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Endocrine

Instructions:

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. hyperthyroidism signs/symptoms
Heat intolerance - weight loss - inc appetite - hyperactivity - diarrhea - inc reflexes - pretibial myxedema (graves) warm - moist skin - fine hair - chest pain - palpitations - arrhythmias
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Kidney stones and stomach ulcers
Growth factors - IGF-1 - FGF - and PDGF all MAP kinase pathway

2. endocrine hormones that use cAMP - FLAT CHAMP - What are they?
Bone growth - brain (CNS maturation) - inc Beta 1 receptors - BML - inc glycogenolysis - gluconeogenesis and lipolysis
25- OH vitamin D
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon
Excessive water retenion - hyponatremia - urine osm > serum osm

3. Neuroblastoma does not come with...
Hyperthyroid early in course - thyrotoxicosis during follicular rupture
Vitamin d
HTN
Caused by aldosterone secreting tumor - resulting in HTN - hypokalemia - metaboolic alkalosis low plasma renin - B/L or unilateral

4. When is the onset of DM1 vs DM2 causing what kind of DM
25- OH vitamin D
Chvostek's sign
1 = juveline - IDDM - 2 = adult - NIDDM
DKA - inc insulin requirements from inc stress (infxn) - excess fat breakdown and inc ketogenesis from FFA made into ketone bodies

5. What diseases can cause primary adrenal insufficiency
Autoimmune - TB - metastasis
AD
T3/T4 - cytosol
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

6. What does adrenal insufficiency cause
Medullary thyroid carcinoma - calcitonin
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Def in aldosterone and cortisol leading to hypotension (hyponatremic volume contraction) hyperkalemia - acidosis - and skin hyperpigmentation
Riedel's - fixed hard and painless goiter

7. All three effects of hyperinsulinemia lead to which two clinical features
Def in aldosterone and cortisol leading to hypotension (hyponatremic volume contraction) hyperkalemia - acidosis - and skin hyperpigmentation
Inhib
Dehydration and acidosis leading to coma and death
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

8. Where is low serum phosphorus sensed to maintain phosphorus homeostasis - and what substance is key for increasing serum levels of phosphorus
GH - prolactin also IL-2
Kidney - 1 -25 OH2 vit d
Less likely
Dec glucose uptake - inc protein catabolism - inc lipolysis

9. What vasodilators use the cGMP pathway
ANP - NO and EDRF
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
TGB - dec in hepatic failure - inc in pregnancy via estrogen
11beta - HTN because - 11 deoxycorticosterone is a mineralcorticoid and secreted in excess - masculinization because too much DHEA shuttling

10. What does NEG cause in small vessels
Less likely
Diffuse thickening of the BM
TSH - elevated in hypo - low in hyper
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm

11. How does the left adrenal gland drain
Left adrenal - left adrenal vein - left renal vein - IVC
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon
Chief cells of parathyroid
Inc in ACTH because low levels of cortisol

12. inc lipolysis leads to...
Iatrogenic - decreased
Bromocriptine
Peripheral tissue
Inc plasma FFAs - ketogenesis - ketonuria - ketonemia

13. What is the effect of prolactin on GnRH
Inhib
Thyroid hormones T3/T4
Pancreas - pituitary and PTH
Zona fasciculata - ACTH - hypothalamic CRH - cortisol/sex hormones

14. What is secondary adrenal insuff and how can you distinguish it from primary
DM1 = severe - DM2 = mild to moderate
Dec in pit ACTH production - no skin hyperpigmentation and no hyperkalemia
Transcellular shif from dec insulin
Parafollicular C cells - calcitonin histo = sheets of cells in amyloid stroma - associated with MEN 2A/2B

15. What is the TX for carcinoid syndrome
Octreotide
FLT - hCG
T3/T4 - cytosol
Rugal thickening and acid hypersecretion causing recurrent ulcers - associated with MEN type 1

16. What causes skin hyperpigmentation in primary adrenal insuff
Kids = rickets - adults = osteomalacia
Amenorrhea - galactorrhea - low libido - infertility from dec GnRH - - bitemporal heminanopia from imgingement of optic chiasm
Dec in DM1 - variable in DM2 with possible amyloid
MSH - a by product of inc ACTH production from POMC

17. In which DM is there an HLA association and What is it
Free hormone is active T3 bind more than T4
DM1 - HLA- DR3 and DR4
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
Parafollicular cells of thyroid (C cells) - dec bone resorption of Ca

18. What kind of cells are in the adrenal medulla and What do they secrete
Inc cortisol after low dose - dec cortisol after high dose
Chromaffin cells - catecholamines
Epi - norepi - and DA - epidosic HTN - urinary VMA and elevated catecholamines
Hyperglycemia - inc H+ - dec bicarb leading to anion gap acidosis - inc blood ketone levels - leukocytosis - hyperkalemia - but depleted intracellular K

