ENDOCRINOLOGY Flashcards
What are the clinical features of McCune-Albright Syndrome?
BONES AND ENDOCRINE:
- Polyostic fibrous dysplasia
- Cafe au lait spots (jagged edge “Coast of Maine” appearance)
- Hyperthyroidism
- Precocious puberty
What are the 3 Es of Diencephalic syndrome?
- Emesis
- Emaciation
- Euphoria
Results from hypothalamic tumor
Body is in catabolic state
Child will want to eat a lot
What hormones influence growth? (6)
- Growth hormone
- Insulin
- Insulin Growth Factor -1
- Cortisol
- TSH
- Androgens/estrogen
Which hormone controls prenatal growth? Postnatal growth?
Pre-natal growth: insulin
Postnatal growth: GH
What is the most accurate way of predicting adult height? What is the least accurate way?
Most accurate - bone age
Least accurate - mid parental height
3 causes of delayed bone age:
- Constitutional delay
- Chronic disease
- Endocrine disease
What is the most common cause of endocrine-related growth failure?
Primary hypothyroidism (causes growth arrest)
What is the most common cause of hypoglycemia in patients over 18 months old?
Ketotic hypoglycemia: substrate (glucose) deficiency
What is the management of a newborn found to have increased TSH and decreased thyroid hormone (T4) on newborn screening and confirmed again on bloodwork?
IMMEDIATE initiation of thyroid hormone replacement (levothyroxine)
-delay in therapy greater than 2 weeks of age can result in cognitive impairment
What are the Tanner/sexual maturity rating stages in girls?
- pubic hair
- breasts
SMR stages:
- Preadolescent
- Sparse pubic hair, small mound of breast and papilla
- Darker, increased pubic hair; enlarged breast and areola
- Coarse, abundant pubic hair; areola and papilla form double mound
- Adult feminine triangle, spread to medial surface of thighs; mature breasts, nipple projects
At what Tanner/SMR stage does menstruation occur?
30% in stage 3, 90% by stage 4
At what Tanner/SMR stage does axillary hair production occur for:
- boys
- girls
Boys: stage 4
Girls: stage 3
**Remember that girls mature more quickly than boys!
What are the Tanner/sexual maturity rating stages in boys?
- pubic hair
- penis
- testes
- No pubic hair, preadolescent penis and testes
- Sparse pubic hair; minimal change in penis size, enlarged scrotum
- Darker pubic hair, lengthening of penis, testes grow larger
- Coarse, abundant pubic hair; glans and breadth of penis increase, increased size and darkening of scrotum
- Adult distribution of pubic hair with spread to medial surface of thighs, adult size penis and testes
What is the cycle of menses?
- follicular phase
- luteal phase
- Follicular phase: begins with onset of menses –> results in mid cycle LH surge which induces ovulation from the follicle. Empty follicle then forms the corpus luteum initiating the luteal phase
- Luteal phase: progesterone and estradiol are secreted from the corpus luteum maintaining the endometrial layer of the uterus. If pregnancy does not occur and there is no HCG to maintain the corpus luteum, it dies which results in withdrawal of progesterone and thus endometrium sloughs, giving you a period
What are the stages of puberty in females?
-what age does puberty start?
Onset of puberty: 8-13 yo
- Thelarche: onset of breast development (precedes pubarche by 6-12 mo)
- Adrenarche –> Pubarche: onset of adrenal androgen production which leads to onset of sexual hair growth
- Menarche: follows thelarche by 2-3 years
Remember boobs, pubes, grow, flow
**Growth spurt starts with early puberty and occurs over 2-3 years with peak height velocity achieved about 1 year before menarche
Growth spurt is completed by what age in females?
99% of growth is complete by 15 yo
What are the stages of puberty in males?
-what age does puberty start?
Avg age of onset: 9-14 yo
- Testicular enlargement: 1 yr before pubarche
- Adrenarche/pubarche: from adrenocortical androgen production and gonadal activity
- Pubertal growth spurt: occurs 2 years later in boys than girls and occurs during SMR pubic hair stages 3 and 4
- Facial hair/voice change during SMR stage 4
Growth spurt is completed by what age in males?
99% of growth is complete by 17 yo
What does the adrenal medulla secrete?
What does the adrenal cortex secrete?
- glomerulosa
- fasciculata
- reticularis
Adrenal medulla:
-catecholamines
Adrenal cortex:
- zona glomerulosa: mineralocorticoids aka aldosterone (think glomerulus in kidney)
- zona fasciculata: glucocorticoids
- zona reticularis: sex hormones + small amt glucocorticoids (“I had sex with reticularis”)
After the onset of menarche, how much more will girls typically grow?
7 cm after menarche
-but need to get bone age xray to know for sure
What are the effects of cortisol?
- metabolic
- CVS
- growth
- immune
- skin/bone/calcium
- CNS
- Metabolic: increases serum glucose by increasing hepatic gluconeogenesis and glycolysis
- CVS: positive inotropic effect on the heart
- Growth: inhibit linear growth and skeletal maturation by decreasing GH and IGF1
- Immune: decreases inflammation and immune response
- Skin/bone/calcium: inhibits fibroblasts leading to poor wound healing, decreases serum Ca and decreases osteoblastic activity –> osteoporosis
- CNS: crosses BBB and has direct effects on brain metabolism –> stimulates appetite, insomnia, irritability, emotional lability
What are the 3 urine catecholamines you test for in cases of possible adrenal medulla tumors?
- VMA
- Metanephrine
- Normetanephrine
What are the steps of sex differentiation in utero?
- If there is a Y chromosome, then the bipotential gonads can differentiate into testes between 6-8 wks.
- The testes produce testosterone (Leydig cells) and anti-Mullerian hormone (Sertoli cells) –> testerone directs formation of the internal male reproductive organs from Wolffian ducts and AMH suppresses development of the Mullerian ducts (ie. preventing female internal reproductive organ formation)
- At 8-12 wks, the testosterone made by testes is changed to DHT (by 5 alpha reductase). DHT causes formation of male external genitalia. If there is no DHT, then female external genitalia develops.
**In infants with CAH, there is an excess of DHT due to build up of intermediate metabolites and thus female babies can have virilization (formation of male external genitalia) while still having normal female internal reproductive organs
What is the most common cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency (90% of cases)
-two types: classic (severe form, 75% have salt wasting) and non-classic (milder)