Endo #1 Flashcards
hGH- Human Growth Hormone secreted by ?
acidophil cells
hGH- Human Growth Hormone modulates ?
Modulates growth from birth until the end of puberty
hGH- Human Growth Hormone when is it secreted ?
Secreted in response to sleep, exercise, ingestion of protein, and response to hypoglycemia
hGH- Human Growth Hormone
own notes ?
fluctuates with sleeep, glucose levels in the blood stream or types of meals that we are eating
need to remember that Gh fluctuate in the serum
to much GH from childhood is giantism
GH assay: Increased ?
Gigantism - starts in childhood
Acromegaly - excess growth hormone starting in adult hood
- *Arcomegaly - large extremities and head circumference gets bigger
- *
GH assay: Decreased ?
Dwarfism - decrease at childhood ( achondroplasia)
Pituitary insufficiency -
GH Hormone Stimulation Test use ________ or ___________ hypoglycemia to stimulate GH secretion
Arginine
insulin-induced
GH Hormone Stimulation Test: decreased ?
Pituitary deficiency
GH deficiency
GH Hormone Stimulation Test own notes ?
lower the BG then more GH will be secreted
we used insulin or arginine ( to stimulate hyperglycemia) to stimulate GH secretion - if they can secret cause they are deficit
GH Suppression Test aka ?
Oral glucose tolerance test
Oral glucose tolerance test: GH will not be suppressed in patients with ?
acromegaly or gigantism
Oral glucose tolerance test own notes ?
give them a big oral glucose load, it should surpass GH secretion ( if you cant suppress it , like acromegaly and giantism )
given to prig patients to see if gestational diabetes
Insulin-like Growth Factor (Somatomedin C) reflects ?
More accurately reflects GH activity
Insulin-like Growth Factor (Somatomedin C) increased ?
Acromegaly
Gigantism
Insulin-like Growth Factor (Somatomedin C) decreased ?
Dwarfism
GH deficiency
Pituitary deficiency
Insulin-like Growth Factor (Somatomedin C) own notes ?
GH are all somatomedin
Insulin like Growth factors is one of them
when they are circulating, you can check for these instead of the GH cause it does not fluctuate like the GH does = get a better average of what the GH activity look like
ADH aka ?
Anti-diuretic hormone, Vasopressin
ADH own notes ?
it lines the tubules and sucks water back into the tissue tr into the bodty = helps retain water
concentrates the urine bay acting on the tubules to retain water
taking free water out
less aADH - more dilute urine - water is not being reabsorbed
bug part in osmotic homeostasis and helps maintain BP
ADH: Osmotic homeostasis ?
Concentrates the urine by acting on the collecting tubules to reabsorb the water
ADH: Volume homeostasis ?
↑ water reabsorption : maintains BP
vasoconstrictor
ADH is secreted in response to ?
Hypernatremia
Dehydration
Hypotension
Stress/ anxiety - retain water
anywhere where our body wants to retain water
ADH is surpassed by ?
Hyponatremia
CHF
Vasoconstrictors
when our body want to get rid of free water 9 less ADH lining tubules so we dont retain the water
Abnormal ADH: DI ?
ADH secretion is inadequate
Nephrogenic
Central (Neurogenic)
Abnormal ADH: SIADH ?
Carcinoma of thymus or lung (SCLC)
Severe stress
CNS tumor/ CVA ( stroke)
ADH testing: Serum ADH increased ?
SIADH
Nephrogenic DI
because if we have ADH that is trying to stimulate the K to retain water and the K can respond and it is still release water - High ADH levels but still going to have volume depletion ( K cannot concentrate urine)
CNS tumors/ infection
Ectopic ADH secretion (paraneoplastic syndrome)
Dehydration
ADH testing: Serum ADH decreased ?
Neurogenic DI
lack of ADH coming from central area
Ablation of pituitary
pituitary problems
Hypervolemia
ADH Suppression Test purpose ?
