Endocrinology Flashcards
(257 cards)
1
Q
What are the hormones released by the anterior pituitary?
A
- ACTH, adrenocotropic hormone
- PRL Prolaction
- GH Growth Hormone
- LH Luteinizing Hormone
- FSH Follicle-Stimulating Hormone
- TSH Thyroid Stimulating Hormone
2
Q
What are the hormones released by the posterior pituitary?
A
- Anti-diuretic homone (ADH) vasopressin
- Oxytocin
3
Q
What is the function of Oxytocin?
A
1 uterine contraction during delivery
2 enhances breast milk flow
3 behavior, memory, sperm transport
4
Q
What is the function of LH (leutinizing hormone)?
A
-regulates gonadal function
5
Q
What is the function of LH in men?
A
-stimulates testosterone production
6
Q
What is the function of LH in women?
A
- stimulates estrogen and progesterone production from the ovary
- mid-menstrual cycle causes ovulation
7
Q
When is LH increased in women?
A
-during the follicular phase
8
Q
What is the function of Follicle-Stimulating hormone (FSH) in men?
A
-stimulates testicular growth
9
Q
What is the function of FSH in females?
A
-develops ovarian follicle
10
Q
What does prolactin stimulate?
A
-stimulates lactation in the postpartum period
11
Q
What does Hyperprolactemia do in men?
A
- decreased testosterone synthesis
- decreased libido
- decreased spermatolgenesis
12
Q
What does Hyperprolactemia do in women?
A
- hypogonadism
- anovulation
- amenorrhea
- infertility
13
Q
What is the function of TSH?
A
-stimulates the thyroid to produce T3/T4
14
Q
What does a pituitary adenoma do to pituitary function?
A
-most common cause of hypothalamic-pituitary disfunction
15
Q
What are the types of pituitary adenoma?
A
-Prolactinomas are the most common
- Microadenoma < 1cm in diameter
- Macroadenoma > 1cm in dameter
16
Q
What is the Tx for a pituitary adenoma?
A
- transsphenoial microsurgery
- radiation
- medical Tx: *Bromocriptine for prolactinoma
17
Q
What is the most common cause of hyperprolactinemia?
A
-Prolactinoma (a pituitary adenoma)
18
Q
What are the other causes of hyperprolactinemia?
A
- pregnancy
- hypothyroidism
- renal failure
- cirrhosis
- chronic nipple stimulation–nipple piercing
- drugs: OC, tycyclic antidepressants, cimetidine
19
Q
What are the S/Sx of hyperprolactinemia?
A
Galactorrhea, Infertility (Galactorrhea is excessive or inapropriate production of milk)
—Male Gonadal dysfunction
erectable dysfunction
decreased libido
gynocomastia
–Female Gonadal dysfunction
oligomenorrhea
amenorrhea
20
Q
What other things need to be ruled out when a lab of hyperprolactinemia is found?
A
- pregnancy
- hypothyroidism
- renal failure
- cirrhosis
21
Q
How is a prolactinoma Dx?
A
MRI of pituitary and hypothalamus
22
Q
What is the Tx for hyperprolactinemia?
A
1 Dopamine Agonists: initial choice
Bromocriptine* fatigue, N, dizziness
orthostatic hypotension
Capergoine : more potent, longer acting,
better tolerated
2 Surgery : transsphenoidal pituitary surgery
3 Radiation
23
Q
When does Acromegaly occur?
A
occurs after the closure of epiphyses
24
Q
When does Giantism?
A
occurs before the closure of epiphyses
25
What is the etiology of Acromegaly & Giantism?
-almost always due to a pituitary adenoma
26
What are the characteristics of Acromegaly & Giantism?
-Excessive growth of hands, feet, cranium, jaw internal organs
- increased glove/ring size, increased shoe width
- protrusion of the lower jaw
- increased hat size
27
What are the S/Sx of Acromegaly and Giantism?
- overgrowth of bone & soft tissue overgrowth
- doughy hands and moist handshake
- carpal tunnel syndrome : parathesias
- deeper voice
- facial features coarsen
- tooth space widens
- macroglossia
- hypertension
- cardiomegaly
- diabetes mellitius: insulin resistance
- headaches
28
What are the lab findings for Acromegaly and Giantism?
-evelvated GH > 10ng/ml
29
What are the radiographic/MRI findings with Acromegaly and Giantism?
-MRI will show pituitary tumor
30
What is the Tx for Acromegaly & Giantism?
- -surgery : transphenoidal pituitary microsurgery
- -medical : ****Octreotide****especially if acromegaly persists after surgery
- -Radiation
31
What are the 2 types of Dwarfism?
