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73 Cards in this Set

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Endocrine

What are the three layers of the adrenal cortex and what do they regulate and secrete?
Zona Glomerulosa: Salt (renin-angiotensin --> aldosterone)

Zona Fasiciculata: Sugar (ACTH, hypothalamic CRH --> Cortisol) note: cortisol acts like glucagon

Zona Reticularis: Sex (ACTH, hypothalamic CRH) --> androgens
Endocrine

What is made in the adrenal medulla?
Catecholamines (Epi, NE)

(Preganglionic sympathetic fibers)
Endocrine

What is the most common adult adrenal medulla? children?

Differences?
Adults: pheochromocytoma
(causes episodic hypertension)

Children: neuroblastoma (no hypertension assoc)
Endocrine

Explain the adrenal gland drainage:
Left adrenal --> left adrenal vein --> left renal vein --> IVC

Right adrenal --> right adrenal vein --> IVC
Endocrine

What is the inhibitory function of somatostatin?
(from the hypothalamus)
It is a negative inhibitor of GH and TSH
Endocrine

What is the mechanisms of hormone action for:
1. all the hormones in the anterior pt
2. all the hormones in the posterior pt
3. steroid hormones and thyroid horm?
4. insulin
5. NO
1. ant pit: cAMP --> PKA --> phos
2. post pit: PLC --> IP3 and Ca --> PKC and arachidonic acids (to prostaglandins)
3. steroid/thyroid: intercell binding --> exposes DNA binding domain --> DNA transcription --> mRNA translation --> new protein synth
4. insulin: tyrosine kinases
5. NO: cGMP
Endocrine

What two organs depend on insulin for increased glucose uptake? What two organs do not use insulin?
Skeletal muscle and adipose tissue (GLUT-4)

Brain and RBC's: don't need insulin (GLUT 1)
Endocrine

What are the five functions of cortisol?
1. anti-inflammatory
2. increase gluconeogenesis, lipolysis, and proteolysis
3. decrease immune function
4. maintains blood pressure
5. decreases bone formation
Endocrine-HY

What can be used to suppress a prolactinoma?
Bromocriptine
Endocrine

What two symptoms do only women get when they have a prolactinoma?
amenorrhea and galactorhea
Endocrine-HY

What medications can induce "prolactinoma-like" effects?
Any drug that interfers with dopamine (prolactin inhibitory factor) and is assoc with estrogen therapy:

OC
methyldopa
reserpine
hydralazine
Ca channel blocers
Endocrine

Other than general enlargement of jaws, face, hands and feet, what does acromegaly do that is negative? (4)
Enlargement of the viscera
Hyperglycemia (insulin resistance)
Osteoporosis
Hypertension
Endocrine

What do you use to treat gigantism with?
Octreotide

(when you are as big as a tree you need 8x as much medication = OCT-TREE-odide
Endocrine

Is an increased GH normal with stress?
Yes! My GH must be through the roof!!
Endocrine

If a high level of dexamethasone decreases cortisol (and low doesn't) what is the dx?
Pituitary Cushings
Endo

What is an example of ectopic ACTH production?
Small cell CA of the lung
Endo

How do you distinguish Cushing from Cushing-like obestity?
Get a 24hr urine cortisol test -- it takes alot of cortisol to make it into the urine (thus it would be Cushings)
Endo

What does the anterior pituitary gland secrete?
FLAT PiG
FSH
LH
ACTH
TSH
Prolactin
GH
Endo

What causes Sheehans syndrome? What does it cause?
Often pregnancy related ischemia of the pituitary gland (hypotension --> vasospasm --> ischemic necrosis)

Causes: anorexia, fatigue, poor lactation, loss of pubic and axillary hair
Endo

What is the best way to test for growth hormone deficiency?
5am blood draw for insulin-like growth factor or arginine stimulation test (this is why weightlifters get arginine tests)

Note: arginine and histadine are absolutely necessary for growth.
Endo

Which causes increased skin pigmentation: Primary or Secondary adrenal failure?

What is an example of an enzyme that can cause this?
Primary since it allows for release of both ACTH and beta melanocyte stimulating hormone and since there is no cortisol produced = no inhibition on ACTH => lots of beta melanocyte stim.

