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Endocrine

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Is there an association with obesity in DM1 or DM2
FLAT PiG - FSH - LH - ACTH - TSH - Prolactin - GH
T3/T4 - cytosol
Ketone bodies
DM2

2. Medullary carcinoma forms From what cells and What do they produce - histo and association
Chief cells of parathyroid
FLAT PiG - FSH - LH - ACTH - TSH - Prolactin - GH
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B
Toxic multinodular goiter

3. What kind of inheritance to MEN syndromes have
Neuroendocrine cells of GI tract
11beta - HTN because - 11 deoxycorticosterone is a mineralcorticoid and secreted in excess - masculinization because too much DHEA shuttling
AD
Hyperglycemia - glucosuria - osmotic diureses - lyte depletion

4. Which steroid receptors are nuclear and where are the others located
HVA
Hashimotos
T3/T4 - cytosol
Hypocalcemia and tetany

5. What causes primary hyperaldosteronism (Conn's syndrome) and What are the lab findings
Peroxidase
Lower free testosterone and gynecomastia
Hyperthyroid early in course - thyrotoxicosis during follicular rupture
Caused by aldosterone secreting tumor - resulting in HTN - hypokalemia - metaboolic alkalosis low plasma renin - B/L or unilateral

6. cystic bone spaces filled with brown fibrous tissue causing pain
Ingested from plants
During stress - childbirth
Chromaffin cells - catecholamines
Osteitis fibrosa cystica

7. What is octreotide
Diabetes insipidus - lack of ADH - or lack of response to ADH in kidney
Somatostatin analog
Inactive form
Diffuse thickening of the BM

8. What are the 2 P's of MEN 2A
Bromocriptine
Pheochromocytoma and PTH
FLAT
Inc cortisol after low dose and high dose

9. What are the labs of DKA
TSH receptor leading to inc release of T3 and T4 - hot nodules are rarely malignant
Zona fasciculata - ACTH - hypothalamic CRH - cortisol/sex hormones
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon

10. What drugs cause shrinkage of prolactinoma
Bromocriptine or cabergoline
Inc absorption of dietary Ca and phosphate - inc bone resorption of Ca and phosphate
Stress induced catecholamine surge leading to death by arrhythmia - graves
Excessive water retenion - hyponatremia - urine osm > serum osm

11. What does adrenal insufficiency cause
Def in aldosterone and cortisol leading to hypotension (hyponatremic volume contraction) hyperkalemia - acidosis - and skin hyperpigmentation
Hyperthyroid early in course - thyrotoxicosis during follicular rupture
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
Caused by aldosterone secreting tumor - resulting in HTN - hypokalemia - metaboolic alkalosis low plasma renin - B/L or unilateral

12. Which are the basophiles
Waterhouse friderichsen - n meningitidis septicemia
DM1
FLAT
Metanephrine

13. How does right adrenal gland drain
Antibodies against TSH receptors - II
Right adrenal - right adrenal vein - IVC
Dec in DM1 - variable in DM2 with possible amyloid
Stim

14. Where is the source of PTH
Antibodies against TSH receptors - II
Chief cells of parathyroid
Hypo is low - hyper is high on all
Hyperthyroid early in course - thyrotoxicosis during follicular rupture

15. What are the 5 fxns of thyroid hormone
Inc cortisol after low and high dose
Excellent prognosis - risk with childhood radiation - papillary carcinoma
AD
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis

16. What are the findings of hypoPTH
Peripheral tissue
Hypocalcemia and tetany
Inhib
Zollinger Ellison

17. bone lesions due to secondary or tertiary hyperPTH due in turn to renal disease
Renal osteodystrophy
Neuroblastoma
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH
Stim

18. What is the tx for hyperaldosteronism
Surgery to remove tumor - sprinolactone - (K sparing diuretic)
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Nonenzymatic glycosylation
Hashimotos

