Endo - Stuff Missed Flashcards
1
Q
Side effect of thialidozines
A
Fluid retention, weight gain and edema
2
Q
Side effect of metformin therapy
A
Lactic acidosis -
** don’t use in patients with abnormal renal function, liver function, CHF, alcoholism, and sepsis
3
Q
Thialidozines
A
bind to PPAR-gamma to improve insulin resistance
- may take days to weeks to work
4
Q
Congenital hypothyroidism
A
presents soon after birth with hypotonia, poor feeding, jaundice, macroglossia, constipation and umbilical hernia
- diagnosis early to prevent mental retardation
5
Q
Pulsatile administration of GnRH analogs has what effect?
A
It has an AGONIST effect and stimulates LH and FSH release
6
Q
Continuous adminsitration of GnRH analogs have what effect?
A
It has an ANTAGONIST effect and suppresses LH and FSH release
7
Q
Anovulation
A
- common cause of infertility
- can be treated by administering menotropin (human menopausal gonadotropin analog) that acts like FSH and leads to formation of dominant follicle
- Ovulation is induced by large dose of hCG which stimulates LH surge
8
Q
FSH
A
- stimulates dominant follicle to form in one of ocaries
- stimulates estrogen production from ovaries
- as follicle expands, there is a rise in estrogen
- In follicular phase, estrogen has positive feedback on LH leading to LH surge which eventually causes rupture of follicle
9
Q
Anastrozole
A
selective aromatase inhibitor
- thus less conversion of androgens into estrogens
- suppress estrogen to postmenopausal levels
- in treatment of metastatic breast cancer, aromatase inhibitors are equivalent or superior to tamoxifen
10
Q
Ketoconazole
A
- selective aromatase inhibitor
- antifungal agent that decreases androgen synthesis
11
Q
2 y.o. girl has ambiguous genetailia. Has clitoral enlargement and partial fusion of labioscrotal folds - has high BO - hypokalemic - is 46, XX Likely diagnosis?
A
11-B hydroxylase deficiency
- less cortisol production
- less aldosterone production (hypertension and hypokalemia)
- more testosterone production (virilization of female)
-
12
Q
11-B hydroxylase deficiency
A
- results in excessive adrenal androgen and mineralcorticoids (but NO ALDOSTERONE)
- females are born with ambiguous genitalia
- develop hypertension because of weak mineralcorticoid excess (not as good as aldosterone but good enough)
- hypokalemia
13
Q
17-alpha hydroxylase deficiency
A
- results in:
- less cortisol
- less teststerone
- Females are born with normal genitalia
- Males are born UNDERVIRILIZED (less testosterone)
- affected don’t undergo puberty (no sex hormones)
- develop HYPERtension and hypokalemia (mineralcorticoid excess)
14
Q
21 hydroxylase defiency
A
- most common cause of adrenal hyperplasia
- less cortisol
- less mineralcorticoids
- more testosterone
- Females have ambiguous genitalia (due to testosterone excess)
- HYPOtension and HYPERkalemia
15
Q
Finasteride
A
5-alpha reductase inhibitor
- suppresses peripheral conversion of testosterone to DHT
- used in BPH and androgenetic alopecia
16
Q
Nephrogenic DI
A
caused by lack of response to ADH
- can be treated by hydrochlorothiazide
17
Q
Primary polydipsia
A
- excessive pathological water drinking
- psych disorder no underlying medical etiology
- water deprivation test will show increase in urine osmolality
- low serum sodium levels
- restriction of water normalizes urine osmolality
18
Q
Neurogenic DI
A
- due to decreased production of ADH in posterior pituitary
- decreased urine osmolality with dehydration
- increased urine osmolality with ADH
19
Q
Nephrogenic DI
A
- due to decreased responsiveness of collecting tubules to ADH
- decreased urine osmolality with dehydration
- decreased urine osmolality with ADH
20
Q
Thiazolidinediones (TZDs)`
A
- bind to peroxisome proliferator activated receptor-gamma (PPAR-gamma) - a transcript regulator involved in glucose and lipid metabolism
- takes days to work
- lowers glucose by decreasing insulin resistance
- increaeses expression of adiponectin gene
21
Q
Leptin
A
- secreted by fat cells
- responsible for appetitie suppression and decreased insulin resistance
22
Q
How do prolactinomas leads to osteoporosis?
