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HD 3 > Endocrine - to midterm > Flashcards

Endocrine - to midterm Flashcards

0
Q

3 questions to always ask about pituitary tumors

A
  1. Functional (makes hormones)?
  2. Mass effects?
    (ie: bitemporal hemianopsia or erosion into sinuses)
  3. Production of other hormones affected?
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1
Q

Types of Hormone Receptors

A
  1. Cell Membrane Rs: amt hormone => response size

2. Cytoplasmic/Nuclear Rs: #Rs => response size

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2
Q

Common causes of hyperprolactinemia

A
  1. prolactinoma (in pituitary, often large)
  2. pituitary stalk damage
  3. chest wall trauma
  4. kidney failure
  5. drugs (esp. antipsychotics)
  6. hypothyroidism (=> high TRH)
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3
Q

Treatment for hyperprolactinemia

A

1. dopamine agonist –> decreases secretion AND shrinks prolactinomas!

  1. surgery if unresponsive
    * none if mild
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4
Q

metabolic consequences of GH-producing pituitary tumors

A
  1. excess DNA, RNA & protein synth
  2. FA mobilization
  3. insulin resistance (use fat more than glucose)
    * irreversible bone changes
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5
Q

Diagnosis for acromegaly

A

high IGF-1 & GH >1ug after oral glucose load,
Xrays (skull, hand, feet)
Pituitary MRI or CT

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6
Q

Iodine deficiency

  • where?
  • why does it matter?
A
  1. low iodine in soil @ places far from ocean (comes down in rain)
  2. need iodine for thyroid hormone synthesis (100ug/day)
    (thyroglobulin + tyrosine + Iodine => T4 & T3)
    *TSH binding to THR increases thyroid uptake of Iodine!
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7
Q

Function of T3 hormone

A

(binds to TRE –> histone acetylation –> activate transcription)

  1. Metabolic:
    - increase O2 consumption, heat production
    - increase metabolic rate (ie: food, drugs, anesthesia)
    - increase protein/fat/cholest. synth & degrad.
  2. increase SNS tone
  3. normal brain dvpt in infants (need!)
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8
Q

Congenital Hypothyroidsim

A

= Cretinism, due to failed thyroid dvpt.

Sx: lethargy, mental retardation, failure to grow/feed/gain weight

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9
Q

Adult hypothyroidism

A

Thyroid hormone deficit,
Causes: autoimmune, thyroid damage (radioactive I, surg, drugs); low TSH (secondary)
Sx: fatigue, cold intolerance, low HR/contractility, HTN, infertility, slow reflex relaxation

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10
Q

Thyrotoxicosis

A

too much thyroid hormone
(due to hyperthyroidism or thyroiditis)
Sx: heat intolerance, weight loss, stare & proptosis, high HR, A-fib., tremor

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11
Q

Grave’s disease

A

familial, autoimmune stimulation of thyroid; 10x F>M.
* most common cause of hyperthyroidsim
Dx: high radioiodine uptake, low TSH, high T3/T4

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12
Q

Treatment for hyperthyroidism

A
  1. radioactive iodine
  2. anti-thyroid hormone drugs (methimazole, PTU)
  3. surgery (only if Large goiters, bleeding, etc.)
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13
Q

Thyroiditis

A

destruction of thyroid follicle epithelial cells
=> initially thyrotoxic bc leak T3/T4, but then hypothyroid bc damaged.
Causes: viral, autoimmune, radiation, drugs (amiodarone, iodine)

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14
Q

Aldosterone secretion stimulated by:

A
  1. Angiotensin II (from RAAS)
  2. Renin (low Na delivery to distal conv. tubule)
  3. SNS activity
  4. K+ & ACTH
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15
Q

Effects of Cortisol

A
  1. metabolic: promote gluconeogen & liver glycogen storage
    • -> insulin resistance, weight gain (stim. appetite)
  2. anti-inflammatory
  3. mineralcorticoid (retain Na+)
16
Q

Effects of aldosterone

A
  1. retain Na+ (mineralcorticoid)

2. increase excretion of K+ & H+ (in urine)

17
Q

effects of DHEA

A
  1. maintains axillary & pubic hair,
    * normal levels decrease w/ increasing age
    * deficit => female virilization
18
Q

Adrenal insufficiency (Dx, Tx)

A

= cortisol deficit
Dx: ACTH stim test (<18)
Tx: Cortisol

19
Q

Primary vs. Secondary adrenal insufficiency

causes & signs

A

Primary: adrenalitis, TB, carcinoma met or adrenal hemorrhage
- high ACTH, low cortisol; hyperpigmentation.
Secondary: pituitary trauma/postpart. apoplexy, tumor/radiation
- low ACTH & cortisol; pallor.

