Term
|
Definition
Inc Cortisol
Number 1 cause is from exogenous steroids
Disease: from ACTH secretion from pituitary adenoma. Small cell lung cancers and carcinoid tumors can also secrete ACTH
Adrenal adenomas will show low ACTH
HTN, wt gain, moon facies, truncal obesity, buffalo hump, hyperglycemia, skin changes, osteoporosis, amenorrhea, immune suppression |
|
|
Term
| Dexamethasone suppression test |
|
Definition
Dexamethasone is a steroid analog
Normal: suppressed, suppressed
ACTH pituitary tumor: elevated, suppressed
Ectopic ACTH tumor: elevated, elevated
Cortisol producing tumor: elevated, elevated |
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Term
|
Definition
"Conns syndrome"
Adrenal hyperplasia or aldosterone secreting adrenal adenoma
HTN, hypokalemia, metabolic alkalosis, low plasma renin
Tx: surgery or Spironolactone and K sparing diuretic |
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Term
|
Definition
Renal perception of low intravascular volume results in overactive RAAS
Due to renal artery stenosis, CRF, CHF, cirrhosis, nephrotic syndrome
Assoc high plasma renin
Tx: spironolactone |
|
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Term
|
Definition
Chronic adrenal insufficiency due to adrenal atrophy or destruction by disease
Def of cortisol and aldosterone
Hypotension, hyperkalemia, acidosis, skin hyperpigmentation
Spares the medulla
Distinguish from the secondary adrenal insufficiency (dec ACTH) > no skin changes and no hyperkalemia |
|
|
Term
| Waterhouse-Friedrichson syndrome |
|
Definition
Acute adrenal insufficiency due to adrenal hemorrhage
Assoc with N meningitides, septicemia, DIC, endotoxic shock |
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Term
|
Definition
Most common tumor of the adrenal medulla in adults
From chromaffin cells (neural crest)
Most tumors secrete epinephrine, NE and DA
Episodic HTN, urinary VMA elevated
Assoc NF1, MEN 2A and 2B
Tumor removed only after effective a and B blockade
Phenoxybenzamine given first to avoid HTN crisis
10: malignant, bilateral, extra drenal, calcify, kids |
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Term
|
Definition
The most common tumor of the adrenal medulla in children
Anywhere along the sympathetic chain
HVA is the breakdown product of DA
Less likely to develop HTN
Overexpression of n-myc oncogene
Tumor marker bombasin, stain neurofilament |
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Term
|
Definition
| Hashimotos thyroiditis, cretinism, subacute thyroiditis, Reidels thyroiditis |
|
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Term
|
Definition
Most common cause of hypothyroid
Autoimmune against thyroid peroxidase and antithyroglobulin Abs
HLA-DR5 (type 2)
Inc risk of non hodgkins lymphoma
Hurhtle cells, lymphocytic infiltrate with germinal centers
*non tender, enlarged thyroid |
|
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Term
|
Definition
Severe fetal hypothyroidism
Lack of dietary iodine
Sporadic cases caused by defect in T4 formation
*pot bellied, pale, puffy faced, protruding umbilicus, protuberant tongue |
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Term
|
Definition
Self limited following a flu like illness
Granulomatous inflammation
Inc ESR, jaw pain, early inflammation,
*very tender thyroid |
|
|
Term
|
Definition
Thyroid replaced by fibrous tissue
Fixed, hard, rock-like and painless goiter
IgG4 related disease |
|
|
Term
|
Definition
| Toxic multinodular goiter, Graves disease, Thyroid storm |
|
|
Term
| Toxic multinodular goiter |
|
Definition
Focal patches of hyperfunctioning follicular cells working independent of TSH
Mutation in TSH receptor
Hot nodules are rarely malignant
Follicles distended with colloid and lined by flattened epithelium with areas of fibrosis and hemorrhage |
|
|
Term
|
Definition
thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
Amioderone has a lot of iodine |
|
|
Term
|
Definition
AI hyperthyroid with thyroid stimulating immunoglobulins
Proptosis, pretibial myxedema, diffuse goiter
Often presents during stress |
|
|
Term
| Papillary carcinoma of the thyroid |
|
Definition
Most common, excellent prognosis
Orphan annie eyes, psammoma bodies, nuclear grooves
Inc risk with childhood radiation
Assoc with RET gene |
|
|
Term
| Follicular carcinoma of thyroid |
|
Definition
Good prognosis
Uniform follciles
Common in areas low in iodine, RAS mutation |
|
|
Term
| Medullary carcinoma of thyroid |
|
Definition
From C cells which produce calcitonin
Sheets of cells in amyloid stroma
Assoc with MEN 2A and 2B |
|
|
Term
| Primary Hyperparathyroidism |
|
Definition
usually an adenoma
Hypercalcemia, hypercalcuira, hypophosphatemia, Inc PTH, inc Alk phos, Inc cAMP in urine
Osteitis fibrosa cystica: brown fibrous tissue |
|
|
Term
| Secondary Hyperparathyroidism |
|
Definition
Hyperplasia due to dec gut Ca absorption and Inc phosphate
CKD is a common cause
Hypocalcemia, hyperphosphatemia (in CKD), in Alk Phos, inc PTH |
|
|
Term
| Tertiary Hyperparathyroidism |
|
Definition
Refractory hyperparathyroidism resulting from chronic renal disease
Inc PTH, inc Ca |
|
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Term
|
Definition
| Bone lesions due to secondary or tertiary hyperparathyroidism due in turn to renal disease |
