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Endo Repro 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Primary hyperparathyroidism

A 
Painful bones (osteoporosis)
Renal stones (neprolithiasis)
Abdominal groans (constipation, gallstones)
Psychic moans (depression, lethargy, siezures)

Causes: adenoma (85-95%)
hyperplasia
carcinoma

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2
Q

Osteitis fibrosis cystica

A

symptom of primary hyperparathyroidism
aka brown tumor, can look like metastatic cancer
osteoclast driven bone destruction, small fractures and hemorrhage

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3
Q

Parathyroid adenoma

A

Most common cause of primary hyperparathyroidism
Affects only 1 parathyroid gland
normal rim of parathyroid tissue

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4
Q

Parathyroid hyperplasia

A

Indicates primary or secondary hyperparathyroidism
affects all 4 glands
no normal rim of parathyroid tissue

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5
Q

Parathyroid carcinoma

A

Causes Primary hyperparathyroidism
metastasis
local invasion
elevated PTH that does not go down after surgery

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6
Q

Hypercalcemia, symptomatic vs asymptomatic

A

asymptomatic → primary hyperparathyroidism

symptomatic → malignancy

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7
Q

Hypercalcemia of malignancy

A

caused from PTHrP, analogue of PTH, released from lung and breast cancers
or lymphomas releasing vitamin D
or just osteolysis from breast/lung cancer

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8
Q

Secondary hyperparathyroidism

A

Renal failure causes ↓Ca++ which triggers ↑ PTH
all 4 glands will undergo hyperplasia
renal osteodystrophy (rugby jersey)
Calciphylaxis → patients may die from sepsis from gangrene

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9
Q

Tertiary hyperparthyroidism

A

prolonged hypocalcemia causes parathyroids to lose regulation and just always release a bunch of PTH

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10
Q

Hypocalcemia

A 
Trosseau sign (BP cuff wrist flexion)
Chvostek sign (CNVII twitching)
prolonged QT interval
Muscle cramps, spasms, tetany
Convuslsions
Numbness and parathesia
Behavioral disturbances
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11
Q

DiGeorge syndrome’s effects on parathyroids

A

parathyroid hypoplasia/aplasia
hypocalcemia
DiGeorge syn: facial abnormalities, cyanosis, infection, tetany

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12
Q

Familial hypocalciuric hypercalcemia

A

LOF mutation of CaSR
↑ PTH
↑ Ca++
↓ renal excretion (hypocalciURIA)

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13
Q

Autosomal dominant hypoPTH

A

GOF mutation of CaSR
↓ PTH
↓ Ca++
↑ renal excretion of Ca++

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14
Q

Pseudohypoparathyroidism

A

hypocalcemia despite ↑↑PTH

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15
Q

Albrights heriditary osteodystrophy

A

short stature
shortened fingers and toes
obesity

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16
Q

Mass effect of pituitary enlargement

A 
headache
confusion
shallow breathing
nausea
papilledema
HTN
bradycardia
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17
Q

Lactotroph adenoma

A

Most common secretory pituitary adenoma
Psammoma bodies, pituitary stone
Women → menstrual irregularities, galactorrhea, diminished libido, infertility, mass effect
Men → decreased libido, decreased sperm count, mass effect

Treatment is dopamine agonists (bromocriptiine and cabergoline) or surgery

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18
Q

Somatotroph adenoma

A

gigantism, acromegaly
↑IGF-1
Glucose tolerance test to confirm
glucose should cause ↓ GH, if it doesn’t then they have adenoma

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19
Q

Cushing syndrome

A 
centripetal obesity
moon face
abdominal thick stria
thin skin
hirsutism
usually caused iatrogenically, glucocorticoid administration
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20
Q

corticotroph adenoma

A 
aka cushing's disease
↑ cortisol
↑ ACTH
cortisol decreases in response to high dose dexamethasone suppression test
USP8 mutations possible
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21
Q

Ectopic ACTH producing tumor

A

paraneoplastic syndrome of small cell carcinoma of the lung, or pancreatic carcinoma
↑ cortisol
↑ ACTH
Cortisol levels do not respond to high dose dexamethasone suppression test

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22
Q

Nelson syndrome

A

A syndrome caused by adrenal removal in the case of corticotroph adenoma.