Differentiate between SIADH and other edematous conditions
ADH Suppression Test procedure ?
Administer water (20 mL/kg up to 1500 mL) in 10-20 minutes
Collect urine every hour for 6 hours and send for SG ( specific gravity) and urine osmolality measurements
ADH Suppression Test: results - SIADH ?
Water excretion: little
Urine osmolality: ↑
Urine SG: ↑
U/S ratio: ↑
ADH Suppression Test: results - other edematous states ?
Begin excreting up ~80% of water load = NL
ADH Suppression Test own notes ?
NL alot of water they will just pee it out
SIADH the more water we give them they still can get it out and they continue to be more and more volume overloaded ( no free water secretion into urine)
Water Deprivation Test: ADH Stimulation Test
purpose ?
Differentiate between causes of polyuria including neurogenic/ nephrogenic DI = peeing alot of free water
ADH Stimulation Test: procedure ?
Pt is deprived of fluids
Serum osmolality rises above 288 mOsm/kg to consider pt adequately dehydrated
Administer Vasopressin SQ
Obtain urine osmolality
ADH Stimulation Test
own notes ?
we dehydrate them even further
kidney problem or neurologic problem
Neurogenic Problem - and we give them vasopressin - then we will see a rise in urine osmolality - cause it is from a central place ( when give the V you should see a rise in UOsmolality if neurogenic )
Kidney Problem - and kidney is not responding and you give them the V - the kidneys still cannot concentrate the urine
Water Deprivation Test: results - Rise in Urine Osmolality of > 9% ?
Neurogenic DI
Water Deprivation Test: results - Little to No increase in Urine Osmolality ?
Nephrogenic DI
_________- - Ca balance and homeostasis ( calcitonin, calcitriol, regulateds)
parathyroid
Thyroid and Parathyroid
Calcium homeostasis is regulated by ?
Parathyroid hormone (PTH)
Calcitriol
Calcitonin
Calcium Balance own notes ?
decrease loss of Ca from the urine
pulls Ca from the bone
PTH - is supposed to increase Ca
we need healthy liver ( for VD) and precusrose to make calcitriol ( active VD) which we need to get Ca increase
PTH leaks Ca out of bone
calcitonin - deposits it back to the bone
they do the opposite
Calcium: NL physiology ?
PTH,
↓Phosphate,
↓1,25 (OH)2 Vit D ( cause it needs it for the Ca) ,
↑ Calcitonin ( decrease serum Ca)
Calcium Increased: in blood stream ?
Malignancy - bone mets, neruoendorcine acts
Hyperparathyroidism (Primary) - uncheck PTH release that increase serum Ca
Calcium decreased ?
Hypoparathryoidism
Liver disease (malabsorption of vitamin D)
Calcium Balance own notes ?
Ca is inverse P ( not Mg)
just know it is related between these tings
dont worry about the arrows
need VD to absorb the Ca
PTH NL physiology ?
↑ Ca,
↓ Phosphate
PTH increased ?
Hyperparathyroidism
PTH decreased ?
Malignancy ( because of negative feedback mechanism)
Hypoparathyroidism
Calcitonin NL physiology ?
↓ Ca
Calcitonin increased ?
Tumor marker for medullary carcinoma (thyroid CA) - highly likely
used all the time to monitor this CA
1,25- (OH)2 Vit D Calcitriol aka ?
Calcitriol
Calcitriol NL physiology ?
↓PTH
↑Ca
Calcitriol decreased ?
Renal failure
Liver failure
**rickets
osteomalacia **
Intact PTH range ?
(10-65)
Serum Calcium range ?
(9-10.5)
Intact PTH = 75.2
Serum Calcium = 11.2
condition ?
Hyperparathyroidism ( primary - coming from the gland itself - something wrong with the gland
Intact PTH = 23.8
Serum Calcium = 9.2
condition ?
NL
Intact PTH = 8
Serum Calcium = 11.6
condition ?