-Pituitary and Achondroplasia
32
What is pituitary dwarfism?
-short stature with proportional parts due to deficiency of growth hormone
33
What is Achondroplasia dwarfism?
- 70 % of dwarfism with limbs being disproportionally short compared to the trunk
- autosomal dominant disorder with a faulty allele
34
What is the height of a dwarf?
-adult height under 4 feet 10 inches
35
Where does ADH (vasopressin) originate?
-ADH/vasopressin is produced by the hypothalamus but is stored and secreted in the posterior pituitary gland
36
What are the effects of ADH/vasopressin?
- regulates the body's retention of water by conserving water and concentrating the urine
- causes moderate vasoconstriction in high doses
37
What stimulates ADH/vasopressin?
-Angiotension II
38
What is the antagonist of ADH/vasopressin?
Ethanol
39
What is Diabetes Insipidus?
-deficiency of vasopressin causing increased thirst and large quantities of urine with low specific gravity
40
What is the Etiology of Diabetes Insipidus?
****Vasopressin Deficiency******
41
What are the causes of vasopressin deficiency?
- tumor
- trauma
- infection
- last trimester of pregnancy
- renal failure
- pylonephritis
- myeloma
- potassium depletion
- sickle sell anemia
- sorgrens's syndrome
- chronic hypercalemia
-Drug induced
42
What drugs cause vasopressin deficiency?
* ***Lithium*****
- demeclocycline
- foscarnet
- methicillin
43
What are the S/Sx of Diabetes Insipidus?
- Intense thirst, especially for ice water
- Polyuria : 2-20L per day
- Dehydration
44
What are the Lab finding with Diabetes Insipidus?
- Hypernatremia
| - Hyperuricemia
45
How is Diabetes Insipidus Dx?
- MRI
| - Vasopressin Challenge Test
46
What is the differential for polyuria?
- Cushing's syndrome
- steroid Tx
- lithium
- Parkinson's Disease
47
What is the Tx for Diabetes Insipidus?
Desmopressin
48
What is SIADH?
Syndrome of Inappropriate Antidiuretic Hormone (caused by excess Vasopression/ADH)
49
What causes SIADH?
excess vasopressin
50
What is the etiology of SIADH? What causes excessive vasopressin/ADH?
Ectopic production of vasopression (cancer)
51
What are the type of cancer that cause the Ectopic production of vasopression?
- Bronchogenic carcinoma
- carcinoma of duodenum
- carcinoma of pancreas
- uterine carcinoma
- prostate cancer
- bladder cancer
52
Which drugs induce SIADH?
- Desmopression
- oxytocin
- carbamazepine
- ecstasy
- SSRI
- TCA's
- MAOI
53
What pulmonary disorders cause SIADH?
- pneumonia
| - Tuberculosis
54
What are the Clinical Criteria for SIADH?
- increased sodium excretion
- increased osmolality
- Inappropriate concentrations of the urine
- Clinical euvolemia
55
What are the S/Sx of SIADH?
*****Hyponatremia****
56
What is the Tx for SIADH?
- Discontinue hypotonic fluids
- restriction of free water
- Hypertonic NaCl (3%0
- IV Conivaptan (Vaprisol) : blocks the effects of vasopressin of the V2 receptor agonists in the kidney
57
What is the etiology of Grave's Disease?
Grave's disease is autoimmune (90%) causing the thyroid to produce too much T4
58
What type of disorder is Graves' Disease?
- hyperthyroidism
| - autoimmune disorder with autoantibodies to TSH receptors
59
What are the other conditions associated with Graves' Disease?
- pernicious anemia
- myasthenia gravis
- diabetes mellitus
- Addison's disease
- celiac diseas
60
What are the Lab findings for hyperthyroidism?
- ****Decreased TSH****
- increased T4
- increased receptor antibody
- increased antithyrogrobulin
- increased ANA
- increased anti-double stranded DNA
- Radioactive iodine uptake and scan show high uptake
61
What are the symptoms of Graves' Disease?
- heat intolerance
- sweating
- weight loss
- increased appetite
- nervousness
- loose stools
- frequent urination
- muscle cramps
- irritability
- fatigue
- weakness
- dyspnea on exertion
62
What are the signs of Grave's Disease?
- Eye
- thyroid
- cardiac
- M/S
- Skin
63
What are the Eye PE finding with Graves' Disease?
- exophthalmos
- chemosis
- conjunctivis
- proptosis
64
What are the thyroid PE findings with Grave's Disease?
