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Endo Buzzwords
Endocrine pathophys buzzwords for step 1
136
Medical
Graduate
06/02/2010

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Term
MC Tumor of the adrenal gland in adults
Definition
Phaeochromocytoma
Term
MC Tumor of that adrenal gland in children
Definition
Neuroblastoma (no episodic HTN)
Term
Embryological origin of Adrenal cortex
Definition
mesoderm
Term
Embryological origin of Adrenal medulla
Definition
neural crest
Term
Embryological origin of posterior pituitary
Definition
neuroectoderm
Term
Embryological origin of anterior pituitary
Definition
oral ectoderm
Term
hormones w/ common alpha subunit
Definition
TSH, FSH, LH and hCG
Term
Hormones produced by acidophils
Definition
GH and prolactin
Term
Hormones produced by pituitary basophils
Definition
B-Flat: B for basophils
1. FSH
2. LH
3. ACTH
4. TSH
Term
product of pancreatic delta islet cells
Definition
SST
Term
insulin-dependent glucose uptake channel(s) and location
Definition
GLUT-4
Skeletal muscle and adipose tissue
Term
non-insulin dependent glucose transporter(s) and location
Definition
GLUT-1, 2,3, 5
Brain and RBCs and Kidneys and everywhere else
Term
Dopamine's affects on PRL
Definition
dopamine inhibits PRL secretion, but PRL stimulates dopamine secretion
Term
PRL affect on GnRH
Definition
In females, PRL inhibits GnRH and thus ovulation.
Prolactinoma is a cause of amenorrhea
Term
Hypathalamic source of Oxytocin and ADH
Definition
Supraoptic and paraventricular nuclei
Term
MCC of Congenital Adrenal Hyperplasia
Definition
21 Hydroxylase deficiency
Term
Sx of 21-Hydroxylase deficiency
Definition
hypotension and hyperkalemia
Term
Renal site of action for PTH
Definition
DCT
Term
Effects of PTH
Definition

↑ Serum Ca

↓ Serum Phosphate

↑ urine Phosphate

Term
Regulation of Vitamin D
Definition

Increase Vit D production: ↑ PTH, ↓ serum Ca, ↓ PO4

Decrease Vit D production: ↑ Vit D

Term
Effects of SHBG
Definition

Men: ↑ SHBG → ↓ free testo → gynecomastia

Women: ↓ SHBG → ↑ free testo → hirsutism

Term
Effects of T3 on Bones
Definition
stimulates bone growth (synergistic w/ GH)
Term
Effects of T3 on CNS
Definition
stimulate maturation
Term
Effects of T3 on CVS
Definition
↑ B1 receptors in heart = ↑ CO, HR, SV and contractility
Term
Mechanism by which T3 ↑BMR
Definition
via ↑ Na/K ATPase activity → ↑ O2 consumption, RR, and body temperature
Term
enzyme that oxidizes and organifies iodide in the thyroid
Definition
peroxidase
Term
enzyme that couples MIT and DIT
Definition
peroxidase
Term
MCC of Cushing's Syndrome
Definition
Chronic steroid use
Term
↑ Renin and HypOtension
Definition
21 hydroxylase deficiency
Term
↑ Renin and HypERtension
Definition
2o hyperaldo
Term
HTN and HypOkalemia
Definition
11 Beta-hydroxylase deficiency Conn's Syndrome/Aldo secreting tumor
Term
Dexamethasone suppression test
Definition

