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Endocrine 2

Autoimmune disorder resulting in hypothyroidism. Autoimmune disorder resulting in hyperthyroidism Hashimoto, Graves
Painful thyroid Subacute thyroiditis, Graves,
Painless thyroid Hashimoto, Riedel's thyroiditis, Lymphocytic subacute thyroiditis
Fixed, hard, painless goiter. what is it? cause? presents as hypo/hyperthyroidism Riedel's thyroiditis. Caused by thyroid tissue being replaced by fibrous tissue
Multinodular goiter is caused by ____. What does it cause release of? Iodine deprivation followed by iodine restoration. Causes release of T3, T4
Hypothyroidism causes and increase/decrease in cholesterol? If its a primary hypothyroidism, will TSH be high or low? increase cholesterol. TSH will be high
What are Hurthle cells? What disease is associated with them? Epithelial cells with eosinophilic granules. Associated with hashiomoto's disease
What other diseases are associated with Hashimoto's hypothyroidism? Pernicious anemia, DMM, Sjogrens,
Antibodies against Hashimotos? HLA markers? Anti I-,TSH, thyroglobulin, microsomal. DR5, B5
Lymphoid infiltration with germinal center formation/atrophy follicles Hashimoto's
Autoimmune disorder with hypothyroidism. Slow course that may have thyrotoxicosis due to follicular rupture. Hashimoto
Self-limited hypothyroidism often following flu-like illness. Elevated ESR, jaw pain, early inflammation, tender thyroid. Can be hyperthyroid early in course. Subacute thyroiditis. de Quervains
Granulomatous inflammation in thyroid. Subacute thyroiditis. de Quervain's
Thyroid replaced by fibrous tissue (hypothyroid). Presents with fixed, hard, painless goiter riedel's thyroiditis
HLA and antibodies associated with Grave's DR3, B8, Anti TSH/TSHr atnibodies
Opthalmopathy, pretibial myxedema, diffuse goiter. Presents during stress (eg ___) Grave's. Childbirth.
TSH antibodies to Grave's are what type of antibody. What type of hypersensitivty is presetn? II; IgG
How is death caused in Grave's/hyperthyroidism? Stress-induced catecholamine surge leading to death by arrythmia.
Glandular hyperplasia with papillary infoldings, scalloped colloid, lymphocytic infiltrate grave's
Rule of 10s for pheochromoctyoma malignant, calcified, bilateral, kids, familial, extra-adrenal
Jod-Basedow phenomenon Thyrotoxicosis if a patient with iodine deficiency gioter is made iodide replete
Thyroid cancer:Most common, excellent prognosis, ground glass nuclei (orphan annie), psammoma bodies, nuclear grooves. What puts you at an increased risk? Papillary carcinoma of the thyroid. risk with childhood iradiation
Thyroid cancer:good prognosis, uniform follicles Follicular carcinoma
Thyroid cancer:parafollicular "C" cells; produce calcitonin, sheets of amyloid stroma. Associated with what diseases? Medullary carcinoma. MEN types 2A/B
Thyroid cancer:older patients, poor prognosis Undifferentiated/anaplastic
Thyroid cancer: associated with hashimoto's hypothyroidism Lymphoma
Nodular goiter, hyperthyroidism, no exopthalmos Plummer disease
Fetal hypothyroidism. What causes it? Cretinism. Endemic (lack of iodine), sporadic (deffect in T4 formation/development of thyroid)
Cretinism presentation pot-bellied, pale, puffy-faced child, with protruding umbilicus and tongue
Acromegaly presentation large tongue with deep furrows, deep voice, large hands/feet, coarse facial features, impaired glucose tolerance,
Treatment for increased GH pituitary adenoma resection/octreotide administration
Diagnosis of acromegaly/gigantism Increased IGF-I; failure to suppress serum GH following oral glucose test
Hyperparathyroidism is usually caused by ____ adenoma
Hyperparathyroidism Symptoms "Stones, bones, groans": hypercalcemia, hypercalciuria (renal stones), hypophosphatemia. may present with wiakenss, constipation, osteitis fibrosa cystica
Increased PTH, alkaline phosphatase, increased cAMP in urine hyperparathyroidism
What is osteitis fibrosa cystica (aka ____). What is it caused by? von Recklinghousen's syndrome = cystic bone spaces filled with brown fibrous tissue (bone pain). (hyperPTh --> osteoclastic activity)
Renal osteodystrophy Bone lesions due to secodnary hyperparathyroidsim (renal disease)
Secondary hyperparathyroidism is caused by decreased Calcium absorption in gut and increased phosphorous; most often due to chronic renal disease and failure to produce vitamine D. will have increased alakline phosphatase, hyperphosphatemia, hypocalcemia
Causes of hypoparathyroidism accidental surgical excision, autoimmune destruction, DiGeorge syndrome.
