Endocrinology Flashcards
1
Q
Connection of thyroid to tongue
A
thyroglossal duct (foramen cecum= normal remnant)
2
Q
Where thyroid diverticulum arise
A
primitive pharynx
3
Q
Layers and products of adrenal medulla
A
Zona glomerulosa: Aldosterone
Zona fasciculata: cortisol
zona reticularis: sex hormones
4
Q
Common tumors of adrenal medulla in adults vs kids
A
adults: pheo
kids: neurobalstoma (HTN uncommon)
5
Q
Venous drainage of L vs R adrenal gland
A
L: L adrenal vein, L renal vein, IVC
R: R adrenal vein, IVC
6
Q
Rathke pouch- what does it become
A
Anterior pituitary
7
Q
Secreted by posterior pituitary
A
vasopressin, oxytocin
8
Q
secreted by anterior pituitary
A
FSH, LH, ACTH, TSH (Basophils)
prolactin, GH (Acidophils)
9
Q
a cells of pancrease: secreted and location
A
glucagon, peripheral
10
Q
b cells of pancreas: secreted and location
A
insulin, central
11
Q
delta cells of pancreas: secreted and location
A
somatostatin, interspersed
12
Q
Insulin R is a ___
A
tyrosine kinase
13
Q
pathways induced by insuline receptor
A
PI3 kinase, RAS/MAP kinase
14
Q
Gluc transporter in adipose tissue, skeletal muscle
A
GLUT-4 (insulin dependent)
15
Q
Gluc transpoter in RBC, brain, cornea
A
GLUT-1 (insulin independent)
16
Q
Gluc transporter in spermatocytes, GI tract
A
GLUT-5 (Fructose, insulin independent)
17
Q
Gluc transporter in b islet, liver, kidney, SI
A
GLUT-2 (bidirectional, insulin independent)
18
Q
What inhibits glucagon?
A
insulin, hyperglycemia, somatostatin
19
Q
what is the action of glucagon?
A
glyocgenolysis, gluconeogenesis, lipolysis, ketone production
20
Q
Effect of CRH
A
incr ACTH, MSH, b-endorphin
21
Q
Effect of dopamine on pituitary
A
decr prolactin
22
Q
Effect of Prolactin on pituitary
A
decr GnRH
23
Q
Affect of somatostatin on pituitary
A
decr GH, TSH
24
Q
Effect of TRH on pituitary
A
Incr TSH, prolactin
25
Effect of GnRH on pituitary
Tonic: supresses HPA
Pulsatile: puberty, fertility
via FSH, LH
26
Bromocriptine
Dopamine agonist, used to inhibit prolactin secretion
27
what stimulates prolactin secretion
dopamine antagonists (antipsychotics), estrogens
28
What 2 factors inhibit GH
glucose, somatostatin
29
What mediates GH effects
IGF-1/somatomedin
30
Which nucleus synthesizes ADH
supraoptic nuclei of hypothalamus
31
What is treatment of central DI
desmopressin (ADH analog)
32
What receptors sense ADH, what to they regulate?
