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Endocrine > Extras > Flashcards

Extras Flashcards

1
Q

PTH acts on what

A

OSTEOBLASTS!!!

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2
Q

Where does leptin act

A

receptors in hypothlamus and choroid plexus where initiates appetite by counteracting the effects of neuropeptide Y (potent appetite stimulator) and promoting synthesis of alpha melanocyte stimulating hormone- an appetite supressant

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3
Q

Ghrelin does what

A

stimulates growth hormone secretion
produced by stomach and pancreas
stimulates appetite

REDUCD GHRELIN may partially account for the effect of some obesity surgery

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4
Q

glucagon achieves what

A

Glucagon increases gluconeogenesis and glycogenolysis

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5
Q

what is the transporter for glucose reuptake in kidney?

A

SGLT

1 is low capacity high affinity (in S3)
2 (in S1) is low affinity high capacity- 90%

in type 2 DM this capacity is increased!
Once in the ep cells, uses GLUT to get into blood

NOT GLUT!!!!

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6
Q

Role of PPAR gamma

A

adipocyte differentiation and prolif, fatty acid uptake and storage

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7
Q

What is HNF?

A

hepatocyte nuclear factors
transcription factors in the liver

mutation leads to MODY 3 and renal cysts

important in pancreatic beta cells to regulate expression of the insulin gene and genes involved in glucose transport

IN MODY there is no problem with actual insulin, but glucose sensing and secretion impaired

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8
Q

what converts vitamin D to active and where

A

1 alpha hydroxylase in prox tubule cells

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9
Q

What happens to vit D and calcium in preg

A

increase 1,25 and 25 vitamin D
placenta has 1 alpha hydroxylase activity

hence increase calcium in preg

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10
Q

GLP-1 actions

A

decreases glucagon
increases insulin
reduces gastric emptying
reduces appetite

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11
Q

FIRST thing that happens with hypoglycaemia

A

reduced insulin secretion
next increase glucagon
third adrenaline (which also blocks more insulin secretion via alpha 2 adrenergic effects)
GH begins to rise after hours, cortisol too

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12
Q

glucagon does what

A 
gluconeogenesis 
glycogenolysis
lipolysis
ketosis
increase satiety and decrease food intake
thermogenesis and energy expend increase
increase bile acid synthesis
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13
Q

How does primary adrenal insuff cause low sodium

A

cortisol def–>By increasing CRH–>stimulates ADH release

If aldosterone low–>renal sodium loss, hypovolaemia adn baroreceptor mediated ADH release

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14
Q

what does amoiodarone do peripherally

A

reduces conversion of T4 to T3

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15
Q

thyroglobulin good in what cancers

A

papillary
follicular

If thyroglobulin is detectable on thyroxine treatment, it will increase after thyroxine has been withdrawn

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16
Q

adrenal incidentaloma over 4cm, think

A

cancer- even if not doing anything, prob resect

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17
Q

How do you define dexameth supression test

A

failure to fall to less than 50% baseline value

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18
Q

Suppress on 2mg dex sup test…
No suppress on 2mg but suppress on 8mg…
No suppress on 8mg,,,,,

A

no cushing
cushing disease
ectopic ACTH or adrenal tumour (look at ACTH- adrenal tumour will have low ACTH, etopic ACTH will be high)

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19
Q

If 8mg suppresses and suspect cushing and see tumour or MRI vs no tumour

A

operate vs inferior petrosal sinus sampling

look for basal ratio central to periph of 2:1 or after CRH of 3:1

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20
Q

what predicts DM in indigenous

A

age and BMI

lean is protective

some communities have been able to improve insulin resistance, increase red cell folate and reduce homocysteine levels

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21
Q

obestity and thyroid

A

can look like subclin hypothyroid
TSH up and borderline upper T3

reverses with weight loss

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22
Q

micro or macro more likely to be cured in acromeg

A

micros- 80% cured
use octreotide and lanreotide pre op in macro to shrink

if no cure, can use octreotide WITH dopamine agonist post to supress

if looks like acromegaly but MRI normal, do CT chest and abdo to look for ectopic

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23
Q

What is pegvisomant

A

GH receptor antagonist

use where not cured by surgery and not responding to somatostatin analogues

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24
Q

What is KALLMAN syndrome

A 
Anosmia + deficient LH/FSH From HYPOTHALAMUS
Usually X linked or AR
Usually at puberty diagnosed 
MRI to exclude hypothalamic causes
Hormone replacement
Can become fertile
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25
Q

CF and diabetes, what is the insulin choice

A

short acting with meals

do not need much overnight

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26
Q

Which dopamine agonist safe in preg?

A

Bromocriptine loads of data

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27
Q

Does cabergoline give you valve disease

A

at low doses like pituitary disease no

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28
Q

Gastrin actions

A 
increase HCL secretion via parietal cells
stimulate growth gastric mucosa
up gastric motility
increase LES pressure
lower iliocaecal pressure
increase pepsinogen secretion
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29
Q

MEN2- is ret a gain or loss of function

A

gain

loss in Hirschprungs disease

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30
Q

late onset CAH- what does LH and FSH do?

