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1
Q

Gonadotropin use

A

used for fertility in MALES to promote spermatogenesis and leydig development (in undescended testest etc), can tx prostate cancer

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2
Q

Menotropin

A

gonadotropin from postmenopausal womens urine that stimulates fsh and LH surge to cause ovulation (IM injxn can cause multiple births)

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3
Q

Lupron Depot

A

GnRH agonist
TREATS UTERINE LEIOMYOMA (FIBROIDS) AND ENDOMETRIOUSIS (leuporlide?)
NON-PULSATILE (cont) GNRH DOSE TO actually LOWER estro (unlike pulstile which would incr estro)

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4
Q

Dysmenorreha

A

CRAMPS/ painful menses

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5
Q

Phytoestrogens

A

antiestrogen from plants, may loewr BC, tofu etc

note DES is ethinyl estradiol

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6
Q

Premarin

A

natural pharmaceutical estrogen from horse uterus used in menopause

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7
Q

environmental estro contaminents

A

BPA and DDT

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8
Q

Neuroendocrine tumor stains?

A

synaptophysin and chromogranin, cytokeratin, NSE, Cd56

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9
Q

Neuroendocrine tumor examples?

A 
SIADH (maybe)
Medullary thyroid carcinoma
Pancreatic neuroendcorine tumor eg insulinoma or gastrinoma etc
Pheochromocytoma
Ganglionneuroma (MEN2B TAG)
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10
Q

What structure does a pit adenoma lack on histo?

A

NO RETICULIN NETWORK!

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11
Q

Wht can cause hyperPIT

A

pit adenoma (most common), rarely pit carc

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12
Q

What can cause hypOpit

A

Sheehan, empty sella syndrome, Rathke cleft cyst

Inflam like sarcoidosis and TB

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13
Q

Post pit sydnromes?

A

DI, Hypothalamic suprsellar tumors (eg craniopharyngiomas), SIADH

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14
Q

What can cause hyperthyroid?

A

graves, subacute lymphocytic (painless), thyrotoxicosis
Thyroid neoplasms like FOLLIC thyroid adenoma, carc, PAPILLARY thyroid carc, ANAPLASTIC (undiff) thyroid carc, MEDULLARY thyroid carc

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15
Q

What can cause hypothyroidism?

A

Cretinism, myxedema/ hashimotos, Riedel fibrosing thyroiditis, granulmatous dequervian

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16
Q

What disorders have transient hyper then hypothyroid?

A

granulomatous De Quervian
hashimoto
goiters may be either

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17
Q

What can cause hyperPTH?

A

PRIMARY- PTH adenoma (rarely pth hyperplasia or carc)
SECONDARY- chronic hypocalc from RF, vit D def
(speudo is hypocalc but elev PTH but end organ is res to pth)

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18
Q

What can cause hyPO-PTH?

A

digeorges, absence

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19
Q

Pancr neuroendocrine tumors

A

Insulinoma, Gastrinoma, glucagonoma, somatostaninoma, VIPoma, carcinoid

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20
Q

HYPER adrenal CORTEX

A

HYPERCORT– either from PIT or ADREnal adenoma
HYPERALDO- conn’s (primary, aldo secreting adenoma), and rarely glucocorticoid-remediable aldosteronism, or SECONDARY hyperaldo- CHF activates RAAS
HYPER ANDRO- CAH
Also: NEOPLASMS: adrenal adenoma, carc, and myelolipoma

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21
Q

HYPO adrenal CORTEX

A

Primary (addisons) due to APS1, APS2, waterhouse-frederichssen
Secondary due to def

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22
Q

Hyper adrenal MEDULLA

A

Pheochromocytoma

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23
Q

Empty Sella syndrome

A

can cause hypopit

herniation of arachnoid and CSF into sella, compresses pit, may be congen or dmg

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24
Q

Rathke celft cyst

A

Rathke’s patch (usu turns into ant pit) doesnt develop, causing hypo-pit
BENIGN MUCIN-FILLED CYST, ciliated cuboidal epith with GOBLET cells

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25
Q

What does SIADH commonly arise from?

