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150 Cards in this Set

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Overactive endocrine syndrome
most often adenomas; use suppression tests (most do not suppress)
Tumors that do suppress:
prolactinoma (bromocriptine), pituitary Cushings (high dose dexamethasone)
Underactive endocrine syndrome
autoimmune destruction MCC; stimulation tests
Hypopituitarism in adults
non-functioning adenoma MCC, Sheehan's postpartum necrosis (stop lactation)
Hypopituitarism in children
craniopharyngioma (Rathke's pouch remnant) MCC; visual field defects
S/S of hypopituitarism
dec FSH and LH: amenorrhea, dec testosterone in male
Growth hormone functions
muscle growth, gluconeogenesis; release of insulin growth factor (IGF)
IGF
synthesized in liver; bone and cartilage growth
S/S of decreased GH/IGF in children
growth retardation; decreased height and weight
Sleep and arginine infusion
stimulation tests for GH and IGF
S/S of decreased GH/IGF in adults
hypoglycemia
S/S of decreased TSH
secondary hypothyroidism; dec T4, dec TSH; muscle weakness, dry skin
S/S of decreased ACTH
secondary hypocortisolism; dec cortisol, dec ACTH; fatigue; hypoglycemia
Metyrapone
stimulation test for ACTH reserve
Metyrapone action
blocks adrenal 11-hydroxylase -> inc ACTH and 11 -deoxycortisol (proximal to block)
Metyrapone test -> dec ACTH and 11-deoxycortisol
pituitary/hypothalamic dysfunction
Metyrapone test- inc ACTH and dec 11-deoxycortisol
Addison's disease
Diabetes insipidus
loss of ADH (central), refractory to ADH (nephrogenic); always diluting urine
Diabetes Iinsipidus
dec UOsm and inc POsm with water deprivation; vasopressin causes inc UOsm > 50%
causes of diabetes insipidus
pituitary stalk transection, hypothalamic lesion (site for ADH synthesis)
nephrogenic diabetes insipidus
dec UOsm and inc POsm with water deprivation; vasopressin causes inc UOsm < 50%
Causes of Nephrogenic Diabetes Insipidus
lithium, demeclocycline, nephrocalcinosis, severe hypokalemia
Gigantism
GH secreting pituitary adenoma before epiphyses have fused
Acromegaly
GH secreting pituitary adenoma after epiphyses have fused
S/S of acromegaly
cardiomyopathy; large hands, feet, jaw; hyperglycemia
Prolactin
inhibited by dopamine
Prolactinoma
MC pituitary tumor; secondary amenorrhea and galactorrhea; prolactin inhibits GnRH
Rx for prolactinoma
surgery or bromocriptine (dopamine analog)
Other causes of hyperprolactinemia
primary hypothyroidism, drugs
Inappropriate ADH syndrome
hyponatremia < 120 mEq/L; inc UOsm (always concentrating urine)
Causes of inappropriate ADH syndrome
small cell carcinoma lung, CNS injury, chlorpropamide
Rx for syndrome of inappropriate ADH
restrict water; demeclocycline in small cell carcinoma
Serum T4
inc or dec in free hormone or thyroid binding globulin (TBG)
inc Serum T4 and normal TSH
inc TBG; due to inc in estrogen T
inc serum T4 and dec TSH
thyrotoxicosis
dec Serum T4 and normal TSH
dec in TBG; due to anabolic steroids
dec Serum T4 and inc TSH
primary hypothyroidism
dec Serum T4 and dec TSH
secondary hypothyroidism
TSH:
negative feedback with T4 and T3; best screening test
I131 uptake
inc in Graves; dec in thyroiditis, patient taking excess thyroid, hypothyroidism
Causes of inappropriate ADH syndrome
small cell carcinoma lung, CNS injury, chlorpropamide
Rx for syndrome of inappropriate ADH
restrict water; demeclocycline in small cell carcinoma
Serum T4
inc or dec in free hormone or thyroid binding globulin (TBG)
inc Serum T4 and normal TSH
inc TBG; due to inc in estrogen T
inc serum T4 and dec TSH
thyrotoxicosis
dec Serum T4 and normal TSH
dec in TBG; due to anabolic steroids
dec Serum T4 and inc TSH
primary hypothyroidism
dec Serum T4 and dec TSH
secondary hypothyroidism
TSH:
negative feedback with T4 and T3; best screening test
I131 uptake
inc in Graves; dec in thyroiditis, patient taking excess thyroid, hypothyroidism
Cold nodule
non-functioning nodule; no uptake of I131
Hot nodule
