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Endocrine Midterm > Path > Flashcards

Path Flashcards

1
Q

“Is the pt unable to make adequate amounts of this hormone?”

What test are we likely to perform?

A

Stimulation test

-Pt receives or does something that should raise levels of the hormone. If response is not adequate, dx is made.

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2
Q

“Is this pt unable to limit production of this hormone to what is appropriate?”

What test are we likely to perform?

A

Suppression test

-Pt receives or does something that should lower levels of the hormone. If response is not adequate, dx is made.

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3
Q

Thyroxine (T4) and tri-iodothyronine (T3) are produced in the thyroid gland.

What hormone (and from where) stimulates their production and secretion?

A

Thyroid stimulating hormone (TSH, thyrotropin) from the anterior pituitary

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4
Q

TSH production and secretion is stimulated by what (and from where)?

A

TSH releasing hormone (TRH) from the brain

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5
Q

Low T4 confirms:

A

HYPOthyroidism

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6
Q

Pts who are HYPOthyroid from thyroid dz will have high TSH. Why?

A

Loss of negative feedback on the pituitary

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7
Q

Pts who are HYPERthyroid from thyroid dz will have low TSH. Why?

A

Strong negative feedback on pituitary

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8
Q

Low T4, high TSH:

A

Hypothyroidism

-mimics depression, mental illness

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9
Q

High T4, low TSH:

A

Hyperthyroidism

-mimics anxiety, mental illness

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10
Q

Labs for 2° hypothyroidism:

Cause of 2° hypothyroidism:

A

Low T4, low TSH.

Pituitary does not produce adequate amount of TSH.

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11
Q

Labs for 2° hyperthyroidism:

Cause of 2° hyperthyroidism:

A

High T4, high TSH.

Overactive pituitary OR a tumor elsewhere producing excess TSH.

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12
Q

Anti-thyroid peroxidase Abs (anti-TPO) target an:

A

Iodine oxidizer

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13
Q

Anti-thyroglobulin Abs target the:

A

Colloidal storage form of thyroid hormone

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14
Q

Anti-TSH receptor Abs (anti-TR, “TRAbs”) are often stimulatory and cause:

A

Hyperthyroidism

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15
Q

Cortisol from the adrenal cortex is the body’s principal glucocorticoid.

Excess cortisol produces what syndrome?

A

Cushing’s

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16
Q

Adrenal or pituitary dz with HYPOadrenocorticism:

A

Addison’s

  • Cannot stimulate cortisol production
  • Mimics depression or anorexia nervosa
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17
Q

Adrenal or pituitary dz with HYPERadrenocorticism:

A

Cushing’s

  • Cannot suppress cortisol production
  • Mimics mental illness and other common problems
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18
Q

Cortisol production by the adrenal cortex is stimulated by:

A

ACTH

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19
Q

A morning serum cortisol > __ ug/dL or a morning salivary cortisol > __ ug/mL basically excludes adrenal insufficiency.

What test would you perform?

A

Serum cortisol > 18 ug/dL
Salivary cortisol > 5.8 ug/mL

ACTH stimulation test.

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20
Q

What is expected in an ACTH stimulation test in primary adrenal cortical insufficiency (due to dz of the gland itself)?

A

Cortisol levels won’t rise despite ACTH administration.

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21
Q

Auto-Abs detected in autoimmune adrenalitis:

A

Anti-21-hydroxylase Abs

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22
Q

Plasma ACTH LOW
Aldosterone LOW
Renin HIGH

Dx:

A

Primary adrenal insufficiency

adrenal gland problem

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23
Q

Plasma ACTH LOW
Aldosterone NORMAL
Renin NORMAL

Dx:

A

Secondary adrenal insufficiency

pituitary problem

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24
Q

In suspected hyperadrenocorticism, screen with:

A

24 hour urinary cortisol

Cushing’s pts have > 3x the upper limit of ref range

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25
Q

For borderline hyperadrenocorticism, what test is used?

A

Dexamethasone suppression test

26
Q

Explain dexamethasone suppression testing.
If cortisol is still high:
If ACTH is still high:

A

Pt is given 2mg of dexamethasone…
If cortisol is still high, 1° or 2° hyperadrenocorticism is likely.
If ACTH is still high, it is likely 2° (comes from pituitary).

27
Q

Too much aldosterone is responsible for:
How is it screened?
Consider screening pts with: (3)

A

Hypertension
Screened through spot plasma aldosterone + plasma aldosterone / renin ratio (both will be high).
Consider screening pts with hypokalemia, severe refractory HTN, or a known adrenal tumor.

28
Q

Low aldosterone is familiar as:

A

Renal tubular acidosis, type IV

29
Q

Low usable levels of growth hormone before closure of the epiphyses results in:

High levels produces _________ in children/teens and _________ in adults.

A

Low GH&raquo_space; Permanent short stature (i.e., dwarfism)

High GH&raquo_space; GIGANTISM in children/teens, ACROMEGALY in adults.

