endocrine Flashcards

Question

causes of ED?

Answer 1

1) primary hypogonadism – gonads/testis themselves are malfunctioning – low testosterone or elevated LH (bc attempting to stimulate the testes) 2) secondary hypogonadism – could be hypopituitarism (low testosterone or low LH), or hyperprolactinemia 3) meds: most anti-hypertensives, SSRIs (i.e. Prozac), GnRH agonists or antagonists 4) vascular disease: smoking, HTN, hyperlipidemia, diabetes, peripheral vascular disease (PVD) 5) neurological disease: diabetic neuropathy, spinal cord injury 6) psychological stressors

Answer 2

ocular/visual symptoms may occur with bluish discoloration (there is PDE-6 in the retina); rare reports of NAAION (but remember this may not be causal because the age ranges and risks overlap); systemic Sx include low BP (so do not take with certain meds to lower BP)

Answer 3

1) nitrates – causes dilated vessels, so if you add med you could cause a serious drop in the blood pressure 2) LV outflow obstruction (e.g. aortic stenosis) 3) alpha-blockers: orthostatic hypotension can be exacerbated

Answer 4

posterior pituitary hormone synthesized in the magnocellular neurons that regulates water balance

Answer 5

1) kidney (resorp free water/anti-getting-rid-of-fluid) – concentrates urine 2) blood vessels (vasoconstriction and increased BP)

Answer 6

1) increased serum osmolality – want to hold water (sensitive to 1% changes) 2) volume contraction/decrease – want to hold all the fluid you can

Answer 7

ADH level is inappropriately high for the serum osmolality - excessive absorption of free water - hyponatremia (low Na+) but euvolemic (volume normal) - symptoms are related to brain edema: headache, nausea, confusion, neuro defects, seizures, death if untreated

Answer 8

* pulmonary disease (i.e. tuberculosis or pneumonia) * bronchogenic carcinoma – certain lung cancers * central nervous system diseases * drugs: SSRI really only if elderly (Prozac), ecstasy

Answer 9

ACTH stimulates cortisol, aldosterone, androgens from adrenal gland

Answer 10

Stress, psychological, surgery, serious infection, trauma, physical, Hypoglycemia

Answer 11

ACTH peaks early morning, troughs in later afternoon/evening - cortisol peaks 6-8am (when you are waking up) and troughs at midnight (bedtime) - cycling of hormones helps with normal sleep-wake cycle -> this is why it is important to keep consistent wake up and sleep times

Answer 12

Zona glomerulosa→Aldosterone Zona fasciculata→ Cortisol Zona reticularis→Androgen (DHEA / S)

Answer 13

catecholamines (epi and norepi)

Answer 14

ACTH is counterregulatory hormone – too much cortisol can give diabetes

Answer 15

```  hyperglycemia/DM  irregular menses  immune suppression  depression, insomnia, various mood and sleep disorders  weight gain  osteoporosis  cataracts  secondary HTN *Proximal Muscle weakness ```

Answer 16

stimulated by renin-angiotensin | Also ACTH, hyperkalemia, hypovolemia

Answer 17

Cushing’s syndrome is a general term for excessive glucocorticoid Cushing’s disease = specific subset of Cushing’s syndrome where secondary cause of glucocorticoid excess is pituitary oversecretion of ACTH (i.e. in a pituitary tumor)

Answer 18

``` Adrenal tumor (primary) Exogenous glucocorticoid ```

Answer 19

1) Urinary free cortisol (24 hours)-Test for excess production of cortisol 2) Midnight cortisol (serum or saliva) -Test for lack of diurnal variation (nadir around midnight) 3) Overnight dexamethasone supression test Dexamethasone - synthetic glucocorticoid not detected by lab assay. Exogenous glucocorticoid should suppress AM ACTH and cortisol Abnormal: Cortisol elevated False positive: Medical illness, depression, alcoholism

Answer 20

Nelson’s syndrome – results after bilateral adrenalectomy - ACTH-secreting macroadenoma in pituitary – gives hyperpigmentation and compression of local structures (i.e. optic chiasm – think visual impact) * prevention: pituitary irradiation after bilateral adrenalectomy

Answer 21

Angiotensin 2

Answer 22

kidneys produce renin | angiotensin is produced in liver

Answer 23

Na ↑ K ↓ H ↓

Answer 24

renovascular hypertension (i.e. renal artery stenosis) -> renal artery is narrowed so the kidney senses volume depletion

Answer 25

Hypertension with hypokalemia (or refractive hypertension – very difficult to control even with multiple meds – much more suspicious of secondary cause if HTN is refractory)

Answer 26

Chronic: -weakness, fatigue, hypOtension (postural) - hyperpigmentation (PRIMARY only) -Hyponatremia, Hypoglycemia, Hyperkalemia (primary), -Metabolic acidosis Acute=collapse, emergency

Answer 27

Addison’s disease is an autoimmune that usually gives both mineralo- and glucocorticoid deficiency *primary adrenal insufficiency

Answer 28

elevated plasma ACTH will only be seen in primary causes

Answer 29

adrenal virilism: overproduction of weak androgens by the adrenal glands -women undergo a degree of masculinization: hirsuitism (increased hair), menstrual irregularity, acne, virilization (other male sex characteristics such as voice changes and increased muscle) -pre-pubertal boys: exaggerated hair growth, premature development of gonads but with small testes resulting accelerated linear growth but epiphyseal closure is premature -> grow earlier but also stop early – think of it as puberty sort of happening earlier

