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Endocrine Flashcards

1
Q

Thyroid development

  • derived from
  • connections to tongue and what it turns into
  • thyroglossal duct cyst: sxs
  • thyroid follicular and parafollicular cells derived from
A
  • primitive pharynx
  • thyroglossal duct -> normally disappears but can persist as pyramidal lobe
  • anterior midline neck mass that moves w/ swallowing
  • endoderm
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2
Q

Adrenal Cortex

  • derived from
  • glomerulosa: primary reg, hormone produced, hormone class
  • fasiculata
  • reticularis
A
  • mesoderm
  • Angiotensin II, Aldosterone, mineralcorticoids
  • ACTH, cortisol, glucocorticoids
  • ACTH, DHEA, androgens
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3
Q

Adrenal Medulla

- dervied from

A
  • neural crest
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4
Q

Ant pit

  • secretes
  • derived from
  • basophila
A
  • FSH, LH, ACTH, TSH, prolactin, GH,
  • oral ectoderm
  • FSH, LH, ACTH, TSH
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5
Q

Post pit

  • secretes
  • created
  • transported
  • derived
A
  • vasopressin and oxytocin
  • hypothalamus
  • post pit via neurophysins
  • neuroectoderm
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6
Q

Endocrine Pancreas

  • alpha cell
  • beta cell
  • delta cell
  • arise from
A
  • glucagon
  • insulin
  • somatostatin
  • pancreatic buds
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7
Q

Insulin

  • synthesis: 1st product, 2nd product, final product
  • function: binds, next steps
  • anabolic effects: muscle, adipose, glycogen, triglyceride, Na, proteins, K and AA, glucagon, lipolysis
  • insulin dependent glucose transporters: location
  • organs with non insulin dependent glucose transporters: BRICK LIPS
  • regulation
  • insulin binding pathway
  • insulin release pathway
A
  • preproinsulin -> cleavage of presignal -> proinsulin -> cleavage of proinsulin -> exocytosis of insulin and C peptide
  • binds insulin receptor -> induce glucose uptake -> gene transcription
  • increase glucose in muscle and adipose, glycogen synthesis and storage, triglyceride synthesis, Na retention, protein synthesis, cellular uptake of K and AA; decreased glucagon release, and lipolysis
  • GLUT 4: adipose and muscles
  • Brain, RBC, Intestine, Cornea, Kidney, Liver, Iselt cells, Placenta, Spermatocyte
  • controlled by glucose concentration in blood, increase in glucose causes increase in insulin
  • insuling binds receptor -> PIP 3 activated -> glut 4 to membrane -> glucose into cell
  • glucose binds glut2 -> ATP/ADP ratio increased -> K channels close -> voltage gated Ca channel open -> increase in intracellular Ca -> exocytosis of insulin
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8
Q

Glucagon

  • made by
  • function
  • regulation
A
  • alpha cells of pancrea
  • glycogenolysis, gluconeogenesis, lipolysis, ketogenesis -> elevates blood sugar to maintain homeostasis
  • secreted in response to hypoglycemia
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9
Q

Hypothalamic - Ant Pit Hormones

  • ADH: function,
  • CRH: function
  • Dopamine: function
  • GHRH: function
  • GnRH
  • MSH
  • Oxytocin
  • Prolactin
  • Somatostatin
  • TRH
A
  • ADH: increase in water permeability to DCT and collecting guct -> increase water reabsorption
  • CRH: Increase ACTH and beta endorphin
  • Dop: decrease in prolactin
  • GHRH: increase GH
  • GnRH: increase FSH, LH
  • MSH: increase melanogenesis by melanocytes
  • Oxy: causes uterine contraction during labor, responsible for milk letdown reflex
  • Prolactin: decrease in GnRH
  • Somato: decrease in GH, TSH
  • TRH: Increase in TSH, prolactin
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10
Q

Prolactin

  • source
  • function: breast milk, fertility
  • reg: inhibition,
A
  • ant pit
  • stimulates milk production, inhibits ovulation and spermatogenesis by inhibiting GnRH synthesis and release
  • inhibited by dopamine; prolactin inhibits own secretion by increasing dopamin synthesis
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11
Q

