PathEndocrine Flashcards
1
Q
3 classic symptoms of prolactinoma
A
Galactorrhea, amenorrhea (females) Impotence (males)
2
Q
A typical complication of prolactinoma
A
Fracture/osteopenia
3
Q
Secondary complication of growth cell adenoma (besides growth) and its mechanism
A
Diabetes Mellitus, because growth hormone is gluconeogenic
4
Q
Diagnostic test for GH adenoma
A
Failure of glucose to suppress GH
5
Q
bone condition seen in women with prolactinoma and its mechanism
A
Osteoporosis Prolactin inhibits GnRH = no estrogen = increased osteoclast activity
6
Q
Lab findings of GH cell adenoma GH: Glucose, IGF1, OGTT test
A
Elevated GH, elevated glucose, high IGF-1 in serum and impaired OGTT test
7
Q
cell of origin in prolactinoma
A
acidophilic cells of ant. pituitary
8
Q
Woman gives birth, begins breast feeding and then a week later she notices loss of pubic hair and difficulty with breast feeding
A
Sheehan syndrome
9
Q
Sheenan syndrome pathogenesis
A
During pregnancy, pituitary swells 2x but doesn’t increase blood flow. If blood is lost during labor, pituitary infarcts (coagulative necrosis)
10
Q
Empty sella syndrome defect
A
Herniation of arachnoid and CSF into the sella, destroying the pituitary
11
Q
Sudden onset severe headache and bitemporal hemianopsia and diplopia
A
Pituitary apoplexy
12
Q
Major cause that central DI
A
Null cell adenoma, hypothalamic injury, etc
13
Q
Lab findings of nephrogenic DI (serum ADH, urine sp. gravity)
A
high, low
14
Q
Most common site of ectopic ADH production
A
Small Cell Lung Cacner/oat cell carcinoma
15
Q
2 lab values that distinguish SIADH from DI
A
Sodium and serum osmolality SIADH is hyponatremic, low osmolality, the others are hypernatremic, high osmolality
16
Q
Midline anterior neck mass in a child
A
Thyroglossal duct cyst
17
Q
Graves disease defect (name one antibody)
A
IgG stimulates TSH receptor
18
Q
3 PE findings of Graves
A
Goiter Exophthalmos Myxedema and skin pigmentation
19
Q
mechanism of exopthalmos and pretibial myxedema
A
T cells stimulate Fibroblasts release to glycosaminoglycans –> increases osmotic swelling and adipocyte size –> exopthalmos
20
Q
3 major cell types involved in exophthalmos
A
Fibroblasts T cells Fat cells
21
Q
Histology of graves
A
Tall follicular cells, papillary processes with colloid scalloping Scalloped colloid looks like little tombstones –> like…GRAVES
22
Q
Patient with hyperthyroidism undergoes a surgery under general anesthesia. When they wake up they develop severe hyperthermia, Delerium, tachycardia and arrhythmias
Diagnosis?
A
Thyroid Storm
23
Q
Are hot nodules (with I131 thyroid scan) benign or malignant
A
Benign (mostly)
24
Q
Infant with pot bellly, swollen face, protruding umbilicul, tongue falling out of mouth
A
Cretinism –> congential hypothyroid
25
6 Ps of cretinism
Pot belly Protruding umbilicus Protouding tongue Pale Puffy Face Poor brain development
26
Myxedema cause
accumulation of glycosaminoglycans in skin and soft tissue
27
Patent states they've been gaining weight despite not eating more, feels fatigued and has noticed deepening of voice and feels like their tongue is larger than normal
Hypothryoidism
28
Hashimoto defect (3 Ab)
IgG ab against thyroid peroxidase, IgG against thyroglobulin, Antimicrosomal Ab
29
HLA association with hashimoto
HLA DR5
30
classic paradox in lab findings in Hashimoto
Patients initially present with elevated T4 levels and SSx of hyperthyroid, then come back and have SSx of hypothyroid
31
Why do T4 levels initially increase in Hashimoto
follicle damage causes release of T4
32
2 unique histology findings of Hashimoto
1- Germinal center formation (appears like a lymph node), with plasma cells 2- hurthle cells
33
hurthle cell description
Eosinophlic metaplasia that lines the follicles
34
which cancer does hashimotos increase risk for? why?
Diffuse large B cell lymphoma b/c germinal cells are being formed
35
Patient has an upper respiratory infection, then develops periodic episodes of tachycardia, sweating, increased appetite. C/o Jaw pain and anterior neck pain.
Subacute granulomatous Thyroiditis
36
Subacute granulomatous thyroiditis labs
Elevated ESR
37
SGT clinical course
Hyperthyroidism that may progress to hypothyroid
38
SGT biopsy
Granulomatous inflammation w/ giant cells
39
20-year-old presents with dysphagia and wheezing. The thyroid is firm when palpated but not painful, and it doesn't move when palpated.