V2- serum osmolarity (primary function)
| V1- blood pressure
33
mineralocorticoid, cortisol, sex hormone levels in 17a-hydroxylase deficiency
incr mineralocorticoid, decr cortisol, decr sex hormone levels
34
mineralocorticoid, cortisol, sex hormone levels in 21-hydroxylase deficiency
decr mineralocorticoid, decr cortisol, incr sex hormone levels
35
mineralocorticoid, cortisol, sex hormone levels in 11b-hydroxylase deficiency
decr mineralocorticoid, decr cortisol, incr sex hormone levels; incr BP due to incr 11-deoxycorticosterone
36
Presents as hypertension, hypokalemia, lack secondary sexual development in females
17a hydroxylase deficiency
37
Presents as hypotension, hyperkalemia, incr renin; salt wasting in infants, precocious puberty in children
21 hydroxylase deficiency
38
presents as hypertension with low renin, virilization in females
11b hydroxylase deficiency
39
Functions of cortisol (BIG FIB)
```
INCR:
Blood pressure
Insuline resistance
Gluconeogensis, lipolysis, proteolysis
DECR:
Fibroblast activity
Inflammatory response
Bone formation
```
40
What are patients on exogenous cortisol susceptible to? what is mechanism
TB, candidiasis; blocked IL-2 production
41
Regulation of cortisol secretion
CRH produced by hypothalamus, ACTH produced by pituitary
42
Cells that produce PTH
chief cells of parathyroid
43
Effect of PTH on bone
incr resorption of Ca2+, PO43-
44
Effect of PTH on kidney (3)
incr reabsoprtion Ca2+ DCT
decr reabsorption PO43- in PCT
incr production calctriol
45
Effect of Mg on PTH levels
moderate decreae Mg: incr PTH
severe decrease Mg: decr PTH
Causes if hypomagnesemia: diarrhea, aminoglycosides, diuretics, alcohol abuse
46
Effect of incr pH on Ca levels
incr affinity to albumin, symptoms of hypocalcemia
47
Source of calcitonin
Parafollicular C cells of thyroid
48
T3 functions (4 Bs)
Brain maturation
Bone growth (synergize with GH)
B-adrenergic effects (incr B1 on heart)
Basal metabolic rate
49
Cushing disease vs cushing syndrome
Cushing Disease= ACTH secreting pituitary adenoma
| Cushing syndrome= incr cortisol (multiple causes)
50
Cushing syndrome with low ACTH, diagnostic test
primary adrenal adenoma, hyperplasia, or carcinoma; MRI to confirm tumor; expect atrophy of uninvolved gland
51
Cushing syndrome with high ACTH, suppression via high dose dexa
Cushing disease, usually pituitary adenoma
52
Cushing syndrome with high ACTH, no suppression via high dose dexa
ectopic ACTH secretion
53
Hypertension, hypokalemia, metabolic acidosis, low renin
primary hyperaldonsteronism
54
Conn syndrome- define
aldosterone-secreting adrenal adenoma
55
Causes of secondary hyper aldost
renal artery stenosis, CHF, cirrhosis, nephrotic syndrome (renal perception of low intravascular volume)
56
treatment of secondary hyperaldost
spironolactone
57
distinguis primary vs secondary hyperaldosterone
primary: low renin
secondary: high renin
58
Addison disease- define
chronic primary adrenal insuffeciency, deficiency of aldosterone and cortisol
59
Hypotension, hyperkalemia, acidosis, hyperpigmentation
Addison disease
60
Primary vs secondary adrenal insufficiency
Secondary: no hyperpigmentation, hyperkalemia (decr pituitary ACTH)
61
Waterhouse-friedrichsen syndrome- describe
acute primary adrenal insufficiency due to hemorrhage
62
causative organism of waterhouse-friedrichsen syndrome
N. meningitidis
63
Oncogene assoc with neuroblastoma
N-myc
64
Neuroblastoma vs Wilms tumor- presentation
Neuroblastoma: firm irregular mass, can cross the midline
Wilms: smooth, unilateral
65
Urine and histology marker for neuroblastoma
Homovanillic acid in urine
| Bombesin + with rosettes
66
Syndromes associated with pheo (3)
von Hippel-Lindau, MEN 2A, 2B
67
Treatment for pheo
a antagonist (phenoxybenzamine) before b blocker; resection
68
what cell type makes pheo
chromaffin cell
69
Cholesterol levels in hypothyroidism and mechanism
hypercholesteremia; decr LDL receptor expression
70
Assoc with Hurthle cells
Hashimoto's thyroiditis
71
HLA type assoc with Hashimoto's thyroiditis
HLA-DR5
72
Pot-bellied, pale, protruding umbilicus, protuberant tongue, poor brain function
congenital hypothyroidism (cretinism)
73
Riedel thyroiditis