Growth Hormone

  • other name
  • production
  • function
  • regulation: released in response to, inhibited by
  • excess secretion of GH causes -> TX
A
  • somatotropin
  • ant pit
  • linear growth and muscle mass
  • pulsatile, released in response to growth hormone releasing hormone, which is increased during exercise, deep sleep, puberty, hypoglycemia; inhibited by glucose and somatostatin
  • acromegaly of gigantism; TX w/ somatostatin analogs
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12
Q

Appetite Reg

  • Ghrelin: function; produced by; sleep deprivation/ prader willi causes; location of effect
  • Leptin: function; produced by; mutation causes; sleep deprivation or starvation causes
  • Endocannabinoids: location; function; exogenous
A
  • stimulates hunger and GH release; produced by stomach; sleep deprivation or prader willi causes increased ghrelin production; lateral area of hypothalamus
  • satiety hormone; produced by adipose tissue; congenital obesity; decrease in leptin production
  • act at cannabinoid receptor in hypothalamus to increase appetite; reason why exogenous cannabinoid causes the munchies
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13
Q

Anti-diuretic Hormone

  • other name
  • production
  • function
  • regulation
  • central diabetes insipidus vs nephrogenic
A
  • vasopressin
  • hypothalamus and stored and secreted in post pit
  • reg serum osmolality and blood pressure via reg of aquaporin channel insertion in principal cells
  • plasma osmolality/ hypovolemia
  • ADH decreased vs ADH normal
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14
Q

Cortisol

  • source
  • function: increases, decreases
  • regulation
A
  • adrenal zona fasiculata
  • increase appetite, DP, insulin resistance, gluconeogenesis/lypolysis/proteolysis; decreases fibroblast activity, inflammatory and immune responses, bone formation
  • CRH stimulates ACTH release causes cortisol
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15
Q

Ca homeostasis

  • forms
  • increased pH
  • decreased pH
A
  • ionized, hound to albumin, bound to anions
  • albumin binds more Ca -> decrease free Ca -> increase PTH
  • albumin binds less Ca -> increase in free Ca -> decrease PTH
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16
Q

PTH

  • source
  • function
  • reg: increases PTH; decreases PTH
A
  • chief cells of parathyroid
  • increase bone resorption of Ca and PO4, kidney reabsorption of Ca in DCT, and D3 production; decrease reabsorption of PO4 in PCT
  • decreased serum Ca, high PO4, low serum MG; very low MG
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17
Q

Calcitonin

  • source
  • function
  • reg
A
  • parafollicular cells of thyroid
  • decrease bone resorption of Ca
  • increase serum Ca -> calcitonin secretion
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18
Q

Thyroid Hormones

  • source
  • secreted form vs activated form
  • function- 6 B’s
  • reg
  • TBG: what is it, function, increased by, decreased by
A
  • follicles of thyroid
  • T4 vs T3
  • Brain maturation, bone growth, beta adrenergic effects, increase basal met rate, increase blood sugar, breaks down lipids
  • TRH -> TSH -> T4 -> T3 -> w/ neg feeback from T3/T4
  • thyroxine binding gobulin; binds T3 and T4 making it inactive in blood -> will increase w/ estrogen, heaptic failure, steroid use, nephrotic syndrome
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19
Q

Signaling Pathways of endocrine hormones

  • cAMP: pathway; FLAT ChAMP CGGH
  • cGMP: BAD GraMPa
  • IP3: GOAT HAG
  • Intracellular receptor: PEE CAT TV
  • Tyrosine Kinase: Get Found In the MAP
  • Non TK: PIGGlET
A
  • G-alpha-s -> AC -> cAMP -> PKA; FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH, calcitonin, GHRH, glucagon, histamine
  • BNP, ANP, NO
  • GnRH, Oxytocin, ADH, TRH, histamine, angiotensin II, Gastrin
  • Progesterone, estrogen, tetosterone, cortisol, aldosterone, T3/T4, Vit D
  • Insulin, IGF-1, PDGF
  • Prolactin, Immunomodulators, GH,G-CSF, Erythropoeitin, Thrombopoeitin
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20
Q