-goiter (enlarged thyroid) with bruit
65
What are the cardiac PE findings with Graves' Disease?
- palpitations
- sinus tachy
- ****Atrial Fibrillation****
66
What are the M/S physical exam findings with Graves' disease?
- fine resting tremor
| - hyperreflexia
67
What are the skin PE findings in Graves' Disease?
- warm moist skin
- fine hair
- onycholysis (separation of the nail from the nail bed
68
What is the Tx for Graves' disease?
- B-Blockers control symptoms
- Thiourea drugs (agranulocytosis)
- Methimazole
- Propylthiouracil--drug of choice in pregnancy and breast feeding women
-Radioactive iodine is preferred to surgery for permanent control (not in pregnancy)
-Surgery- larger goiters, malignancy
(often caused hypothyroidism)
69
What is the etiology of Hypothyroidism (Myxedma)?
- Hashimoto's throiditis
- Thyroid surgery
- radiation therapy
70
What are the S/Sx of Myxedema (Hypothyroidism)?
* ***Fatigue****
- lethargy
- anorexia
- constipation
- depression
- muscle stiffness
- memory impairment
- cold intolerance
- dry skin
- weakness
- weight gain
- ******hoarseness********
71
What are the Lab findings in Myxedema (hypothyroidism)?
- elevated TSH
- decreased T3/T4
- anemia
72
What is the lab finding in Hashimoto's ?
+ antithyroid peroxidase and antithyroglobulin antibidies
73
What is the Tx for Myxedema/hypothyroidism?
-Levothyroxine
74
Describe how thyroid cancer is characterized?
****painles mass : "Cold Nodule"***** on scan
75
What are the 4 types of thyroid cancer?
1 Papillary
2 Follicular
3 Medullary Carcinoma
4 Anaplastic Carcinoma
76
How prevalent is Papillary cancer of the thyroid?
- 76% of thyroid cancers
77
Which is the least aggressive of the thyroid cancer?
-Papillary thyroid cancer is least aggressive
78
What percentage of thyroid cancers is Follicular?
-16%
79
What percentage of thyroid cancers are Medullary Carcinoma?
-4% are medullary carcinoma of the thyroid
80
What factors are unique to Medullary Carcinoma of the thyroid?
- 1/2 is familial
- associated with MEN type 2 (hereditary condition associated with three primary types of tumors: medullary thyroid cancer, parathyroid tumors, and pheochromocytoma)
81
Describe Anaplastic Carcinoma?
- 1% of all thyroid carcinomas are Anaplasica
- Most aggressive of all thyroid carcinomas
- Worse prognosis
82
What is Thyrotoxic Crisis also known as?
-Thyroid Storm
83
Is Thyrotoxic Crisis/Thyroid Storm serious?
-it is life threatening
84
What are 3 times that Thyroid Storm/Thyrotoxic Crisis occurs?
1 following a stressful event
2 thyroid surgery
3 radioactive iodine
85
What are the S/Sx of Thyroid Storm/Thyrotoxic Crisis?
- high fever
- tachycardia
- vomiting
- diarrhea
- dehydration
- marked weakness
- muscle wasting
- extreme restlessness
- comfusion & emotional lability
86
What is the Tx for Thyroid Storm/Thyrotoxic Crisis?
- Beta Blockers
- Hydrocortisone
- supportive therapy
87
What secretes Calcitonin?
-calcitonin is secreted by the parafollicular C cells in the thyroid
88
What are the effects of Calcitionin?
* ***Decreases serum calcium****
| - does this by inhibiting osteoclastic bone resorption
89
What cancer conditions is a Lab draw for Calcitonin important?
****calcitonin**** is an important tumor marker in medullary carcinoma of the thyroid?
90
What are the therapeutic uses of calcitonin as an inhibitor of osteoclastic bone resorption?
- Paget's disease of the bone
- Hypercalcemia
- Osteoporosis
91
What are the effects of Parathyroid Hormone (PTH)?
* ***increases serum calcium****
| * ***decreases serum phosphorus****
92
What 3 organs does PTH effect?
- Bone
- Intestinal mucosa
- Kidney
93
What is the effect of PTH on Bone?
-releases calcium and phosporus
94
What is the effect of PTH on the Intestinal Mucosa?
-increases calcium reabsorption
95
What is the effect of PTH on the Kidney?
- increases production of Vitamin B
- increases reabsorption of calcium
- decreases reabsorption of phosphate & bicarbonate
96
What is Hyperparathyroidism?
-the excessive secretion of PTH producing frank hypercalcemia
97
Is hyperparathyroidism seen more in men or women?
