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Harrison's Principles of Internal Medicine 18th Ed. > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Hormones Produced by anterior pituitary

A

Prolactin, growth hormone, adrenocorticotropic hormone, luteinizing hormone, follicle stimulating hormone, and thyroid stimulating hormone

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2
Q

What is the weight of the pituitary gland?

A

About 600 mg

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3
Q

This is due to defective hypothalamic gonadotropin releasing hormone (GnRH) synthesis and is associated with anosmia, hypogonadism (males), and amenorrhea with failure to develop secondary sexual features (females)

A

Kallmann Syndrome

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4
Q

This developmental hypothalamic disorder is characterized by mental retardation, renal abnormalities, obesity, abnormal digits, and retinal degeneration.

A

Bardet-Biedl Syndrome

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5
Q

This is due to a deletion of the paternal copies of the imprinted SNRPN and NECDIN gene on chromosome 15q

A

Prader-Willi Syndrome

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6
Q

This characterized by hypogonadism, hyperphagia-obesity, muscle hypotonia, mental retardation, and adult onset diabetes mellitus.

A

Prader-Willi Syndrome

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7
Q

This is an endocrine emergency which is due to intrapituitary hemorrhage.

A

Pituitary Apoplexy

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8
Q

This is an autosomal dominant disorder characterized by a genetic predisposition to parathyroid, pancreatic islet, and pituitary adenoma

A

Multiple Endocrine Neoplasia 1 (MEN 1)

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9
Q

Multiple Endocrine Neoplasia (MEN 1) is due to a defect on what tumor suppressor gene and on what chromosome?

A

MENIN on chromosome 11q13

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10
Q

This syndrome is characterized by spotty skin pigmentation, myxoma, and endocrine tumors such as testicular, adrenal, and pituitary adenomas.

A

Carney Syndrome

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11
Q

This consists of polyostotic fibrous dysplasia, pigmented skin patches, and endocrine disorders (such as precocious puberty, autonomous ovarian function, acromegaly, and adrenal adenomas)

A

McCune-Albright Syndrome

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12
Q

These are benign suprasellar cystic masses that present with headache, visual field defects, and variable degrees of hypopituitarism.

A

Craniopharyngiomas

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13
Q

This disorder is characterized by diabetes insipidus, exothalmos, and punched out lyric bone lesions. It is also associated with granulamtos lesions.

A

Hand-Schüller-Christian Disease

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14
Q

About half of pituitary metastasis originate from _____

A

Breast Cancer

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15
Q

This syndrome is character end by harmatomas, craniofacial abnormalities, imperforate anus, cardiac, renal, lung, and pituitary failure. Mutation in GLI3 gene

A

Pallister-Hall Syndrome

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16
Q

Screening Test for Cushing’s Disease

A

24 hour urinary free cortisol, Dexamethasone Challenge, ACTH Assay

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17
Q

This hormone of the anterior pituitary is unique due to the central control mechanism is inhibitory rather than stimulatory.

A

Prolactin

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18
Q

What inhibits prolactin release?

A

Dopamine

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19
Q

What is the most common pituitary hormone hypersecretion syndrome in both men and women?

A

Hyperprolactinemia

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20
Q

What are the hallmarks of hyperprolactinemia in women?

A

Amenorrhea, galactorrhea, and infertility

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21
Q

Examples of oral dopamine agonist used for the treatment in prolactinomas.

A

Bromocriptine and Cabergoline

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22
Q

The most abundant anterior pituitary hormone is _____

A

Growth Hormone

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23
Q

Hypersecretion of growth hormone in adults leads to what condition?

A

Acromegaly

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24
Q

What is the most common cause of GHRH mediated acromegaly?

