Endocrine Flashcards
Pituitary
Releases follicle SH
Stimulates ovaries/testes
Hypothalamus
Releases Gonadotropin RH
Stimulate pituitary
Best predictor of menstruation onset
Weight
Peripheral early puberty
Decrease in GnRH
Results in shorter adult height
Treat with hormones that reduce estrogen/androgen (GnRH analog/antagonist)
Childhood obesity appetite suppressant
Phentermine
Orlistat: saturated lipstatin, inhibit lipases. Give multivitamin b/c less absorption of fat soluble vit.
Sibutramine inhibit 5HT,NE, reuptake
Mazindol inhibit NE
Satiety
Ghrelin increases hunger (inhibit)
Leptin decreases hunger
hypothalamus
Serotonergic
Anorexia nervosa
High cortisol, low 5HT, NE
Fluoxetine
Olanzapine atypical antipsych
Risperidone
Calcium vitD for bone health
Bulimia
Dehydration
Electrolyte imbalance
Fluoxetine
TCA
BZD
Ondansetron for N/V
Bone remodeling
Clast : chip
Blast : build
10 years to remodel entire skeleton
Constantly remodel BMUnits
Rank ligand
matures osteoclasts
Stimulated by PTH to increase calcium
OPG suppresses maturation
Calcium
Ionized=active
Most abundant mineral in human body
For neurotransmission
Muscle contraction
Bone formation
Regulated by parathyroid gland and VitD
Kidney, intestine, bone major organs involved in calcium-mineral processes
Affected by albumin, pH
Hypercalcemia >10.5
Primary hyperPTH
Confusion, dehydration, kidney stones
Fluids and loop diuretics
(Furosemide, bumetanide)
N-Biphosphonate: ARBZ
Have PCP backbone, inhibit FPPS and osteoclastgenesis
Non-N containing ECT- compete with ATP in osteoclasts, decrease resorption
Can give corticosteroids
May be due to lithium toxicity
6) Calcitonin
Produced in thyroid
Opposes parathyroid and reduces blood calcium
Negative feedback from high Ca levels
3rd line: only decreases vertebral fractures
Hypocalcemia <9
Hypoparathyroidism, vit D deficiency
CaCO3 give with meals
CaCitrate with or within meals
Cardio and muscle weakness, brittle hair, hand spasm
Active Vit D3
125 cholecalciferol or calcitriol
2 hydroxylase (renal) steps to add OH
Promotes Ca absorption
And reabsorption in kidney
Osteoporosis
Reassess BMD every 2 years
Height every year
DXA scan to monitor drug therapy
Non-pharm tai chi, exercise
Teriparatide (PTH)
Intermittent daily for treatment
For women with high risk of fracture
Antiresorptive agents
Biphophonates
Calcitonin
Estrogen replacement
Parathyroid hormone
Regulate ECF calcium
Increase bone resorption
GI Ca absorption (due to increased calcitriol production)
Kidney reabsorption (increase Ca transport proteins)
Increase RANKL osteoclastgenesis
Intermittent injections build bone
5) Denosumab
Refractory to biphosphonates
Inhibit RANKL to suppress osteoclastgenesis
Decrease risk of non vertebral and hip fractures
May cause hypocalcemia
Avoid if renal impairment
Compact bone
For strength
Trabecular/cancellous
Metabolically active
Osteoid
Collagen
Mineral
Calcium, phosphorus
Hydroxyapatite
Corrected calcium
Measured Ca + 0.8(4-albumin)
Osteomalacia
Defective bone mineralization
VitD deficiency
Softening of bones
Rickets in children, reduced renal hydroxylase activity, bowing
Elevated PTH in response and elevated alkaline phosphatase (high bone turnover)
Phenytoin, phenobarbital
Osteoporosis
Diagnose with DEXA X-ray for
women >65, men >70
BMD t score <-2.5
FRAX 10 year risk score
Fragility of bone decreased amount of bone, but normal cellular composition
Increased osteoclast activity
Menopause, aging, white, dementia, smoking alcohol
Decline of estrogen
Hip fracture is most serious
Corticosteroids, aluminum, lithium
Primary hyperparathyroidism labs
Causes hypercalcemia
High serum Ca
Low serum phosphate (excretion inc)
High PTH
HypoPTH: opposite and low Mg
Solidarity adenoma
Single PTH gland enlarged
Benign
PTH hyperplasia
All four glands enlarged
Cancer PTHrP
Pagets disease
Resorption with abnormal repair
Elevated alkaline phosphatase
Renalosteodystrophy
Bone mineral abnormality with renal failure
Lack of kidney hydroxylase causing decreased production of 125 Vit D (calcitriol)
Secondary hyper PTH
Response to hypocalcemia to normalize Ca
Tertiary hyperPTH
Hypertrophy parathyroid due to secondary PTH
and uncontrolled PTH secretion causing hypercalcemia
Calcium VitD supplementation
800 vit D, 1200 calcium in men and women >70
Women >50 need 1200 calcium
Space calcium from iron zinc, levothyroxine by at least 2 hours
Caution, increased risk of MI
1) Alendronate
ARBZ
Take in morning with water, without food
Decreases hip,spine, and vertebral fractures
Max 5 year treatment
2) Risedronate
Decreases vertebral and non-vertebral fractures
3) Ibandronate (boniva)
All of these biphosphonates can help those expected to take corticosteroids >1 year
Only decreases vertebral fractures
4) zoledronic acid
Prevent new fractures in patients with recent low trauma hip fracture
Decreases vertebral, non vertebral, and hip fractures
Osteonecrosis of the jaw
Due to biphosphonates
Treat with chlorhexidine mouth rinse
1-3 weeks of antibiotics
Prevent with dental hygiene
DC biphosphonates after 5 years
Estrogens with/without progestin
Approved for prevention of osteoporosis
Phenobarbital
Enzyme inducer
Decrease vit D levels
Delayed puberty
Give low dose estrogen/testosterone
Lithium
Increases set point of calcium levels
Osteoporosis risk factors
Low weight, female, Asian, white
Smoking, pregnant, menopause
Corticosteroids, aluminum
PPI decrease calcium absorption
No exercise
Duavee
CEE estrogen + bazedoxifine
Estrogen agonist in tissue
Antagonist in uterus
Decreases risk of endometrial hyperplasia
