Endocrinology (7) Flashcards by Marco DiFederico

causes of true endocrine disorders (3)

Undersecretion or receptor problem (XY, testicular feminization)
Hyperplasia (enlargement of endocrine gland)
Over secretion (bushings)

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lab tests for hormone diseases (3)

measurement on horomone conce
- -if high=supress then measure
- -if low= stim then measure
Imaging organ producing horomones
Serum autoantibody measurement for cause

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hormone measurement methods (3)

Bioassays measure bioactivity (gold)
Immunoassays for peptide hormones
Mass spectrometry

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hormones measured from hypothalamus(1), Pituitary(5), Throid (3), Adrenal (4)

hypothalmus- ADH

Pituitary- ACTH,TSH,GH,LH,FSH,Prolactin

Thyroid- t4,T3, calcitonin

Adrenal- sex, cortisol, aldosterone, catechoamines

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hypothalamic disease causes (4)

anatomic abnormality
tumor
severe head injury
post surgical

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what does the ant pituitary release

Thyroid stim hormone
adreno cortical h
luteinizing h
follicle stim
growth hormone
prolactin

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what are the post pituitary horomones

ADH (urinary retention)

Oxytocin

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ADH causes what in acute and chronic def

diabetes insipidus

acute- develop in pt with known pituitary disease as result of surgery/radiotherapy

chronic- more than 1 month (perminent disease)

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Causes of diabetes insipidus (4)

pituitary and hypothalmic tumors
latrogenic (surgery)
idiopathic
kidney tubule resistance to ADH

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hypopituitarism- s/s actute and chronic

acute- fatigue, weakness, dizziness, nausea etc

chronic- tiredness, pallor, anorexia, weight loss

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causes of hypopituitarism

Tumor (mc)
infarction
tauma
cong

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Hormones released into blood in hyperpituiritism tumor

prolactin (50% of tumors)
GH
ACTH (cushings)
LH/FSH
non functional (20%)

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what does hyperprolactinaemia cause

infertility

- visual probs

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possible causes of smallness

primary hypothyroidism
glucocorticoid excess
hypopituitarism
growth hormone decreased
growth hormone resistance

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lab assessmentt of GH

Stim tests using: Arganine, insuline, clonidine, l dopa etc

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What is turners syndrome

low GH causing small stature

webbed neck
widley spaced nips
coartication of aorta
wide carrying angle
primary amenorrhea

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Growth hormone excess diseases/ could be due to (4)

pituitary tumor
congenital adrenal hyperplascia
hyperthyroidism
klinefelter syndrome

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Adverse effects of GH therapy

Creutzfeldt jacob disease
lukemia/cancer incidence
acromegaly
personality changes
SCFE

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Acromegaly hormone causes

GHRH increases GH
Somatostatin decreases GH
most effect of GH is seen after GH metabolism to IGF1

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how to test for GH disease

inhibit GH and see if oral glucose response causes no response

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if thyroid disease is in your genes what symptoms will u see

premature graying hair
hair loss
left handedness
dyslexia in males

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thyroid function and control

what is released and what does it stim
feedback

thyrotropin releasing hormon stims TSH from ant pituitary

-free t3/t4 supresses TRH

biologically active from of thyroid hormones

t3
t4

-t3 is 3-4x more biologically active

thyroid functioning testing

Serum/plama TSH - usually the only test needed

Free T4- confirmatory test

key aspect with thyroid disease and lab data

Can be thyroid disease w normal serum thyroid hormone levels as there is a lag phase (lots of thyroid hormone is stored in fate)

clinical features of hypothyroid

``` letharygy, fatigue, sleepiness slow pulse cold intolerance weight gain dryness hoarness ```

etiology of hypothroid

autoimmune destruction of thyroid (hashimoto) surgical tx radiation of thyroid hypopituitarism

mayo clinic testing protocol TSH

undetected- hyperthyroid sub normal- borderline normal seum TSH- no more tests Increased serum TSH-hypothyroid

hashimotos thyroiditis- age, gender etc

``` older W (W;M 10:1) in 50% of Hashimotos the thyroid becomes under active ```

in systemic illness serum TSH is what

TSH is decreased

clinical features of hyperthyroidism

``` Heat intolerence weight loss palpitations fatigue Exophthalmos (usually women 20-45 years of age complain or sore, gritty eyes, irritability etc ```

causes of hyperthroid

diffuse toxic goiter (graves disease) Solitary or multiple toxic adenoma thyroiditis iodine/iodine containing drugs

What are thyrotropic-receptor antibodies

IgG against TSH receptors seen in Graves disease

How to test for thyroid cancers

Tests for Serum TSH | Then i131 uptake

Adrenocorticotrophin (ACTH) release from pituitary is caused by

corticotropin releasing horomone from hypothalamus in respnse to: - cortisol decrease in plasma - stress - glucose decrease - bac pyrogens

outer/middle/inner layers of adrenal and what they make

outer- zona glomerulosa= aldosterone middle- zona fasciculata= corticosteroids, androgens, oestrogens Inner- zona reticularis= corticosteroids, androgens oestrogen medulla makes catecholamines

Hypoadrenalism (addisons disease) s/s

- low blood pressure - low plasma sod - high plasma pot - low plasma cortisol - letharagy - anorexia - pigmintation of hand creases

hypoadrenalism etiology (3)

Autoantibodies (mc) Infections Long term steroid use

Hypoadrenalism (addisons) lab abnormalities

``` Serum Na decreased Serum K increased No serum cortisol response to ACTH low serum glucose serum urea increased ```

Hyperadrenalism hormones to note

cortisol adosterone adrenal androgens

Cortisol effects (5)

1. gluconeogenesis 2. Increased pro breakdown 3. anti inflammatory 4. Haematopoiesis 5. lipolysis

what is hypercosticsol called and population

Cushings syndrome | Male to femal 1:4

Hypercostisolism symptoms

- increased abdominal fat 94% - high blood pressure 82% - Secondardy diabetes mellitues 85% - Sexual malfunction 75% - Baldness and facial hair in women 75%

Causes of hypercortisolism (5)

``` Pituitary tumor (cushings) Adrenal tumor (cushings) Lung tumor (ectopic acth) iatrogenic stress ```

lab dx in hypercostisol

serum cortisol increased low dose dexamethasone used to supress serum cortisol, Then high dose dexamethasone to supress serum cortisol (to distinguish cushings disease from syndrome)

How to tell cushings disease from ccushings syndrome

ACTH iis increased in CD but not in syndrome

cushings syndrome symptoms

``` face changes buffalo hump cardiac probs obesity purple stretch marks ```

hyper adrenal symtoms

ovarian or adrenal carcinomas give excess androgens (hair on face and virillization in women) - polydipsia/polyuria - weakness/mm cramps - mild to mod high bp

Adosterone excess primary (lab, cause)

rare | -serum aldosterone increased and serum renin decreased

Aldosterone excess secondary lab

serum aldosterone and serum renin increased

adrenal hyperplasia screening tests + confirmatory tests

serum k decreased, urin k increased confirm - normal saline IV supresses plama aldosterone - captopril supresses

hyper adrenaline cause

90% in adrenal medulla (pheochromocytoa)

Pheochromocytoma symptoms

headache excess sweat palpatins hypertension

dx tests for pheochromocytoma

urine metanephrine urine vanillyl mandelic acid (VMA) --both increased substatially