Diagnosis?
Riedel fibrosing thyroiditis
40
how does I 131 uptake help distinguish hyperthyroid/toxic goiter from cancer
Cancer is a cold nodule (doesn't take up I 131)
41
5 classic cancers of the thyroid
Follicular Adenoma Follicular Carcinoma Papillary carcinoma Medullary carcinoma Anaplastic carcinoma
42
Hallmark of follicular adenoma on gross exam/histology
Follicles are surrounded by a thick fibrous capsule
43
CLassic risk factor for developing papillary carcinoma of thyroid
Radition to the head and neck area as a child
44
Papillary carcinoma histology (2 unique features)
Empty nuclei with central clearing (orphan annie cells), Psammoma bodies Papillary = Psammoma and Pupils (eyes)
45
Most common pituitary adenoma
Prolactinoma
46
Follicular carcinoma mutation and mechanism of invasion
RAS, capsular and vascular invasion by collagenase
47
Follicular carcinoma spread and prognosis
HEMATOGENOUS SPREAD. it forgot its a carcinoma Good prognosis
48
Dexa test result in pituitary corticotrophic adenoma
1.0 mg and 8.0 mg
1. 0 mg- no change in serum/urine ACTH and cortisol level (remain high)
8. 0 mg- lower level of serum and urine ACTH and cortisol level
49
Medullary carcinoma is a malignancy of
Calcitonin secreting parafollicular C cells
50
medullary carcinoma labs and inheritance
Hypocalcemia w/ hypercalciuria (b/c calcitonin increases renal excretion of Ca), Autosomal dominant (MET protooncogene)
51
Classic medullary carcinoma histology
sheets of cells in an amyloid (pink) stroma
52
Medullary carcinoma mutation
RET mutation (MEN2a 2b)
53
What should be done if pt has RET mutation?
Prophylactic thyroidectomy
54
What is the amyloid made of in medullary carcinoma?
Calcitonin deposition
55
Patient presents with asymptomatic hypercalcemia
Primary hyperparathyroidism
56
histology of papillary carcinoma
the papillary process, hypochromatic nuclei, psammoma bodies
57
4 main symptoms of hypercalcemia
"Stones, bones, groan, psychiatric overtones" Kidney stones Osteitis fibrosis cystica Constipation, abdominal pain, pancreatitis Depression
58
serum alk phos level in primary hyperPTH. Why?
Elevated b/c PTH activates osteoblasts, which secrete alk phos b/c it needs an alkaline environment to make bone
59
Osteitis fibrosa cystica (OFS) cause
excessive bone resorption by overactive osteoclasts
60
OFC gross and Xray appearance
Cysts full of brown fibrous tissue Multiple cystic spaces on Xray
61
Why is the cyst in OCF is brown?
Hemosiderin form macrophages
62
2 most common causes of secondary hyperPTH
chronic renal failure Hypovitaminosis D Really, anything that causes low Ca or high Phos
63
Muscle effects of hypocalcemia
Muscle spasms and fatigue
64
2 PE findings for hypocalcemia
Chovestek sign (tap on facial nerve = twitch) Trousseau (occlude brachail artery = carpal spasm)
65
3 most common causes of hypoparathyroidism
Lab findings in this case:
Surgical excision of thyroid Autoimmune DiGeorge!
Low serum PTH, low calcium and high K
66
If ostitis fibrosa cystica like abnormality is seen in a patient in renal failure- the condition is known as:
Renal Osteodystrophy
67
inheritance of MEN syndromes
Autosomal dominant. "MEN are Dominant"
68
MEN1 SSx
Pituitary adenoma Pancreatic tumor (ZE, gastrinoma, insulinoma) Parathyroid adenoma
69
MEN2a SSx
Parathyroid adenoma Pheochromocytoma Medullary Carcinoma of thyroid
70
MEN2b SSx
Pheochromocytoma Medullary carcinoma of thyroid Mucosal neuromas Marfanoid habitus- A TALL PERSON
71
MEN2 defect and pathogenesis
RET mutation, which codes for receptor tyrosine kinase
72
embryonic origin of the cells affected Craniopharyngioma
Rathke's pouch
73
MCC (most common cause) of primary hyperaldosteronism
Bilateral adrenal hyperplasia, Adrenal adenoma (conn)
74
MCC of secondary hyperaldosteronism
Renal artery stenosis, CHF
75
How to differentiate b/w primary and secondary hyperaldo
Primary = Low Renin w/o edema Secondary = High Renin + Edema
76
Mechanism of striae in cushing
Cortisol inhibits fibroblast prolferation and collagen production
77
Classic triad of symptoms that aren't related to physical appearance in cushings
HTN, hypokalemia and metabolic alkalosis
78
The basis for high dose (8.0 mg overnight) dexa suppression test
Pituitary cushings is suppressed with high dose dexa, Ectopic cushings is not
79
imaging findings for exogenous steroid induced cushings
bilateral adrenal atrophy
80
2 causes of bilateral adrenal hypertrophy
Pituitary Cushings, Ectopic Cushings (Oat cell lung carcinoma)
81
major cause of unilateral adrenal hypertrophy and atrophy of the opposite gland
Adrenal adenoma
82
major way to distinguish b/w 21OH and 11OH deficiency
21OH = hypotension , hyponatremia, hyperkalemia 11OH= Hypertension, hypernatremia, hypokalemia
83
21OH vs 17OH def (sexual appearance)
21OH is precocious puberty in males, ambiguous in females; 17OH is amenorrhea in females and ambiguous in males
84
screening test of choice for any type of congenital adrenal hyperplasia
ACTH- will be high
85
SSx of acute adrenal insufficiency
acute drop in BP to the point they can't perfuse organs
86
2 MCC of Addison disease
autoimmune destruction of the gland (with polyglandular syndrome, TB and AIDS
87
how to differentiate primary vs secondary adrenal insufficiency
Primary causes hyperpigmentation due to high ACTH Secondary doesn't affect skin b/c ACTH is low
88
which cancer can cause adrenal insufficiency?
