Endocrine Flashcards
Do endocrine glands have ducts
No
2 Hormones released from the posterior pituitary
- oxytocin
2. ADH
what are the 6 hormones released from the anterior pituitary
- TSH (thyroid stimulating)
- ACTH
- FSH,LH
- GH growth hormone
- PRL proctin
- Dopamine
Where is the parathyrid gland
posterior side of the thyroid
effect of Parathyroid hormone
Increases Ca in the blood
ACTH causes what to be released from the adrenal cortex
glucocorticoids
what is an example of a positive feedback loop
Oxycontin and child birth
what ways do hormones circulate
- free
2. bound to plasma proteins
effect of binding to plasma
increased 1/2 life
benefit of having hormones bond to plasma
they can serve as a resivore
which hormone is bound to a protein T3 or T4
T4
what hormone correlates best with clinical findings (free or bound)
free
The secretion of most hormones have what nature
pulsatile
Circhoal
released every hour
Ultradian
-released
> 1 hr
<24 hours
circadian
released every 24 hours
Diurnal
episodic activity is expressed at defined periods of the day
involves the organ(s) that produce the hormone
what order disease
Primary Disease
related to the pituitary which produces trophic hormones
what order disease
Secondary Disease
hypothalamic problems what order disease
hypothalamic problems
Tertiary Disease
- Hashimoto’s thyroiditis
- Addison’s disease
- Type 1 DM
are all examples or what order diseases
Primary Deficiency Disorder
feeling cold all the time could be what kind of issue
hypothyroid
Secondary hypothyroidism
Secondary adrenal insufficiency
(where is the issue)
pituitary
Tertiary hypothyroidism
where is the issue
issue is in the hypothalamus
Hyperthyroid is also called
Graves disease
The primary focus of endocrine testing is
hormone measurement
(blank) test to assess hypofunctioning
stimulation
(blank) test to assess hyperfunctioning
suppression
4 sources for endocrine testing
- Blood
- Urine
- Imagine
- Tissue
what is more common blood from an artery or vein
Vein
where does the blood for an ABG come from
artery
capillary puncture gives you what
glucose
what gets glocose into the cell
Insulin
what organ is the most sensitive to a change in glucose
brain
Insulin is made by what organ
pancreas
insulin has what effect on blood glucose
lowers
what is the opposite of insulin
glucagon
Fatty acids packaged for future use
Triglycerides (TG)
Source of fuel that is the product of protein breakdown
Amino Acids (AA)
Breakdown of glucose to make energy (ATP) for the cell
Glycolysis
Generation of glucose from non-carbohydrate substances (such as glycerol from pyruvate, lipids, amino acids, and lactic acid).
Gluconeogenesis
Long term storage molecule of glucose which is stored and synthesized mainly in the liver and muscles
glycogen
where is glycogen stored (2)
- Liver
2. Muscle
Formation of glycogen from glucose
Glycogenesis
Glycogenolysis
Breakdown of glycogen into glucose for use as fuel
Breakdown of triglycerides to fatty acids and further degradation which leads to production of ketones and energy
Lypolysis
Islets of Langerhans make up what percent of the pancreas
2%
98% of the pancreas is what
digestive enzymes (exocrine glands)
Insulin secreted by what cells
beta cells
RBCs absorb glucose without insulin,
- Brain
- Liver
- Kidney
- RBCs
glucagon secreted by what cells
alpha
released in response to rising amino acid levels in blood
Glucagon
The body wants to keeo blood glucose at what level
90-100 (mg/DL)
glucose > 100 mg, Dl
HYPERGLYCEMIA
gluclose 70-100 Mg/Dl
NORMOGLYCEMIA (Euglycemia)
LOW Blood Glucose (< 70 mg/dL)
HYPOGLYCEMIA
Immune system sees its own cells as foreign and attacks and destroys β-cells of the pancreas
DM type I
Cannot use insulin effectively (insulin resistance) so glucose builds up in the blood
DM type II
If there is urine in the blood what must blood glucose be
180 mg/Dl
bed wetting could be a sign of what condition
DM type I
Blood test that represents the amount of glycosylated hemoglobin – the average blood sugar level for the 120 day period before the test
Hemoglobin A1c
