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Endocrinology

FA complete review

QuestionAnswer
From which embryonic parts does the Thyroid diverticulum arise? Floor of primitive pharynx and descends into neck
What is the normal remnant of the Thyroglossal duct? Foramen cecum
What is the most common ectopic thyroid tissue site? Tongue
What is a rare consequence of lingual thyroid removal? Hypothyroidism
Where in the neck does a Thyroglossal duct cyst appear? Anterior midline neck mass
What mass is located at the lateral neck? Branchial cleft cyst
Persistent cervical sinus may lead to development of: Branchial cleft cyst
Why neck mass moves with swallowing or protrusion of tongue? Thyroglossal duct cyst
If the neck mass moves as the patient is asked to swallow, it most likely indicates? Where in the neck is it located MC? Thyroglossal duct cyst; most commonly located anterior midline of neck
Thyroid follicular cells are derived from which embryonic tissue? Endoderm
What tissue gives rise to Parafollicular cells? Neural crest
What is another name used for Parafollicular cells? C cells
What is produced by C cells? Calcitonin
What are the 3 zones that make up the Cortex of the Adrenal gland? Z. Glomerulosa, Z. Fasciculata, and Z. Reticularis
What is the main hormone produced by the Zona Glomerulosa? Aldosterone
What is the primary regulation substance for the Z. Glomerulosa? Angiotensin II
What class of hormone is Aldosterone considered? Mineralocorticoids
What are regulatory hormones of the Z. Fasciculata? ACTH and CRH
What hormone class is secreted by the Z. Fasciculata? Glucocorticoids
What hormone is primarily secreted by Z. Fasciculata? Cortisol
Which zona of the adrenal medulla secretes Androgens? Zona Reticularis
What is the primary hormone produced by the Z. Reticularis? DHEA
The adrenal cortex is derived from ____________________. Mesoderm
The adrenal medulla is derived from _________________. Neural crest
What are the main catecholamines secreted by the Adrenal medulla? Epinephrine and Norepinephrine
What accounts for the regulation of catecholamine secretion in the adrenal medulla? Preganglionic sympathetic fibers
What is another term used for Anterior Pituitary? Adenohypophysis
What is another name used for the Posterior Pituitary? Neurohypophysis
What hormones are secreted by the anterior pituitary gland? FSH, LH, ACTH, TSH, prolactin, GH, and B-endorphin.
What area of the pituitary gland releases MSH? Intermediate lobe of the pituitary (considered more anterior)
What is the name of the oral ectoderm that gives rise to the anterior pituitary? Rathke pouch
Which adenohypophysis hormones are considered Basophils? FSH, LH, ACTH, TSH
What is the mnemonic sued to remember Anterior pituitary basophil hormones? B-FLAT
GH and PRL are ___________________________. Acidophils
FLAT PiG FSH, LH, TSH, PRL (prolactin), GH
What hormones are derivatives of Proopiomelanocortin? ACTH, MSH, and B-endorphin
Which subunit in the hormones secreted by the anterior pituitary determines hormone specificity? Beta subunit
The alpha-subunit is shared by which anterior pituitary hormones? TSH, LH, FSH, and hCG (not secreted by adenohypophysis)
Which hormone is shares the alpha subunit with TSH, LH, and FSH, but is not secreted by the anterior pituitary? hCG
What hormones are stored and secreted in the Posterior Pituitary? Vasopressin (ADH) and Oxytocin
Where are Oxytocin and Vasopressin, both, made? Hypothalamus
Which Hypothalamic nucleus make Vasopressin? Supraoptic Nucleus
Which Hypothalamic nucleus synthesizes Oxytocin? Paraventricular nucleus
What are the name for the carrier proteins used by Posterior Pituitary hormones? Neurophysins
Which embryonic tissue layer gives rise to the Posterior Pituitary? Neuroectoderm
What are the Pancreatic Islets of Langerhans? Collections of alpha, beta and gamma endocrine cells
What are the Pancreatic peripheral endocrine cells? Alpha cells
Pancreatic alpha cells secrete? Glucagon
Where in the Islet of Langerhans are the Pancreatic Beta cells located? Centrally
What is secreted by the Pancreatic Beta cells? Insulin
Gamma cells of the pancreas are ___________________ in the Islet of Langerhans and secrete ____________________. Interspersed; Somatostatin
Where is preproinsulin made? Rough Endoplasmic Reticulum
Where is Proinsulin stored in the cell? Secretory granules
How are the endogenous quantities of Insulin and C-peptide as they are naturally released? Equal amounts
What two pathologic conditions yield high levels of Insulin and C-peptide? Insulinoma and Sulfonylurea use
A patient with exogenous insulin therapy will yield a ________ level of C-peptide. Low
What is the type of Insulin receptors? Tyrosinase kinase activity
What kind of transport is used to induce glucose uptake upon insulin stimulation? Carrier-mediated transport
Insulin ____________ cross the placenta. Cannot
What are some anabolic effects of insulin? Increase: - glucose transport in skeletal muscle and adipose tissue - Glycogen synthesis and storage - Triglyceride synthesis Decrease: - Glucagon release - Lipolysis in adipose tissue
What are the anabolic effects of insulin in the kidneys? Increase Sodium ion retention
Which pancreatic hormone can cause increase protein synthesis in muscles upon release? Insulin
What is the main Insulin-dependent glucose transporter? GLUT 4
GLUT 4 is: Insulin-dependent glucose transporter
What tissues and situations use or increase expression of GLUT4? Adipose tissue, striated muscle. Exercise increases GLUT4 expression
Which are the Insulin- Independent transporters? GLUT1, GLUT2, GLUT 3, GLUT 5, and SGLT1/SGLT2.
What mnemonic is used to remember the Insulin-independent glucose transporter tissues? BRICK LIPS
What tissues use GLUT-1? RBCs, brain, cornea, placenta
GLUT-2 is used by: B-islet cells, liver, kidney, small intestine.
GLUT-2 is an Insulin - _______________________ glucose transporter, and it is also _________________. Independent; Bidirectional
GLUT-3 receptors are seen in: Brain and placenta
What kind of sugar is used by GLUT-5? Fructose
GLUT-5 serves as receptor for which kind of tissues or organs? Spermatocytes and GI tract
When can the brain start using ketone as source of energy? Starvation
What organelle is lacking in RBCs? Mitochondria
Why does RBCs are unable to use ketone for energy source at starvation times? Lack of mitochondria
What is the major regulator of insulin release? Glucose
What are the two major Incretins? GLP-1 and GIP
How do incretins work? Release after meals and Increase Beta cell sensitivity to glucose
The stimulation of alpha-2 receptors leads to a ______________ in insulin. Decrease
Beta-2 receptor stimulation leads to an ______________ in insulin secretion. Increase
What is the main function of Glucagon? Elevate blood sugar levels to maintain homeostasis when concentration of bloodstream glucose falls too low.
Glucagon promotes: 1. Glycogenolysis 2. Gluconeogenesis 3. Lipolysis 4. Ketone production
What 3 states or hormones inhibit glucagon release? Insulin, hyperglycemia, and somatostatin
Glucagon is secreted by _______________________, in response to_____________________. Alpha-cells of pancreas; Hypoglycemia
What is the function of ADH? Increase water permeability of DCT and Collecting duct cells in kidney to increase water reabsorption.
