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75 Cards in this Set

  • Front
  • Back
What are the two systems involved in maintaining homeostasis?
• autonomic nervous system
• endocrine system
What hormones control the release of growth hormone?
• growth hormone-releasing hormone (GHRH)
• somatostatin (SS)
What hormones control the release of prolactin?
• prolactin releasing-inhibiting hormone (PIH)
• prolactin releasing hormone (PRH)
How is the anterior lobe of the pituitary gland stimulated?
from hormones via venous vessels from the posterior pituitary (hypothalamic-hypophyseal portal system)
Where is ADH and oxytocin produced and stored?
• produced in the hypothalamus
• stored in the posterior lobe
Which anterior pituitary hormones are not regulated by negative feedback?
• prolactin
• growth hormone
The 2 lobes of the thyroid gland are connected by the thyroid isthmus. The thyroid isthmus is located at approximately which tracheal ring?
2nd tracheal ring
Which muscles cover the thyroid gland?
• Anteriorly: platysma
• Anterolaterally: sternocleidomastoid, sternohyoid, & sternothyroid muscles
What arteries supply the thyroid gland?
• Superior thyroid arteries (1st branch of the external carotid artery)
• Inferior thyroid arteries (a branch of the thyrocervical trunk that arises from the subclavian artery)
Which veins drain the thyroid gland?
superior, middle, and inferior thyroid veins
Which nerve can be injured during thyroid surgery?
recurrent laryngeal nerve
What are the 2 groups of hormone-producing cells of the thyroid gland?
• Follicular cells: produce, store, and release T4 and T3
• Parafollicular cells (C cells): secetes calcitonin
Which thyroid hormone is more active?
What is the storage form of thyroid hormone?
iodinated thyroglobulin
What is the function of calcitonin?
• inhibits osteoclast activity
• decreases serum calcium levels
How is hyperthyroidism diagnosed?
• history & physical
• increased radioactive iodine uptake
• increased T3 & T4 levels
How can you determine wheter hyperthyroidism is putuitary dependent or independent?
• Pituitary-independent: serum TSH levels are decreased
• Pituitary-dependent: serum TSH levels are increased
What is the immunoglobin that is asociated with Graves disease?
TSAb (a circulating IgG)
What are treatment options for hyperthyroidism?
• medically:
- Iodine (potassium iodine; Lugol's solution)
- Propanolol
- Propylthiouracil (PTU)
- Methimazole (Tapazole)

• radioactive iodine ablation

• subtotal or total thyroidectomy
What is the isotope of choice for the radioablation of hyperactive thyroid tissue?
I ^(131)
What is the treatment of choice for hyperthyroidism (Graves disease)?
radioactive iodine ablation
What is the treatment of choice for hyperthyroidism in pregnany women?
subtotal thyroidectomy
What is the a toxic adenoma?
• a solitary tumor of the thyroid gland
• produces excessive amounts of thyroid hormone
• causes clinically overt hyperthyroidism
How does the hyperthyroidism caused by toxic adenoma differ from Graves' disease?
• patients with toxic adenoma do not have associated ophthalmoopathy or pretibial myxedema

* toxic adenoma is not an autoimmune disease
What is Plummer's disease?
toxic multinodular goiter
What is the difference between a "hot" and "cold" nodule?
• a hot nodule is a functional hyperplasia (usually not cancerous)
• a cold nodule is suggestive of carcinoma
What is the treatment for pituitary or hypothalamic hypothyroidism?
hydrocortisone treatment before thyroid replacement therapy
True/False: A solitary nodule/lesion in a man is significantly more likely to be a malignant than a comparable nodule in a women
The correct answer is: True
What is a Pemberton's sign?
• raising the arms above the head, causing venous compression at the thoracic inlet with engorgement of the head and neck and a feeling of strangulation

• indicates compression in patients whose goiter is retrosternal
What is the single most important study in evaluating a thyroid mass?
fine-needle aspiration cytology
What is the treatment of patients with solid nodules that are diagnosed as benign on fine-needle aspiration?
• monitor for 3-6 months
• treat with oral thyroid hormone to suppress TSH stimulation of tumor growth
What is the treatment for patient with a thyroid nodule suspected of being cancer?
• intial procedure is thyroid lebectomy and isthmectomy
• if frozen-section analysis shows cancer, total thyroidectom is performed
What are different types of thyroid carcinomas?
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma
• Lymphoma
Which is the most common thyroid malignancy in the US, occuring in approximately 70%-80% of cases?
papillary carcinoma
Which type of thyroid carcinoma has the worst prognosis?
medullary carcinoma
Which nodule is more suspicious for cancer, lateral or midline nodules?
lateral nodules
What are symptoms of hyperparathyroidism?
"stones, bones, moans, groans, and psychic overtones"
• renal calculi
• decalcified bones
• puptic ulcer and pancreatitis
• diffuse joint and muscle pains
• depression or worsening psychosis
What are the different types of hyperparathyroidism?
• Primary: hyperplasia, adenoma or carcinoma
• Secondary: from hypocalcemia
• Tertiary: chronnic form of secondary type
What are the 3 distinct lesions that can cause primary hyperparathyroidism?
• parathyroid adenoma (85%)
• parathyroid hyperplasia (15%)
• parathyroi carcinoma (<1%)
What are some causes of secondary hyperparathyroidism?
• renal failure
• vitamin D deficiency
What is the most common cause of outpatient hypercalcemia?
primary hyperparathyroidism
What is the most frequent source of inpatient hypercalcemia?
malignancy (either by paraneoplastic syndrome or bony metastases)
What are some tumors of epithelial origin that may produce PTH and cause hypercalcemia?
• bronchial squamous cell carcinoma (most common)
• breast tumors
• renal tumors
• ovarian tumors
What are other cause of hypercalcemia that do not elevate parathyroid-hormone-related peptide (PTHrP)?
• bone destruction by primary cancer (ex. multiple myeloma)
• granulomatous lesions activating Vitamin D (ex. sarcoidosis)
• lytic bone metastases
• Vitamin D analogues (ex. lymphoma)
What are options for medical management of hypercalcemia?
• saline
• loop diuretics
• drugs (ex. bisphosphonates, calcitonin)
• acute dialysis
What is the surgical treatment for a single gland adenoma?
resection of the tumor
What is the surgical treatment of parathyroid hyperplasia?
subtotal (3½ gland) resection
What are the arteries that supply the adrenal gland?
superior, middle, and inferior adrenal arteries
Where do the left and right adrenal veins drain?
• right adrenal vein drains into the inferior vena cava
• left adrenal vein drains into the left renal vein
What is unusual about the innervation of the adrenal medulla?
there are no postganglionic cells
What are the 3 layers of the adrenal cortex and what hormones does each layer produce?
• Outer zona glomerulosa: secretes mineralocorticoids (ex. aldosterone)
• Middle zona fasiculata: secretes glucocorticoids (ex. cortisol)
• Inner zona reticularis: secretes adrenal androgens (ex. progesterone, androgen)
What is the imaging modality of choice for adrenal cortical carcinomas?
CT scan
What is the treatment of choice adrenal carcinoma?
surgical excision with removal of all visible tumors