Effects on Cortisol

Healthy: ↓ after low dose

ACTH-producing pitutary adenoma: only ↓ after high dose

Ectopic ACTH production (SCLC): can't ↓

Cortisol-prucing tumor: Can't ↓

Term
Sx of Conn's Syndrome
Definition
HTN, HypOkalemia, metabolic alkalosis, and ↓ plasma renin
Term
Causes of 2o Hyperaldo
Definition
Kidney perception of low intravascular volume: CHF, nephrotic syndrome, RAS, CRF, cirrhosis
Term
Tx of hyperaldo
Definition
Spironolactone (aldo-antagonist/K-sparing diuretic)
Term
Addison's Dz
Definition
1o adrenal insufficiency (↓ cortisol and aldo) due to adrenal atrophy or destruction by dz involving all 3 cortical divisions.
Term
Sx of Addison's
Definition
hypOtension (hyponatremic volume contraction), Hyperkalemia, skin hyperpigmentation
Term
difference b/w Addison's and 2o adrenal insufficiency
Definition
2o (↓ pituitary ACTH): no hyperpigmentation and no hyperkalemia
Term
Waterhouse Friderichsen
Definition
Acute adrenocortical insufficiency due to adrenal hemorrhage associate w/ meningococcal septicemia
Term
Screening for Pheochromocytoma
Definition
In setting of periodic "spells":
increased Urinary VMA, catecholamines, and metanephrines or plasma metanephrines
Term
Pheochromocytoma spell
Definition
5 Ps:
Pressure- sudden major increase in BP
Pain- abrupt throbbing HA, CP, abd pain
Perspiration- generalized and diffuse
Palpitations- often w/ panic or anxiety
Pallor of the skin from vasoconstriction
Term
Syndromes Assoc. w/ pheos
Definition
MEN 2A and MEN 2B and NF
Term
Rule of 10s for pheos
Definition
10% malignant
10% bilateral
10% extra-adrenal
10% familial (MEN 2A/B and VHL)
Term
Oncogene assoc. w/ neuroblastoma
Definition
N-myc
Term
Screening test for Neuroblastoma
Definition
elevated urine HVA (breakdown produce of dopamine)
Term
location of neurblastomas
Definition
Adrenal medulla or anywhere along the sympathetic chain
Term
MEN 1
Definition
Wermer's Syndrome (3 Ps)
Parathyroid tumors
Pituitary Tumors (prolactinomas or GH)
Pancreatic endocrine tumors- Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas.
Term
MEN 2A
Definition
Sipple's Syndrome MTC (↑ Calcitonin) Pheo Hyperparathyroid
Term
MEN 2B
Definition
MTC (↑ Calcitonin)
Pheo
Mucosal (oral/gut) ganglioneuromatosis
Marfanoid habitus
Term
Oncogene for MEN 2A/B
Definition
Ret Protooncogene
Term
Coarse and brittle Hair (hypo or hyperthyroidism)
Definition
Hypothyroidism
Term
Menorrhagia (hypo or hyerthyroidism)
Definition
Hypothyroidism
Term
Fine hair (hypo or hyerthyroidism)
Definition
Hyperthyroidism
Term
Hurthle Cells
Definition
Hashimoto's Thyroiditis
Term
Auto-Ab assoc. Hashimoto's
Definition
Anti-microsomal (Anti-TPO) and anti-thyroglobulin
Term
Type of infiltrate seen in Hashimoto's
Definition
Lymphocytic w/ germinal centers
Term
Tender thyroid w/ jaw pain following a URI
Definition
de Quervain's/sub-acute thyroiditis
Term
Histology of Subacute thyroiditis
Definition
Granulomatous
Term
Reidel's thyroiditis
Definition

Thyroid replaced by fibrous tissue causing hypothyroid

Fixed, hard and painless goiter

Term
Pre-tibial myxedema
Definition
Grave's Dz
Term
Diffuse goiter
Definition
Grave's Dz
Term
Tx for graves
Definition
propylthiouracil
Term
What type of HSE rxn is Graves?
Definition
Type II
Term
Jod-Bosedow Syndrome
Definition
When a pt w/ I2 deficiency is made I2 replete and thyrotoxicosis results
Term
Psammoma Bodies
Definition

Laminated calcifications (PSaMMoma):

1. Papillary Thyroid Cancer

2. Serous cystadenocarcinoma of the ovary (malignant)

3. Meningioma

4. Malignant Mesothelioma

Term
Toxic MNG
Definition
Focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation in TSH receptor.
Increases release of T3 and T4.
Nodules are not malignant.
Term
Orphan Annie Eyes
Definition
ground glass nuclei of PTC
Term
MC type of thyroid Cancer
Definition
PTC
Term
Type of thyroid cancer w/ increased risk caused by radiation as a child
Definition
PTC
Term
Type of Thyroid cancer w/ uniform follicles
Definition
FTC
Term
Type of thyroid cancer w/ sheets of cells in amyloid stroma
Definition
MTC
Term
Type of thyroid cancer assoc. w/ older pts
Definition
Undifferentiated/anaplastic
Term
Type of thyroid cancer assoc. w/ Hashimoto's
Definition
Lymphoma
Term
Pot-bellied, pale, puffy-faced child w/ protruding umbilicus and proturberant tongue
Definition
Cretinism
Term
Cause of Cretinism
Definition
fetal hypothyroidism, defect in T4 formation, or failure in thyroid development
Term
Tx of Acromegaly/gigantism
Definition
resection of pituitary adenoma and octreotide administration (GH antagonist)
Term
Dx of Acromegaly
Definition