20
Q

Cushing’s Syndrome (causes, Sx)

A

Excess cortisol;
Causes: adrenal adenoma/carcinoma, ACTH-prod. pituitary tumor
Sx: weight gain/round face, HTN, amenorrhea, hirsutism, growth retardation (in kids only)

21
Q

Cushing’s Syndrome Dx & Tx

A

= excess cortisol.
Dx:
- Screen: bedtime salivary cortisol, 24 hr urine free cortisol, overnight dexamethasone suppression test (am plasma cort.>2)
- Localize: plasma ACTH, high dose dexameth. suppression test
Tx:
- surgery (adrenal tumor) - pasireotide (pit. tumor)
- decrease dose (exog. glucocorticoids)

22
Q

primary hyperaldosteronism

A

excess aldosterone production ==> HTN
Causes: adrenal adenoma or bilat adrenal hyperplasia (rare)
Dx: plasma Aldosterone/Renin activity RATIO >30
Tx: surgery (if adenoma), Spironolactone (if hyperplasia)

23
Q

Congenital Adrenal Hyperplasia

A

bc 21-hydroxylase deficiency => Low cortisol synth.
Dx: serum 17-hydroxyprogesterone
Tx: replacement doses of cortisol (or prednisone, dexamethasone)

24
Q

Pheochromocytoma

A

tumor of adrenal medulla that secretes catecholamines
Sx: SNS activation – tremor, high HR, palpitations, sweating, etc.
Dx: urine or plasma metanephrines
Tx: surgical excision

25
Q

Familial combined hyperlipidemia

A

excess ApoB produced by liver
=> varied presentation in family & individual over time
(high TG, high cholesterol OR both)

26
Q

Familial hypercholesterolemia

A

AD => LDL R mutation bc over-expressed enzyme
High risk:
severe hypercholesterolemia, tendinous xanthomas, atherosclerosis

27
Q

familial hypertriglyceridemia

A

defective ApoC or deficit of LPL (lipoprotein lipase)

–> strong familial trend of high TGs

28
Q

Remnant Disease

A

defective ApoE = reduced clearance by remnants & LDL Rs

29
Q

physical exam signs of hyperlipidemia (5)

A
  • corneal arcus (choles., age milky retinal blood vessels)

- central obesity

30
Q

how to Dx hyperlipidemia

A

fasting TG and LDL, HDL, & total cholesterol…

a) TG < 400: LDL = total - (HDL + TG/5) (*TG/5 = VLDL)
b) TG > 400: non-HDL chol. = total - HDL
* refer to treatment guidelines for Dx values

31
Q

When to start treatment for hyperlipidemia

A

Start treatment with a statin IF…

a) known CV disease
b) LDL =190+
c) LDL = 70-189 & DM & age 40-75
d) LDL = 70-189 & 10 yr CV risk > 7.5% (no DM)

32
Q

Drugs that cause overproduction of lipids

A
  • EtOH
  • diuretics
  • beta blockers
  • steroids
  • retinoic acid
  • HIV drugs
33
Q

Diseases that associated with secondary hyperlipidemia

A

Over-production: diabetes, liver disease, nephrotic syndrome

Under-excretion: Renal failure, hypOthyroidism

34
Q

ApoE (where? why?)

A 
on remnants (not LDLs), = LDL remnant R ligand
*mutated in Remnant Disease
35
Q

ApoCII (where, why?)

A

on chylomicrons coming from liver,
= LPL cofactor! (needed for breakdown)
*mutated in familial HyperTGemia

36
Q

ApoB100

A

on liver LDLs,
1 ApoB per particle OTHER than HDL
=> if high = high # particles; low = fewer, large particles.
*mutated in familial hyperCHOLesterolemia

37
Q

ApoA1

A

on HDLs

–> tag for heading back to liver for recycling

HD 3 (8 decks)

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