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Endocrinology Flashcards

1
Q

Connection of thyroid to tongue

A

thyroglossal duct (foramen cecum= normal remnant)

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2
Q

Where thyroid diverticulum arise

A

primitive pharynx

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3
Q

Layers and products of adrenal medulla

A

Zona glomerulosa: Aldosterone
Zona fasciculata: cortisol
zona reticularis: sex hormones

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4
Q

Common tumors of adrenal medulla in adults vs kids

A

adults: pheo
kids: neurobalstoma (HTN uncommon)

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5
Q

Venous drainage of L vs R adrenal gland

A

L: L adrenal vein, L renal vein, IVC
R: R adrenal vein, IVC

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6
Q

Rathke pouch- what does it become

A

Anterior pituitary

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7
Q

Secreted by posterior pituitary

A

vasopressin, oxytocin

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8
Q

secreted by anterior pituitary

A

FSH, LH, ACTH, TSH (Basophils)

prolactin, GH (Acidophils)

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9
Q

a cells of pancrease: secreted and location

A

glucagon, peripheral

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10
Q

b cells of pancreas: secreted and location

A

insulin, central

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11
Q

delta cells of pancreas: secreted and location

A

somatostatin, interspersed

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12
Q

Insulin R is a ___

A

tyrosine kinase

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13
Q

pathways induced by insuline receptor

A

PI3 kinase, RAS/MAP kinase

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14
Q

Gluc transporter in adipose tissue, skeletal muscle

A

GLUT-4 (insulin dependent)

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15
Q

Gluc transpoter in RBC, brain, cornea

A

GLUT-1 (insulin independent)

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16
Q

Gluc transporter in spermatocytes, GI tract

A

GLUT-5 (Fructose, insulin independent)

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17
Q

Gluc transporter in b islet, liver, kidney, SI

A

GLUT-2 (bidirectional, insulin independent)

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18
Q

What inhibits glucagon?

A

insulin, hyperglycemia, somatostatin

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19
Q

what is the action of glucagon?

A

glyocgenolysis, gluconeogenesis, lipolysis, ketone production

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20
Q

Effect of CRH

A

incr ACTH, MSH, b-endorphin

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21
Q

Effect of dopamine on pituitary

A

decr prolactin

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22
Q

Effect of Prolactin on pituitary

A

decr GnRH

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23
Q

Affect of somatostatin on pituitary

A

decr GH, TSH

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24
Q

Effect of TRH on pituitary

A

Incr TSH, prolactin

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25
Q

Effect of GnRH on pituitary

A

Tonic: supresses HPA
Pulsatile: puberty, fertility
via FSH, LH

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26
Q

Bromocriptine

A

Dopamine agonist, used to inhibit prolactin secretion

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27
Q

what stimulates prolactin secretion

A

dopamine antagonists (antipsychotics), estrogens

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28
Q

What 2 factors inhibit GH

A

glucose, somatostatin

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29
Q

What mediates GH effects

A

IGF-1/somatomedin

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30
Q

Which nucleus synthesizes ADH

A

supraoptic nuclei of hypothalamus

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31
Q

What is treatment of central DI

A

desmopressin (ADH analog)

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32
Q

What receptors sense ADH, what to they regulate?

A

V2- serum osmolarity (primary function)

V1- blood pressure

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33
Q

mineralocorticoid, cortisol, sex hormone levels in 17a-hydroxylase deficiency

A

incr mineralocorticoid, decr cortisol, decr sex hormone levels

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34
Q

mineralocorticoid, cortisol, sex hormone levels in 21-hydroxylase deficiency

A

decr mineralocorticoid, decr cortisol, incr sex hormone levels

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35
Q

mineralocorticoid, cortisol, sex hormone levels in 11b-hydroxylase deficiency

A

decr mineralocorticoid, decr cortisol, incr sex hormone levels; incr BP due to incr 11-deoxycorticosterone

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36
Q

Presents as hypertension, hypokalemia, lack secondary sexual development in females

A

17a hydroxylase deficiency

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37
Q

Presents as hypotension, hyperkalemia, incr renin; salt wasting in infants, precocious puberty in children

A

21 hydroxylase deficiency

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38
Q

presents as hypertension with low renin, virilization in females

A

11b hydroxylase deficiency

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39
Q

Functions of cortisol (BIG FIB)

A 
INCR:
Blood pressure
Insuline resistance
Gluconeogensis, lipolysis, proteolysis
DECR:
Fibroblast activity
Inflammatory response
Bone formation
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40
Q

