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Diagnostics > Endocrine > Flashcards

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
Q

Glucagon

A

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
Q

Normal Blood Sugar

A

70-100 mg/dL

27
Q

Diabetes Diagnosis

A

Plasma glucose and HgA1C
A1c>6.5%, fasting glucose >126 mg/dL, random plasma glucose >200, 2hour plasma >200
high ketones, high protein

28
Q

Pre-diabetes

A

fasting BG:100-126
2hour:140-199
A1c: 5.7-6.4%

29
Q

Diagnostic study of choice for Thyroid Disease

A

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
Q

Primary Hypothyroid

A

TSH high, free T4 low

31
Q

Primary Hyperthyroid

A

TSH low, free T4 high (T4 more specific than T3)

32
Q

Thyroglobulin

A

Elevated in Graves’, acute thyroiditis, thyroid cancer

Not routinely measured unless after thyroidectomy

33
Q

Hashimoto’s

A

Thyrotropin receptor antibody (TBAb/TSAb) ALWAYS present in pts with Hashimotos

34
Q

Graves’ Disease

A

TSH Receptor antibodies (TSI and TBII) in 75-90% pts with graves’

35
Q

Thyroid Nuclear Medicine Scan

A

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
Q

Thyroid Ultrasound

A

Used for: abnormal thyroid labs, physical findings, distinguish solid vs cystic nodules, needle aspiration, follow growth
Sensitive (diagnostic study of choice)

37
Q

Procedure of choice for nodule

A

fine-needle aspiration biopsy

used for “cold” nodules to differentiate benign or cancerous

38
Q

Procedure of choice for nodule

A

fine-needle aspiration biopsy

used for “cold” nodules to differentiate benign or cancerous

39
Q

Calcium Responsibilities

A

muscle contraction, exocytosis, blood clotting, formation of cardiac action potentials, enzyme activation, cell signaling (intracellular), bone/tooth structure

40
Q

Osteoclast

A

breaks down bone, releases calcium

41
Q

Osteblast

A

manufactures bone using calcium (goes up with calcium levels)

42
Q

PTH and Calcium regulation

A

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
Q

Primary Hyperparathyroidism

A

80% due to hyper-functioning adenoma
Typically over 40 (if <30 higher concern for cancer)
typically identified on chem panel (asymptomatic)

44
Q

Primary Hyperparathyroidism

A

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
Q

Hypoparathyroidism

A

Destruction of parathyroid glands (post-op or autoimmune)

congenital abnormal parathyroid gland development

46
Q

Hypoparathyroidism

A

Destruction of parathyroid glands (post-op or autoimmune)
congenital abnormal parathyroid gland development
Labs: Low Ca, Low PTH, Low vit D, high phosphate

47
Q

Hypocalcemia

A

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
Q

Tests for calcium imbalances

A

PTH, total calcium, phosphate, vitamin D

Calcium goes up with PTH/vit D, phosphate goes down

49
Q

Vitamin D

A

25-hydroxyvitamin D tested to monitor levels, 1,25dihyrdoxy changes too much

50
Q

Diagnostic study of choice for parathyroid

A

resection/biopsy

51
Q

Parathyroid Nuclear Medicine Scan

A

Sestamibi-radionuclide taken up by parathyroid

done to confirm primary hyperparathyroidism, glands taking up most sestamibi at 180 minutes

52
Q

Cortisol

A 
Pulsatile, diurnal release
under control of ACTH
>10mg/dL unlikely to have adrenal insufficiency
<3mg/dL-very likely
3-10mg/dL inconclusive
53
Q

24 hour Urinary Free Cortisol

A 
24hour urine collection
kept cool
discard 1st morning void, record 1st and last time
Measures free cortisol
Ideal for suspicion of hypercorticolism
54
Q

Plasma ACTH

A

Collected with serum cortisol (8-9AM) to differentiate primary (adrenal) vs secondary (pituitary) vs. tertiary (hypothalamus) cortisol imbalance

55
Q

ACTH Stimulation Test

A

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
Q

Dexamethasone Suppression Test

A

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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