Hi Yield 15.0-15.8

mhewett's version from 2016-06-30 16:24

Section 15.0 Pituitary Hyperfunction

Question Answer
What are the symptoms of a prolactinoma?Amenorrhea/oligomenorrhea, Impotence, Galactorrhea, Gynecomastia, Visual changes/complaints
What is Cushing's disease?Overproduction of ACTH resulting in over production of cortisol (causes Cushing's syndrome but is d/t an anterior pituitary tumor)
Which condition related to overproduction of growth hormone secondary to an anterior pituitary adenoma occurs before puberty? After puberty?Before puberty: Gigantism
After puberty: Acromegaly
What is the primary issue in PCOS?Direct result of LH overproduction not associated with a pituitary adenoma
(LH stims theca cells increasing androgens→aromatase in the fat cells and granulosa cells convert the androgens to estrone→estrone causes negative feedback on FSH resulting in no mature follicles→result is numerous cysts that won't mature to ovulation→anovulatory=infertility)
What is the cause of menopause?Ovarian failure (results in no estrogen or progesterone so have high levels of FSH and LH)
What are the primary symptoms of SIADH?Cerebral edema (with neuro dysfxn)
+/- HTN
Urine osmolarity > Serum osmolarity

Section 15.1 Pituitary Hypofunction

Question Answer
What are the 2 most common causes of panhypopituitarism?pituitary tumor, postpartum pituitary necrosis (Sheehan's Syndrome)
What is pituitary dwarfism?congenital deficiency of growth hormone; short and proportionally small
What are the common causes of central diabetes insipidus?(adh deficiency d/t..) Head trauma; Anything that damages the posterior pituitary or hypothalamus

Section 15.2 Adrenal Gland Disorders

Section 15.2.1 Adrenal Adenomas/Carcinomas

Question Answer
What condition causes overproduction of aldosterone secondary to adrenal adenoma? What symptoms would you expect?Conn's Syndrome
Hypernatremia (increases H2O uptake); HTN (with resulting occipital headaches); Hypokalemia (causes mm weakness)
What is Cushing's syndrome?d/t anything that causes increased glucocorticoids
What causes HTN episodes, sporadic palpitations, paroxysmal hyperhidrosis, and episodic aggressive behavioral changes? What genetic conditions is it associated with?Pheochromocytoma
MEN II; von Hippel Lindau
You have a patient under 3 yoa who presents to you with an enlarged abdomen with HTN. What do you suspect and what are some other complications that could be seen in this pt?Neuroblastoma (malignant tumor or adrenal medulla and/or sympathetic ganglia resulting in excess NE production)
Other: painful bony mets, resp distress d/t mets, bowel and urinary obstruction d/t mets, gait disturbance and incontinence d/t spinal cord mets, SEVERE diarrhea secondary to vasoactive intestinal peptide release

Section 15.2.2 Adrenal Gland Hypofunction

Question Answer
What is Addison's disease?decreased aldosterone production
dec aldosterone --> excess Na (and water) loss through kidney -> hypotension
dec aldosterone --> dec negative feedback on ant pituitary - excess ant pituitary production of POMC --> excess production of ACTH and MSH --> the MSH results in excess melanocyte stimulation --> hyperpigmentation

Section 15.3 Thyroid

Question Answer
What lab values would you expect to see for primary hyperthyroidism?primary: Hi T3/T4 & Lo TSH (Graves dz - abs stim the receptors to produce T3/T4)
What lab values would you expect to see for secondary hyperthyroidism?secondary: Hi T3/T4 & Hi TSH (functional pituitary tumor producing excess TSH)
What lab values would you expect to see for primary hypothyroidism?low T3/T4; hi TSH (Hashimoto's thyroiditis)
What lab values would you expect to see for secondary hypothyroidism?low T3/T4, TSH (Sheehan's syndrome)
What lab values would you expect to see for factitious hyperthyroidism and struma ovarii?hi T3/T4; low TSH (when pt takes thyroxine unnecessarily and struma ovarii is a type of ovarian teratoma that produces thyroid hormone)
What lab values would you expect to see for subacute thyroiditis?hi or low T3/T4; hi or low TSH (De Quervain's thryoiditis)
Hyperthyroidism d/t anti-TSH receptor abGrave's disease
What type of thyroid condition is seen in post-menopausal, multiparous females d/t hyperactivity of nests of cells in their thyroid?Plummer's dz (nodular toxic goiter)
Causes recurrent fatigue, tiredness, malaise d/t the rest of the gland being inadequately stimulated d/t to the overactive nests shutting down the ant. pituitary's production of TSH
What is Hashimoto's thyroiditis?a T cell disorder with anti-thyroid antibodies (antimicrosomal ab) and/or anti-thyroglobulin ab
What type of thyroiditis is seen secondary to chronic use of ergots for migraines?Riedel's thyroiditis (fibrous thyroiditis)
Causes severe hypothyroid
What is De Quervain's thyroiditis?hyperthyroid sxs sometimes followed by hypothyroid sxs; etiology is probably viral and usually follows a viral URI.
What is sick euthyroid syndrome?d/t severe illness, trauma, stress; all have normal TSH

