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48 Cards in this Set
- Front
- Back
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What labs are seen in PCOS?
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-hi LH, androstenedione, testosterone, estrone
-low FSH, with LH:FSH ratio of 2:1 or more -More LH |
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What is the main problem in PCOS?
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considered to be a direct result of LH overproduction, with subsequent stimulation of theca cells to produce androgens
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What labs are seen in menopause?
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low progesterone, low estrogen, hi LH, hi FSH, with FSH:LH ratio of 2:1 or more
-More FSH |
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What clinical features are seen in SIADH?
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hyponatremia and cerebral edema +/- hypertension
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What is SIADH?
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Excess ADH secretion from the posterior pituitary, causing excess water absorption at the kidney
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What is panhypopituitarism?
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-decreased production of all the pituitary homones: TSH, GH, ACTH, LH, and FSH
-Causes: pituitary tumor, postpartum pituitary necrosis (Sheehan's syndrome) |
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What is the cause of Diabetes Insipidus?
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Caused by ADH deficiency secondary to decreased secretion by the posterior pituitary
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What are clinical findings of Diabetes Insipidus?
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Polyuria, polydipsia
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What is Conn's disease?
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-due to benign adrenal adenoma
-overproduction of aldosterone -hypernatremia -hypokalemia -metabolic alkalosis -low renin levels |
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What are some causes of Cushing's syndrome?
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Due to any cause for increased glucocorticoids:
-adrenal adenoma (overproducing cortisol) -adrenal carcinoma (overproducing cortisol) -Cushing's disease (pituitary ACTH-producing adenoma) -small cell lung carcinoma (with paraneoplastic production of ACTH) -prolonged use of glucocorticoids |
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What is the screening for Cushing's syndrome?
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-24 hour urinary cortisol; confirm diagnosis with dexamethasone suppression test
-5'HIAA is final common metabolite of cortisol |
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What is the rule of 10s for pheochromocytoma?
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-10% bilateral
-10% familial-->MEN II, NF, von Hippel Lindau -10% malignant -10% kids -10% extrarenal -10% calcify |
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How do you screen for pheochromocytoma?
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-Best: 24 hours urinary VMA
-Next best: 24 hour urinary metanephrines -Next best: 24 hour urinary catecholamines |
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What is a neuroblastoma?
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-Malignant tumor of the adrenal nedulla or sympathetic chain ganglion or bothe
-produces excess NE |
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What is a typical presentation for neuroblastoma?
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-peak age less than 3 years old
-presenting sign of enlarging abdomen -hypertension -irritability due to bony mets -respiratory distress from mets to thorax -bowel and urinary obstruction from mets to pelvis -gait disturbance and incontinence from mets to spinal cord -severe diarrhea secondary to secretion of VIP |
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What is the main problem in Addison's disease?
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Decreased aldosterone production
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What problems are seen secondary to the main hormone disturbance in Addison's?
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-hyponatremia
-hypotension -hyperkalemia -excess anterior pituitary production of POMC=excess ACTH and MSH-->hyperpigmentation |
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What labs are seen with secondary hyperthyroidism?
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high TSH, high T3, hgh free T4
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What labs are seen with secondary hypothyroidism?
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low TSH, low T3, low free T4
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Treatment for Grave's disease
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propylthiouracil
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Treatment for Hashimoto's Thyroiditis
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levothyroxine
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What is Plummer's Disease?
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-nodular toxic goiter
-due to reactivation and hyperactivity of isolated nests of cells within the thyroid gland -hyperthryoid state, but produces hypothryoid symptoms -low TSH levels (producing the hypothryoid symptoms) because of negative feedback to the anterior pituitary of thyroid hormones T3 and T4 |
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What type of thyroid state is Diffuse simple goiter and what is the treatment?
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-Hypothyroid
-Tx: iodine |
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What thyroid condition present with hyperthryoid followed by hypothyroid symptoms?
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DeQuervain's thyoiditis/Subacute Thyroiditis/Granulomatous Thyroiditis
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What finding are normal in sick euthryoid syndrome?
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normal TSH levels
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In thyroid carcinomas, what thyroid hormone levels are seen?
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Normal, because it is just one nodule of the thyroid that is not functioning properly
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What thyroid hormone levels are often seen in a follicular adenoma?
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often hyperthyroid
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Describe papillary carcinoma of thyroid.
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-most common type
-best prognosis -most often females in their 20s -psammoma bodies (calcified spheres) -associated with prior radiotherapy of neck |
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Describe follicular carcinoma of thyroid.
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-middle-aged patients
-poorer prognosis than papillary |
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Describe anaplastic carcinoma.
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-VERY aggressive.
-elderly patients |
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Describe medullary carcinoma of the thyroid.
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-late middle age/early elderly
-parafollicular C cells tumor -produces high amounts of calcitonin=hypocalcemia -can occur spontaneously or as a part of MEN type 2A or 2B |
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What is the role of PTH on overall serum phosphate and calcium levels?
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-overall decrease in serum phosphate levels
-overall increase in serum calcium |
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What are the lab findings in primary hyperparathyroidism?
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-hi PTH, hi calcium, lo phosphate
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What are the lab findings in secondary hyperparathyroidism?
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-hi PTH, lo calcium, hi phosphate
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What is the cause of primary hyperparathyroidism?
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Pathology of the parathyroid gland
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What is the cause of secondary hyperparathyroidism?
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low calcium with resulting response of activity by parathyroid gland
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What are the lab findings in hypoparathyroidism?
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results in lo PTH-->lo calcium, hi phosphate
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What is the cause of hypoparathyroidism?
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Lack of parathyroid activity, for example with accidental removal with thyroidectomy
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What is the cause of pseudohypoparathyroidism?
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PTH receptors are non-functional, so the tissues that PTH normally stimulate do not respond
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What are the lab findings with pseudohypoparathyroidism?
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hi PTH, lo calcium, hi phosphate
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Describe components of diabetic glomerular injury.
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-Kimmelstiel-Wilson nodules
-nodular schlerosis -thickened BM, hyaline arteriocleriosis |
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What substance secreted by the placenta leads to gestational diabetes?
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human placental lactogen (hPL)
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What enzyme is lacking in MODY?
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glucokinase
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What does a defect in glucokinase cause in MODY?
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-prevents cells from being able to adequately phosphorylate the glucose that is made available to them
-without phosphorylation, glucose cannot be used and is released back into the serum=hyperglycemia |
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What is the inheritance pattern of MENs?
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-autosomal dominant
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Describe MEN type I=Wermer's Syndrome
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-Adrenal cortex-->adrenal adenoma often hyperfunctioning with Conn's, Cushing's, or Virilization
-Pituitary--> adenoma; visual disturbance -parathyroid-->adenoma; hyperparathyroidism=hi PTH, hypercalcemia -pancreas-->gastrinoma; hi gastrin=Zollinger-Ellison syndrome, peptic ulcers, or insulinoma |
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Describe MEN type IIa=Sipple's Syndrome
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-Adrenal medulla-->pheochromocytoma
-thyroid medulla-->medullary thyroid CA, hi calcitonin, hypocalcemia -parathyroid-->adenoma, hyperparathyroidism, hi PTH, hypercalcemia |
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Describe MEN Type IIb=MEN Type 3
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adrenal medulla-->pheochromocytoma
thyroid medulla-->medullar thyroid CA, hi calcitonin, hypocalcemia mucosal neuromas marfanoid features |
