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79 Cards in this Set
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- Back
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Hormone inc/decr in Cushing's
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Increased cortisol
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Hormone inc/decr in Conn's syndrome
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Increased aldosterone
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Hormone inc/decr in Addison's disease
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Deficient aldosterone and cortisol
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Hormone inc/decr in Grave's disease
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TSH-> increased T4
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Cause of Cushing's disease
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Primary pituitary adenoma-> increased ACTH-> increased cortisol
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Cushing's syndrome etiologies with increased ACTH
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Cushing's disease (primary basophilic pituitary adenoma)
Ectopic ACTH production (SCLC) |
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Cushing's syndrome etiologies with decreased ACTH
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Primary adrenal hyperplasia/neoplasia
Iatrogenic (chronic steroids) |
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MC pit tumor
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Prolactinoma w hyperprolacinemia
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Staining of Prolactinoma w hyperprolactinemia
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chromophobic
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Effect of prolactinoma on women
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amenorrhea
galactorrhea |
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Cuases of prolactinoma
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hypothal lesions
Meds (methyldopa, reserpine) that interfere w dopamine secretion (inh prolactin) Estrogen therapy |
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Second MC pituitary tumor
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Somatotropic adenoma w hypersecretion of growth hormone
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Staining of somatotropic adenoma
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Acidophlic
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Liver effects of somatotropic adenoma
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Secondary hyperproduction of somatomedins by liver
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End organ effects of somatotropic adenoma
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End organ effects: caused by growth hormone and somatomedins, esp IGF-1/somatomedin-C
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When does gigantism occur in somatotropic adenoma
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If adenoma develops begfore epipthyseal closure
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When des acromegaly occur in somatotropic adenoma
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if adenoma develps after epiphyseal closure
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Characteristics of acromegaly
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Overgrowth of jaws, face, hands and feet, generalized enlargement of viscera, hyperglycemia, osteoporosis, hypertension
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Effects of corticotropic adenoma and hypersecretion of ACTH
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Increased production of adrenal cortical hormones (hypercorticism)
AKA Cushing's syndrome |
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Cuase of cushing's diseases
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Basophilic adenoma, a corticotropic adenoma of the pituitary
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Cushing syndrome
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hypercorticism regardless of cause
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Small cell carcinoma of lung: endocrine manifestations?
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Cushing syndrome secondary to ectopic ACTH procution
SIADH |
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Simmond's disease
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This is pituitary cachexia or generalized panhypopituitarism
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Types of pituitary cachexia
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Pituitary tumors
Sheehan syndrome |
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Sheehan syndrome
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Postpartum pituitary necrosis
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Cause of Sheehan syndrome
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Ischemic necrosis of pituitary gland; associated w/ hemorrhage and shock during childbirth
Loss of gonadotropins, then subsequent loss of thyroid-sti mulating hormone (TSH) and ACTH |
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MC cause of SIADH
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Small cell carcinoma of the lung (ectopic production of ADH)
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Clinical features of SIADH
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Dilutional hyponatremia due to water retention
Reduced serum osmolality Inability to dilute urine--> higher than appropriate urine osmolality Absence of hypokalemia Absence of hypotension |
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Presentation of SIADH
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Vague, w/ confusion, nausea, irritability, and later seizures followed by coma.
NO EDEMA |
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Treatment of SIADH
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Restriction of fluid intake
Demethylchlortetracycline (if water restriction is poorly tolerated) Hypertonic saline rarely in severe cases Frequent measurement of plasma osmolality and body wt |
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characteristics of Type II DM
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Positive family history is MORE common than in type I disease
Begins in middle age usually; more likely to be assoc w obseity Much more common than type I Due to increased insulin resistance |
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Causes of increased insulin resistance
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Decreased cell membrane insulin receptors
Post-insulin receptor dysfunction Impaired processing of proinsulin to insulin Decreased sensing of glucose by beta cells Impaired fxn of intracellular carrier proteins |
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Characteristics of Type II DM
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Ketoacidosis is unusual
Plasma insulin levels usually normal or increased; thus insulin is not required usually Mild carbohydrate intolerance can most often by managed by diet and oral antidiabetic agents |
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Which pts need insulin?
