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Endocrine

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Answer 50 questions in 15 minutes.
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1. What is the effect of somatostatin on GH and TSH
Prolactin and GH
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
1 -25 OH2 vitamin D (active form)
Inhib

2. What causes primary hyperaldosteronism (Conn's syndrome) and What are the lab findings
Caused by aldosterone secreting tumor - resulting in HTN - hypokalemia - metaboolic alkalosis low plasma renin - B/L or unilateral
Free hormone is active T3 bind more than T4
21 hydroxylase - masculinization - hypotension - hyperkalemia - inc plasma renin - volume depletion
Parafollicular cells of thyroid (C cells) - dec bone resorption of Ca

3. What is the tx for diabetes inspidus - central and nephrogenic
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
FLT - hCG
Epi - norepi - and DA - epidosic HTN - urinary VMA and elevated catecholamines
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR

4. increase protein catabolism leads to...
Inc plasma amino acids - nitrogen loss in urine
Autoimmune - TB - metastasis
Inactive form
Thyroid hormones T3/T4

5. What are the clinical findings in cretinism
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
All 3 - spares medulla
TSH - elevated in hypo - low in hyper
Dec glucose uptake - inc protein catabolism - inc lipolysis

6. How does right adrenal gland drain
Hyperthyroid early in course - thyrotoxicosis during follicular rupture
Right adrenal - right adrenal vein - IVC
Ingested from plants
Rugal thickening and acid hypersecretion causing recurrent ulcers - associated with MEN type 1

7. tapping of the facial nerve leads to contraction of facial muscles

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8. What are the 3 problems in SIADH
PseudohypoPTH - albright's hereditary osteodystrophy
Peroxidase
DM2
Excessive water retenion - hyponatremia - urine osm > serum osm

9. What are the 4 fxns of PTH
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Central - pituitary tumor - truama - surgery - histiocytosis X and nephrogenic - hereditary - 2ndary to hypoglycemia - lithium - demeclocycline (ADH antagonist)
Pheochromocytoma
Inc bone resorption of Ca and PO4 - inc kidney reabsorption of Ca in DIC - dec kidney reabsorption of PO4 - inc calcitriol production by stimulated 1alpha - hydroxylase

10. Which are the acidophiles
Hashimotos
Prolactin and GH
Inc in serum Ca causes calcitonin secretion
TSH - elevated in hypo - low in hyper

11. What is the rule of 10s in pheochromocytoma
10% malignant - 10% bilateral - 10% extra - adrenal - 10% calcify - 10% kids - 10% familial
Z- E - insulinomas - VIPomas - glucagonomas are rare
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid
Zona glomerulosa - renin - angiontensin - aldosterone

12. What is the most common tumor of the adrenal medulla in children
TGB - dec in hepatic failure - inc in pregnancy via estrogen
Inc in serum Ca causes calcitonin secretion
Hypo is low - hyper is high on all
Neuroblastoma

13. What is the pathway of catecholamine production
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
Cretinism - whereever there is endemic goiter - sporadic version due to defect in T4 formation or thyroid development
Stim
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor

14. What is the most common tumor of the adrenal medulla in adults
GH - large tognue - deep furrows - deep voice - large hands/feet - coarse fascial features - impaired glucose tolerance
Undifferentiated/anaplastic
Antibodies against TSH receptors - II
Pheochromocytoma

15. What is 24 - 25 OH2 vit D
Inactive form
Lumen of follicles - thryglobulin + I2 with MIT and DIT - proteolysis and secrete into blood back through follicular cell
ANP - NO and EDRF
All 3 - spares medulla

16. nonenzymatic glycosylation leads to what 3 catageories of defects
1 = juveline - IDDM - 2 = adult - NIDDM
Small vessel disease - large vessel disease and osmotic drainage
Right adrenal - right adrenal vein - IVC
Follicles of thyroid - most T3 formed in the blood

17. What is the effect of prolactin on GnRH
Pheochromocytoma and PTH
Removal of pituitary adenoma and octreotide
ANP - NO and EDRF
Inhib

18. Neuroblastoma does not come with...
HTN
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Small vessel disease - large vessel disease and osmotic drainage
Hurthle cells - lymphocytic infiltrate with germinal centers