|
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Term
|
Definition
Accidental surgical excision, AI destruction or Di George syndrome
Findings: hypocalcemia and tetany
Chvostek's sign- tapping of facial nerve > contraction of facial muscles
Trousseaus sign |
|
|
Term
|
Definition
(alights hereditary osteodystrophy)
Autosomal dominant kidney unresponsiveness to PTH
Hypocalcemia, shortened 4th and 5th digits, short stature |
|
|
Term
|
Definition
Most commonly a prolactinoma
Amenorrhea, galactorrhea, lowlibido, infertility
Bitemporal hemianopsia
Tx: bromocriptine, cabergoline (DA agonists) |
|
|
Term
|
Definition
Excess GH in adults, typically from pituitary adenoma
Large tongue, deep voice, large hands and feet, impaired glucose tolerance
Inc serum IGF-1: failure to suppress serum GH follwing glucose tolerance test
Octreotide for tx |
|
|
Term
| Acute manifestations of DM |
|
Definition
Decreased glucose uptake > hyperglycemia, glycosuria, osmotic diuresis, electrolyte depletion
Increased protein catabolism > increased plasma AA, nitrogen loss in the urine
Increased lipolysis > inc plasma FFAs, ketogenesis, ketonuria, ketonemia |
|
|
Term
| Chronic manifestations of DM |
|
Definition
| NEG- small vessel dz (diffuse thickening of BM) leads to retinopathy (hemorrhage, exudates, micro aneurysms, vessel proliferation), glaucoma, nephropathy (nodular sclerosis, progressive proteinuria, CRF, arteriosclerosis, leading to HTN) |
|
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Term
|
Definition
Sorbitol accumulation in organs with aldose reductase
Neuropathy and cataracts |
|
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Term
|
Definition
Anti islet cell Abs
HLA DR-3 and DR-4 association (type 2)
Islet cell leukocytic infiltration |
|
|
Term
|
Definition
Inc insulin requirements from inc stress
Excess fat breakdown and inc ketogenesis from inc FFA, which are then made into ketone bodies (B hydroxybutyrate > acetocetate)
Kussmal breathing, N/V, fruity breath odor
Hyperglycemia, inc acid, anion gap metabolic acidosis,
Life threatening mucromycosis, Rhizopus, cerebral edema, cardiac arrythmias |
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|
Term
|
Definition
Neuroendocrine cell tumor, especially metastatic small bowel tumors, which secrete high levels of serotonin
If limited to GI tract, no symptoms
Diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease
Inc 5-HIAA in urine, niacin def
Tx: somatostatin |
|
|
Term
| Zollinger Ellison syndrome |
|
Definition
Gastrin secreting tumor of pancreas or duodenum.
Stomach shows rugal thickening with acid hyper secretion
Can cause recurrent ulcers
May be assoc with MEN type 1 |
|
|
Term
|
Definition
"Diamond"
Parathyroid tumors
Pituitary tumors
Pancreatic endocrine tumors
Presents with kidney stones and stomach ulcers |
|
|
Term
|
Definition
"Square"
Medullary thyroid carcinomas secretes calcitonin
Pheochromocytoma
Parathyroid tumors
RET mutation |
|
|
Term
|
Definition
Medullary thyroid carcinoma secretes calcitonin
Pheochromocytoma
Oral/intestinal glanglioneuromatosis assoc with marfainoid habitus
RET mutation |
|
|
Term
|
Definition
RA- lispro, aspart, glulisine
SA- Regular
IA- NPH
LA- Glargine, detemir |
|
|
Term
|
Definition
Dec gluconeogenesis, glycolysis, inc peripheral glucose iptake
Can be used in pts without islet cells
Safe in pregnancy
T- GI upset, lactic acidosis (CI'd in renal failure) |
|
|
Term
|
Definition
Chlorpropamide, tolbutamide, Glyburide, glipizide, glimepiride
Close K channel, so cell depolarizes, Inc insulin release
Requires some islet cell function
T- FG: disulfram reaction. SG: hypoglycemia |
|
|
Term
| Glitazones/Thiazolinediones |
|
Definition
Inc insulin sensitivity in peripheral tissue
Binds to PPAR-g nuclear transcription regulator
T- Weight gain, edema, hepatotox, heart failure |
|
|
Term
|
Definition
Acarbose, miglitol
Inhibit intestinal a-glucosidase, delayed sugar hydrolysis and glucose absortpion
T- GI disturbances |
|
|
Term
|
Definition
Pramlintide
Dec glucagon, delays emptying
Only works if also taking insulin
T- hypoglycemia, Nausea, diarrhea |
|
|
Term
|
Definition
Exenatide, Liraglutide
Inc insulin, dec glucagon release
T- Nausea, vomiting, pancreatitis |
|
|
Term
|
Definition
Linagliptin, Saxagliptin, sitagliptin
Inc insulin, dec glucagon release
T- mild urinary or respiratory infections |
|
|
Term
|
Definition
Blocks peroxidase, thereby inhibiting organification of iodide and coupling of thyroid hormone synthesis
PTU also blocks 5-deiodinase which dec peripheral conversion of T4-T3
T- Skin rash, agranulocytosis, aplastic anemia, hepatotoxicity |
|
|
Term
| Hypothalamic/Pituitary drugs |
|
Definition
GH- GH def, Turner syndrome
Octreotide- Acromegaly, carcinoid, gastirnoma, glucagonoma, esophageal varices
Oxytocin- Stimulates labor, uterine contractions, milk let down, controls uterine hemorrhage
ADH- Pituitary (central not nephrogenic) DI |
|
|
Term
|
Definition
ADH antagonist
SIADH
T- nephrogenic DI, photosensitivity, abnormalities of bone and teeth |
|
|
Term
|
Definition
Dec production of LTs and PGs by inhibiting PLA2 and COX2
Can cause Cushing's disease |
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