Answer 30

Elevated catecholamines in plasma or 24 hour urine

Answer 31

pheochromocytoma: adrenal tumors that secrete catecholamines - adrenergic hyperactivity (tachycardia, sweating, palpitations) - secondary hypertension - weight loss - may be episodic

Answer 32

α-block (phenoxybenzamine) first, then β-block (propranolol), then calcium channel block (nifedipine)

Answer 33

Multiple Endocrine Neoplasia Syndromes MEN I – not typically assoc. with pheochromocytoma = the “P’s” -Hyperparathyroidism – hypercalcemia, osteoporosis, kidney stones -Pituitary tumors – usually prolactinomas -Pancreatc islet cell tumors – insulinomas usually (hypoglycemia results) or gastrinomas (give gastic ulcers) MEN II - hyperparathyroidism; - medullary carcinoma of thyroid of parafollicular C cells - when this tumor is seen, always think MEN II - pheochromocytomas * **in MEN type II variant get thickened corneal nerves

Answer 34

``` o Café au lait macules 6+ (big freckles) o Neurobibromas ****Bilateral Optic nerve glioma- pathognomonic o Lisch nodules o Freckles in axillary or inguinal areas o Sphenoid bone dysplasia o Family Hx o Congenital glaucoma o Epilepsy o Renal artery stenosis ```

Answer 35

``` CN VIII tumors (bilateral schwannomas) Meningiomas (multiple, may involve optic nerve sheeth) **Juvenile posterior subcapsular lens opacity Family history of NF2 or CN VIII tumor Other **Gliomas (optic disk) **Epiretinal membranes Café au Lait spots Peripheral neurofibromas ```

Answer 36

gland mostly produced T4, but T3 is more biologically active

Answer 37

TBG •Low TBG: liver disease, nephrotic kidney disease, nutritional deficiency •High TBG: pregnancy, estrogen therapy

Answer 38

Free T4 measures active thyroid hormone directly Free T4 corrects for changes in TBG T4 highly protein-bound (Thyroid Binding Globulin TBG) Total T4 influenced by TBG

Answer 39

Primary hypothyroidism Free T4 ↓; TSH ↑ Secondary hypothyroidism Free T4 ↓; TSH ↓

Answer 40

Primary hyperthyroidism Free T4 ↑; TSH ↓ Secondary hyperthyroidism Free T4 ↑; TSH ↑

Answer 41

``` Loss of lateral 1/3 of eyebrows Periorbital edema Ptosis Cataracts Graves-type ophthalmopathy (autoimmune) Keratoconjunctivitis sicca (dry eye syndrome) ```

Answer 42

causes osteoporosis, infertility

Answer 43

Thyroid storm / thyrotoxic crisis: acute onset of severe hyperthyroid Sx -life-threatening (often these pts present to the ER) -precipitated by infection, trauma, or surgery -findings: high fever, sweating, tachycardia, restlessness, delirium, psychosis, tremor, coma (if not Dx and treated properly) (basically – extremes of a lot of hyperthyroid symptoms)

Answer 44

usually elderly patients with few obvious hyperthyroid symptoms, that present (commonly) for cardio care, esp. new a-fib •depressed mental function, cardio comps: a-fib, other tachyarrythmias, heart failure

Answer 45

Graves/hyperthyroid | -Hashimoto's

Answer 46

true *Clinically significant in 20-40% of Grave’s patients Present in up to 50%

Answer 47

decrease swelling (inflammation, edema) Glucocorticoids Diuretics Elevate head of bed

Answer 48

if Graves’ – avid iodine uptake

Answer 49

often follows a viral illness: pain in neck that might radiate to the ears and is worse with swallowing (often the patient swears they have an ear infection but the ears appear fine) -tender thyroid -basically happens because inflammation causes the preformed thyroid hormones to be released 2 phases: 1) Transient hyperthyroidism with ↑ T4 (very early - normal TSH) 2) Followed by hypothyroid phase (TSH will increase)

Answer 50

- may be sporadic or post-partum - transient hyperthyroidism (lymphocytic infiltration causes release of preformed thyroid hormone) followed by a hypothyroid phase (TSH lags…) - recovery normal function in 1-3 months, typically (this is different than Hashimoto’s hypothyroid which has no recovery)

Answer 51

medial rectus

Answer 52

``` Skeletal structure Muscle contraction Neurological function Coagulation Intracellular signaling ```

Answer 53

osteoclasts resorb bone matrix to let Ca2+ free | osteoblasts lay down bone matrix and incorporate Ca2+

Answer 54

1) stimulates renal tubular calcium resorption 2) increase calcium resorption from the bones 3) increase renal hydroxylation of vitamin D - activated vit D (activated by the kidney) allows/increases calcium absorption in gut

Answer 55

Increase calcium absorption (small bowel) Increase calcium resorption (bone) Decrease PTH synthesis

Answer 56

liver and kidneys

Answer 57

osteoclasts

Answer 58

symptoms: “stones, bones, moans, groans” • renal stones and nephrocalcinosis – calcium deposits in kidneys • increased risk of fracture o osteitis fibrosa cystica (OFC) – high bone turn over o increased PTH in osteoporosis • depression, lethargy, if severe seizures -> neuropsych Sx • abdominal pain, constipation, pancreatitis, gallstones • also band keratopathy -> subepithelial corneal calcium phosphate deposits – usually asymptomatic and do not require Tx

Answer 59

``` Heparin Thyroxine (excess) Glucocorticoid Anticonvulsants Cyclosporine (blood thinners, seizures, steroids) ```

Answer 60

USPSTF recommends women 65+ are screened routinely | -start screening at age 60 for women who are at increased fracture risk

Answer 61

T score: Comparison w/ peak adult bone mass | Z score: Age comparison