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Endocrinology Flashcards

1
Q

What is the function of LH

A

Testis: Releases T
Ovary: Androgens and Progesterone

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2
Q

What is the function of FSH

A

Male: Sperm, MIF Inhibin B
Female: Estradiol (E2)

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3
Q

What is Central DI?

A

Brain doesn’t produce enough ADH

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4
Q

What is nephrogenic DI?

A

ADH receptor (Aqp V2) broken
Li and Demeclocycline

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5
Q

What does the water deprivation test tell you?

A

Failing to concentrate urine means pathology (not primary DI / drinking too much water)

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6
Q

What does DDAVP during the water deprivation test tell you?

A

More than 50% increase: Central complete DI
10-50%: Central partial DI
Less than 10%: psychogenic polydipsia
No change: Nephrogenic DI

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7
Q

What does ANP do?

A

Inhibits aldosterone
Dilates Afferent Arteriole

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8
Q

Presentation of Neuroblastoma

A

Dancing eyes and feet
Adrenal medulla tumor in kids that secretes catecholamines

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9
Q

Conn’s Syndrome

A

High Aldosterone from primary tumor
Captopril test makes it worse (increases secretin)

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10
Q

MEN 1

A

Parathyroid (Hyper-Ca++)
Pancreas (Z-E)
Pituitary (Prolactinoma)

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11
Q

MEN 2a

A

Parathyroid
Pheochromocytoma
Medullary Thyroid CA (RET)

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12
Q

MEN 2b

A

Pheochromocytoma
Medullary Thread CA (RET)
Mucosal Neuromas
Marfanoid body

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13
Q

What does CCK do?

A

Contracts gallbladder to release bile
Inhibits gastric motility
Made by I-Cells of Duodenum

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14
Q

What is Cushings?

A

High ACTH causing high cortisol
Primary pituitary tumor or Small Cell Lunch CA

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15
Q

What does a Low-Dose Dexamethasone test tell you?

A

Depresses ACTH and therefore cortisol? Not Pathology
No suppression? Cushing’s syndrome. Do High dose.

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16
Q

What does a High-Dose Dexamethasone test tell you?

A

Depresses ACTH and therefore cortisol? Pituitary (ACTH) Tumor / Cushing’s Disease
Still high cortisol but ACTH lowered? Adrenal Tumor secreting cortisol
Still high cortisol and ACTH high? Ectopic ACTH

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17
Q

What does Gastrin do?

A

Stimulates Parietal cells to release Intrinsic factor and H+

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18
Q

Achondroplasia

A

Abnormal FGF receptors in extremities (FGF3)

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19
Q

Pathology of “midgets”

A

Decreased Somatomedin receptor sensitivity

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20
Q

What does GIP do?

A

Gastric Inhibitory Peptide
Increases insulin action
Responsible for post-prandial hypoglycemia

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21
Q

Abs responsible for DM1

A

Anti-islet cell / GAD (Glutamic Acid Decarboxylase)