Findings in hypoparathyroidism hypocalcemia, tetany
what is Chvostek's sign? when is it used? Hypoparathyroidism; tapping of facial nerve--> contraction of facial muscles (tetany)
Trousseau's sign? when is it used? Hypoparathyroidism; occlusion of brachial artery with BP cuff --> carpal spasm (tetany)
Autosomal-dominant kidney unresponsibe to PTH. Presents with pseudohypoparathyroidism; presents with hypocalcemia, shortened 4/5th digits, short stature.
Pseudohypoparathyroidism is due to what gene defect? GNASE1 = g protein that emdiates tissue response to hormones; only mom allele expressed (Father imprinted)
Hypercalcemia causes CHIMPANZEE = calcium ingestion (milk-alkali syndrome), Hyperparathyroid, Hyperthyroid, Iastrogenic (thiazides), Multiple myeloma, Paget's disease, Addison's disease, Neoplasm, Zollinger Ellison, Excess vitamin D, Excess vitamin A, Sarcoidosis
What hormones are unopposed during insulin absence? GH, epinephrin (exacerbate hyperglycemia)
Diabetes HLA for type 1 HLA DR3, DR5 = type 1
Beta cells with amyloid deposits- 1 or 2? 2
Anatomic changes in type 1 insulitis = lymphocytic infiltration
Anatomic changes in type 2 focal islet fibrosis, hyalinization (amyloid deposits)
Osmotic damage in diabetes causes what two problems? 1. neuropathy, 2. Cataracts (sorbital accumulation)
Hyperglycemia in ketoacidosis in DKA decreased glucose uptake, decreased glycogenolysis, increased aa, increased FFA, ketoacids
Hypotension in DKA High blood glucose --> osmotic diuretic
Metabolic acidosis in DKA overproduction of keto acids
Ketoacidosis in DKA increased catabolism of fat
What are secondary causes of DMM2? Pancreatic disease (hereditary hemochromatosis -bronze diabetes, pancreatitis, pancreatic carcinoma), Cushing syndrome, acromegaly, Pheyochromocytoma)
5 changes of kidney in diabetes increased width of glomerula BM, glomerulosclerosis (kmmelsteil-wilson disease), pyelonephritis with renal papillary necrosis
Armannin-Ebstein lesion what is it? when does it happen? tubular deposition of glycogen (diabetes)
What is the Whipple triad? Episodic hyperinsulinoma, hypoglycemia, CNS dysfunction, reversal of CNS with insulin (think insulinoma)
Gastrinoma: what disease is it associated with? Zollinger ellis
VIPoma- what is it? (vasoactive intestinal peptide: Pancreatic cholera (WDHA) watery diarrhea, hypokalemia, achloryida
What is MODY? Autosomal dominant; no loss of Beta cells, mild hyperglycemia. Single gene defect
Intense thirst, polyuria, with inability to concentrate urine Diabetes insipidus (ADH isn't working)
What are the 2 causes of diabetes insipidus Central: pituitary tumor, trauma, surgery; Nephrogenic: lack of renal response: secondary to hypercalcemia, lithium, demeclocycline)
Tests for ADH problems Water deprivation test; no increase in urine osmolarity
Response to desmopressin indicates that ___ diabetes insipidue is occuring central
Treatment for central DI intranasal desmopressin
Treatment for nephrogenic DI hydrochlorthiazide, indomethicin, amiloride
SIADH triad 1. excessive water retention, hyponatriemia, urine osmolarity> serum concentration
What happens in hyponatremia? seizures (correct slowly)
Treatment for SIADH demeclocycline/H20 restriction
Causes of SIADH (4) 1. ectopic ADH (small cell lung cancer), CNS disorders, pulmonary disease, Drugs (cyclophosphamide)
what are carcinoid tumors? where are they found? what do they produce? neuroendocrine cells that usuall smallw bowel, secrete 5HT. (5HT not seen if tumor is in GI since 5HT is easily degraded).
symptoms of carcinoid Diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease
Most common tumor of appendix Carcinoid syndrome
Diagnosis of carcinoid syndrome 5-H1AA in urine
rule of 1/3 for carcinoid syndrome 1/3 metastasize, 1/3 present with 2nd malignancy, 1/3 multiple
Treatment for carcinoid octreotide
Gastrin secreting tumor of ___ or ____ pancreas/duodenum; Zollinger-Ellison
Zollinger ellison secretes ___ and causes ____. Maybe associatd with what disease? gastrin, recurrent ulcers. associated with MEN1a
Created by: ddecampo



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