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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. In which DM is polyuria - polydipsia - thirst and weight loss more common
DM1 = severe - DM2 = mild to moderate
All 3 - spares medulla
During stress - childbirth
DM1

2. What 3 things does insuline def and glucagon excess lead to...
T3/T4 - cytosol
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis
Dec glucose uptake - inc protein catabolism - inc lipolysis
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH

3. What is the 1 P of MEN 2B
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
Moderatly enlarged nontender thyroid
Bromocriptine or cabergoline
Pheochromocytoma

4. What are the complications of DKA
Mucormycosis - Rhizopus infxn - cerebral edema - cardia arrhythmias - HF
Small vessel disease - large vessel disease and osmotic drainage
Growth factors - IGF-1 - FGF - and PDGF all MAP kinase pathway
Somatostatin analog

5. In which DM is there a stronger genetic association
No - proinsulin to insulin + C peptide
DKA - inc insulin requirements from inc stress (infxn) - excess fat breakdown and inc ketogenesis from FFA made into ketone bodies
DM2
DR5 - antimicrosomal - antithyroglobulin

6. What happens in the dexamethasone suppression test in somoeone with an ectopic ACTH producing tumor
Autoimmune - TB - metastasis
Gigantism - linear bone growth
Diffuse thickening of the BM
Inc cortisol after low dose and high dose

7. What is the effect of TRH on TSH and prolactin
BRICK L - brain - RBC - intestine - cornea - kidney - liver
DM1 - HLA- DR3 and DR4
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
Stim

8. What is the breakdown product of dopamine
Hypo is low - hyper is high on all
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K
Iatrogenic - decreased
HVA

9. How does cortisol travel in the blood
Excellent prognosis - risk with childhood radiation - papillary carcinoma
Undifferentiated/anaplastic
Bound to corticosteroid binding globulin - CGB
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis

10. What kind of cells are in the adrenal medulla and What do they secrete
Chromaffin cells - catecholamines
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
Kids = rickets - adults = osteomalacia

11. How does the left adrenal gland drain
Chromaffin cells from NC
Left adrenal - left adrenal vein - left renal vein - IVC
Free hormone is active T3 bind more than T4
Toxic multinodular goiter

12. What is the most common tumor of the adrenal medulla in adults
Parafollicular cells of thyroid (C cells) - dec bone resorption of Ca
All 3 - spares medulla
Pheochromocytoma
Tonic DA from hypothalamus inhibits - prolactin causes DA synthesis and increases own inhibition - TRH stimulates prolactin

13. What are the consequences of thyrotoxicisos - and who is at risk
ATP from glucose metabolism closing K channels and depolarizing cells - required for adipose and skeletal muscle uptake of glucose
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Autoimmune - TB - metastasis
Stress induced catecholamine surge leading to death by arrhythmia - graves

14. What is the rule of 10s in pheochromocytoma
No - proinsulin to insulin + C peptide
10% malignant - 10% bilateral - 10% extra - adrenal - 10% calcify - 10% kids - 10% familial
Zona glomerulosa - renin - angiontensin - aldosterone
Chromaffin cells - catecholamines

15. What other conditions are associated with MEN 2B
ADH - oxytocin - made in the hypothalamus and shipped to posterior pituitary
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Cretinism - whereever there is endemic goiter - sporadic version due to defect in T4 formation or thyroid development
Raises free testosterone and they gey hirsutism

16. What thyroid condition is associated with lymphoma
Beta - hydroxybutyrate > acetoacetate
Parafollicular cells of thyroid (C cells) - dec bone resorption of Ca
Hashimotos
Kidney - 1 -25 OH2 vit d

17. What is the difference in PTH vs active vit d
Renal osteodystrophy
PTH = inc ca reabsorption and dec PO4 reabsorption in DIC - active vit D = inc absorption of both in gut
Pheochromocytoma and PTH
Removal of pituitary adenoma and octreotide

