Busy. Please wait.

show password
Forgot Password?

Don't have an account?  Sign up 

Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Remove Ads
Don't know
remaining cards
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Goljan Endocrine

Overactive endocrine syndrome most often adenomas; use suppression tests (most do not suppress)
Tumors that suppress prolactinoma (bromocriptine), pituitary Cushings (high dose dexamethasone)
Underactive endocrine syndrome autoimmune destruction MCC; stimulation tests
Hypopituitarism adults non-functioning adenoma MCC, Sheehan’s postpartum necrosis (stop lactation)
Hypopituitarism in children craniopharyngioma (Rathke’s pouch remnant) MCC; visual field defects
S/S ↓ FSH and LH amenorrhea, ↓ testosterone in male
Growth hormone functions muscle growth, gluconeogenesis; release of insulin growth factor (IGF)
IGF synthesized in liver; bone and cartilage growth
S/S ↓ GH/IGF in children growth retardation; ↓ height and weight
Sleep and arginine infusion stimulation tests for GH and IGF
S/S ↓ GH/IGF in adults hypoglycemia
S/S ↓ TSH secondary hypothyroidism; ↓ T4, ↓ TSH; muscle weakness, dry skin
S/S ↓ ACTH secondary hypocortisolism; ↓ cortisol, ↓ ACTH; fatigue; hypoglycemia
Metyrapone stimulation test for ACTH reserve
Metyrapone blocks adrenal 11-hydroxylase → ↑ ACTH and 11-deoxycortisol (proximal to block)
Metyrapone test ↓ ACTH and 11-deoxycortisol pituitary/hypothalamic dysfunction
Metyrapone test ↑ ACTH and 11-deoxycortisol Addison's disease
Diabetes insipidus loss ADH (central), refractory to ADH (nephrogenic); always diluting urine
Central diabetes insipidus (CDI) ↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm > 50%
Causes CDI pituitary stalk transection, hypothalamic lesion (site for ADH synthesis)
Nephrogenic diabetes insipidus (NDI) ↓ UOsm and ↑ POsm with water deprivation; vasopressin causes ↑ UOsm < 50%
Causes NDI lithium, demeclocycline, nephrocalcinosis, severe hypokalemia
Gigantism GH secreting pituitary adenoma before epiphyses have fused
Acromegaly GH secreting pituitary adenoma after epiphyses have fused
S/S acromegaly cardiomyopathy; large hands, feet, jaw; hyperglycemia
Prolactin inhibited by dopamine
Prolactinoma MC pituitary tumor; secondary amenorrhea and galactorrhea; prolactin inhibits GnRH
Rx surgery or bromocriptine (dopamine analog)
Other causes hyperprolactinemia primary hypothyroidism, drugs
Inappropriate ADH syndrome hyponatremia <120 mEq/L; ↑ UOsm (always concentrating urine)
Causes small cell carcinoma lung, CNS injury, chlorpropamide
Rx restrict water; demeclocycline in small cell carcinoma
Serum T4 ↑ or ↓ in free hormone or thyroid binding globulin (TBG)
↑ Serum T4 and normal TSH ↑ TBG; due to ↑ in estrogen
↑ Serum T4 and ↓ TSH thyrotoxicosis
↓ Serum T4 and normal TSH ↓ TBG; due to anabolic steroids
↓ Serum T4 and ↑ TSH primary hypothyroidism
↓ Serum T4 and ↓ TSH secondary hypothyroidism
TSH negative feedback with T4 and T3; best screening test
I131 uptake ↑ in Graves; ↓ in thyroiditis, patient taking excess thyroid, hypothyroidism
Cold nodule non-functioning nodule; no uptake I131
Hot nodule functioning nodule; ↑ uptake I131
Thyroglossal duct cyst midline cystic mass
Branchial cleft cyst cyst in anterolateral neck
Acute/subacute thyroiditis painful thyroid; early thyrotoxicosis; ↓ I131 uptake
Hashimoto’s thyroiditis MCC hypothyroidism; HLA Dr3/Dr5; inhibitory IgG TSH receptor antibody
Hashimoto’s thyroiditis ↑ anti microsomal and thyroglobulin antibodies
