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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
Q

Growth hormone hypersecretion before epiphyseal long bone closure is associated with the development of ______

A

Gigantism

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26
Q

What is the most common presenting feature of adult hypopituitarism?

A

Hypogonadism

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27
Q

The posterior pituitary are formed by axons that originate in the ______

A

Supraoptic and Paraventricular Nuclei of the Hypothalamus

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28
Q

What are the hormones produced by the posterior pituitary?

A 
Arginine Vasooressin (Antidiurectic Hormone) and 
Oxytocin
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29
Q

A deficiency in vassopressin causes

A

Diabetes Insipidus

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30
Q

Vassopressin acts on what part of the nephron?

A

Medullary collecting ducts

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31
Q

What is the normal weight of the thyroid?

A

12-20 g

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32
Q

What cells of the thyroid produce calcitonin?

A

Medullary or C cells

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33
Q

What is the most useful marker of thyroid hormone action?

A

Thyroid Stimulating Hormone (TSH)

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34
Q

These glycoprotein hormones share a common alpha subunit.

A

LH, FSH, TSH, and hCG

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35
Q

What is the crucial first step in thyroid hormone synthesis?

A

Iodide uptake by the sodium iodide sum porter at basolateral membrane

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36
Q

What is the most common cause of preventable mental deficiency?

A

Iodine deficiency which leads to cretinism

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37
Q

What is the recommended daily intake of iodine in adults?

and children?

A

150-250 micrograms per day for adults

90-120 micrograms per day for children

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38
Q

Where are thyroid hormone receptors located?

A

At nuclear receptors (thyroid hormone receptors)

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39
Q

What is the method of choice in determining the size of the thyroid?

A

Ultrasound

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40
Q

A bruit over the thyroid glad indicates what?

A

Increased vascularity such as in hyperthyroidism

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41
Q

Venous distinction over the neck and difficulty breathing especially when arms are raised.

A

Pemberton’s sign

42
Q

What is the most common cause of hypothyroidism worldwide?

A

Iodine deficiency

43
Q

What is the weight of a single adrenal gland?

A

6-11 grams

44
Q

From outer to inner name the layers of the adrenal glands.

A

Capsule, Zoma Glomerulosa, Zona Fasiculata, Zona Reticularis, Adrenal Medulla

45
Q

The right supra renal vein drains into the _____ and the left supra renal vein drains into the ______.

A

Inferior Vena Cava

Left Renal Vein

46
Q

What region of the hypothalamus will secrete corticotropin releasing hormon and subsequently cause the release of ACTH from the anterior pituitary.

A

Suprachiasmatic Nucleus

47
Q

Peak levels of ACTH occur during what time of day?

48
Q

Renin is produced by what cells?

A

Juxtaglomerular Cells Kidney

49
Q

What cleaves angiotensinogen to angiotensinogen I?

50
Q

What cleaves angiotensin I to angiotensin II

A

Angiotensin Converting Enzyme

51
Q

Mineralocorticoid synthesis occurs in what layer of the adrenal gland?

A

Zona Glomerulosa

52
Q

Glucocorticoids are produced in what layer of the adrenal gland?

A

Zona Fasciculata

53
Q

In what layer will primarily produce adrenal androgens?

A

Zona Reticularis

54
Q

Most frequent cause you Cushing’s Syndrome

A

ACTH Producing Pituitary Adenoma

55
Q

Most common source of ectopic ACTH production

A

Occult Carcinoid Tumor Most Frequently in the Lung

56
Q

Lung cancer that may produce ectopic ATCH

A

Small Cell Lung Cancer

57
Q

Aldosterone producing adrenal adenoma causing hypertension and hypokalemia

A

Conn’s Syndrome

58
Q

Most common cause of primary adrenal insufficiency?

A

Autoimmune Adrenalitis

59
Q

What is the characteristic biochemical feature of patients with adrenal insufficiency?

A

Hyponatremia

60
Q

The diagnosis of adrenal insufficiency is established by what test?

A

Cosyntropin Test

61
Q

Referred to as the “master gland”

A

Anterior Pituitary

62
Q

What are the “rule of tens” in pheochromocytoma?