functioning nodule; inc uptake I131
Thyroglossal duct cyst
midline cystic mass
Branchial cleft cyst
cyst in anterolateral neck
Acute/subacute thyroiditis
painful thyroid; early thyrotoxicosis; dec I131 uptake
Hashimoto's thyroiditis
MCC hypothyroidism; HLA Dr3/Dr5; inhibitory IgG TSH receptor antibody
Hashimoto's thyroiditis
inc anti microsomal and thyroglobulin antibodies
S/S of Hashimoto's
muscle weakness, periorbital puffiness, dec reflexes, diastolic hypertension, constipation, dry skin
Lab in Hashimoto's
dec T4 inc TSH
Cretinism
maternal hypothyroidism before fetal thyroid developed, genetic disorder
S/S of cretinism
mental retardation; short stature and increased weight; coarse skin
Thyrotoxicosis
any cause of inc thyroid hormone activity; Graves disease, excess hormone, thyroiditis
Hyperthyroidism
inc synthesis of thyroid hormone; Graves disease and toxic nodular goiter
Graves disease
autoantibody against TSH receptor (type II reaction); HLA Dr3
S/S unique to Graves
exophthalmos, pretibial myxedema
S/S of thyrotoxicosis
tachycardia/atrial fibrillation, systolic hypertension, diarrhea, brisk reflexes
Labs in thyrotoxicosis
inc T4, dec TSH, inc glucose, calcium
I131 uptake
inc in Graves, toxic nodular goiter; dec in thyroiditis, excess hormone, hypothyroidism
Rx Graves disease
Beta-blocker; drug to decrease hormone synthesis (propylthiouracil)
Toxic nodular goiter
hyperthyroidism; develops out of a multinodular goiter; no exophthalmos
Goiter
enlarged thyroid; iodine deficiency MCC; relative thyroid hormone deficiency
S/S of hemorrhagic Goiter
rapid enlargement due to hemorrhage into cyst; Rx thyroxine
Solitary thyroid nodule in woman
most often benign (cyst)
Solitary thyroid nodule in man or child
often malignant
Papillary carcinoma thyroid
MC thyroid cancer; radiation exposure; psammoma bodies
Follicular carcinoma thyroid
invades blood vessels
Medullary carcinoma thyroid
parafollicular cells; calcitonin; amyloid (calcitonin conversion)
MEN I syndrome
pituitary tumor, parathyroid adenoma, pancreatic tumor (ZE or Beta-islet cell tumor)
MEN IIa syndrome
medullary carcinoma thyroid, pheochromocytoma, parathyroid adenoma
MEN IIb syndrome
medullary carcinoma thyroid, pheochromocytoma, mucosal neuromas
Alkalotic pH
tetany with normal total calcium, dec ionized calcium and inc PTH
Hypoalbuminemia
dec total calcium, normal ionized calcium and PTH
Tetany
dec ionized calcium level; threshold potential comes closer to resting potential
S/S of tetany
thumb adducts into palm, twitching after tapping of facial nerve
PTH
maintains ionized Ca2+; inc Ca2+ renal reabsorption; dec phosphate/bicarbonate reabsorption in kidneys
Primary HyperPTH
inc Ca2+, hypophosphatemia, inc PTH
Cause of hyperparathyroidism
adenoma MCC, hyperplasia, cancer
S/S of hyperparathyroidism
renal stone, peptic ulcers, pancreatitis, hypertension, metastatic calcification
Secondary hyperparathyroidism
dec Caz+, inc PTH; hypovitaminosis D from renal failure MCC
Malignancy-induced hypercalcemia
inc Ca2+ , dec PTH; all other non-parathyroid causes same results
Causes of hypercalcemia
osteolytic lesions, sarcoidosis, inc vitamin D, PTH-related peptide, myeloma
Tertiary hyperparathyroidism
hypercalcemia developing from secondary HPTH
Primary hypoparathyroidism
dec Ca2+ and dec PTH
Causes of hypoparathyroidism
previous thyroid surgery, autoimmune, DiGeorge syndrome
S/S of hypoparathyroidism
tetany; calcification basal ganglia
Pseudohypoparathyroidism
dec Ca2+ with normal to inc PTH; end-organ resistance to PTH
Other causes of dec Ca2+:
hypomagnesemia (dec PTH), dec vitamin D, DiGeorge
dec Ca2+, dec PTH
primary hypoparathyroidism
dec Ca2+, inc PTH
secondary hyperparathyroidism
inc Ca2+, inc PTH
primary hyperparathyroidism
inc Ca2+, dec PTH
malignancy induced hypercalcemia; other causes hypercalcemia
Waterhouse-Friderichsen syndrome
meningococcemia with bilateral adrenal hemorrhage due to DIC
Addison's disease