What is the stimulus for ADH secretion? Increase in plasma osmolality
How is the level of ADH in SIADH? Inappropriately elevated despite low plasma osmolality
What is the function of CRH? Increase release of ACTH, MSH, and B-endorphin.
What can lower the release of CRH? Chronic exogenous steroid use
Increasing levels of prolactin lead to: Decreased release of prolactin and TSH
Dopamine antagonist, such as antipsychotics may cause: Galactorrhea due to hyperprolactinemia
GHRH works by increasing the release of: GH
What is an GHRH analogue? Tesamorelin
What is a common use for Tesamorelin HIV-associated lipodystrophy
What is the main function of GnRH? Increase secretion of FSH and LH
Tonic GnRH: Suppresses HPG axis
Pulsatile GnRH: leads to puberty and treatment of infertility
How is GnRH secretion inhibited? By Hyperprolactinemia
What is the main function of Oxytocin? 1. Causes uterine contractions during labor. 2. Milk letdown reflex in response to suckling
Increase levels of prolactin lead to a ________________ release of GnRH. Decreased
What is a common malignancy that causes increased levels of Prolactin? Pituitary adenoma
What are accompanying symptoms of Pituitary adenoma? Amenorrhea, Osteoporosis, Hypogonadism, and Galactorrhea
Somatostatin analogs are used to treat? Acromegaly
TRH stimulates the secretion of: TSH and Prolactin
What is a common symptom seen with increased levels of TRH? Galactorrhea
Prolactin is structurally homologous to _________. Growth Hormone
Prolactin inhibits: In females Ovulation and in males Spermatogenesis
What is associated with high levels of Prolactin? Decreased libido
What pathway does Dopamine uses to inhibit Prolactin? Tuberoinfundibular pathway of Hypothalamus
What is a common Dopamine agonist? Bromocriptine
Bromocriptine is a ___________________ ____________________. Dopamine agonist
Dopamine ANTAGONISTS: Stimulate Prolactin secretion
Another name for Growth Hormone is: Somatotropin
What are the 2 main functions of Growth hormone? 1. Stimulates linear growth and muscle mass through IGF-1 secretion in liver. 2. Increase insulin resistance (diabetogenic)
What is the name often used for IGF-1? Somatomedin C
What are some activities that stimulate the release of GH? Exercise, deep sleep, puberty, hypoglycemia
Excess secretion of GH in adulthood leads to _______________. Acromegaly
Excess secretion of GH in childhood leads to _________________. Gigantism
What is the mco common cause of excess GH release? Ptituitary adenoma
Octreotide is an: Somatostatin analog used in treatment of acromegaly
What hormone stimulates hunger? Ghrelin
Where is Ghrelin produced? Stomach
What condition stimulate the release of Ghrelin? Sleep deprivation and Prader-Willi syndrome
Where in the Hypothalamus does Ghrelin act on? Lateral area at the hunger center
What is the satiety hormone? Leptin
Leptin is produced by: Adipose tissue
A mutated leptin gene lead to ----> Congenital obesity
Decreased levels of Leptin are seen with: Sleep deprivation and Starvation
Leptin acts via: Ventromedial area of the hypothalamus to decrease appetite
Where is the Satiety center in the Hypothalamus? Ventromedial area
Where do Endocannabinoids work on? Receptors in hypothalamus and Nucleus accumbens
Where in the Hypothalamus is ADH produced? Supraoptic and Paraventricular nuclei
What is the function of ADH in V2-receptors? Osmolality regulation
What is regulated by ADH at the V1-receptors? Blood pressure
What is the primary function of ADH? Serum osmolality regulation (ADH decreases serum osmolality, and Increase urine osmolality)
How is serum and urine osmolality regulated by ADH? Regulation of aquaporin channel insertion in principal cells or renal collecting duct
How are ADH levels in Central Diabetes insipidus? Low
Nephrogenic DI has ____________________ levels of ADH. Normal to increased
What type of DI is developed in a mutated V-2 receptors? Nephrogenic DI
What is a very common ADH analog? Desmopressin
What are some common uses for Desmopressin? 1. Central DI 2. Nocturnal enuresis
What are the two regulation actions of ADH? 1. Osmoreceptors in hypothalamus 2. Hypovolemia
Which congenital adrenal hyperplasia is the ONLY one seen with Hypotension? 21-hydroxylase deficiency
What is/are the significant labs seen in 17a-hydroxylase deficiency? Decrease androstenedione
What is the male presentation of 17a-(OH) deficiency? Ambiguous genitalia, undescended testitcles
What is the female presentation of 17a-(OH) deficiency? Lack of Secondary sexual characteristics
17a-hydroxylase deficiency is seen with excessive levels of: Mineralocorticoids, which indicates Z. Glomerulosa hypertrophy
What type of adrenal cortex hormones are seen elevated in both congenital adrenal 21-(OH) and 11B-hydroxylase deficiencies? Elevated Sex hormones (Androgens)
What is the difference in renin activity between 11B-(OH) and 21-(OH) deficiencies? Renin activity is increased/elevated in 21-hydroxylase deficiency, and decreased n 11B-(OH) deficiency
Increases levels of 17-hydroxyprogesterone are seen in: 21-hydroxylase deficiency
What is the MC congenital adrenal deficiency? 21-hydroxylase deficiency
Presents in infancy with child wasting, or in childhood with precocious puberty. Dx? 21-hydroxylase deficiency
11B-hydroxylase deficiency is seen with key mineralocorticoid levels: 1. Decreased Aldosterone 2. Elevated 11-deoxycorticosterone
Elevated levels of 11-deoxycorticosterone results in: Elevated Blood pressure
How is the presentation the Female presentation of 21-hydroxylase deficiency? Virilization
Decreased renin activity often indicates what congenital adrenal deficiency? 11B-hydroxylase
What dermatologic condition is shared by all congenital adrenal enzyme deficiencies? Skin hyperpigmentation
Why is there skin hyperpigmentation in all Congenital Adrenal enzyme deficeines? Increased MSH production, which is co produced and secreted with ACTH.
