```
187
How is the water restriction test made?
No water intake for 2-3 hr followed by hourly measurements of urine volume and osmolarity and plasma Na+ concentration and osmolarity
188
What is DDAVP?
Desmopressin- ADH analog is administered of normal values are not clearly reached
189
Etiology of Nephrogenic Diabetes Insipidus
Hereditary (ADH receptor mutation), secondary to hypercalcemia, lithium, demeclocycline
190
What is demeclocycline?
ADH antagonist
191
How is ADH in Nephrogenic Diabetes Insipidus?
Normal ADH levels
192
Findings in Nephrogenic Diabetes Insipidus
Urine specific gravity 290 mOsm/L
| Hyperosmotic volume contraction
193
What is the result of water restriction test in Nephrogenic Diabetes Insipidus?
No change in urine osmolarity
194
Which is the treatment for Nephrogenic Diabetes Insipidus?
Hydrochlorothiazide, indomethacin, amiloride
| Hydration
195
Characteristics of Syndrome of innapropiate Antidiuretic hormone secretion (SIADH)
Excessive water retention
Hyponatremia with continued urinary Na+ excretion
Urine osmolarity> serum osmolarity
196
How does the body responds to water retention?
↓ aldosterone (hyponatremia) to maintain near normal volume status
197
Which is the risk for very low serum sodium levels?
Can lead to cerebral edema, seizures
198
When Serum sodium levels are corrected what you need to be careful?
Correct slowly to prevent central pontine myelinosis
199
Causes of Syndrome of innapropiate Antidiuretic hormone secretion (SIADH)
Ectopic ADH
CNS disorder/ head trauma
Pulmonary disease
Drugs
200
Which drug can cause Syndrome of innapropiate Antidiuretic hormone secretion (SIADH)?
Cyclophosphamide
201
What produces ectopic ADH?
Small cell lung cancer
202
Treatment for Syndrome of innapropiate Antidiuretic hormone secretion (SIADH)
Fluid restriction, IV hypertonic saline, conivaptanm tolvatan, demeclocycline
203
Causes of undersecretion of pituitary hormones
```
Nonsecreting pituitary adenoma, craneopharyngioma
Sheehan syndrome
Empty sella syndrome
Brain injury, hemorrhage
Radiation
```
204
What happens in Sheehan syndrome?
Ischemic infarct of pituitary following postpartum bleeding
205
Usually how is Sheehan syndrome presented?
Failure to lactate
206
What is the empty sella syndrome?
Atrophy or compression of pituitary, often idiopathic
207
In which patients is empty sella syndrome more common?
Obese women
208
Treatment for Hypopituitarism
Hormone replacement therapy (corticosteroids, thyroxine, sex steroids, human growth hormone)
209
What is pituitary apoplexy?
Hypopituitarism due to brain injury, hemorrhage
210
Main effects of Insulin deficiency (and glucagon excess)
Decreased Glucose uptake
Increased protein catabolism
Increased lipolysis
211
Effect of decreased glucose uptake
Hyperglycemia
Glycosuria
Osmotic diuresis
Electrolitic depletion
212
Result of increased protein catabolism
Increased plasma amino acids, nitrogen loss in urine
213
Once Increased plasma amino acids, nitrogen loss in urine what could be the result
Hyperglycemia
Glycosuria
Osmotic diuresis
Electrolitic depletion
214
In insulin deficiency, what is the result of Increased lipolysis
Increased plasma FFAs, ketogenesis, ketonuria, ketonemia
215
Final result of insulin deficiency
Dehydration, acidosis → Comma, death
216
Acute manifestations of Diabetes
Polydipsia, polyuria, polyphagia, weight loss
217
Acute manifestion of Type 1 Diabetes
Diabetic Ketoacidosis
218
Acute manifestation of Type 2 Diabetes
Hyperosmolar comma
219
Rare causes of Diabetes Mellitus
Unopposed secretion of GH and epinephrine
220
Chronic manifestations of Diabetes
Nonenzymatic glycosylation
| Osmotic damage
221
What happens in small vessel disease in diabetes?
Diffuse thickening of basement membrane
222
Who are affected by Nonenzymatic glycosylation?
