Endocrine Flashcards
what are the major glands of the endocrine system?
Hypothalamus
Pituitary
Thyroid
Parathyroid
Pancreas
Adrenals
Ovaries/Testes
Pineal Gland
What is a specific cell with specific receptors that will respond to specific hormones
target cells
Why does TSH bind to receptos on cells of the thyroid gland but not to the cells of ovaries
because ovarian cells do not have TSH receptors
What are the lipid soluble hormones
steroid hormones
thyroid hormones
nitric oxide
what are water soluble hormones
amino acids:
Short chain- Antidiuretic hormone
Long Chain - Insulin
how do hormones influence their target cells
by chemically binding to specific protein receptors
what is the master gland of the body because it regulates the activity of endocrine glands
pituitary gland
what is the stalk like structure that attaches the pituitary gland to the hypothalamus
infundibulum
what is the blood vessels of the infundibulum called
hypophyseal portal veins which connect capillaries in the hypothalamus to capillaries in the anterior pituitary and carries hormones secreted by the hypothalamus
what is a hormone that stimulates an endocrine gland to grow and secrete its hormones
tropic hormones
what hormone promotes synthesis and secretion of Insulinlike Growth Factors (IGF’s)
Human Growth Hormone (hGH)
What stimulates protein synthesis, helps maintain muscle and bone mass and promote healing of injury and tissue repair
Insulinlike growth factor
What stimulates the synthesis and secretion of thyroid hormones by the thyroid gland
Thyroid stimulating hormone
What initiates the development of ovarian follicles and stimulates follicular cells to excrete estrogen
Follicle- stimulating hormone (FSH)
What triggers ovulation in females and stimulates the testes to secrete testosterone
Luteinizing hormone (LH)
Where is ACTH secreted from
The anterior pituitary
What hormone causes construction of arterials thus causing an increase in blood pressure
Antidiruretic hormone (ADH)
Follicular cells produce which two thyroid hormones
Thyroxine (T4)
Triiodothyronine (T3)
Where is T3/T4 produced
Follicular cells of the thyroid
What stimulates protein synthesis, increases the use of glucose and fatty acid for ATP production, increase triglyceride breakdown and reduce cholesterol
Thyroid hormones
Which also play an important role in maintenance of normal body temperature
What hormone is produced by the parafollicular cells of the thyroid gland
Calcitonin (CT)
What is within the parathyroid glands that release parathyroid hormone
Secretory cells called CHIEF CELLS
What promotes the formation of calcitrol (active form of vitamin D) which acts in the gut to instead the rate of calcium, magnesium and phosphate absorption from food into the blood
Parathyroid hormone
Alpha cells in the pancreatic islets secrete what and is stimulated from where
Secretes glucagon
Stimulated by the sympathetic division of the autonomic nervous system
Beta cells in the pancreatic islets secrete what and is stimulated from where
secretes insulin
stimulated by the parasympathetic division of the ANS
what conditions initiate the renin-angiotensis-aldosterone pathway
dehydration
sodium deficiency
hemorrhage
in the adrenal cortex- zona fasciculata the most abundant glucocorticoid is cortisol, how does cortisol have anti-inflammatory effects
inhibit white blood cells that participate in inflammatory response
what are the female sex hormones
estrogen
progesterone
what is a protein hormone that inhibits the secretion of FSH
inhibin
what produces testosterone, the primary androgen/ male sex hormone
the testes
what is a small endocrine gland attached to the roof of the third ventricle of the brain at the midline
the pineal gland
what is the hormone secreted by the pineal gland
melatonin
With age, what happens to human growth hormone
decreses- causing muscle atrophy
with age, what happens to the thyroid hormones
decreases - causing decreased metabolic rate, increased body fat and hypothyroidism
with age, what happens to the parathyroid hormone
rises - rise in PTH and fall in calcitonin decreases bone mass
with age, what happens with insulin production
releases more slowly - blood glucose levels will increase faster
pronlonged exposure to high levels of cortisol causes what
wasting of muscles
supression of immune system
