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ERM > Endocrinology Part 2 > Flashcards

Endocrinology Part 2 Flashcards

1
Q

What cell types release hormones from the anterior pituitary?

A 
Corticotroph
Gonadotroph
Somatotroph
Thyrotroph
Lactotroph
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2
Q

What do corticotrophs release?

A

ACTH

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3
Q

What do gonadotrophs release?

A

LH

FSH

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4
Q

What do somatotrophs release?

A

GH

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5
Q

What do thyrotrophs release

A

TSH

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6
Q

What do lactotrophs release?

A

PRL

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7
Q

What stimulates corticotrophs?

A

CRH

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8
Q

What stimulates gonadotrophs?

A

GnRH

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9
Q

What inhibits gonadotrophs?

A

PRL

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10
Q

What stimulates somatotrophs?

A

GHRH

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11
Q

What inhibits somatotrophs?

A

SST

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12
Q

What inhibits thyrotrophs

A

SST

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13
Q

What stimulates thyrotrophs?

A

TRH

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14
Q

What stimulates lactotrophs?

A

TRH

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15
Q

What inhibits lactotrophs?

A

DA

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16
Q

Which cells do TRH stimulate?

A

thyrotrophs

lactotrophs

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17
Q

Which cells do SST inhibit?

A

Somatotroph

Thyrotroph

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18
Q

At what receptor does prolactin act?

A

Cytokine receptor

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19
Q

What does prolactin do during pregnancy?

A

Stimulate breast development to prepare for lactation

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20
Q

What do estrogens released from the placenta do during pregnancy?

A

Inhibit milk production (so no milk is produced before baby arrives)

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21
Q

What does prolactin do post-partum?

A

Stimulate milk production and lactation

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22
Q

What inhibits the release of prolactin?

A

Dopamine

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23
Q

What stimulates the release of prolactin?

A

Pregnancy
Nursing
High TRH
Sleep

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24
Q

What can cause hyperprolactinemia?

A

Prolactinoma (tumor in the ant. pit.)

High TRH (due to hypOthyroidism)

Hypothalamic/pituitary stalk damage

DA-R antag

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25
Q

What is seen in women with hyperprolactinemia?

A

Galactorrhea

Low levels of LH, FSH, and estrogen --> 
amenorrhea
anovulation
infertility 
decreased libido
dry skin
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26
Q

What is seen in men with hyperprolactinemia?

A

Low levels of LH, FSH, and testosterone –>
decreased libido
impotence
infertility

Minor galactorrhea

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27
Q

How is hyperprolactinemia treated?

A

D2 receptor agonists (particularly useful for tumors) –> cabergoline
bromocriptine

Surgery (remove the tumor)

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28
Q

What actions are INCREASED by growth hormone acting at the cytokine receptor?

A 
INC:
plasma glucose
gluconeogenesis
lipolysis
IGF-1 release

Have some growth

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29
Q

What actions does growth hormone have after IGF-1 is released from liver, muscle fat, and bone?

A 
Growth:
bones 
organs
glands 
muscle
skin
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30
Q

What can stimulate the release of growth hormone?

A 
GHRH
Low glucose
AA (arginine)
Ghrelin
Puberty
Sleep
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31
Q

What can INHIBIT the release of growth hormone?

A 
SST
GH
IGF-1
High glucose
High FFA
Age
Emotional stress
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32
Q

What can cause growth hormone DEFICIENCY?

A

Decreased GHRH release from the hypothalamus

Damage to the anterior pituitary

Non-functional GH (gene defect)

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33
Q

What decreases are seen clinically in growth hormone deficiency?

A

DEC:
strength
muscle mass
height in kids

34
Q

What stimulation tests are used to measure low growth hormone?

A

GHRH + arginine infusion
Insulin-induced hypoglycemia

If normal = GH will increase
If abnormal = GH will not increase adequately

35
Q

How can you treat growth hormone deficiency?

A

Administer recombinant GH (somatropin)

36
Q

What can cause EXCESS growth hormone?

A

Pituitary adenoma
Hypothalamic overproduction of GHRH
Exogenous GH

37
Q

What is seen clinically with excess growth hormone?

A

Acromegaly

Children = gigantism
Adults = normal height
38
Q

What suppression test can be done to test for growth hormone excess?

A

Oral glucose test

Normal = decrease GH
Abnormal = GH will not decrease adequately
39
Q

How can you TREAT growth hormone EXCESS?

A

Surgery of the tumor

Octreotide - SST analog

Pegvisomant (GH receptor antagonist) - decreases GH activity and inhibits release of IGF-1

40
Q

What does C cells produce? What is another name for C cell?

A

Calcitonin

Parafollicular cell

41
Q

Where does iodine trapping occur?

A

From blood to follicular cell

42
Q

Where does organification occur? What enzyme does this?

A

In the colloid

TPO (thyroid peroxidase)

43
Q

What drugs inhibit thyroid peroxidase?

A

Methimazole and PTU (propylthiouracil)

44
Q

What is the radioactive iodide uptake test (RAIU)?

A

Give a patient radioactive iodide and measure it’s take up by the thyroid

If the patient has high TSH-R activity or hyperactive nodules/tumors it will show up as bright spots

This means the patient has higher than normal iodide trapping and organification

45
Q

What does TSH do? (4 items)

A
  1. Increase iodide trapping
  2. Increase TPO activity
  3. Increase hormone synthesis and release
  4. Increase thyroid gland growth
46
Q

What is euthyroid hyperthyroxinemia?