↑ serum IGF-1

inability to suppress GH following oral GTT

Term
Presentation of 1o hyperparathyroidism
Definition
Asx or weakness and constipation
Term
Osteitis Fibrosa Cystica
Definition
Cystic bone lesions filled w/ brown fibrous tissue seen in 1o hyperparathyroidism
Term
2o hyperparathyroidism
Definition
All parathyroid glands are hypertrophied usually from chronic renal dz
Term
Renal osteodystrophy
Definition
bone lesions from 2o hyperparathyroidism caused by renal dz
Term
Causes of hypoparathyroidism
Definition

Accidental surgical resection

Autoimmune destruction

DiGeorge Syndrome

Term
DiGeorge Syndrome
Definition
defect in formation of the 3rd and 4th pharyngeal pouches leading to an absent parathyroid and thymus.
Term
Findings in Hypoparathyroidism
Definition
Hypocalcemia, tetany
Term
Chvostek's sign
Definition
tapping on facial nerve causing contraction of facial muscles sign of low calcium in hypoparathyroidism
Term
Trousseau's sign
Definition

carpal spasm after inflation of BP cuff

sign of hypocalcemia caused by hypoparathyroidism

Term
Pseudohypoparathyroidism
Definition
auto-dominant kidney unresponsiveness to PTH Hypocalcemia, shortened 4th and 5th digits, short stature
Term
Causes of Hypercalcemia
Definition

CHIMPANZEES

Ca ingestion

Hyperparathyroid/Hyperthyroid

Iatrogenic (thiazides)

Malignancy

Paget's Dz

Addison's Dz

Neoplasms

Zollinger-Ellison Syndrom

Excess Vitamin D

Excess Vit A

Sarcoidosis

Term
Sx of pituitary adenoma
Definition
Amenorrhea, galactorrhea, low libido, infertility, visual disturbances (bitemporal hemianopia)
Term
MC type of pituitary adenoma
Definition
Prolactinoma
Term
Tx for pituitary adenoma
Definition
Cabergolin or Bromocriptine (dopamine agonists)
Term
DM retinopathy
Definition
hemorrhage, exudates, microaneurysms and vessel proliferation
Term
Complications of DKA
Definition
Life-threatening mucormycosis
Rhizopus infx
Cerebral edema
Cardiac arrythmias
Heart failure
Term
Tx of DKA
Definition
K, fluids, insulin and glucose
Term
Causes of Central Diabetes insipidus
Definition
Pituitary tumor
trauma
surgery
histiocytosis X
Term
Causes of Nephrogenic DI
Definition
1. hypercalcemia
2. hypokalemia
3. Drugs: demeclocyclin, lithium
Term
Dx of DI
Definition
Water Deprivation test and response to desmopressin
Term
Tx for DI
Definition
adequate H2O intake
Central: intranasal desmopressin
Nephrogenic: thiazide, amiloride, indomethicin to prevent hypokalemia
Term
Tx for SIADH
Definition
Demeclocycline (ADH antagonist)
H2O restriction
Term
Possible complication of SIADH
Definition
Seizures caused by hyponatremia
Must correct slowly
Term
Causes of SIADH
Definition
1. Ectopic ADH (SCLC)
2. CNS/head trauma
3. Pulm dz
4. Drugs (cyclophosphamide, e.g.)
Term
Carcinoid Syndrome
Definition
Caused by carcinoid tumors (serotonin-secreting tumors).
Usually metastatic small bowel tumors
Term
Sx of carcinoid tumor
Definition
1. Diarrhea 2. cutaneous flushing 3. wheezing 4. right-sided valvular dz Elevated urine 5-HIAA
Term
rule of 1/3 in carcinoid syndrome
Definition
1/3 metastisize
1/3 present w/ 2nd malignancy
1/3 multiple
Term
Tx of Carcinoid Syndrome
Definition
Octreotide
Term
DM drugs that cause hypoglycemia
Definition
1. Insulin 2. sulfonylureas 3. pramlintide
Term
suffix for sulfonylureas
Definition
-ide (glyburide, glipizide, glimeperide)
Term
MOA of sulfonylureas
Definition
close K+ channel of beta-islet cells → depolarization and release of endogenous insulin
Term
DM drugs that cause weight gain
Definition
1. Insulin
2. sulfonylureas
3. TZDs
Term
Side effect of Metformin
Definition
Lactic Acidosis in renal insufficiency or hepatic dysf(x)
Term
MOA of Glitazones/TZD (pio and rosi)
Definition
insulin sensitizer → increases target cells response to insulin by interacting with the PPAR-gamma.
Term
Side effects of alpha-glucosidase inhibitors
Definition
GI disturbances
Term
MOA for exenatide
Definition
↑ insulin and ↓ glucagon
analog of glucagon-like peptide 1 (GLP1) by facilitating glucose-stimulated insulin release
Term
DM drug that causes weight loss
Definition
Exenatide
Term
Difference b/w MOA of propylthiouracil and methimmazole
Definition
PTU inhibits converstion of T4 to T3 in the thyroid and in the periphery. Methimazole is a more potent inhibitor but it only works in the thyroid
Term
SE of PTU and methimazole
Definition
1. rash 2. Agranulocytosis 3. aplastic Aneima
Term
SE of Demeclocycline
Definition
Bone and teeth abnormalities
nephrogenic DI
Photosensitivity
Term
Embryonal origin of thyroid parafollicular cells
Definition
neural crest cells and the 4th pharyngeal pouch
Term
oncogene: n-myc
Definition
f(x): nuclear transcription
mutation: amplification
Ca: neuroblastoma
Term
Oncogene: ret
Definition
f(x): receptor synthesis
mutation: point mutation
ca: MEN IIa/IIb
Term
Von Hippel Lindau MOI and characteristics
Definition