2-3 x more common in women
98
What is the etiology of hyperparathyroidism?
- single parathyroid adenoma (8%)
| - hyperplasia (15%)
99
What are the complaints of patient symptomatic with hyperparathyroidism?
****bones, stones, abdominal groans, psychic moans, & fatigue overtones****
100
What are the body areas that are characteristically effected most by hyperparathyroidism?
- bone loss
- kidney disease
- psychic disturbances
- abdominal symptoms
- cardiac
101
Are people with hyperparathyroidism symptomatic or asymptomatic?
-most are symptomatic
102
What are the bone S/Sx of in hyperparathyroidism?
* ***bone pain & pathologic Fx's, increased ALP****
| - osteoporosis
103
What are the kidney disease S/Sx of hyperparathyroidism?
* ***kidney stones**** (calcium oxalate)
| - possible renal insufficiency
104
What are the CNS S/Sx of hyperparathyroidism?
- Malaise, fatiuge, depression, increased sleeping
| - Disorientation, psychosis, stupor
105
What are the Cardiac S/Sx of hyperparathyroidism?
* ***Bradyarrhythmias, heart bock, asytole****
| - HTN, prolonged PR interval, shortened QT interval
106
What are the GI S/Sx of hyperparathyroidism?
****abomimal pain, N/V, anorexia, constipation
107
What are the Lab findings with hyperparathyroidism?
* ***hypercalcemia, low-normal phosphorus****
- high urine calcium & phosphate excretion
- increase Alkaline phospatase (only in bone disease)
- Vitamin D deficiency is common
108
How is Hyperparatyroidism Dx?
- 99m Tc-sestmibescanning
- CT
- MRI
- Ultrasound
109
What is the tx for hyperparathyroidism?
-surgery (parathyroidectomy) = definitive Tx
-Medical
-****Biphosphonates**** : inhibit bone resorption (Pamidronate and Zoledronic Acid)
(they help prevent bone loss)
-Estrogen therapy (minimal improvement)
110
What is the etiology for Hypoparathyroidism?
- thyroidectomy
- heavy metals (iron, from thalassemias)
- Mg++deficiency (poor aborbtion in the gut)
- Drugs
- loop diuretics
- phenytoin
- alendronalte (Fosmax)
- foscarnet (tx CMV in aids patients)
111
What are the S/Sx with hypoparathyroidism?
* ***tetany, muscle cramps, Carpopedal spasms****
* ***parasthesias around mouth, hands, feet****
- letargy, personality changes, convulsions
- Chvostik sign : facial muscle contraction on tapping on the facial nerve in front of head
- Trousseau sign : carpal spasm after BP is increased
- hyperactive deep tendon reflexes
112
What are the lab findings in hypoparathyroidism?
* ***low serum calcium, high serum phosphate****
- low urinary calcium
- normal ALP, low PTH level
113
What gives the definitive Dx in hypoparathyroidism?
- -respiratory alkalosis
- -also
- paresthesias, muscle cramps, or tetany
114
What is the Tx for hypoparathyroidism?
- IV calcium gluconate
| - oral calcium
115
What is the recommended daily intake for vitamin D?
-400 units of vitamin D
116
How does sunlight produce Vitamin D?
- vitamin D is formed in the epidermis with sunlight (pro hormone)
- it is metabolized in the liver to (OH) D, kidney to 1.125(OH) 2D
117
What foods are sourced of Vitamin D?
- milk
- fish oils
- fish liver
- eggs
118
How is Vitamin D absorbed from foods?
-absorbed in small intestine
119
Where in the body is vitamin D stored after absorbtion?
-vit D is stored in adipose tissue
120
What drugs reduce serum 25 (OH) D levels?
- phenytoin
| - phenobarbital
121
Who takes phenytoin and who takes phenobarbital?
phenytoin : siezures, certain irregular heartbeats
phynobarbital : seizures, tremor, insomnia, narcotic withdrawal
122
When is vitamin D increased in the kidney?
- in response to decreased phosphorus
- in response to decreased serum calcium
- in response to increased PTH
123
What are the diseases of Vit D deficiency?
- Rickets
| - Osteomalacia (adults)
124
What is Osteomalacia?
-inadequate calcium mineralization
125
What is the etiology for Osteomalacia?
- vitamin D decficiency (renal failure, no sun)
- low calcium intake
- Rickets
- malabsorpion
126
What are the S/Sx for Osteomalacia?
- bone pain
| - painful proximal muscle weakness
127
What are the Lab findings for Osteomalacia?
