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Endocrinology Flashcards

1
Q

Anterior pituitary hormones (6x)

A

GH, PRL, ACTH, TSH, LH, FSH

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2
Q

Posterior pituitary hormones

A

oxytocin, AVP/ADH

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3
Q

ACTH stimulates the ____ to secrete ___

A

adrenal cortex

cortisol

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4
Q

FSH and LH stimulate the ____ to secrete ____

A

ovaries

estrogen and progesterone

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5
Q

TSH stimulates the ____ to secrete ____

A

thyroid gland

T3 and T4

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6
Q

What stimulates the production of prolactin?

What inhibits the production of prolactin?

A

TRH

Dopamine

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7
Q

What inhibts secretion of GnRH?

A

prolactin

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8
Q

what is the target gland of oxytocin?

A

uterus and mammary glands

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9
Q

what is the target of AVP/ADH?

A

kidneys

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10
Q

what is the target of GH?

A

somatomedin

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11
Q

What will be increased and decreased in hypothyroidism?

A

decreased T3 and T4

elevated TRH and TSH

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12
Q

What will be increased and decreased when the there is damage to the thyroid (primary hypothyroidism)?

A

decreased T3 and T4

elevated TSH

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13
Q

In regards to thyroid hormones, what levels will be affected if there is damage to pituitary gland or hypothalamus?

A

decreased TSH and TRH

decreased T3 and T4

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14
Q

In primary thyroid disorder the problem is in the

A

target organ [thyroid]

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15
Q

In secondary thyroid disroder the problem is in the

A

pituitary

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16
Q

In tertiary thyroid disorder the problem is in the

A

hypothalamus

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17
Q

Hormone that stimulates the liver and other organs to synthesize and secrete IGF to stimulate division of progenitor cells located in the growth plates and in skeletal muscles for body growth

A

growth hormone

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18
Q

hormone that promotes mammary gland development

A

prolactin

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19
Q

hormone that maintains structure and stimulates secretion of glucocorticoids and gonadocorticoids by the zonafasciculata and zonarecticularis of the adrenal cortex

A

adrenocorticotropic hormone (ACTH)

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20
Q

hormone that stimulates follicular development in the ovary and spermatogenesis in the testis

A

follicle stimulating hormone (FSH)

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21
Q

hormone that regulates final maturation of ovarian follicle, ovulation and corpus luteum formation; stimulates steroid secretion by follicle and corpus luteum; in males, essential for maintenance of and androgen secretion of the Leydig cells of the testis

A

luteinizing hormone (LH)

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22
Q

hormone that stimulates growth of thyroid epithelial cells; stimulates production and release of thyroglobulin and thyroid hormones

A

Thyrotropic hormone (TSH)

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23
Q

How does elevated levels of prolactin in pregnancy and lactiation cause amenorrhea?

