Endo Review 3

Question 1

Name 4 possible endocrine causes of hypertension.

Answer 1

Cushing's syndrome
Hyperthyroidism
Adrenal Insufficiency
Pheochromocytoma
Metabolic syndrome

Question 2

Pathophysiology of Cushing’s Syndrome? (3)

Answer 2

Loss of diurnal variation (late night salivary cortisol)
Autonomy from ACTH control (1mg Dexa test)
Excess cortisol (24 hour urine free-cortisol)

Question 3

What test do you run to test for primary hyperaldosteronism? How do you interpret the results?

Answer 3

Early morninng aldo:renin.
Ratio >20 suggestive (but not diagnostic) of hyperaldo.

If elevated, check 24-hour urine aldo.

Question 4

Where does amiloride act?

Answer 4

Inhibits the ENaC (inward sodium channel) in kidney. The channel normally causes sodium reabsorption.

Question 5

Where do spironolactone and eplerenone act?

Answer 5

They block the mineralocorticoid receptor.

Question 6

3 Tx’s for aldo, in order?

Answer 6

1. Correct udnerlying cause
2. Surgery (adrenalectomy)
3. Medications

Question 7

What are the Tx’s for Cushing’s?

Answer 7

? Treatment depends on source of Cushing’s:
?Cure likely in a unilateral adrenal adenoma with adrenalectomy
?Trans-sphenoidal hypophysectomy: 60-75% cure
?Other therapies such as ketoconazole, metyrapone, or bilateral adrenalectomy may be required


Question 8

3 uses of spironolactone? (peripherally mentioned in review)

Answer 8

1. Hyperaldo
2. Congestive heart failure
3. PCOS

Question 9

How do you test for blood levels of catecholamines?

Answer 9

Plasma free metanephrines (longer half life)

Question 10

Men 2B affects what organs?

What mutation?

Answer 10

Thyroid C cells
Adrenal Medulla
Neural tissue of oral and GI systems
Skeletal and lens eye abnormalities
Mutation in ret protooncogene

Question 11

Test of choice to assess for secondary adrenal insufficiency IF patient has been on long term steroids?

Answer 11

Cosyntropin stimulation test

Question 12

What, specifically, does metyrapone do the best job assesssing?

Answer 12

SHORT-TERM secondary adrenal insufficiency

Question 13

Why is oral hydrocortisone not commonly prescribed for inflammation?

Answer 13

1. It does not have potent anti-inflammatory activity

2. It causes the unwanted side effect of edema due to its mineralocorticoid activity

Question 14

Talk to me about the thyroid receptor

Answer 14

TR can act as a transcriptional activator or repressor [[depending on the target gene and presence or absence of thyroid hormone]]

Question 15

What catalyzes the organification of iodine?

Answer 15

TPO

Question 16

Sx of subclinical hypothyroidism? (3)

Answer 16

1. Elevated serum TSH level >5.0mU/L (usually

Question 17

Will you ever see bulging eyes in transient hyperthyroidism?

Answer 17

No, it’s unique to Grave’s

Question 18

Why may pregnancy cause a low normal TSH in the presence of a high T4?

Answer 18

Pregnancy increases hepatic production of TBG, and hCG has homology to TSH (so you get some T4 stimulation from hCG agonism).

Question 19

2 conditions which can increase TBG?

4 which can decrease it?

Answer 19

Increase: estrogen (PREGNANCY), hepatic release (hepatitis)
Decrease: androgens, decreased hepatic production (malnutrition, liver disease, illness), congenital (X-linked)

Question 20

What happens if you lose the function of TR-beta?

Answer 20

TR-b is present on the hypothalamus and pituitary for negative regulation, and on cells that carry out the peripheral actions of T3. But, TRa is present on heart muscle.

Thus pt will present with Tachycardia and Hyperactivity.

Question 21

What is Luprolide (Lupron)

Answer 21

A GnRH agonist (used to delay puberty).

Question 22

Most common cause of hyperparathyroidism?

Answer 22

Adenoma (85% of the time)

Question 23

What is one thing that can cause secondary hyperparathyroidism?

Answer 23

Vitamin D deficiency.

Question 24

Who should be considered for osteoporosis pharmacotherapy?

Answer 24

•Postmenopausal women and men age 50 and older presenting with the following:
• A hip or vertebral (clinical or morphometric) fracture
• T-score ≤ -2.5 at the femoral neck or spine after appropriate
evaluation to exclude secondary causes
• a 10-year probability of a hip fracture ≥ 3% or a 10-year probability of a major osteoporosis-related fracture ≥20% based on FRAX

Question 25

Teriparatide MoA? Side effect?

Answer 25

rPTH: It is an anabolic (bone-building) agent administered by daily subcutaneous injection.

Worry about Osteosarcoma.

Question 26

What is the first line therapy for a prolactinoma?

Answer 26

Dopamine agonist (very effective, MAY work sometimes even in very large tumors)

Question 27

3 notable physical manifestations of Cushing’s syndrome?

Answer 27

1. Osteoporosis
2. Cardiac hypertrophy (hypertension)
3. Muscle weakness

Question 28

Enzyme in the cortisol shunt?

Answer 28

11b-HSD2 shunts Cortisol–>Cortisone