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Endocrine

QuestionAnswer
Pituitary Acidophils & Basophils FLAT PiG: Fsh, Lh, Acth, Tsh (Basophils) ProlactIn, Gh (Acidophils)
Alpha & Beta Subunits - Alpha: Common to TSH, LH, FSH, hCG. Beta: Determines hormone specificity. - ACTH & MSH (and beta-endorphin) derived from POMC
Endocrine Pancreas Cells Alpha cells: Glucagon, peripheral. Beta Cells: Insulin, central. Delta Cells: Somatostatin, interspersed.
TRH -> TSH, Prolactin. Dopamine --| prolactin. Somatostatin --|TSH.
CRH -> ACTH
Somatostatin (Octreotide) (physiologic & Therapeutic functions) --| GH, TSH Octretoide treats gigantism, Acromegaly, Carcinoid, Gastrinoma, Glucagonoma (Necrolytic migratory erythema, stomatitis, chelosis)
POMC Derivatives Produces Beta endorphin, ACTH, MSH
17alpha-Hydroxylase Deficiency CAH. Aldosterone only, no Cortisol or Androgens. -> Hypertension & Hypokalemia. Phenotypic female w/o maturation.
21-Hydroxylase Deficiency #1 CAH. Androgens only. No cortisol or aldosterone. -> Masculinization/female pseudohermaphrodite, Hypotension & hyperkalemia, elevated renin. Hypovolemic shock in newborn.
11beta-Hydroxylase Deficiency CAH. Androgens & aldosterone pre-cursor (11-Deoxycorticosterone). No cortisol. -> Masculinization & HYPERtension.
PTH Function - Activates Ca absorption (renal, GI) & inhibits PO4 absorption(renal). - Active 1,25(OH)2D production. - Osteoclast/blast stimulation.
Vit D Synthesis & Function Sources: D2 (Plants) & D3(sun) –(liver)-> 25-(OH)D. Low PO4/Ca, High PTH: 25-(OH)D –(kidney)-> 1,25-(OH)2D. -> -> Ca & PO4 GI reabsorption & bone release.
Etiology of AlkPhos Elevation Pagets, Osteoblastic bone tumor, HyperPTH, Rickets/Osteomalacia.
Glut4 Insulin-Dependent glucose uptake. Skeletal muscle & fat.
Glut1 Insulin-Independent glucose uptake. Brain, RBCs
cAMP-Mediated Hormones hCG, Calcitonin, CRH, Glucagon, Straight-up “hormones”
cGMP-Mediated Hormones Vasodilators (ANP, NO/Endothelium Derived Relaxing Factor)
IP3-Mediated Hormones Hypothalamus-Derived Hormones (GhRH, TRH, GHRH, ADH, Oxytocin)
Steroid Receptor-Mediated Hormones Glucocorticoids, Vit D, T3/4
Tyrosine Kinase-Mediated Hormones Insulin, Growth FACTORS (IGF-1, FGF)
Cushings Syndrome Etiology - Cushing Disease (Pituitary adenoma, only responds to high Dex suppression, others don’t respond) - Adrenal hyper/neoplasia - Small Cell Lung Cancer - Steroid use
Adrenal Insufficiency Sx, Etiology - Primary Adrenal Insufficiency (Addison’s). HypoTN, skin hyperpigmentation (high ACTH). Tx: Glucocorticoids. - Waterhouse-Freidrichsen Syndrome (n. meningitidis bacteremia-> infarct). - Secondary: Pituitary insufficiency (low ACTH).
Pheochromocytomas Genetics & Characteristics #1 adult adrenal tumor. VMA. MEN II, III (ret), neurofibromatosis. +/-Bilateral, malignant, ectopic, calcified, pediatric, inherited.
Neuroblastoma #1 pediatric adrenal tumor. HVA. N-myc. Local or sympathetic chain-ectopic.
Sheehan’s Syndrome Cause & Sx Postpartum hemorrhage/hypotn-> pituitary infarct. Poor lactation.
MEN I Cancers & Sx Kidney stones & gastric ulcers. - Pancreas (ZE, VIPoma, Insulinoma) - Pituitary (Prolactinoma) - Parathyroid
MEN II Cancers ret - Pheochromocytomas - (Para)Thyroid.
MEN III Cancers ret. - Pheochromocytoma - Medullary thyroid carcinoma (Amyloid) - Oral/GI mucosal neuromas
Riedel’s Thyroiditis Fibrosis of thyroid. HypoThyroid
Hashimoto’s Thyroiditis Sx, Dx - Hypothyroid w/Thyrotoxicosis - AI: Anti-Microsomal & Thyroglobulin Antibodies. Hurthle Cells.
Subacute/de Quervain’s Thyroiditis Presentation & variants Post-flulike illness. Jaw pain. - Granulomatous form is painful - Lymphocytic form is painless.
Toxic Multinodular goiter TSH-independent TH production. Not malignant
Jod-Basedow Phenomenon Thyrotoxicosis when endemic-goiter patient moves to Iodine non-deficient area.
