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Oral REI Boards > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What percentage of kids experience pubic hair growth as first sign of puberty?

A

20%

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2
Q

When do GnRH neurons migrate to hypothalamus

A

6-9 wga

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3
Q

When does FSH/LH secretion start in the fetus

A

12 weeks

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4
Q

When do fetal levels of FSH/LH peak

A

20-24 weeks

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5
Q

What happens to FSH/LH after delivery

A

GnRH pulsatility starts with FSH/LH rising with FSH > in females (peaks 12-18 months)

LH > males (peaks 3-6 months)

**Then there is change in central inhibition of pulsatile GnRH and high sensitivity to low levels of gonadal steroid feedback –> diphasic pattern of secretion

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6
Q

How does adrenarche start and when?

A

Age 6
Increased in responsiveness of adrenal glands to ACTH causing shift in sex steroid production
Decreased 3B HSD activity + increased activity in P450 Cyp 17
Shunts towards DHEA/DHEAS

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7
Q

Genes associated with early puberty

A

LIN28B, FTO, NEGR1

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8
Q

Shift in body composition associated with puberty

A

% body fat
16-23%

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9
Q

Leptin and puberty

A

Made by adipocytes and acts on CNS to regulate eating/energy balance
Leptin knockout mice have normal sexual development but are anovulatory

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10
Q

What is precocious puberty

A

Pubertal development occurring more than 2.5 SD earlier than the norm

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11
Q

Types of precocious puberty

A

GnRH Dependent: early activity of HPG axis
-constitutional (RUNS IN FAMILY) /idiopathic (does NOT RUN in family & onset is usually younger)
-CNS pathology
-Hypothyroidism

GnRH Independent:
-Sex steroid production independent of HPG axis
-Ovarian tumors
-McCune Albright
-Adrenal disease
-Exposure to estrogens

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12
Q

Hypothalamic hamartoma

A

Heterotopic neuronal masses of GnRH neurons that function as ectopic GnRH pulse generator
PP in first few years of life

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13
Q

Craniopharyngioma

A

Neuroepithelial CNS tumor
Disrupts normal pre-pubertal HP axis inhibition

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14
Q

Hypothyroidism and GnRH dependent PP

A

Delayed bone age (Thyroid hormones have permissive activity directly on bone and GH)
High TSH stimulates FSH-R and causes high prolactin and galactorrhea

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15
Q

Gonadoblastoma

A

complex tumor with a mix of gonadal elements
90% associated with abnormal karyotype, gonadal dysgenesis, or Y chromosome

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16
Q

Premature adrenarche

A

pubic hair < 8 yo
consider checking bone age to make sure there isn’t precocious puberty too (~20% have both)

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17
Q

Most significant outcome of precocious puberty

A

short stature because of premature epiphyseal closure

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18
Q

GnRH stimulation test

A

Check basal LH
leuprolide 20 ug/kg subcu
if LH > 5 IU/L suggests HPG axis activation
if LH is normal/low eg < 5 then likely to be GnRH independent

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19
Q

When to treat precocious puberty

A

-Sexual maturity advances to next stage in 3-6 months
-growth velocity > 6 cm/year
-bone age is advanced by > 1 year
-predicted adult height is < target range or decreased on serial measurements

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20
Q

Treatment for GnRH dependent precocious puberty

A

lupron
monitor symptoms and E2 (<10 pg/mL) at 3-6 month intervals

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21
Q

Delayed puberty

A

Absent or incomplete sexual maturation by age at which 95% of kids of same sex started pubertal development

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22
Q

Short stature

A

height 2 or more standard deviations below mean height for children of same sex/age
-Dx: familial/constitutional, chromosomal (downs/turners), idiopathic

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23
Q

Treatment of short stature

A

consider GH if height > 2.25 SD below mean

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24
Q

Treatment of tall stature

A

start treatment before menarche
ethinyl estradiol 15-30 ug (low dose OCP)
continue until epiphysis close

25
Q

Metformin

A

Biguanide antihyperglycemic approved for T2DM not adequately managed by diet and exercise.

Does not cause hypoglycemia
Decrease hepatic glucose production, thus reducing the need for insulin secretion

Decreases intestinal absorption of glucose.
Lowers free fatty acid concentrations, thus reducing gluconeogenesis

26
Q

Where is DHEA made?

A

Adrenal 50%
Ovary 20%
DHEAS conversion 30%

27
Q

Where is androstenedione made?

A

Adrenal 50%
Ovary 505

28
Q

Where is testosterone made?