19. In which DM is there an HLA association and What is it
DM1 - HLA- DR3 and DR4
Z- E - insulinomas - VIPomas - glucagonomas are rare
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B
T3/T4 - cytosol

20. What diseases can cause primary adrenal insufficiency
Hyperthyroid early in course - thyrotoxicosis during follicular rupture
DM2
Autoimmune - TB - metastasis
Pheochromocytoma and PTH

21. What is the TX for carcinoid syndrome
Dec aldosterone causing hyponatremia which can lead to seizures
Octreotide
Dec in DM1 - variable in DM2 with possible amyloid
Free hormone is active T3 bind more than T4

22. In congenital bilateral hyperplasia what enzyme def would lead to a dec in cortisol - aldosterone and corticosterone - enzyme and why do you have HTN and masculinization
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor
Stim
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
11beta - HTN because - 11 deoxycorticosterone is a mineralcorticoid and secreted in excess - masculinization because too much DHEA shuttling

23. What are the 5 fxns of thyroid hormone
Medullary thyroid carcinoma - calcitonin
Prolactinoma
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis
Inside

24. What does vitamin D deficiency cause in kids and adults
Pheochromocytoma
Hyperthyroid early in course - thyrotoxicosis during follicular rupture
Kids = rickets - adults = osteomalacia
PseudohypoPTH - albright's hereditary osteodystrophy

25. What class of drugs are dopamine antagonists
Dehydration and acidosis leading to coma and death
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR
Diffuse thickening of the BM
Most antipsychotics and all OCPs - estrogen in pregs

26. What are the common causes of dec Mg
ATP from glucose metabolism closing K channels and depolarizing cells - required for adipose and skeletal muscle uptake of glucose
Diarrhea - aminoglycosides - diuretics - and EtOH
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Neuroendocrine cells of GI tract

27. How is prolactin secretion regulated
Tonic DA from hypothalamus inhibits - prolactin causes DA synthesis and increases own inhibition - TRH stimulates prolactin
Sun exposure in skin
Inc glucose transport - inc glycogen synthesis and storage - inc triglyceride synthesis and storage - inc Na retention in kidney - inc protein synthesis in muscle - inc cellular uptake of K and amino acids
Inc bone resorption of Ca and PO4 - inc kidney reabsorption of Ca in DIC - dec kidney reabsorption of PO4 - inc calcitriol production by stimulated 1alpha - hydroxylase

28. What is secondary hyperPTH due to and What are the expected serum values
Due to dec gut absorption of Ca - inc PO4 due to chronic renal disease (no vit D) hypOcalcemia - hyperphophatemia - inc alk phos - inc PTH
Neural crest
Osteitis fibrosa cystica
Hypocalcemia and tetany

29. What is the breakdown product of dopamine
HVA
Hurthle cells - lymphocytic infiltrate with germinal centers
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis

30. How does cortisol travel in the blood
Anwhere along the sympathetic chaing - HVA - N- myc
Inc bone resorption of Ca and PO4 - inc kidney reabsorption of Ca in DIC - dec kidney reabsorption of PO4 - inc calcitriol production by stimulated 1alpha - hydroxylase
Chief cells of parathyroid
Bound to corticosteroid binding globulin - CGB

31. What is the tx for hyperaldosteronism
DM2
21 hydroxylase - masculinization - hypotension - hyperkalemia - inc plasma renin - volume depletion
Surgery to remove tumor - sprinolactone - (K sparing diuretic)
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid

32. cholecalciferol
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Vitamin d
Carcinoid syndrome
Dehydration and acidosis leading to coma and death

33. In which DM is polyuria - polydipsia - thirst and weight loss more common
DM1
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Follicles of thyroid - most T3 formed in the blood
Neuroblastoma

34. What is the fxn of vitamin D
Inc absorption of dietary Ca and phosphate - inc bone resorption of Ca and phosphate
Beta - hydroxybutyrate > acetoacetate
Demeclocycline or H2O restriction
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis

35. Where is low serum phosphorus sensed to maintain phosphorus homeostasis - and what substance is key for increasing serum levels of phosphorus
Kidney - 1 -25 OH2 vit d
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
Cretinism - whereever there is endemic goiter - sporadic version due to defect in T4 formation or thyroid development
ATP from glucose metabolism closing K channels and depolarizing cells - required for adipose and skeletal muscle uptake of glucose