Papillary Thyroid Carcinoma #1, good prognosis. - Orphan annie nuclei, Psamomma bodies. - Increased risk w/childhood radiation
Follicular Thyroid Carcinoma Good prognosis - uniform follicles.
Medullary Thyroid Carcinoma Parafollicular C cells->calcitonin. - MEN II, III - Amyloid forming
Undifferentiated/Anaplastic Thyroid Cancer Older patients, very poor prognosis
Thyroid Lymphoma Hashimoto’s-associated
Acromegaly/Gigantism Dx, Tx Dx’d w/ Poor glucose tolerance test. Octreotide tx Gigantism.
Primary HyperPTH Etiology, associations, labs. - PTH Adenoma: elevated urine cAMP, calcuria, constipation, Alk Phos - Assoc. w/Osteitis Fibrosa Cystica (Bone cysts w/ brown fibrous tissue)
HypoPTH Etiology, PE - DiGeorge - AI - Surgical - Chvostek + (facial nerve), Trousseau + (BP cuff-> carpal spasm) - PseudoHypoPTH: Kidney insensitivity to PTH. Short & small digits 4 & 5.
HyperCalcemia Etiology CHIMPANZEES: - Calcium intake - HyperPTH, HyperThyroid - Iatrogenic (thiazides) - Multiple myeloma - Paget’s - Addison’s - Neoplasms - Z-E - Excess vit D, A - Sarcoid
DM1 Insulin dependent (profound hypoinsulinism). DKA common. Viral-triggered AI attack on beta cells. Weak gene association (hla-DR3,4)
DM2 Insulin Independent. Strong genetic association
DKA (Sx, Tx) - Kussmaul respiration, N/V, abdominal pain - Anion gap metabolic acidosis. Intercellular hypoK (Arrhythmias), Mucormycosis, Rhizopus Infx, heart failure. - Rx: Fluid, insulin, K.
Diabetes Insipidus (Etiology, Dx) - Pituitary tumor - trauma/surgery - Histiocytosis X - Secondary HyperCa [renal] - Lithium, Demeclocycloine - Dx: Water deprivation. Desmopressin (ADH analog) distinguishes central & nephrogenic. - Urine <1.006, blood >290 mOsm/L.
Diabetes Insipidus Tx Central: Desmopressin. Nephrogenic: HCTZ, Amiloride, Indomethacin.
SIADH Etiology, Labs, Tx - Small cell Lung Ca & Pulm Dz - CNS trauma - Cyclophosphamide - Labs: HypoNa, Urine > Serum osmolarity. - Tx: slowly w/ demeclocycline, Lithium (SE’s), H20 Restriction.
Carcinoid Syndrome Labs, Sx, Morphology, Tx Elevated urine 5-HIAA. - GI enterochromaffin cell tumor (serotonin) outside GI. Sx: Flushing, Diarrhea, wheezing, peripheral edema. #1 appendix tumor, R Endocardial Fibrosis. MULTIPLE (metastatic, addt’l malignancy, multiple). - Tx: Octreotide
Insulin Time: Lispro & Aspart < NPH < Lente < Ultralente. Tx DM1, HyperK
1st Gen Sulfonylureas Tolbutamide, Chlorpropramide. SE: Disulfram-like effects.
2nd Gen Sulfonylureas Glyburide, Gilmepiride, Glipizide.
Sulfonylurea mech Close Beta cell K channel -> depolarization -> Ca influx -> Insulin release. Only DM2
Biguanides Metformin Mech: Reduce gluconeogenesis, increase glycolysis, lowers serum glucose SE: Lactic Acidosis. CI:Renal, Liver Failure/Alcoholics, CHF, Sepsis
Glitazones Pio/Rosi-glitazone Mech: Increase sensitivity to insulin via PPAR gamma. SE: Wt gain, edema, hepato & cardio toxic
Alpha Glucosidase Inhibitors Acarbose & Miglitol Mech: inhibits brush border glucosidase -> slows glucose absorption SE: GI disturbances DM2 only
Methimazole, Propylthiouracil Inhibits TH synthesis via -|thyroid peroxidase PTU also inhibits T4->T3. SE: Rash, Agranulocytosis & Aplastic Anemia
GH Therapy GH Deficiency, Turner’s Syndrome
Desmopressin Therapy Central DI
Glucocorticoid Use Addison’s.
Secondary HyperPTH Labs, Associations Renal failure: Low Ca, high PO4 & Alk Phs Assoc w/Renal osteodystrophy (bone lesions b/c high PTH)
Cortisol Physiology Stimulates Gluconeogenesis, Glycolysis, Epinephrine synthesis, Proteolysis, Lipolysis, Neutrophil Demargination. Suppresses Insulin, non-neutrophil lymphocyte counts.
Neurophysin Transports ADH & Oxytocin from Hypothalamus to Neurohypophysis
Acute Hyperthyroid Tx Beta blockers
Kallmans Syndrome GnRH migration failure-> primary hypoandrogenism. + Anosmia
Conn's Syndrome Primary Aldosteronism: Adrenal Hyperplasia/Adenoma
Created by: Kyle Tiemeier