What are patients on exogenous cortisol susceptible to? what is mechanism

A

TB, candidiasis; blocked IL-2 production

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41
Q

Regulation of cortisol secretion

A

CRH produced by hypothalamus, ACTH produced by pituitary

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42
Q

Cells that produce PTH

A

chief cells of parathyroid

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43
Q

Effect of PTH on bone

A

incr resorption of Ca2+, PO43-

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44
Q

Effect of PTH on kidney (3)

A

incr reabsoprtion Ca2+ DCT
decr reabsorption PO43- in PCT
incr production calctriol

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45
Q

Effect of Mg on PTH levels

A

moderate decreae Mg: incr PTH
severe decrease Mg: decr PTH
Causes if hypomagnesemia: diarrhea, aminoglycosides, diuretics, alcohol abuse

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46
Q

Effect of incr pH on Ca levels

A

incr affinity to albumin, symptoms of hypocalcemia

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47
Q

Source of calcitonin

A

Parafollicular C cells of thyroid

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48
Q

T3 functions (4 Bs)

A

Brain maturation
Bone growth (synergize with GH)
B-adrenergic effects (incr B1 on heart)
Basal metabolic rate

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49
Q

Cushing disease vs cushing syndrome

A

Cushing Disease= ACTH secreting pituitary adenoma

Cushing syndrome= incr cortisol (multiple causes)

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50
Q

Cushing syndrome with low ACTH, diagnostic test

A

primary adrenal adenoma, hyperplasia, or carcinoma; MRI to confirm tumor; expect atrophy of uninvolved gland

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51
Q

Cushing syndrome with high ACTH, suppression via high dose dexa

A

Cushing disease, usually pituitary adenoma

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52
Q

Cushing syndrome with high ACTH, no suppression via high dose dexa

A

ectopic ACTH secretion

53
Q

Hypertension, hypokalemia, metabolic acidosis, low renin

A

primary hyperaldonsteronism

54
Q

Conn syndrome- define

A

aldosterone-secreting adrenal adenoma

55
Q

Causes of secondary hyper aldost

A

renal artery stenosis, CHF, cirrhosis, nephrotic syndrome (renal perception of low intravascular volume)

56
Q

treatment of secondary hyperaldost

A

spironolactone

57
Q

distinguis primary vs secondary hyperaldosterone

A

primary: low renin
secondary: high renin

58
Q

Addison disease- define

A

chronic primary adrenal insuffeciency, deficiency of aldosterone and cortisol

59
Q

Hypotension, hyperkalemia, acidosis, hyperpigmentation

A

Addison disease

60
Q

Primary vs secondary adrenal insufficiency

A

Secondary: no hyperpigmentation, hyperkalemia (decr pituitary ACTH)

61
Q

Waterhouse-friedrichsen syndrome- describe

A

acute primary adrenal insufficiency due to hemorrhage

62
Q

causative organism of waterhouse-friedrichsen syndrome

A

N. meningitidis

63
Q

Oncogene assoc with neuroblastoma

A

N-myc

64
Q

Neuroblastoma vs Wilms tumor- presentation

A

Neuroblastoma: firm irregular mass, can cross the midline
Wilms: smooth, unilateral

65
Q

Urine and histology marker for neuroblastoma

A

Homovanillic acid in urine

Bombesin + with rosettes

66
Q

Syndromes associated with pheo (3)

A

von Hippel-Lindau, MEN 2A, 2B

67
Q

Treatment for pheo

A

a antagonist (phenoxybenzamine) before b blocker; resection

68
Q

what cell type makes pheo

A

chromaffin cell

69
Q

Cholesterol levels in hypothyroidism and mechanism

A

hypercholesteremia; decr LDL receptor expression

70
Q

Assoc with Hurthle cells

A

Hashimoto’s thyroiditis

71
Q

HLA type assoc with Hashimoto’s thyroiditis

A

HLA-DR5

72
Q

Pot-bellied, pale, protruding umbilicus, protuberant tongue, poor brain function

A

congenital hypothyroidism (cretinism)

73
Q

Riedel thyroiditis

A

thyroid is replaced by fibrous tissue; can extend to local structures

74
Q

Tender vs nontender thyroiditis

A 
Tender= de Quervain (usually self-limiting)
Nontender= hashimoto
75
Q

Histologic finding of de Quervain thyroiditis

A

granulomatous inflammation

76
Q

Cause of toxic multinodular goiter

A

Mutation in TSH receptor- fxn independent of TSH

77
Q

Jod-Basedow phenomenon

A

thyrotoxicosis when pt with iodine-deficiency goiter is given iodine

78
Q

Wolf-Chaikoff effect

A

excess iodine temporarily inhibits thyroid peroxidase

79
Q

Treatment of thyroid storm

A

propanolol, propylthiouracil, corticosteroids

80
Q

Describe thyroid storm

A

stress-induced catecholamines– agitation, delirium, fever, diarrhea, coma, tachyarrythmia

