6-07 Endo

Front 1

gluagaon/insulin interaction

Back 1

insulin --| glucagon --| insulin (mutually inhibitory)

Front 2

neurophysins (what are they)

Back 2

carrier proteins for oxytocin and ADH produced within paraventricular and supraoptic nuclei, respectivelysubarachnoid hemorrhage vs sellar mass w/ suprasellar extension (pituitary tumor)

Front 3

pituitary apoplexy

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acute bleeding into preexisting pituatiry adenoma -- get acute sx (severe headaches, visual disturbances) on top of chronic mass-effect sx (chronic headaches, hormone deficiencies)

Front 4

suprasellar mass w/ 3 components (solid, cystic, and calcified)

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craniopharyngioma

Front 5

rule of 10s

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features of pheo: 10% hereditary (MEN@, VHL); 10% b/l, 10% extra-adrenal, 10% malignant

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three clinical presentations of glucagonoma

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1) DM; 2) necrolytic erythema; 3) anemia

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MEN I

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hyper parathyroidism (hypercalcemia); pancreatic tumor (gastrin --> zollinger elliso or insulin --> hypoglycemia or VIP --> diarrhea); ppituitary (prolactin, ACTH)

Front 8

what hormone to check if suspect hypothyroidism?

Back 8

TSH (rises below T4 levels drop -- T3 has exponential? feedback effect on TSH)... T3 declines even later

Front 9

branching paipllary structures with interspersed calcified bodies

Back 9

psammoma bodies

Front 10

which glucose transporter is responsive to insulin?

Back 10

glut-4

Front 11

which cells have insulin-depndent glucose transporters (and which glucose transporter is it?)

Back 11

glut 4: adipocytes, skeltal muscle cells

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distribution of glut-1

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red cells, CNS (basal glucose transport)

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distribution of glut-2

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hepatocytes, pancreatic beta-cells (relguation of insulin rlease)

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distribution of glut-3

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placenta, brain, kidney (placental glucose xport)

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distribution of glut-4

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muscle-cells, adipocytes (insulin-mediated)

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distribution of glut-5

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spermatocytes, GI tract (fructose transport)

Front 17

chvostek's sign

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facial muscle excitability due to hyPOcalcemia

Front 18

estrogen's effects on thyroid hormones

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estrogen increases TBG (thyroid binding globulin) levels --> increased total T4, but normal free T4 and T3 -- pts remain euthyroid, normal TSH

Front 19

hypertension with low plasma renin activity

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primary hyperaldosteronism --> hypokalemia, metabolic alkalosis

Front 20

replacment for aldosterone

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9-alpha fludrocortisone

Front 21

small, round, blue neuroblasts

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neuroblastoma: neuroendocrine tumor from neural crest; usu in kids

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drainage of L and R adrenal glands

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just like testes -- L to renal vein, R to IVC; (both via adrenal veins)

Front 23

source of melanotropin

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ant pit (aka MSH = melanocyte stimulating hormone --> production/relase of melanin)

Front 24

embryologic origin of pituitary

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anterior: oral ectoderm; posterior: neuroectoderm

Front 25

alpha subunit in pituitary gland

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common subunit for FSH, LH, TSH, and hCG (speicificity by unique beta subunit)

Front 26

site of prolactin secretion

Back 26

anterior pit

Front 27

hormonal regulation of prolactin secretion

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from hypothalamus: DA inhibits secretion, TRH promotes secretion

Front 28

prolactinoma: symptoms and tx

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sx: amenorrhea (women), galactorrhea (both?); tx: bromocriptine (DA agonist, inhibits prolactin secretion

Front 29

effects of PTH (4)

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1) inc bone resoroption --> Ca and Pi; 2) inc renal reabsorption of Ca; 3) dec renal reabsorption of Pi; 4) increased renal production of Vit D

Front 30

regulation of PTH

Back 30

decreased Ca --> inc PTH

Front 31

net PTH effects (w/o renal dz)

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inc serum Ca++, dec Pi, inc urine Pi, dec bone mass

Front 32

pth effects on osteoblasts/clasts

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directly stims osteoblasts --> indirectly stims osteoclasts

Front 33

regulation of Vit D3 formation

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positive: PTH; negative: Ca, Pi, Vit D3 (self-regulated)

Front 34

effects of calcitriol (vit D3)

Back 34

1) bone resoprtion --> inc Ca and Pi; 2) increases calcium and phosphate reabsorption from intestines

Front 35

renal insufficiency --> effects on Ca, Pi, Alk Phos, PTH

Back 35

renal insufficiency --> impaired Pi secretion --> inc Pi --| Vit D --> dec Ca reabsorption --> inc PTH; NET RESULT: dec Ca, inc Pi, inc PTH, n/c AlkPhos

Front 36

calcitonin: source, effects, regulation

Back 36

SOURCE: C-cells of thyroid (neural crest); EFFECT: inhibits bone resoprtion (opposed PTH); REGULATION: upregulated by Ca++

Front 37

what hormones act on intracellular receptors?

