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IPA > Adrenal > Flashcards

Adrenal Flashcards

1
Q

what 6 hormones are released by anterior pituitary

A
  1. TSH
  2. FSH
  3. LH
  4. GH
  5. ACTH
  6. Prolactin

posterior

  • ADH
  • oxytocin
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2
Q

where is GnRH produced and what does it cause

A

produced by hypothalamus

causes production of FSH and LH

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3
Q

what is the GnRH stimulation test the gold standard for

A

reveals premature activation of HPG axis in precocious puberty (early onset of secondary sex characteristics)

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4
Q

what is GnRH and analogs / antagonists of it used to treat

A

infertility
endometriosis
precociuous pubtery
cancer

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5
Q

what are the two gonadotropins

A

LH

FSH

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6
Q

what do FSH and LH do in males

A

FSH: stimulates sertoli cells to procduce sperm
LH: stimulates Testosterone secretion by leydig cells of testes

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7
Q

what do FSH and LH do in females

A

FSH= stimulates growth and development of ovarian follicles

LH= stimulates ovulation and changes in follicle->corpus luteum , secretion of estrogen and progesterone

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8
Q

when does typical menarche typically occur

A

age 11-15

pituitary starts secreting LH/FSH more around 8-12

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9
Q

what is the ovulation prediction tests (OPK)

A

enables women to dectect LH in urine test at about day 10 of cycle to see if it will most likely result in ovulation

at home kits

$$$

97% accurate

limited in just gives ballpark of when ovulating

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10
Q

what are the three phases of the ovarian endometrial cycle

A
  1. proliferative: estrogen promotes growth
  2. secretory: progesterone and estrogen levels high and prepare endometrium for fertilization
  3. menstruation: reduction of estrogen and progesterone = necrosis of endometrium
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11
Q

what is estrogen

A

steriod hormone responsible for development of female sexual characterisitics

forms: estrone, estradiol, estriol

negative feedback

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12
Q

why do we evaluate estrogen in man and women

A

men: help explain gynecomastia and feminization
women: evaluate sexual maturity, menses, fertility probs

important in milk lactation, uterus endometrial cell proliferation, long bone developmnet, increases HDL / decreases LD for total chol

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13
Q

what is premature adrenarche

A

maturation of the zonal reticularis resulting in pubic hari gorwth (pubarche= pubic hari before age 9)

assocaited with insulin resistance, metabolic syndrome, polycystic ovary syndrome

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14
Q

what causes high estrogen levels

A

ovulation
preg
choriocarcinoma
molar preg

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15
Q

decreased level of estrogen

A 
preeclampsia
threatened abortion
placental failure
fetal death 
amennorrhea
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16
Q

what are the indication for getting progesterone labs

A

eval women with difficulty getting pregnant or maintaining preg
montior high risk preg

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17
Q

high progesterone

A

ovulation
preg
choricoarcinoma
molar preg

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18
Q

decreased progesteron

A

preeclampsia
threatened abortion
placental failure
fetal death

same as estrogen

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19
Q

what is menopausal transition

A

change in intermentraul interval with or without menopausal symptoms

no reliable method to predict final menstraul period

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20
Q

define menopause

A

12 months of amenorrhea in absence of other biologic or physiologic causes for women over age 45

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21
Q

how to diagnose menopausal transition

A

measure FSH
if FSH level >25 indicated pt likely entered transition

if pt 40-45 should look at other reasons for menstrual dysfunction

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22
Q

as women age, what increases and what decreases

A

older women have higher FSH and estradiol

lower LH and progesterone

23
Q

what is testosterone boudn to

A

sex hormone binding globulin (SHBG)!!!

most bound to this protein but 2% actually active free form

24
Q

when should you draw for a testosterone test

A

in morning when values are lowest

venous blood draw

red top tube

25
Q

what is testosterone/ where produced

A

steriod hormone

95% produced in leydig cells

stimulate spermatogenesis in males, influences development of secondary sex characteristics