Section 15.4 Thyroid Tumors

Question Answer
What type of thyroid tumor can cause hyperthyroid most commonly in females over 45 yo?Follicular adenoma
Are cold or hot nodules in a thyroid malignant?Cold nodules are more likely to be malignant as they are non-functional and not using iodine - an indication that they are no longer well differentiated cells
papillary CAmost common type; best prognosis; finger-like projections; Orphan Annie nuclei; psammoma bodies; females in their 20s
follicular CAmiddle aged pts; poorer prognosis
Anaplastic CAelderly pts; VERY aggressive with very poor prognosis
What type of thyroid tumor involves parafollicular C cells and what is the normal function of the parafollicular C cells?Medullary carcinoma
Normal fxn is to make calcitonin which fxns to encourage Ca deposition into the bone - tumor results in high calcitonin and thus hypocalcemia
(associated with MEN 2A and 2B)

Section 15.5 Parathyroids

Question Answer
What actions does PTH encourage (general and specific)?Increases calcium and decreases phosphate
- activates osteoclasts (inc serum Ca)
- increases renal tubular reabsorption of Ca
- increases Vit D conversion to 1,25-Vit D in kidneys (inc serum Ca and PO4)
- increases renal phosphate excretion
- increases GI absorption of Ca
What is the active form of vitamin D?1,25 - dihydroxy-cholecalciferol
What are the labs you would expect in hyperparathyroidism?High PTH and Ca & Low PO4
Secondary hyperPTH would cause low calcium with hi PTH and PO4 - this is seen in chronic renal failure b/c the kidney can't respond to PTH resulting in low Ca reabsorption - causes parathyroid to continue making PTH and for the PO4 levels to continue rising
What is hypoparathyroidism?d/t lack of parathyroid activity (like with accidental parathyroid removal with thyroidectomy); results in low pTH --> low Ca, hi PO4
Whats the difference between pseudohypoparathyroidism and pseudopseudohypoparathyroidism?Pseudo: defective PTH receptors make body unable to respond adequately to the PTH signal resulting in high PTH, low Ca++ and high PO4 - ONLY INHERITED FROM MOTHER
Pseudopseudo: receptors work fine but the 2ndary messenger system in the tissues is defective resulting in a SLOOOOW response to PTH - the Ca++ and PO4 levels will slowly equilibrate after any disruption in their balance - ONLY INHERITED FROM FATHER D/T GENE IMPRINTING

Section 15.6 Renal Osteodystrophy

Question Answer
Chronic renal failure causesdec phosphate excretion and dec active vitamin D production
High PO4 -->hypocalcemia
dec active vit D production -->hypocalcemia
hypocalcemia -->inc PTH --> bone demineralization --> renal osteodystrophy

Section 15.7 Diabetes Mellitus

Question Answer
What causes ketoacidosis risk and how does it present? T1 or T2?T1
lack of insulin + stress allows for extreme over activation of hormone sensitive lipase, resulting in explosive lipolysis and consequent ketoacids
features abd pain, severe dehydration, metabolic acidosis
How does hyperosmolar nonketotic coma occur in T2DM?Extremely high blood glucose levels draw water out of tissues and into blood - this includes the brain which eventually causes coma
Why is neuropathy such a concern in diabetics?Causes blunted sensations so later in life they may be having a massive heart attack but only feel slight discomfort or "funny feeling" in chest
What occurs in gestational diabetes?beta- cell reserve is inadequate for inc demands of pregnancy
exacerbated by human placental lactogen (product of placenta causing mild insulin resistance)
What defect is seen in MODY (maturity onset diabetes of the young)?Glucokinase defect - can't phosphorylate glucose to keep it in cell resulting in hyperglycemia

Section 15.8 Multiple Endocrine Neoplasia

Question Answer
What is the inheritance pattern of MEN syndromes?autosomal dominant (all MEN are dominant)
What cancers are pts with MEN Type 1 at an increased risk of developing?3P's and an A
- Pituitary
- Parathyroid
- Pancreas (gastrinoma --> hi gastrin --> Zollinger-Ellison syndrome --> peptic ulcers OR insulinoma --> hypoglycemic all the time)
- Adrenal cortex (adrenal adenoma)
What cancers are pts with MEN type 2A at an increased risk of developing?2Ps and a T
- Parathyroid
- Pheochromocytoma (adrenal medulla)
Thyroid medullary carcinoma
What cancers are pts with MEN type 2B at an increased risk of developing?1 P
- Pheochromocytomas
- Thyroid medullary carcinoma
- Mucosal neuromas (oral)
- Marfanoid features