1
Q
constipation, abdominal pain, polyuria, mentation changes?
A
hypercalcemia
- stones, bones, grones, psychiatric undertones
2
Q
- very high PTH
- Elevated serum calcium
- Hypophosphatemia
- Increased urine calcium levels
A
primary hyperPTH
3
Q
- mildly high PTH
- very low urine calcium
A
Familial hypocalciuric
hypercalcemia (FHH)
4
Q
what causes an increase in secretion of calcitonin by the parafollicular cells (C-cells) of the thyroid?
A
elevated calcium levels
5
Q
inappropriately concentrated urine
A
SIADH
6
Q
Squamous cell carcinomas of the lung can cause a paraneoplastic syndrome in which the tumor secretes what?
A
parathyroid hormone-related peptide
- has the same physiological action and effect as that of endogenous PTH
7
Q
what malignancies can cause hypoPTH?
A
- squamous cell of lung (secretes PTHrP)
* Multiple myeloma (osteoclast activating factor [IL-1] by plasma cells)
8
Q
what granulomatous diseases can cause hypoPTH?
A
- Lymphomas
- Tuberculosis (caseating)
- Sarcoidosis (NONcaseating)
9
Q
what is the tx for carcinoid syndrome?
- neuroendocrine tumor, most of which originate in the GI tract, but symptoms don’t appear until there is metastasis to the liver
- dx by increased 24-hour urinary excretion of 5-HIAA
A
octreotide
10
Q
what neuroendocrine tumor?
• High volume watery diarrhea
• Hypokalemia
• Hypochlorhydria
A
VIPoma
11
Q
what neuroendocrine tumor?
• Dermatitis (necrolytic migratory erythema)
• Diabetes
A
glucagonoma
12
Q
what neuroendocrine tumor? • Abdominal pain • Weight loss • Gallstones • Diabetes • Diarrhea
A
somatostatinoma
13
Q
what neuroendocrine tumor?
• Diarrhea
• Esophagitis
• Peptic ulcer disease
A
gastrinoma (ZES)
- look for other MEN type 1 sx
14
Q
carcinoid syndrome can lead to what vitamin deficiency?
A
niacin
- due to a relative deficiency of tryptophan (precursor of niacin and 5HT)
15
Q
what are the 4 D’s of niacin deficiency?
A
- Dermatitis: Pellagra, which means “raw skin,” is characterized by a photosensitive pigmented dermatitis located in sun-exposed areas.
- Diarrhea: Severe diarrhea may lead to hypovolemia, hypotension, and nutritional deficiencies.
- Dementia: Lack of niacin leads to neurologic findings including delusions, encephalopathy, and dementia.
- Death: Niacin is an essential vitamin, and therefore with prolonged deficiency, death may occur.
16
Q
reversible syndrome characterized by the triad of encephalopathy, oculomotor dysfunction, and gait ataxia
A
Wernicke encephalopathy
- progresses to Korsakoff (confabulation/memroy impairment) and becomes irreversible
17
Q
symmetrical peripheral neuropathy with motor and sensory impairment
A
dry Beriberi
18
Q
cardiomegaly, cardiomyopathy, heart failure, peripheral edema, and tachycardia
A
wet Beriberi
19
Q
self-limited hypothyroidism that is typically seen following a viral, flu-like illness
- tender, enlarged thyroid gland with referred jaw pain
A
DeQuervian thyroiditis
- tx is supportive: nonsteroidal antiinflammatories, beta blockers, and if severe, steroids
20
Q
Functional thyroid hormone secreted from ovarian tumor
A
struma ovarii
21
Q
a fixed, firm, painless goiter
- thyroid gland is replaced with fibrous tissue
A
Reidel thyroiditis (HYPOthyroid)
22
Q
exophthalmos and pretibial myxedema
A
Graves disease
- MCC HYPERthyroidism
- result of autoimmune, thyroid stimulating/TSH receptor antibodies
23
Q
primary adrenal insufficiency that results in inadequate secretion of various adrenal steroid hormones
- HYPOnatremia
- hyperkalemia
- acidosis and skin hyperpigmentation
A
Addison disease
- caused by adrenal atrophy that affects all 3 layers of the adrenal cortex
NOTE: early Addison’s often presents with uncontrolled hiccups…
24
Q
lack of ADH?