Back 37

steroid/thyroid: Progesterone, Estrogen, Testosterone, Aldosterone, Cortisol, Thyroxine and T3 (all Adrenal cortex products + Thyroid hormones)

Front 38

effects of sex-hormone-binding globulin (SHBG)

Back 38

steroid hormones must travel in blood bound to SHBG b/c they are lipophilic (remember, intracellular receptor); changes in SHBG affects efficacy of hormones; eg inc SHBG --> dec free testosterone --> gynecomastia; dec SHBG --> inc free testosterone --> hirsutism

Front 39

T3 functions

Back 39

4 B's: 1) Brain maturation; 2) Bone growth (synergy with GH); 3) Beta adrenergic effects (on heart); 4) BMR increased (inc NaK pump activity)

Front 40

what causes fluctuation in TBG (thyroxine binding globulin)

Back 40

dec TBG in liver failure, inc TBG in pregnancy

Front 41

which organs depend on glucose for metabolism (normally)

Back 41

brain, RBCs (both use GLUT-1 transporter, insulin-independent

Front 42

whats the insulin-dependent GLUT and on which organs is it found?

Back 42

GLUT-4: skeletal muscle and adipocytes

Front 43

cortisol effects on skin

Back 43

thinning, striae (think cushing's)

Front 44

cortisol effects on bone

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osteoporosis

Front 45

cortisol effects on menstruation

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amenorrhea

Front 46

primary vs secondary hyperaldosteronism

Back 46

renin levels (high in secondary, low in primary)

Front 47

causes of secondary hyperaldosteronism

Back 47

renal artery stenosis, chronic renal failure, CHF, cirrhosis, nephrotic syndrome

Front 48

primary vs secondary adrenal insufficiency

Back 48

skin pigmentation: PRIMARY (addison's) --> inc ACTH --> inc MSH --> hyperpigmentation; SECONDARY: dec ACTH --> dec cortisol, no inc in MSH --> no skin hyperpigmentation

Front 49

adrenal medulla tumors: kids and adults

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adults: PHEOchromocytoma, chromaffin cells (neural crest), episodic HTN/hyperglycemia; kids: NEUROBLASTOMA, can occur anywhere along sympathetic chain, NON episodic, usually malignant

Front 50

what disorders is pheo a/w

Back 50

neurofibromatosis, MEN II, MEN III

Front 51

neurofibromatosis increases risk of which cancers

Back 51

pheochromocytoma, meningioma

Front 52

pheo rule of 10s

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10% extra-renal, 10% b/l, 10% malignant, 10% affect kids, 10% familial, 10% calcify

Front 53

periodicity of sx in pheo, neuroblastoma

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NEUROBLASTOMA: constant; PHEO: relapse/remit (need urine sample to integrate levels)

Front 54

tx for pheo

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phenoxybenzmine (irreversible nonselective alpha blocker), give before beta blocker (otherwise massively inc HTN)

Front 55

MEN I organs

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tumors of: Parathyroid, Pituitary, and Pancreas (Zollinger-ellison, insulinoma, glucagonoma, VIPoma)

Front 56

sx of MEN I

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kidney stones (parathryoid --> inc Ca), stomach ulcers (pancreatic --> Zollinger-ellison --> H++++)

Front 57

Riedel's thyroiditis

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thyroid replaced by fibrous tissue --> hypothyroidism; can extend into neighboring tissues like a malignancy

Front 58

thyroid hormone's effects on skin/hair

Back 58

hypothyroidism --> dry, thick, cool skin; coarse, brittle hair

Front 59

Subacute thyroiditis (de Quervain's)

Back 59

self-limited hypothyroidism following flu-like illness; elevated ESR, **jaw pain**, early inflammation, very tender thyroid gland; can be hypERthyroid at beginning (kinda like jarish-herxheimer rxn)

Front 60

which type of thyroid cancer has poor prognosis?

Back 60

undifferntiated / aplastic (OLDER patients)

Front 61

name the three types of thyroid cancers with good prognosis, + defining features

Back 61

1) PAPILLARY: most common, psammoma bodies, orphan annie (ground glass) nuclei 2) MEDULLARY: sheets of parafollicular C cells in amyloid stroma (MEN II and III) 3) FOLLICULAR: uniform follicles, more malignant (hematog. spread to lung/bones)

Front 62

cause and findings of cretinism

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CAUSE: iodine deficiency; FINDINGS: pot-bellied, pale, puff-faced child with protruding umbilicus and protuberant tongue, + MR (thyroid hormone needed for Brain maturation)

Front 63

relationship between cushings and sugar

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cushing's disease (excess cortisol) --> insulin resistance --> hyperglycemia; other diabeties like sx (weight gain, hypertension, truncal obesity)

Front 64

relationship between acromegaly and sugar

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acromegaly causes insulin resistance (like cushing's) --> hyperglycemia

Front 65

stimuli for GH release

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stress, exercise, hypoglycemia (same as cortisol)

Front 66

sx of hyperparathyroidism

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hypercalcemia --> "Stones, Bones, and Groans" (renal stones, bone pain, weakness/constipation)

Front 67

pseudohypoparathyroidism

Back 67

AR, kidney doesn’t respond to PTH --> hypocalcemia, shortened 4th/5th digits, short stature

Front 68

what hormones counter insulin's effects?

