Tesamorelin
GHRH analog for HIV lipodystrophy
ADH-Rs
V1 = BP V2 = Osmolarity
permissive effect of cortisol
upregulated a1-Rs on BVs
so when NE release it can cause VC
inc/dec TBG via:
increase via OCP/pregnancy (still euthyroid; total T4 increased but free T3/T4 amt same)
decrease via liver failure or steroids
wolff-Chaikoff
excess iodine inhibits TPO activity
NIS competitive inhibitos
Pertechnetate
Perchlorate
Thiocyanate
anti TPO
excessive iodine
propothyouracil (also inhibits 5’deiodinase)
Methimazole (DOC unless pregnant)
anti 5’deiodinase
PTU b-clockers ipodate (contrast) glucocorticoids amiodarone
metyrapone stimulation test
blocks 11-b-OHase
so no cortisol, no inhibition of CRH/ACTH, ACTH should increase
[in 2’ adrenal insufficiency, there is no increase in ACTH because you can’t make it]
CRH stimulation test for:
cushing disease (AP tumour) vs ectopic ACTH [can also use high dose DEX test]
Addisons pathophys
TB, mets, autoimmune
phew rule of 10s
10%:
- bilateral
- kids
- malignant
- extra-adrenal
- calcify
DeQuervains
Granulomatous, mixed cellular infiltrate, giant cells
High ESR
Jaw pain
IgG4-related systemic disease
- Reidel’s thyroiditis
- autoimmune pancreatitis
- Retroperitoneal fibrosis
- Non-infectious aortitis
random marker of thyroid storm
high ALP (from bone turnover)
Graves rx causing worsening opthamology
radioablation
artery with recurrent laryngeal nerve
inferior thyroid a.
papillary CA thyroid
- Orphan annie
- nuclear grooves
- RET and BRAF
- psammoma
- lymphocytic infiltrate
follicular CA thyroid
- RAS
- hematogenous mets
Vagus branches
Superior:
- external = cricothyroid
- internal = sensory above vocal cords
Recurrent laryngeal:
- all larynx muscles except cricothyroid
- sensory below vocal cords
Albright disease
pseudohypoparathyroidism:
- kidneys dont sense PTH
- hypoCa++, short, short 4th + 5th digits, AD, round facies, mild mental retardation
McCune-Abright disease
example of mosaicism (only survivable is mosaic)
- altered G-protein signalling
- unilateral cafe-au-lait, precocious puberty, polystotic fibrous dysplasia, multiple endocrine problems
defective PTH sensing vs. Ca++ sensing
PTH = albright Ca = hereditary hypocalciuric hypercalcemia
increased cAMP in urine
hyperparathyroidism because PTH signals through Gs
