Endocrinology Flashcards
it is critical to evaluate what in short stature to differentiate it from normal to pathologic stature
growth rate
children who grow how many inches a year between 3 years and puberty do not have something wrong with them
2 inches
what ratio can indicate diproportionate short stature
U/L ratio
familial short stature
normal bone age
normal onset of puberty
constitutional short stature
delayed bone age
late onset of puberty
- normal
4 causes of prenatal onset proportionate short stature
- environmental exposures
- chromosome
- genetic
- viral
what do you consider when you see disproportionate short stature
rickets
skeletal dysplasia
indirect test for insulin insufficiency
IGF-1
what must be considered in any child older than 5 years of age who is not growing 2 inches per year
craniopharyngioma
name 4 endocrinopathies that cause short stature
- GH deficiency
- hypothyroidism
- hypercortisolism
- turner
Thelarche
onset of breast devleopment
Adrenarche
onset of pubic or axillary hair
onset of female puberty
7-13 years
onset of male puberty
9-14
first sign of puberty in males
testicular enlargment
precocious puberty for girls
breast or hair before 7 years
menarche before 9 years
precocious puberty for boys
before 9
Isosexual precocious puberty or central precocious pubterty
early onset of gonadotropin mediated puberty
cause of Isosexual precocious puberty or central precocious pubterty in girls
idiopathic
Isosexual precocious puberty or central precocious pubterty in boys
need to get an MRI of head
test to demonstte premature acitivation of hypothalamus
GnRH stimulation test
GnRH stimulation test for Isosexual precocious puberty or central precocious pubterty
LH increases
Peripheral precocious puberty or heterosexual gonadotropin-independent puberty
peripheral production of male and female steroids
GnRH test for Peripheral precocious puberty or heterosexual gonadotropin-independent puberty
flat response
do boys have testicular enlargement in Peripheral precocious puberty or heterosexual gonadotropin-independent puberty
no
3 causes of Peripheral precocious puberty or heterosexual gonadotropin-independent puberty in boys with testicular enlargement
- McCune-Albright syndrome
- Testotoxicosis
- Beta-HCG secreting tumor
testotoxicosis
testes enlarge bilaterally independent of HPGA
Delayed puberty for boy
no testicular enlargement by 14
delayed puberty for girls
no breast tissue by 13
no menarche by 14
3 genetic disorder of hypogonadotropic hypogonadism
- Kallman syndrome
- Prader-Willi
- Lawrence-Moon-Biedle syndrome
chromosomal disorders for hypergonadotropic hypogonadism
boys: Klinefelter
girls: Turner
when is sex determined
7 weeks gestation
fetal testes produce? from what cell
testosterone: leydig cells
anti-mullerian hormone: sertoli cells
what hormone is responsible for extra genitalia in males
DHT
mixed gonadal dysgenesis
45XO/46XY
true hermaphroditism
both ovarian and testicular gonadal tissue
testicular feminization syndrome
female on outside but 46XY
most common cause of female pseudohermaphroditism
Congenital adrenal hyperplasia
21-hydroxylase deficiency
Increase blood pressure and decrease blood pressure suggests
increase: CAH with 11B-OH deficiency
decease: adrenal insufficiency
what regulates mineralcorticoid synthesis
renin-angiotensin system
what is lab value that indicates aldosterone deficiency
hyperkalemia
what is not deficient in secondary adrenal insufficiency
no aldosterone deficiency
how is CAH inhertied
autosomal recessive
3 enzymes that can be deficient in CAH
- 21 hydroxylase
- 11Beta-hydroxylase
- 3Beta-hydroxyteroid dehydrogenase deficiency
difference between 1Beta-hydroxylase and 1 hydroxylase
11Beta-hydroxylase: hypertensive and hypokalemic
if you are 21 hydroxylase deficient, what is elevated
17-hydroxyprogesterone
if you are 11Beta-hydroxylase deficient, what is elevated
11-deoxycortisol (specific compound S)
Addison’s disease
autoimmune destruction of adrenal cortex
how do you test adrenal insufficiency
ACTH stimulation test
is adrenal crisis a medical emergency
yes
most common cause of glucocorticoid excess
iatrogenic
cushing disease
excessive ACTH production
Cushing syndrome
benign or malignant adrenal tumors
test for excessive cortisol
dexamethasone suppression test
most Type I diabetic have what HLA defect
HLA haplotype DR3 and DR4
autoimmune factors for type I Diabetes
- islet cell antibodies
- antibodies against insulin
- antibodies against glutamic acid decarboxylase
“honeymoon period”
patients see reduction in daily insulin requirements
Somogyi phenomenon
evening dose of insulin is too high
- morning hypoglycemia
- body compensates with high glucose and ketone in morning
which one has a higher genetic componenet Diabetes 1 or 2
2
define DKA
sugar greater than 300
bicarb less than 15
ph less than 7.30
what does insulin do to potassium
move K in cell
what does glucagon do during DKA
converts free fatty acids into ketone bodies
Management of DKA
fluids, insulin, and potassium
T3 and T4 bind to what in circulation
thyroid-binding protien