Back 68

CORTISOL (--| response to insulin), EPINEPHRINE (inc glycogenlolysis and lipolysis), GROWTH HORMONE (inhibits cellular uptake of gluc, stims lipolysis), THYROID HORMONE (permits epi's efficts and reqd for GH production), GLUCAGON (inhibits insulin response, promotes catabolism)

Front 69

HLA association of DM type I

Back 69

HLA-DR3 and -DR4

Front 70

kussmaul's respiration

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rapid deep breathing seen in DKA to blow off excess acid

Front 71

signs of DKA

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kussmaul respirations, hyperthermia, psychosis/dementia, dehydration, FRUITY BREATH (acetone)

Front 72

labs in DKA

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inc ketones --> dec HCO3- (anion gap metabolic acidosis); inc H+ --> inc K+ (pulled from inside cells as excess H+ goes into cells); hyper glycemia, leukocytosis

Front 73

complications of DKA

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MUCORMYCOSIS (Mucor or Rhizospus infection, also seen in leukemic patients, tx mucor with capsofungin); CEREBRAL EDEMA, cardiac ARRYTHMIAS, HEART FAILURE

Front 74

mucor vs aspergillus morphology

Back 74

both MOLDs with hyphae, MUCOR has WIDE angle branching, ASPERGILLUS has ACUTE angle (<45') branching

Front 75

causes of central DI

Back 75

pit tumor, trauma, surgery, histiocytosis X

Front 76

causes of nephrogenic DI

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hypercalcemia, Lithium, Demeclocycline (a Tetracycline) --> used as tx for SIADH

Front 77

tx for NDI

Back 77

HCTZ, indomethasin, amiloride (K+ sparing diuretic)

Front 78

tx for central DI

Back 78

ADH analog (desmopressin = DDAVP)

Front 79

what drugs can cause SIADH

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cyclophosphamide

Front 80

carcinoid tumor, rule of thirds

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1/3 metastasize, 1/3 present with 2nd malignancy, 1/3 multiple

Front 81

tx for carcinoid syndrome

Back 81

octreotide (somatostatin analog, neutralizes 5-HT)

Front 82

side effects of first-generation sulfonylureas

Back 82

disulfiram like reaction

Front 83

role of sertoli cells

Back 83

produce MIF, inhibin (--| FSH), ABP, and promote spermatogenesis

Front 84

concentrically calcified structures found in thyroid tumors

Back 84

psammoma bodies -- papillary thyroid cancer

Front 85

marfinoid habitus

Back 85

tall, slender, disporoportionately long arms -- a/w MEN III (MEN IIb)

Front 86

mediators of islet cell destruction in DM type I

Back 86

T- cells (Abs are believed to be generated in response to cell destruction)

Front 87

consequences of celiac disease

Back 87

fat malabsorption --> dec nutrients, minerals, ADEK

Front 88

where is ADH synthesized?

Back 88

in the hypothalamus (paraventricular or supraoptic nuclei, along with oxytocin)

Front 89

damage to post pit vs hypothalamus

Back 89

damage to post pit causes only transient DI-like sx (polydipsia, polyuria), because ADH from hypothalamus eventually enters circulation directly from pituitary stalk; hypothalamic damage, however, is permanent

Front 90

how does excess of sex hormones produce short stature?

Back 90

sex hormones promote growth (initially early growth spurt), but also close epiphyseal plates (eventually these kids are short)

Front 91

histo appearnce of medullary carcinoma of the thyroid

Back 91

uniform polygonal / spindle-shaped cells w/ extracellular amyloid deposits; secreted calcitonin forms AMYLOID

Front 92

types of amyloid

Back 92

AL: primary (mult myeloma, waldenstroms); AA: secondary (chronic inflam disease like TB, RA, osteomyelitis, syphilis); A-BETA (alzheimers); CALCITONIN (medullary carcinoma of thyroid); AMYLIN (DM type II)

Front 93

histo appearance of anaplastic thyroid cancer

Back 93

pleomorphic giant cell nests w/ occasional multinucleated cells

Front 94

histo appearance of papillary thyroid cancer

Back 94

well differentiated, branching structures with interspersed calcified bodies

Front 95

role of hCG in infertility

Back 95

can stimulate LH surge

Front 96

causes of polyuria and polydipsia

Back 96

DM, DI, primary (psychogenic) polydipsia

Front 97

use of indomethacin in NDI

Back 97

inhibits prostaglandins which inhibit ADH

Front 98

what in overweight individuals causes insulin resistance?

Back 98

elevated FFA and serum triglycerides

Front 99

hCG and TSH -- similarities and implications

Back 99

both share beta unit, so some homology between the two. Excessively high hCG levels (eg germ cell testicular/ovarian tumors) can cause hyperthyroidism

Front 100

consequences of untreated prolactinoma

Back 100

prolactin --| GnRH (remember no menstruation while prolactin is high -- sex during first 6 months) ==> amenorrhea, anovulation, hypogonadism; direct effect at breast ==> galactorrhea; can see normal sequelae of hypoestrogen (osteoporosis, hot flashes, etc)