• adrenalectomy and excision of involved regional lymph nodes (in early disease)

• ipsilateral nephrectomy and resection of contiguous structures or hepatic metastases with presence of local invasion of visceral metastases
What is the organ of Zuckerkandl?
• an area of chromaffin tissue inferior to the take-off of the inferior mesenteric artery and anterior to the aorta
• a possible location of pheochromocytoma
Surgical excision is the standard of care for pheochromocytoma. What must be done first to prepare the patient for surgery?
administration of the alpha-adrenergic blocking agent phenoxybenzamine to control blood pressure
Adrenal insufficiency is an important postoperative complication of adrenalectomy. What are common signs and symptoms of adrenal insufficiency?
• abdominal pain
• fatigability
• hyperkalemia
• hyponatremia
• nausea/vomiting
• postural hypotension
• weakness
When should an adrenal incidentaloma be excised?
• if its hyperfunctional
• larger than 6 cm (due to high likelihood of malignancy)
Which neurotransmitters are pre- and post-ganglionic?
• pre-gangilonic: ACH
• post-ganglionic: epinephrine
The effect of epinephrine and norepinephrine are similar in many ways. In what ways do their effects differ?
• Epinephrine activated the reticular formation in the brain, while norepi has little effect

• Epinephrine promotes the breakdown of glycogen to glucose and causes hyperglycemia, while norepi has little effect on blood sugar
How can very low and very high levels of ACTH help differentiate the etiology of Cushing's syndrome?
• very low levels of ACTH indicate hyperadrenocorticism due to primary adrenal causes (ex. adenoma, nodular hyperplasia, or carcinoma)

• very high levels of ACTH are diganostic for a pituitary adenoma or ectopic ACTH secretion
What is the most common cause of ectopic ACTH production?
• bronchial carcnoids
• lung cancer
What is the treatment of choice for a solitary adrenal adenoma?
unilateral adrenalectomy
What is Waterhouse-Friderichsen Syndrome?
• hemorrhagic necrosis of the adrenal gland during the course of meningococcemia
• causes marked hypotension, purpura, fever, shock
What are the 4 multiple endocrine neoplasia syndromes?
• MEN-1
• MEN-2A
• MEN-2B
• Familial medullary thyroid carcinoma
What is MEN-1?
• parathyroid hyperplasiam
• pituitary adenoma (prolactin is most common)
• pancreatic islet cell carcinoma
• carcinoid tumors and lipomas
What is the most common endocrine disorder in MEN-1?
primary hyperparathyroidism (occurs in 90% of cases)
What is the most common functional and non-functional islet cell neoplasm of MEN-1?
• functional: gastrinoma
• non-functional: islet cell neoplasm that secretes pancreatic polypeptide
What is MEN-2A?
• medullary thyroid cancer
• pheochromocytoma
• primary hyperparathyroidism
What is MEN-2B?
• medullary cancer of the thyroid
• pheochromocytoma
• gangloneuromas
What are characteristics of Familial Medullary Thyroid Carcinoma?
• medullary thyroid carcinoma as the their only inherited endocrine disorder
• arised from the parafollicular (or C cells) of the thyroid
What is the gene responsibile for MEN-2A, MEN-2B, FMTC?
RET protooncogene on chromosome 10
What is the treatment for MEN-1?
• resection of pituitary adenoma
• parathyroidectomy
• pharmacologic or surgical management of pancreatic tumor
What is the treatment for MEN-2?
• resect pheochromocytoma
• total parathyroidectomy
When should a RET-positive patients with MEN-2A undergo total thyroidectomy? with MEN-2B?
• MEN-2A: before 6 years-old
• MEN-2B: before 6 months-old
What is the characteristic phenotype of MEN-2B?
• bumpy tongue
• hyperflexible joints
• marfanoid habitus
• prognathism
• puffy lips