MORE Flashcards
Gonadotropin use
used for fertility in MALES to promote spermatogenesis and leydig development (in undescended testest etc), can tx prostate cancer
Menotropin
gonadotropin from postmenopausal womens urine that stimulates fsh and LH surge to cause ovulation (IM injxn can cause multiple births)
Lupron Depot
GnRH agonist
TREATS UTERINE LEIOMYOMA (FIBROIDS) AND ENDOMETRIOUSIS (leuporlide?)
NON-PULSATILE (cont) GNRH DOSE TO actually LOWER estro (unlike pulstile which would incr estro)
Dysmenorreha
CRAMPS/ painful menses
Phytoestrogens
antiestrogen from plants, may loewr BC, tofu etc
note DES is ethinyl estradiol
Premarin
natural pharmaceutical estrogen from horse uterus used in menopause
environmental estro contaminents
BPA and DDT
Neuroendocrine tumor stains?
synaptophysin and chromogranin, cytokeratin, NSE, Cd56
Neuroendocrine tumor examples?
SIADH (maybe) Medullary thyroid carcinoma Pancreatic neuroendcorine tumor eg insulinoma or gastrinoma etc Pheochromocytoma Ganglionneuroma (MEN2B TAG)
What structure does a pit adenoma lack on histo?
NO RETICULIN NETWORK!
Wht can cause hyperPIT
pit adenoma (most common), rarely pit carc
What can cause hypOpit
Sheehan, empty sella syndrome, Rathke cleft cyst
Inflam like sarcoidosis and TB
Post pit sydnromes?
DI, Hypothalamic suprsellar tumors (eg craniopharyngiomas), SIADH
What can cause hyperthyroid?
graves, subacute lymphocytic (painless), thyrotoxicosis
Thyroid neoplasms like FOLLIC thyroid adenoma, carc, PAPILLARY thyroid carc, ANAPLASTIC (undiff) thyroid carc, MEDULLARY thyroid carc
What can cause hypothyroidism?
Cretinism, myxedema/ hashimotos, Riedel fibrosing thyroiditis, granulmatous dequervian
What disorders have transient hyper then hypothyroid?
granulomatous De Quervian
hashimoto
goiters may be either
What can cause hyperPTH?
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)
What can cause hyPO-PTH?
digeorges, absence
Pancr neuroendocrine tumors
Insulinoma, Gastrinoma, glucagonoma, somatostaninoma, VIPoma, carcinoid
HYPER adrenal CORTEX
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
HYPO adrenal CORTEX
Primary (addisons) due to APS1, APS2, waterhouse-frederichssen
Secondary due to def
Hyper adrenal MEDULLA
Pheochromocytoma
Empty Sella syndrome
can cause hypopit
herniation of arachnoid and CSF into sella, compresses pit, may be congen or dmg
Rathke celft cyst
Rathke’s patch (usu turns into ant pit) doesnt develop, causing hypo-pit
BENIGN MUCIN-FILLED CYST, ciliated cuboidal epith with GOBLET cells
What does SIADH commonly arise from?
lung small cell carcinoma!
in addn to hyponatremia has cerebral edema and neuro dysfxn etc
Hypothalamic suprasellar tumors
gliomas and craniopharyngiomas
can cause hyper/hypo fxn of ant or post pit
Hypermotility/diarrhea, malabs, hypocholesterol, hyperglycemia and osteo/weakness may mean which hormomne is elev?
HYPERTHYROID
Levels of T3 and TSH in thyrotoxicosis?
ELEV FREE CIRC T3/T4
so LOW TSH
Subacute lymphocytic painless thyroiditis
mild hyper, goiter, middle aged females, lympho infilitration, germ ctrs
Graves mech
IgG antibodies against TSH RECePTOR
these overstim TSH R which increases T3/T4 but decr TSH (tyep II HS)
Dermopathy (with shin rash aka pretibial myxedema) may mean which hormone is elev?
