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173 Cards in this Set
- Front
- Back
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when is hyperplasia of the pituitary expected
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increased number of lactotrophs during pregnancy or multiparous women
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what is located superior and lateral to the pituitary
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superior - optic chiasm
lateral - cavernous sinus containing internal carotids and CN III, IV, V, and VI |
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blood supply of the pituitary
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arterial blood goes directly to posterior lobe
venous blood goes mostly to anterior lobe (portal system) |
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arises from ectoderm of the mouth cavity, Rathke's pouch
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adenohypophysis (anterior lobe)
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comes for the neuroectoderm of the diencephalon
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neurohypophysis (posterior lobe)
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cells of the anterior lobe of the pituitary
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chromophils - acidophils (40%) and basophils
chromophobes (50%)- poorly staining |
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hormones associated with acidophils (simple proteins)
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GH
prolactin |
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beta subunit of glycoproteins produced by basophils (FSH, LH, TSH)
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portion of molecule that is unique for each hormone
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polypeptides that are produced by basophils
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ACTH
MSH |
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this pituitary adenoma can make any hormone
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chromophobe adenoma
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for storage and release of hormones made in the hypothalamus
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posterior lobe
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where is ADH and oxytocin manufactured
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ADH - supraoptic nucleus of hypothalamus
Oxytocin - paraventricular nucleus |
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posterior lobe is often absent in this
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anencephaly
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pituitary aplasia
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defective Rathke's pouch formation associated with absent anterior lobe
adrenals and thyroid are hypoplastic |
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chronic inflammation of the pituitary
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granulomatous - TB, sarcoidosis, syphilis
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metastatic carcinoma of the pituitary comes from which sites
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breast
lung thyroid |
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xanthomatosis in the pituitary
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neurohypophysis - diabetes insipidus from no ADH release
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when does hypopituitarism occur
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when destruction of at least 75% of the anterior lobe occurs
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Sheehan's syndrome
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post partum pituitary necrosis during hypovolemic shock
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signs of Sheehan's syndrome
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women can't nurse her baby
hypothyroidism Addison's disease |
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space-occupying effects of pituitary neoplasm
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enlargement of sella tursica
bilateral homonymous hemianopsia increased ICP |
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malignant neoplasms of the pituitary
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usually metastatic and involve the posterior lobe because of greater blood supply
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two cells that adenomas mostly arise from in pituitary
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chromophobe (75%)
Acidophil (24%) *both have increased GH or prolactin |
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If there is a basophil adenoma, what does it produce - very rare
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ACTH
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functional adenomas are most commonly which 3 hormones
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prolactin
growth hormone ACTH |
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calcified suprasellar intracranial mass in young person
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craniopharyngioma
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basophil adenoma secreting ACTH
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cushing's disease
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Nelson's syndrome
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pituitary adenoma arising in a patient who had a previous bilateral adrenalectomy for Cushing's syndrome
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Forbes-Albright syndrome
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prolactin-secreting adenoma with galactorrhea and amenorrhea
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differentiate gigantism vs. acromegaly
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gigatism - chronic excess GH before epiphyses close
acromegaly - chronic excess GH after epiphyses close |
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Simmond's syndrome
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hypopituitarism not related to pregnancy
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associated with hyponatremia, cerebral edema and confusion
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SIADH
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low urine specific gravity, polyuria, polydipsia, no glycosuria
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diabetes insipidus
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MEN I
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1. Pancreatic islet tumors (usually gastrinoma) - peptic ulcerations
2. pituitary adenoma/hyperplasia 3. parathyroid adenoma/hyperplasia |
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MEN IIa
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1. Medullary carcinoma of thryoid - produce calcitonin
2. parathyroid adenoma/hyperplasia 3. adrenal medulla lesion (pheochromocytoma) |
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MEN IIb
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same as MEN IIa with the addition of neuromas or neurofibromas
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associated with mutation in the RET proto-oncogene on chormosome 10
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MEN II syndromes
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associated with inactivation of tumor suppressor protein menin
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MEN I syndrome
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two relationships with the thryoid gland
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recurrent laryngeal nerve
parathyroid gland |
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differentiate what follicular and parafollicular cells secrete
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follicular - T3/T4
parafollicular - calcitonin |
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when is thyroxine metabolically active
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when it is free and not bound to albumin, >99% is bound to albumin normally
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cretinism
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thyroid agenesis or hypoplasia is young individual that is still growing
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Is cretinism reversible
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If caught early enough - before late stages develop
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symptoms of neonatal cretinism