18. inc lipolysis leads to...
Inc plasma FFAs - ketogenesis - ketonuria - ketonemia
5- HIAA
Phenylalaline - tyrosine - L- dopa - dopa - NE - epi
DKA - inc insulin requirements from inc stress (infxn) - excess fat breakdown and inc ketogenesis from FFA made into ketone bodies

19. What is the TX for DKA
HTN
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
Somatostatin analog
Hyperthyroid early in course - thyrotoxicosis during follicular rupture

20. All three effects of hyperinsulinemia lead to which two clinical features
Dehydration and acidosis leading to coma and death
T3/T4 - cytosol
Correct is slowly
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)

21. When diagnosing diabetes insipidus - what happens to the urine osm in the water deprivation test and How do you distinguish between central and nephrogenic

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22. What are the findings of prolactinoma
Waterhouse friderichsen - n meningitidis septicemia
Chromaffin cells from NC
Amenorrhea - galactorrhea - low libido - infertility from dec GnRH - - bitemporal heminanopia from imgingement of optic chiasm
Pheochromocytoma

23. What are the 5 fxns of thyroid hormone
Inhibits glucagon release
Undifferentiated/anaplastic
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis
Bidirectional - beta cells - liver kidney - small intestine

24. What happens in the dexamethasone suppresion test in a health individual
Polydipsia - polyuria - polyphagia - weight loss - DKA (type1) - hyperosmolor coma (type2) unopposed secretion of GH and epi (exacerbating hyperglycemia
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
Dec cortisol after lose dose
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR

25. What is the most common tumor of the adrenal medulla in children
MSH - a by product of inc ACTH production from POMC
T3/T4 - cytosol
GnRH - Oxytocin - ADH (V1) - TRH
Neuroblastoma

26. What occurs to beta cells in DM1 vs DM2
Inc serum IGF-1 - failure to suppress serum GH following oral glucose tolerance test
ATP from glucose metabolism closing K channels and depolarizing cells - required for adipose and skeletal muscle uptake of glucose
Heat intolerance - weight loss - inc appetite - hyperactivity - diarrhea - inc reflexes - pretibial myxedema (graves) warm - moist skin - fine hair - chest pain - palpitations - arrhythmias
Dec in DM1 - variable in DM2 with possible amyloid

27. self - limiting hypothyroidism following a flu - like illness - dz - hist - and findings
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid
Neuroendocrine cells of GI tract
Lower free testosterone and gynecomastia
17alpha - HTN - hypokalemia - in males - dec DHT - externally phenotypic females - in females nl genitals but no secondary sex characteristis

28. What HLA association is with hashimotos and what kind of autoantibodies
DR5 - antimicrosomal - antithyroglobulin
Dec in pit ACTH production - no skin hyperpigmentation and no hyperkalemia
Pheochromocytoma and PTH
Dehydration and acidosis leading to coma and death

29. What are the 3 endogenous causes of cushing's syndrome and What are the ACTH values for each

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30. What is the tx for hyperaldosteronism
Pheochromocytoma
Dec in pit ACTH production - no skin hyperpigmentation and no hyperkalemia
ANP - NO and EDRF
Surgery to remove tumor - sprinolactone - (K sparing diuretic)

31. Carcoid tumors are derived From what cells
Neuroendocrine cells of GI tract
Riedel's - fixed hard and painless goiter
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K
Epi - norepi - and DA - epidosic HTN - urinary VMA and elevated catecholamines

32. Do you see C peptide in exogenous insulin intake
Lumen of follicles - thryglobulin + I2 with MIT and DIT - proteolysis and secrete into blood back through follicular cell
DM1 = dec - DM2 = variable
Trousseau's sign
No - proinsulin to insulin + C peptide

33. How does MEN type 1 usually present
Vitamin d
1 -25 OH2 vitamin D (active form)
17alpha - HTN - hypokalemia - in males - dec DHT - externally phenotypic females - in females nl genitals but no secondary sex characteristis
Kidney stones and stomach ulcers