S/S muscle weakness, periorbital puffiness, ↓ reflexes, diastolic hypertension, constipation, dry skin
Lab ↓ T4, ↑ TSH
Cretinism maternal hypothyroidism before fetal thyroid developed, genetic disorder
S/S mental retardation; short stature and increased weight; coarse skin
Thyrotoxicosis any cause ↑ thyroid hormone activity; Graves disease, excess hormone, thyroiditis
Hyperthyroidism ↑ synthesis thyroid hormone; Graves disease and toxic nodular goiter
Graves disease autoantibody against TSH receptor (type II reaction); HLA Dr3
S/S unique to Graves exophthalmos, pretibial myxedema
S/S thyrotoxicosis tachycardia/atrial fibrillation, systolic hypertension, diarrhea, brisk reflexes
Lab thyrotoxicosis ↑ T4, ↓ TSH, ↑ glucose, ↑ calcium
I131 uptake ↑ Graves, toxic nodular goiter; ↓ thyroiditis, excess hormone, hypothyroidism
Rx Graves disease ß-blocker; drug to decrease hormone synthesis (propylthiouracil)
Toxic nodular goiter hyperthyroidism; develops out of a multinodular goiter; no exophthalmos
Goiter enlarged thyroid; iodine deficiency MCC; relative thyroid hormone deficiency
S/S rapid enlargement due to hemorrhage into cyst; Rx thyroxine
Solitary thyroid nodule woman most often benign (cyst)
Solitary thyroid nodule man or child often malignant
Papillary carcinoma thyroid MC thyroid cancer; radiation exposure; psammoma bodies
Follicular carcinoma thyroid invades blood vessels
Medullary carcinoma thyroid parafollicular cells; calcitonin; amyloid (calcitonin conversion)
MEN I syndrome 3 P's; pituitary tumor, parathyroid adenoma, pancreatic tumor (ZE or ß-islet cell tumor)
MEN IIa syndrome 2 P's; medullary carcinoma thyroid, pheochromocytoma, parathyroid adenoma
MEN IIb syndrome 1 P; medullary carcinoma thyroid, pheochromocytoma, mucosal neuromas
Alkalotic pH tetany with normal total calcium, ↓ ionized calcium and ↑ PTH
Hypoalbuminemia ↓ total calcium, normal ionized calcium and PTH
Tetany ↓ ionized calcium level; threshold potential comes closer to resting potential
S/S thumb adducts into palm, twitching after tapping of facial nerve
PTH maintains ionized Ca2+; ↑ Ca2+ renal reabsorption; ↓ phosphate/bicarbonate reabsorption in kidneys
Primary HPTH ↑ Ca2+, hypophosphatemia, ↑ PTH
Cause adenoma MCC, hyperplasia, cancer
S/S renal stone, peptic ulcers, pancreatitis, hypertension, metastatic calcification
Secondary HPTH ↓ Ca2+, ↑ PTH; hypovitaminosis D from renal failure MCC
Malignancy-induced hypercalcemia ↑ Ca2+, ↓ PTH; all other non-parathyroid causes same results
Causes hypercalcemia osteolytic lesions, sarcoidosis, ↑ vitamin D, PTH-related peptide, myeloma
Tertiary HPTH hypercalcemia developing from secondary HPTH
Primary hypoparathyroidism ↓ Ca2+ and ↓ PTH
Causes previous thyroid surgery, autoimmune, DiGeorge syndrome
S/S tetany; calcification basal ganglia
Pseudohypoparathyroidism ↓ Ca2+ with normal to ↑ PTH; end-organ resistance to PTH
Other causes ↓ Ca2+ hypomagnesemia (↓ PTH), ↓ vitamin D, DiGeorge
↓ Ca2+ and ↓ PTH primary hypoparathyroidism
↓ Ca2+ and ↑ PTH secondary hyperparathyroidism
↑ Ca2+ and ↑ PTH primary hyperparathyroidism
↑ Ca2+ and ↓ PTH malignancy induced hypercalcemia; other causes hypercalcemia
Waterhouse-Friderichsen syndrome meningococcemia with bilateral adrenal hemorrhage due to DIC
Addison’s disease autoimmune destruction adrenal cortex MCC, adrenogenital syndrome, metastasis
S/S hypotension (salt loss), hyperpigmentation (ACTH), hypoglycemia
Lab ↓ sodium, ↓ cortisol, ↑ potassium, ↑ ACTH