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T1DM pts, eventually T2DM pts
T2DM pts with MI, Infection, Need surgery Emergency tx of hyperkalemia (along w/ administration of glc) |
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Emergent tx of hyperkalemia
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Insulin plus glucose
Insulin moves potassium from extracellular to intracellular compartment Glucose keeps blood glc from falling after insulin administration |
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Mass effects of apituitary adeoma
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Can impinge on optic chiasm, leading to bitemporal hemianopia
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What is a good treatment of pituitary adenoma bsides surgery
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Bromocriptine (dopamine agonist) causes shrinkage
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Findings of acromegaly
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Large tongue w deep furrows
Deep voice Large hands and feet Coarse facial fetaures Impaired glc tolerance (insulin resistance) Increased GH in children leading to gigantism |
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Medical treatment of acromegaly
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Octreotide
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Normal causes of increase in growth hormone
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Stress
Exercise HYPOGLYCEMIA |
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Test for increased growth hormone
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Oral glucose tolerance test
(if GH still high w high glc, then GH is increased?) |
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Symptoms of Sheehan's syndrome
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Fatigue
Anorexia Poor lactation Loss of pubic and axillary hair |
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Effects of deficiency of TSH
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Secondary hypothyroidism
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Effects of deficiency of gonadotropins
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Preadolescent kids: retarded sexual maturation
Adults: loss of libido, impotence, loss of muscular mass, decreased facial hair in men, amenorrhea and vaginal atrophy in women |
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Effects of deficiency of growth hormone
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Kids: pituitary dwarfism
Adults: Increased insulin sensitivity leading to hypoglycemia Decreased muscle strength Anemia |
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Effects of deficiency of ACTH
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Secondary adrenal failure
NO hyperpigmentation of skin b/c lack of both ACTH and beta-melanocyte-stimulating hormone |
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What is waterhouse-freiderichsen syndrome
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Acute adrenocortical insufficiency caused by adrenal hemorrhage after meningococcal septicemia
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Most common tumor of adrenal medulla in adults
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Pheochromocytoma
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Where does a pheochromocytoma come from?
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Deived from chromaffin cells from the neural crest
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Diseases associated w pheochromocytomas
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Neurofibromatosis
MEN type II and III von Hippel-Lindau disease |
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What do you find in the urine in pheochromocytoma?
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VMA (increased urinary excretion of catecholamines and their metabolites--metanephrine, normetanephrine, vanillylmandelic acid)
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Most common tumor of adrenal medulla in children
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Neuroblastoma
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Where can a neuroblastoma occur
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MC in adrenal medulla in kids, but can occur anywhere along the sympathetic chain
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What do you find in the urine in neuroblastoma?
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HVA
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How often is a pheochromocytoma benign?
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Usually benign (90%)
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Uncommon but important cause of surgically correctable hypertension
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Pheochromocytoma
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Effects of pheochromocytoma
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Hyperproduction of catecholamines (epi/NE) by the tumor
Leads to episodic hypertension (may be persistent) Increased urinary excretion of catecholamines and their metabolites |
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Is a neuroblastoma malignant or benign?
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Highly malignant
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What is a highly malignant catecholamine producing tumor that occurs in early childhood?
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Neuroblastoma
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Presentation of neuroblastoma
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large abdominal mass (adrenal medulla mass)
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Differentiated form of neuroblastoma
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Ganglioneuroma
May also differentiate into benign cells, leading to a marked reduction in n-myc gene amplification |
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Anatomic lesion in cushing syndrome
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Bilateral hyperplasia of adrenal zona fasciculata
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Conn's syndrome
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Primary hyperaldosteronism
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Cause of Conn syndrome
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ALDO-secreting tumor
Leads to hyperALDO |
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Symptoms of Conn syndrome
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Hypertension
Sodium and water retention Hypokalemia Often hypokalemic alkalosis (metabolic alkalosis) |
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Mnemonic for alkalosis and potassium
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ALKalosis = A Low K+ (hypokalemia)
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Renin levels in Conn syndrome
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Decreased due to negative feedback of increased BP on renin secretion
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Which type of hyperaldosteronism has increased renin
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secondary aldosteronism
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which type of hyperaldosteronism has decreased renin
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primary aldosteronism, or Conn syndrome
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Treatment of hyperaldosteronism
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Spironolactone
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Mechanism of spironolactone used in hyperaldosteronism
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It is a K+-sparing diuretic that works by acting as an aldosterone antagonist
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Causes of secondary hyperaldosteronism
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Renal artery stenosis
Chronic renal failure CHF Cirrhosis Nephrotic syndrome |
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Pathophysiology of secondary hyperaldosteronism
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Kidney perception of low intravascular volume results in overactive renin-angiotensin system
Therefore assoc w high plasma renin |
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Causes of Addison disease
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MC: Idiopathic adrenal atrophy (autoimmune lymphocytic adrenalitis)
Destruction by disease (TB, metatstatic tumor, infxn) Leads to primary deficiency of aldosterone and cortisol |
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Sx of Addison disease
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Hypotension (hyponatremic volume contraction)
Skin hyperpigmentation |
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Cause of skin hyperpigmentation in Addison disease
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MSH, a by-product of increased ACTH from POMC
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Pathology mnemonic for Addison disease
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Adrenal Atrophy and Absence of hormone production; involves All three cortical divisions
Increased ACTH |
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Which kind of hypocorticism (adrenal hypofunction) does NOT lead to skin hyperpigmentation?
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Secondary adrenal insufficiency (decreased pituitary ACTH production)
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Tumor secretes epinephrine, NE, and dopamine
Urinary VMA levels and plasma catecholamines elevated |
Pheochromocytoma
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