Endocrine 1 Flashcards
Exam 3
What are the 3 secreting pituitary tumors?
growth hormone, ACTH, prolactin
What are diseases/indications for GH?
Turner syndrome, normal GH but delayed growth, intrauterine growth retardation, muscle augmentation in the elderly.
Adverse effects of GH
myalgia, arthralgia, glucose intolerance, hypothyroidism
GH excess if before epiphyseal plate closure
gigantism
GH excess after epiphyseal plate close
acromegaly
What are issues in acromegaly in adults?
glucose intolerance, cardiac enlargement, htn, renal failure, soft tissue swelling
What are two options for treating GH excess disorders?
GH inhibiting hormone, GH receptor antagonist
Indications for somatostatin agonists include
utility in acromegaly & carcinoid syndrome; growth limitations
What is the main indication for GH receptor blockade?
non-responsive acromegaly
Function of prolactin hormone
lactation, stress, sexual, fluid balance, immunologic
typical hyperprolactinema cases in adult females:
amenorrhea, galactorrhea
typical hyperprolactinema cases in adult males:
reduced libido, muscle mass decrease, reduced facial hair growth, ED, gynecomastia
Most common cause of hyperprolactinemia is drug induced?
anti-psychotic agents
In a psychotic patient, what drug is contraindicated?
dopamine agonists
What is the best choice for hyperprolactemia?
cabergoline
What are the adverse effects of dopamine agonists?
nausea, orthostatic hypotension. slight increased risk of HTN/CVA
What amino acid is iodinated into T3 and T4?
tyrosine
What thyroid hormone stimulates and enhances cell function in everything?
T3
An excess of T3/T4 produces symptoms and signs of ____ _____ excess
sympathetic agonist
In older patients, it is important to not advance levothyroxine dosage because of what?
it increases metabolism and oxygen requirements
For pt >65 y/o, hypothyroidism tx is ___
“low and slow”
What is the lag time for thyroid-pituitary axis?
6-8 wks
What are the adverse effects of thyroxine?
symptoms of hyperthyroidism
Hyperthyroidism tx (3)
- control symptoms via beta adrenergic blocker
- prevent thyroid storm
- definitive tx
Best choice beta blocker for hyperthyroidism
propanolol
This is an anti-thyroid agent that blocks the synthesis of T3/4 and needs 3-4 wks to deplete T3/4
Thioamides
This anti-thyroid med is the best choice for pregnant women
propylthiouracil
This anti-thyroid med prevents the reuptake of iodide.
Potassium perchlorate- anion inhibitor
What can anion inhibitors cause?
aplastic anemia
This anti-thyroid med suppresses the T3/4 release and has a quick onset
iodides
When do you avoid iodides?
radioactive iodine use is likely
What blocks T4 to T3 conversion?
iodinated contrast media
This med destroys thyroid in a few weeks and is safe for > 30 but is contraindicated in pregnancy
Radioactive Iodine I131
What are the symptoms of the thyroid storm?
high fever, tachy, d/v/d, coma
What is the thyroid storm tx?
- hospitalize 2. propanolol 3. diltiazem 4. potassium iodide 5. PTU 6. hydrocortisone
What are the big androgen adversities?
increased hematocrit - vascular thrombosis
increased libido- increased aggressiveness
What are the indications of aromatase inhibitors?
breast cancer tx, breast cancer prevention, ovulation induction
This anti-fungal blocks steroidogenesis and has a drug interaction with CYP 450 inhibitors
ketoconazole
How does finasterid (propecia) work?
blocks T to DHT
Indications for antiandrogen utilization
women: hirsutism, masculinization, PCO
men: balding, bph, prostate cancer
How is T converted to DHT?
5-alpha reductase
In BPH and male pattern baldness, medical tx are :
5-alpha reductase inhibitors
Most commonly rx 5-alpha reductase inhibitors
finasteride, dutasteride
Androgen caution in pregnancy
masculinization of a female fetus
special caution in pregnancy regarding anti-androgens
incomplete masculinization of a male fetus
Taking androgens and/or anti-androgens can produce what adverse effect in pregnancy?
ambigouous genitalia