81
Q

Mutations associated with papillary thyroid carcinoma

A

RET, BRAF

82
Q

Assoc with “orphan annie” eye nuclei

A

papillary thyroid carcinoma

83
Q

Follicular adenoma vs follicular carcinoma

A

follicular carcinoma invades thyroid capsule

84
Q

Amyloid stroma assoc with

A

medullary thyroid carcinoma

85
Q

Syndromes associated with medullary carcinoma

A

MEN 2A, MEN 2B

86
Q

Osteitis fibrosa cystica

A

cystic bone spaces filled with brown fibrous tissue, assoc with hyperparathyroidism

87
Q

Hypercalcemia, hypercalciuria, hypophosphatemia, Incr ALP, incr cAMP in urine

A

hyperparathyroidism

88
Q

Renal osteodystrophy

A

bone lesion due to secondary or tertiary hyperparathyroidism

89
Q

Cause of secondary, tertiary hyperparathyroidism

A

chronic renal disease

90
Q

Albright hereditary osteodystrophy

A

psuedohypoparathyroidism; AD, kidney unresponsive to PTH; hypocalcemia, shorthened 4th, 5th digit, short stature

91
Q

Chvostek sign

A

tapping of facial nerve induces contraction of facial muscle; indicates hyocalcemia

92
Q

Trousseau sign

A

carpal spasm when brachial arterl occulded; indicates hypocalcemia

93
Q

Treatment of prolactinoma

A

bromocriptine, cabergoline (dopamine agonist)

94
Q

Pegvisomant

A

growth hormone receptor antagonist

95
Q

GH response to oral glucose challenge

A

should suppress, will not suppress in acromegaly

96
Q

Intense thirst and polyuria, inability to concentrate urine

A

diabetes insipidus

97
Q

Demeclocycline

A

ADH antagonist

98
Q

Destinguish central vs nephrogenic DI

A 
ADH levels (decr in central)
Water restriction test (no response in nephrogenic)
Vasopressiin administration (no response in nephrogenic)
99
Q

treatment of central DI

A

intranasal DDAVP

100
Q

treatment of nephrogenic DI

A

HCTZ, indomethacin, amiloride

101
Q

Causes of SIADH (3)

A

Small cell lung cancer, CNS, pulmonary disease

102
Q

what drug can cause SIADH

A

cyclophosphamide

103
Q

Treatment of SIADH

A

fluid restriction, IV hypertonic saline, conivaptan, tolvaptan, demeclocycline

104
Q

Define SIADH

A

excess water retention, dilutional hyponatremia, urine osmolarity> serum osmolarity

105
Q

Sheehan syndrome

A

ischemic infarct of pituitary (esp ant pituitary) after postpoartum bleeding

106
Q

Kimmelstiel-Wilson nodules

A

assoc with diabetic nephropathy

107
Q

Most common cause of death in diabetic

A

MI

108
Q

Small vessel disease in diabetics

A

retinopathy, glaucoma, nephropathy

109
Q

Large vessel disease in diabetics

A

atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene

110
Q

Osmotic damage in diabetics

A

neuropathy, cataracts

111
Q

HLA types associated with Type 1 diabetes

A

HLA-DR3, DR4

112
Q

Histologic finding T1 DM

A

Islet leukocytic infiltrate

113
Q

Histologic finding T2 DM

A

islet amyloid polypeptide deposits

114
Q

Kussmaul respirations, n/v, abdominal pain, delirium, dehydration

A

DKA

115
Q

Lethargy, syncope, diplopia

A

whipple triad; insulinoma

116
Q

Infection associated with DKA

A

mucormycosis (Rhizopus)

117
Q

MEN syndrome associated with marfanoid habitus

A

MEN 2B

118
Q

MEN syndrome associated with pancreatic endocrine tumors

A

MEN 1

119
Q

Also called Wermer syndrome

A

MEN 1

120
Q

MEN associated with pituitary tumors

A

MEN 1

121
Q

Also called Sipple syndrome

A

MEN 2A

122
Q

MEN syndrome associated with mucosal neuromas

A

MEN 2B

123
Q

MEN syndromes associated with medullary thyroid carcinoma

A

MEN 2A, 2B

124
Q

MEN syndromes associated with parathyroid tumor/hyperplasia

A

MEN 1, 2A

125
Q

MEN syndromes associated with Pheo

A

MEN 2A, 2B

126
Q

Treatment of carcinoid syndrome

A

resection, somatostatin analog

127
Q

Diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease

A

carcinoid syndrome

128
Q

Assoc with incr 17-OH progesterone

A

21a-hydroxylase deficiency

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