A
diabetes insipidus
25
- high serum osmolality (decreased urinary sodium excretion)
- high urine output
- desmopressin corrects osmolality
central DI
26
- dysfunctional ADH receptors that are unable to recognize ADH
- high serum osmol (less Na excreted)
- high urine output
- no change after desmopressin
peripheral DI
27
hyperexcretion of aldosterone, usually due to an adrenal adenoma or hyperplasia
- hypernatremia
- hypokalemia
- metabolic alkalosis
- low plasma renin
- HTN
Conn syndrome (primary hyperaldosteronism)
28
which layer of adrenal medulla produces cortisol?
fasciculata
29
which layer of adrenal medulla produces aldosterone?
glomerulosa
30
which layer of adrenal medulla produces DHEA-S,
| DHEA, androstenedione?
reticularis
31
Cushing symptoms, that are suppressed with a HIGH-dose dexamethasone test?
ACTH producing pituitary tumor
32
what stimulates the release of ACTH from the pituitary?
corticotropin-releasing hormone (CRH) from the hypothalamus
CRH -> ACTH -> adrenals
33
what is the MOA of metformin?
decreases *gluconeogenesis* in the liver
- activates adenosine monophosphate-activated protein kinase (AMPK)
NOTE: can lead to B12 deficiency by decreasing absorption
34
where is B12 normally absorbed?
ileum
35
what stimulates glycogenolysys?
epinephrine, cortisol (stress!)
| - also glucagon and insulin
36
HYPERnatremia, HYPOkalemia?
hyperaldosteronism
| - aldosterone keeps NA IN
37
autoimmune hyperthyroidism (Graves dz) is what type of immune response?
Type 2, non-cytotoxic
| - Ab against a TISSUE
38
SLE, and serum sickness are what type of immune response?
Type 3
| - Ab-Ag complexes, go on to injur kidneys, joints and small vessels
39
ABO transfusion reaction is what type of immune response?
Type 2, cytotoxic
| - Abs react with foreign blood, cause hemolysis (cytotoxic)
40
palpitations, tremor, exophthalmos, and increased deep tendon reflexes?
- low TSH, high T3/T4
HYPERthyroid
41
abdominal pain and wt loss w/
1. diabetes/glucose intolerance
2. cholelithiasis
3. diarrhea/steatorrhea
somatostatinoma
| - usually found in the head of the pancreas
42
what hormone inhibits insulin, glucagon, gastrin, CCK, and growth hormone?
somatostatin
| - released from delta cells of pancreas
43
suprasellar adenoma on CT scan?
```
pituitary tumor
- neg feedback on hypothalamus = low
Thyrotropin-releasing hormone (TRH)
Gonadotropin-releasing hormone (GnRH)
Growth hormone-releasing hormone (GHRH)
Corticotropin-releasing hormone (CRH)
```
44
solitary thyroid nodule
| - fine-needle aspiration shows uniform follicles invading the thyroid capsule
follicular carcinoma
45
solitary thyroid nodule exhibiting “ground-glass" nuclei (aka large nuclei with a clear center) and *psammoma bodies*
papillary thyroid carcinoma (MC thyroid cancer!)
- look out for past hx of radiation exposure in childhood
Papillary is Popular, has Psammoma bodies
46
when do you see mucosal neuromas?
| - what do they look like?
MEN 2B
| - look like skin colored warts/vesicles on inside of mouth
47
what distinguishes primary hyperaldosteronism from secondary?
renin levels
- secondary hyperaldosteronism is often caused by hypovolemia or low renal perfusion -> activates RAAS
- primary will have low renin levels
48
gestational diabetes has what effect on newborns insulin levels?
increased insulin levels in utero (due to GDM) will cause hypoglycemia once baby is born
49
when would you see myxedema coma?
| - decreased mental status, hypothermia
severe HYPOthyroid
50
where does medullary thyroid carcinoma arise from?
parafollicular C-cells
| - produces calcitonin
51
what b-blocker can be used to treat hyperthyroid?
propanolol
| - decreases sympathetic stimulation
52
what is the treatment for adrenal hyperplasia?
spironolactone
53
what would the BP look like of someone with primary hyperaldosteronism?
HTN (due to excess aldosterone -> Na reabs)
54
what is the most common adverse effect of thyroidectomy?
hypocalcemia due to (accidental/unavoidable) parathyroid removal
- can see effects in as little as 1 day post-op (hypothyroidism is more gradual onset)
55
what causes parathyroid gland to secrete PTH?
low serum calcium
| - low Ca -> increases PTH -> activates osteoCLASTS -> increases serum Ca
56
what is a pheochromocytoma?
tumor of adrenal medulla
57
Anti-smooth muscle antibodies
autoimmune hepatitis
58
Anticentromere antibodies
scleroderma
59
Antihistone antibodies
drug-induced lupus
60
Antimitochondrial antibodies
PBC
| - causes severe itching due to excess bile acids!