* ***increased ALP****
- decreased Vit D
- decreases calcium
- increased PTH
128
What is Paget's disease of Bone?
-Paget's is a focal disorder of bone remodeling that leads to greatly accelerated rates of bone turnover
129
What are the S/Sx of Paget's bone disease?
- 2/3 are asymptomatic
| - pain, fractures, deformities (1/3)
130
What are the Lab findings in Paget's?
* ***ALP is markedly elevated****
| - serum calcium & phosphorus are normal
131
What is the TX for Paget's disease of bone?
-Biphosphonates & calcitionin
132
What are the effects of Glucocorticoids (Cortisol) on Gulcose Metabolism?
-increased glucose (increased glucogeneis, decreased glucose uptake)
133
What are the effects of Cortisol on WBC's?
- increased neutrophils
| - decreased lymphocytes
134
What are the effects of Cortisol on Immunology?
- anti-inflammatory
| - immunosuppressive
135
What are the cardiac effects of Cortisol?
- increased cardiac output
| - increased peripheral vascular tone
136
What are the effects of Cortisol on the Nervous System?
- Eurphoria
| - Psychologic abnormalities
137
What are the effects of Cortisol on the Thyroid?
-minimal decrease in T3 & T4
138
What is the effect of Cortisol on the Gonadal Function?
-decreased testosterone and LH (decreased estrogens & progestins causing amenorrhea?
139
What are the effects of cortisol on the GI system?
-promotes peptic ulcer disease
140
What are the Ophthalmologic effects of Cortisol?
-increased intraoccular pressure
141
What type of hormone is Aldosterone?
-it is a mineralcorticoid
142
Where is Aldosterone produced?
-made exclusively in the zone glomerulosa (outer layer) of the adrenal cortex
143
How is Aldosterone released?
-it is controlled by the renin-agiotnesion system
144
What are the effects of Aldosterone?
- stimulated by hypovolemia & hyperkalemia
- causes the renal tubule to resorb sodium and excrete potassium
- maintain normal exracellular fluid volume
- inhibited by atrial natriuretic factor & dopamine
145
What is Cushing's Syndrome?
- Cushing's Syndrome is glucocorticoid excess
| - ****increased cortisol****
146
What is the major etiology of Cushing's Syndrome?
****70% Cushing's Disease****, due to excessive pituitary ACTH secretion
147
What are the other etiology of Cushing's Syndrome?
(15%) Nonpituitary neoplasm ****small cell carcinoma****
(15%) Adrenal tumor--adenoma (most) or carcinoma
only cause that ****has low ACTH**** due to negative feedback
148
What are the S/Sx of Cushing's Syndrome?
- Obesity: most common manifestation
- "Moon facies & Buffalo hump"
- Hyperlipidemia (70%)
- ****Glucose intolerance (70%)
- Skin changes (60%)
* ***Hirsutism (75%) : facial is most common
* ***CNS 85%)**** emotional lability, anxiety, depress
* ***muscle weakness (60%)****
* ***osteoporosis/osteopenia (80%) Fx, AVN
* ***Renal Calculi (15%)****glucocorticoid-induced hypercalcuria
- thirst and polyuria: due to hyperglycemia
149
What type of obesity is seen in Cushing's Syndrome?
****Central obesity****, face, neck, trunk, and
150
What are the skin changes seen in Cushing's Syndrome?
- thinning of the skin: transparency, easy bruising
- ****Striae : red to purple****, acne, slow wound healing
- fungal infections
151
What is the Lab findings for Cushing's Syndrome?
****elevated cortisol levels (100%)****
****Hyperglycemia****
-elevated ACTH : due to tumor in pituitary or ectopic
Normal/low ACTH if caused by adrenal tumor
152
How is Cushing's Syndrome Dx?
-CT or MRI for adrenal or pituitary tumor
****Dexamethasone Suppression Test****
-urine-free cortisol: highly accurate and specific
-Diurnal Rhythm
cortisol & ACTH are usually highest in a.m. and lowest in the pm
153
What is the Tx for Cushing's Syndrome?
1 microsurgery, radiation therapy
2 adrenal adenoma : unilateral adrenalectomy
3 adrenal carcinoma: Mitotane (meds), radiation, chemotherapy
4 meds such as ketoconazole block steroid synthesis
154
When Tx Cushing's syndrome with unilateral adrenalectomy what else does this patient need for tx?
require glucocorticoid therapy during and after surgery until the remaining adrenal recovers
155
What is Hirsutism?
* ***Hyperanrogenism of testosterone****, &
| - DHEAS (Dehydroepiandosterone)
156
What is the etiology of Hersutism?
