Endocrine Pathology Flashcards
Euvolemic hyponatremia with urinary NA+ secretion
Urine osmolality> Blood osmolality
SIADH
What happens to Aldosterone and ANP in SIADH
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.
Rapid correction of SIADH induced hyponatremia can cause
Osmotic Demyelination Syndrome
locked in
SIADH can be caused by what malignancy
SMALL cell lung Carcinoma
What drugs can caused SIADH
Carbamazepine
Cyclophosphamide
SSRIs
How to treat SIADH
Fluid restriction is 1st line Salt Tablets ADH antagonist (–Vaptans & Demeclocycline) IV fluids (slowly and if emergent)
What drug causes Nephrogenic DI
high ADH, high blood osmolality, low urine osmolality
Lithium
Demeclocycline
A patient with LOW Blood osmolality and LOW urine osmolality probably has
Polygenic Polydipsia
Desmopressin elevates urine osmolality after water deprivation test.
Central Diabetes Insipidus
Desmopressin minimally increases urine osmolality even after water deprivation test
Nephrogenic Diabetes Insipidus
Pituitary tumor, Sheehan syndrome, Blunt head trauma, surgery, encephalopathy can all cause
Central Diabetes Insipidus
Ischemic infarct of the pituitary following postpartum bleeding due to hypoperfusion of hypertrophied gland
Sheehan syndrome
Presents with failure to lactate post-partum, cold intolerance, ammenorhea
Sheehan syndrome
Frontal bossing, large hands and feet, coarse facial features, deep furrows, thick jaw, insulin resistance, +/- lowered labido
Acromegaly
Acromegaly increases the risk of _____ cancer
Colorectal polyps & cancer
Acromegaly is diagnosed via elevated ____ levels following oral glucose tolerance test
IGF-1
Acromegaly is treated with
Ocretotide (somatostatin analog)
Pegvisomant (GH receptor anatagonist)
DiGeorge syndrome presents with __ PTH & ___ Phosphate
Low PTH
High Ph
Multiple Myeloma presents with ___ Calcium & __ Phosphate
High (both)
Elevated Alkphosphate indicates
high bone turnover
functioning PTH
How does Chronic Kidney Disease affect levels of: \_\_\_ Alkphosphate \_\_\_ Calcium \_\_\_ Calciferol (inactive VIt. D) \_\_\_ pH
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)
High PTH
Low Calcium
*MOST COMMON
CKD
Vit. D inactive/deficient (Chron’s, CF, malabsoprtion)
Low PTH
High Calcium
Cancer
Excess active Vit.D
Low PTH
Low Calcium
Primary Hypoparathyroidism (accidentally removed in surgery or autoimmune dest)
High PTH
High Calcium
Primary Hyperparathyroidism
Hyperplasia, adenoma/carcinoma
presents with episodic hypertension
200>180
Pheochromacytoma
Treatments of Pheochromacytoma
FIRST __blocker
then
__ blocker
alpha (phenoxybenzamine)
beta
Phenoxybenzamine for Pheochroma
A before B
Pheochromacytoma can be caused by what 3 mutations
VHL
NF-1
MEN2a/b
Explain why and alpha blocker needs to be used before a beta blocker in pheochromacytoma?
To prevent HYPERTENSIVE CRISIS
Alpha blocker stops Vasoconstriction
Beta blockers slow down HR (which would cause vasoconstriction thus HTN)
Most common adrenal tumor in children
Neuroblastoma (neural crest cell origin)
abdominal mass
irrregular
firm
crosses midline
Neuroblastoma (neural crest cell origin)
abdominal mass
smooth
firm
does NOT cross midline (Unilateral)
WIlm’s Tumor (Kidney tubular cells)
Normotensive baby with an abdominal mass and
jerking limbs, plus non-rhythmic eye movements
Neuroblastoma (neural crest cell origin)
Bombesin +
NSE+
N-myc amplification
Homer Wright- rosettes (small blue round cells in a circle with a pink center)
Neuroblastoma (neural crest cell origin)
*mass may compress spine = DUMBELLS
Dermatitis (Necrolytic) Diabetes (Hyperglycemia/weight loss) DVT Diarrhea Depression
Glucagonoma
*give octreotide
Insulinoma is associated with what endocrine disorder
MEN1
*so is Zollinger-Elison
Intestinal ulcers (doudenum/jejunum)
Peptic Ulcer Disease
diarrhea/steatorrhea
Hypertrophies Rugae
Zollinger-Elison
*give octreotide + PPi
Asthma/wheezing
Diarrhea/ Dermatitis/ Dementia
Cutaneous Flushing
Murmur (right heart)
Carcinoid syndrome
+ Urine 5HIAA
Carcinoid syndrome
If a carcinoid tumor is located in the GI tract it will be asymptomatic why?
5HT will go to liver via portal circulation and be inactivated
*becomes symptomatic is tumor spreads to the liver
Chromogranin A +
Synpatophysin +
Granular Rosettes
Carcinoid syndrome
Classic Triad: Hyperpigmentation Hyperkalemia Hypotensive (syncope etc.) Low aldosterone
Primary adrenal Insufficiency
List 2 causes of chronic Primary adrenal Insufficiency
autoimmune destruction (in western world) TB (in developing countries)
Pituitary apoplexy
Sheehan syndrome
Pituitary tumor can precipitate secondary
adrenal insufficiency
No hyperpigmentation
Normal ACTH levels
No hyperkalemia
normal aldosterone (RAAS okay)
secondary adrenal insufficiency
The most common cause of adrenal insufficiency is due to
abrupt withdrawl of glucocorticoid (iatrogenic)
*taper patient off of medication
Sugar and salt cravings can be suggestive of
Adrenal Insufficiency
Adrenal crisis can precipitate
hypotensive shock (no aldosterone or cortisol to retain water and vasoconstrict)
Hypotension
Seizures (+/-)
Altered mental status
Hypotensive shock
Adrenal crisis
Elevated ACTH = __ adrenal insufficiency
Primary
* low 11-doxycortisol clinches the diagnosis
Low ACTH = __ adrenal insufficiency
secondary/tertiary (glucocorticoid withdrawl)
The most common cause of cushing syndrome is due to
Iatrogenic (Prednisone) Pituitary adenoma (Organic cause)
Cushing syndrome can be precipitated by what malignancy
SMALL cell lung cancer