ulceration of GI tract
Failure of the pancreatic beta cells
what is whipples triad
< 70 mg/dl glucose
altered mental status
signs and symptoms resolve with glucose elevation
where does ACTH come from
corticotropin-releasing hormone
what are two types of spontaneous hypoglycemia
fasting and postprandial
what glucose level shows impairment of brain function
50 mg/dl
what are symptoms of sympathomimetic hypoglycemia
anxiety
nervousness
irritability
nausea
vomiting
palpations
tremors
what are clinical finding of neuroglycopenic hypoglycemia
altered consciousness
lethargy
confusion
combative
agitation
unresponsive
what is the treatment for hypoglycemia
eat or drink glucose
glucagon if unable to eat/drink
50% dextrose 50-100mg IV
what are three stages of stress response
fight or flight
slower stress response
exhaustion
what is the fasting glucose in someone who is prediabetic
100-125 mg/dl
what could cause abnormal glucose values that may seem as though someone might be prediabetic
patient forgot to fast
well controlled type I or II
cushing syndrome (excess cortisol)
medications such as corticosteroids, antibiotics, beta blockers, psychiatric meds, HCTZ
Hyper thyroidism
what is the first line treatment for prediabetes
weight loss/ exercise
if weight loss and exercise do not work for prediabetes what is the second line of treatment
metformin
what is the overnight fasting glucose value that must occur on more than one occasion for type one diabetes
126 mg/ml
how is type I diabetes characterized
autoimmune antibodies
children to 30 years old
deficiency of insulin production
what are the essentials of diagnosis for type I
3 P’s
polyuria
polydipsia
polyphagia
what are the clinical finding in type I
unexplained weight loss
fatigue
poor wound healing
blurred vision
higher prevalence of STI, UTI, YEAST infection
what is the treatment for type I
insulin is the only medication effective in lowering glucose levels in type I
what are some complications of type I diabetes
insulin overdose
neuropathy
nephropathy
heart disease
opthalmology
what are the essentials of diagnosis for type II diabetes
insulin resistant due to inadequate activity
over 40
obese
what are the glucose parameters for someone with type II. Random and overnight fasting
Overnight fasting- 126 or higher on more than one occasion
Random - 200+
what is the stage one treatment for type II
diet and exercise
what is the stage two treatment for type II
Metformin/Glucophage is first line medication
what is stage III treatment for type II
insulin requirement due to inability to control with oral medications
what is macrosomia
high birth weight
what is the glucose level of someone with DKA
> 250
what are the findings in someone in DKA
dehydration- possible stupor
rapid deep breathing with “FRUITY” breath
hypotension with tachycardia
mild hypothermia
what is the treatment for DKA
volume repletion is the initial management priority (3-4L of LR first 8 hours)
insulin
MEDEVAC
what are the complications of DKA
AMI
Bowel infarction
renal failure
rarely cerebral edema
what is the most common cause of endemic goiter
iodine deficiency
what are the clinical findings of a goiter
usually asymptomatic
or
tracheal compression
respiratory distress
dysphagia
what are the essentials of diagnosis for hypothyroidism
weak
cold intolerance
constipation
depression
menorrhagia
delayed DTR
what are some causes of hypothyroidism with a goiter
autoimmune
- hashimotos
- thyroiditis
subacute (de quervains thyroiditis)
IODINE DEFICIENCY
genetic
hep C
Drugs: lithium, amiodarone, methimazole
what early signs of hypothyroidism occur with the hair
thinning of hair
thin, brittle nails
primary hypothyroidism is due to what
thyroid gland disease
secondary hypothyroidism is due to what
lack of pituitary TSH
what are causes of hypothyroidism without goiter
thyroid surgery
deficient pituitary TSH
severe illness
drugs: lithium, amiodarone…..iodine
radiation therapy
what is the treatment for hypothyroidism
Levothyroxine (T4)
what are the symptoms of hyperthyroidism
sweating
weight loss
heat intolerance
menstrual irregularity
tachycardia
tremor
stare (exophthalmos)
what is the seen in graves disease
goiter often with a bruit
ophthalmopathy
thyroid stimulating immunoglobulins
whais the most common cause of hyperthyroidism
graves disease
what lab results will you see in hyperthyroidism