****POCS****polycysitic ovarian syndrome
- Ovarian tumors
- Adrenal carinoma
157
What are the S/Sx of Hirsutism?
****Menstrual irregularities*** : amenorrhea, anovuation
****Virilization**** : Frontal balding, muscularity, clitoromegaly, deapin voice
158
What is the Tx for Hirsutism?
- spironalactone
- OC, birth control pill
- metformin
159
What is Addison's disease? What 2 hormones are released by the adrenal glands?
a disorder that occurs when the adrenal glands do not produce enough of their hormones, cortisol: and less often aldosterone
160
What is Addison's also called?
"chronic adrenal insufficiency" or hypocortisolism
161
What are the functions of Cortisol?
1) helps the body deal with stress
- helps regulate body's use of protein, carbohydrates, & fat
- helps maintain blood pressure and cardio function
- controls inflammation
162
What are the functions of aldosterone?
- helps kidneys regulate salt and water
| - blood pressure control
163
What are the two forms of Addison's Disease?
1 primary adrenal insufficiency when the problem is the adrenal glands themselves
2 secondary adrenal insufficiency if the adrenal glands are affected by a problem somewhere else such as the pituitary gland
164
With Addison's Disease where is the problem usually at?
-most cases result from a problem with the adrenal glands themselves (primary adrenal insufficiency)
165
What is the usual cause of the adrenal glands to stop producing enough cortisol?
1 autoimmune disease accounts for 70% of Addison's disease
-this occurs when the body's immune system mistakenly attacks the adrenal glands, and the autoimmune assault destroys the outer layer of the glands
166
Can infections harm the adrenal glands?
long-lasting infections such as TB, HIV and fungal infections can cause the hypothalamus or pituitary gland probs, which can turn on or off the production of hormones to the rest of the body
-improper use of prednisone can cause secondary adrenal insufficiency
167
What are the symptoms of Addison's Disease (adrenocortical insufficiency)?
* ***Hyperpigmentation of the skin****
* ***Weakness and fatigue****
* ***Weakness and fatigue****(100%)
* ***Weight loss and anorexia**** (100%)
- GI disturbance (50%)--NV
- Hypotenston (90%)
- hypogylcemia
- Amenorrhea
168
What are the Lab findings with Addison's Disease?
* ***Hyponatremia, Hyperkalemia****
| * ***low cortisol levels, increased ACTH****
169
What is the Dx test for Addison's Disease?
Cosynropin Stim Test
170
What is the Tx for Addison's Disease?
-Cortisol (hypdrocortisone) : 100mg IV Q 6 hours X 24 hours, then taper (acute adrenal crisis)
- Cortisol : 10 - 15 mg in am, 5-15 mg in pm
- increased doses during stress
171
What is Primary Aldosteronism?
-abnormally high aldosterone level causing
****hypertension, hypokaklemia, weakness****
-also causing sodium retension & suppression of plasma renin
172
What is the etiology of primary aldosteronism?
-adrenal ademoma (75%)
173
What are the S/Sx of primary aldosteronism?
- Hypokalemia (muscular weakness, fatigue, HA)
- Hypertension : due to increased Na+ and volume retention
- Polyuria & Polydipsia
174
How is Aldosteronism Dx?
-established by suppressed plasma renin activity and elevated aldosterone production that is not suppressed by high salt intake
175
What are the Lab findings for Aldosteronism?
* ***Hypokalemia****
- low plasma renin activity
- mild metalbolic aklalosis
- 24 hr urinary aldosterone > 21 ug/24hr
- plasma aldosterone (8 am or hour after recumbency) > 25 ng/dl
176
What further tests are needed to Dx the Aldosteronism problem?
-CT or MRI to identify the tumor
177
What is the Tx for Aldosteronism?
- Spirolactone or eplerenone
| - Adrenolectomy
178
What is Pheochromocytoma?
-tumor of there adrenal medulla causing abnormal secretion of epinephrine and norepinephrine
179
What is the adrenal medulla?
- the inner part of the adrenal gland, it is located in the center of the gland, being surrounded by the adrenal cortex
- it helps an individual deal with physical and emotional stress
180
What does the adrenal medulla secrete?
-it synthesizes and secretes epinephrine and norepinephrine
181
What are the symptoms of pheochromocytoma?
```
****Hypertension*****
Headache
Perspiration
Palpitations
*****Tremor****
```
- anxiery
- trachyarrythmias
- Abd pain
- N/V
- weight loss
- heat intolerance
- Heart failure
182
How is Pheocromoaytoma Dx?