A

Chest or abdominal carcinoid tumor

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25
Growth hormone hypersecretion before epiphyseal long bone closure is associated with the development of ______
Gigantism
26
What is the most common presenting feature of adult hypopituitarism?
Hypogonadism
27
The posterior pituitary are formed by axons that originate in the ______
Supraoptic and Paraventricular Nuclei of the Hypothalamus
28
What are the hormones produced by the posterior pituitary?
``` Arginine Vasooressin (Antidiurectic Hormone) and Oxytocin ```
29
A deficiency in vassopressin causes
Diabetes Insipidus
30
Vassopressin acts on what part of the nephron?
Medullary collecting ducts
31
What is the normal weight of the thyroid?
12-20 g
32
What cells of the thyroid produce calcitonin?
Medullary or C cells
33
What is the most useful marker of thyroid hormone action?
Thyroid Stimulating Hormone (TSH)
34
These glycoprotein hormones share a common alpha subunit.
LH, FSH, TSH, and hCG
35
What is the crucial first step in thyroid hormone synthesis?
Iodide uptake by the sodium iodide sum porter at basolateral membrane
36
What is the most common cause of preventable mental deficiency?
Iodine deficiency which leads to cretinism
37
What is the recommended daily intake of iodine in adults? | and children?
150-250 micrograms per day for adults | 90-120 micrograms per day for children
38
Where are thyroid hormone receptors located?
At nuclear receptors (thyroid hormone receptors)
39
What is the method of choice in determining the size of the thyroid?
Ultrasound
40
A bruit over the thyroid glad indicates what?
Increased vascularity such as in hyperthyroidism
41
Venous distinction over the neck and difficulty breathing especially when arms are raised.
Pemberton's sign
42
What is the most common cause of hypothyroidism worldwide?
Iodine deficiency
43
What is the weight of a single adrenal gland?
6-11 grams
44
From outer to inner name the layers of the adrenal glands.
Capsule, Zoma Glomerulosa, Zona Fasiculata, Zona Reticularis, Adrenal Medulla
45
The right supra renal vein drains into the _____ and the left supra renal vein drains into the ______.
Inferior Vena Cava | Left Renal Vein
46
What region of the hypothalamus will secrete corticotropin releasing hormon and subsequently cause the release of ACTH from the anterior pituitary.
Suprachiasmatic Nucleus
47
Peak levels of ACTH occur during what time of day?
Morning
48
Renin is produced by what cells?
Juxtaglomerular Cells Kidney
49
What cleaves angiotensinogen to angiotensinogen I?
Renin
50
What cleaves angiotensin I to angiotensin II
Angiotensin Converting Enzyme
51
Mineralocorticoid synthesis occurs in what layer of the adrenal gland?
Zona Glomerulosa
52
Glucocorticoids are produced in what layer of the adrenal gland?
Zona Fasciculata
53
In what layer will primarily produce adrenal androgens?
Zona Reticularis
54
Most frequent cause you Cushing's Syndrome
ACTH Producing Pituitary Adenoma
55
Most common source of ectopic ACTH production
Occult Carcinoid Tumor Most Frequently in the Lung
56
Lung cancer that may produce ectopic ATCH
Small Cell Lung Cancer
57
Aldosterone producing adrenal adenoma causing hypertension and hypokalemia
Conn's Syndrome
58
Most common cause of primary adrenal insufficiency?
Autoimmune Adrenalitis
59
What is the characteristic biochemical feature of patients with adrenal insufficiency?
Hyponatremia
60
The diagnosis of adrenal insufficiency is established by what test?
Cosyntropin Test
61
Referred to as the "master gland"
Anterior Pituitary
62
What are the "rule of tens" in pheochromocytoma?
10% bilateral, 10% extraadrenal, 10% malignant
63
Classic triad of pheochromocytoma
Palpitations, Headaches, and Profuse Sweating
64
Dominant sign of pheochromocytoma
Hypertension
65
Examples of catecholamines
Epinephrine, norepinephrine, and dopamine
66