Bilateral adrenal gland enlargement is seen all congenital adrenal enzyme deficiencies due to: Increased ACTH stimulation
If the Congenital adrenal enzyme deficiency starts with 1 ---> Hypertension
If the Congenital adrenal enzyme deficiency ends with 1 ----> Virilization in females
Anastrozole and Exemestane work in the Z. _____________ of the adrenal cortex, and inhibit _____________. Reticularis; Aromatase
Which enzyme is inhibited by Anastrozole? Aromatase
Finasteride inhibits what Z. Reticularis enzyme? 5a-reductase
The use of Finasteride prevents the formation of ________. DHT
How is Cortisol most commonly found? Bound to corticosteroid-binding globulin
Exogenous Corticosteroids can cause: Reactivation of TB and candidiasis by blocking IL-2 production
How does cortisol affect Blood Pressure? Increases BP: -- Upregulates a-1 receptors on arterioles --> increase sensitive to NE and Epi (permissive action)
How does Cortisol affects glucose levels? Increases gluconeogenesis, lipolysis, and proteolysis
Why does high levels of Cortisol are seen with poor wound healing and decrease collagen synthesis? Decreased fibroblast activity
What are the inflammatory and immune functions of Cortisol? - Inhibits rodciotn of Leukotrienes and prostaglanins - Inhibits WBC adhesion ----> NEUTROPHILIA - Blocks histamine release from mast cells - Eosinopenia, lymphopenia -Blocks IL-2 production
How does Cortisol affect bone formation? Decreases by decreasing osteoblast activity
Excess Cortisol often leads to: Decreased CRH, ACTH, and cortisol secretion
What is the MC presentation Calcium in Plasma? Ionized/free form which is the active form
How does an increase in pH affect Calcium homeostasis? Increase affinity to albumin leading to ----> HYPOCALCEMIA
What are some signs and/or symptoms of hypocalcemia? Cramps, pain, paresthesias, carpopedal spasm
What is the primary regulator of PTH? Ionized/free Calcium
Changes in ____ affect PTH secretion. pH
Changes in ________________ do not affect PTH secretion. Albumin
Which cells in the Parathyroid gland secrete PTH? Chief cells
What are the 4 main functions of PTH? 1. Increase bone resorption of Ca2+ and phosphate. 2. Increase kidney reabsorption of Ca2+ in DCT 3. Decrease reabsorption of phosphate in PCT 4. Increase 1,25-(OH)2 production
Another name for 1, 25-(OH)2 D3? Calcitriol
How is calcitriol production stimulated by PTH? Stimulating kidney 1a-hydroxylase in PCT
What actions of PTH take place in the PCT? Decrease reabsorption of phosphate and Increase production of calcitriol
Describe major anion and cation changes caused by PTH: In serum: -- Increase Calcium concentration -- Decrease phosphate concentration In Urine: -- Increased phosphate and cAMP
RANK-L is secreted by: Osteoblasts and Osteocytes
What hormone increases the expression (concentration) of RANK-L? PTH
On which bone cell do RANK-L bind to RANK? Osteoclasts
The formation of RANK-RANK-L complex on osteoclasts cause --> Stimulate osteoclasts and increased serum Calcium --> bone resorption
How is PTH affected by a increases in serum Phosphate? Increased PTH secretion
What are 3 common serum ionic changes that cause an increase in PTH release? Decrease in serum Calcium and Mg2+, and an increase in serum Phosphate
Severe Mg2+ serum decrease causes a _______________ in PTH release. Decrease
What are some common causes of Mg2+ loss? Diarrhea, aminoglycosides, diuretics, and alcohol use
What is the function of Calcitonin? Decrease bone resorption of Calcium
What happens to Calcitonin with an increase in serum Ca2+? Increase Calcitonin secretion
Calcitonin opposes the actions of: PTH
What is the main source of Thyroid hormones? Follicles of Thyroid
What is the major Thyroid product? T4
What enzyme converts T4 into T3 in the Peripheral tissue? 5'-deiodinase
What drugs can prevent the peripheral conversion of T4 into T3 int he peripheral tissue? Glucocorticoids, Beta-blockers, and PTU
What are the important functions of Thyroid Peroxidase? 1. Oxidation, organification of iodide 2. Coupling of MIT and DIT
What drugs inhibit thyroid peroxidase? PTU and methimazole
DIT + DIT = T4
DIT + MIT = T3
What is the Wolff-Chaikoff effect? Excess iodine temporary negatively inhibit thyroid peroxidase leading to decreased T3/T4 production.
What is the active form of thyroid hormone? T3
Which form of TH has greater affinity to nuclear receptors? T3
What are the Beta-adrenergic effects of T3? Increase B1 receptors in heart ----> Increase in CO, HR, SV, and Contractility.
What drugs are used to treat the beta adrenergic effects of Thyrotoxicosis? Beta blockers
How is Basal metabolic rate increased by T3? Increase in NA+/K+-ATPase activity --> Increased Oxygen consumption, RR, adn body temperature.
What blood sugar-related processes are stimulated by TH? Glycogenolysis and Gluconeogenesis
What are the two main ways of Negative feedback of free T3/T4 release? 1. Anterior pituitary ---> Decrease sensitivity to TRH 2. Hypothalamus ---> Decrease TRH secretion
Bound T3/T4 is -- INACTIVE
What protein binds most of T3/T4 in blood? Thyroxine-binding globulin (TBG)
What condition is seen with increased TBG? Pregnancy and OCP use
What i the relation between TBG and Estrogen? Elevated Estrogen (pregnancy) increased TBG, which leads to an increase in total T3/T4
What kind of conditions lead to an overall increase in total T3/T4? Conditions that increase Estrogen levels such as pregnancy and OCP use.
What are conditions that decrease levels of TBG? Hepatic failure, steroids, and Nephrotic syndrome
TSI is positive in what thyroid pathological condition? Graves disease
Steroid hormones are ____________________. Lipophilic
How are most steroid hormones circulate in blood? Bound to specific binding globulins
The bingidn of Steroid hormones to theri specific blood binding globluin causess: Increase their solubility
In men, an increase in sex hormone-binding globulin (SHBG) cause: Lowers free testosterone ---> Gynecomastia
How is SHBG changed in concentration by use of OCPs and pregnancy? Increased
In women a decrease in SHBG --> Raises free testosterone leading to Hirsutism
Increased levels of cortisol result in development of what condition? Cushing Syndrome
What is the MCC of Cushing Syndrome? Exogenous corticosteroids, as these cause a decrease in ACTH, and bilateral adrenal atrophy.
What hormone level is measured to determine the cause of Cushing syndrome? ACTH levels
In case of elevated Cortisol and ACTH, which then ACTH secretion is suppressed by Low dose Dexamethasone test, what are the most common causes of Cushing syndrome? Exogenous glucocorticoids or adrenal tumor
What is the most common cause of No suppression of ACTH secretion with high dose dexamethasone test in screening for Cushing syndrome? Ectopic ACTH secretion
Cushing disease is often referred as: ACTH-secreting pituitary adenoma
What is responsible for majority of Endogenous cases of Cushing syndrome? Cushing disease
What is the MC example of Ectopic ACTH secretion? Small cell Lung cancer
What are the initial screening tests for Cushing syndome? 1. Increase free cortisol on 24 hour urine analysis 2. Increase midnight salivary cortisol 3. No suppression with overnight low-dose dexamethasone test
What is adrenal insufficiency? Inability of adrenal glands to generate enough glucocorticoids and/or mineralocorticoids for the body's needs.
What are the general symptoms of adrenal insufficiency? Weakness, fatigue, orthostatic hypotension, muscle aches, weight loss, GI disturbances, sugar and/ or salt cravings
What is the main lab measure disturbance in diagnosis adrenal insufficiency? ACTH levels
Primary adrenal insufficiency is characterized by ______ cortisol and ______ ACTH. Low cortisol; High ACTH
Low cortisol and ACTH levels indicate: Secondary and Tertiary Adrenal Insufficiency
What type of adrenal insufficiency is seen with Pituitary/Hypothalamic disease? Secondary and Tertiary Adrenal Insufficiency
Metyrapone is a drug used in diagnosis what disease? Adrenal insufficiency
A Metyrapone Stimulation test in a patient with Primary adrenal insufficiency will yield ? - Increase in ACTH - 11-deoxycortisol remains low
If ACTH and 11-deoxycortisol remain low after Metyrapone test, it indicates? Secondary/Tertiary adrenal insufficiency
Addison's disease is? Chronic Primary adrenal insufficiency
Primary adrenal insufficiency is: Deficiency of aldosterone and cortisol production due to loss of adrenal gland
What are the clinical symptoms of Primary Adrenal insufficeincy? - Hypotension (due to hyponatremic volume contraction) - Hyperkalemia -Metabolic acidosis - Skin and mucosal hyperpigmentation
What is the most common cause of Acute Primary adrenal insufficiency? Massive hemorrhage
What is Waterhouse-Friderichsen syndrome? Acute primary adrenal insufficiency due to adrenal hemorrhage associated with septicemia, DIC, and endotoxic shock.