-CT or MRI to identify the tumor of the adrenal medulla
183
What is the Tx for Pheochromocytoma?
-Surgery
-Medical : alpha blockers
CCB
****Beta Blockers*****
184
What is Diabetes Mellitus?
-inappropriate hyperglycemia due to either deficiency of insulin and or insulin resistance
185
How many people in the US have Diabetes Mellitius?
24 million
186
What are the types of Diabetes Mellitus?
- Type I
- Type II
- Metabolic Syndrome / Syndrome X
187
What is Type I Diabetes?
-Immune-mediated > Idiopathic
188
What is Type II DM?
-Insulin resistance
189
What is Metabolic Syndrome?
- a combination of medical disorders that, when together, increase the risk of developing cardiovascular disease and diabetes. Up to 25% of the general population and prevalence increases with ages.
190
What is the criteria for Dx of Diabetes Mellitus?
-2 fasting glucose > or equal to 126 mg/mg/dl
(on 2 different days)
- Fasting glucose > 200 with symptoms
- perform glucose tolerance test if needed
191
Describe the glucose tolerance test normal and abnormal values?
2 hours after 75g glucose load
- normal < 140
- impaired glucose tolerance > 140 - 190
- Diabetes Mellitus > or equal to 200
192
What is Type 1 Diabetes Mellitius?
-decreased or absent insulin production
193
What is the etiology of Type I DM?
-immune-mediated (90%)
-starts commonly in children and young adults
-genetic and environmental factors
-most have antibodies against pancreatic islet
cells
194
What are the S/Sx of Type 1 diabetes?
* ***polyuria, polydipsia, polyphagia****
- weight loss
- postural hypotension
- paresthesias
- ketoacidosis
- hypeglycemia
195
What other disorder is associated with Type 1 diabetes?
-celiac sprue
196
What are the Lab findings for Type 1 diabetes?
- elevated HBGA1C (Glycosolated Hbg) > 7%
| - Urine : + glucose and ketones
197
What is the Tx for DM Type 1?
- Insulin : preprandial + basal or long acting
- Exercise
- Healthy diet
- Blood pressure control
- Lipid management
198
What is the HbgA1C level goal in Type 1 DM?
HgbA1C < 7%
199
What is the preferred BP n Type 1 DM ?
< 130/80
200
What is the preferred LDL in Type 1 DM?
100
201
What is the preferred level of HDL in Type 1 DM?
40
202
What is the preferred level of Trigliycerides in Type 1 DM?
150
203
What is the preferred Preprandial glucose level in Type 1 DM?
90-130 mg/dl
204
What is the preferred postprandial glucose level in Type 1 DM?
<180 mg/dl
205
Why are ACE-1 used in Type 1 DM?
to prevent kidney damage
206
What is the Dawn Phenomenon?
elevated blood sugars in the morning due to cortisol
207
How is Dawn Phenomenon Tx?
- increase bedtime insulin
| - avoid carbs before bedtime
208
What is the Somongyi Effect?
****Nocturnal hypoglycemia**** causes reactive morning hyperglycemia
209
What is the Tx for the Somogyi effect?
decrease the amount of dinner or bedtime insulin
210
Is Diabetic Ketoacidosis a serious condition?
it is life threatening
211
What patients are more likely to get ketoacidosis?
it is the usual presentation for people with Type 1 DM
212
Why does ketoacidosis occur?
the body cannot use glucose for fuel because there is no insulin available, so the body begins to breakdown fat for fuel and results in build up of wastes called ketones
213
What are the S/Sx of Diabetic Ketoacidosis?
- N/V
- 3-Polys (dipsia, phagia, uria)
- dehydrated
- + / - stupor
214
What are the PE findings for debetic ketoacidosis?
- fruity breath
| - hypotension
215
What is found with testing Arterial Blood Gas with diabetic ketoacidosis?
-metabolic acidosis
216
What is the Lab findings for Diabetic Ketoacidosis?
- Ketones
- glucose in urine
- BS > 250 mg/dl
217
What is the Tx for Diabetic Ketoacidosis?
-fluids
-insulin
-potassium monitoring
+/- bicarbonate
218
What are the severe acute possible effects of Type 2 DM?
- DKA (diabetic ketoacidois) is rare
| - Hyperosmolar coma may occur
219
What is the Tx for Type 2 DM?
* ***Diet****
* ***Excercise****
- oral hypoglycemics
- insulin
220
How prevalant is Metalbolic Syndrome?
25% of the general non obese non diabetic population has insulin resistance
221
What are the factors that are considered in the criterial for Dx of Metabolic Syndrome?