Hemoglobin A1c works because its involved with what type of cell
RBC
How long does A1C look back
120 days
Pre-diabetes qualification
100 to 126 mg/dl on the FBG test, OR
140-199 mg/dl on the OGTT, OR
Hemoglobin A1c between 5.7 – 6.4%
overweight is what BMI
25
In the absence of criteria (risk factors), testing for diabetes should begin at age
45 years old
If results are normal, testing should be repeated at least at (?) intervals
3 year
Sweet taste of the urine, distinguished diabetes mellitus from diabetes insipidus (what is this)
(frequent urination due to ADH)
Cut off for DM A1C
6.5% (pre: 5.7-6.4)
Fasting plasma glucose for DM
> 126 mg/ Dl (pre: 100-126)
2 hour plasma glucose for DM
> 200 mg/DL (pre: 140-199)
random glucose for DM
> 200 mg/ DL
A positive result (ketonuria) is associated with
diabetic ketoacidosis
Horseness can be a symptome of what
enlarges thyroid
what percent of T3 and T4 are bound to a protein
> 99%
TSH is released by the
puititary
In the early phases of developing thyroid disease, (what)is the first marker to reflect the disorder
TSH
Low TSH =
hyperfunctioning
High TSH =
hypofunctioning
what does ordering a “TSH with reflex” mean
They check the TSH if that is abnormal they will check T4
Total T4 or T3 is an (inadequate OR adequate) indicator of thyroid status
inadequate
What can effect levels of T3 T4 (another hormone)
estrogen therapy
what is a better indicator T3 or T4
T4
Acute thyroiditis
Graves’ disease
Thyroid cancer
(these conditions will cause you to look into what)
Thyroglobulin (Tg)
Monitoring of Tg levels is frequently used to evaluate the effectiveness of treatment for (what)
thyroid cancer
Thyrotropin Receptor Blocking Antibodies elevated in what condition
Hashimoto’s disease
TSH Receptor Antibodies elevated in what condition
Graves disease
Very good modality for evaluating nodule activity
Thyroid Nuclear Medicine Scan
Hypothyroidism – causes what kind of uptake in the Thyroid Nuclear Medicine Scan
decreased uptake
Non-specific term for enlargement of the thyroid.
Goiter
Discrete area that is clearly different from the surrounding thyroid tissue.
Nodule
Hyperfunctioning (hot) nodules are (unlikely or likely) to be cancerous.
unlikely
Cold nodule shows up what on the thyroid scan
white
It tells if a nodule is “solid” or a fluid-filled cyst, but it will not tell if a nodule is benign or malignant. (What is)
Thyroid ultrasound
It is the most reliable test to differentiate the “cold” nodule that is cancerous from the “cold” nodule that is benign. (what is)
FNA (fine needle aspiration)
Do not let the term “follicular” mislead you. Follicular cells are (what) until proven other wise
malignant
~75% will be benign with “high confidence”
~20% will be “indeterminate” (~20-40% of these will be cancer)
~5% will diagnose a malignant lesion
75% benign
20% unsure (20-40% malignant)
5% malignant
PTH does what to blood calcium
increases
Muscle contraction Exocytosis Blood clotting Formation of cardiac action potentials Enzyme activation Cell signaling Bone & tooth structure (what hormone)
calcium
PTH has (what effects) on intestinal absorption of Ca+2
no directs effect
PTH stimulates osteoclast or osteoblast
osteoclast
does PTH involve the hypothalmus
no
Secreted by thyroid C cells (parafollicular cells)
Calcitonin
medullary thyroid cancer marker
Calcitonin
Hyperparathyroidism
Bone malignancies
Prolonged immobilization
Excess vitamin D and calcium in the diet
causes of Hypercalcemia
Bones, stones, abdominal groans, psychic moans, with fatigue overtones”
Hypercalcemia
PTH Total Calcium Phosphate Vitamin D (what gland is this testing)
patathyroid
Only about (?)% of total body phosphate is present in the blood
1%
The main role of vitamin D is to help regulate blood levels of (3)
- Calcium
- Phosphorous
- Magnesium
Active vitamin D levels (should or should not) be used to DX Vit-D deficiency
Not
Sestamibi is used to examine what gland
parathyroid
what is the primary Glucocorticoid
cortisol
Cortisol secretion is pulsatile, diurnal and under the control of
ACTH