19. inc cortisol creates what syndrome

20. Which substances bind receptor associated tyrosine kinase via the JAK/STAT pathway
GH - prolactin also IL-2
Diabetes insipidus - lack of ADH - or lack of response to ADH in kidney
Cretinism - whereever there is endemic goiter - sporadic version due to defect in T4 formation or thyroid development
TSH receptor leading to inc release of T3 and T4 - hot nodules are rarely malignant

21. thyroid replaced by fibroid tissue - dz and findings

22. cholecalciferol
Inc absorption of dietary Ca and phosphate - inc bone resorption of Ca and phosphate
No - proinsulin to insulin + C peptide
Vitamin d
Sun exposure in skin

23. What is the effect of somatostatin on GH and TSH
Inhib
Diarrhea - aminoglycosides - diuretics - and EtOH
BRICK L - brain - RBC - intestine - cornea - kidney - liver
T3/T4 - cytosol

24. The adrenal cortex derives From What embryonic tissue
Peripheral tissue
Mesoderm
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple
Inc in serum Ca causes calcitonin secretion

25. What stimulus causes beta cells to make insulin
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
2A and 2B
ATP from glucose metabolism closing K channels and depolarizing cells - required for adipose and skeletal muscle uptake of glucose
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid

26. What are two examples of ectopic ACTH producing tumors
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Small (metastatic) bowel tumors - 5HT goes to liver for first pass -
25- OH vitamin D
Small cell lung cancer and bronchial carcinoids

27. Describe the signs and symptoms of DKA

28. All three effects of hyperinsulinemia lead to which two clinical features
Dehydration and acidosis leading to coma and death
Diffuse thickening of the BM
GH - large tognue - deep furrows - deep voice - large hands/feet - coarse fascial features - impaired glucose tolerance
5- HIAA

29. What is seen in the urine in carcinoid syndrome
Chvostek's sign
Beta - hydroxybutyrate > acetoacetate
Zona fasciculata - ACTH - hypothalamic CRH - cortisol/sex hormones
5- HIAA

30. What is the rule of 1/3s in carcinoid syndrome
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple
Rugal thickening and acid hypersecretion causing recurrent ulcers - associated with MEN type 1
17alpha - HTN - hypokalemia - in males - dec DHT - externally phenotypic females - in females nl genitals but no secondary sex characteristis
Cushing's

31. Recurrent diarrhea - cutaneous flushing - asthatic wheezing - right side valvular disease
Carcinoid syndrome
Bound to corticosteroid binding globulin - CGB
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR
Alpha = glucagon - beta = insulin - delta = somatostatin

32. How can hashimotos present that is not typical hypothyroidism
Proptosis - EOM swelling - pretibial mxyedema - diffuse goiter
Hypo is low - hyper is high on all
Stress induced catecholamine surge leading to death by arrhythmia - graves
Hyperthyroid early in course - thyrotoxicosis during follicular rupture

33. What is the common etiology of primary hyperPTH and What are the expected changes in serum and urine - How does it present
Toxic multinodular goiter
Adenoma - hypercalcemia - hypercalciuria - hypophosohatemia - inc PTH - inc alk phos - inc cAMP in urine - often asymptomatic present as weakness and contipation - groans
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K
RBC brain

34. What vasodilators use the cGMP pathway
ANP - NO and EDRF
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
Vitamin d

35. How many cortical divisions are involved in primary adrenal insuff
Thyroid hormones T3/T4
Pheochromocytoma
1 = juveline - IDDM - 2 = adult - NIDDM
All 3 - spares medulla

36. What happens in the dexamethasone suppression test in someone with a cortisol producing tumor
Inc cortisol after low and high dose
Cushing's diseaes = ACTH secretion from pit ademona - inc ACTH - ectopic ACTH = non pit tissue secreting ACTH - inc ACTH - adrenal production of cortisol = ademona - carcinoma - nodular adrenal hyperplasia - dec ACTH
Inc in ACTH because low levels of cortisol
Urine specific grav < 1.006 - serum osm > 290