Adrenal cortical deficiency in 21 alpha hydroxylase would cause hyperpigmentation --> no cortisol to inhibit ACTH
Endo

What does SIADH do to sodium levels?
It causes dilutional hyponatremia.
Endo

What drug is used to treat SIADH?
Demeclocyline and H2O retriction

(Deme Moore has SIADH)
Endo

FA: What drug can induce SIADH?
Cyclophosphamide
Endo

What causes diabetes insipidus?
deficiency of ADH = polyuria, insatiable thirst, and dehydration

Can be caused by trauma, tumors, inflammatory processes, lipid
Endo

How can a water deprivation test be used to diagnose Diabetes insipidus vs central diabetes?
give patient ADH:
Does urine increase in osmolality? Yes = central diabetes insipidus

No increase in osmolality = nephrogenic (not DI)
Endo

Where does a craniopharyngioma come from?
Rathke's pouch

It is a benign childhood tumor derived from remnants of the Rathke pouch and is not a true pituitary tumor.
Endo

Describe the appearance of craniophayngioma:
Nest and cords of squamous or columnar cells in a loose stroma, closely resembling the appearance of the embryonic tooth bud enamel organ.

This tumor is often cystic and the lining epithelium of flat or columnar cells often expands into papillary projections. Has keratin.
Calcification is common
Endo

MC sign of craniopharyngioma?
Bitemporal hemianopsia
Endo

Where is the MC location of a craniopharyngioma?
Suprasellar
Endo

Cause of empty sella syndrome?
Any condition that destroys all or part of the pituitary. It leads to a defect in the diaphragm sellae
Endo

What is Nelson syndrome?
A large adenoma that develops following bilateral adrenalectomy. This is thought to be due to a loss of feedback inhibition on growth of preexisting pituitary microadenomas.
Endo

Midline cyst in the neck?
Thyroglossal duct cyst
Endo

Where is a brachial cleft cyst found?
In the anterolateral neck
Endo-Goljan

Name four things that tyrosine is used to make?
T4T3 (binds with iodide)
Dopamine
NE,Epi
Melanin
Endo-Goljan

What kind of hypertension is seen in hypothyroidism?
Diastolic
Endo

What is two embryologic problems causes hypothyroidism?
Cretinism caused by failure of the fetal thyroid to descend from its origin at the base of the tongue

Transplacental transfer of antithyroid antibodies from a mother with autoimmune thyroid disease
Endo-Goljan HY

What receptors does T4 upregulate?
Beta1 receptors
Endo-Goljan HY

Why would you use a beta blocker to treat Grave's disease?
To block adrenergic response, all symptoms will go away including sweating

If you just used proprothyrutine to inhibit gland you would not stop the sweating.
Endo

What type of hypersensitivity reaction is involved in Grave's disease?
Type II
Endo-Goljan

What heart problem will "all people with Graves" get?
A-fib -- if a pt comes in with a-fib you must get a TSH level to rule out Graves dz
Endo-Goljan

What are three major disorders that involve a deposition of glycosomaminoglycans?
Mitral valve prolapse (increase in dermatan-sulfate)
Hashimotos
Graves
Endo

What is a thyroid storm?
A underlying Graves dz with a stress-induced catecholamine surge leading to death by arrhythmia
Endo-QBANK

Pt who is pregnant, in labor, with no prenatal care. Pt is noted to very restless, with fever, profuse sweating, tachycardia, and abdominal pain between contractions.

Dx?
Thyrotoxic crisis: untreated Grave's
Endo

Describe the histo of Hashimoto's thyroiditis?
Massive infiltrates of lymphocytes with germinal centers; thyroid follicles are atrophic with Hurthle cells (epithelial cells with eosinophilic granular cytoplasm).
Endo

What chromosomal abnormality is assoc with Papillary CA?
chr10
Endo

Where does follicular CA metastasize to?
It INVADES blood vessels!!! Not lymphnodes!!