Malignancy ( PTH is low cause it is trying to lower Ca) think CA first before anything else
Intact PTH = 124
Serum Calcium = 9.1
condition ?
Secondary Hyperparathyroidism ( just barely bring Ca into NL range - maybe secondary to kidney disease )
Intact PTH = 6.4
Serum Calcium = 8.0
condition ?
Hypoparathyroidism
remember the Ca levels are very sensitive ?
a little change? then follow up and investigate it
Thyroid own notes ?
like gas petal in car
hyperthyroid - sweating , palpatations, anoxiat7 attacks, diarrhea
hypothyroid - cold all the time, sluggish , tired, gained wiehgt, constipation
TRH from Hypothalamus then goes to the Pituitary to release TSH and then it goes to the thyroid to release T3 and T4
Thyroid stimulating hormone (TSH) aka ?
Thyrotropin
Thyroid stimulating hormone (TSH) stimulates ?
Stimulates thyroid to secrete T3 and T4
Thyroid stimulating hormone (TSH) increased ?
Primary hypothyroidism
Thyroid stimulating hormone (TSH) decreased ?
Hyperthyroidism ( primary)
trying to put break on thyroid but it keeps release T3 and T4 but the TSH decline and the T keeps pumping it out ( TSH levels dont matter)
Secondary hypothyroidism
P is failing to put out TSH , decreased TSH levels , something wrong with the producer
T4/ Thyroxine: 90% total = ?
Bound + Unbound
**free T4 is more metabolically active **
T4/ Thyroxine free: increased ?
Hyperthyroidism
T4/ Thyroxine free: decreased ?
Hypothyroidism
T3/ Triiodothyronine
free: increased ?
Hyperthyroidism
T3 aka ?
Triiodothyronine
T4 aka ?
Thyroxine
Antithyroglobulin antibody (Anti-TG Ab) increased in ?
Hashimoto’s
Grave’s disease
Antithyroglobulin antibody (Anti-TG Ab) bates page ?
Mosby’s pg. 103, Table 2-7
Antithyroglobulin antibody (Anti-TG Ab) own notes ?
Thyroid disease is often from a autoimmune problem
H ( AI hypo) and GD ( AI hyper)
ABS toward the thyroid and you can test for the ABS
Thyroid globulin is normally in the thyroid and with damage it can be in the serum and it acts like a antigen and the body attacks
more likely to be found in H (70%) then GD ( 55%)
Antithyroglobulin antibody (Anti-TG Ab) is more sensitive to ?
more likely to be found in H (70%) then GD ( 55%)
Antithyroid peroxidase antibody (Anti-TPO Ab)
increased in ?
Hashimoto’s
Grave’s disease
Antithyroid peroxidase antibody (Anti-TPO Ab)
own notes ?
only found in the microsomes in the epithelial cells inside the T and NL not in the serum
if tissue destruction - some escape the microsomes and our body sees it as an FB antigen
90% H have this ABS
70% with GD have this ABS
GD - inflammation of the T and stimulates the T cells that relate the Hormones
Antithyroid peroxidase antibody (Anti-TPO Ab) is more sensitive to ?
90% H have this ABS
70% with GD have this ABS
Thyroid Stimulating Immunoglobulin (TSI)
supports what dx ?
Grave’s disease
- *This is more for GD dx the other two are more for H
- *
TSH NL range ?
0.3-5
Free T4 ?
0.8-2.8
TSH = 0.1
Free T4 = 3.6
Diagnosis ?
Hyperthyoridism ( GD)
TSH = 10.2
Free T4 = 0.6
Diagnosis ?
Hypothyroidism ( primary)
TSH = 3.2
Free T4 = 2.6
Diagnosis ?
NL
TSH = 0.03
Free T4 = 0.4
Diagnosis ?
secondary hypothyroidism( pituitary is failing)
TSH = 0.12
Free T4 = 6.5
Diagnosis ?
Hyperthyroidism ( could be GD but you need ABS)
