Endocrine Pathology

Question 1

Euvolemic hyponatremia with urinary NA+ secretion

Urine osmolality> Blood osmolality

Answer 1

SIADH

Question 2

What happens to Aldosterone and ANP in SIADH

Answer 2

Low Aldosterone
High ANP

SIADH increases blood volume which causes the atrial to secrete ANP to lower blood volume and lowers aldosterone secretion which would also increase blood volume.

Question 3

Rapid correction of SIADH induced hyponatremia can cause

Answer 3

Osmotic Demyelination Syndrome

locked in

Question 4

SIADH can be caused by what malignancy

Answer 4

SMALL cell lung Carcinoma

Question 5

What drugs can caused SIADH

Answer 5

Carbamazepine
Cyclophosphamide
SSRIs

Question 6

How to treat SIADH

Answer 6

Fluid restriction is 1st line
Salt Tablets
ADH antagonist (–Vaptans & Demeclocycline)
IV fluids (slowly and if emergent)

Question 7

What drug causes Nephrogenic DI

high ADH, high blood osmolality, low urine osmolality

Answer 7

Lithium

Demeclocycline

Question 8

A patient with LOW Blood osmolality and LOW urine osmolality probably has

Answer 8

Polygenic Polydipsia

Question 9

Desmopressin elevates urine osmolality after water deprivation test.

Answer 9

Central Diabetes Insipidus

Question 10

Desmopressin minimally increases urine osmolality even after water deprivation test

Answer 10

Nephrogenic Diabetes Insipidus

Question 11

Pituitary tumor, Sheehan syndrome, Blunt head trauma, surgery, encephalopathy can all cause

Answer 11

Central Diabetes Insipidus

Question 12

Ischemic infarct of the pituitary following postpartum bleeding due to hypoperfusion of hypertrophied gland

Answer 12

Sheehan syndrome

Question 13

Presents with failure to lactate post-partum, cold intolerance, ammenorhea

Answer 13

Sheehan syndrome

Question 14

Frontal bossing, large hands and feet, coarse facial features, deep furrows, thick jaw, insulin resistance, +/- lowered labido

Answer 14

Acromegaly

Question 15

Acromegaly increases the risk of _____ cancer

Answer 15

Colorectal polyps & cancer

Question 16

Acromegaly is diagnosed via elevated ____ levels following oral glucose tolerance test

Answer 16

IGF-1

Question 17

Acromegaly is treated with

Answer 17

Ocretotide (somatostatin analog)

Pegvisomant (GH receptor anatagonist)

Question 18

DiGeorge syndrome presents with __ PTH & ___ Phosphate

Answer 18

Low PTH

High Ph

Question 19

Multiple Myeloma presents with ___ Calcium & __ Phosphate

Answer 19

High (both)

Question 20

Elevated Alkphosphate indicates

Answer 20

high bone turnover

functioning PTH

Question 21

How does Chronic Kidney Disease affect levels of:
\_\_\_ Alkphosphate 
\_\_\_ Calcium
\_\_\_ Calciferol (inactive VIt. D)
\_\_\_ pH

Answer 21

High (thus PTH is working)
Low
Low (PTH is working, kidneys must be & letting Ca go)
high (PTH and pH always go in the same direction)

Question 22

High PTH
Low Calcium
*MOST COMMON

Answer 22

CKD

Vit. D inactive/deficient (Chron’s, CF, malabsoprtion)

Question 23

Low PTH

High Calcium

Answer 23

Cancer

Excess active Vit.D

Question 24

Low PTH

Low Calcium

Answer 24

Primary Hypoparathyroidism
(accidentally removed in surgery or autoimmune dest)

Question 25

High PTH | High Calcium

Answer 25

Primary Hyperparathyroidism | Hyperplasia, adenoma/carcinoma

Question 26

presents with episodic hypertension | 200>180

Answer 26

Pheochromacytoma

Question 27

Treatments of Pheochromacytoma FIRST __blocker then __ blocker

Answer 27

alpha (phenoxybenzamine) beta Phenoxybenzamine for Pheochroma A before B

Question 28

Pheochromacytoma can be caused by what 3 mutations

Answer 28

VHL NF-1 MEN2a/b

Question 29

Explain why and alpha blocker needs to be used before a beta blocker in pheochromacytoma?