Adrenal Steroid Synthesis

  • aldosterone
  • glucocorticoids: 2 pathways; inhibited by
  • androgens
  • estrogen
A
  • chol -> pregnenolone -> progesterone + 21- hydroxylase -> 11-deoxycorticosterone + 11 beta hydroxylase -> corticosterone -> aldosterone
  • chol -> pregnenolone -> 17 hydroxy pregnenolone -> 17 hydroxy progesterone -> 11 deoxy cortisol -> cortisol –OR– Chol -> pregnenolone -> progeterone -> 17 hydroxy progesterone -> de oxy cortisol -> cortisol; metyrapone
  • chol -> pregnenolone -> 17 hydroxy pregnenolone -> DHEA -> androstenidione -> testosterone -> DHT –OR – chol -> pregnenolone -> progesterone -> 17 hydroxy pregnenolone -> androstenidion -> testosterone
  • aromatase, from androstenidione or testosterone
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21
Q

Androgen Enzyme Deficiencies

  • 17 alpha hydroxylase: amount of mineral corticoids, amount of cortisol, amount of sex hormone, BP, [K], labs, presentation
  • 21 hydroxylase: amount of mineral corticoids, amount of cortisol, amount of sex hormone, BP, [K], labs, presentation
  • 11 beta hydroxylase: amount of mineral corticoids, amount of cortisol, amount of sex hormone, BP, [K], labs, presentation
A
  • used to make 17 hydroxy pregnenolone and progesterone -> will result in lots of mineral corticoids, low cortisol and androgens , high BP, low K; XY: ambiguous genitalia w/ undescended testes and XX lacks seconday sex development
  • low mineral corticoids, low cortisol, high sex, low, BP, high K, high renin and 17-hydroxy progesterone; salt wastin or precocious puberty w/ virilization in women
  • low aldosterone but high deoxycorticosterone, low cortisol, high sex, high BP (deoxycoritco), decreased K, decreased renin, virilization in women
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22
Q

Cushing syndrome

  • etiology
  • causes (3 ish)
  • findings
  • DX
  • Exogenous glucocorticoids or adrenal tumor
  • Ectopic ACTH
  • Cushing DX
A
  • increased cortisol
  • exogenous corticosteroids, adrenal adenoma/ hyperplasia/ carcinoma; ACTH secreting pit adenoma
  • hypertension, weight gain, moon face, buffalo hump, skin changes, hirsutism, amenorrhea
  • increased free cortisol on 24 hr UA, increased late night salivary cortisol, no suppression w/ low dose dexamethasone
  • suppressed ACTH test
  • elevated ACTH w/ no suppression on dexamethasone test and no increase in ACTH and cortisol w/ CRH
  • elevated ACTH w/ adequate suppression on dexamethason test and an increase in ACTH and cortisol on CRH stim test
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23
Q

Nelson Syndrome

  • what is it
  • sequalae
  • sxs
  • tx
A
  • removal of cortisol feedback after bilateral adrenalectomy for refractory cushing dx
  • enlargement of existing ACTH secreting pit adenoma
  • hyperpigmentation, headache, bitemporal hemianopia
  • pit radiation or resection
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24
Q

Adrenal insufficiency

  • what is it
  • sxs
  • tx
A
  • inability of adrenal gland to generate enough glucocorticoids +/- mineralcorticoids
  • weakness, fatigue, orthostatic hypotension,
  • glucocorticoid and mineralcorticoid replacement
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25
Q

Primary Adrenal Insufficiency

  • what is it// caused by
  • acute
  • addisons dx
  • waterhouse- friedrichsen: what is it
A
  • deficiency of aldosterone and cortisol production because of loss of gland function
  • hypotension, hypekalemia, metabolic acidosis, skin/mucosal hyperpigmentation
  • sudden, presents w/ shock in acute adrenal crisis
  • caused by adrenal atrophy/destruction by DX (Autoimmune or TB)
  • acute primary adrenal insuff bc of adrenal hemmorrhage associated w/ septicemia, DIC and endotoxin shock from N meningitidis
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26
Q

