Endocrine Stuff Flashcards
MEN2A S/S
Pheochromocytoma
Medullary Thyroid Carcinoma (Increased Calcitonin)
Primary Hyperparathyroidism
Stem clearly discusses pheochromocytoma and also mentions a neck mass…what should you worry about?? MTC and increased Calcitonin levels
Levothyroxine is less effective when?
When taking OCPs
What is a branchial cyst?
Branchial cleft cysts are epithelial cysts typically located anterior to the sternocleidomastoid muscle and superior to the clavicle in the lateral neck. They arise from a failure of the second branchial cleft to be obliterated during embyologic development.
Pt’s with MEN2A may have what other symptoms, besides the pheochromocytoma?
May have s/s of hypocalcemia due to the MTC S/s include: fatigue, weakness, tetany
Familial hypocalciuric hypercalcemia will have similar PTH and serum calcium levels to 1’ hyperparathyroidism. How do you tell the difference?
Look at the urine- 1’ hyperparathyroidism will have a UrCa of >0.02 In the case presented, the UrCa was >0.01 FHH will have VERY low ca levels, typically less than 100mg/24hr
Which MEN is the three P’s?
MEN1
- Pancreatic (includes insulinomas, glucagonomas, etc)
- Pituitary Adenomas
- Parathyroid Hyperplasia (or adenoma, 1’ parahyperthyroidism)
In this case, the pt was in distress and presented with hypoglycemia and the s/s along with that. Parathyroid Hyperplasia is the only answer option that made sense.
What is the best systematic way to make a Cushing’s diagnosis?
What common tumor in children can elaborate catecholamine derivatives and is easily confused with pheochromocytoma?
Neuroblastoma
may have abdominal mass on exam
probably won’t mention high BPs in stem
The presence of hypertension, hypokalemia, and ambiguous genitalia in a genetic 46, XX female is suggestive of what disorder?
congenital adrenal hyperplasia (CAH) secondary to 11β-hydroxylase deficiency
patients with 21-hydroxylase deficiency experience salt wasting and often present with what?
with hypotension and hyperkalemia.
Elevation of which hormone can lead to calcium (envelope) kidney stones?
PTH
What is the initial test to see if someone may have Cushing’s Syndrome?
24-hour Urinary Free Cortisol level
(or a low-dose dexamethasone supression test)
What disorder presents with abnormal external genitalia, hypotension and hypovolemia, and elevated adrenocorticotropic hormone with low cortisol levels.
3β-hydroxysteroid dehydrogenase (3BHSD) deficiency, a rare form of congenital bilateral adrenal hyperplasia,
What complication can be seen the day after a thyroidectomy ?
Hypocalcemia because the parathyroid glands may have been removed as well.
What pituitary macroadenoma is the most common cause of bitemporal hemianopsia, headache in a post-menopausal woman?
Prolactinoma (lactotroph hyperplasia)
*would see amenorrhea and galactorrhea in a pre-menopausal woman
Which drug for T2DM is known for causing gas and bloating?
acarbose (a-glucosidase drug)
Pituitary adenomas, specifically, macroprolactinoma, will present with bilateral hemianopsia, headaches, decreased libido and gynecomastia in men. These latter two symptoms are due to what?
decreased leydig cell stimulation (due to inhibited GnRh which decreases sex hormones-causes hypogonadotrophic hypogonadism)
paraneoplastic syndrome from small cell lung carcinoma would lead to elevated levels of what mineral?
What would PTHrP and PTH look like?
Calcium (hypercalcemia)
PTHrP would be high
PTH would be low
What drug inhibits an enzyme in the lung and ends up protecting the kidney from diabetic glomerulosclerosis?
ACE inhibitors (lisinopril)
How does a benign thyroid nodule appear on histology?
contains follicular cells without features of papillary thyroid carcinoma such as nuclear grooves, pseudonuclear inclusions, and nuclear clearing, in a macrofollicular (normal thyroid follicles) architectural pattern.
What will the C-Peptide levels be like in someone with an insulinoma?
C-Peptide levels will be high along with high insulin levels and low blood glucose levels
What cell type do glucagonomas come from?
Pancreatic a-cells
*remember the 4 d’s of glucagonomas: Dermatitis, Diabetes, Depression, and DVTs?
How should Carcinoid syndrome be treated (sx include flushing, wheezing, diarrhea, tachycardia)
Often caused by neuroendocrine tumors
can treat with somatostatin analogue-Octreotide or lantreotide
How does Metformin work?