Adrenogenital syndrome AR; enzyme deficiency; hypocortisolism; hyperpigmentation from ↑ ACTH
21-Hydroxylase deficiency ↑ 17 KS, ↓ 17 OH, lose salt, hypotension; female pseudohermaphrodite
11-Hydroxylase deficiency ↑ 17 KS, ↑ 17 OH, retain salt, hypertension; female pseudohermaphrodite
17-Hydroxylase deficiency ↓ 17 KS, ↓ 17 OH, retain salt, hypertension; male pseudohermaphrodite
MCC Cushings long-term corticosteroid therapy
Tests Cushings syndrome low/high dose dexamethasone suppression; urine free cortisol (best test)
Normal dexamethasone suppression cortisol analogue; ↓ ACTH and ↑ cortisol
Pituitary Cushings MCC Cushing’s; ACTH secreting pituitary tumor
Lab low dose dexamethasone not suppress cortisol; high dose suppresses
Adrenal Cushings adrenal adenoma secreting cortisol; suppressed ACTH
Lab no suppression with low/high dose dexamethasone
Ectopic Cushings ACTH secreting small cell carcinoma of lung; high ACTH and cortisol levels
Lab no suppression with low/high dose dexamethasone
S/S Cushings purple stria, truncal obesity, hypertension, DM
Primary aldosteronism benign adenoma in zona glomerulosa
S/S hypertension and muscle weakness (hypokalemia), no pitting edema
Lab hypernatremia, hypokalemia, metabolic alkalosis, ↑ urine K+ and Na+
Pheochromocytoma benign tumor in adrenal medulla in adults
Associations von Hippel Lindau, neurofibromatosis, MEN IIa and IIb
S/S labile hypertension, anxiety, sweating, headache
Lab ↑ 24 hr urine for VMA and metanephrines
Neuroblastoma malignant tumor adrenal medulla child; widespread metastasis; hypertension
ß-islet cell tumor (insulinoma) benign tumor; hypoglycemia, ↑ insulin and C-peptide
Patient taking excess insulin hypoglycemia, ↑ insulin, ↓ C-peptide
Glucagonoma malignant α-islet cell tumor; hyperglycemia and rash
Zollinger Ellison syndrome malignant islet cell tumor secreting gastrin; peptic ulcers
Somatostatinoma malignant δ islet cell tumor; DM, malabsorption, cholelithiasis, achlorhydria
VIPoma malignant islet cell tumor; diarrhea, hypokalemia, achlorhydria
DM organ damage correlates with glycemic control
Type 1 young, thin person; no insulin; HLA DR3/4; insulitis; islet cell antibodies; ketoacidosis
Type 2 older person; obese; relative insulin deficiency (↓ insulin receptors, postreceptor problems)
Type 2 family history; fibrotic islet cells with amyloid; hyperosmolar nonketotic coma
↑ Non-enzymatic glycosylation glucose attaches to amino acids in basement membranes
Non-enzymatic glycosylation ↑ vessel permeability producing hyaline arteriolosclerosis
Osmotic damage glucose converted into sorbitol by aldose reductase
Osmotic damage lens (cataracts), Schwann cell (neuropathy), pericytes retinal vessels (microaneurysms)
Pathogenesis hyperglycemia ↑ gluconeogenesis (most important), glycogenolysis
Pathogenesis hyperlipidemia no insulin to stimulate capillary lipoprotein lipase; ↑ chylomicrons/VLDL
Pathogenesis ketoacidosis ↑ oxidation fatty acids with excess acetyl CoA; liver synthesis ketone bodies
Most commons due to DM neuropathy, blindness, CRF, hyperglycemia, non-traumatic amputation
Glycosylated HbA1c measure of long term glycemic control (8-12 weeks)
Gestational DM ↑ placental size, human placental lactogen
Complications macrosomia (↑ muscle/fat from insulin), RDS, newborn hypoglycemia (↑ insulin)
Hypoglycemia insulin/oral hypoglycemics MCC, liver disease; carnitine deficiency
Carnitine deficiency no ß-oxidation of fatty acids; all cells compete for glucose
Created by: megankirch