39 Erythropoietic Effects if Endocrine Disorders Flashcards
TRUE OR FALSE
Anemia is a well-recognized complication of thyroidectomy and is associated with hypo- and hyperthyroidism and subclinical thyroid dysfunction.
TRUE
Anemia is a well-recognized complication of thyroidectomy and is associated with hypo- and hyperthyroidism and subclinical thyroid dysfunction.
A normocytic normochromic anemia may be seen in primary adrenal insufficiency (Addison disease), but the anemia may also be masked by the concomitant (increase or decrease) in plasma volume
Decrease
TRα or TRβ
Both TRα and TRβ proteins are expressed in human CD34+ progenitors, but only _______ is detectable in late erythroblasts.
TRβ
TRUE OR FALSE
The anemia in hypothyroidism has been described variably as normocytic, macrocytic, or microcytic.
TRUE
The anemia in hypothyroidism has been described variably as normocytic, macrocytic, or microcytic.
- Significant reduction in their red cell mass, anemia is not always evident from hemoglobin and hematocrit values, owing to a concomitant reduction of plasma volume
- Chronic autoimmune (Hashimoto disease) thyroiditis have an increased incidence of chronic autoimmune gastritis and celiac disease, with resultant in impaired cobalamin and iron absorption
- Iron deficiency impairs TH synthesis by reducing the activity of heme-dependent thyroid peroxidase and may also alter central nervous system control of thyroid metabolism.
TRUE OR FALSE
Thyroid hormone administration increases red cell production in animals, humans with hyperthyroidism generally have erythrocytosis.
FALSE
Although thyroid hormone administration increases red cell production in animals, humans with hyperthyroidism generally do not have erythrocytosis.
Hematologic changes in primary adrenal insufficiency (Addison disease)
- Normocytic normochromic anemia (can be masked by the concomitant reduction in plasma volume)
- Transient anemia after initiation of hormone replacement therapy, presumably secondary to an increased plasma volume
Autoimmune gastric atrophy (pernicious anemia) can occur in patients with autoimmune adrenal insufficiency
Manifestations include mucocutaneous candidiasis and hypoparathyroidism
Type I polyglandular autoimmune syndrome
TRUE OR FALSE
Glucocorticoids interact with erythropoietin in vitro to reduce erythroid colony proliferation.
FALSE
Glucocorticoids interact with erythropoietin in vitro to enhance erythroid colony proliferation.
Adrenal conditions associated with erythrocytosis
- Cushing syndrome
- Primary aldosteronism
- Bartter syndrome
- Congenital adrenal hyperplasia
- Pheochromocytomas, paraganglioma - rare
Strong association between testosterone levels and hemoglobin and hematocrit was demonstrated
The most common cause of congenital adrenal hyperplasia is
21-hydroxylase deficiency
The patients’ with pheochromocytomas, paraganglioma were heterozygous for various gain-of-function mutations of the gene encoding _________________, and erythropoietin transcript was present not only in tumor tissue but also in the surrounding normal tissue.
HIF-2α (EPAS1)
Consequently, resection of the tumor does not resolve the erythrocytosis
TRUE OR FALSE
Sexually mature males have higher hemoglobin levels than prepubertal males, older males, and females.
TRUE
Sexually mature males have higher hemoglobin levels than prepubertal males, older males, and females.
Hormone responsible for the sex difference in hemoglobin
Testosterone
Testosterone levels directly correlated with hemoglobin levels
Orchiectomy results in a median decrease in hemoglobin concentration of 120 g/L.
Effects of Testosterone
- Promotes the differentiation of CD34+ umbilical cord cells into erythroid progenitor cells
- Associated with an increase in erythropoietin levels and a decrease in hepcidin levels
The most common cause of pituitary insufficiency
Pituitary tumors or consequences of their therapy
Deficiencies of which hormones are considered the major contributors to anemia of hypopituitarism
Thyroid hormones, adrenal hormones, and androgens
Regardless of the cause, hypopituitarism results in a moderately severe normochromic normocytic anemia, with an average hemoglobin level of 100 g/L.
TRUE OR FALSE
Red cell survival is decreased in hypopituitarism and the marrow is hypoplastic.
FALSE
Red cell survival is normal in hypopituitarism, but the marrow is hypoplastic.
Drug which which stimulates prolactin secretion, improved hemoglobin levels or reduced transfusions in three of nine patients with Diamond-Blackfan anemia
Metoclopramide
However, macroprolactinomas have not been associated with erythrocytosis, but with anemia, likely the result of a concomitant decrease in testosterone levels.
TRUE OR FALSE
The anemia of hyperparathyroidism is normochromic and normocytic and resolves or improves after parathyroidectomy.
TRUE
The anemia of hyperparathyroidism is normochromic and normocytic and resolves or improves after parathyroidectomy.
TRUE OR FALSE
The presence of marrow fibrosis may positively correlate with improvement in anemia after parathyroidectomy
TRUE
The presence of marrow fibrosis may positively correlate with improvement in anemia after parathyroidectomy
There is no correlation with marrow fibrosis and the duration of hyperparathyroidism
TRUE OR FALSE
Secondary hyperparathyroidism in CKD, may contribute to refractoriness to erythropoietin therapy.
TRUE
Secondary hyperparathyroidism in CKD, may contribute to refractoriness to erythropoietin therapy.
Parathyroidectomy or medical treatment of hyperparathyroidism may improve anemia and decrease requirements for exogenous erythropoietin therapy.