A

No symptoms off thyroid hormone excess or deficiency = normal levels of free hormone

High levels of total hormone

47
Q

What is euthyroid hypothyroxinemia?

A

No symptoms off thyroid hormone excess or deficiency = normal levels of free hormone

Low levels of total hormone

48
Q

What can cause euthyroid hyperthyroxinemia?

A

Slow increase in TBG binding

Estrogens and 5-FU

49
Q

What can cause euthyroid hypothyroxinemia?

A

Slow decrease in TBG binding

Androgens, niacin, and aspirin

50
Q

What converts T4 to T3?

A

5’-deiodinase (non-prime form creates a non-active form)

51
Q

What does thyroid hormone do? (items 1-5)

A
  1. Linear growth = normal growth, development, and function of tissues
  2. Increase metabolism
  3. Increase HR and oxygen use by heart
  4. Vasodilation
  5. Tremor (increase beta2 receptors)
52
Q

What is the MOA of thioamides?

A

Decrease TPO activity –> thyroid hormone synthesis

Methimazole and PTU

53
Q

What does thyroid hormone do? (items 6-10)

A
  1. Increase EPO release from kidney
  2. Increase GI motility
  3. Increase bone resorption

9 Increase deep tendon reflex

  1. Increase drug/hormone metabolism
54
Q

How long does it take for thioamide to reach maximum efficacy?

A

3-6 weeks due to continued release of stored hormone

55
Q

What are the adverse effects of thioamides?

A

Agranulocytosis

56
Q

What is the MOA of high dose iodide?

A

DEC:
NIS activity
TPO activity
Thyroid hormone release

57
Q

How long does it take before the effects of high dose iodide wear off?

A

2-3 weeks

58
Q

What is the MOA of levothyroxine?

A

Replacement T4 (some T3)

59
Q

What are the adverse effects of levothyroxine?

A

Tachycardia, Afib, angina, insomnia, tremor

Contraindicated with soy

60
Q

How is propranolol used for hyperthyroidism?

A

Blocks beta1 to decrease cardiac toxicity
Blocks beta2 to decrease tremor
Decreases 5’-deiodinase activity

61
Q

How is lithium used for hyperthyroidism?

A

inhibits GPCR transduction in the TSH pathway to decrease thyroid hormone secretion, NIS, and TPO

May cause hypothyroidism

62
Q

How is amiodarone used for hyperthyroidism?

A

Contains iodide = use as source to make hormones

Can cause hyper or hypothyroidism

63
Q

What is goiter?

A

Swelling of the thyroid gland

64
Q

What is diffuse goiter?

A

Whole thyroid gland is enlarged due to increased TSH receptor activity

65
Q

What is nodular goiter?

A

One area of the thyroid gland is enlarged due to tumor of some kind

66
Q

What is hypothyroidism?

A

Low levels of thyroid hormone

67
Q

What can cause primary hypothyroidism?

A

thyroid failure

  • low iodide intake
  • Hashimoto’s thyroiditis
  • antithyroid meds)
68
Q

What can cause secondary hypothyroidism?

A

pituitary failure causing low TSH

69
Q

What can cause tertiary hypothyroidism?

A

hypothalamic failure causing low TRH

70
Q

What are the effects of hypothyroidism?

A 
Fatigue,
depression
weakness, 
low temp, 
cold intolerance, 
constipation, bradycardia, 
low CO, 
decreased DTRs, 
dry skin, 
brittle hair, 
loss of hair, 
low glucose, 
high LDL, 
weight gain, 
anemia, 
myxedema, 
cretinism (not reversible, but preventable)
71
Q

Why is hypothyroidism problematic in the elderly?

A

Symptoms are similar to that of aging

72
Q

How is T4, T3, TSH, goiter, and RAIU seen in very low dietary iodide?

A

Increased:
TSH
RAIU

Decreased:
T3
T4

Goiter:
diffuse

73
Q

How is T4, T3, TSH, goiter, and RAIU seen in anterior pituitary failure?

A 
Decreased:
TSH
T3
T4
RAIU

Goiter:
none

74
Q

How is T4, T3, TSH, goiter, and RAIU seen in Hashimoto’s thyroiditis?

A

Increased:
TSH

Decreased:
T3
T4
RAIU

Goiter:
none

75
Q

How can you treat hypothyroidism?

A

Give T4 (levothyroxine) on empty stomach and avoid soy

76
Q

What happens if you miss a dose of levothyroxine?

A

It’s not good, but the drug has a long-half life so it will not show immediate problem

77
Q

What is hyperthyroidism?

A

High T3/T4 due to high activity of the thyroid gland

78
Q

What is thyrotoxicosis?

A

High T3/T4 not necessarily associated with overactive thyroid gland

79
Q

What actions are DECREASED by growth hormone acting at the cytokine receptor?

A

DEC:
glucose use
insulin

80
Q

Signs of Acromegaly

A 
Large hands/feet, 
Soft tissue growth 
Thickened bones
Sweaty/oily skin 
Carpal tunnel
Hyperglycemia
Arthritis
81
Q

What increases are seen clinically in growth hormone deficiency?

A

INC:
Body fat

Normal height in adults

ERM (27 decks)

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