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