30
Q

How is GH measured?

A

IGF-1 in the liver

31
Q

To screen for acromegaly, measure:

A

Serum IGF-1

32
Q

Acromegaly is most often caused by:

A

Pituitary adenoma

33
Q

IGF-1 and IGFBP-3 are both low in deficiency of:

A

hGH

34
Q
  • Children who grow up in a neglectful/non-nurturing environment produce insufficient hGH and develop short stature as a result. Remember this when working up “pituitary GH deficiency.”
  • When removed from environment, pts exhibit catch-up growth.

Dx:

A

Psychosocial dwarfism

35
Q

Prolactin is produced in the pituitary in response to absence of:

A

Dopamine

inhibits production and secretion of prolactin

36
Q
  • Woman with galactorrhea / amenorrhea or who doesn’t have a normal cycle
  • Loss of libido, infertility, “trouble seeing”

High values (> 10x the top of ref range) suggest:

A

Prolactinoma

37
Q
  • Released from posterior pituitary

- Allows reabsorption of water by renal collecting ducts

A

ADH (aka vasopressin)

38
Q

Too little ADH.

Clinical syndrome is:

A

Diabetes insipidus

polyuria without glycosuria, SG < 1.020

39
Q

The distinction between pituitary and nephrogenic diabetes insipidus is usually made by injecting:

A

Desmopressin (synthetic ADH)

40
Q

Too much ADH (SIADH) usually results from: (2)

Pts have low levels of:

A
  • Ectopic ADH secretion by a tumor, often oat cell lung cancer
  • Porphyria (from the brain)

Low sodium (pt is hyponatremic)

41
Q

Abnormal serum calcium levels on routine screening and/or passing a calcium kidney stone should raise suspicion for:

A

Hyperparathyroidism

42
Q

Dx of hyperparathyroidism is based on:

A

Elevated serum PTH

43
Q

When low calcium levels are detected, screen for:

A

Hypoparathyroidism

  • DiGeorge syndrome – no parathyroids
  • Autoimmune parathyroiditis
  • Post-thyroid surgery
44
Q

The best known marker for type I diabetes is Abs against:

A

Gamma-glutamyl decarboxylase

45
Q

Pts with hypoglycemia, measure: (2)

A
  • Insulin

- C-peptide (production accompanies production of insulin)

46
Q
  • Pts appear anxious
  • Intermittent or persistent HTN
  • Sweating attacks
  • Severe headaches

Dx:

A

Pheochromocytoma

47
Q

Best screen for pheochromocytoma:

A

24 hour urinary fractionated catecholamines and metanephrines

48
Q
  • Common origin = adrenal medulla

- Increased dopamine and/or homovanillic acid (HVA) and vanillylmandelic acid (VMA) in urine

A

Neuroblastoma

49
Q
  • Ulcers and/or diarrhea prompt consideration for:

- Caused by:

A

Zollinger-Ellison syndrome

Caused by an endocrine tumor in the pancreas or duodenum producing excess gastrin (gastrinoma)

50
Q

Elevated gastrin levels are also seen in:

A
  • Achlorhydria from dz (atrophic gastritis)

- Meds (antacids)

51
Q

What stimulates the release of gastrin from gastrinomas but suppresses it from normal G-cells?

A

Secretin

52
Q

What is the marker in medullary thyroid cancer?

A

Calcitonin

53
Q

-Wheezing, flushing, diarrhea

Think…

A

Carcinoid syndrome

54
Q

Carcinoid syndrome is due to production of _________ by the tumor.

A

Carcinoid syndrome is due to production of SEROTONIN by the tumor.

55
Q

A screen for carcinoid is:

A

5-hydroxy-indole acetic acid (major metabolite of serotonin) in urine

56
Q
  • Boy who doesn’t undergo puberty when it’s time
  • Grown man who is troubled by infertility, erectile dysfxn, or “loss of energy”

What is ordered?

A

Serum testosterone, FSH and LH levels

57
Q
  • Often unrecognized XXY
  • Testosterone is low
  • FSH and LH are high
A

1° hypogonadism

58
Q
  • Problem is in the brain / hypothalamus
  • Most often “idiopathic”
  • Testosterone, FSH and LH are all low
A

2° hypogonadism

59
Q
  • Pituitary adenomas (usually prolactinomas)
  • Parathyroid adenomas / hyperplasias
  • Pancreatic endocrine tumors (gastrinomas, etc)

Think…

A

MEN-I

60
Q
  • Caused by mutated RET
  • Features medullary thyroid cancer and pheochromocytomas

Think…

A

MEN-II

61
Q
  • Mutant RET

- Parathyroid adenomas / hyperplasias

A

MEN-IIa

62
Q
  • Mutant RET
  • Marfanoid habitus
  • Mucosal neuromas
A

MEN-IIb

Endocrine Midterm (8 decks)

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