34. GOAT goes IP3
GnRH - Oxytocin - ADH (V1) - TRH
10% malignant - 10% bilateral - 10% extra - adrenal - 10% calcify - 10% kids - 10% familial
Waterhouse friderichsen - n meningitidis septicemia
Inc plasma amino acids - nitrogen loss in urine

35. What is important to remember when correcting hyponatremia
Toxic multinodular goiter
HVA
Autoimmune - TB - metastasis
Correct is slowly

36. What are the common pancreatic endocrine tumors in MEN type 1
Thyroid hormones T3/T4
25- OH vitamin D
Z- E - insulinomas - VIPomas - glucagonomas are rare
Removal of pituitary adenoma and octreotide

37. What causes secdonary hyperaldosteronism and what plasma marker is different from primary
HVA
VMA
17alpha - HTN - hypokalemia - in males - dec DHT - externally phenotypic females - in females nl genitals but no secondary sex characteristis
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

38. Where are the beta cells located in the islets
Type 1
Most antipsychotics and all OCPs - estrogen in pregs
Inside
Hashimotos

39. What are the findings of hypoPTH
During stress - childbirth
Hypocalcemia and tetany
Bound to corticosteroid binding globulin - CGB
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH

40. What drugs cause shrinkage of prolactinoma
Medullary thyroid carcinoma - calcitonin
Bromocriptine or cabergoline
Antibodies against TSH receptors - II
Correct is slowly

41. hyperthyroidism signs/symptoms
Peroxidase
Chvostek's sign
Heat intolerance - weight loss - inc appetite - hyperactivity - diarrhea - inc reflexes - pretibial myxedema (graves) warm - moist skin - fine hair - chest pain - palpitations - arrhythmias
17alpha - HTN - hypokalemia - in males - dec DHT - externally phenotypic females - in females nl genitals but no secondary sex characteristis

42. hypothyroidism - signs/symptoms
Left adrenal - left adrenal vein - left renal vein - IVC
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
Z- E - insulinomas - VIPomas - glucagonomas are rare
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

43. In what hormones are the alpha subunit the same
Amenorrhea - galactorrhea - low libido - infertility from dec GnRH - - bitemporal heminanopia from imgingement of optic chiasm
Nonenzymatic glycosylation
FLT - hCG
Prolactin and GH

44. What are the likely causes of hypoPTH
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
DM2
Diabetes insipidus - lack of ADH - or lack of response to ADH in kidney
Kidney - 1 -25 OH2 vit d

45. What is the general chronic manifestation of DM
Demeclocycline or H2O restriction
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR
Inside
Nonenzymatic glycosylation

46. What is the source of thyroid hormone
Amenorrhea - galactorrhea - low libido - infertility from dec GnRH - - bitemporal heminanopia from imgingement of optic chiasm
Lower free testosterone and gynecomastia
Excellent prognosis - risk with childhood radiation - papillary carcinoma
Follicles of thyroid - most T3 formed in the blood

47. What is the breakdown product of epi
Less likely
Inc cortisol after low dose - dec cortisol after high dose
Trousseau's sign
Metanephrine

48. What diseases can cause primary adrenal insufficiency
Correct is slowly
Dec cortisol after lose dose
Trousseau's sign
Autoimmune - TB - metastasis

49. What is the tx for gigantism/acromegaly
Peripheral tissue
Dec aldosterone causing hyponatremia which can lead to seizures
Removal of pituitary adenoma and octreotide
Riedel's - fixed hard and painless goiter

50. Where are T3/T4 made
Hypo is low - hyper is high on all
Lumen of follicles - thryglobulin + I2 with MIT and DIT - proteolysis and secrete into blood back through follicular cell
Adquate fluid intake - central intranasal desmopressin - for nephrogenic use thiazide (for hypernatremia) - amiloride (for hypokalemia) and indomethacin to dec GFR
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple