Chapter 10: Endocrine Flashcards
Likely causes of Hyperpituitarism
benign pituitary adenoma
microdenoma (< 1cm) or macroadenoma (> 1 cm)
Manifestations of a microadenoma (lactotroph)
hyperpituitarism
manifestations of hormone excess
lactotroph = increased prolactin = hypogonadism and infertility
Manifestations of a macroadenoma
hyperpituitarism
headache, visual disturbances (impingement on cranial nerves and optic chiasm [where optic nerves cross])
causes of hypopituitarism
pituitary = congenital defect, surgery/radiation, infection (TB, meningitis), pituitary tumor, pituitary infarction (Sheehan syndrome)
hypothalmic = hypothalmic tumor, infection, infiltrative disorder (histocytosis, sarcoidosis), TBI, Radiation
hypopitiuitarism manifestations
growth hormone deficiency = delayed growth and development
fsh/lh deficiency = impaired reproductive (infertility, amenorrhea, irregular menses, hot flashes)
tsh deficiency = central hypothyroidism
acth deficiency = secondary adrenal insufficiency (cortisol deficiency, not aldosterone)- weakness, nausea, anorexia, hypotension
ADH deficiency = diabetes insipidus – excessive urination.
signs of SIADH
hyponatremia (dilutional), high urine osmolality (concentrated), low urine output, low serum hypo-osmolarity (<270), n/v, confusion, weakness, cramping
signs of DI
hypernatremia, low urine osmolarity, high urine output, serum hyperosmolarity (>320), polydipsia, nocturia
cause of acromegaly or gigantism,
excess GH and IGF-1
often due to an adenoma
cause of dwarfism
growth hormone deficiency d/t tumor, GHRH receptor mutations, pituitary agenesis (no organ development), panhypopituitarism
what is a pheochromocytoma
As a tumor of adrenal medullary tissue, a pheochromocytoma produces symptoms of catecholamine excess. Anxiety, headache, and palpitations are direct effects of catecholamine discharge; weight loss is secondary to one of the metabolic effects of excessive circulating catecholamines. These include an increase in basal metabolic rate and an increase in glycolysis and glycogenolysis, leading to hyperglycemia and glycosuria
causes of goiters
increased intake of foods containing goitrogens (eg, rutabaga, cabbage, turnip, cassava)
A diminished intake of foods containing iodine (eg, fish)
Use of medications associated with goiter (eg, propylthiouracil, methimazole, nitroprusside, sulfonylureas, lithium)
Symptoms of thyroid encroachment on surrounding structures such as respiratory or swallowing difficulties should be elicited.
Because of this patient’s fatigue and depression, the physician should also probe for other symptoms of hypothyroidism.
- A predominant effect of a prolonged excessive growth hormone level is:
A) short stature with obesity.
B) high androgen hormone levels.
C) increased blood glucose levels.
D) insulin-like growth factor (IGF) depletion.
C) increased blood glucose levels.
- The most common cause of hypothyroidism is:
A) goiter.
B) myxedema.
C) thyroidectomy.
D) autoimmune thyroiditis.
D) autoimmune thyroiditis.
- Thyroid hormone deficit , which alters the function of all major organs in the body.
A) decreases metabolism
B) increases protein synthesis
C) causes vitamin deficiencies
D) enhances absorption of glucose
A) decreases metabolism
- The most common cause of thyrotoxicosis is Graves disease, which has the distinguishing characteristic of in addition to a diffuse goiter.
A) muscle fatigue
B) facial myxedema
C) ophthalmopathy
D) decreased cholesterol
C) ophthalmopathy
- The major adrenal cortical hormones are steroids and are synthesized from acetate and:
A) ACTH.
B) albumin.
C) amino acids.
D) cholesterol.
D) cholesterol.
- Primary adrenal insufficiency is manifested by:
A) truncal obesity and edema.
B) hypokalemia and hypervolemia.
C) hyponatremia and hypoglycemia.
D) hypopigmentation and hypertension.
C) hyponatremia and hypoglycemia.
- One of the earliest signs of Cushing syndrome is the loss of variable diurnal secretion of cortisol-releasing hormone (CRH) and:
A) GH.
B) TSH.
C) DHEA.
D) ACTH.
D) ACTH.
- The iatrogenic form of Cushing syndrome is caused by:
A) long-term cortisone therapy.
B) pituitary tumor-secreting ACTH.
C) benign or malignant adrenal tumor.
D) ectopic ACTH secreting lung tumor.
A) long-term cortisone therapy.
- The major manifestations of Cushing syndrome include:
A) excessive salt loss.
B) muscle hypertrophy.
C) overt diabetes mellitus.
D) hair and weight loss.
C) overt diabetes mellitus.
10 The immune suppressive and anti-inflammatory effects of cortisol cause:
.
A) moderate insulin resistance.
B) increased capillary permeability.
C) increased cell-mediated immunity.
D) inhibition of prostaglandin synthesis.
D) inhibition of prostaglandin synthesis
11 Which of the following individuals is experiencing the effects of a primary
. endocrine disorder?
A) A patient with adrenal cortical insufficiency due to pituitary hyposecretion of ACTH
B) A patient who has hypothyroidism as a result of low TSH production
C) A patient whose dysfunctional hypothalamus has resulted in endocrine imbalances
D) A patient who has low calcium levels because of the loss of his parathyroid gland
D) A patient who has low calcium levels because of the loss of his parathyroid gland
12 Which of the following physiologic processes is a direct effect of the release
. of growth hormone by the anterior pituitary?
A) Development of cartilage and bone
B) Production of insulin-like growth factors (IGFs) by the liver
C) Increase in overall metabolic rate and cardiovascular function
D) Positive feedback of the hypothalamic-pituitary-thyroid feedback system
B) Production of insulin-like growth factors (IGFs) by the liver
13 Which of the following individuals displays the precursors to acromegaly?
.
A) An adult with an excess of growth hormone due to an adenoma
B) A girl who has been diagnosed with precocious puberty
C) An adult who has a diagnosis of Cushing syndrome
D) A patient who has recently developed primary adrenal carcinoma
A) An adult with an excess of growth hormone due to an adenoma
14 Which of the following residents of a long-term facility is exhibiting signs
. and symptoms that are indicative of hypothyroidism?
A) An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold
B) A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe
C) An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering more frequently
D) A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis
A) An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold
15 Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is
. implicated in cases of:
A) Cushing syndrome.
B) Graves disease.
C) Addison disease.
D) Cushing disease.
B) Graves disease.
16 A patient has developed the facial appearance that is characteristic of
. myxedema, along with an enlarged tongue, bradycardia, and voice changes.
Which of the following treatment modalities is most likely to benefit this patient?
A) Synthetic preparations of T3 or T4
B) b-Adrenergic blocking drugs and antithyroid drugs
C) Corticosteroid replacement therapy
D) Oral or parenteral cortisol replacement
A) Synthetic preparations of T3 or T4
17 A 33-year-old patient has been admitted to the hospital for the treatment of
. Graves disease. Which of the following assessments should the patients care team prioritize?
A) Assessment of the patients level of consciousness and neurologic status
B) Assessment of the patients peripheral vascular system and assessing for thromboembolism
C) Assessment of the patients vision and oculomotor function
D) Cardiac monitoring and assessment of peripheral perfusion
C) Assessment of the patients vision and oculomotor function
18 A patient who has been taking 80 mg of prednisone, a glucocorticoid, each
. day has been warned by his primary care provider to carefully follow a plan for the gradual reduction of the dose rather than stopping the drug suddenly. What is the rationale for this directive?
A) Sudden changes in glucocorticoid dosing may reverse the therapeutic effects of the drug.