Answer 29

To prevent HYPERTENSIVE CRISIS Alpha blocker stops Vasoconstriction Beta blockers slow down HR (which would cause vasoconstriction thus HTN)

Question 30

Most common adrenal tumor in children

Answer 30

Neuroblastoma (neural crest cell origin)

Question 31

abdominal mass irrregular firm crosses midline

Answer 31

Neuroblastoma (neural crest cell origin)

Question 32

abdominal mass smooth firm does NOT cross midline (Unilateral)

Answer 32

WIlm's Tumor (Kidney tubular cells)

Question 33

Normotensive baby with an abdominal mass and | jerking limbs, plus non-rhythmic eye movements

Answer 33

Neuroblastoma (neural crest cell origin)

Question 34

Bombesin + NSE+ N-myc amplification Homer Wright- rosettes (small blue round cells in a circle with a pink center)

Answer 34

Neuroblastoma (neural crest cell origin) | *mass may compress spine = DUMBELLS

Question 35

``` Dermatitis (Necrolytic) Diabetes (Hyperglycemia/weight loss) DVT Diarrhea Depression ```

Answer 35

Glucagonoma | *give octreotide

Question 36

Insulinoma is associated with what endocrine disorder

Answer 36

MEN1 | *so is Zollinger-Elison

Question 37

Intestinal ulcers (doudenum/jejunum) Peptic Ulcer Disease diarrhea/steatorrhea Hypertrophies Rugae

Answer 37

Zollinger-Elison | *give octreotide + PPi

Question 38

Asthma/wheezing Diarrhea/ Dermatitis/ Dementia Cutaneous Flushing Murmur (right heart)

Answer 38

Carcinoid syndrome

Question 39

+ Urine 5HIAA

Answer 39

Carcinoid syndrome

Question 40

If a carcinoid tumor is located in the GI tract it will be asymptomatic why?

Answer 40

5HT will go to liver via portal circulation and be inactivated *becomes symptomatic is tumor spreads to the liver

Question 41

Chromogranin A + Synpatophysin + Granular Rosettes

Answer 41

Carcinoid syndrome

Question 42

``` Classic Triad: Hyperpigmentation Hyperkalemia Hypotensive (syncope etc.) Low aldosterone ```

Answer 42

Primary adrenal Insufficiency

Question 43

List 2 causes of chronic Primary adrenal Insufficiency

Answer 43

``` autoimmune destruction (in western world) TB (in developing countries) ```

Question 44

Pituitary apoplexy Sheehan syndrome Pituitary tumor can precipitate secondary

Answer 44

adrenal insufficiency

Question 45

No hyperpigmentation Normal ACTH levels No hyperkalemia normal aldosterone (RAAS okay)

Answer 45

secondary adrenal insufficiency

Question 46

The most common cause of adrenal insufficiency is due to

Answer 46

abrupt withdrawl of glucocorticoid (iatrogenic) *taper patient off of medication

Question 47

Sugar and salt cravings can be suggestive of

Answer 47

Adrenal Insufficiency

Question 48

Adrenal crisis can precipitate

Answer 48

``` hypotensive shock (no aldosterone or cortisol to retain water and vasoconstrict) ```

Question 49

Hypotension Seizures (+/-) Altered mental status Hypotensive shock

Answer 49

Adrenal crisis

Question 50

Elevated ACTH = __ adrenal insufficiency

Answer 50

Primary | * low 11-doxycortisol clinches the diagnosis

Question 51

Low ACTH = __ adrenal insufficiency

Answer 51

secondary/tertiary (glucocorticoid withdrawl)

Question 52

The most common cause of cushing syndrome is due to

Answer 52

``` Iatrogenic (Prednisone) Pituitary adenoma (Organic cause) ```

Question 53

Cushing syndrome can be precipitated by what malignancy

Answer 53

SMALL cell lung cancer