What is the most common organism the causes Septicemia leading to Waterhouse-Friderichsen syndrome? Neisseria meningitidis
What is the MCC of Chronic Primary adrenal insufficeiney? Adrenal atrophy or destruction by disease
What are the most common causative disease of Addison disease in the Western world? Autoimmune destruction of gland
TB is the most common cause of ______________ disease in the developing world. Addison
What level of adrenal isnusfficity is seen with decreased pituitary ACTH production? Secondary adrenal insufficiency
How is Secondary Adrenal insufficiency different from Primary, clinically? Secondary Adrenal insufficiency does not present skin/mucosal hyperpigmentation and no Hyperkalemia
What is the term used for increased secretion of aldosterone form adrenal gland? Hyperaldosteronism
What are the main clinical features of Hyperaldosteronism? Hypertension, Low to normal K+, and metabolic Alkalosis
What is Conn Syndrome? Primary Hyperaldosteronism due to adrenal adenoma
What are the causes of Primary Hyperaldosteronism? Conn syndrome and bilateral adrenal hyperplasia
How are the levels of Primary Hyperaldosteronism of aldosterone and renin? Increased Aldosterone and Decreased Renin
What kind of hypertension is seen with Conn Syndrome? Resistant hypertension
What are some common causes of Secondary Hyperaldosteronism? Renovascular hypertension, Juxtaglomerular cell tumor (renin-proeding), and edema
What type of tumors arise from Neuroendocrine cells? Neuroendocrine tumors
What enzyme is contained in Neuroendocrine cells? Amine precursor uptake decarboxylase (APUD)
What are some hormones released by Neuroendocrine cells? Serotonin, histamine, calcitonin, neuron-specific enolase [NSE], chromogranin A
Which are the two most common Neuroendocrine GI tumors? Carcinoid and Gastrinoma
Which is a Neuroendocrine Lung tumor? Small cell Carcinoma of the lung
Insulinoma and Glucagonoma are examples of: Pancreatic Neuroendocrine tumors
Which kind of thyroid cancer is a neuroendocrine tumor? Medullary carcinoma of the thyroid
Pheochromocytoma is an: Adrenal gland neuroendocrine tumor
What is the MC adrenal gland tumor in children? Neuroblastoma
Neuroblastoma originates from which kind of cell? Neural crest cells
What is a common and key characteristic of Neuroblastoma? Present with Opsoclonus-myoclonus syndrome
"dancing eyes-dancin feet" is a description of: Opsoclonus-myoclonus syndrome seen in Neuroblastoma
Irregular abdominal mass in a 3 year old that crosses the midline. Patient present with uncontrollable feet movements and constant irregular blinking. Dx? Neuroblastoma
What is a key histological findings in Neuroblastoma? Homer-Wright rosettes
Neuroblastoma clinical labs: Urine -- (+) for HVA and VMA (+) for Bombesin and NSE
N-myc oncogene + APUD tumor. Dx.? Neuroblastoma
What is the most common adrenal gland tumor in adults? Pheochromocytoma
What do most Pheochromocytomas secrete excess? Epinephrine, NE, and dopamine
Which adrenal tumor causes symptoms in "spells"? Pheochromocytoma
Besides catecholamines, what other hormone is secreted in Pheochromocytoma? EPO
The excess EPO secretion in Pheochromocytoma results in : Polycythemia
What are the five most common episodic hyperadrenergic symptoms of Pheochromocytoma? Pressure (increased BP) Pain (headache) Perspiration Palpitations (tachycardia) Pallor
What is found in UA of a patient with Pheocrhomactoma? ELevated levels of catecholamines and catecholamine metabolites
What is the best treatment protocol for Pheochromocytoma, prior to surgery? First irreversible a-antagonists (phenoxybenzamine), followed by beta-blockers
What is the most common alpha blocker used in tx of Pheochromocytoma? Phenoxybenzamine
VIPoma is associated with with Autosomal dominant disorder? MEN-1
What is VIPoma's priamry symtpm? Secretory diarrhea
VIPoma is associated with which syndrome? WDHA syndrome
What does the WDHA syndrome consists of? Watery diarrhea, Hypokalemia, Achlorhydria
What is achlorhydria? Absence of hydrochloric acid in gastric secretions
What are the levels of K+ seen in WDHA syndrome? Low
Hypothyroidism common symptoms include: Cold intolerance Decreased sweating, weight gain, and hyponatremia Dry skin Periorbital edema Constipation
What are musculoskeletal findings of Hypothyroidism? Hypothyroid myopathy (proximal muscle weakness, Increased CK) Carpal Tunnel syndrome, myoedema
Heat intolerance, profuse sweating, and unintentional weight loss are associated with which kind of thyroid condition? Hyperthyroidism
Increased calorigenesis is an metabolic associated finding of: Hyperthyroidism
Pretibial myxedema is associated with: Graves disease
What are important and relevant ocular findings of Hyperthyroidism? Ophthalmopathy in Graves disease including periorbital edema, and exophthalmos.
What is the difference in Thyrotoxic myopathy and Hypothyroid myopathy? CK is elevated only in Hypothyroid myopathy
What are 5 most common presentations of Hypothyroidism? 1. Hashimoto thyroiditis 2. Postpartum thyroiditis 3. Congenital hypothyroidism (Cretinism) 4. Subacute Granulomatous thyroiditis (de Quervain) 5. Riedel thyroiditis
What is another term used for Congenital hypothyroidism? Cretinism
What is another term used for Subacute granulomatous thyroiditis? de Quervain
What is the MCC of Hypothyroidism? Hashimoto thyroiditis
Hashimoto thyroiditis is positive to which antibodies? 1. Antithyroid peroxidase (antimicrosomal) 2. Antithyroglobulin
What is Hashimoto thyroiditis associated with? - HLA-DR3 - Increased risk of non-Hodgkin lymphoma of B cell origin
What is the histology seen in Hashimoto thyroiditis? Hurthle cells, lymphoid aggregates with germinal centers
What are the findings of the thyroid in Hashimoto thyroiditis? Moderately enlarged, NON-tender thyroid
When is postpartum thyroiditis presented? Self-limited throdoidid arising up to 1 year after delivery
What is the common histology seen in Postpartum thyroiditis? Lymphocytic infiltrate with coaccional germinal center formation
What are the common findings of Cretinism? Pot-bellied, Pale, Puffy face child with Protruding umbilicus, Protuberant tongue, and Poor brain development
What is an fetal form of hypothyroidism, due to antibody-mediated maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis? Cretinism
Which condition is associated with dyshormonogenetic goiter? Cretinism
What is the most common cause of Cretinism in the USA? Thyroid dysgenesis
What form of hypothyroidism often follows a flu-like illness? de Quervain thyroiditis
Granulomatous inflammation is seen in the histology of which presentation of Hypothyroidism? de Quervain thyroiditis
What are the clinical and lab findings of de Quervain thyroiditis? Increased ESR, jaw pain, and very tender thyroid
Thyroid replaced by fibrous tissue with inflammatory infiltrate describes which type of Hypothyroidism? Riedel thyroiditis
Riedel thyroiditis is considered a manifestation of: IgG4-related systemic disease
What are some examples of a IgG4-related systemic disease? Autoimmune pancreatitis, retroperitoneal fibrosis, non-infectious aortitis
Thyroid on physical exam is fixed, hard (rock-like), painless goiter Riedel thyroiditis
What are some lesser causes of Hypothyroidism? Iodine deficiency, goitrogens, Wolff-Chaikoff effect
What are some common goitrogens? Amiodarone and Lithium
What is the most common cause of Hyperthyroidism? Graves disease
What type of hypersensitivity is Graves disease considered? Type II
The thyroid-stimulating immunoglobulin stimulates the TSH receptors on: 1 Thyroid --> Hyperthyroidism, diffuse goiter 2. Dermal fibroblasts --> Pretibial myxedema
What HLA subtypes are associated with Graves disease? HLA-DR3 and HLA-B8
Inflammation and infiltration of retrorbital space by activated T-cells in Hyperthyroidism lead to: Exophthalmos
What is the described histology of Graves disease? Tall, crowded follicular epithelial cells; scalloped colloid
What is the cause of Toxic Multinodular goiter? Focal patches of hyperfunctioning follicular cells idistendenwith collid working independently of TSH
What type of nodules are rarely malignant? Hot nodules
A mutated TSH receptor often lead to: Toxic Multinodular goiter
How is A Thyroid storm treated? 1. Beta blocker (Propranolol) 2. PTU 3. Prednisolone (corticosteroid) 4. Potassium iodide
What is a Thyroid storm? Uncommon but serious complication that occurs when hyperthyroidism is incompletely treated/untreated and then significantly worsens in the setting of acute stress
What condition are common to precipitate a Thyroid storm? Stress, infection, trauma, and surgery
What is a common activity that leads to Jod-Basedow phenomenon? After iodine IV contrast
What is the opposite to Wolff-Chaikoff effect? Jod-Basedow phenomenon
What is the Jod-Basedow phenomenon? The consequences of administering iodine to a patient with iodine deficiency, to the point of making iodine replete.