ACTH has no adrenals to act on, but nothing is suppressing ACTH secretion

Hyperpigmentation remains, because ACTH → MSH

Tumor keeps on growing so mass effect may occur

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23
Q

Gonadotroph adenoma

A

asymptomatic until tumor is large enough to cause mass effect

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24
Q

GNAS mutations

A

Gs loses GTPase activity making GTP always active, and cascade always turned on

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25
Q

Craniopharyngioma

A

Causes hypopituitarism
kids → adamantinomatous, growth retardation
adults → papillary, intracranial pressure
derived from rathke’s pouch remnants

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26
Q

Things that cause hypopituitarism

A

pituitary gets squashed, has ischemia, or hemorrhaged

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27
Q

Empty sella syndrome

A

CSF leaks and squished pituitary

Pituitary expands, infarcts, and then necrotizes, leaving empty sella

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28
Q

Sheehan syndrome

A

postpartum necrosis of ant pituitary from ischemia or infarction

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29
Q

Diabetes insipidus

Central vs nephrogenis

A 
↓ ADH (AVP)
↑ water excretion
hyperosmolarity
hypernatremia
polyuria which is dilute
↑ thirst

Central: DDAVP adminstration fixes it
Nephrogenic: DDAVP administration does nothing

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30
Q

SIADH

A 
↑ ADH
concentrated low volume urine
hyponatremia
hypernatriuria
mental status changes, muscle weakness, siezures
↑ thirst

Caused from small cell carcinoma of the lung, brain trauma, drugs

31
Q

Paraneoplastic syndromes associated with small cell carcinoma

A

Cushing syndrome (↑ ACTH)

SIADH (↑ ADH)

32
Q

Thyroid storm

A

Fever
Tachycardia
diarrhea
jaundice

Common causes:
pregnancy/postpartum
hemithyroidectomy
amiodarone

33
Q

Grave’s disease

A

Triad:
hyperthyroidism with gland enlargement
exophthalmos
pretibial myxedema (edema of shins with scaly skin)

↑ T3/4
↓ TSH
↑ TSI (thyroid stimulating Ig, mimics TSH)

34
Q

Cretinism

A 
congenital hypothyroidism
seen in children
mental and growth retardation
coarse facial features
umbilical hernias
caused from lack of iodine in pregnancy
35
Q

Myxedema

A 
hypothyroidism in adults
mental and physical sluggishness
weight gain
cold intolerance
brittle hair, nales
coarse skin
↓ CO
hypercholesterolemia
36
Q

Hashimoto thyroiditis

A

Autoimmune hypothyroidism
antibodies against thyroglobulin and thyroid peroxidase (TPO)
lymphocytes
diffuse, painless enlargment of thyroid with
Hurthle cell metaplasia
looks like lymph node is taking over thyroid tissue
initial hyperthyroid, then chronic hypothyroid
↑hTg-Ab
↑hTPO-Ab
↑TSHR-Ab

37
Q

Subacute lymphocytic thyroiditis

A

Post partum hypothyroid

painless

38
Q

Subacute granulomatous thyroiditis

A

aka deQuervain thyroiditis
post viral infection (mumps usually)
painful

39
Q

Reidel thyroiditis

A

thyroid fibrosis
cement-like
Ig4-related disease
fibrosis, lymphocytes and plasma cells

40
Q

Diffuse nontoxic goiter

A

Endemic goiter → iodine deficiency
Also caused from cassava root and excess broccoli, cauliflower, cabbage and radish ingestion
symptoms due to mass effect
more common in younger patients

41
Q

Multinodular goiter

A

some nodules can be neoplastic
strikingly large
Cold and hot nodules more likely benign
Cold → more concern for malignancy than hot

42
Q

Papillary thyroid carcinoma (PTC)

A

Psammoma bodies

RET-PTC

BRAF

Orphan Annie Eye nuclei

43
Q

Follicular PTC

A 
PAX8/PPARG 
RAS 
PTEN
mushroom invasion of capsule
angio-invasion
44
Q

Anaplastic carcinoma

A

elderly
highly aggressive, less than 1 year to live
TP53 mutation

45
Q

Medullary thyroid carcinoma

A 
Neuroendocrine tumor derived from C-cells (which secrete calcitonin)
Blue cells
amyloid (Acal)
C-cell hyperplasia
RET mutations
46
Q

Release of insulin pathway

A 
Glucose enters pancreatic Beta cell through GLUT-2 channel
↑ ATP
ATP blocks K+ channel
membrane depolarization
Ca++ channel opens
influx of Ca++
insulin released
47
Q

Incretins

A

Increase insulin release

inhibit glucagon release

include GLP-1 and GIP

48
Q

Prediabetes and diabetes test values

A

A1C 5.7-6.4%
FPG 100-125
OGTT 140-199

A1C over 6.5%
FPG over 126
OGTT over 200
RPG over 200

49
Q

Type 1 diabetes

A 
Autoimmune disease due to failure of T-cell self tolerance
HLA DR/DQ on chromosome 6
Classic triad
polyphagia (hunger)
polyuria
polydipsia
increased thirst and frequent urination
extreme hunger
weight loss
fatigue
irritability 
fruity smelling breath
50
Q

