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Flashcards

Endocrine

Laxmi Kotha Inglês 85 flashcards

Flashcards do conjunto (85)

  1. 1Pituitary adenomabenign, ant pituitary, nonfxnal=mass effect or make hormone
  2. 2Mass EffectBitemporal hemianopsia= compress optic chiasm
    Hypopituitarism (compress pituitary), headache. seen more in men be grows larger before discovered
  3. 3Prolactinomarelease prolactin, galactorrhea, amenorrhea (no period), less libido & headache in males.
    Tx: dopamine agonist (bromocriptine/cabergoline)
  4. 4GH cell adenomaGigantism (kids), acromegaly (adults): enlarged bones, visceral organs (cardiac failure), big tongue. DM bc GH->liver gluconegenesis (make glucose). More GH & IGF-1 & no GH supression w/oral glucose
    Tx: Octerotide (somatostatin)
  5. 5ACTH cell adenomasCushing cyndrome
  6. 6Hypopituitarismwhen you loose 75%, pituitary adenomas (adults) & craniopharyngioma (kids)
    Sheehan: preg realted, bigger pituary but same amt of blood->infarct
    Empty sella
  7. 7Sheehanpreg realted, bigger pituary but same amt of blood->infarct
    poor lactation, no pubic hair, fatigue
  8. 8Empty Sella syndromecongenital defect, herniation of arachnoid & CSF into sella->compress & kill pituitary gland. 2nary if tumor taken out
  9. 9ADHon distal tubules & collecting ducts->free water retention
  10. 10Oxytocinuterine contration during labour & release breast milk
  11. 11Central Diabetes InsipidusADH def, loose free water: polyuria & polydipsia (dehydration), increased Na & high serum osmolality, low urine osmolality (bc so much h2o leaves). Water deprivation test doesn’t work. Tx: Desmopressin
  12. 12Nephrogenic DIkidneys don’t react to ADH, bc mutations or Li, demeclocycline
    like centra DI but doesn’t respond to desmopressin
  13. 13SAIDHexcessive ADH release bc ectopic (small cell CA of lung), Cyclophosphamide. Retain free water: hyponatremia & low serum osmolality, mental status changes & seizures (bc neural swelling & cerebal edema)
  14. 14Thyroglossal duct cystant neck mass, thyroid remnants
  15. 15Hyperthyroidismmore thyroid hormone:inc basal meta rate bc more Na+/K+ ATPase, SS bc beta1-receptor
  16. 16Hyperthyroidismweight loss, heat intol, tachycardia, arrthythmia, tremor, ataring gaze w/ lid lag, diarrhea, bone resorp w/hyerCa (risk of osteoporosis), decreased muscle mass, less cholesterolemia, hyperglycemia (bc glucenogneesis & glycogenolysis)
  17. 17GravesIgG (autoAb) stimulates TSH (type 2 HS)->more thyroid hormone in women 20-40s
  18. 18Graves clinical featureshyperthyroidism, diffuse goiter (bc TSH stimulation->thyroid hyperplasia), fibroblasts express TSH-R->GAGs (chondroitin sul & hyaluronic acid)-->exophthalomos & pretibal myxedema, scalloped follicles
  19. 19Graves labs & Txinc total & free T4, hypocholesterolemia, increased serum glucose
    Tx: beta-blockers, thioamide, radioiodine ablation
  20. 20Thyroid storminc catecholamines & lots of hormone excess bc of stress. Arrthythmia, hyperthermia, vomit w/hypovolemic shock
    Tx: PTU, betal blockers, steroids
  21. 21multinodular goiterbig thyroid w/lots of nodules, bc iodine def, not toxic but if regions become TSH independent->release a lot of T4 (toxic)
  22. 22HypothyroidismCretinism, myxedema, throiditis (hashimotos, de quervain, reidel)
  23. 23cretinisminfants: mental retardation, short, coarse features, large tongue, umbilical hernia bc maternal hypothyroid, dyshormonogenic goiter (thyroid peroxidase), iodine def.
  24. 24myxedemaadults, dec metabolic rate & SNS, accumulate GAGS (deep voice & large tongue). weight gain, muscle weakness, cold intolerance, bradycardia, hypercholesterol, constipation
  25. 25myxedema causesiodine def, Hashimoto thyroiditis, drugs (lithium)
  26. 26hashimoto thyroiditisHLA-DR5, autoimmune (antithyroglobulin & antithyroid peroxidase Ab): hyperthyroidism (follicle damage)-->hypothyroidism
  27. 27hashimoto thyroiditis histologychronic inflam w/ germinal centers & Hurthle cells (eosinophilic), inc risk for B cell (marginal zone) lymphoma (enlarge gland)
  28. 28subacute granulomatous thyroiditisde Quervain, Granulomatous thyroiditis after viral infxn. tender thyroid (transient hyperthyroid). self-limited