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22
Q

Dawn phenomenon

A

Morning hyperglycemia secondary to Growth hormone

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23
Q

Somogyi Effect

A

Morning hyperglycemia from evening hypoglycemia

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24
Q

Erythrasma

A

Rash in the skin folds, coral red under Wood’s lamp

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25
What does Motilin do?
Stimulates segmentation, primary peristalsis, migrating motor complexes
26
What does PTH do?
Stimulates osteoblasts to activate osteoclasts Stimulates reabsorption of Ca+ and exertion of phosphate from kidneys Activates Vit D
27
What do stomach chief cells secrete?
Pepsin
28
Disease: Serum Ca+ and Serum PO4 are decreased
Vitamin D deficiency
29
Pseudo-Hypoparathyroidism
Bad kidney, PTH receptor, decreased urinary cAMP
30
Pseudo-Pseudo-Hypoparathyroidism
G-Protein defect, no calcium problem
31
Hungry bone syndrome
Removal of PTH causes bones to suck up calcium
32
What does secretin do?
Secretion of HCO3- Inhibits Gastrin Tightens Pyloric sphincter Secreted by S-Cells of Duodenum
33
What does somatostatin do?
Inhibits secretin, motilin, CCK
34
Hyperthyroid diseases
Graves, DeQuervians, Silent, Plummer's, Jod-Basedow
35
What do you see in Grave's?
Exophthalmos, pre-tibial myxedema, anti-TSH Abs
36
DeQuervian's disease
Viral origin, painful jaw, hypothyroid
37
Jod-Basedow
Transient hyperthyroidism from increased Iodine
38
Euthyroid Sick
Low T3, decreased conversion from T4 From decreased Deiodinase activity Normally from acute or chronic conditions
39
Wolff-Chaikoff
Transient Hypothyroidism
40
Plummer's Syndrome
Hyperthyroid Adenoma + Esophageal webs = Vinson
41
Sub-clinical thyroiditis
Decreased thyroid function Increased TSH, NORMAL T4 Mild Sx like increased LDL
42
What does TPO and Thymosin do?
Helps T cells mature
43
What does VIP do?
Opens sphincters Inhibits secretin, motilin, CCK
44
Hashimoto's thyroiditis Ab
Anti-Microsomal and Anti-TPO
45
Indications for Insulin
DM, Hyperkalemia, Stress-induced hyperglycemia, gestational DM
46
Rapid acting insulins
Aspart, Lispro, Glulisine
47
Long-Acting insulins
Detemir, Glargine (also Ultralente, Zinc, Protamine)
48
Sulfonylurea MOA
Closes K+Channels in b-Cells so K can't get out making Ca+ come in. This depolarizes it for the release of more endogenous insulin
49
First gen sulfonylureas
Chlorpropramide and Tolbutamide AE: Disulfiram-like rxn
50
Second gen sulfonylureas
Glyburide Glimepiride Glipizide
51
MOA of Biguanides
Decreased Gluconeogenesis Increased Glycolysis Increased peripheral glucose uptake (insulin sensitivity)
52
AE of biguanides
Lactic Acidosis (C/I in RF pts, stop when using contrast)
53
MOA of Thiazolidinediones
PPAR-y increased, more insulin influx from more channels
54
a-Glucosidase inhibitors
Inhibits it on intestinal brush border Delays sugar hydrolysis and glucose absorption Decreases post-prandial hyperglycemia Acarbose and Miglitol
55
KPP-4 Inhibitors
This is the enzyme that deactivates GLP-1, so therefore GLP-1 gets increased -Gliptins
56
Mimetics
Decreases glucagon Pramlintide
57
GLP-1 Analogs
-tides (exanetide, liraglutide) WEIGHT LOSS, pancreatitis
58
Octreotide
Somatostatin analogue Decreases release of GH, Gastrin, CCK, Carcinoid, VIP, Glucagon, Insulin
59
Indications for octreotide
Acromegaly, Carcinoid syndrome, glucagonoma, insulinoma
60
Oxytocin
Induces labor Controls Uterine hemorrhage
61
Desmopressin
aka DDAVP aka ADH Recruits water channels to luminal membrane in collecting duct Anti-diuresis, Central (pituitary) DI
62
PTU, Methimazole
Inhibits peroxidase enzyme in Thyroid and decreases thyroid hormone synthesis Agranulocytosis
63
Demeclocycline
ADH antagonist Used for SIADH AE: Nephrogenic DI, photosensitivity, bone abnormalities
64
Cinacalcet
Sensitize Ca+ receptor in Parathyroid Used for Primary hyperparathyroidism or RF
65
Sevelamer
Phosphate binder: prevents PO4 absorption in gut Used for CKD
66
Steroids and the Cortisol pathway
Double negative: Inihibits cortisol's inhibition on precursors +CRH, +ACTH
67
Cushing's syndrome vs disease
Syndrome: many organs (primary Increased cortisol) Disease: 1 organ (Increased ACTH)
68
Labs of Cushing's
Hyperglycemia Hypokalemia Glucosuria Dexamethasone doesn't suppress
69
Treat Cushing's