A

Lh usually up

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31
Q

Premature ovarian failure

A

FSH raised

32
Q

PCOS hormones do what

A

raised FSH/LH

33
Q

STop metformin at what CrCl

A

reduce dose from 2g to 1g per day when 30-60
stop at less than 30

use short acting sulfonylureas in renal impairment

34
Q

is acarbose ok in CKD

A

yes, broken down metabs are absorbed and secreted in urine

35
Q

exenatide in renal imp

A

reduce dose if 30-50

dont use under 30

36
Q

sitagliptin in renal impairment

A

usually ok- dose reduce
can even use under 30
weight neutral and unlikely to cause hypos

37
Q

Investigation in suspected pheo- what order

A

first can do plasma fractionated metanephrine
if neg can do 24 hour urine catecholamines and metanephtines (Urine adrenaline highest spec)
Clonidine supression test can be used to confirm

NOT VMA
NOT plasma catecholamines

38
Q

Treatment for thiazide induced DI

A

stop drug, most will recover
if over 4L per day uring, can give thiazides and amiloride
can screen for this with annual 24 hour urine volume

39
Q

SGLT-2 make you…

A

live longer!!
also get DKA
weight loss
lower BSL

MEtformin also reduce mortality

40
Q

Which bariatric surg has highest risk of osteoporosis and iron def

A

hepatobiliary bypass

41
Q

prolactin level interpret

A

up to 2 times ULN stalk comp
over 5 times ULN prolactinoma
inbetween either

42
Q

hypothyroidism and MCV

A

makes it a BIT high

pernicious anaemia consider if WAY high

43
Q

which drug blocks thyroxine release from gland

A

potassium iodide

44
Q

When insulin binds, what happens

A

Insulin binds alpha subunit of the insulin receptor
Then 2 pathways

MAP kinase pathway to increase growth and priliferation

PI-3K pathway whcih increases synthesis lipids, protein, glycogen, cell survival and proliferation, and increases insertion of vesicles containing GLUT 4 into membrane of cell–>glucose transport into cell

45
Q

How do sulfonylureas work

A

Bind to potassium receptor on beta cells
This closes potassium channel so that cell depolarises faster
This increses calcium influx into cell
increase calcium triggers cell to release insulin

46
Q

association with pretibial myxoedema and thyroid ophthamopathy

A

in graves if have pretib myx almost always have the other

stronger assoc than smoking

47
Q

Half life to T3 and T4

A

1 day

1 week

48
Q

in type1 DM, which of the counter reg hormones do you lose first

A

adrenaline
then glucagon later

do not lose GH secretion

49
Q

What is a heterophile Ab?

A

Makes an ELISA test positive but not really- Ab heterophile bridges the gap between the Ag receptor in host and the Ab of the assay instead of the Ag actually being there

50
Q

Inherited thyroid hormone resistance, what does the patient look like

A

euthyroid!

51
Q

weight loss hypoglycaemics

weight neutral hypoglycaemics

A

exenatide makes lose a bit, SGLT-2 inhib, metformin
neutral acarbose and sitagliptin
weight gain- sulfonylurea, thiazolidinedione

52
Q

in primary hyper PT do you need imaging if the person is for surg?

A

no! surg can just chop and it is better sens without imaging

53
Q

Obese patient- why low am testosterone

A

low SHBG

54
Q 
Times of hormone peaks and testing
growth hormone
insulin
cortisol
testosterone
adrenaline
A

adrenaline all over the place
testosterone highest in am
insulin bounces and increase with food
cortisol highest at 8am, lowest at midnight
growth hormone highest at midnight, lower at 8am

(not stressed at night but growing pains at night!)

55
Q

normal calcium and high PTH, think

A

Vit D def

56
Q

diabetic control getting worse after 15 years of type 2 think

A

reduced insulin secretion

not first phase as this is lost early in course type 2

57
Q

type 1 hypoing at night, probably due to

A

excess basal insulin

58
Q

prolactinoma most common clinical presentation

A

amenorrhoea

59
Q

low morning fasting glucose in a type 2 diet controlled patient will be from…

A

overnight gluconeogenesis

60
Q

highest risk of DM 1 developing

A

father has DM 1

61
Q

What is the libido hormone?

A

LSH

FSH is for sperm
LH causes testosterone

62
Q

DKA leads to low sodium how

A

dilutional

63
Q

correct sodium in hyperglycaemia

A

sodium + glucose/4

64
Q

small fibre burning diabetic neuropathy, what histo

A

on skin biopsy, reduced density of epidermal and dermal nerve fibres

65
Q

Kleinfelters LH and FSH

A

high

66
Q

When can you not give dapagliflozen

A

GFR under 60

on diuretics- risk dehydration

67
Q

Three benefits of an insulin pump

A

reduce HbA1c 0.3%
reduce severe hypos
improve QOL

68
Q

Worries in pioglitazone

A 
weight gain
low hypo risk
heart failure
fracture risk
bladder cancer
69
Q

PRIMARY mechanism of sulfonylurea

A

oposing action of glucagon and inhibiting hepatic gluconeogenesis

70
Q

when do you start looking for retinopathy

A

diagnosis in type 2
5 years in type 1
rapid improvement in glycaemic control can cause temporary worsening

71
Q

type 1 diabetic no microalb at 20 years post diagnosis////

A

unlikely to get to ESKD

72
Q

Proportion of cancers attributable to obesity and lack of exercise

A

30-40%

73
Q

Fat cells secrete lots of lots of hormones except for what

A

adiponectin (decrease levels with increase in fat)

74
Q

satiety centre and hunger centres are where

A

medial and lateral hypothalamus respectively

75
Q

Why is levemir weight neutral?

A

binds FFA and get across BBB to inhibit apetitie

76
Q

What hormones turn off appetite>

A 
leptin
GLP-1
insulin
panc polypeptide
CCK
oxyntomodulin
77
Q

if you lose weight, what happens to ghrelin

A

increase

body has weight homeostasis

Endocrine (12 decks)

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