  29. 29Reidel fibrosing thyroiditischronic inflam w/lots of fibrosis. hard as wood, into local structures. like anaplastic carcinoma but in younger ppl
  30. 30benign I 131 untake (nodules)increased uptake (hot): graves & nodular goiter
    decreased uptake (cold): adenoma/carcinoma (need biopsy)
  31. 31Follicular adenomabenign pol of follicels around fibrous capsule, usually non-fxnal
  32. 32Papillary Carcinomamost common, bc ionizing radiation exposure, "orphan annie eye” nuclei, nuclear grooves w/ psammoma bodies. Cervical lymph nodes. good prognosis
  33. 33Follicular Carcinomapol of follicles surrounded by fibrous capsule w/invasion (vs adnoma). have to look at whole can’t just look at FNA. mets through blood
  34. 34Medullary Carcinomaparafollicular C cells, neuroendocrine (secrete calcitonin->kicks Ca out of kidney), hypoCa, calcitonin deposits as amyloid.
    MEN 2A & 2B (RET ongogene)
  35. 35MEN 2Amedullary CA, pheochromocytoma, parathyroid adenoma
  36. 36MEN 2Bmedullary CA, pheochromocytoma, ganglineuromas of oral mucosa
  37. 37Anaplastic Carcinomaundiff, elderly, invades local structures->dysphagia & resp compromise. poor prog
  38. 38Parathyroid glandsCheif cells->PTH->ionized free Ca
    more osteoblasts activity->osteoclasts->release Ca & phosphate from bone
  39. 39Primary hyperPTexcess PTH, bc parathyroid adenoma( benign, one gland), hyperplasia, CA.
  40. 40Parathyroid adenomabenign, one gland, inc PTH->hyperCa->CaOx stones, nephrocalcinosis (tubuels cal), CNS, constapation, peptic ulcer, acute panc, Osteitis fibrosa cystica (lots of bone resorption).
  41. 41Parathyroid adenoma labsinc PTH, inc serum Ca, dec serum potassium , inc urinary cAMP, inc serum alk phos
  42. 422ndary hyper parathyroidismmake excess PTH outside of parathyroid gland, bc chronic renal failure->dont excrete phosphate->phosphate binds to Ca->less free Ca->all 4 PT glands stimulated->lots of bone resorbtion.
  43. 432ndary hyper parathyroidism labsinc PTH, dec serum Ca, inc serum phosphate, inc alk phos
  44. 44hypoPTbc autoimmune damage, surgical excision, DiGeorge. low serum Ca. low PTH & serum Ca
  45. 45Low serum Canumbness & tingling (aroung mouth), muscle spasms (tetany) from blood pressure cuff & facial nerve.
  46. 46Pseudoparathyroidismend organ resisitance to PTH, hypoCa w/ increased PTH. AD->short w/ short 4th & 5th digit. also no inc in alk phos
  47. 47Insulinfrom beta cells, (islet center), anabolic, upreg GLUT4 on sekletal muscle, adipose tissure->inc glycogen syn. protein syn, lipogenensis
  48. 48glucagonalpha cells, inc blood glucuse levels w/ glycogenolysis & lipolysis
  49. 49Type 1 DMAutoimmune destroy beta cells by T lymph, inflam of islets. HLA-DR3 & HLA-DR4. in knids: high serum glucose, weight loss, polyuria & polydips, glycosuria. risk of diabetic ketoacidosis
  50. 50Diabetic ketoacidosisexcessive serum ketones, inc lipolysis (inc FA)->ketone bodies in liver (beta-hydroxybutric acid & acetoacetic acid. hyperglycemia (300+), anion gap metabolic acedosis, hyperK+, Kussmaul sign , dehydration, N/V, fruity breath
  51. 51DKA Txfluids, insulin, replace electrolytes (K+)
  52. 52Type 2 DMend organ insulin resistance, obesity (dec insulin receptors), genentic predisposiiton, insulin inc at first->then dec (beta exhausation)->amyloid depot in islets, hypermolar non-ketoic coma
  53. 53Type 2 DM labsglucose (7-120), random glucose (200+), fassting glucose (126+), glucose tol test (200+) after 2 hrs
  54. 54Type 2 DM Txinsulin resistance (sulfonylurea, metformin), exogenous insulin
  55. 55Hypermetabolic non-keto comaglucose 500+->end oof life diuresisi w/ hypotension & coma. no ketones bc come circulating insulin
  56. 56Non-enzymatic glycosylation (NEG)in vascular BM, atherosclerosis->cardiovascular (CoD), peripheral vascualr disease )amputations)
  57. 57NEG in kidneysrenal arterioles->glomerulosclerosis->small scarred kidneys w/ granular surface. Efferent side (hyperfiltration w/albumin in urine)->nephoric syndrome (Kimmelstiel Wilson nodule glomeruli). HbA1C
  58. 58DM osmotic damageglucose goes into Schwann cells, oericytes of renal BV, lens. Aldose reductase->sirbitol->osmotic damage: peripheral neuropathy, impotence, cataracts (blindness)