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hypothermia
constipation |
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later clinical manifestation of cretinism
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broad nose, thick tongue, dry skin, retarded growth, sexual infantilism, deafness, mental retardation
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signs and symptoms of adult hypothyroidism
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lethargy, cold intolerance, slowed mentation, thick tongue, puffiness of face and tibia
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struma ovarii
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functioning ovarian teratoma that secretes thyroxine
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T4 and TSH levels seen in iatrogenic hyperthyroidism
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increased T4
decreased TSH |
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enzymatic defect in synthesis of thyroid hormones with increased TSH and non-toxic goiter
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dyshormogenetic goiter
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failure of involution of thryoid stalk found in midline neck
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thyroglossal duct cyst
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two common places for ectopic thyroid
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retro-sternal location
laterally within lymphoid tissue |
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thyroiditis secondary to bacterial or viral infection, associated with interstitial neutrophils, tender thryoid, and fever
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acute suppurative thyroiditis
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granulomatous thryoiditis due to cytotoxic T-lymphocytes, preceded by an upper respiratory infection
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subacute thryoiditis
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two common autoimmune antibodies seen in Hashimoto's disease
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thryoblobulin
microsomal antigens |
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Can you develop Hashimoto's from Grave's disease and vice versa
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Yes, both associated with HLA-B8
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painless goiter with infiltration of lymphocytes and plasma cells (germinal centers) associated with increased risk of papillary thryoid carcinoma or thryoid lymphoma
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Hashimoto's disease
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represent end-staged Hashimoto's disease with fibrosed thryoid
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Reidel's struma
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is using I-131 isotope for diagnnostic purposes causing increased risk for developing carcinoma
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No
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Non-toxic goiter secondary to increased TSH stimulation
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diffuse colloid goiter
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Causes of diffuse colloid goiter
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Iodine deficiency
dyshormogenetic goitrogens |
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nodular colloid goiter
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end-stage of diffuse colloid goiter presenting with nodules that are either cold or hot
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what kind of nodule doesn't uptake I-131 isotope and is associated with increased risk of thryoid carcinoma
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cold nodule
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long acting thryoid stimulator
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IgG antibody that stimulates thryoid follicules to secrete thyroxine, mimicks TSH
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cause of exophthalmos in Grave's disease
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accumulations of hydrophilic mucopolysaccharides in extraocular muscles and orbital tissues
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Are there nodules associated with grave's disease
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No, no nodules present
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thyroid gland shows increased amounts of diffuse follicular cells, no lymphocytes or nodules present
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Grave's disease
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what types of adenomas have increased risk of malignancy
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cold nodule in female
solitary nodules in males and children |
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most common thyroid adenoma
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follicular adenoma
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most common thryoid carcinoma
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papillary carcinoma
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thyroid carcinoma associated with lymph node metastasis
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papillary carcinoma
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thyroid disease associated with orphan Annie eye nuclei and psammoma bodies
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papillary carcinoma
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thyroid carcinoma associated with blood stream metastasis
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follicular carcinoma
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how can one distinguish an encapsulated follicular carcinoma from a benign adenoma
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capsular and/or vascular invasion
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medullary carcinoma
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tumor of parafollicular cells (C cells)
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autosomal dominant carcinoma associated with MEN syndromes
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medullary carcinoma
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solid cell tumor with dense fibrous stroma and amyloid deposits
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medullary carcinoma
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rapidly growing, highly invasive thyroid carcinoma
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undifferentiated carcinoma of the thyroid
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basic functioning cell of the parathyroid gland
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Chief cell
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what composes the majority of the parathyroid gland
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50% occupied by adipocytes
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where do the superior and inferior parathyroid glands arise from
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superior - 4th branchial pouch
inferior - 3rd branchial pouch |
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where are the parathyroid glands located
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posterolateral to the lower thyroid lobes
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what is the blood supply of the parathyroid glands
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superior thyroid artery
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calcium and phosphate balance seen in parathormone
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increased gut calcium absorption
increased phosphate excretion decreased calcium excretion increased osteoclastic stimulation |
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calcium and phosphate balance seen in calcitonin
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increased phosphate excretion
increased calcium excretion inhibits bone resorption of calcium |
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calcium and phosphate balance seen in Vitamin D
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increases gut calcium absorption
stimulates bone resorption of calcium |
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where is 1,25-OH Vit. D3 activated
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biologically activated in the kidney via 1-a-hydroxylase
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All parathyroid glands increase in size