19. What are the consequences of thyrotoxicisos - and who is at risk
Hypocalcemia and tetany
Direct stimulation of osteoblasts - which indirectly stimulates osteoclastic cells via RANK L (down regulates OPG that usually blocks RANK L from binding RANK)
Stress induced catecholamine surge leading to death by arrhythmia - graves
FLAT

20. What is the difference in PTH vs active vit d
ADH - oxytocin - made in the hypothalamus and shipped to posterior pituitary
Dec free serum Ca inc PTH secretion - dec free serum Mg dec PTH secretion
PTH = inc ca reabsorption and dec PO4 reabsorption in DIC - active vit D = inc absorption of both in gut
11beta - HTN because - 11 deoxycorticosterone is a mineralcorticoid and secreted in excess - masculinization because too much DHEA shuttling

21. What is the depleted intracellular K due to in DKA
FSH - LH - ACTH - TSH - CRH - hCG - ADH (V2) - MSH - PTH - + calcitonin - GHRH and glucagon
Vitamin d
Small vessel disease - large vessel disease and osmotic drainage
Transcellular shif from dec insulin

22. increase protein catabolism leads to...
25- OH vitamin D
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
Ectopic ADH in small cell lung cancer - CNS disorder/head trauma - pulmonary diseae - drugs like cyclophosphamide
Inc plasma amino acids - nitrogen loss in urine

23. Cortisol fxn is BBIIG
DM1 - HLA- DR3 and DR4
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
Blood pressure - dec bone formation - anti - inflammatory - dec immune fxn - inc gluconeogenesis - lipolysis - proteolysis
Cushing's

24. What does vitamin D deficiency cause in kids and adults
Zollinger Ellison
Kids = rickets - adults = osteomalacia
Dec free serum Ca inc PTH secretion - dec free serum Mg dec PTH secretion
Hyperglycemia - glucosuria - osmotic diureses - lyte depletion

25. What are the common causes of dec Mg
Free hormone is active T3 bind more than T4
Diarrhea - aminoglycosides - diuretics - and EtOH
Ketone bodies
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue

26. The adrenal cortex derives From What embryonic tissue
Alpha antagonists - esp phenoxybenzamine - nonselective - irreversible - surgery to remove tumor
Pheochromocytoma and PTH
Ingested from plants
Mesoderm

27. What is the rule of 10s in pheochromocytoma
Hypocalcemia and tetany
10% malignant - 10% bilateral - 10% extra - adrenal - 10% calcify - 10% kids - 10% familial
Episodic hyperadrenergic symptoms - pressure - pain (headache) - perspiration - palpitations (tachycardia) - pallor
DM1

28. What other diseases or syndromes are associated with pheochromocytoma
Neurofibramtosis - MEN types 2A and 2B
Growth factors - IGF-1 - FGF - and PDGF all MAP kinase pathway
TRH from the hypothalamus stimulates TSH release from ant pit which stimulates follicular cells - neg feedback to ant bit dec sens to TRH
Medullary thyroid carcinoma - calcitonin

29. What is the most external latery of the adrenal cortex - What is its primary control and What does it secrete
Inside
Zona glomerulosa - renin - angiontensin - aldosterone
Lumen of follicles - thryglobulin + I2 with MIT and DIT - proteolysis and secrete into blood back through follicular cell
Nonenzymatic glycosylation

30. GOAT goes IP3
Hashimotos thyroiditis
Kids = rickets - adults = osteomalacia
Ectopic ADH in small cell lung cancer - CNS disorder/head trauma - pulmonary diseae - drugs like cyclophosphamide
GnRH - Oxytocin - ADH (V1) - TRH

31. What occurs to beta cells in DM1 vs DM2
Stim
Inc serum IGF-1 - failure to suppress serum GH following oral glucose tolerance test
Dec in DM1 - variable in DM2 with possible amyloid
Osteitis fibrosa cystica

32. DM1 complication - most important - pathogenesis
Subactute thyroiditis - granulomatous inflammation - elev ESR - jaw pain - ealy inflammation - tender thyroid
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
Left adrenal - left adrenal vein - left renal vein - IVC
DKA - inc insulin requirements from inc stress (infxn) - excess fat breakdown and inc ketogenesis from FFA made into ketone bodies

33. What other conditions are associated with MEN 2B
Proptosis - EOM swelling - pretibial mxyedema - diffuse goiter
Inhibits glucagon release
Lumen of follicles - thryglobulin + I2 with MIT and DIT - proteolysis and secrete into blood back through follicular cell
Medullary thyroid carcinoma with calcitonin and oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)