Goes to lung and bone
Endo

Which thyroid CA has the poorest prognosis?
Follicular CA
Endo

What CA originates from the C cells of the thyroid? What does this produce?
Medullary CA of the thyroid

Produces calcitonin, a calcium lowering hormone
Endo

What histo distinguishing characteristic do medullary CA of the thyoid tumor cause?
Amyloid-containing stroma
Endo

What endocrine disorder is in MEN I and MEN IIa?
Hyperparathyroidism
Endo

What bone disorder is seen in hyperparathyroidism?
Osteitis fibrosa cystica (cystic changes in bone due to osteoclastic resorption; aka von Reckinghausen disease = fibrous replacement of bone leads to "brown tumors")

"Bones, stones, groans"
Endo

In hyperparathyroidism there are increased levels of circulating Ca: what main problem can this cause?
Ca can deposit in any organ (esp the kidney) = renal stones
Endo

MCC of hypoparathyroidism?
Accidental surgical excision during thyroidectomy
Endo

What is the major sign of hypoparathyroidism?
Hypocalciemia induced tetany
Endo

What is Chovostek's sign and Trosseau's sign?
Chovosteks: tap facial n --> contraction of facial m.

Trosseaus: occlusion of brachial a with BP cuff causes carpal spasm
Endo

Describe psuedohyperparathyroidism:
Autosomal dominant kidney unresponsiveness to PTH. Characteristics include hypocalcemia, shortened 4th/5th digits, short stature.
Endo

Why do you get tetany with primary aldosteronism?
Primary aldosteronism:
Overproduction of adrenal minerocorticoid by adrenal glands causes hypertension, sodium and water retention, hypokalemia and hypercalcemia.

However because of increased H excretion there is a metabolic alkalosis --> this causes albumin to take on an increased negative charge -> bind more Ca = hypcalcemia!!!

TETANY!
Endo:

Compare primary and secondary aldosteronism in terms of renin levels:
Primary: decreased renin

Secondary: increaed renin
Endo - ON TEST!!! HY

What is the most likely cause a baby with ambiguous genitalia?
21-hydroxylase deficiency: which is salt wasting and hypotensive.

Adrenal virilism produces virilism in females and precocius puberty in males.
(other cause: 11-hydroxylase def)
Endo

What is the cause of Addison's disease?
Idiopathic adrenal atrophy (autoimmune destruction of gland)
Endo

What are the four characteristic features of Addison's disease? (and 5 lab values)
1. hypotension
2. increased pigmentation of skin
3. decreased serum Na, Cl, glucose, and bicarbonate, and potassium
4. peaked t waves
Endo

How many of the regions of the adrenal cortex are involved in addison's?
All three!!!
Endo

How do you distinguish primary Addison's with secondary?
secondary has no skin pigmentation
Endo

What findings of an ACTH stimulation test lead to a dx of Addisons and lead to hypopituitarism?
ACTH stim test --> give ACTH and test urine for 17-hydroxycorticoids

Day 1-5 --> nothing happens = Addison's disease (gland was destroyed)

If days 2-3 there was an increase in 17-hydroxycorticoids --> hypopituitarism (gland was atropic because it wasn't being stimulated by ACTH)
Endo

What will blood pH be in a patient with Addisons?
acidic --> no aldosterone = no excretion of H = acidotic
Endo

Pheochromocytoma: origin, effects
Pheochromocytoma: neural crest origin that causes HTN

Tumor of chromaffin cells of the adrenal medulla
Endo-Goljan

How do you distinguish a pt with regular HTN with a pt with Pheochromocytoma?
In pheochromocytoma the HTN is unstable and stress related; comes when they are very anxious; accompanied with sweat.
Endo

What is a neuroblastoma?
A highly malignant neural crest tumor in children.

Present as a large abdominal mass.

FA: It can occur anywhere along the sympathetic chain; will have HVA in the urine; less likely to cause HTN (compared to pheochromcytoma)
Endo

What oncogene is assoc with neuroblastoma?
N-myc oncogene
Endo

What are the 3P's of MEN I?
Pituitary, Parathyroid, Pancreatic islets - can also include hyperplasias or tumors of thyroid or adrenal cortex.
Endo

What MEN syndrome can manifest as Zollinger-Ellison syndrome?
MEN I (4 P's - last one for peptic ulcer)
Endo

Tumors assoc with MEN IIa and IIb?
IIa: pheochromo, medullary thyroid CA, and hyperparathyroid due to hyperplasia or tumor

IIb: pheochromo, medullary CA, oral and intestinal mucus neuromas (no parathyro)

Both are linked to the ret oncogene but linked to different mutations!