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Endocrine Flashcards

1
Q

Endocrine Glands

A

Ductless glands; secrete hormones into circulation; controlled by feedback loops

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2
Q

Hypothalamus Gland

A

Releases TRH, CRH, GnRH

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3
Q

Pituitary Gland

A

Anterior- releases TSH, ACTH, FSH/LH, GH, PRL, endorphins
Posterior-Releases Oxytocin and ADH
extension of hypothalamus

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4
Q

Thyroid Gland

A

Stimulated by TSH to release T3/T4 (99.95% bound to proteins)
Close to laryngeal nerves (could cause hoarseness if enlarged)
Thermostat example

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5
Q

Parathyroid Glands

A 
Commonly 4 (can be 2-6)
embedded in posterior thyroid
Releases PTH (increase Ca levels/absorption, bone resorption and synthesis of calcitrol, decreases urine)
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6
Q

Best time to draw Cortisol

A

6-8AM

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7
Q

Circhoral

A

episodic hormone release hourly

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8
Q

Ultradian

A

episodic hormone release between 1-24 hours

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9
Q

Best time to draw Cortisol

A

8-9AM

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10
Q

Diurnal

A

episodic hormone activity at defined period of the day

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11
Q

Primary Disease

A

Organ that produces hormone
Trophic hormone levels increased due to normal feedback (^TSH low T3/T4)
Hashimotos, Addisons disease (adrenal), Type I DM

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12
Q

Secondary Disease

A

Involves pituitary gland
Secondary hypothyroidism/adrenal insufficiency
All levels low

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13
Q

Tertiary Disease

A

Involves hypothalamus

change in releasing hormones

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14
Q

Endocrine Hyperfunction Diseases

A 
Parathyroid adenoma (1st)
Graves' disease (1st)
Pituitary adenomas (2nd)
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15
Q

Sources of endocrine testing

A

Blood (capillary, vein, artery), urine, imaging, tissue biopsy

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16
Q

Sources of endocrine testing

A

Blood (capillary, vein, artery), urine, imaging, tissue biopsy

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17
Q

Gycolysis

A

Breakdown of glucose for energy (ATP)

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18
Q

Gluconeogenesis

A

generation of glucose from non-carbs (glycerol, lipids, aminos, lactic acid)

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19
Q

Glycogen

A

Long term storage molecule of glucose stored/synthesized in liver and muscles

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20
Q

Glycogenesis

A

formation of glycogen from glucose

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21
Q

Glycogenolysis

A

breakdown of glycogen into glucose for fuel

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22
Q

Lypolysis

A

breakdown of triglycerides to fatty acids>production of ketones/energy

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23
Q

Pancreatic Islets

A

2% of pancreatic cells

produce insulin/glucagon (other 98% makes digestive enzymes)

24
Q

Insulin

A

Secreted by Beta cells after meal
stimulates cells to absorb nutrients to lower BS
promotes synthesis of glycogen, fat and protein
surpasses stored fuel use
Not needed by brain, liver, kidney, RBCs