B) Stopping the drug suddenly may shock the HPA axis into overactivity.
C) Sudden cessation of a glucocorticoid can result in adrenal gland necrosis.
D) Stopping the drug suddenly may cause adrenal insufficiency.
D) Stopping the drug suddenly may cause adrenal insufficiency.
19 The signs and symptoms of abrupt cessation of pharmacologic
. glucocorticoids closely resemble those of:
A) Addison disease.
B) Cushing disease.
C) Cushing syndrome.
D) Graves disease.
A) Addison disease.
20 Which of the following pathophysiologic phenomena may result in a
. diagnosis of Cushing disease?
A) Hypopituitarism
B) Excess ACTH production by a pituitary tumor
C) Autoimmune destruction of the adrenal cortex
D) Malfunction of the HPA system
B) Excess ACTH production by a pituitary tumor
Why does Addisons lead to hyponatremia and hypotension?
Damage to the zona glomerulosa of the adrenal gland depletes levels of aldosterone, which contributes to retention of sodium and water
manifestation of microadenoma? (somatotroph)
somatotroph = increased growth hormone = acromegaly/gigantism
manifestation of microadenoma? (corticotroph)
corticotroph = increased ACTH = increased cortisol = cushings
manifestation of microadenoma? (gonadotroph)
gonadotroph = increased LH, FSH = precocious puberty
manifestation of microadenoma?(thyrotroph)
thyrotroph = hyperthyroidism
The posterior pituitary gland is responsible for which 2 hormones?
ADH and Oxytocin
Oxytocin and GH
ACTH and TSH
ADH and GH
ADH and Oxytocin
What are the clinical manifestations of a thyroid storm? Select all that apply
High temp (104-106)
Hypotension
Abdominal pain
Decreased mental alertness
High temp (104-106)
Abdominal pain
Decreased mental alertness
- Which of the following hormones is known to stimulate appetite and increase food intake?
A. Ghrelin
B. Leptin
C. Glucagon-like peptide 1 (GLP-1)
D. Peptide YY (PYY)
A. Ghrelin
- A 45-year-old patient presents with progressive enlargement of facial features, notably the jaw and brow, along with complaints of joint pain, fatigue, and a recent diagnosis of hypertension. Laboratory results reveal elevated insulin-like growth factor 1 (IGF-1) levels and a failure of growth hormone suppression following an oral glucose tolerance test. Which of the following is the most likely underlying cause of these findings?
A. Pituitary microadenoma affecting corticotroph cells
B. Hypothalamic dysfunction resulting in decreased dopamine levels
C. Somatotroph adenoma in the anterior pituitary gland
D. Gonadotroph adenoma leading to elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
C. Somatotroph adenoma in the anterior pituitary gland
Insufficient PTH production in hypoparathyroidism results in which electrolyte abnormality?
A: Hypophosphatemia
B: Hypermagnesemia
C: Hypocalcemia
D: Hypercalcemia
C: Hypocalcemia
Which of the following is not a typical manifestation of Addison’s Disease?
A: Postural hypotension
B: Hyperglycemia
C: Dehydration
D: Patchy vitiligo
B: Hyperglycemia
What cell is responsible for the secretion of glucagon?
A. Delta Cells
B. Alpha Cells
C. Pancreatic Polypeptide
D. Epsilon Cells
B. Alpha Cells
What is the criteria for diagnosis of Diabetes?
A. HAB1C >5.7%
B. Fasting Glucose <80
C. Random plasma glucose >100
D. HBA1C >6.5%
D. HBA1C >6.5%
Which cell in the Islet of Langerhans is responsible for producing insulin?
a. Alpha
b. Beta
c. Charlie
d. Delta
b. Beta
The thyroid gland DOES NOT produce which of the following hormones?
a. Thyroxine
b. Thyrotropin releasing hormone
c. Triiodothyronine
d. Thyrocalcitonin
b. Thyrotropin releasing hormone