Secondary Adrenal insufficiency

  • caused by
  • sxs
A
  • decreased in pit ACTH production

- no hyperpigmentation and no hyperkalemia bc aldosterone is intact

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27
Q

Tertiary Adrenal insufficiency

  • caused by
  • adlosterone
A
  • chronic use of exogenous steroids w/ abrupt withdrawal

- aldosterone unaffected so K and htn should be fine

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28
Q

Hyperaldosteronism

  • what is it
  • sxs
  • primary: caused by; aldosterone vs renin levels; main sxs
  • secondary:
A
  • increased secretion of aldosterone from adrenal gland
  • hypertension, decreased K, met alkalosis
  • caused by adrenal adenoma or bilateral adrenal hyperplasia; increase in aldosterone with decrease in renin; treatment resistant HTN w/o edema
  • pts w/ renovasc HTN, juxtaglomerular tumors and edema
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29
Q

Neuroendocrine tumors

  • what is it
  • GI, Pancreas, lungs, thyroid, adrenals
A
  • heterogenous groups of neoplasms originating frm neuroendocrine cells
  • GI tract (gastrinoma) , pancreas (insulinoma), lungs (small cell), thyroid (medullary carcinoma), adrenals (pheochromocytoma)
30
Q

Neuroblastoma

  • what is it
  • derived from / location
  • sxs
A
  • most common tumor of adrenal medulla in children
  • neural crest cells, anywhere along sympathetic chain
  • abdominal distention and firm irregular mass that can cross midline, normotensive, opsoclonus-myoclonus syndrome (dancing eyes and feet)
31
Q

Carcinoid Syndrome

  • what is it
  • sxs
  • markers
  • tx
  • mets
A
  • syndrome caused by neuroendocrine tumors secreting hormones such as serotonin, histamine, leukotriene
  • recurrent diarrhea (serotonin on GI), cutaneous flushing (histamine dilating vessels), athmatic wheezing (serotonin causing broncho constriction) , right sided valvular heart dx (serotonin increasing fibrin deposition in heart)
  • chromogranin A and synaptophysin
  • surgical resection and somatostatin analog for sxs control (somatostatin binds to tumor and prevents release of hormones)
  • liver
32
Q

Pheochromocytoma

  • etiology
  • symptoms
  • findings
  • tx
A
  • most common tumor of adrenal medulla in ADULTS
  • chrommafin cells (come from neural crest cells)
  • NF1, VHL, RET, MEN 2A and 2B
  • epi, nor epi, dopamine -> HTN or EPO -> polycythemia; in spells
  • increase in catecholamines and metabolites in urine
  • Irreversible alpha antagonist (phenoxybenzamine) and beta blocker before resection
33
Q

Insulinoma

  • what is it
  • whipple triad
  • labs
  • tx
A
  • tumor of pancreatic beta cell -> over production of insulin -> hypoglycemia
  • low blood glucose, sxs of hypoglycemia, and resolution of sxs after glucose normalization
  • low glucose and high c peptide
  • surgical resection
34
Q

Glucagonoma

  • what is it
  • sxs (5 D’s)
  • tx
A
  • tumor of pancreatic alpha cell -> over production of glucagon
  • dermatitis, diabetes, DVT, declining weight, depression
  • octreotide, surgery
35
Q

Somatostatinoma

  • what is it
  • sequalae
  • sxs
A
  • tumor or pancreatic delta cells -> overproduction of somatostatin
  • decrease in secretion of glucagon, insulin, gastrin
  • diabetes, glucose intolerance, gallstones, steatorrhea
  • surgical resection, somatostatin analogs
36
Q

Zollinger Ellison Syndrome

  • what is it
  • sequelae
  • sxs
  • secretin stimulation test
A
  • gastrin secreting tumor of pancreas or duodenum
  • acid hyper secretion causes recurrent ulcers in duodenum and jejunum
  • abdominal pain and diarrhea
  • gastrin levels remain elevated after secretin administration
37
Q

VIPoma

  • what is it
  • location
  • syndrome
  • sxs
A
  • rare neuroendocrine tumor that secretes vasoactive peptide
  • pancreas
  • MEN 1
  • Watery diarrhea, hypokalemia, achloryhydia
38
Q