What is the term used to describe a non-functional Thyroid adenoma? "Cold"
The autonomous thyroid hormone production due to a Thyroid adenoma, is referred as: "hot" or "toxic"
What is the histology seen in Thyroid adenoma? Follicular; absence of capsular or vascular invasion
What are the most common complication of thyroidectomy to treat thyroid cancer? Hoarseness of voice, hypocalcemia, and transection of recurrent and superior laryngeal nerves.
Reason for hoarseness complication after thyroidectomy? Recurrent laryngeal nerve damage
What causes the hypocalcemia seen as adverse complications in thyroidectomy? Removal of Parathyroid glands
What is a possible complication seen during ligation of the Recurrent and Superior Laryngeal nerves in a thyroidectomy? Transection of the recurrent and superior laryngeal nerves
What is the most common type of Thyroid cancer? Papillary carcinoma
What is the histologic description of Papillary thyroid cancer? Empty-appearing nuclei with central clearing, psammoma bodies, and nuclear grooves.
What are some associated risk for the development of Papillary thyroid cancer? 1. RET and BRAF mutations, 2. Childhood neck irradiation
Which thyroid cancer is associated with Psammoma bodies? Papillary carcinoma
Which thyroid cancer is seen with "Orphan Annie eyes" and excellent prognosis? Papillary carcinoma
Empty-appearing nuclei with central clearing "Orphan Annie" eyes
Which thyroid cancer is associated with RAS mutation? Follicular carcinoma
Thyroid cancer that invades thyroid capsule and vasculature; uniform follicles. Follicular carcinoma
What kind of cells give rise to the Medullary Thyroid cancer? Parafollicular "C cells"
Which thyroid cancer is seen with increased levels of Calcitonin release? Medullary carcinoma
Which thyroid cancer is described as: sheets of cells in amyloid stroma (stains for Congo Red)? Medullary carcinoma
What are the associated conditions with Medullary carcinoma? MEN 2A and MEN 2B (RET mutations)
Which population is more often associated with Undifferentiated/anaplastic thyroid cancer? Older
Which thyroid cancer has a very poor prognosis? Anaplastic carcinoma
What kind of malignancy is associated with Hashimoto thyroiditis? Lymphoma
Which are the MCC of Secondary Hyperparathyroidism? Vitamin D deficiency, Decreased Calcium intake, and chronic renal failure.
What are the MCC of Primary Hyperparathyroidism? PTH gland hyperplasia, adenoma, or carcinoma
Primary Hypothyroidism is mostly seen with? Surgical resection of PTH glands and by autoimmune disease.
What are the levels of Calcium and PTH in PTH-independent hypercalcemia? Decreased PTH and high Ca2+
What are the MCC of PTH-independent hypercalcemia? Excess Ca2+ intake, cancer, and Increased vitamin D
Increased PTH with low levels of Calcium, indicates which PTH condition? Secondary hyperparathyroidism
What are the common findings of Hypoparathyroidism? Tetany, hypocalcemia, and hyperphosphatemia
What are two common signs associated with Hypoparathyroidism? Chvostek and Trousseau signs
What is Pseudohypoparathyroidism type 1A? Unresponsiveness of kidney to PTH --> hypocalcemia despite increasing PTH levels
What is the name given to the constelatin of physical findings in Pseudohypoparathyroidism type 1A? Albright hereditary osteodystrophy
What are the findings that make up Albright hereditary osteodystrophy? Shortened 4th/5th digits, short stature, obesity, developmental delay, and autosomal dominant heritage.
What is the genetic cause of Pseudohypoparathyroidism type 1A? Defective Gs protein alpha-subunit causing end-organ resistance to PTH.
How is the inheritance of Pseudohypoparathyroidism type 1A? AD; the defect must be inherited from mother due to imprinting
What is the difference in Pseudohypoparathyroidism type when the defective Gs protein alpha subunit comes from the father? Same clinical presentation but there is no end-organ PTH resistance (PTH level normal).
What is osteitis fibrosa cystica? Cystic bone spaces filled with brown fibrous tissue, known as "brown tumor".
What is the "brown tumor" seen in Osteitis fibrosa cystica? Osteoclasts and deposited hemosiderin form hemorrhages --> bone pain.
Which type of HyperPTH are seen with Osteitis fibrosa cystica? Mainly primary, but also seen in secondary hyperparathyroidism.
Primary hyperparathyroidism is seen clinically with: Hypercalcemia, hypercalciuria, polyuria, hypophosphatemia, elevated PTH, elected ALP and cAMP in urine.
What are some secondary symptoms seen in Primary hyperparathyroidism? Weakness and constipation, abdominal/flank pain, and neuropsychiatric disturbances.
Hypercalciuria seen in Primary hyperPTH causes ---> Renal stones
Which renal condition is associated with secondary and tertiary hyperPTH? Renal osteodystrophy
Renal osteodystrophy pathogenesis Renal disease --> Secondary and Tertiary hyperparathyroidism ---> Bone lesions
What is commonly seen with Secondary Hyperparathyroidism? Chronic renal disease
Decreased Ca2+ absorption and/or increased phosphate absorption , due to CKD, develops into ---> Secondary hyperparathyroidism
How are the serum calcium levels different in Primary vs Secondary Hyperparathyroidism? Primary Hyper PTH ----> Hypercalcemia Secondary Hyper PTH ---> Hypocalcemia
Which type of hyperparathyroidism is seen with hypocalcemia? Secondary hyperparathyroidism
Which kind of hyperPTH is seen with extremely high PTH, hypercalcemia, and due to chronic renal disease? Tertiary hyperparathyroidism
What is Nelson syndrome? Enlargement of existing ACTH-secreting pituitary adenoma after bilateral adrenalectomy for refractory Cushing disease
What is the clinical presentation of Nelson syndrome? Hyperpigmentation, headaches and bitemporal hemianopsia.