thyroid is replaced by fibrous tissue; can extend to local structures
74
Tender vs nontender thyroiditis
```
Tender= de Quervain (usually self-limiting)
Nontender= hashimoto
```
75
Histologic finding of de Quervain thyroiditis
granulomatous inflammation
76
Cause of toxic multinodular goiter
Mutation in TSH receptor- fxn independent of TSH
77
Jod-Basedow phenomenon
thyrotoxicosis when pt with iodine-deficiency goiter is given iodine
78
Wolf-Chaikoff effect
excess iodine temporarily inhibits thyroid peroxidase
79
Treatment of thyroid storm
propanolol, propylthiouracil, corticosteroids
80
Describe thyroid storm
stress-induced catecholamines-- agitation, delirium, fever, diarrhea, coma, tachyarrythmia
81
Mutations associated with papillary thyroid carcinoma
RET, BRAF
82
Assoc with "orphan annie" eye nuclei
papillary thyroid carcinoma
83
Follicular adenoma vs follicular carcinoma
follicular carcinoma invades thyroid capsule
84
Amyloid stroma assoc with
medullary thyroid carcinoma
85
Syndromes associated with medullary carcinoma
MEN 2A, MEN 2B
86
Osteitis fibrosa cystica
cystic bone spaces filled with brown fibrous tissue, assoc with hyperparathyroidism
87
Hypercalcemia, hypercalciuria, hypophosphatemia, Incr ALP, incr cAMP in urine
hyperparathyroidism
88
Renal osteodystrophy
bone lesion due to secondary or tertiary hyperparathyroidism
89
Cause of secondary, tertiary hyperparathyroidism
chronic renal disease
90
Albright hereditary osteodystrophy
psuedohypoparathyroidism; AD, kidney unresponsive to PTH; hypocalcemia, shorthened 4th, 5th digit, short stature
91
Chvostek sign
tapping of facial nerve induces contraction of facial muscle; indicates hyocalcemia
92
Trousseau sign
carpal spasm when brachial arterl occulded; indicates hypocalcemia
93
Treatment of prolactinoma
bromocriptine, cabergoline (dopamine agonist)
94
Pegvisomant
growth hormone receptor antagonist
95
GH response to oral glucose challenge
should suppress, will not suppress in acromegaly
96
Intense thirst and polyuria, inability to concentrate urine
diabetes insipidus
97
Demeclocycline
ADH antagonist
98
Destinguish central vs nephrogenic DI
```
ADH levels (decr in central)
Water restriction test (no response in nephrogenic)
Vasopressiin administration (no response in nephrogenic)
```
99
treatment of central DI
intranasal DDAVP
100
treatment of nephrogenic DI
HCTZ, indomethacin, amiloride
101
Causes of SIADH (3)
Small cell lung cancer, CNS, pulmonary disease
102
what drug can cause SIADH
cyclophosphamide
103
Treatment of SIADH
fluid restriction, IV hypertonic saline, conivaptan, tolvaptan, demeclocycline
104
Define SIADH
excess water retention, dilutional hyponatremia, urine osmolarity> serum osmolarity
105
Sheehan syndrome
ischemic infarct of pituitary (esp ant pituitary) after postpoartum bleeding
106
Kimmelstiel-Wilson nodules
assoc with diabetic nephropathy
107
Most common cause of death in diabetic
MI
108
Small vessel disease in diabetics
retinopathy, glaucoma, nephropathy
109
Large vessel disease in diabetics
atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene
110
Osmotic damage in diabetics
neuropathy, cataracts
111
HLA types associated with Type 1 diabetes
HLA-DR3, DR4
112
Histologic finding T1 DM
Islet leukocytic infiltrate
113
Histologic finding T2 DM
islet amyloid polypeptide deposits
114
Kussmaul respirations, n/v, abdominal pain, delirium, dehydration
DKA
115
Lethargy, syncope, diplopia
whipple triad; insulinoma
116
Infection associated with DKA
mucormycosis (Rhizopus)
117
MEN syndrome associated with marfanoid habitus
MEN 2B
118
MEN syndrome associated with pancreatic endocrine tumors
MEN 1
119
Also called Wermer syndrome
MEN 1
120
MEN associated with pituitary tumors
MEN 1
121
Also called Sipple syndrome
MEN 2A
122
MEN syndrome associated with mucosal neuromas
MEN 2B
123
MEN syndromes associated with medullary thyroid carcinoma
MEN 2A, 2B
124
MEN syndromes associated with parathyroid tumor/hyperplasia
MEN 1, 2A
125
MEN syndromes associated with Pheo
MEN 2A, 2B
126
Treatment of carcinoid syndrome
resection, somatostatin analog
127
Diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease
carcinoid syndrome
128
Assoc with incr 17-OH progesterone
21a-hydroxylase deficiency