Blocks hepatic gluconeogenesis by inhibiting mitochondrial GPD
PTU causes which concerning side effect?
agranulocytosis
(can lead to infections)
Which diabetes drugs can lead to edema and weight gain?
thiazolidinedione (pioglitazone or rosiglitazone)
What is the drug of choice for nephrogenic DI?
Hydrochlorothiazide
Will present with frequent thirst/urination
What drug can worsen Addison’s Disease?
Etomidate
Which drug is an antiemetic and a prokinetic drug in the GI that has extrapyramidal symptoms as a side efefct?
Metoclopramide
What four signs/symptoms point to the diagnosis of primary hyperaldosteronism
Hypertension, hypokalemia, metabolic alkalosis, and low renin
Hypocalcemia with high PTH and high phosphate levels that does not respond to exogenous PTH indicate?
Pseudohypoparathyroidism
What is a way of describing “Orphan annie eyes”?
Ground glass or
overlapping nuclei with finely dispersed chromatin
Patients with familial type I chylomicronemia syndrome will have what response to heparin administration?
releases lipases and increases the LPL in serum
In acute adrenal crisis in a patient who has been on long term glucocorticoids, what will happen with the HPA axis?
atrophy of the whole axis and decreased CRH, ACTH and cortisol.
Cushing Syndrome with hyperpigmentation and/or hyperandrogenism, will present with what lab values and be due to what etiology?
elevated ACTH (ACTH dependent cushing syndrome)
either from cushing disease or ectopic ACTH production
babies of hyperglycemic mothers will have what type of pancreas (hypo or hyper functioning?)
hyperfunctioning pancreas
In the zona glomerulosa, what does the enzyme 21-hydroxylase convert?
Progesterone to 11 deoxycorticosterone
For acute adrenal crisis, if not hydrocortisone, what can be given emergently?
Dexamethasone
What will Na, K, and bicarb look like in primary hyperaldosteronism?
Na-normal
K-low
Bicarb-high
What might orphan annie eyes look like
What does this make you think of?
Diabetes
abdominal pain
gallstones
weight loss
diarrhea
Somatostatinoma
calculate standard deviation
the standard deviation is 0.10 mcU/mL, so ± 2 standard deviations is ± 0.20 mcU/mL from the mean value of 2.50 mcU/mL, or 2.30-2.70 mcU/mL.
what hormone would be affected by compression of the pituitary stalk?
prolactin
Compression of the pituitary stalk by a mass effect would cause decreased neuronal input to the pituitary and would lead to decreases in ADH and oxytocin, while the removal of dopamine inhibition of the adenohypophysis would increase the release of prolactin. This is the same mechanism by which antipsychotics (antidopaminergic agents) can induce galactorrhea, and by which bromocriptine (a dopamine analog) can be used to treat galactorrhea.
Prolactinomas are usually treated with what?
What is a common side effect?
Caberogoline or bromocriptine
DELUSIONS
In ectopic production of SIADH, like SCLC, is the ADH coming from the tumor or the post. pit?
the tumor….:(
in pheochromocytoma, PNMT converts __ to __
norepinephrine to epinephrine
What labs should be checked for unintentional weight gain?
bHCG, TSH, Lipids
What will be elevated in hypothyroidism (besides thyroid stuff)?
elevated prolactin levels
hint: if they want hashimotos to be the answer, the pt will have some kind of hx of autoimmune dz
primary hyperparathyroidism can lead to what disaese if untreated?
CKD due to nephrocalcinosis
If someone has a suprasellar adenoma and s/s of hyperthyroid, should you check a TRH or TSH?
TSH
(suprasella is where the pit. is which is where TSH comes frm, not TRH)
what could be the histology of papillary thyroid carcinoma?
which mutation?
Nuclei are enlarged, crowded, and overlapping, and may demonstrate features including nuclear grooves, powdery chromatin, and pseudonuclear inclusions
braf
what is the term for device prevention of human errors?
forcing function
are babies with 21-hydroxylase def. hypotensive or hypertensive?
hypotensive (becasue can’t make aldosterone)
can hyperthyroidism cause proximal muscle weakness and make you get it confused with dermatomyositis?
yes.
PTH inhibits co transport of what ions in the kidney?
Na/PO cotransport
(PTH-PO trashing hormone)