61
sweating, palpitations, shaking, and nervousness that often accompany a falling or low blood sugar are caused by what?
the epinephrine response
62
what is the primary tx for Addison's disease?
corticosteroids
63
what is tetany a sign of?
hypocalcemia
64
what effect does PTH have on phosphorus?
it inhibits reabsorption
65
what effect does vitamin D have on calcium and phosphorus?
it increases the absorption of both phosphorus and calcium from the GI tract
66
what effect does PTH have on calcium levels?
it stimulates reabsorption of calcium into the blood
67
what is tamsulosin used for?
alpha-1 blocker used specifically for benign prostatic hyperplasia
68
what is phenoxybenzamine used for?
pheochromocytoma
| - irreversibly blocks both alpha-1 and alpha-2 receptors
69
what should you always think of when you see vanillylmandelic acid?
pheochromocytoma
70
what is the treatment for central DI?
intranasal desmopressin
71
what is the treatment for nephrogenic DI?
low salt diet and diuretic (hydrochlorothiazide or amiloride)
72
normally, depriving someone of water has what effect on on ADH levels?
dehydration causes an increase in ADH secretion
73
PTH = Phosphate Trashing Hormone
increases phosphate excretion
- for every molecule of calcium that gets reabsorbed a phosphate molecule needs to be excreted into the urine to maintain electrical neutrality
74
what effect does PTH have on the kidneys?
it inhibits the sodium/phosphate co-transport allowing for increased calcium reabsorption and increased phosphate excretion
75
masculinization and female pseudohermaphroditism, hypotension, hyperkalemia, increased plasma renin, and volume depletion?
21-hydroxylase deficiency
76
externally phenotypic female
- will have normal internal sex organs
- lack secondary sex characteristics
17-a-hydroxylase deficiency
77
• AMP-activated kinase decreases gluconeogenesis
• Increases glucose uptake in fat and muscle
- GI upset, reduced folate and B12 absorption, lactic acidosis
metformin
78
```
antidiabetic drugs that block potassium channels to allow depolarization and release of insulin from pancreatic beta cells. Adverse effects:
• Hypoglycemia
• Weight gain
• Rash
• Disulfiram reactions
```
sulfonylureas
- Glipizide
- Glyburide
- Glimepiride
79
antidiabetic drug:
• PPAR gamma agonist to enhance nuclear transcription
• Increase GLUT-4
Thiazolidinediones (oral)
- Pioglitazone
- Rosiglitazone
80
antidiabetic drugs that inhibits intestinal brush border enzyme, delay starch digestion and decrease glucose absorption
cause flatulence and diarrhea
Alpha-glucosidase inhibitors (oral)
- Acarbose
- Miglitol
81
cellular aspirate, papillary architecture, nuclear features including pseudonuclear inclusions, nuclear grooves, nuclear clearing
papillary thyroid carcinoma
82
dispersed cells that have eccentric nuclei, cytoplasmic tails, and granular cytoplasm
medullary thyroid carcinoma
83
marked pleomorphism, with bizarre, markedly enlarged cells, occasionally spindle cells
anaplastic carcinoma
84
undifferentiated small blue cells, and many feature Homer Wright rosettes — rings of cells around little clumps of nerve fibers, without lumens
neuroblastoma
85
Peak age 3-4 years
- Mass seldom crosses midline. Intrinsic to kidney on imaging ("claw sign")
- Calcifications are rare
- Rings have true lumens
- Paraneoplastic effects are rare
nephroblastoma (Wilms tumor)
86
Peak age < 2 years
- Mass often crosses midline (compresses but does not invade)
- Calcifications are common
- Rings contain neural filaments
- Paraneoplastic effects (neurologic) are common
neuroblastoma
87
what type of pancreatic tumor causes diabetes mellitus, cholelithiasis, steatorrhea, and hypochlorhydria?
delta cell tumor (somatostatinoma)
88
A high calcitonin level is associated with what type of thyroid carcinoma?
medullary thyroid carcinoma
- due to the proliferation of parafollicular C-cells, which secrete calcitonin
- also associated with the endocrine disorders MEN-2a and MEN-2B*
89
what type of hypersensitivity rxn?