- central obesity, waist size
- triglycerides
- HDL's
- Blood Pressure
- Fasting blood sugar levels
222
What is the waist size (central obesity) in metabolic syndrome?
- men, 40 inches
| - women, 36 inches
223
What is the triglyceride level in metabolic syndrome?
> 150
224
What are the HDL levels in metabolic syndrome?
< 40 in women
| < 50 in men
225
What is the blood pressure in metabolic syndrome?
> 130/85
226
What is the fasting blood sugar in metabolic syndrome?
> 110
227
What are the complications of DM?
1 macrovascular
| 2 microvascualr
228
What are the macro vascular complications of DM?
- coronary artery disease
- periferal artery disease
- carotid disease
- stroke
229
What are Ocular microvascular complications of DM?
-Ocular--retinopathy, gluacoma, cataracts
230
What are the Renal microvascular complications of DM?
diabetic nephropathy
231
What are the microvascual Neuological complications of DM?
- peripheral neuopathy
| - foot drop
232
What are the skin microvascular effects os DM?
- ulcers
- slow healing
- infections
233
What are the bone microvasclar effects of DM?
carpal tunnel syndrome
234
What systems are effected by the vascular complications of DM?
- ocular
- renal
- neurological
- skin
- bone
235
What two hormones are secreted by the posterior pituitary?
-Oxytocin and antidiuretic hormone (ADH, and vasopressin)
236
What is Sheehan's syndrome?
-Ischemia of the pituitary due to volume depletion during or after childbirth.
237
How do glitazones work?
-They improve insulin sensitivity.
238
What is the most common pituitary adenoma?
-Prolactinoma
239
Large doughy hands should make you think of what diagnosis?
-Gigantism
240
Diabetes insipidus is caused by a deficiency of which hormone?
-Vasopressin
241
How much more potent is T4 than T3?
- T4, 3-4 times
242
What is the first line treatment for a pheochromocytoma?
-Alpha blocker. You should never a pure bata blocker.
243
What is the best imaging for a thyroid nodule?
-Ultrasound
244
A patient presents with erectile dysfunction and complains of some numbness in his feet. On second thought he has noticed polyuria and polydipsia. What diagnosis should you be thinking of?
-Diabetic neuropathy
245
Pretibial myxedema should make you think of what diagnosis?
-Graves's disease
246
A 35 year old female presents with heat intolerance, weight loss and palpitations. What is the most likely diagnosis?
-Hyperthyroidism
247
What are the 3 P's of Diabetic Ketoacidosis?
- Polydipsia--increased thirst
- Polyphagia--frequent eating
- Polyuria--frequent urination
248
What is aldosterone?
-a corticosteroid hormone that stimulates absorption of sodium by the kidneys and so regulates water and salt balance
249
How is aldosterone secreted?
-production of aldosterone (20-200 micrograms/day in adults) in the zone glomerulosa of the adrenal cortex is regulated by the renin-angiotensin system. Renin is secreted by the kidneys in response to variations in blood pressure and volume and plasma sodium and potassium levels.
250
How does aldosterone affect blood pressure?
-it plays a central role in the regulation of blood pressure mainly by acting on organs including the kidney and colon to increase the amount of sodium reabsorbed into the bloodstream and the amount of potassium removed in the urine. Aldosterone also causes water to be reabsorbed along with sodium, this increases the blood volume and therefore blood pressure. Thus, aldosterone indirectly regulates blood levels of electrolytes (sodium, potassium, hydrogen) and helps maintain the blood pH.
251
The drugs stimulate insulin secretion for tx of diabetes Type II.
Sulfonylureas
- glypburide
- glipizede
- glimepiride
252
This medication lowers glucose by reducing hepatic glucose production for diabetes Type II tx.
-Metfomin (is first line therapy)
253
These medications decrease carbohydrate absorption from the small intestine in Tx of diabetes Type II.
-alpha-Glucosiede inhibitors
- acarbose
- miglitol
254
In Tx of Type II diabetes these medications increase tissue sensitivity to insulin.
-Thiazolidinediones
- rosiglitazone
- pioglitazone
255
Name 2 medications that can cause hypothyroidism.
- amiodarone
| - lithium
256
Name 2 medications used to tx hyperthyroidism. These help lower the levels of T3 T4.
- Methimazole
| - Propylthiouracil (PYU)
257
What is the long term tx for hypothyroidism?
- Levothyroxine (synthetic T4)
- start on lowest possible dose and is slowly moved up monitoring symptoms and TSH levels, then TSH levels checked yearly (watch for hyperthyroidism)