Vanillylmadelic acid, and metanephrines are commonly used for initial testing of what disorder? Which is more sensitive?
Pheochromocytoma, and metanephrines are more sensitive
67
This autosomal dominant disorder is characterized by medullary thyroid carcinoma, pheochromocytoma, and hyperparathryroidism
MEN 2A
68
This autosomal dominant disorder is characterized by medullary thyroid carcinoma, pheochromocytoma, as well as multiple mucosal neuromas, and marfanoid habitus.
MEN 2B
69
What is the leading cause of end stage renal disease?
Diabetes mellitus
70
Diagnosis of Diabetes Mellitus
- Fasting Plasma Glucose > or = 7 mmol/L (126 mg/dL) - 2 Hour Plasma Glucose Challenge > or = 11.1 mmol/L (200 mg/dL) - HbA1C > or = 6.5%
71
Diagnosis for impaired fasting glucose
- Fasting Plasma Glucose > or = 5.6-6.9 mmol/L (100-125 mg/dL) - 2 Hour Plasma Glucose Challenge > or = 7.8-11 mmol/L (140-199 mg/dL) - HbA1C > or = 5.7-6.4%
72
Recommended screening for DM
At age 45 and every 3 years thereafter. May start earlier if overweight or with risk factors
73
What cell produce insulin?
Beta cells of the pancreatic islets
74
This is a useful marker in insulin secretion and allows discrimination between endogenous and exogenous sources of insulin.
C Peptide
75
What is the key regulator of insulin secretion? At what level will it stimulate secretion?
Glucose | It will stimulate insulin if levels > 3.9 mmol/L (70mg/dL)
76
What is the rate limiting step that controls glucose regulated insulin secretion?
Glucokinase
77
Glucagon is secreted by what cell?
Alpha Cells of the Pancreatic Islets
78
Delta cells of the pancreatic islet secrets ______
Somatostatin
79
Diabetic Ketoacidosis is more common in Type 1 or Type 2 Diabetes Mellitus
Type 1 DM
80
Kussmaul Respiration, fruity odor on breath, abdominal pain, and nausea and vomiting.
Diabetic Ketoacidosis
81
The basic patholophysology of diabetic ketoacidosis
Relative or absolute insulin deficiency combined with counter regulatory hormone excess
82
Case: An elderly patient with Type 2 DM with several week history of polyuria, weight loss, and diminished oral intake is noticed to be in mental confusion and then progressed to lethargy.
Hyperosmotic Hyperosmolar State
83
What are the microvascular complications of DM?
Retinopathy, Neuropathy, and Nephropathy?
84
What are the macrovascular complications of DM?
Coronary Artery Disease, Peripheral Atrial Disease, and Cerebrovasular Disease
85
What is the leading cUse of blindness in patients aged 20-74 in the U.S.
Diabetic Retinopathy
86
What is the blood pressure goals of diabetic individuals based on Harrison's
87
What is the most common pattern of dyslipidemia in patients with DM
Hypertriglyceridemia and reduced HDL
88
HbA1C goal for patients with DM
89
Goal for preprandial capillary plasma glucose
3.9-7.2 mmol/L (70-130 mg/dL)
90
Goal for peak postprandial capillary plasma glucose
91
Goal for Triglycerides in Patients with DM
92
Examples of short acting insulin
Aspart, Glulisine, Lispro, Regular
93
Examples of long acting insulin
Detemir and Glargine
94
Example of Biguanides
Metformin
95
Mechanism of action of Metformin
Decrease Hepatic Glucose Production
96
Examples of Insulin Secretagogues - Sulfonylureas
Glimepiride, Glipizide, Glyburide
97
Mechanism of action of insulin secretagogues such as the sulfonylureas and nonsulfonylureas
Stimulates insulin secretion by interacting with the ATP sensitive potassium channel in the beta cell
98
Examples of "incretins"
Exenatide and Liraglutide
99
Examples of Dipeptide Peptidase-4 Inhibitors which result in inhibiting the degradation of native GLP-1
Saxagliptin, Sitagliptin, and Vildagliptin
100
Examples of Alpha Glucosodase Inhibitors and their mechanism of action
Acarbose and Miglitol which reduces post prandial hyperglycemia by delaying glucose absorption

Harrison's Principles of Internal Medicine 18th Ed. (2 decks)

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