- ABO mismatch
- Goodpasture’s syndrome
- Rh hemolytic disease of the newborn
- myasthenia gravis
type 2 (Ab against tissue/receptors)
90
what is metoclopramide used as a treatment for?
increasing gastric motility by sensitizing the gastric mucosa to acetylcholine
91
achalasia, megacolon -> caused by what bug?
T. cruzi (Chagas)
92
gastroparesis?
diabetes (secondary to autonomic neuropathy)
93
Conn syndrome
```
adrenal adenoma (unilat) or hyperplasia (bilat)
- excess aldosterone -> increased Na reabs, hypokalemia -> suppresses RAAS
```
94
what is the medical management of Conn syndrome?
spironolactone or eplerenone
| - K-sparing aldosterone antags (adrenal hyperplasia causes hypokalemia)
95
adrenal adenomas that may cause virilization or Cushing syndrome
- *lipid-rich and is often > 4 cm*
adrenocortical carcinoma
96
pretibial myxedema is caused by a buildup of what?
```
hyaluronic acid (HA) from Graves' disease
- HA is a glycosaminoglycan produced by fibroblasts, which are stimulated by both the thyrotropin receptor antibodies and thyrotropin hormone
```
97
what medication is used for symptomatic tx of Graves disease?
B-blockers: metoprolol or propranolol
98
what is the treatment for Hashimoto's?
levothyroxine
99
what are definitive tx options for Graves?
- PTU and methimazole (methimazole less hepatotoxic)
- NOTE: PTU in first trimester, methimazole 2nd and 3rd
- radioactive iodine ablation, or thyroidectomy
100
young, otherwise healthy pt with resistant HTN, unexplained hypokalemia, metabolic alkalosis (elevated bicarb)?
adrenal hyperplasia
101
10 weeks pregnant w/heat intolerance, palpitations, tremor, diarrhea, proptosis
PTU 1st trimester for Graves!
| - methimazole 2nd and 3rd
102
what are the most common symptomatic pancreatic tumors?
gastrinoma
103
development of bilateral multifocal kidney cancer
- Dermatologic manifestations include fibrofolliculomas (benign white hamartomatous papules of hair follicles commonly found on the nose and cheeks)
- most have cysts in the lungs and often develop spontaneous pneumothoraces
Birt-Hogg-Dubé syndrome
104
what is another name for MEN 2B?
mucosal neuroma syndrome
- 3 M's and 1 P
- mucosal neuroma, medullary thyroid CA, marfanoid body habitus
- pheochromocytoma
105
rare form of congenital bilateral adrenal hyperplasia
- abnormal external genitalia
- hypotension/hypovolemia
- elevated ACTH with low cortisol levels
3β-hydroxysteroid dehydrogenase (3BHSD) deficiency
- causes decreased sex steroids, resulting in incompletely masculinized male infants with a small penis and varying degrees of hypospadias
106
Difficulty rising from a chair or reaching arms overhead in the setting of an increased metabolic state (weight loss, tachycardia, hypocholesterolemia) are consistent with?`
hyperthyroidism
| - thyrotoxic myopathy in which proximal muscles are more affected than distal
107
weight gain, hyperglycemia, moon facies, truncal obesity, a buffalo hump, and osteoporosis
- what is the dx and what is the tx?
Cushings
| - dexamethasone suppression test
108
painless thyroid nodule with histology demonstrating clusters of follicular cells; fine, powdery chromatin; nuclear grooves; and pseudonuclear inclusions?
papillary thyroid carcinoma
- BRAF mutation MC in adults
- RET mutation MC in children
109
biopsy of the thyroid gland showing germinal centers with a lymphocytic infiltrate and follicular destruction characteristic of what?
Hashimoto's thyroiditis
110
what does prolactin have an inhibitory effect on?
the release of gonadotropin releasing hormone (GnRH) from the hypothalamus
- less GnRH -> less LH/FSH
111
dopamine agonist used to treat a prolactinoma?
cabergoline
112
difference between primary and secondary hypothyroidism?
primary: Hashimoto, high TSH, low T4
secondary: central cause (Shehan synd), low TSH, low T4 -> look for other pituitary abnormalities (amenorrhea)
113
ACTH secreting pituitary tumor?
Cushing disease
114
thyrotropin receptor Ab vs thyroid peroxidase Ab?
- thyrotropin (TSH) = Graves
- TPO = Hashimoto, postpartum thyroiditis
NOTE: thyroglobulin is nonspecific, but more common in hypothyroid
115
newborn with normal TSH, normal free T4, low total thyroxine (T4)
TBG deficiency
COMLEX
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