Hypothyroidism vs Hyperthyroidism

  • metabolic findings
  • skin/ hair findings
  • ocular findings
  • GI findings
  • MS
  • Reproductive
  • Neuro
  • CV
  • Labs
A
  • O: cold intolerance, sweating, weight gain– ER: heat intolerance, sweating, weight loss
  • O: dry/cool skin w/ brittle hair and diffuse allopecia, brittle nails, puffy face; ER: warm/moist skin, fine hair, pretibial myxedema
  • O: peri-orbital edema; ER: exophthalmos and lid lag
  • O: constipation; ER: diarrhea
  • O: myopathy, carpal tunnel; ER: thyrotoxic myopathy w/ increased risk of fracture
  • O: abnrml uterine bleeding and decreased libido; ER: abnrml uterine bleedin, gynecomastia
  • O: lethargy, fatigue, weakness, depression; ER: restless, anxious, insomnia
  • O: bradycardia, dyspnea on exertion; ER: tachcardia, palpations, arrythmias
  • high TSH, low T3 and 4; low TSH, high T3 and 4
39
Q

Hyperthyroidism Causes

  • Graves Dx: epi, pathogenesis, triggers, HLA, histo
  • Toxic multi nodular goiter: what is it, labs, prognosis
  • Thyroid storm: what is it, triggers, labs, tx 4 ps
  • Jod-Basedow phenomenon: what is it
A
  • most common cause; Thyroid stimulating Ig stimulates TSH receptors, dermal fibroblasts, orbital fibroblasts; stress, HLA 3 and 8, tall crowded follicular epi cells w/ scalloped colloid
  • focal patch of hyperfunctioning follicular cells w/ colloid working independently of TSH; increase release T3/4, non malignant
  • complication when hyperthyroidism is untreated and significantly worsens w trigger, infection/ trauma/ surgery; agitation/ delirium/ fever/ diarrhea/ arrythmia; increase lfts; propanolol, propylthiouracil, prednisolone, potassium iodide
  • Ionine induced hyperthyroidism, pt with iodine deficieny and autonomous thyroid tissue is given iodine
40
Q

Hypothyroidism Causes

  • Hashimotos Thyroiditis: epi, pathogenesis, HLA’s, histo, increased risk of, sxs
  • Post partum thyroiditis: what is it, sxs; tx; sxs; histo
  • Congenital Hypothyroidism: what is it; caused by; sxs (6 Ps)
  • Subacute Granulomatous thyroiditis: caused by; course; sxs; histo
  • Riedel: what is it; mimics; thyroid feels
  • Other causes
A
  • most common cause of hypothryoidism; AI w/ anti-thyroid peroxidase and thithyroglobulin; HLA-DR3 and DR5; increase risk of non hodgkins lymphoma; huerthle cells; enlarged, non tender thyroid
  • self limited thyroiditis; transient hyperthyroidism, hypothyroidism, or both; euthyroid following resolution; thyroid is painless and normal size; lymph infiltrate w/ occasional germinal centers
  • severe fetal hypothyroidism bc of maternal anti-bodies; Pot bellied, Pale, Puffy face, protruding umbilicus, protuberat tongue, poor brain development
  • self limited dx following flu like illness; can start as hyperthyroid and followed by hypothyroid; granulomatous inflammation; increased ESR, jaw pain, very tender thyroid
  • thyroid replaced by fibrous tissue w/ inflamm infiltrate which can extend to local strx (trachea and esophagus); mimics anaplastic carcinoma; fixed, rockhard, painless goiter
  • iodine deficiency
41
Q

Radiation induced damage to thyroid gland

- what is it

A
  • exposure to radiation can increase risk of hypothyroidism

- potassium iodide will saturate thyroid gland with stable iodine

42
Q

Thyroid adenoma

  • what is it
  • hot vs cold
  • histo
A
  • benign solitary growth of thyroid
  • most are cold and do not cause hyperthyroidism and others are hot
  • follicular, absence of capsular or vascular invasion
43
Q

Papillary Carcinoma

  • epi
  • prognosis
  • histo
  • mutation
A
  • most common
  • excellent
  • empty appearing nuclei w/ central clearing, psammoma odies, nuclear grooves
  • RET/ PTC rearrangements and CRAF mutations
44
Q