What is the cause of Familial hypocalciuric hypercalcemia? Defective G-coupled Ca2+-sensing receptors in multiple tissues (Parathyroids, Kidneys).
What is the pathogenesis of Familial hypocalciuric hypercalcemia? Higher than normal Calcium Levels required to suppress PTH.
What is the result of the excessive levels of renal calcium as consequence in Familial Hypocalciuric hypercalcemia? Mild hypercalcemia and hypocalcemia with normal to elevated PTH levels
Elevated ALP is seen in ________ and _______ hyperparathyroidism. Primary and Secondary
Excess GH in adults is: Acromegaly
What is the MCC of acromegaly? Pituitary adenoma
What does diaphoresis mean? Excessive sweating
What is an associated increased in risk of developing in patients with Acromegaly? Colorectal polyps and cancer
Increased GH in children causes: Gigantism (increase linear bone growth)
What are non-surgical treatments of Acromegaly? Octreotide (somatostatin analog) and Pegvisomant (GH receptor antagonists), dopamine agonists (cabergoline)
What are some clinical features of Acromegaly? Large tongue with deep furrows, deep voice, large hands and feet, coarsening of facial features, frontal bossing, diaphoresis, impaired glucose tolerance (insulin resistance), and hypertension
What is Laron syndrome? Defective growth hormone receptors --> decreased linear growth.
What is another term used for Laron syndrome? Dwarfism
What are the clinical features of Dwarfism? Short height, small head circumference, characteristic facies with saddle nose and prominent forehead, delayed skeletal maturation and small genitalia.
What are the main characteristics of Diabetes insipidus? Intense thirst and polyuria with inability to concentrate urine due to lack of ADH (central) aor failure of response to circulating ADH (nephrogenic)
Which kind of DI is due to lack of ADH? Central DI
Which kind of DI is due to failure of response to circulating ADH? Nephrogenic DI
What are the MCC of Central DI? Pituitary tumor, autoimmune, trauma, surgeny, ischemic encephalopathy, and idiopathic.
What are the MCC of Nephrogenic DI? Hereditary (ADH receptor mutation, Secondary to hypercalcemia, hypokalemia, LITHIUM, demeclocycline (ADH antagonist)
What mood stabilizer is often a cause of Nephrogenic DI? Lithium
Which kind of DI is seen with minimal change in urine osmolality, even after administration of ADH analog? Nephrogenic DI
Increase of > 50% in urine osmolality after administration of ADH analog, is characteristic of ________ Diabetes insipidus. Central
What are the treatments for Central DI? Desmopressin and Hydration
What are some of the treatments used in Nephrogenic DI? HCTZ, indomethacin, amiloride Hydration, dietary salt restriction, and avoidance of offending agent
How is the level of ADH in Central DI? Low
How are the levels of ADH seen in Nephrogenic DI? Normal to elevated
SIADH MCC by: 1. Ectopic ADH (small cell lung cancer) 2. CNS disorders/head trauma 3. Pulmonary disease 4. Drugs (cyclophosphamide)
What are some of the most important features of SIADH? - Excessive free water retention - Euvolemic hyponatremia with continued urinary Na+ secretion - Urine osmolality > Serum Osmolality
What is the first line of treatment for SIADH? Fluid restriction
What are the secondary measures of treatment of SIADH? Salt tablets, IV hypertonic saline, diuretics, conivaptan, tolvaptan, demeclocycline.
What test and result indicate Psychogenic polydipsia? Increased urine osmolality during water deprivation test
How is the Euvolemic hyponatremia seen in SIADH causes? Body responds to water retention by synthesizing more ANP and BNP --> increased Na+ secretion --> normalization of extracellular fluid volume ----> euvolemic hyponatremia
If the hyponatremia (low Na+ serum) is corrected to fast it may cause ----> Osmotic Demyelination syndrome
What are some clinical signs seen in very low serum levels? Cerebral edema and seizures.
Undersecretion of the pituitary hormones is known as: Hypopituitarism
What is Sheehan syndrome? Form of hypopituitarism. Ischemic infarct of pituitary following postpartum bleeding
Why does Sheehan syndrome occurs? During pregnancy the pituitary gland experiences an induced growth leading to a increased susceptibility to hypoperfusion
What are the most common and characteristic features that indicated Sheehan syndrome? Failure to lactate, absent menstruation, and cold intolerance.
Which are 3 very important and distinctive forms and causes of Hypopituitarism? Sheehan syndrome, Empty sella syndrome, and Pituitary apoplexy.
What is the Empty sella syndrome? Atrophy or compression of pituitary, often idiopathic. It is very commonly seen in obese women
What is a common morbidity of Empty sella syndrome? Idiopathic intracranial hypertension
Where, anatomically, does the pituitary is located? Lies in the Sella Turcica
What is Pituitary Apoplexy? Sudden hemorrhage of pituitary gland, often in the presence of an existing pituitary adenoma.
How is the clinical view of a patient with Pituitary apoplexy? Sudden onset severe headache, visual impairment, and features of hypopituitarism.
What are the ocular or vision deficits seen in Pituitary apoplexy? Bitemporal hemianopia and Diplopia due to CN III palsy
What is a rare cause of Diabetes Mellitus? Unopposed secretion of GH and Epinephrine
What are the main features of Diabetes mellitus? Polydipsia, polyuria, polyphagia, weight loss, DKA (type 1), hyperosmolar hyperglycemic state (type 2).