A

Adrenal 25%
Ovary 25%
Androstenedione conversion 50%

29
Q

Insulin and PCOS

A

decreases SHBG
increases activity of LH on ovary
increase in IGF-1 potentiates response of ovary to LH

30
Q

Hair stages

A

Anagen- growth
Catagen- involution phase
Telegen- quiescent phase

31
Q

Clitoral index

A

> 35 mm (LxW)

32
Q

Signs of virilization

A

deepening of voice
hirsutism
clitoromegaly
breast atrophy
muscle mass distribution

33
Q

Spironolactone

A

aldosterone antagonist
50-100 mg BID
SE: dyspepsia, nausea, fatigue, HA
Feminization of male fetus

34
Q

Eflornithine

A

Ornithine decarboxylase inhibitor
inhibition of cell division and synthetic function
13.9% application
SE: acne, folliculitis, pain/rash

35
Q

Finasteride

A

5a reductase inhibitor
inhibits type II mostly
5mg QD

36
Q

flutamide

A

androgen receptor blocker
500 mg daily
SE: green urine, hepatotoxicity

37
Q

SRY gene

A

Gene encoding DNA-binding protein
Located next to pseudo-autosomal region on short arm of Y
Presence causes gonadal differentiation to testes
No SRY - ovaries

38
Q

Normal fasting insulin

A

25 mIU/L

39
Q

Normal triglyceride

A

< 150 mg/dL

40
Q

normal total cholesterol

A

200 mg/dL

41
Q

HAIR-AN

A

Hyperandrogenic insulin-resistant acanthosis nigricans

42
Q

Differential diagnosis for low E2 level in pregnancy?

A

placental sulfatase deficiency
placental aromatase deficiency
impending fetal demise
fetal demise
adrenal hypofunction
drugs

43
Q

Infant presentation with placental sulfatase deficiency

A

ichthyosis
hyperkeratosis develops because of alteration in cholesterol: cholesteryl ester ratio from accumulation of cholesterol sulfate
corneal opacities
pyloric stenosis
cryptorchidism

44
Q

Amniotic fluid with placental sulfatase deficiency

A

Amniotic fluid has high levels of DHEAS, normal DHEA, and androstenedione

45
Q

normal free T4

A

0.8-1.8 ng/dL

46
Q

Premature ovarian insufficiency

A

<40
Elevated FSH and amenorrhea
1% of women and 90% idiopathic
5-10% may experience spontaneous ovulation

47
Q

Ovulatory dysfunction for PCOS in adolescence

A
  1. Lack of menarche by 15 yo or 3 yr s/p thelarche
  2. Menarchal intervals < 21 or > 45 days (1-3 years post menarchal)
  3. Persistent menstrual intervals < 21 or > 35 days or < 8 cycles/year > 3 years post menarche to menopause
48
Q

What hormones do ovaries lack?

A

21 hydroxylase
11 beta hydroxylase
**Favors androgen production

49
Q

StAR

A

carrier protein aiding in cholesterol transport across the membrane

functions in adrenals and gonads but NOT the placenta

Congenital lipoid adrenal hyperplasia is caused by AR mutation in STAR causing males to have female external genitalia and adrenal glads to be filled with lipoid globules

50
Q

Sequence of FSH/LH on receptors

A

FSH/LH bind to GPCR which stimulates adenylate cyclase and leads to release of cAMP and cholesterol transfer via StAR and nuclear steroidogenesis

51
Q

What increases SHBG?

A

Hyperthyroidism
Pregnancy
Exogenous estrogen

52
Q

What decreases SHBG?

A

Insulin
IGF-1
Corticoids
Androgens
Progestins
GH
Prolactin

53
Q

What proportion of hormones are bound to carrier proteins?

A

SHBG: 69%
Albumin: 30%
Free: 1%

54
Q

how many carbons does cholesterol have

A

27

55
Q

Function of FSH at granulosa cells

A

induce more FSH R
induce transcription of aromatase leading to E2 production
As follicle grows FSH induces LH R appearance on granulosa cells –> progesterone production (LH mediated)

56
Q

Prolactin levels caused by meds?

A

25-100

57
Q

What med can increase prolactin to 300?

A

Risperidone

58
Q

What meds can cause hyperprolactinemia?

A

risperidone, olanzapine, haloperidol, bupropion, TCA, SSRI, reglan, cimetidine, prochlorperizine, verapamil, methyldopa, opiates, OCPs, transgender meds, medicinal herbs

59
Q

How do dopamine agonists suppress prolactin?

A

DA bind to D2 receptors on lactotrophs and decrease intracellular cAMP and lower prolactin secretion

Oral REI Boards (13 decks)

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