Small vessel disease
| Large vessel disease
223
Small vessel disease in Diabetics
Retinopathy
Glaucoma
Nephropathy
224
Findings in Retinopathy in Diabetic patients
Hemorrhage, exudates, microaneurysms, vessel proliferation
225
Findings in Nephropathy in Diabetic patiens
Nodular sclerosis, progressive proteinuria, chronic renal failurem arteriosclerosis leading to hypertension, Kimmelstiel Wilson nodules
226
Consequences of Large vessel atherosclerosis in Diabetes
```
Coronary Artery disease
Peripheral Vascular oclussive disease
Gangrene
Limb loss
Cerebrovascular disease
```
227
Which is the most common cause of death in MI?
Large vessel atherosclerosis
228
What happens in Osmotic damage in Diabetes Mellitus?
Sorbitol accumulation in organs with aldosereductase and ↓ or absent sorbitol dehydrogenase
229
Clinical effects of Osmotic damage
Neuropathy
| Cataracts
230
Manifestations of Neuropathy
Motor, sensory, and autonomic degeneration
231
Test for Diabetes Mellitus diagnosis
Fasting serum glucose
Oral glucose tolerance test
HbA1c
232
What is the purpose of HbA1c?
Reflects average blood glucose over prior 3 months
233
Primary defect in Type 1 Diabetes
Autoimmune destruction of β cells
234
Is insulin necessary for treating Type 1 Diabetes?
Always
235
Often Age of Type 1 Diabetes onset
236
Is Type 1 Diabes associated to Obesity?
No
237
Which is the Genetic predisposition of Type 1 Diabetes?
Relatively weak (50% concordance in identical twins), polygenic
238
What is associated to Type 1 Diabetes?
HLA-DR3 and 4
239
How is the glucose intolerance in Type 1 Diabetes?
Severe
240
How is insulin sensitivity in type 1 Diabetes?
High
241
Which Diabetes type presents with more Ketoacidosis?
Type 1
242
How are β cell numbers in the islets?
Decreased
243
How are serum insulin levels in Type 1 Diabetes?
Decreased
244
In which Diabetes type is more common to see classic symptoms of polyuria, polydipsia, poliphagia and weight loss?
Diabetes Type 1 more common
| Sometimes Diabetes Type 2
245
Classic symptoms in Diabetics
Polyuria, polydipsia, poliphagia and weight loss
246
Histology findings in Type 1 Diabetes
Islet Leukocyte infiltrate
247
Histology findings for Type 2 Diabetes
Islet amyloid polypeptide (IAPP) deposits
248
Primary defect in Type 2 diabetes
↑ resistance to insulin, progressive pancreatic β cell failure
249
Is insulin necesary for treating Type 2 diabetes?
Sometimes
250
Age of onset for Type 2 diabetes
>40 yr
251
Which Diabetes Type is associated to Obesity?
Type 2
252
How is the genetic predisposition of type 2 Diabetes?
Relatively strong (90% concordance in identical twins), polygenic
253
Is type 2 diabetes associated to HLA system?
No
254
How is glucose intolerance in Type 2 Diabetes?
Mild to moderate
255
How is insulin sensitivity in Type 2 diabetes?
Low
256
β cells numbers in the islet in Type 2 diabetes
Variable (with amyloid)
257
Histology of Type 2 Diabetes
Islet amyloid polypeptide
258
One of the most important complications of diabetes (usually type 1)
Diabetic ketoacidosis
259
Which is the usual reason to develop Diabetic ketoacidosis?
Due to ↑ insulin requirements from stress (eg, infection)
260
Which is the pathophysiology of Diabetic Ketoacidosis?
Excess fat breakdown and ↑ Ketogenesis from ↑ free fatty acids, which are then made into ketone bodies (β hydroxybutyrate> acetoacetate)
261
Signs/symptoms in Diabetic ketoacidosis
```
Kusmaul respirations
Nausea/ vomiting
Abdominal pain
Psychosis/ delirium
Dehydration
Fruity breath odor
```
262
Reason of fruity breath odor in Diabetic Ketoacidosis
Exchaled acetone
263
What are the Kusmaul respirations?
Rapid/ deep breathing
264
Labs found in Diabetic Ketoacidosis
```
Hyperglycemia
↑ H+
↓ HCO3- (anion gap metabolic acidosis)
↑ blood ketones levels
Leukocytosis
Hyperkalemia
```
265
What happens to K+ in Diabetic Ketoacidosis?