25
Glucagon
Secreted by Alpha cells between meals to raise BS In liver-stimulates gluconeogenesis, glycogenolysis and release of glucose into blood In adipose-stimulates fat catabolism and release of fatty acids Promotes amino acid absorption
26
Normal Blood Sugar
70-100 mg/dL
27
Diabetes Diagnosis
Plasma glucose and HgA1C A1c>6.5%, fasting glucose >126 mg/dL, random plasma glucose >200, 2hour plasma >200 high ketones, high protein
28
Pre-diabetes
fasting BG:100-126 2hour:140-199 A1c: 5.7-6.4%
29
Diagnostic study of choice for Thyroid Disease
TSH-First marker to reflect thyroid disease (extremely sensitive) low-hyperthyroid high-hypothyroid T4 tested with it, T3 if T4 is normal (T3 has more free cells, fluctuates more)
30
Primary Hypothyroid
TSH high, free T4 low
31
Primary Hyperthyroid
TSH low, free T4 high (T4 more specific than T3)
32
Thyroglobulin
Elevated in Graves', acute thyroiditis, thyroid cancer | Not routinely measured unless after thyroidectomy
33
Hashimoto's
Thyrotropin receptor antibody (TBAb/TSAb) ALWAYS present in pts with Hashimotos
34
Graves' Disease
TSH Receptor antibodies (TSI and TBII) in 75-90% pts with graves'
35
Thyroid Nuclear Medicine Scan
Thyroid uptake scan Only done after ultrasound (less intrusive) Measurements at 4-6hours and 24 hours; pt low on iodine for 4 weeks prior Used to differentiate Graves', multi nodular goiter, thyroiditis and thyroid malignancy hyperthyroidism-decreased uptake, hypo-diffuse (graves') or localized (nodule/goiter) "hot" nodules less likely to be cancerous
36
Thyroid Ultrasound
Used for: abnormal thyroid labs, physical findings, distinguish solid vs cystic nodules, needle aspiration, follow growth Sensitive (diagnostic study of choice)
37
Procedure of choice for nodule
fine-needle aspiration biopsy | used for "cold" nodules to differentiate benign or cancerous
38
Procedure of choice for nodule
fine-needle aspiration biopsy | used for "cold" nodules to differentiate benign or cancerous
39
Calcium Responsibilities
muscle contraction, exocytosis, blood clotting, formation of cardiac action potentials, enzyme activation, cell signaling (intracellular), bone/tooth structure
40
Osteoclast
breaks down bone, releases calcium
41
Osteblast
manufactures bone using calcium (goes up with calcium levels)
42
PTH and Calcium regulation
PTH stimulates osteoclast (increases Ca) PTH stimulates Ca absorption in tubules (kidneys), stimulates 1-hydroxylation PTH activates vitamin D increasing Ca absorption in intestines PTH increases when Ca decreases; as Ca rises phosphate decreases
43
Primary Hyperparathyroidism
80% due to hyper-functioning adenoma Typically over 40 (if <30 higher concern for cancer) typically identified on chem panel (asymptomatic)
44
Primary Hyperparathyroidism
80% due to hyper-functioning adenoma Typically over 40 (if <30 higher concern for cancer) typically identified on chem panel (asymptomatic) Labs: high Ca, high PTH, High bit D, low phosphate
45
Hypoparathyroidism
Destruction of parathyroid glands (post-op or autoimmune) | congenital abnormal parathyroid gland development
46
Hypoparathyroidism
Destruction of parathyroid glands (post-op or autoimmune) congenital abnormal parathyroid gland development Labs: Low Ca, Low PTH, Low vit D, high phosphate
47
Hypocalcemia
Due to: removal of parathyroids, hypoparathyroidism, fit D deficiency Hyper-reflexia, spontaneous muscle contraction (tetany) typically of face(Chvosteks sign) and hands (Trousseau's sign) laryngeal spams, contraction of respiratory muscles
48
Tests for calcium imbalances
PTH, total calcium, phosphate, vitamin D | Calcium goes up with PTH/vit D, phosphate goes down
49
Vitamin D
25-hydroxyvitamin D tested to monitor levels, 1,25dihyrdoxy changes too much
50
Diagnostic study of choice for parathyroid
resection/biopsy
51
Parathyroid Nuclear Medicine Scan
Sestamibi-radionuclide taken up by parathyroid | done to confirm primary hyperparathyroidism, glands taking up most sestamibi at 180 minutes
52
Cortisol
``` Pulsatile, diurnal release under control of ACTH >10mg/dL unlikely to have adrenal insufficiency <3mg/dL-very likely 3-10mg/dL inconclusive ```
53
24 hour Urinary Free Cortisol
``` 24hour urine collection kept cool discard 1st morning void, record 1st and last time Measures free cortisol Ideal for suspicion of hypercorticolism ```
54
Plasma ACTH
Collected with serum cortisol (8-9AM) to differentiate primary (adrenal) vs secondary (pituitary) vs. tertiary (hypothalamus) cortisol imbalance
55
ACTH Stimulation Test
Differentiates source of adrenal insufficiency 250mg cosyntropin injected IV, plasma cortisol measured at 30 and 60 minutes, if adrenal gland is working levels will double
56
Dexamethasone Suppression Test
Confirm abnormal excess production of cortisol (from 24 hour free urine) 1mg dex administered PO at11PM, plasma cortisol measured at 8AM, cortisol levels should decrease if gland is functioning

Diagnostics (7 decks)

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