A
- High levels of prolactin decrease GnRH
- Less GnRH leads to less estrogen
- Less estrogen means loss in bone density as estrogen is protective against osteoporosis
23
Q
MEN1
A
3Ps
- Parathyroidism
- Peptic ulcer
- Pituitary adenoma
24
Q
Men2A
A
2s
- Pheochromocytomas
- Pituitary adenoma
- Medullary thyroid carcinomas
25
Men 2B
- Medullary thyroid Carcinoma
- Pheochromocytoma
- Oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
26
Medullary Thyroid Carcinoma
- usally from parafollicular C cells
- produce calcitonin, sheets of cells in amyloid strom
- associated with MEN2A and MEN 2B
27
Carcinoid syndrome
caused by neuroendocrine cells esp. metastatic bowel caner tumors
- secrete high levels of 5-HT
- not seen if tumor is limited to GI tract because liver processes
- presents with recurrent flushing, asthmatic wheezing, and right side valvular disease
28
Carcinoid syndrome Findings and Treatment
- Recurrent flushing, asthmastic wheezing, right-sided valvular disease
- 5-HIAA inurine
- Niacin deficiency
Tx: Somatostain analog (e.g. octreotide)
29
Conditions associated with excess growth hormone. In children? in adults?
In children: Gigantism - excess growth hormone before closure of epiphyses
In adults: Acromegaly - excess growth hormone after closure of epiphyses
30
Growth hormone
- increases linear growth by stimulating production of IGF-1 from liver
- defective growth hormone receptors leads to decrease in linear growth
31
Laron dwarfism
- due to decrease in linear growth
| - characterized by high serum growth hormone levels with low IGF-1
32
Acute effects of corticosteroids
- Increased neutrophil count
- Decreased lymphocyte, monocyte, basophil, and eosinophil counts
- Increase in neutrophil due to demargination of neutrophils previously attached to vessel walls
33
Which hormone needs to be monitored in amiodarone therapy?
TSH
- Amiodarone (40% iodine) can lead to hypothyroidism
- Amiodarone induced hypothyroidism is treated with levothyroxine
34
Amiodarone
```
class III anti-arrhythmic used to suppress cardiac conduction
-
```
35
Amiodarone side effects
- Thyroid dysfunction
- Corneal microdepsots
- Blue-gray skin discoloration
- Drug related hepatitis
- Pulmonary fibrosis (rare but life threatening)
36
Glucocorticoiids
- predominatwly carabolic, causing muscle weakness, skin thinning, impaired wound healing, osteoporosis, and immunosuppression
- increase liver protein synthesis, specifically ones involved in gluconeogenesis and glyconegenesis
37
Hydrochlorothiazide
- acts on distal tubules (blocks Na/Cl)
- causes HYPERgluc -
- Hyperglycemia
- Hyperlipidemia
- Hyperuricemia
- Hypercalcemia
38
Risperodine and amenorrhea
- Risperidone (atypical anti-psychotic) is associated with hyperprolactinemia
- Riperiodone suppresses dopamine. Dopamine suppresses prolactin
- More prolactin means less GnRH which means less FSH and less LH thus no menstruation
39
Mechanism of B-blockers in thyrotoxicosis
- Decrease in effect of sympathetic adrenegic impulses reaching target orens
- Decrease in peripheral conversion of T4 to T3
40
teen girl presents as thin with downy hair
- presents with inadequate diet and regular excercises
- asks about weight loss advice
Likely diagnosis?
Anorexia nervosa - often presents as decreased LH, FSH, estriadiol, and estrone
- hypogonadotropic amenorrhea
- often presents with downy
41
Long term use of glucocorticoids leads to what effect on adrenal glands
Long term glucocorticoids suppress HPA axis (by decreasing ACTH release)
- Leads to bilateral adrenocortical atrohy
42
What occurs if patient suddenly stops taking doses of corticosteroids?
Adrenal crisis
43
Glucagon
- increases serum glucose by increased production of glucose from liver
- stimulates insulin secretion from pancreas
- has little effect on skeletal muscle
44
Addison's disease
Chronic primary adrenal insufficiency due to adrenal atrophy OR
destruction by disease (e.g. autoimmune, TB, metasstasis)
- aldosterone deficiency and cortisol
- HYPOtension
- HYPERkalemia
- skin HYPOpigmentation
45
Epinepherine (and glucose)
epinepherine increases glucose by various mechanisms
- increased glycogenolysis and gluconeogenesis
- decreases glucose uptake in skeletal muscle
- increases alanine release from skeletal muscle for gluconeogenesis in liver
- increases TG breakdown in fat tissue
46
Propylthiouracil
thionamide medication used for treatment of hyperthyroidism
| - decreases formation of thyroid hormone by inhibiting thyroid peroxidase
47
Potassium iodide
- may prevent thyroid absorption of radioactive iodine isotopes by competitive inhibition