Type 2 diabetes

A

Insulin resistance

Beta cell exhaustion

identified on screening or vision changes

51
Q

Mature onset diabetes of the young

A

Type 2 DM, mutation resulting in loss of glucokinase, so beta cells do not breakdown glucose which would normally trigger insulin release

52
Q

Diabetic ketoacidosis

A 
T1DM
Triad of 
hyperglycemia
Ketonemia
Metabolic acidosis

Symptoms of Nausea/vomitting, tachycardia, Kussmaul respirations
Treat with insulin, hydration, and potassium

53
Q

Hyperglycemic hyperosmotic syndrome (HHS)

A 
T2DM
prolonged insulin deficiency
glucose over 600
severe dehydration
hyperosmolality → coma, death
impaired renal function
no ketones
54
Q

Diabetic nephropathy

A

glomerular sclerosis causing leak of large molecules into urine, such as protein
mesangial matrix accumulation → Kimmelstiel wilson disease
urine albumin creatinine ratio (UACR) is the gold standard test
↑ albumin in urine as it progresses

55
Q

Insulinoma

A

small pancreatic tumor of beta cells

Amyloid

56
Q

Gastrinoma

A

aka zollinger ellison syndrome
G cell tumor → ↑gastrin
↑ HCl leading to ulceration, which do not respond to therapy
Can cause perforation → free air in abdomen

57
Q

Somatostatinoma

A 
diabetes, cholelithiasis, steatorrhea
Somatostatin is inhibitory so think....
reduced insuling
reduced gallbladder motility
reduced exocrine pancreatic secretions
58
Q

Glucagonoma

A

mild diabetes

necrolytic migratory erythema in groin and lower extremities → skin rash with erythema and necrotic patches and crusted erosions

4 D’s → diabetes, dermatitis, depression, DVT

59
Q

VIPoma

A 
WDHA syndrome
- Watery Diarrhea
- Hypokalemia
- Achlorhydria
may also have flushing
60
Q

Primary adrenal adenoma

A

Cushings syndrome

↑ cortisol

↓ ACTH

so ACTH independent

61
Q

Conn’s syndrome

A

Primary hyperaldosteronism

HTN

Hypokalemia

Hypomagnesemia

62
Q

Secondary hyperaldosteronism

A 
HTN
Hypokalemia
Hypomagnesemia
Caused from activation of Renin-angiotensin-aldosterone system,
hypovolemia
decreased renal perfusion
renin secreting tumor
pregnancy
63
Q

Aldosterone-secreting adenoma

A

Spironolactone bodies

64
Q

Congenital Adrenal Hyperplasia

A 
Autosomal recessive
defective enzyme, often 21-hydroxylase
prevents production of aldosterone and cortisol but allows production of sex hormones
salt wasting aka hyponatremia
hyperkalemia
hypotension
virilization of females at birth
65
Q

Primary Acute Adrenocortical insufficiency

A

3 causes
Adrenal crisis
rapid withdrawl of steroids
massive adrenal hemorrhage (waterhouse friderichsen syndrome)

Hypotenstion
hyponatremia
hyperkalemia
abdominal pain
fever
nausea/vomitting
hypoglycemia
66
Q

Primary chronic adrenocortical insufficiency

A 
aka Addison's disease
malaise and fatigue
anorexia and weight loss
joint pain
hyperpigmentation of the skin
67
Q

Autoimmune polyendocrine syndrome type 1

A 
Adrenalitis
parathyroiditis
hypogonadism
pernicious anemia
candidiasis
ectodermal dystrophy (teeth and nails)
68
Q

Autoimmune polyendocrine syndrome type 2

A

adrenalitis

thyroiditis

T1DM

69
Q

Adrenal carcinoma

A

much larger than adrenal adenoma

compression of adjacent structures

70
Q

Pheochromocytoma

A 
tumor of adrenal medulla
↑ NE
classic triad
headache
palpitations
diaphoresis
71
Q

MEN1

A

germline mutation of tumor suppressor gene MEN1

3 P’s
Pituitary adenoma
Pancreatic endocrine tumor
Primary hyperparathryoidism

72
Q

MEN2A

A

Germline GOF mutation in RET

2 P’s, 1 M
Parathryoid hyperplasia
Pheochromocytoma
Medullary thyroid carcinoma

73
Q

MEN2B

A

Germline GOF mutation in RET

1 P, 2 M’s
Pheochromocytoma
Medullary thyroid carcinoma
Mucosal neuromas

Endo Repro 2 (2 decks)

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