Hyperkalemia, but depleted intracellular K+ due to transcellular shift from ↓ insulin
266
Complications of Diabetic Ketoacidosis
Life threatening mucormycosis
Cerebral edema
Cardiac arrythmias
Heart failure
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Who causes life threatening mucormycosis?
Rhizopus infection
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Treatment for Diabetic Ketoacidosis
IV fluids, IV insulin, and K+ (to replete intracellular stores)
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Is glucose necessary for treating Diabetic Ketoacidosis?
Glucose if necessary to prevent hypoglicemia
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Tumor of β cells of the pancreas
Insulinoma
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Which is the effect of Insulinoma?
Overproduction of insulin→ Hypoglicemia
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What is found in patients with insulinoma?
Whipple triad
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What is the Whipple triad?
Episodic CNS symptoms:
Lethargy
Syncope
Diplopia
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Findings on symptomatic patients with insulinoma
↓ blood glucose and ↑ C peptide levels (vs exogenous insulin use)
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Treatment for Insulinoma
Surgical Resection
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Which tumors cause Carcinoid syndrome?
Carcinoid Tumors (neuroendocrine cells), especially metastatic small bowel tumors
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What do Metastatic small bowal tumor secrete?
High levels of Serotonin (5HT)
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In these cases the carcinoid syndrome is not seen...
If tumor is limited to GI tract (5HT undergoes first pass metabolism in the liver)
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Findings of Carcinoid syndrome
Recurrent diarrhea
Cutaneous flushing
Asthmatic wheezing
Right sided valvular disease
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What is increased in urine in Carcinoid syndrome?
↑ 5- hydroxyindoleacetic acid (5-HIAA) in urine
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Which vitamin deficiency is found in carcinoid syndrome?
Niacin deficiency (pellagra)
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Which is the treatment for Carcinoid syndrome?
Resection, somatostatin analog (ocreotide)
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What is the rule of 1/3s in Carcinoid syndrome?
1/3 metastasize
1/3 [resent with 2 nd malignancy
1/3 are multiple
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Most common malignancy in the small intestine
Carcinoid syndrome
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Gastrin secreting tumor of pancreas or duodenum
Zollinger Ellison syndrome
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Where is commonly found the Zollinger Ellison syndrome?
Pancreas or duodenum
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What is the final result of Zollinger Ellison syndrome?
Acid hypersecretion causes recurrent ulcers in distal duodenum and jejunum
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Clinical presentation of Zollinger Ellison syndrome
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Abdominal pain (peptic ulcer disease, distal ulcers)
Diarrhea (malabsorption)
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What is associated to Zollinger Ellison syndrome?
May be associated with MEN 1
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What does MEN means?
Multiple Endocrine Neoplasis
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What syndrome is MEN-1?
Wermer syndrome
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Which Tumors are related to MEN-1?
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Parathyroid tumors
Pituitary tumors (prolactin or GH)
Pancreatic endocrine tumors- Zollinger Ellison syndrome, insulinomas, VIPomas, glucagonomas (rare)
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How is MEN-1 commonly presented?
Kidney stones and stomach ulcers
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Which syndrome is MEN-2A?
Sipple syndrome
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Tumors related to MEN 2A
Medullary thyroid carcinoma (secretes calcitonin)
Pheocromocytoma
Parathyroid hyperplasia
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MEN 2B Tumors realted
Medullary thyroid carcinoma
Pheocromocytoma
Oral/ intestinal ganglioneuromatosis (mucosal neuromas)
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What characteristics are associated to MEN 2B?
Marfanoid habitus
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Mnemonic for MEN 1
3 P's (from cephalad to caudad: Pituitary, Parathyroid, and Pancreas; remember by drawing a diamond)
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Mnemonic for MEN 2A
2 P's (Parathyroids and Pheochromocytoma: remember by drawing a square)
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Mnemonic for MEN 2B
1P (Pheocromocytoma remeber by drawing a Triangle)
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Mode of inheritance of all MEN syndromes
Autosomal dominant
| "All MEN are dominant"
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Which mutliple endocrine neoplasias have ret gene mutations?
MEN 2A and 2B