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hyperplasia of parathryoid glands seen in MEN syndromes or kidney disease
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associated with secondary hyperparathyroidism
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renal disease causes hyperplasia of all parathyroid glands
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most common cause of primary hyperparathyroidism
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Adenoma - not all glands are hyperplastic
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palpable mass with serum calcium of > 15 mg/dL, and is adherent to adjacent tissue
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Parathyroid carcinoma
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two common causes of primary hyperparathryoidism
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single adenoma
MEN syndrome |
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manifestation of hyperaparathyroidism
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polyuria, nephrocalcinosis, nephrolithiasis, metastatic calcification, osteitis fibrosa cystica
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Lab findings in hyperparathyroidism
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serum - increased calcium, PTH, alkaline phosphate, decreased phosphate
urinary - increased cAMP, hydroxyproline, calcium, phosphate |
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manifestations of hypoparathyroidism
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numbness and tingling, tetany, cataracts, calcification of basal ganglia,
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Lab findings in hypoparathyroidism
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serum - decreased calcium, PTH, increased phosphate
urinary - decreased phosphate and calcium |
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associated with QT interval prolongation
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hypoparathyroidism
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associated with myasthenia gravis
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thymus hyperplasia
thymoma |
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thymic follicles may participate in formation of autoantibodies
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myasthenia gravis - autoantibodies against ACh receptors at NMJ
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3 neoplasms of thymus gland
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thymoma
germ cell neoplasm lymphoma |
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most common pineal gland tumor
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germinoma - such as seminoma
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what are the 4 layers of the adrenal gland from top to bottom and what they each secrete
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zona glomerulosa - mineralcorticoids
zona fasiculata - glucocorticoids zona reticularis - androgens and some estrogen medulla - catecholamines (mainly epinephrine) |
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what layer of the medulla is not controlled by ACTH
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zona glomerulosa - controlled by serum potassium or RAAS
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makes up the bulk of the adrenal gland (80%)
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zona fasiculata
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what part of the adrenal gland is not essential for life
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adrenal medulla
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what part of the adrenal gland still function if the pituitary is knocked out
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zona glomerulosa
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two syndromes caused by functional adenomas
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Cushing's syndrome - excess cortisol
Conn's syndrome - excess aldosterone |
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adrenal tumor with hemorrhage and necrosis
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adrenal carcinoma
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most common cause of femal pseudohermaphroditism
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congenital hyperplasia of adrenal gland
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what causes the hyperplasia in congenital hyperplasia of the adrenal gland
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decreased cortisol production leads to increased ACTH feedback and hyperplasia
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3 congenital hyperplasia deficiencies
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21-OH
11-OH 17-OH |
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most common congenital hyperplasia deficiency
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21-OH deficiency
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associated with decreased aldosterone and cortisol with increased androgen production - hypotensive male
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21-OH deficiency
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associated with decreased cortisol with increased deoxy-corticosterone and androgens - hypertensive male
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11-OH deficiency
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associated with decreased cortisol and androgens with increased aldosterone - hypertension
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17-OH deficiency
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most common cause of cushing's syndrome
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iatrogenic - hospital administered steroids
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secondary causes for cushing's syndrome
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1. basophil adenoma of pituitary (Cushing's disease)
2. ectopic ACTH tumor (small cell tumor of lung) 3. exogenous excessive cortisol |
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primary cause for cushing's syndrome
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bilateral adrenocortical hyperplasia
functioning adrenal adenoma |
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most common cause for Conn's syndrome
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functioning adrenal adenoma
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Are most adrenal adenomas functioning
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No - most are non-functional
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syndrome associated with hypertension, hypokalemic metabolic alkalosis, tetany and paresthesias
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Conn's syndrome
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what causes the tetany and paresthesias in Conn's syndrome
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the alkalosis leads to increased negative charges on albumin which binds calcium leading to hypocalcemia
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Causes for acute adrenal insufficiencies
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1. waterhouse-friderichsen syndrome
2. hypovolemic shock 3. abrupt steroid withdrawal (adrenal glands cannot react in time) |
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effects of acute adrenal insufficiencies
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shock, hypoglycemia, hyperkalmia, hyponatremia
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what is needed for chronic adrenal insufficiency to occur (Addison's Disease)
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loss of at least 90% of the cortex of both adrenals
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causes of primary and secondary Addison's disease
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primary - autoimmune, TB, AIDS, Metastatic tumors
secondary - destruction lesions of hypothalamus and/or pituitary |
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compare effects seen in primary vs. secondary Addison's disease
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primary - hyperpigmentation from increased ACTH/MSH, electrolyte disturbances, hyperkalemic metabolic acidosis, hyponatremia, hypotension
secondary - No hyperpigmentation, No ACTH produced from pituitary so only zona glomerulosa is functioning (no electrolyte disturbances) |
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where is epinephrine and norepinephrine mainly synthesized