Lung cancer! remember, lung cancers met to the adrenals; and also RCC
89
Pheochromocytoma is a tumor of
chromaffin cells
90
Classic presentation of pheo.
EPISODIC Anxiety/panic palpitations headaches sweating
91
screening test for pheo
Most common catecholamines in the urine and serum
92
the buzzword for the facial appearance of hyperthyroidism
"frightened appearance" Refers to staring gaze with lid lag (eyes wide open)
93
Histology of orbital muscles in exophthalmos will show what 2 features?
Inflammation (T cells) Increased Adipocytes
94
4 Tx for thyroid storm
PTU Prednisone Propanolol Potassium Iodine
95
High Intact PTH, low calcium, dwarfism, blunting of the fourth and fifth knuckles of the hand
Pseudohypoparathyroidism (Albright hereditary dystrophy)
96
What is the specific defect in PsHP (Pseudohypoparathyroidism (Albright hereditary dystrophy))?
Defective Gs protein in the renal tubular cells --\> kidney doesn't respond to PTH (PsHP is to PTH as Nephrogenic DI is to ADH)
97
Pseudopseudohypoparathyroidism presentation
Look like albrights (short stature, short 4th/5th digits) but don't have end organ PTH resistance...PTH and Ca levels are normal
98
Familial Hypocalciuric Hypercalcemia defect
Defective Ca Sensing receptor in the PTH means body can't respond to high Ca
99
Pseudohypoparathyroidism (Albright hereditary dystrophy) Labs (serum Ca, PTH)
Low serum Ca High intact PTH
100
Relationship of Prolactinoma and Bone in a woman
Increases risk for osteoporosis Prolactin inhibits GnRH = low estrogen = increased osteoclastic activity and fracture
101
Sodium levels in primary vs secondary adrenal insufficiency. Why?
Low in Primary b/c entire adrenal is dead
Normal in secondary b/c ACTH doesn't directly stimulate the zona glomerulosa!!
102
Basis for CRH stimulation test in adrenal insufficiency
If CRH stimulates the production of new cortisol, the Dx is Secondary/tertiary adrenal insufficiency (b/c the pituitary wasn't releasing ACTH) This is the same logic as in pituitary cushings vs ectopic ACTH production
103
Sheehan's which hormone functions return after a few months
ADH
104
The earliest symptom of Sheehan's
difficulty breastfeeding or an inability to breastfeed.
105
Prolactinoma cell of origin
acidophilic cells
106
Stalk effect
all pituitary hormones are low, but prolactin is high
107
Cause of these findings (visual field defect)
Prolactinoma- mass effect- compression on optic optic chiasm superiorly
108
Which hormone defect is seen with the associated image
Excess GH
109
Diseases associated with the attached image
McCune – Albright syndrome
1. Female patient common
2. Polyostotic Fibrous Dysplasia
3. Café au lait spot
4. Precocious puberty
5. Endocrine abnormality (Gigantism, Hyperthyroidism, Cushing syndrome)
110
Likely diagnosis?
Probably prolactinoma- macroadenoma
111
* Blood and urine samples will be sent to measure the concentration at 0900, 1200, 1500 and 1600.
* 3/4th samples are taken after vasopressin infection.
•
•\< 10% increase in urine osmolality following injection vasopressin during the test-? diagnosis
nephrogenic DI
112
* Blood and urine samples will be sent to measure the concentration at 0900, 1200, 1500 and 1600.
* 3RD/4th samples are taken after vasopressin infection.
* \> 50% increase in urine osmolality following injection vasopressin during the test-? diagnosis
complete neurogenic DI