Follicular Carcinoma

  • prognosis
  • invades
  • histo
  • spread
  • mutations
A
  • good
  • thyroid capsule and vasculature
  • uniform follicles
  • blood
  • RAS and PAX8 - PPAR translocation
45
Q

Medullary Carcinoma

  • cells type
  • secretes
  • histo
  • associated w
A
  • parafollicular cells
  • calcitonin
  • sheets of amyloid stroma
  • MEN 2A and B
46
Q

Undiff anaplastic carcinoma

  • epi
  • sxs
  • prognosis
  • mutation
A
  • older pts
  • enlarging neck mass -> compressive sxs
  • very poor
  • TP53
47
Q

Hypo-parathyroidism

  • caused by
  • sxs
  • Chvosteck sign
  • Trosseau sign
  • pseudo 1A: genetics, pathogenesis, sxs, inherited from
  • pseudo-pseudo: what is it, inherited from
A
  • injury to parathyroid glands or their blood supply
  • hypocalcemia, tetany, hyperphosphatemia
  • tapping of facial n causing contraction of facial muscles
  • occlusion of brachial a w/ BP cuff causing carpal spasm
  • auto dom, inactive Gs protein causing kidney and bone resistance to PTH; hypocalcemia despite high PTH; shortened 4th and 5th digits, short, obese, developmental delay, inherited from mother and caused by imprinting
  • auto dom, features of albright hereditary osteodystrophy (above findings) w/o PTH resistance and normal Ca levels; inherited from father but normal maternal allele maintain response to PTH
48
Q

Hyperparathyroidism

  • primary: caused by; labs; sxs
  • secondary: caused by, labs
  • tertiary: caused by, labs
A
  • due to parathyroid adenoma or hyperplasia; hyper Ca, calciuria, hypophosphatemia, high PTH; asymptomatic
  • secondary hyperplasia due to decrease in Ca absorption and/or increase in PO4 in CKD; hypo Ca w/ hyper PO4]
  • Refractory hyperparathyroidism from CKD, high PTH and Ca
49
Q

Familial hypocalciuric hypercalcemia

  • what is it
  • sequalae
  • labs
A
  • defective G coupled Ca sensing receptors in multiple tissues, specifically parathyroid and kidneys
  • higher than normal Ca levels required to suppress PTH
  • Excessive renal reabsorption causing hypercalcemia w/ normal PTH levels
50
Q

Hypopituitarism

  • what is it
  • non secreting pituitary adenoma: what is it
  • sheehan syndrome: what is it; pathogenesis; sxs
  • empty sella syndrome: what is it; cause; associated with
  • pit apoplexy: what is it; associated with; sxs
  • TX
A
  • undersecretion of pit hormone
  • cancer in the pituitary gland that renders it unable to do its job
  • ischemic infarct of pituitary following postpartum bleeding -> pituitary increases in size during pregnancy because of increase in hormones and since it is normally fed through a plexus it is already low in blood flow so when postpartum bleeding occurs it is one of first areas to become ischemic; failure to lactate, absent mensturation, cold intolerance
  • atrophy or compression of pituitary; idiopathic; idiopathic intracranial hypertension
  • sudden hemorrhage of pit; existing pit adenoma; sudden onset severe headache, visual impairment, diplopia
  • hormone replacement therapy
51
Q

Acromegaly

  • what is it
  • caused by
  • sxs: tongue, voice, hands/feet, face, sweat
  • DX
  • tx
A
  • excess GH in adults
  • pit adenoma
  • large tongue, deep voice, large hands and feet, coarsening of facial features w/ age, frontal bossing, diaphoresis
  • increased serum IGF-1 and failure to suppress GH w/ oral glucose tolerance test; pit mass seen on MRI
  • pit adenoma resection and octreotide
52
Q

Laron Syndrome

  • genetic
  • caused by
  • labs
  • sxs
A
  • AR
  • defective GH receptors -> decreased linear growth,
  • high GH, low IGF1
  • short stature, small head circumference, saddle nose and prominent forehead, small genitals
53
Q