HYPERTHYROID as in GRAVES
Graves triad
Hyperthyroid
Exphtalmos
Dermopathy of tibia
Cretinism
HYPOthyroid in kids, has a dyshormonogenic goiter which is acongenital defect in Thyroid Perox (so lack of fxnl TH)
Myxedema is accum of
GAGs causing hypOthyroid, deepining of voice and enlarged tongue etc
Riedel Fibrosing Thyroiditis
HYPOthyroid due to inflam with fibrosis of HARD AS WOOD thyroid (NONtender!), airway etc
Granulomatous De Quervain thryoiditis
transient hyper to hypo, females mid aged
following VIRAL infxn and SELF limited, TENDER THYROID (unlike riedel fibrosing)
Hashimoto genetics ab's t4/tsh levels histo
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
GOITERS (diffuses nontoxic/colloid simple, and multinodular)
- 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
Thyroid neoplasms
follic adenoma and carc
papillary thyroid carc
anaplastic undifferentiated thyroid carc
medullar thyroid carc
FOLLIC thyorid adenoma and carc
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)
PAPILLARY thyroid carc
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
ANAPLASTIC undiff thyroid carc
AGGRO, 100% mort, older, invades local structure and causes issues w swallowing and breathing, variable morph
MEDULLARY thyroid carc
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!
cell types in PT gland
chief cells secrete pth
oxyphils are acidophilic, large
fat
Primary hyperPTH sx
painful BONES, renal STONES, abdominal GROANS and psychiatric MOANS
(eg PT adenoma)
Secondary hyperPTH causes and sx
chronic hyPOcalc! maybe from renal failure, low Ca intake, steat, vit D Def
metastatic calcs in tissues
Sx of hypocalcemia
eg from hypoPTH (from digeorges, dmg etc)
tetany, mental status, CV ocular and dental issues
PTH Ca and PO levels in psuedohypoPTH?
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
what do D cells and PP cells in endocrine pancr do
D cells secrete somatostatin to suppress BOTH insulin and glucagon
Pancr Polypeptide cells inhibit intestinal motility
Diseases that can be incr in DM
reitnopathy, cerebral infarct, MI, atheroscl, gangrene, infections, nephroscl, pierph neurop, HTN
Insulinoma and Gastrinoma
Pancreatic endocrine tumors
INsulinoma- NET benign causing episodic hypogly with metnal status changes, give glucose to tx
Gastrinoma: ZE sydnrome
Others
What cells make up adrenal medulla?
Enterochromaffin cells which secre catechol and SUSTENACULAR cells which support
Diff in RAA levels between primary and secondary hyperaldo?
primary (conns)- excess aldo, lowering renin
secondary (from CHF)- excess activation of RAAS so high renin AND aldo
Addisons types
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
Sx of addisons types
primary adrenal insuff
Fatiguer/weakness/GI, high ACTH causing skin pigment from MSH,
low aldo thus high K/H so hypokalemia
Pheochromocytomas are usually
unilateral, benign, HTN assoc (10-10-10), often have CV issues or arr
pheochromo histo
lobualr pattern with salt n pepper chromatin, polygonal cells surr by sustenacular cells
MEN sydnromes
MEN 1 Wermer (PPP)
MEN 2A Sipple (PAT)
MEN 2B (TAG)
Wermers
genetics
sx
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
Sipples
genetics
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)
MEN2B
genetics
clincical pres
TAG
Thyroid med carc (hypocalc)
Adrenal pheochrom
Ganglioneuroma
Genetics RET protooncogene mut
clinical: marfoid features, tumor
Cretinism sx
hypothyroid in kids, coarse facial features, dyshormone goiter with defect in TPO, MR, protruding tongue, umbilical hernia
Candida can cause
APS1! (a type of addisons adrenal insuff)
Neisseria mening in kids may cause?
Waterhouse fredrichson, with sepsis and adrenal insuff (like addisons)
Marfanoid features may mean
MEN2B TAG! (thyroid carc, pheochromo cyt adrenal, and ganglio) from RET proto
Which disease incorporate Pheochrom?
MEN2 A and B! (PAT and TAG)
Which endocrine tumor comes from previous exposure to ionizing radiation?
Papillary thyroid carcinoma, with orphan annie eye cells
Which goiter is nontoxic?
Multinodular!
from iodine def but can progress to thyrotox, colloid
Which issue causes painful thyroid?
GRANULOMATOUS DEQUERVIAN! follows viral infxn
riedels fibrosing is hard as wood NONtender
Which endocrine issue has abd striae?
cushings
Calcium Correction Equation!
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