A

lung small cell carcinoma!

in addn to hyponatremia has cerebral edema and neuro dysfxn etc

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26
Q

Hypothalamic suprasellar tumors

A

gliomas and craniopharyngiomas

can cause hyper/hypo fxn of ant or post pit

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27
Q

Hypermotility/diarrhea, malabs, hypocholesterol, hyperglycemia and osteo/weakness may mean which hormomne is elev?

A

HYPERTHYROID

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28
Q

Levels of T3 and TSH in thyrotoxicosis?

A

ELEV FREE CIRC T3/T4

so LOW TSH

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29
Q

Subacute lymphocytic painless thyroiditis

A

mild hyper, goiter, middle aged females, lympho infilitration, germ ctrs

30
Q

Graves mech

A

IgG antibodies against TSH RECePTOR

these overstim TSH R which increases T3/T4 but decr TSH (tyep II HS)

31
Q

Dermopathy (with shin rash aka pretibial myxedema) may mean which hormone is elev?

A

HYPERTHYROID as in GRAVES

32
Q

Graves triad

A

Hyperthyroid
Exphtalmos
Dermopathy of tibia

33
Q

Cretinism

A

HYPOthyroid in kids, has a dyshormonogenic goiter which is acongenital defect in Thyroid Perox (so lack of fxnl TH)

34
Q

Myxedema is accum of

A

GAGs causing hypOthyroid, deepining of voice and enlarged tongue etc

35
Q

Riedel Fibrosing Thyroiditis

A

HYPOthyroid due to inflam with fibrosis of HARD AS WOOD thyroid (NONtender!), airway etc

36
Q

Granulomatous De Quervain thryoiditis

A

transient hyper to hypo, females mid aged

following VIRAL infxn and SELF limited, TENDER THYROID (unlike riedel fibrosing)

37
Q 
Hashimoto 
genetics
ab's
t4/tsh levels
histo
A

HLA-DR5 assoc
ab’s to antimicrosomal, anti-TPO, and anti-thyroglobulin, destroys thyroid gland
low T4 raises TSH
histo: lympho inf, germ ctrs, hurthle cells

38
Q

GOITERS (diffuses nontoxic/colloid simple, and multinodular)

A
  • diffuse colloidal nontoxic simple: low iodine enalrages entire gland withOUT nodularity, incr TSH, colloid invol
  • multinnod: iodine def, also nontoxic euthyroid, but can progress to toxic, multilob, asymm, coilloid in follicles, flattened epith, follic hyperplasia
39
Q

Thyroid neoplasms

A

follic adenoma and carc
papillary thyroid carc
anaplastic undifferentiated thyroid carc
medullar thyroid carc

40
Q

FOLLIC thyorid adenoma and carc

A

FOLLIC adenoma and carc (aden is solitary mass from TSH R mutl, encaps, colloid) (carc is common in iodine def areas, females, capsular/vasc invazn)

41
Q

PAPILLARY thyroid carc

A

PAPILLARY thyroid carc- a bit yougner than above, good px, orphan annie eye and psammoma, due to exposrue to ionizing radiation usu follic type sclerosising

42
Q

ANAPLASTIC undiff thyroid carc

A

AGGRO, 100% mort, older, invades local structure and causes issues w swallowing and breathing, variable morph

43
Q

MEDULLARY thyroid carc

A

neuroendocrine!
parafollic C cells secrete calcitonin! decr Ca (thru renal excretion incr), can deposit in tumor as AMYLOID
markers are calcito and CEA!
from MEN sydnrome!

44
Q

cell types in PT gland

A

chief cells secrete pth
oxyphils are acidophilic, large
fat

45
Q

Primary hyperPTH sx

A

painful BONES, renal STONES, abdominal GROANS and psychiatric MOANS
(eg PT adenoma)

46
Q

Secondary hyperPTH causes and sx

A

chronic hyPOcalc! maybe from renal failure, low Ca intake, steat, vit D Def
metastatic calcs in tissues

47
Q

Sx of hypocalcemia

A

eg from hypoPTH (from digeorges, dmg etc)

tetany, mental status, CV ocular and dental issues

48
Q

PTH Ca and PO levels in psuedohypoPTH?