Syndrome of inappropriate ADH

  • what is it
  • causes
  • labs
  • pathogenesis of labs
  • tx
A
  • ADH being secreted when its not supposed to be
  • ectopic ADH, CNS disorder, pulm dx, drugs (cyclophosphamide)
  • hyponatremia with continued urinary excretion of Na and urine osmolality > serum osmolality
  • increase in water causes decrease in ADH and increase ANP -> increases Na excretion
  • cerebral edema and seizures
  • fluid restriction, salt tablets, IV hypertonic saline, diuretics, ADH antagonist; must be corrected slowly to avoid osmotic demyelination syndrome
54
Q

Diabetes Insipidus

  • what is it
  • central: what is it, causes
  • nephrogenic: what is it, causes
  • labs
  • water deprivation test: central vs nephrogenic
  • TX: central, nephrogenic
A
  • inability to concentrate urine caused by problems with ADH
  • central: unable to produce ADH; pit tumor, AI, trauma, surgery
  • nephrogenic: ADH unable to bind on CT of kidney; hereditary, secondary to hyper Ca, hypo K, lithium
  • urine gravity and urine osmolality are low, serum osmolality is high
  • C: > 50% increase in urine osmolality after ADH analog given; N: minimal change in urine osmolality
  • C: Desmopressin and hydration; HCTZ, indomethacin, hydration, salt restriction
55
Q

Diabetes mellitus

  • sxs
  • small vessel complications
  • large vessel complications
  • dx
A
  • polydipsia, polyuria, polyphagia, weight loss, DKA (I)
  • diffuse thickening of basement membrane -> retinopathy, glaucoma, nephropathy
  • atherosclerosis, CAD, peripheral vascular occlusive dx -> gangrene and high incidence of MI
  • HgbA1C greter than 6.5, fasting glucose over 126, 2 hr oral glucose tolerance over 200
56
Q

Type I vs Type II DM

  • primary defect
  • insulin in tx
  • age
  • obesity
  • genetic
  • glucose intolerance
  • insulin sensitivity
  • ketoacidosis
  • beta cell number in islets
  • serum insulin levels
  • histo
A
  • primary cause - 1: AI destruction of beta cells; 2: increased resistance to insulin w/ progressive pancreatic beta cell failure
  • insulin tx - 1: always; 2: sometime
  • age - 1: < 30 yrs, 2: > 40 yrs
  • obesity - 1: no; 2: yes
  • genetic - 1: relatively weak; 2: relatively strong
  • gluc intol - 1: severe, 2: mild to moderate
  • insulin sen - 1: high, 2: low
  • DKA - 1: common, 2: rare
  • B cell - 1: low, 2: variable
  • serum - 1: low, 2: variable
  • hist - 1: islet leukocyte infiltration, 2: Islet amyloid deposits
57
Q

DKA

  • caused by
  • occurs in
  • sxs
  • labs
  • sequlae of labs
  • complications
  • TX
A
  • excess fat break down causing increase in ketoacids made
  • type I DM
  • Delirium/ psychosis, kussmaul respirations, abd pain, dehydration, fruity breath
  • hyperglycemia, high H, low HCO3, high ketones in blood and urine
  • K starts being switched out for H intracellularly to help with acidosis -> increase in K levels causes increase in excretion of K -> causes decreased overall K levels
  • cardiac arrythmias, heart failure
  • IV fluids, IV insulin, and K+, glucose to prevent hypoglycemia
58
Q

Hyperosmolar hyperglycemic state

  • what is it
  • epi
  • pathogenesis
  • sxs
  • w/o tx
  • labs
  • tx
A
  • state of profound hyperglycemia induced dehydration and high serum osmolality
  • elderly Type 2 DM, unable to drink much
  • hyperglycemia -> excessive osmotic diuresis -> dehydration
  • thirst, polyuria, lethargy, focal neuro deficits
  • coma/death
  • hyperglycemia and high serum osmolality w/o acidosis
  • aggressive IV fluids and insulin therapy
59
Q

MEN 1

  • organs involved
  • mutation
A
  • pituitary (prolactin or GH), pancreas (zollinger-ellison syndrome, insulinoma, VIPoma), parathyroid adenoma
  • MEN1 (menin on chrom 11)
60
Q