Auto-Dominant Chrom 3

1. Cavernous Hemangiomas in skin, mucosa, organs

2. Renal Cell Carcinoma or hemangioblastoma of retina, brain stem, cerebellum

3. Pheochromocytomas

Term
FSH and LH action in dudes
Definition
FSH -> Sertoli cells -> Inhibin B and Androgen Binding Protein (ABP)
LH -> Leydig cell -> Testo
Term
Most reliable test to confirm menopause
Definition
Serum FSH (will be elevated in menopause b/c of lack of feedback inhibation from estro)
Term
Peripherally produced estrogen
Definition
estrone
Term
way to measure adrenal androgens
Definition
urine 17-ketosteroid assay
Term
Location of steroid and thyroid hormone receptors
Definition
Steroid- cyto
Thyroid hormone- nucleus
Term
Glucocorticoids effects on immune system
Definition
1. ↑ PMN (demarginalization)
2. ↓ Eosinophils, basophils and lymphocytes (T > B)
3. inhibition of Ig formation
4. causes lymphocyte apoptosis
5. inhibits monocyte differention into MAC (↓ Ag presentation to T-cells)
Term
pathogenesis of pituitary apoplexy
Definition
hemorrhage into a pituitary adenoma
Term
Sx of pituitary apoplexy
Definition
Sx of tumor present progressing insidiously then:
sudden server HA
signs of meningeal irritation,
CN paralysis
bitemporal hemianopia
CV collapse b/c of loss of adrenocortical f(x)
Term
Differenc in presentation of intracranial hemorrhage and pituitary apoplexy
Definition
pituitary apoplexy will present with a bitemporal hemianopia
Term
Fate of Sorbitol
Definition
if not too much, can be converted to fructose by sorbitol dehydrogenase
In liver and seminiferous tubules
Term
shock + hyponatremia + hyperkalemia + low glucose
Definition
adrenal crisis
Term
adrenal crisis w/ fever, petechial rash, nuchal rigidity and vomiting
Definition
= Waterhouse-Friderichsen Syndrome due to meningococcal septicemia
Term
Fast Acting Insulins
Definition
Lispro
Aspart
regular
glulisine
crystaline zinc insuline (CZI)
Term
Long Acting Insulins
Definition
Glargine (best)
NPH
Lente
ultralente
detemir
Term
Kussmaul Breathing
Definition
rapid deep breathing seen in pts w/ DKA
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