Endocrinology 2 Flashcards

1
Q

If high Sex hormone globulin - what is reduced?

A

Insulin
Androgen
FSH/LH

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2
Q

PCOS ultrasound findings?

A

12 follicles +/- string of pearls

1 ovary > 10 mls

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3
Q

Sex hormone globulin binding affinity?

A

Dihydrotestosterone the most!
Testosterone - 2nd
Estradiol - 3rd

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4
Q

COCP does what?

A

Increase SHBG - bind to estradiol ( ovaries androgen)

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5
Q

What can be given to induce ovulation?

A

Letrozole (1st line)

Clomiphene (2nd line)

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6
Q

Hypothalamic amenorrhoea (Tertiary) causes?

A

Intense exercise - Female athlete triad
—–Amenorrhea + Reduced bone density due to eating disorder

Reduce weight/calorie intake = reduced leptin

High stress - Cortisol inhibit GnRH

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7
Q

Biotin cause false Hyperthyroidism (Graves presentation) why?

A

Biotin bind to Streptavidin site = thyrotrophin (TSH) can’t bind and signal it = so low TSH (falsely low)

No signal so all Free T4 roams around = so high T4 (falsely high)

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8
Q

How clexane affects Thyroid hormone long term?

A

Displace T3/4 from binding proteins = low T3/4

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9
Q

How does anticonvulsants affect thyroid hormone?

A

Hypothyroidism - induce high thyroid hormone metabolism

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10
Q

How does lithium affect thyroid hormone?

A

Lithium reduces pinocytosis process - so thyroid hormone stays in colloid = goitre

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11
Q

When do thyroidectomy?

A

Large goitre + obstruction
Active Graves’ opthalmopathy

Co-existing Hyper parathyroidism
Thyroid malignancy

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12
Q

When do RAI?

A

Relapse post anti-thyroid medications
Poor surgical candidate
Doesn’t want children / breast-feeding

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13
Q

what happens in sick euthyroidism?

A

Low T3 syndrome
-Rapid inhibition of D1 - drops T3

T4/TSH normal but if goes on - T4/TSH drops as well

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14
Q

Causes of secondary hyperthyroidism?

A

Assay interference - main cause

IF assay interference ruled out;
TSHoma/ Thyroid hormone resistance

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15
Q

Medications to prevent DM retinopathy?

A

Anti-VEGF therapy

Fenofibrate

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16
Q

If atherosclerotic event + obese is dominant in DM patients - use what?

If HF + CKD is dominant in DM patients - use what?

A

GLP-1 receptor agonist

SGLT2 inhibitors

17
Q

GnRH antagonist - Degarelix benefit?

A

Avoid testosterone surge thus flare

18
Q

Androgen receptor blocker mechanism of action?

A

Block 17a hydroxylase enzyme

19
Q

Castration of testosterone - aim testosterone level?

A

< 1.7 nmol

20
Q

Main hormone secreted by anterior pituitary hormone?

A

Growth hormone

21
Q

Iron polymatose infusion causes?

A

Reduced serum PO4 - increase FGF-23

22
Q

How leptin induces satiety?

A

Stimulate POMC neurons

Inhibit Neuropeptide Y neurons

23
Q

What causes metabolic syndrome?

A

TNFa from Adipocyte

24
Q

Orlistat mechanism of action?

A

Lipase inhibitor - reduce fatty acid absorption

25
Q

Acromegaly has what type of cancer?

A

Thyroid cancer

26
Q

Diuretics in nephrogenic DI?

A

Paradoxical effect - diuresis causes hypovolemia

Then body reabsorb NA at PCT so less loss of NA/H20 in DCT

27
Q

Extra-adrenal tumor of pheochromocytoma - name? and cause?

A

SDH8 mutations = Paragangliomas ( sympathetic system)

28
Q

PCOS infertility pathway?

A
  1. High adipocytes - high estrogen - inhibit FSH
  2. High insulin - high 17a hydroxylase - more androgen
  3. High LH
29
Q

How clomiphene helps fertility?

A

Induce ovulation - GnRH agonist - increases LH + FSH

30
Q

Testosterone supplement only for what type of hypogonadism?

A

Secondary ( pituitary/hypothalamus) hypoGnRH hypogonadism