Carney triad vs. Carney dyad 🧬 #endotips (thread👇)
A diagnosis of Carney triad requires co-existing paraganglioma (PGL), pulmonary chondroma, and gastrointestinal stromal tumor (GIST) with either a germline pathogenic variant in SDHx or SDHC locus-specific hypermethylation
In contrast, Carney dyad is the association of PGL and GIST with a germline pathogenic variant in SDHx. Don't confuse them with Carney complex, an autosomal dominant lentiginosis syndrome with myxomas, endocrine tumors or overactivity, and schwannomas👇
Carney-Stratakis syndrome is another name for Carney diad (discovered by two giants in the field, Dr Aidan Carney from @MayoClinic and Dr Constantine Stratakis from @NIH)
Carney triad has a fourth component, adrenal cortical adenoma (either micro or macro) or hyperplasia + subclinical hypercortisolism: the only known disease with predisposition to BOTH adrenocortical and adrenomedullary (pheochromocytoma) lesions
1⃣Classification (evolving): type 1, type 2 (90%), gestational, other (meds, genetics, endocrinopathies etc)
2⃣Type 1 and 2 can occur in any age group
3⃣1/3rd of children with type 1 present with DKA
1/7
4⃣Three stages of type 1 diabetes
2/7
5⃣Three established screening tests for diabetes: HbA1c, OGTT, fasting glucose. Generally, these tests are equally appropriate for diagnostic screening although do not necessarily detect diabetes in the same individuals. Their concordance is imperfect
🫀Molecular mechanisms involved in the different types of monogenic hypertension (thread)👇
🔹Gordon syndrome
▪️Autosomal dominant: WNK1 (GoF), WNK4 (LoF)
▪️AKA Pseudohypoaldosteronism Type II
▪️⬇️renin, normal/⬆️aldosterone (mimicking biochemically mild primary aldosteronism), BUT hyperkalemia
▪️Metabolic acidosis, hypercalciuria,⬇️UNa
▪️Rx: low dose thiazide
🔹Liddle syndrome
▪️SCNN1A/B/G (GoF), dominant
▪️⬇️renin/aldosterone/K, alkalosis
▪️Spectrum: mild to severe
▪️Rx: low salt diet and ENaC inhib. (amiloride, triamterene)