Goljan Endocrine Word Scramble
|
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
Normal Size Small Size show me how
Question | Answer |
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
Popular Medical sets