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epinephrine - adrenal medulla
norepinephrine - sympathetic chain |
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tumor associated with positive chromaffin reaction with brown reaction with potassium dichromate
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pheochromocytoma
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two sites where neuroblastomas are found
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adrenal medulla - 25%
sympathetic ganglion - mostly |
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small blue cell tumor with pseudorosettes
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neuroblastoma
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which site of neuroblastoma has more increased risk of malignancy
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paraganglioma
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how can you distinguish the site of neuroblastoma
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adrenal medulla - secretes epinephrine
paraganglioma - secretes norepinephrine |
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AD genetic defects of pancreatic B-cell function without B-cell loss
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maturity-onset diabetes of the young (MODY)
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Gestational diabetes
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during pregnancy there is a decrease in ability to use and store carbohydrates
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secretes glucagon
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alpha cells
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secretes insulin
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Beta cells
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secretes somatostatin
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Delta cells in pancreas
*controls how alpha and beta cells make and release glucagon and insulin |
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autoimmune destruction of pancreatic Beta cells
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type I diabetes
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diabetes associated with HLA-B8 DR3 and DR4
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Type I diabetes
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associated with impaired insulin release or defective insulin receptors on target cells
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type II diabets
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associated with family history of diabetes
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type II
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associated with severe hyperglycemia
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type I
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diabetes dependent on insulin
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type I
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diabetes associated with obesity
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type II
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which age population is diabetes more associated with
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adults - both type I and II
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what is the pathogenesis of diabetes
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irreversible glycosylation end products (AGE) accumulate in vessel walls and basement membranes
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3 classic symptoms of diabetes
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polyuria - osmotic diuresis
polydipsia - hyperosmolarity of glucose polyphagia - catabolism of proteins and fat |
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normal fasting plasma glucose and post-glucose load levels
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< 100 mg/dL
< 140 mg/dL |
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Diabete fasting plasma glucose level and post-glucose load levels
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> 126 mg/dL on two occasions
> 200 mg/dL |
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two tests to look for diabetes besides fasting glucose levels
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glycosylated hemoglobin (HbA1c)
urinary and plasma C-peptide |
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how would you look for a patient no keeping their blood sugar in check between visits
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HbA1c - RBC 120 day life span
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normal range for HbA1c
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4-7% of RBC
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peptide that is removed in the cleavage of proinsulin to form insulin
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C-peptide
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which type of diabetes will have very low C-peptide
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type I diabetes
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which has higher concentration of C-peptide, urine or plasma
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urine
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general manifestations associated with diabetes
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retinopathy
cataracts renal failure accelerated atherosclerosis neuropathy xanthoma formation ischemic changes |
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leading cause of blindness in U.S. adults
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DM
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changes in the eye seen in DM
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microaneurysms with hemorrhage
waxy exudates neovascularizations retinal detachment |
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which type of DM is more associated with diabetic nephropathy
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type I
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How can a physician know when a patient is at risk for diabetic nephropathy
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retinal changes occur before renal
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cause for diabetic nephropathy
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hyperfilatration from dilation of afferent arteriole leading to intra-glomerular hypertension
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classic changes seen in diabetic nephropathy
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micro-albuminuria
glomerular hypertrophy thickening of GBM and mesangium |
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type of glomerular disease associated with DM
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nodular glomerulosclerosis
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two other kidney disorders associated with DM
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necrotizing renal papillitis
pyelonephritis |
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most common cause of death in DM
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MI
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cause of diabetic neuropathy
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segmental demyelination
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type of DM associated with ketoacidosis
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type I
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type of DM associated with hyperosmolar nonketotic coma
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type II
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severe dehydration secondary to hyperglycemia diuresis and inadequate water intake
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hyperosmolar nonketotic coma
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loss of fat at the injection site of insulin
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insulin lipoatrophy
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what else does TSH-RH stimulate the release of
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prolactin
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what four things can infiltrate and accumulate in the anterior pituitary
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metastatic cancer
amyloid mucopolysaccharide iron |
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causes of primary Addison's disease
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1. autoimmune
2. TB 3. AIDS 4. metastasis |