autoimmune destruction adrenal cortex MCC, adrenogenital syndrome, metastasis
S/S of Addison's Disease
hypotension (salt loss), hyperpigmentation (ACTH), hypoglycemia
Labs in Addison's Disease
dec sodium, cortisol; inc potassium, inc ACTH
Adrenogenital syndrome
AR; enzyme deficiency; hypocortisolism; hyperpigmentation from inc ACTH
21-Hydroxylase deficiency
inc 17 KS, dec 17 OH, lose salt, hypotension; female pseudohermaphrodite
17-Hydroxylase deficiency
dec 17 KS, dec 17 OH, retain salt, hypertension; male pseudohermaphrodite
11-Hydroxylase deficiency
inc 17 KS, inc 17 OH, retain salt, hypertension; female pseudohermaphrodite
MCC Cushings
long-term corticosteroid therapy
Tests for Cushings syndrome
low/high dose dexamethasone suppression; urine free cortisol (best test)
Normal dexamethasone suppression
cortisol analogue; dec ACTH and inc cortisol
Pituitary Cushings
MCC Cushing's; ACTH secreting pituitary tumor
Lab in Pituitary Cushings
low dose dexamethasone does not suppress cortisol; high dose does suppresses
Adrenal Cushings
adrenal adenoma secreting cortisol; suppressed ACTH
Labs in Adrenal Cushings
no suppression with low/high dose dexamethasone
Ectopic Cushings
ACTH secreting small cell carcinoma of lung; high ACTH and cortisol levels
Labs in Ectopic Cushing's
no suppression with low/high dose dexamethasone
S/S of Cushings
purple stria, truncal obesity, hypertension, DM
Primary aldosteronism
benign adenoma in zona glomerulosa
S/S of primary aldosteronism
hypertension and muscle weakness (hypokalemia), no pitting edema
Labs in primary aldosteronism
hypernatremia, hypokalemia, metabolic alkalosis, inc urine K+ and Na+
Pheochromocytoma
benign tumor in adrenal medulla in adults
Associations with pheochromocytomas
von Hippel Lindau, neurofibromatosis, MEN IIa and IIb
S/S of pheochromocytoma
labile hypertension, anxiety, sweating, headache
Labs in pheochromocytoma
inc 24 hr urine for VMA and metanephrines
Neuroblastoma
malignant tumor adrenal medulla child; widespread metastasis; hypertension
Beta-islet cell tumor (insulinoma)
benign tumor; hypoglycemia, inc insulin and C-peptide
Patient taking excess insulin
hypoglycemia, inc insulin, dec C-peptide
Glucagonoma
malignant a-islet cell tumor; hyperglycemia and rash
Zollinger Ellison syndrome
malignant islet cell tumor secreting gastrin; peptic ulcers
Somatostatinoma
malignant delta islet cell tumor; DM, malabsorption, cholelithiasis, achlorhydria
VIPoma
malignant islet cell tumor; diarrhea, hypokalemia, achlorhydria
DM
organ damage correlates with glycemic control
Type 1 DM
young, thin person; no insulin; HLA DR3/4; insulitis; islet cell antibodies; ketoacidosis
Type 2 DM
older person; obese; relative insulin deficiency (dec insulin receptors, postreceptor problems)
Type 2 DM
family history; fibrotic islet cells with amyloid; hyperosmolar nonketotic coma
inc in Non-enzymatic glycosylation
glucose attaches to amino acids in basement membranes
Non-enzymatic glycosylation
inc in vessel permeability producing hyaline arteriolosclerosis
Osmotic damage in DM
glucose converted into sorbitol by aldose reductase
Osmotic damage in DM
lens (cataracts), Schwann cell (neuropathy), pericytes retinal vessels (microaneurysms)
Pathogenesis of hyperglycemia
inc gluconeogenesis (most important), glycogenolysis
Pathogenesis of hyperlipidemia
no insulin to stimulate capillary lipoprotein lipase; inc chylomicrons/VLDL
Pathogenesis of ketoacidosis
inc oxidation fatty acids with excess acetyl CoA; liver synthesis ketone bodies
Most commons due to DM
neuropathy, blindness, CRF, hyperglycemia, non-traumatic amputation
Glycosylated HbA1
measure of long term glycemic control (8-12 weeks)
Gestational DM
inc placental size, human placental lactogen
Complications of DM
macrosomia (inc muscle/fat from insulin), RDS, newborn hypoglycemia (too much insulin)
Hypoglycemia
insulin/oral hypoglycemics MCC, liver disease; carnitine deficiency
Carnitine deficiency
no Beta-oxidation of fatty acids; all cells compete for glucose