34. What are the 3 problems in SIADH
Demeclocycline or H2O restriction
Somatostatin analog
Renal osteodystrophy
Excessive water retenion - hyponatremia - urine osm > serum osm

35. What is a good test for primary hypo/hyperthyroidism and What do you expect to see in both
Islets of langerhans are collections of alpha - beta and delta
Z- E - insulinomas - VIPomas - glucagonomas are rare
DR5 - antimicrosomal - antithyroglobulin
TSH - elevated in hypo - low in hyper

36. What is the TX for DKA
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
Removal of pituitary adenoma and octreotide
Mucormycosis - Rhizopus infxn - cerebral edema - cardia arrhythmias - HF

37. In which DM is there an islet cell leukocytic infiltrate and what kind of infiltrate does the other have
Lower free testosterone and gynecomastia
DM1 - DM2 has islet amyloid deposit
DM1
11beta - HTN because - 11 deoxycorticosterone is a mineralcorticoid and secreted in excess - masculinization because too much DHEA shuttling

38. What is the next layer in from ZG - What is its primary control - What does it secrete
Inhib
Inc plasma amino acids - nitrogen loss in urine
Zona fasciculata - ACTH - hypothalamic CRH - cortisol/sex hormones
Prolactin or GH

39. What is the rule of 1/3s in carcinoid syndrome
Type 1
Chvostek's sign
Ectopic ADH in small cell lung cancer - CNS disorder/head trauma - pulmonary diseae - drugs like cyclophosphamide
1/3 metastasize - 1/3 present with 2nd malignancy - and 1/3 multiple

40. What thyroid condition is associated with lymphoma
DM1 - DM2 has islet amyloid deposit
Hashimotos
Cold intolerance - weight gain - dec appetite - lethargy/fatigue - constipation - dec reflexes - myxedema (facial/periorbital) - dry cool skin - coarse brittle hair - bradycardia - dyspnea on exertion
Follicular carcinoma of thyroid

41. How does MEN type 1 usually present
Kidney stones and stomach ulcers
25- OH vitamin D
Peroxidase
Transcellular shif from dec insulin

42. What regulates vit D
11beta - HTN because - 11 deoxycorticosterone is a mineralcorticoid and secreted in excess - masculinization because too much DHEA shuttling
ANP - NO and EDRF
Inc PTH - dec Ca - dec PO4 cause inc in active form and then it feedback inhibits its own production
Gigantism - linear bone growth

43. Where do you see GLUT 2 transporter
Bidirectional - beta cells - liver kidney - small intestine
Demeclocycline or H2O restriction
Dec in pit ACTH production - no skin hyperpigmentation and no hyperkalemia
Bromocriptine

44. What hormones are secreted from the adenohypophysis
AD
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
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
FLAT PiG - FSH - LH - ACTH - TSH - Prolactin - GH

45. How does right adrenal gland drain
ATP from glucose metabolism closing K channels and depolarizing cells - required for adipose and skeletal muscle uptake of glucose
Waterhouse friderichsen - n meningitidis septicemia
Right adrenal - right adrenal vein - IVC
Dec cortisol after lose dose

46. What are the 4 fxns of PTH
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
Accidental surgical excision - autoimmune destruction and DiGeorge syndrome
Gigantism - linear bone growth
Def in aldosterone and cortisol leading to hypotension (hyponatremic volume contraction) hyperkalemia - acidosis - and skin hyperpigmentation

47. What is the tx for gigantism/acromegaly
Pot - bellied - pale - puffy faced witih protruding umbilicus and protuberant tongue
Kidney - 1 -25 OH2 vit d
Removal of pituitary adenoma and octreotide
Fluids - insulin - and K - glucose if necessary to prevent hypoglycemia

48. What are the 3 P's of MEN type 1 (Werners)
Pancreas - pituitary and PTH
DM2
Mucormycosis - Rhizopus infxn - cerebral edema - cardia arrhythmias - HF
PTH = inc ca reabsorption and dec PO4 reabsorption in DIC - active vit D = inc absorption of both in gut

49. What drugs cause shrinkage of prolactinoma
Carrier protiens in posterior pituitary that carry hormones in circulation - derived from neuroectoderm
Inhib
Bromocriptine or cabergoline
No - proinsulin to insulin + C peptide

50. What is the histology with hashimotos thyroiditis
Inactive form
Hurthle cells - lymphocytic infiltrate with germinal centers
Amenorrhea - galactorrhea - low libido - infertility from dec GnRH - - bitemporal heminanopia from imgingement of optic chiasm
Stim