DKA is seen in Diabetes mellitus type ____. 1
What are the two main categories of chronic DM complications? 1. Nonenzymatic glycation 2. Osmotic damage
What are the Nonenzymatic glycation complications of DM? 1. Small vessel disease (due to diffuse thickening of basement membrane). 2. Large vessel atherosclerosis, CAD, peripheral vascular occlusive disease, gangrene
What are the results of Small vessel disease seen in chronic DM? Retinopathy, glaucoma, neuropathy, and nephropathy
What are the nephropathic features seen in a patient with Chronic Diabetes mellitus? Nodular glomerulosclerosis, aka Kimmelstiel-Wilson nodules --> progressive proteinuria and arteriosclerosis ---> hypertension
What is meant by Osmotic damage in chronic DM? Sorbitol accumulation in organs with aldose reductase and decrease or absence sorbitol dehydrogenase
What enzyme is deficient or absent in DM which causes Osmotic damage? Sorbitol dehydrogenase
What are the forms in which osmotic damage is manifested in DM patients? 1. Neuropathy (motor, sensory, and autonomic degeneration) 2. Cataracts
How is the sensory loss seen in DM due to osmotic damage described? Glove and stocking distribution
What is the value of HbA1c to diagnose Diabetes mellitus? Greater or equal to 6.5%
What is the primary defect DM 1? Autoimmune destruction of B-cells
What is the cause of autoimmune destruction of B-cells in DM 1? Due to glutamic acid decarboxylase antibodies
Which type of DM ALWAYS requires insulin injections? Type 1
What is the common age for a patient with DM1? Less than 30 years old
Which DM is assocaited with obesity? Type 2
Which DM has a strong genetic association? Type 2
What are the HLA association for DM type 1? HLA-DR4 and HLA-DR3
Easy way to relate HLA system and type 1 Diabetes mellitus? 4 - 3 = 1
Which type of DM has a stronger or more severe glucose intolerance? Type 1
Which DM is seen commonly developing DKA? Type 1
What is the histology of Diabetes mellitus type 1? Islet leukocytic infiltrate
What is the primary defect of Diabetes mellitus type 2? Increase resistance to insulin, progressive pancreatic B-cell failure
What is the average age to start develon DM type 2? Over 40 years old
How is the histology of DM type 2 featured? Islet amyloid polypeptide (IAPP) deposits
What is the pathogenesis of DKA? Excess fat breakdown and increased ketogenesis from elevated free fatty acids, which are then made into ketone bodies
Which ketone body is most abundant in DKA? B-hydroxybutyrate
What are the signs and symptoms seen in DKA? - Delirium/psychosis, - Kussmaul respirations (papid, deep breathing) -Abdominal pain/N/V -Dehydration
What ist he characteristc breath odor associated with DKA? Fruity breath odor
Why does DKA has a fruity breath odor Due to excess exhacked acetone
DKA cause what kind of metabolic acidosis? Anion-gap Metabolic acidosis
What are some labs seen with DKA? -Hyperglycemia, -Acidosis, -Decreased HCO3 - Elevated serum ketone level -Leukocytosis
Why is characteristic of the Hyperkalemia exhibited in DKA? Serum hyperkalemia, but depleted intracellular K+ due to transcellular shift form decreased insulin and acidosis
What are the most important compilation of DKA? 1. Life-threatening mucormycosis 2. Cerebral edema 3. Cardiac arrhythmias, 4. Heart Failure
What is the treatment for DKA? IV fluids, IV insulin, and K+ to replete the intracellular stores; Glucose if necessary to prevent hypoglycemia
What is the MC causative organism of Mucormycosis in DKA patients? Rhizopus infection
What is hyperosmolar hyperglycemic state? State of profound hyperglycemia-induced dehydration and increased serum osmolality
What kind of population is at higher risk of developing Hyperosmolar hyperglycemic state? Elderly type 2 diabetes with limited ability to drink
What are the alarming labs seen in Hyperosmolar hyperglycemic state? Glucose > 600 mg/dL Serum Osmolality >320 mOsm/kg No acidosis (pH >7.35)
Why is there no acidosis in Hyperosmolar hyperglycemic state? Ketone production is inhibited by the presence of insulin
Common tumor of alpha pancreatic cells, that over secretes glucagon? Glucagonoma
What are the classic symptoms seen in a patient with a Glucagonoma? Dermatitis (necrolytic migratory erythema), diabetes (hyperglycemia), DVT, declining weight, depression
What is the non-surgical treatment for Glucagonoma? Octreotide
An insulinoma is a tumor from which cells? Pancreatic B-cells, which oversecrete insulin leading to severe hypoglycemia
What is the name of the triad of symptoms often associated with an Insulinoma? Whipple triad
What is the Whipple triad seen with Insulinomas? 1. Low blood glucose 2. Symptoms of Hypoglycemia (lethargy, syncope, and diplopia) 3. Resolution of symptoms after normalization of glucose levels
What kind of syndrome is often associated with an Insulinoma? MEN 1
Overproduction of Somatostatin causes: Decrease secretion of secretin, CCK, glucagon, insulin, gastrin, and GIP
What are common clinical features of an Somatostatinoma? Diabetes/glucose intolerance, steatorrhea, gallstones, achlorhydria.
Tumor of pancreatic gamma-cells? Somatostatinoma
What is the most common malignancy of the Small intestine? Carcinoid tumor
What is the first organ in which a carcinoid tumor metastasizes? Liver
Carcinoid tumors are derived from which type of cells? Neuroendocrine cells
What is commonly secreted in high amounts in GI carcinoid tumors? Serotonin (5-HT)
What are the common clinical features seen with Carcinoid syndrome? Recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular heart disease due to lung MAO-A enzymatic breakdown of 5-HT before left heart return
What side of the heart is affected more severely in Carcinoid syndrome? Right side
What substance is elevated in urine in Carcinoid syndrome? 5-hydroxyindoleacetic acid
What is the name of the condition due to Niacin deficiency? Pellagra
What markers are associated with Carcinoid syndrome? Chromogranin A and Synaptophysin
What is the most common treatment for Carcinoid syndrome , other than surgery? Octreotide
What syndrome is associated with Gastrin-secreting tumor of Pancreas or duodenum? Zollinger-Ellison syndrome
What is the common gastrin-secreting tumor in ZES? Gastrinoma
ZES hypersecretion of acid causes --> Recurrent ulcers in duodenum and jejunum
What syndrome is most often associated with Zollinger-Ellison syndrome? MEN 1
How is ZES clinically presented? Abdominal pain (PUD, distal ulcers), diarrhea (malabsorption)
ZES has a _________________ secretin stimulation test. Positive
In a Secretin stimulation test, if gastrin levels remain elevated after administration of secretin, it most likely indicate? Zollinger-Ellison syndrome
What is the inheritance of Multiple Endocrine neoplasias? Autosomal dominant
What are the three neoplasias that compose MEN 1? Pituitary tumors Pancreatic endocrine tumors Parathyroid adenomas
What are the most common substances secreted by Pituitary tumors seen in MEN1? Prolactin >> GH
What are the Pancreatic endocrine tumors seen in MEN 1? Zollinger-Ellison syndrome, insulinomas, VIPomas, and glucagonomas (rare)
What is the associated mutation in MEN 1? Menin, a tumor suppression, chromosome 11
What thyroid carcinoma is associated with MEN 2A and MEN 2B? Medullary thyroid carcinoma
Parathyroid hyperplasia + Medullary thyroid carcinoma + Pheochromocytoma. Dx? MEN 2A
What does RET code for? Receptor tyrosine kinase
Tumor originated from neural crest cells and secretes catecholamines Pheochromocytoma
What substance is secreted by Medullary thyroid carcinoma? Calcitonin
Which two neoplasias are shared in MEN 2A and MEN 2B? Medullary thyroid carcinoma and Pheochromocytoma
What are the examples of Mucosal neuromas seen in MEN 2B? Oral/ intestinal ganglioneuromatosis
Which MEN is associated with marfanoid habitus? MEN 2B
What are the associated neoplasia of MEN 2B? Medullary thyroid cancer, Pheochromocytoma, and Mucosal neuromas
What are the associated side effects of injectable Insulin preparations? Hypoglycemia, lipodystrophy, rare hypersensitivity reactions
What is the action of insulin in the liver? Increase glucose stored as glycogen
How does insulin work in the muscle? Increase glycogen and protein synthesis
In what organ/tissue does insulin increase the level of glycogen and protein production? Muscle
How is the cell membrane affected by exogenous insulin preparations? Increase Potassium ion (K+) uptake
What are the Rapid acting Insulin preparations? Lispro, Aspart, Glulisine
At what time (hours) is the peak action of Rapid insulin preparations? 1 hour
The maximal effect of an exogenous insulin occurred nearly an hour after administration. Which are some common examples? Lispro, Aspart, and Glulisine
How many hours after administration of Short acting insulin preparations is the maximal effect seen? 2-3 hours
Regular insulin is an: Short-acting insulin
NPH is an: Intermediate acting insulin
NPH will see maximal effect _____ hours after administration. 4-10 hours
What are the two most common Long acting insulin preparations? Detemir and Glargine
Pramlintide is an: Amylin analog
What is the most serious adverse effect of Pramlintide? Hypoglycemia in the setting of mistimed prandial insulin
Drug class of GLP-1 analogs? Injectables
What are examples of GLP-1 analogs? Exenatide and liraglutide
Which kind of diabetes medication increases the glucose-dependent insulin release? GLP-1 analogs
What is the most distinctive adverse effect of GLP-1 analogs? Pancreatitis
What is the preferred type of insulin to be administered in cases of DKA? Regular insulin
What is the most common biguanide? Metformin
What is the mechanism of action of Metformin? 1. Inhibit hepatic gluconeogenesis and the action of glucagon, by inhibiting mGPD 2. Increase glycolysis 3. Increased peripheral glucose uptake (increase insulin sensitivity)
What is the most significant side effect of Metformin? Lactic acidosis
Which kind of patients are often at higher risk of developing lactic acidosis by using metformin? Renal insufficient
What kind of anemia is often an associated adverse effect of metformin toxicity? Megaloblastic anemia due to Vitamin B12 deficiency
Which are the 1st generation Sulfonylureas? Chlorpropamide and Tolbutamide
Which adverse effects are shared by 1st and 2nd Sulfonylureas? Hypoglycemia (increased risk of renal failure), and weight gain
What is an associated side effect of 1st generation Sulfonylureas? Disulfiram-like effects
A patient with diagnosed disulfiram-like effects, is probably taking what kind of diabetic medication? 1st Generation sulfonylureas
Chlorpropamide and Tolbutamide are: 1st Generation sulfonylureas
What are the MC 2nd generation sulfonylureas? Glimepiride, Glipizide, and Glyburide
MOA of Sulfonylureas? Close K+ channel in pancreatic beta cell membrane --> cell depolarizes --> insulin release via increased Calcium ion influx
What is the most significant adverse effect of 2nd generation sulfonylureas? Hypoglycemia
What kind of diabetic oral drug shares mechanism of action with Sulfonylureas? Meglitinides
What is the simple difference in MOA between Sulfonylureas and Meglitinides? The binding site
Nateglinide and Repaglinide are: Meglitinides
What are some DPP-4 Inhibitors? Linagliptin, Saxagliptin, and Sitagliptin
What is the shared suffix for DPP-4 inhibitors? --gliptin
What are the major adverse effects of DPP-4 inhibitors? Mild urinary or respiratory infections
What enzyme deactivated by DPP-4 enzyme inhibition? GLP-1
What is a secondary MOA of DPP-4 inhibitors? Increase glucose-dependent insulin release
What are the Glitazones/ Thiazolidinediones? Pioglitazone and Rosiglitazone
Suffix of Glitazones/ thiazolidinediones? --glitazone
What does SGLT-2 inhibitors stand for? Sodium-glucose cotransporter 2 inhibitor
What are some examples of SGLT-2 inhibitors? Canagliflozin, Dapagliflozin, and Empagliflozin
What is the mode of action of Glitazones/ thiazolidinediones? Binds to PPAR-Y nuclear transcription regulator --> Increased insulin sensitivity and levels of adiponectin --> regulation of glucose metabolism and fatty acid storage.
What are the side effects seen with Pioglitazone? Weight gain, edema, HF, increase risk of fractures
SGLT2 inhibitors MOA? Block reabsorption of glucose in PCT
SGLT-2 inhibitors adverse effects? Glucosuria, UTIs, vaginal yeast infections, hyperkalemia, dehydration (orthostatic hypotension), weight loss
What kind of electrical imbalance is seen with SGLT-2 inhibitors toxicity? Hyperkalemia
Women with recurrent vaginal infections are probably on which diabetic medication? SGLT-2 inhibitors
What are some common alpha-glucosidase inhibitors? Acarbose and Miglitol
What is the mechanism of action of Acarbose and Miglitol? Inhibit intestinal brush-border a-glucosidases, which causes delayed carbohydrate hydrolysis and glucose absorption --> decreased postprandial hyperglycemia
Which kind of chronic patients are not indicated or suitable candidates to a-glucosidase inhibitors? Those with impaired kidney function
What are the 2 main Thioamides? Propylthiouracil (PTU) and Methimazole
What enzyme is inhibited by PTU? Thyroid peroxidase
What its inhibited by PTU therapy that causes the decrease of TH synthesis? Thyroid peroxidase inhibition causes the: 1. Inhibition of the oxidation of iodide and the, 2. Inhibition of organification and coupling of iodine
In which trimester(s) of pregnancy is Methimazole safe to be used? Second and Third
PTU is used in pregnant women during the _________ trimester. First
Which Thioamide is very teratogenic? Methimazole
What is the associated risk of PTU-therapy in 2nd and 3rd trimesters of gestation? Hepatotoxicity
Which common Hyperthyroidism complication is not treated with Thioamides? Graves ophthalmopathy
What are the most common adverse effects of Thioamides? Skin rash, agranulocytosis (rare), aplastic anemia, and hepatotoxicity.
What is the teratogenic effect caused by Methimazole? Aplasia cutis
What is a non-intended or unhealthy use of Levothyroxine? Weight loss
What are the associated side effects of Levothyroxine? Tachycardia, heat intolerance, tremors, and arrhythmias
What conditions are treated with Levothyroxine? Hypothyroidism, and Myxedema
What are some common ADH antagonists? Conivaptan and Tolvaptan
What are the clinical uses of Conivaptan? SIADH, block action of ADH at V2-receptor
What drug is used to treat Central DI? Desmopressin
Which conditions are treated with Desmopressin? Central DI, von Willebrand disease, sleep enuresis, hemophila A.
Which congenital syndrome, in women, is treated with Growth hormone? Turner syndrome
How does Oxytocin helps labor induction? Stimulates uterine contractoins
What labor complication can be controled with Oxytocin? Uterine hemorrhage
Octreotide, is used for: Acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices
What is the MOA of Demeclocycline? ADH antagonist
Demeclocycline si a member of which antiobic family? Tetracycline
What condition is treated with Demeclocycline? SIADH
What are adverse effects associeed with Demeclocycline? Nephrogenic DI, photosesnsitivity, abnormalites of bone and teeth
What ist the MOA of Fludrocortisone? Synthetic analog of aldosterone with little glucocorticord effects
What is the clinical use for Fludrocortisone? Mineralcorticoid replacement in Primary adrenal insufficiency
What are some associated adverse effects seen with Fludrocortisone? Edema, exarcebation of HF, and hyperpigmentation
What is Cinacalcet mode of action? Sensitizes Ca2+-sensing recepto (CaSR) in parathyroid gland to ciruclating Ca2+ --> decrease of PTH.
What calcium imbalnce in seen as adverse effect of Cinacalcet? Hypocalcemia
What are the clinical uses of Cinacalcet? Secondary hyperparathyroidism in patients with CKD receiving hemodialysis, hypercalcemia in Primary HyperPTH, or in PTH carcinoma.
What is Sevelamer? Nonabsorbable phosphate binder that prevents phosphate absorption from the GI.
What is the most common use for Sevelamer? Hyperphosphatemia in CKD
What medication is commonly used to reduce the levels of phosphate in blood in a patient with renal insufficiency? Sevelamer
Created by: rakomi