26
Q

what does overproduction of Testosterone do to females and males

A

males: result in precocious puberty (usually tumor cause)
female: masculinizatin

27
Q

how do females get testosterone

A

dehydroepiandrosterone (DHEA) an androgen->androstenedion -> testosterone

30% from adrenal gland
50% in peripheral fat
20% made directly by ovaries

28
Q

what do low testosterone indicate in men

A

klinefelter syndrom

cryptorchidism

hypogonadism

cirrhosis

trisomy 21

orchiectomy

29
Q

what do high testosterone levels in men indicate

A 
sexual precocity 
pinealoma
encephalitis
CAH
adrenocortical tumor
testicular tumor
hyperthyroidism

she did not get into this mostly focused on low

30
Q

what inidcates that low testosterone is due to primary hypotestosterone

A

LH and FSH are elevated

31
Q

what indicated that low testosterone is due to secondary hypotestosterone

A

low LH and FSH

32
Q

increase in testosterone in females indicates

A

ovarian tumor
adrenal tumor
congenital adrenal hyperplasia (CAH)- this is what a heel stick at delivery is for

polycystic ovaries!!!
trophoblastic tumor

33
Q

hyperandrogenism in females

A

manifests as acne or hirsutism

34
Q

how to rule out polycystic ovary syndrome in females with high testosterone

A

do an early morning early follicular phase plasma level of 17-hydroxyprogesterone (17OHP)

if less than 200 = rule it out

!!!

35
Q

what is hyperandogenism

A

elevated serum androgen levels in women

manifests in acne or hirsutism (male pattern hair growth)

36
Q

where are glucocorticoids released (cortisol)

A

adrenal cortex

37
Q

what does cortisol do

A 
increases gluconeogeesis 
protein breakdown 
lipolysis
required for mobilizing energy stores
inhibits insulin and glucose transport into cells

increases with preg

38
Q

what happens with excess cortisol

A

fat distributed around body differently
straie
HTN
hyperglycemia

aka cushings

39
Q

how to collect cortisol

A

urine collection 24 hours

increases with pregnancy, emotion, stress

40
Q

what is ACTH do

A

adrenocortiicotropic hormone (ACTH) stimulated by CRH from hypothalamus

released into circulation to adrenal cortex

stimulates adrenal cortex to secrete cortisol

41
Q

What are the levels of Cortisol and ACTH in Cushing Syndrome adrenal?

A

Cortisol: HIGH

ACTH: Low

aka the adrenal c=gland is the issue

42
Q

What are the levels of Cortisol and ACTH in Cushing Syndrome pituitary?

A

cortisol high

ACTH high

pituitary tumor produces ACTH
ectopic ACTH are commonly in the lungs and produce ACTH = circulating ACTH is high
adrenal glands are doing fine and producing cortisol

43
Q

hat are the levels of Cortisol and ACTH in Addison’s?

A

cortisol: low

ACTH: high

hypocorticolism: msucle wasting, salt cravings, n/v,
this tells us that adrenal gland not wrking

autoimmune disorder

44
Q

What are the levels of Cortisol and ACTH in Hypopituitarism

A

cortisol: low

ACTH: low

prob with pituitary gland = domiino

45
Q

why would you order a ACTH stimulation test

A

used to diagnose adrenal insufficiency help differentiate between primary and secondary

if you think hypocortisol give them synthetic ACTH, measure cortisol before and after

normal response= rise in cortisol
if stays where it was= consider addisions
or secondary adrenal insufficency

46
Q

what is the dexamethasone suppression test

A

measure cortisol levels after administering dexamethasone (dexamethasone is a potent glucocorticoid that should suppress CRH / ACTH)

used to diagnose adrenal hyperfunction and helps to determine cause

47
Q

what is prolactin

A

polypeptide hormone responsible fo r lactation, breast development, hundreds of actions of homeostasis

other things like CNS and immune system can also produce this on otp of pituitary (Ant)

48
Q

why would you order a prolactin test (PRL)!!!!!!!!!!!!!

A

to diagnose/monitor prolactin secreting pituitary adenoma !!!!!!!!!!!!!!!!!!!!!!

this is the most common cause for increased prolactin levels

49
Q

what hormone helps regulate prolactin

A

dopamine

50
Q

increased PRL

A 
glactorrhea
amenorrhea
prolactin secreting pituitary tumor
stress
empty sellae syndrome
PCOS
renal failure
51
Q

what causes decreased PRL

A

pituitary adoplexy (sheehan syndrome)

pituitary destruction by tumor

52
Q

how do you do a PRL test

A

draw blood sample in morning with red top tube

transfer immeadiately to lab or put on ice

!!!!!!!!!

53
Q

what is the most common cause of hyperprolactinemia

A

prolactin secreting pituitary adenoma

54
Q

what provides negative feedback for prolactin

A

dopamine

IPA (14 decks)

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