MEN 2A

- organs involved

A
  • parathyroid hyperplasia, medullary thyroid (parafollicular C cells -> secrete calcitonin), pheochromocytoma (catecholamines)
  • mutation in RET
61
Q

MEN 2B

  • organs involved
  • associated w
  • mutation
A
  • thyroid, pheochromocytoma, mucousal neuroma
  • marfanoid habitus
  • RET gene
62
Q

Diabetic Injectables

  • Insulin preparation: MOA (liver, muscle, fat); side effect
  • Amylin Analog: MOA
  • GLP-1 analog: MOA
A
  • bind insulin receptor -> liver and muscle stores glucose, fat stores TG; hypoglycemia, lipodystrophy, hypersensitivity
  • decrease glucagon release, decrease gastric emptying, increase satiety; hypoglycemia
  • decrease glucagon release, decrease gastric emptying, increase glucose dependent insulin release; nausea, vomiting, pancreatitis, weight loss
63
Q

Insulin preparation

  • rapid acting: name and peak
  • short acting: name and peak
  • intermediate acting: name and peak
  • long acting: name and peak
A
  • Lispro, aspart, glulisine; 1 hr peak
  • regular; 2-3 hr peak
  • NPH: 4-10 hr peak
  • detemir, glargine; no real peak
64
Q

Diabetic oral drugs

  • biguanides
  • sulfonylureas
  • meglitinides
  • DPP4 inhibitors
  • glitazone
  • Na- gluc cotransporter inhibitor
  • alpha glucosidase inhibitors
A
  • inhibit hepatic gluconeogenesis and action of glucagon
  • close K channel in pancreatic beta cell membrane -> cell depolarizes -> insulin release via increase in Ca influx; 1 - chlorpropamide, tolbutamide; 2 - glimepiride, glipizide, glyburide
  • same as sulfonylureas; nateglinide, repaglinide
  • inhibit DPP-4 enzyme that deactivates GLP-1 -> decrease glucagon release and gastric emptying while increasing glucose dependent insulin release; linagliptin, saxagliptin, sitagliptin
  • activate PPAR - gamma -> increase insulin sensitivity and levels of adiponectin -> regulates glucose metabolism and fatty acid storage; pioglitazone, rosiglitazone
  • block reabsorption of glucose in PCT; canagliflozin, dapagliflozin, empagliflozin
  • inhibit intestinal brush border alpha glucosidases -> delayed carb hydrolysis and glucose absorption -> decreased postprandial hyperglycemia; acarbose, miglitol
65
Q

Thionamide

  • MOA
  • indication
  • med first tri-mester vs 2nd and 3rd
A
  • block thyroid peroxidase -> inhibit oxidation of iodide -> inhibit thyroid hormone synthesis
  • hyperthyroidism
  • propylthiouracil and then methimazole
66
Q

Levothyroxine

  • MOA
  • indication
  • abused
A
  • thyroid hormone replacement
  • hypothyroid, myxedema
  • can be abused for weight loss
67
Q

Hypothalamic/pit drugs

  • ADH antagonist
  • desmopressin
  • GH
  • oxytocin
  • somatostatin analog
A
  • block activation of ADH at V2 receptor; SIADH; conivaptan, tolvaptan
  • Central DI
  • GH deficiency, turners syndrome
  • labor induction
  • acromegaly
68
Q

Demeclocycline

  • MOA
  • indication
  • adverse effects
A
  • ADH antagonist
  • SIADH
  • Nephrogenic DI
69
Q

Fludrocortisone

  • MOA
  • indication
A
  • synthetic analog of aldosterone w/ little glucocoticoid effects
  • mineralcorticoid replacement in primary adrenal insuff
70
Q

Cincacalcet

  • MOA
  • indication
A
  • sensitizes Ca sensing receptor in parathyroid gland to circulating Ca -> decrease PTH
  • secondary hyperparathyroidism in CKD, hyper CA in primary hyperparaythyroidism
71
Q

Sevelamer

  • MOA
  • indication
A
  • nonabsorbable phosphate binder that prevents phosphate absoprtion from the GI tract
  • hyperphosphatemia in CKD

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