37. Cortisol fxn is BBIIG
Def in aldosterone and cortisol leading to hypotension (hyponatremic volume contraction) hyperkalemia - acidosis - and skin hyperpigmentation
Inhib
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis
Z- E - insulinomas - VIPomas - glucagonomas are rare

38. Where do you see GLUT 2 transporter
Alpha = glucagon - beta = insulin - delta = somatostatin
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon
Bidirectional - beta cells - liver kidney - small intestine
Undifferentiated/anaplastic

39. What are the 3 problems in SIADH
Excessive water retenion - hyponatremia - urine osm > serum osm
PseudohypoPTH - albright's hereditary osteodystrophy
Zona fasiculata
Ketone bodies

40. Where is cortisol made?
DM1 - HLA- DR3 and DR4
Most antipsychotics and all OCPs - estrogen in pregs
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis
Zona fasiculata

41. What happens in the dexamethasone suppresion test in a health individual
Nonenzymatic glycosylation
Dec cortisol after lose dose
Inc absorption of dietary Ca and phosphate - inc bone resorption of Ca and phosphate
Dec glucose uptake - inc protein catabolism - inc lipolysis

42. self - limiting hypothyroidism following a flu - like illness - dz - hist - and findings
Pheochromocytoma
Free hormone is active T3 bind more than T4
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid

43. What occurs to beta cells in DM1 vs DM2
Inhib
Sun exposure in skin
Dec in DM1 - variable in DM2 with possible amyloid
Urine osm doesn't inc - and desmopressin admin distinguishes

44. What are the complications of DKA
Mucormycosis - Rhizopus infxn - cerebral edema - cardia arrhythmias - HF
Central - pituitary tumor - truama - surgery - histiocytosis X and nephrogenic - hereditary - 2ndary to hypoglycemia - lithium - demeclocycline (ADH antagonist)
Anwhere along the sympathetic chaing - HVA - N- myc
Prolactin or GH

45. What is dopamine agonist is used to inhibit prolactin secretion in prolactinoma
Undifferentiated/anaplastic
DM1 = severe - DM2 = mild to moderate
Bromocriptine
Stim

46. How do T3/T4 travel in blood and what happens to this substance in liver disease and pregnancy
TGB - dec in hepatic failure - inc in pregnancy via estrogen
Polydipsia - polyuria - polyphagia - weight loss - DKA (type1) - hyperosmolor coma (type2) unopposed secretion of GH and epi (exacerbating hyperglycemia
Type 1
Dec aldosterone causing hyponatremia which can lead to seizures

47. What does pheo tumors secrete - What can they cause and what serum and urinary makers are there
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Kidney perception of low intravascular volume results in overactive renin - angiotensin system - due to renal artery stenosis - CRF - CHF - cirrhosis or nephrotic syndrome - associated with HIGH plasma renin
Epi - norepi - and DA - epidosic HTN - urinary VMA and elevated catecholamines
Moderatly enlarged nontender thyroid

48. How is thyroid hormone regulated
DM1 - HLA- DR3 and DR4
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH
Adenoma - hypercalcemia - hypercalciuria - hypophosohatemia - inc PTH - inc alk phos - inc cAMP in urine - often asymptomatic present as weakness and contipation - groans
Follicular carcinoma of thyroid

49. Where do you see the GLUT 1 transporter
Lumen of follicles - thryglobulin + I2 with MIT and DIT - proteolysis and secrete into blood back through follicular cell
Dec in pit ACTH production - no skin hyperpigmentation and no hyperkalemia
Hyperglycemia - glucosuria - osmotic diureses - lyte depletion
RBC brain

50. How does PTH stimulate Ca relase from bone
Peripheral tissue
Insulin responsive - adipose and skeletal muscle
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Inside