Endocrine

Question 1

What permissive effects does cortisol have?

Answer 1

Increased vascular and bronchial smooth muscle reactions to catecholamines

Question 2

What does additive, synergistic, and permissive mean?

Answer 2

Additive: 2+2 =4, Synergistic: 2+2>4, and permissive: one is useless but expands th range of other

Question 3

What are some effects of glucocorticoids on muscle?

Answer 3

Increase lipolysis and protelysis, hence muscle wasting and increased BUN. Catabolic - muscle weakness.

Question 4

Glucocorticoid effects on skin?

Answer 4

Inhibit fibroblast proliferation and collage formation - skin thinning

Question 5

Glucocorticoid effects regarding glucose?

Answer 5

Increase gluconeogenic enzymes and glycogenesis. Increased liver protein synthesis, gluconeogenesis and glycogenesis and without insulin you see rise in glucose

Question 6

Amenorrhea with intense fear of eating has what MSK issues and why?

Answer 6

Anorexia causes loss of pulsatile GnRH which leads to decreased LH/FSH and later decreased estrogen. Low estrogen leads to osteoporosis.

Question 7

What lifestyle change is the single best preventative measure?

Answer 7

Smoking cessation - MI risks drop immediately, all else takes a bit to fall.

Question 8

What is the difference between hirsutism and virilization?

Answer 8

Virilization is hirsutism (terminal hair growth) with acne, clitoromegaly, increased muscle mass and libido, and voice deepening.

Question 9

What causes hirsutism and how do you treat?

Answer 9

Cushing, polycystic ovarian disease, ovarian/adrenal tumors. Also isolated and idiopathic

Question 10

How would you treat hirsutism?

Answer 10

Spirolactone (anti-androgenic), flutamide (testosterone receptor antagonist), or finasteride (5-alpha reductase inhibitor)

Question 11

What drug is clomiplene?

Answer 11

Anti-estrogen that increased GnRH and LH/FSH. For infertility

Question 12

What is milotane used for

Answer 12

adrenocortical carcinoma

Question 13

Medroxyprogesterone is what?

Answer 13

Depo Provera. Progesterone only OCP. Give IM 1x/12 wks.

Question 14

If a man has a testicular mass and is having heat intolerance, diarrhea, and increased reflexes, why?

Answer 14

Testicular mass (or ovarian masses) like teratomas can produce hCG that is structurally similar to TSH.

Question 15

A man has visual defects with sudden CV collapse and HAs and CN paralysis. How would you treat?

Answer 15

Guy has pituitary apoplxy - acute bleeding into a pre-existing pituitary adenoma. Medical emergency, can look like Sub Hemorrage but characteristic visual change. ACTH deficiency -> CV collapse. Treat with neurosurg and prompt corticosteroids.

Question 16

What is the pathology responsible for complete central DI

Answer 16

Neurophysin mutation from hypothalamus. Causes hereditary hypothalamic DI.

Question 17

Distribution of pancreatic cell types?

Answer 17

B cells in center, alpha cells in periphery. Somatostatin interspersed.

Question 18

Regulation of insulin?

Answer 18

Hyperglycemia and GH increased. Cortisol decrease. B agonists increased while alpha 2 agonists inhibit.

Question 19

How is C-peptide released and what can it be used for?

Answer 19

Equimolar concentrations along with insulin. Not extracted on 1st pass in liver, can measure endogenous insulin levels.

Question 20

How does insulin relate to ketoacid formation and lipolysis

Answer 20

Inhibits ketoacid formation and lipolysis

Question 21

How do you treat hypoglycemia, medical setting and not?

Answer 21

IM glucagon in non-medical, dextrose in not.

Question 22

Relation of epinephrine and glucose?

Answer 22

Increases by increasing glycogenolysis and glucogenesis.

Question 23

Symptoms and progression of hypoglyemia

Answer 23

Originally monitored by epi and glucago, less so by cortisol and GH. Increases lipolysis and gluconeogesis. Decreases peripheral glucose consumption. Adrenergic effects -> sweating, tremors, palpitations,nervous. Then later CNS symptoms -> behavioral and CNS changes.

Question 24

What are you scared of with beta-blockers and diabetes?

Answer 24

Can mask effect as non-selective beta blockers can block hepatic gluconeogenesis and peripheral glycogenolysis and lipolysis. Inhibit epi and norepi. Give B1 antagonist instead.

Question 25

What are the extended symptoms of prolactinoma?

Answer 25

Prolonged hypogonadism equaling low estrogen and hence bone loss and vaginal dryness in females. impotence in males.

Question 26

What is the relation of GH and IGF-1?

Answer 26

Causes IGF-1 from liver -> stimulates proliferation of cartilage in bone cells

Question 27

What is Laron dwarfism?

Answer 27

Decrease in linear growth and characterized by increased levels of GH with low levels of IGF-1

Question 28

How do you treat congenital bilateral adrenal hyperplasias?

Answer 28

With steroids to decrease ACTH

Question 29

Hypertensive, tachy, and hypoglycemic? What do you think of?

Answer 29

Adrenal crisis

Question 30

Vomiting, abd pain, weight loss, and hyperpigmentation What do you think of?

Answer 30

Adrenal insufficiency

Question 31

What goes up in 21-hydroxylase deficiency?

Answer 31

17-hydroxyprogesterone as it cannot be cnverted to 11-deoxycortisol by 21-hydroxylase (which can be tested in urine as 17-OHS). Converted instead to androstenedione

Question 32

Symptoms of 21-hydroxylase deficiency?

Answer 32

Hypotension, Elevated K, more renin activity and volume depletion. Only make sex hormones.

Question 33

What are female symptoms of 11B-hydroxylase deficiency?

Answer 33

Develop ambiguous gentialia