TSH will be low
T4 sometimes normal, T3 elevated
what is the treatment for graves disease
radioactive iodine is the treatment of choice in active duty personnel
Propranolol (Beta blocker) for symptomatic relief of tachycardia, tremors, and anxiety
what signs and symptoms will you see in a toxic multinodular goiter
can cause hyperthyroidism
sweating
weight loss
anxiety
loose stools
heat intolerance
tachycardia
tremor
what suggests a possible malignant thyroid nodule
hoarseness or vocal cord paralysis
nodules in men or young women
nodule that is firm, large and adherent to trachea or strap muscles
what is the imaging of choice for a nodule
ultrasound
what is the treatment of a thyroid nodule
refer to endo
ultrasound guided fine needle aspiration
what are signs of acute adrenal crisis
headaches
lassitude
nausea/vomitting
abdominal pain and diarrhea
confusion or coma
cyanosis
dehydration
sparse axillary hair
what are two causes of acute adrenal crisis
primary - destruction or dysfunction of the adrenal cortex
Secondary - resulting from ACTH hyposecretion
what is the hallmark for adrenal crisis
sudden withdrawl of steroid medication
what is the treatment for adrenal crisis
dexamethasone or hydrocortisone
what is a common cause of chronic adrenal insufficiency
addisons disease
what are the symptoms of chronic adrenal
weakness fatigue
weight loss
myalgia
anorexia
n/v
anxiety
mental irritability
what is the treatment for chronic adrenal
hydrocortisone is the drug of choice
what medications can increase blood glucose
prednisone
HCTZ
what is the treatment for gestational diabetes
diet and exercise
what is characterized by Anovulation, polycystic ovaries and hyperandrogenism
polycystic ovarian syndrome
what will you see on LH/FSH lab on someone with pcos
typically 2:1 to 3:1
normal is 1:1
what is the treatment for pcos
weight management and exercise
doesnt work? metformin
how will a male with hypogonadism present
fatigue
decreased strength
poor libido
hot flashes
ERECTILE DYSFUNCTION
gynecomastia
infertility
small testes
what does high fsh/lh indicate in males
primary testicular failure from:
atrophy from previous mumps (ask in history about mumps dx in past)
autoimmune destruction
previous chemo/rad exposure
what does low FSH/LH indicate in males
secondary hypogonadism from:
Hypogonadotropic hypogonadism
hyperprolactinemia
use of opiates or steroids
other hypothalamus or pituitary disorders
what is the treatment for hypogonadism
should only be initiated with MO guidance
-check additional labs
-Transdermal testosterone (preferred)
-IM testosterone (longer acting)
what causes gynecomastia
excess estrogen in males
what causes excess estrogen in males
aging
obesity
puberty
what drug could cause gynecomastia
Isoniazid (INH)
alcohol
anabolic steroid
opioids
marijuana
antipsychotics
true gynecomastia will be localized where
subareolar region only
what is the treatment for gynecomastia
puberty - self resolving
Adult- behavior mod
Adult- selective estrogen receptor modulator
testosterone therapy
what is metabolic syndrome
3 or more of the following:
abdominal obesity
high triglycerides
HDL <40 male 50 for female
fasting glucose 100 or higher
hypertension
what is the treatment for metabolic syndrome
weight management and physical activity
complications of metabolic syndrome
cardiovascular risk
treatment for gynocomastia if no red flags are present
do nothing
clinical findings for pcos
menstral disorder
infertility
obesity
acne
insulin resistant
dyslipidemia
if a pcos patient is desiring pregnancy what is the treatment
clomiphene
who manages pcos
obgyn
if testosterone is low what other labs will you order
obtain LH, FSH and Prolactin
primary hypogonadism is from
mumps
secondary hypogonadism is from
opiates or steroid s
what additional labs will be drawn with treatment of hypogonadism
hematocrit
prostate specific antigen (psa)
what are red flags for gynecomastia
asymmetry
nipple retraction
nipple bleeding, discharge
unusual firmness
what labs are ordered for gynecomastia
free testosterone
LH/FSH
Beta Hcg
Thyroid function panel
Liver function panel
pcos FHS/LH lab ratio
2:1 to 3:1
What is the leading cause of Addison disease
Tuberculosis
Symptoms of Addison disease
Weakness fatigue
Weight loss
Anorexia
N/V
Anxiety
Mental irritability
Hyperpigmentation of skin