A

low Ca so seems like due to low PTH
but PTH high, organs just resistant so builds up
since no calc to bind PO, PO4 high

49
Q

what do D cells and PP cells in endocrine pancr do

A

D cells secrete somatostatin to suppress BOTH insulin and glucagon
Pancr Polypeptide cells inhibit intestinal motility

50
Q

Diseases that can be incr in DM

A

reitnopathy, cerebral infarct, MI, atheroscl, gangrene, infections, nephroscl, pierph neurop, HTN

51
Q

Insulinoma and Gastrinoma

A

Pancreatic endocrine tumors
INsulinoma- NET benign causing episodic hypogly with metnal status changes, give glucose to tx
Gastrinoma: ZE sydnrome
Others

52
Q

What cells make up adrenal medulla?

A

Enterochromaffin cells which secre catechol and SUSTENACULAR cells which support

53
Q

Diff in RAA levels between primary and secondary hyperaldo?

A

primary (conns)- excess aldo, lowering renin

secondary (from CHF)- excess activation of RAAS so high renin AND aldo

54
Q

Addisons types

A

PRIMARY CHRONIC ADRENOCORTICAL INSUFF

Autoimmune Polyendocrine Syndrome type 1 (APS1) wiht chronic candida, skin/dental/nail changes, other autoimm disorders

APS2- autoimm thyroiditis and T1DM assoc

Waterhouse Fredrichsen- necrosis of boht adreanal glands caused by sepsis or DIC in kids with neisseria mening

Can also be caused by TB and fungal, carc from lung etc

55
Q

Sx of addisons types

A

primary adrenal insuff
Fatiguer/weakness/GI, high ACTH causing skin pigment from MSH,
low aldo thus high K/H so hypokalemia

56
Q

Pheochromocytomas are usually

A

unilateral, benign, HTN assoc (10-10-10), often have CV issues or arr

57
Q

pheochromo histo

A

lobualr pattern with salt n pepper chromatin, polygonal cells surr by sustenacular cells

58
Q

MEN sydnromes

A

MEN 1 Wermer (PPP)
MEN 2A Sipple (PAT)
MEN 2B (TAG)

59
Q

Wermers
genetics
sx

A 
MEN 1 (11q13 gene encodes menin for tumros)
PPP
Parathyroid elev
Pancr gastrinoma etc
Pit aden eg prolactinoma

sx ulcers, hypogly, hypercalc, lithasis, gynecom, acromeg

60
Q

Sipples

genetics

A

MEN2A PAT
parathyroid hyper
adrenal pheochrom
thyroid med thyroid carc

RET protooncogene on 10q11
FAMILIA medullary thyroid carc variant of MEN2A (has med carc ONLY, dev at older age)

61
Q

MEN2B
genetics
clincical pres

A

TAG
Thyroid med carc (hypocalc)
Adrenal pheochrom
Ganglioneuroma

Genetics RET protooncogene mut

clinical: marfoid features, tumor

62
Q

Cretinism sx

A

hypothyroid in kids, coarse facial features, dyshormone goiter with defect in TPO, MR, protruding tongue, umbilical hernia

63
Q

Candida can cause

A

APS1! (a type of addisons adrenal insuff)

64
Q

Neisseria mening in kids may cause?

A

Waterhouse fredrichson, with sepsis and adrenal insuff (like addisons)

65
Q

Marfanoid features may mean

A

MEN2B TAG! (thyroid carc, pheochromo cyt adrenal, and ganglio) from RET proto

66
Q

Which disease incorporate Pheochrom?

A

MEN2 A and B! (PAT and TAG)

67
Q

Which endocrine tumor comes from previous exposure to ionizing radiation?

A

Papillary thyroid carcinoma, with orphan annie eye cells

68
Q

Which goiter is nontoxic?

A

Multinodular!

from iodine def but can progress to thyrotox, colloid

69
Q

Which issue causes painful thyroid?

A

GRANULOMATOUS DEQUERVIAN! follows viral infxn

riedels fibrosing is hard as wood NONtender

70
Q

Which endocrine issue has abd striae?

A

cushings

71
Q

Calcium Correction Equation!

A

We need to correct for calcium by using this equation when there is high (>4) albumin in the blood:

corrected ca =
TOTAL SERUM CA +/- [(4-alb)x0.8]

so if alb is higher tan 4, subtract from total serum ca
if alb lower than 4, add to total serum ca

T2 Endo/Repro (11 decks)

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