A

prolactin suppresses GnRH → suppresses FSH and LH → amenorrhea

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24
Q

Predominant inhibitory signal of prolactin

A

dopamine

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25
stimulatory signal of prolactin
TRH
26
4 different causes of prolactinemea
pituitary tumor of PRL secreting cells (prolactinoma) hypothyroidism (elevated TRH) dopamine antagonist therapy stalk compression (non-functioning pituitary tumor)
27
clinical manifestation of hyperprolactinemia in women
oligomenorrhea or amenorrhea reduced fertility reduced libido galactorrhoea
28
clinical manifestations of hyperprolactinemia in men
ED reduced fertility reduced libido gynecomastia
29
Gender neutral clinical manifestations of hyperprolactinemia
visual field defects (MC is bitemporal) headache stunted growth delayed puberty
30
how can stalk compression cause high prolactin levels?
dopamine effect on prolactin cells is blocked
31
With a prolactinoma, elevated prolactin levels are based on ____ and are between the range?
tumor size [mass effect] | 30-200 ng/mL
32
any kind of endocrine tumor is called
adenoma
33
In regards to pituitary tumors, if the tumor is > 1 cm it is called a ____ and if the tumor is < 1 cm is called ____
macroadenoma | microadenoma
34
Treatment of choice in prolactinoma
medical management [dopamine agonist, bromocriptine, cabergoline]
35
what percentage of brain tumors are pituitary adenomas?
10-15%
36
what type of pituitary adenoma causes hypopituitarism?
nonfunctioning pituitary adenoma
37
pituitary adenomas secrete
prolaction → MC | GH and ACTH
38
Why does GH excess cause gigantism in children?
epiphysis is not closed → bone growth longitudinally
39
excess GH after the closure of epiphyses is termed
acromegaly → "extremity enlargement"
40
MC cause of acromegaly
pituitary adenoma → macroadenoma
41
signs and symptoms of acromegaly
``` large, doughy, moist hands carpal tunnel syndrome coarse facial features hypertension and cardiomegaly weight gain visual field defects arthralgia insulin resistance ```
42
Patient has pituitary adenoma that is causing hypofunctioning of the pituitary gladn but they are asymptomatic. What can cause them to be symptomatic?
crisis precidpitated by infection or surgery
43
Three main classes of hormones produced by the adrenal cortex
mineralocorticoids [aldosterone] glucocorticoids [cortisol] adrenal androgens [testosterone and DHEA]
44
what detects and responds to changes in solute concentrations of the blood?
hypothalmic osmoreceptors
45
What does the hypothalamus synthesize when solute concentration is high? What is the effect?
ADH/AVP | inhibits urine formation
46
When are ADH levels the highest in the body?
11pm to midnight
47
If not enough ADH is made/release, what results? | Symptoms?
diabetes insipidus | huge urine output and intense thirst
48
ADH hypersecretion due to neurosurgery, trauma, or cancer cell secretion causes
Syndrome of Inappropriate ADH Secretion [SIADH]
49
6 criteria for diagnosing diabetes insipidus
``` hypotonic polyuria 24 hr urine volume >50 urine specific gravity < 1.010 urine osmolarity < 300 absense of solute diuresis normal thyroid and cortisol ```
50
Causes of central diabetes inspidus
complete or partial ADH deficiency from posterior pituitary head trauma post-surgery tumors infections [TB, syphilis, toxoplasmosis, encephalitis, meningitis, sarcoidosis] cerebrovascular disease
51
what occurs in nephrogenic diabetes insipidus?
ADH/AVP receptors on the kidneys are unresponsive to ADH
52
Abnormal electrolyte levels in nephrogenic diabetes insipidus?
hypercalcemia and hypokalemia
53
MC cause of nephrogenic diabetes insipidus
drug toxicity → lithium, NSAID, demeclocycline
54
How do you differentiate central vs nephrogenic diabetes insipidus?
water deprivation test
55
Results from water deprivation test in a patient with central DI
urine osmolarity after fluid deprivation → < 300 | urine osmolarity after desmopressin → > 800
56
Results from water deprivation test in a patient with nephrogenic DI
urine osmolarity after fluid deprivation → < 300 | urine osmolarity after desmopressin → < 300
57
Results from water deprivation test in a patient with primary polydipsia
urine osmolarity after fluid deprivation → > 800 | urine osmolarity after desmopressin → > 800
58
Treatment for central diabetes insipidus
desmopressin (DDAVP) → hormone replacement
59
Treatment for nephrogenic diabetes insipidus
treat underlying cause encourage fluid intake hydrochlorthiazide or amiloride [excrete more salt]
60