A

10% bilateral, 10% extraadrenal, 10% malignant

63
Q

Classic triad of pheochromocytoma

A

Palpitations, Headaches, and Profuse Sweating

64
Q

Dominant sign of pheochromocytoma

A

Hypertension

65
Q

Examples of catecholamines

A

Epinephrine, norepinephrine, and dopamine

66
Q

Vanillylmadelic acid, and metanephrines are commonly used for initial testing of what disorder? Which is more sensitive?

A

Pheochromocytoma, and metanephrines are more sensitive

67
Q

This autosomal dominant disorder is characterized by medullary thyroid carcinoma, pheochromocytoma, and hyperparathryroidism

68
Q

This autosomal dominant disorder is characterized by medullary thyroid carcinoma, pheochromocytoma, as well as multiple mucosal neuromas, and marfanoid habitus.

69
Q

What is the leading cause of end stage renal disease?

A

Diabetes mellitus

70
Q

Diagnosis of Diabetes Mellitus

A
  • 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
Q

Diagnosis for impaired fasting glucose

A
  • 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
Q

Recommended screening for DM

A

At age 45 and every 3 years thereafter. May start earlier if overweight or with risk factors

73
Q

What cell produce insulin?

A

Beta cells of the pancreatic islets

74
Q

This is a useful marker in insulin secretion and allows discrimination between endogenous and exogenous sources of insulin.

75
Q

What is the key regulator of insulin secretion? At what level will it stimulate secretion?

A

Glucose

It will stimulate insulin if levels > 3.9 mmol/L (70mg/dL)

76
Q

What is the rate limiting step that controls glucose regulated insulin secretion?

A

Glucokinase

77
Q

Glucagon is secreted by what cell?

A

Alpha Cells of the Pancreatic Islets

78
Q

Delta cells of the pancreatic islet secrets ______

A

Somatostatin

79
Q

Diabetic Ketoacidosis is more common in Type 1 or Type 2 Diabetes Mellitus

80
Q

Kussmaul Respiration, fruity odor on breath, abdominal pain, and nausea and vomiting.

A

Diabetic Ketoacidosis

81
Q

The basic patholophysology of diabetic ketoacidosis

A

Relative or absolute insulin deficiency combined with counter regulatory hormone excess

82
Q

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.

A

Hyperosmotic Hyperosmolar State

83
Q

What are the microvascular complications of DM?

A

Retinopathy, Neuropathy, and Nephropathy?

84
Q

What are the macrovascular complications of DM?

A

Coronary Artery Disease, Peripheral Atrial Disease, and Cerebrovasular Disease

85
Q

What is the leading cUse of blindness in patients aged 20-74 in the U.S.

A

Diabetic Retinopathy

86
Q

What is the blood pressure goals of diabetic individuals based on Harrison’s

87
Q

What is the most common pattern of dyslipidemia in patients with DM

A

Hypertriglyceridemia and reduced HDL

88
Q

HbA1C goal for patients with DM

89
Q

Goal for preprandial capillary plasma glucose

A

3.9-7.2 mmol/L (70-130 mg/dL)

90
Q

Goal for peak postprandial capillary plasma glucose

91
Q

Goal for Triglycerides in Patients with DM

92
Q

Examples of short acting insulin

A

Aspart, Glulisine, Lispro, Regular

93
Q

Examples of long acting insulin

A

Detemir and Glargine

94
Q

Example of Biguanides

95
Q

Mechanism of action of Metformin

A

Decrease Hepatic Glucose Production

96
Q

Examples of Insulin Secretagogues - Sulfonylureas

A

Glimepiride, Glipizide, Glyburide

97
Q

Mechanism of action of insulin secretagogues such as the sulfonylureas and nonsulfonylureas

A

Stimulates insulin secretion by interacting with the ATP sensitive potassium channel in the beta cell

98
Q

Examples of “incretins”

A

Exenatide and Liraglutide

99
Q

Examples of Dipeptide Peptidase-4 Inhibitors which result in inhibiting the degradation of native GLP-1

A

Saxagliptin, Sitagliptin, and Vildagliptin

100
Q

Examples of Alpha Glucosodase Inhibitors and their mechanism of action

A

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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