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38 Cards in this Set
- Front
- Back
What are etiologies of Cushing’s syndrome? Is ACTH always elevated?
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increased cortisol due to: 1. Cushing’s disease (primary pituitary adenoma) increased ACTH 2. Primary adrenal (hyperplasia/neoplasia) decreased ACTH 3. Ectopic ACTH production (ie- small cell lung ca) increased ACTH 4. Iatrogenic, decreased ACTH
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Describe the clinical picture of Cushings.
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HTN, wt gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin change (thinning, striae), osteoporosis, immune suppression
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T/F Conn’s syndrome is secondary hyperaldosteronism.
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False. Conn’s syndrome is primary hyperaldosteronism, caused by an aldosterone-secreting tumor. Results in HTN, hypokalemia, metabolic alkalosis, low plasma renin.
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Which hyperaldosteronism is associated with high plasma renin?
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Secondary hyperaldosteronism. It is due to renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome. Kidney perception of low intravascular volume results in an overactive renin-angiotensin sysem.
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What is the tx for hyperaldosteronism?
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Spironolactone, a diuretic that works by acting as a aldosterone antagonist.
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What characterizes addison’s disease? (which hormones are elevated or deficient)? Is it associated with HTN or hypotension?
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Primary deficiency of aldosterone and cortisol due to adrenal atrophy, causing hypotension and skin hyperpigmentation. Adrenal atrophy, absence of hormone production, involves all 3 cortical divisions.
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T/F In primary insufficiency decreased pituitary ACTH production is characterized by skin hyperpigmentation.
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False: increased ACTH causes MSH activity & hyperpigmentation
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T/F Neuroblastoma is the most common tumor of adrenal medulla in adults.
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False. Pheochromocytoma is the most common tumor of adrenal medulla in adults. It is derived from chromaffin cells (arise from neural crest). It is associated with neurofibromatosis MEN types II and III.
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Where does neuroblastoma occur?
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Neuroblastoma is the most common tumor of adrenal medulla in children. It can occur anywhere along the sympathetic chain.
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Pheochromocytoma: secrete combination of two molecules
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epinephrine and norepinephrine
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Pheochromocytoma: epidemiology (rule of 10's)
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10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcify, 10% kids, 10% familial
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Pheochromocytoma: symptoms - 5 P's
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(elevated blood) Pressure, Pain (headache), Perspiration, Palpitations, Pallor/diaphoresis --> relapsing and remittant
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Pheochromocytoma: elevations in two lab values
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urinary VMA and serum catecholamines
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Pheochromocytoma: association with two other endocrine diseases
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MEN II and III
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Pheochromocytoma: treatment
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alpha-antagonists
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Multiple Endocrine Neoplasia type I (Wermer's syndrome) - 3 P's
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Pancreas, Pituitary, and Parathyroid tumors
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Multiple Endocrine Neoplasia type II (Sipple's syndrome)
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medullary carcinoma of thyroid, pheochromocytoma, parathyroid tumor, or adenoma
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Multiple Endocrine Neoplasia type III
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medullary carcinoma of thyroid, pheochromocytoma, oral/intestinal ganglioneuromatosis
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Hypothyroidism or hyperthyroidism myxedema is prominent in which one
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hypothyroidism
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Hypothyroidism or hyperthyroidism chest pain, palpitations, arrhythmias
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hyperthyroidism
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TSH is (increased/decreased) in primary hyperthyroidism? In primary hypothyroidism?
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hyper - decreased, hypo - increased
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Graves' disease involves autoantibodies with what mechanism of action?
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stimulation of TSH receptors
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three symptoms of Graves'
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ophthalmopathy, pretibial myxedema, diffuse goiter
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Graves' is a type __ hypersensitivity
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type II
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Hashimoto's thyroiditis: thyroid is (enlarged/not enlarged) and (tender/nontender)
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enlarged, nontender
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Hashimoto's thyroiditis: autoimmune antibodies directed against ---
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microsomes
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Hashimoto's thyroiditis: histology shows (type of cell) infiltrate
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lymphocytes (with germinal centers)
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Subacute thyroiditis (de Quervain's): self-limited (hyper/hypo)thyroidism following ---
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hypothyroidism following flu-like illness
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Subacute thyroiditis (de Quervain's): symptoms include
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jaw pain, tender thyroid gland, early hyperthyroidism
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Thyroid cancer: most common, good prognosis, "ground glass" nuclei, psammoma bodies
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papillary carcinoma
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Thyroid cancer: poor prognosis, uniform follicles
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follicular carcinoma
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Thyroid cancer: calcitonin producing (C cells), sheets of cells
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medullary carcinoma (MEN II and III)
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Thyroid cancer: older patients, horrible prognosis
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undifferentiated/anaplastic
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Cretinism: caused by a lack of dietary --- or defect in --- formation
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iodine (endemic), T4 (sporadic)
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Cretinism: symptoms include
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pot-belly, paleness, puffy face, protuberant tongue, protruding umbilicus
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Acromegaly: caused by excess --- in adults
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growth hormone
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Acromegaly: symptoms include
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large furrowed tongue, deep voice, large hands and feet, coarse facial features
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Acromegaly: in children, leads to ---
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gigantism
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