Hydrocortisone (replacement) Ketoconazole (decreases cortisol synthesis) Mitotane (tx adrenal CA) Bisphosphonates Surgery (Transsphenoidal resection of pit. adenoma)
70
Bilateral Adrenalectomy
Causes Nelson's: Cortisol withdrawal HTN, DM
71
Pheochromocytoma
Episodic ER visits for NE/Epi Palpitations, HTN, diaphoresis, HA Dx w/ Urinary VMA, metanephrines, Phentolamine Tx w/ Phenoxybenzamine to stabilize until surgery
72
Dancing feet, dancing eyes
Neuroblastoma Like Pheo, Dx w/ urinary VMA, Metanephrines, Phentolamine Tx w Phenoxybenzamine until surgery
73
Dx Pheochromocytoma
VMA, metanephrines. Elevated? CT CT(-)? MIGB Scitntigraphy with MRI
74
What does Vit D do?
Produces Ca binding proteins Produces CaATPase Stimulates Osteoblasts (reduces serum Ca, good for bone)
75
Paget's Disease
Increased All Phos Tx w/ Bisphosphonates (inhibit osteoclasts)
76
Labs of Primary Hypo-Parathyroidism
Decreased PTH Decreased Ca++ Increased PO4-
77
Labs of Primary Hyper-parathyroidism
Increased PTH Increased Ca++ Decreased PO4-
78
Labs of Secondary Hyper-Parathyroidism
Renal Failure: Decreased Ca++, Increased PTH, PO4- X 1a-Hydrox: Decreased Ca++, PO4-, Increased PTH
79
Labs of Secondary Hypo-Parathyroidism
From increased Vitamin D Increased Ca++ and PO4- Decreased PO4-
80
Causes of secondary, tertiary hyper-parathyroidism
Chronic RF Renal osteodystrophy MEN
81
DEXA lab interpretation
Normal: Below 1 1-2.5: Osteopenia 2.5+: Oestoporosis
82
Cinacalcet
Fake / decoy Ca, binds to and decreases PTH
83
PTU, propranolol MOA
Inhibits 5' deiodonase, the thing that converts T4 to T3
84
DeQuervian (subacute) Thyroiditis
Viral, painful, Self-Limiting Reassurance, propranolol, Ipodate sodium
85
Anti-TPO Abs
Hashimoto
86
TSH receptor antibodies
Grave's
87
Tx amiodarone-induced thyroiditis
Propranolol, methimazole, prednisone, ipodate
88
Agranulocytosis
Methimazole, PTU Clozapine, carbamazepine
89
Cretinism
Maternal child cognitive impairment
90
myxedema coma
Decompensated hypothyroidism Give IV T3, Warm, O2, Abx
91
Papillary thyroid cancer
Young people Psammoma bodies, Orphan Annie eye nuclear inclusions
92
Follicular Carcinoma
Old people Mutations in RAS
93
Medullary carcinoma
From the parafollicular cells (C cells) produce Calcitonin Inhibited by GLP-1 RET mutation
94
Anaplastic carcinoma
Old people Lymphovascular invasion Death within 1 year
95
Radioactive iodine uptake
Graves is uniform Vinson is heterogenous
96
Nesidioblastosis
Infants w/ high insulin tx w/ diazoxide
97
Criteria for DM
Fasting over 126 2 hour test over 200 A1c over 6.5
98
Somogyi
Too much PM insulin Hyperglycemic AM, becomes hypoglycemic
99
Waning (DAWN)
From too little insulin Hyperglycemic AM, remains hyperglycemic
100
Meglitinide analogs
Repaglinide, Mitiglinide Block K+, like sulfonylureas
101
Theca Cells
Ovary Stimulated by LH Secretes Androgens
102
Granulosa Cells
Ovary Stimulated by FSH Secretes inhibin (negative feedback) and aromatase Dies in menopause
103
Leydig Cells
Testicular Stimulated by LH Secretes T
104
Sertoli Cells
Testicular Stimulated by FSH Secretes Inhibin B, Sperm, Mullein Inhibin Factor
105
Central DI
Low ADH secretion Head trauma, tumor, surgery DDAVP concentrates urine Get an MRI
106
Nephrogenic DI
ADH receptor broken DDAVP doesn't help Give Amiloride to get rid of Li Give HCTZ to replace Aquaporins Switch to Valproic Acid
107
Null-Cell adenoma
Non-functional pituitary adenoma
108
Acidophilic Adenoma
Pituitary tumor that stains pale pink Secretes growth hormone
109
Basophilic Adenoma
Pituitary tumor stains pale blue with basic dyes Secretes adrenocorticotrophic hormone
110
Cosyntropin
Synthetic ADH, tests adrenal function
111
Treat adrenal insufficiency
Hydrocortisone and D50W now Test for ACTH, cortisol
112
Captopril challenge
Increase in HTN means hyperaldosteronism, CONN's
113
Labs of Conn's
HTN Hypokalemia Increased Aldo, low renin
114
17 a-hydroxylase deficiency
HTN (high aldosterone) Hypokalemia Low cortisol, sex steroids
115
21 a-hydroxylase deficiency
High Androgens Hypotension (low aldosterone) Low cortisol Buildup of 17 a-hydroxylase
116
11 b-hydroxylase deficiency
High androgens HTN Low renin / aldosterone, cortisol Buildup of 11-deoxycortisone
117
Weight changes with DM medications
GLP-1 Analogues: Weight Loss Thiazolinadiones: Weight Gain

Clues (14 decks)

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