What is most problamatic in a patient with SIADH?
dilutional problem → hyponatremia
61
clinical presentation of SIADH
depend on degree of hyponatremia and how rapidly it develops
62
SIADH etiologies
CNS → bleed/hemorrhage, CVA, DTs, trauma, hydrocephalus, infection, tumor Drugs neoplasms [ectopic ADH section] → lungs, prostate, duodenum, etc
63
Serum levels of sodium < 125 in a patient with SIADH will display what symptoms?
muscular weakness, nausea, headache, lethargy, ataxia, psychosis to cerebal edema, increase ICP, seizures, coma
64
diagnostic criteria for SIADH
plasma hypoosmolality urine concentration inappropriate for hypoosmolality [>100] clinical euvolemia absent renal sodium convervation [urine sodium > 30] normal thyroid, adrenal, renal function!!
65
Treatment of SIADH
correct low sodium → not too fast!! Treat underlying cause restrict fluid, oral salt tablets demeclocycline
66
What is the role of aldosterone?
regulates salt and water homeostasis via renin/angiotensin
67
what is the role of cortisol?
carbohydrate metabolism and chronic stress response
68
Clinical manifestations of excessive cortisol levels
``` hypertension hypokalemia central obesity skinny limbs [breakdown of skeletal muscle] thin skin and purple striae bruise easily interscapular fat pad "buffalo hump" osteoporosis simple carb cravings → boost insulin and promote fat storage [cortisol is appetite stimulant] menstrual irregularity and ED ```
69
Cushings syndrome vs Cushings disease
Disease → ACTH and cortisol are both elevated | syndrome → high cortisol and low ACTH
70
Cushings Disease is the result of
too much ACTH from the pituitary
71
Cushings Syndrome is the result of
non pituitary source → adrenal tumor, excess intake of corticosteroids
72
#1 cause of ectopic production of ACTH
small cell carcinoma of lung
73
What will be elevated in ectopic ACTH production?
ACTH and cortisol
74
In diagnosing hypercortisolism, you need documentation of cortisol excess by at least 1 of the following mechanisms
24 hour urine free cortisol levels → on 2 occasions midnight/diurnal salivary cortisol levles → on 2 occasions dexamethasone suppression test → 8-9am cortisol < 1.8
75
What test do you use to confirm the pituitary gland is the source of hypercortisolism?
high dose Dexamethasone suppresion test → give dex @ 11pm & measure ACTH and cortisol → repeat at 8-9 am the next day → decrease of cortisol by >69%
76
What size of pituitary adenoma warrants surgical removal?
> 8 mm
77
Management of Cushings Disease
trans-sphenoid surgery | radiation + surgery [dural/cavernous sinus invasion]
78
Management if Cushings Syndrome is secondary to adrenal gland disease
unilateral or bilateral adrenalectomy
79
Management of Cushings Syndrome secondary to an ectopic source
surgical removal of culprit tumor
80
Medical management in hypercortisolism patient if surgery ineffective or not an option
steroid blocking agents → ketoconazole, metyrapone, mitotane, etomidate
81
Clinical manifestations of adrenal insufficiency
low blood sugar [due to decrease cortisol] → malaise and weight loss, fatigue, weakness hyponatremia and hyperkalemia decreased BP increased ACTH and MHS secretion → increased pigmentation of lips, freckles, buccal mucosa, skin creases!!
82
What test confirms diagnosis of adrenal insufficiency?
8 am cortisol < 3 | normal 10-20
83
How do you determine if adrenal insufficiency is primary or secondary?
look at ATCH ACTH is elevated → primary AI ACTH is suppressed → secondary AI
84
In the ACTH stimulation test, what are you tring to stimulate?
trying to stimulate the adrenal gland to make cortisol with high concentration of ACTH
85
What value in ACTH stimulation test will rule out AI?
cortisol > 18 at 60 min
86
Management of primary adrenal insufficiency
replacing corticosteroids and mineralocorticoids
87
Management of secondary adrenal insufficiency
replacing corticosteroids
88
In treating AI, how should hydrocortisone be dosed?
highest given in the morning → early afternoon (2 dose) or at lunch → afternoon (3 dose)
89
What is it important to counsel a patient with AI on with their hormone replacement?
increase the dose if get fever (>38→double; >39→triple) increase for mild/mod surgery stress increase for major surgery requiring sedation
90
Management of adrenal crisis
rapid infusion of NS or D5N5 | IV HC → taper to PO when tolerate
91
Who do you refer to endocrinologist?
early cases of acromegaly, functional pituitary adenoma, Cushings Syndrome, all hyperfunctioning cases

Endocrinology (7 decks)

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