long term cortisol production will have what effect on the adrenal
atrophy
when do you want to perform your blood draw to test for cortisol
Blood drawn between 8 a.m. and 9 a.m.*
Cortisol
- > 10
- 3-10
- < 3
- Good
- unknown
- adrenal insufficiency
Ideal for suspected hypercortisolism
24 Hour UA
what do you do with the morning void for a 24 hr UA
disregard
Differentiate source of adrenal insufficiency (cortisol deficiency)
ACTH Stimulation Test
- 250 mcg cosyntropin administered via IV
- Measure plasma cortisol levels at 30 and 60 minutes
Dexamethasone Suppression Test
Confirm abnormal excess production
cortisol
How many para thyroid glands do we have
2-6 (normal is 4)
primary Goal of parathyroid hormone
increase blood calcium
where is parathyroid hormone released
parathyroid gland
What does reabsorb mean
Body takes it back. for example bone Calcium absorption means the body takes it from the bone into the blood stream
Does PTH directly or indirectly effect bone absorption
directly
Does PTH directly or indirectly effect ca absorption from intestine
indirectly (via the effect if Vit- D) this has the largest effect on Ca levels
Parathyroid hormones effect on phosphate plasma
decrease
what is more powerful parathyroid of calcitonin
parathyroid
4 things to test for with parathyroid
- PTH
- blood calcium
- Phosphate
- Vit D
when testing for Vit D what do you test for
Vit D 25
Nuclear medicine scan for parathyroid issue uses what chemical
sestamibi
sestamibi is absorbed by what 4 locations
- heart
- thyroid
- salavaery
- Para thyroid
order of exams when you suspect an issue with the thyroid
- Blood tests
- Nuclear medicine scan
- biopsy
2 hormones you would use to monitor the effectiveness of thyroid cancer after thyroid removal
- TG
2. Calcitonin
primary cause of hyperparathroidsim
hyper functioning ademoma
age for hyper functioning adenoma
> 40
how are most hyper functioning adenoma detected
hyper calcemia
4 primary reasons for hyper calcemia
- hyperparathyroid
- Bone malignancy
- Prolonged immobilization
- excessive Vit D supplements
3 clinical findings of hyper calcemia
- hyporeflexive
- kidney stones
- hypertension
primary cause of hypo parathyroidism
thyroid ectomy
Chvosstek’s sign
trousseus sign
hyperreflexia
are indications of what
hypo calcemia
with hypocalcemia why do muscles become more exited
at the level of the nerve
Primary hormone of the glucocorticoid class
cortisol
cortisol is released in a response to
stress
what hormone from the pituitary causes cortisol to be released
ACTH
what hormone cause ACTH to be released
CRH from anterior hypothamus
fight or flight stimulates what hormone
cortisol
if you are on a steroid for > 7 days what can happen
your body stops producing its own cortisol
adrenal insufficiency
5 Lab tests that look into how the cortisol system is doing
- serum total cortisol
- 24 hr UA free cortisol level
- Plasma ACTH
- ACTH stimulation
- dexamethasone suppression
what is the initial study if you suspect an issue with the cortisol
serum total cortisol levels
serum total cortisol levels what do you adjust for
albumin
what time of day do you draw for serum total cortisol levels
8-9 am
3 words to describe the release of cortisol
- pulsitile
- diurnal
- under control of ACTH
what are the 3 ranges for serum total cortisol levels
> 10 (no adrenal insufficiency)
3-10 (unsure)
< 3 adrenal insufficiency
what do you do with your UA during collection
must refriderate
what is the 24HR UA test good for
hypercortisol ism
what is the pattern of ACTH
diurnal
Plasma ACTH helps distinguish what
if the issue is pituitary or adrenal
ACTH stimulation tests done if you suspect
hypo adrenal
describe ACTH stimulation tests
- inject 250mg/dl syntheric ACTH
2. measure 30-60 min
Results of ACTH stimulation
- if cortisol doubles adrenal is good
2. If cortisol does NOT double: adrenal insufficiency
Describe dexamethasne suppression test
- 1mg dexamethasone at 11pm
2. Draw blood at 8 am
Describe dexamethasne suppression test response
decrease in cortisol: adrenal is good
no change in cortisol: adrenal is hyper functioning