36. What is the general chronic manifestation of DM
Nonenzymatic glycosylation
Chromaffin cells from NC
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple
Urine osm doesn't inc - and desmopressin admin distinguishes

37. What are the two types of diabetes insipidus and What causes them
Diffuse thickening of the BM
Central - pituitary tumor - truama - surgery - histiocytosis X and nephrogenic - hereditary - 2ndary to hypoglycemia - lithium - demeclocycline (ADH antagonist)
Somatostatin analog
TSH - elevated in hypo - low in hyper

38. What happens in the dexamethasone suppression test in someone with an ACTH producing pituitary tumor
Pheochromocytoma
Inc cortisol after low dose - dec cortisol after high dose
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
Small cell lung cancer and bronchial carcinoids

39. What hormones are secreted from the adenohypophysis
Neural crest
FLAT PiG - FSH - LH - ACTH - TSH - Prolactin - GH
Diffuse thickening of the BM
Zona glomerulosa - renin - angiontensin - aldosterone

40. inc lipolysis leads to...
Inc plasma FFAs - ketogenesis - ketonuria - ketonemia
Amenorrhea - galactorrhea - low libido - infertility from dec GnRH - - bitemporal heminanopia from imgingement of optic chiasm
Inhibits glucagon release
Small vessel disease - large vessel disease and osmotic drainage

41. What is the serum insulin level of DM1 vs DM2
DM1 = dec - DM2 = variable
HTN - weight gain - moon facies - truncal obesity - buffalo hump - hyperglycemia - skin thinning and striae - osteoporosis - amenorrhea - immune suppression
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor

42. What are the endocrine cells of the pancrea
Islets of langerhans are collections of alpha - beta and delta
No - proinsulin to insulin + C peptide
Rapid/deep breathing (Kussmal's resps) N/V - abdominal pain - psychosis/delirium - dehydration - FRUITY breath odor -
Rugal thickening and acid hypersecretion causing recurrent ulcers - associated with MEN type 1

43. What drugs cause shrinkage of prolactinoma
Bromocriptine or cabergoline
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
DR5 - antimicrosomal - antithyroglobulin
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor

44. In graves dz - what pathological antibody is produced - and what kind of hypersens rxn is it?
GnRH - Oxytocin - ADH (V1) - TRH
Antibodies against TSH receptors - II
Follicular carcinoma of thyroid
DM1 - DM2 has islet amyloid deposit

45. Which substances bind receptor associated tyrosine kinase via the JAK/STAT pathway
Less likely
GH - prolactin also IL-2
FLAT PiG - FSH - LH - ACTH - TSH - Prolactin - GH
DM1 - HLA- DR3 and DR4

46. What kind of inheritance to MEN syndromes have
AD
GH - large tognue - deep furrows - deep voice - large hands/feet - coarse fascial features - impaired glucose tolerance
Proptosis - EOM swelling - pretibial mxyedema - diffuse goiter
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion

47. In which DM is there an islet cell leukocytic infiltrate and what kind of infiltrate does the other have
Zona reticularis - ACTH hypothalamic CRH - sex hormones - androgens
DKA - inc insulin requirements from inc stress (infxn) - excess fat breakdown and inc ketogenesis from FFA made into ketone bodies
DM1 - DM2 has islet amyloid deposit
Dec in DM1 - variable in DM2 with possible amyloid

48. What are the 4 causes of SIADH
Ectopic ADH in small cell lung cancer - CNS disorder/head trauma - pulmonary diseae - drugs like cyclophosphamide
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor
Chief cells of parathyroid
Somatostatin analog

49. Acromegaly in adults results from an incarease In what hormone - and What are the characteristic features
DM1 - DM2 has islet amyloid deposit
Growth factors - IGF-1 - FGF - and PDGF all MAP kinase pathway
Toxic multinodular goiter
GH - large tognue - deep furrows - deep voice - large hands/feet - coarse fascial features - impaired glucose tolerance

50. What thyroid condition is associated with lymphoma
Trousseau's sign
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
Hashimotos
Inc serum IGF-1 - failure to suppress serum GH following oral glucose tolerance test

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Endocrine

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