  59. 59Panc endocrine neoplasmsislet cell tumor (MEN 1), insulin, gastrimona, somatosatainomas, VIPomas
  60. 60Insulinomasepisodes of hypoglycemia w/ mental status changes, dec serum glucose, inc insulin & C-peptide
  61. 61GastrinomaZollinger-Ellison (treatment resisitant peptic ulcers), lots in jejunum
  62. 62Somatostatinomasblock gastrin->achlorhydria, block CCK->cholelithasis w/steatorrhea
  63. 63VIPomalots of VIP= watery diarrhea, hypoK, achlorhydria
  64. 64Glomerulosamineralocorticoids (aldosterone), (from cholesterol). inc Na absorbtion & K+ & H+sec in distal tubule & collecting duct
  65. 65Fasciculataglucocorticoids (cortisol) (from cholesterol).
  66. 66Reticularisandrogens (DHEA) (from cholesterol)
  67. 67Primary hyperaldosteronism causesbilat adrenal hyperplasia, adrenal adenoma (Conn), adrenal CA
  68. 68primary hyperaldosteronismhigh aldosterone, low renin, inc renal perfusion rate
    Tx: mineralocorticoid receptor antagonist (spironolactone & eplerenone)
  69. 692dary hyperaldosteronismactivate renin-angiotensin system (renovasculat HTN or CHF). high aldosterone & high renin
  70. 70Famillial hyperaldosteronism(AD) abnormal expression of aldosterone synthase in fascuculata. in kids HTN, hypoK+, metabolic alkalosis. low aldosterone & low renin.
    Tx: dexamethasome, do genentic testing
  71. 71Liddle syndromeNa channels in CT not deg. HTN, hypoK, matabol alkalosis. low aldosterone & renin
    Tx: potassium sparing diuretic (amiloride/triamterene). block tubular Na channels
  72. 72Cushinghyperchortisol, muscle weakness w/ thin limbs (cholesterol breaks down muscle->gluconeogenesis), moon face, buffalo hump, increase fat storage centrally, striae (impared collagen syn-thin skin), HTN (hypoK & metabol alkalosis), osteoporosis, immune supression
  73. 73cushings diagnosis24hr urine cortisol increased, late night salivary cortisol inc, loe dose dexamethasone supression test (fail). if ACTH dependent (do high dose dexamethosome which blocks pituitay adenoma but not ectopic)
  74. 74Congenital adrenal hyperplasia(AR) enzyme defect to make cortisol. high ACTH->bilat adrenal hyperplasia (could also inc mineralocorticoids & androgens).
  75. 7521 hydroxylase defdec aldosterone & cortisol, make lots of androgens. HypoNa+, HyperK+, Hypovolemia, HYPOtension (bc salt wasting), females w/clitoral enlargement (genital ambiguity), precocious puberty (male), hirsutism w/menstural irregularities
  76. 7611 hydroxylase defweak mineralocorticoids->hypertension (Na retention_ w/ mild hypoK+. low renin & aldosterone
  77. 7717 hydroxylase defweak mineralocorticoids (HTN, hypoK, low renin & aldosterone)
    dec androgen (primary amenorrhea no pubic hair, pseudohermaphroditism)
  78. 78Adrenal insufficiencybc withdraw glucocorticoids (weak & shock), Waterhouse Friderichsen syndrome, Chronic insufficiency (Addison)
  79. 79Waterhouse Friderchsenhemorrhagic necrosis of adrenal glands, bc DIC in kids w/Neisseria meningitidis infxn. no cortisol->hypotension->death
  80. 80Chronic adrenal insufficiencyAddison, progressive destruction of adrenal glands, bc autoimmune destruction, TB, mets lung carcinoma. CF: low BP, low Na, hypovol, hyperK+, metabol acidosis, hyperpigmentation (bc high ACTH stimulate melanocytes). V/D
  81. 81Pheochromocytomaincreased serum catechlamines: HTN, headache, palp, tachcardia, sweating. more metanephrines & 24hr urine metanephrines & vanillylmandelic acid.
  82. 82Pheochromocytoma Txsurgery: Catecholamines leak into bloodstream. Add Phenoxybenzamine (alpha-blocker) before surgery. rules of 90
  83. 83rules of 9090 unilat, 90 sporatic, 90 benign, 90 inside medulla. Related to Men 2A & 2B, vHL disease, NF1
  84. 84NF-1cafe au lait, lisch nodules, bowing of legs, learning disabiliites, NF-1 & optic pathyway gliomas (mal nerve sheath tumors).
  85. 85vHL syndromehemangioblastoma of cerebellum, RCC, phenochromocytoma

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FlashCards sobre Endocrine, criado por Laxmi Kotha em 02-07-2017.
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Laxmi Kotha
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