Handler Lectures Flashcards
1
Q
Turns thyroid on/off and binds to receptors of follicular cells
A
TSH
2
Q
Is essential for manufacture of thyroid hormones
A
Iodine
3
Q
Significant source of hypothyroidism
A
Iodine deficiency
4
Q
Of the thyroid hormones, T3 & T4, what primary enters cells and exhibits effects?
A
T3
5
Q
What is made in the liver and binds 80% of thyroid hormone?
A
Thyroxine Binding Globulin (TBG)
6
Q
If thyroid hormone is absent at birth it leads to severe mental retardation aka___
A
cretinism
7
Q
Helps maintain thermogenic and metabolic homeostasis in the adult; essential for normal metabolism, protein synthesis and organ function
A
Thyroid hormone
8
Q
The most informative tests of thyroid function
A
TSH & free T4
9
Q
TSH is decreased: Graves, toxic nodular goiter
A
Primary hyperthyroidism
10
Q
TSH is increased in___
A
Primary hypothyroidism
11
Q
MC form of hypothyroidism=
A
Hashimoto’s thyroiditis
12
Q
MC form of hyperthyroidism=
A
Graves disease
13
Q
Definitive test for evaluating thyroid nodules
A
Fine Needle Aspiration
14
Q
Lymphocytic infiltration of gland; goiter often present
A
Autoimmune hypothyroidism
15
Q
Tx of hypothyroidism
A
Levothyroxine
16
Q
A clinical syndrome associate with excessive levels of thyroid hormone; aka Hyperthyroidism
A
Thyrotoxicosis
17
Q
MC form of hyperthyroidism:
A
Grave’s Disease
18
Q
Autoimmune disorder: TSH-R Ab-IgG antibodies directed to TSH receptor: over-activate gland–> hyper secretion, hypertrophy and hyperplasia (goiter common)
8x more common in women
A
Grave’s Disease
19
Q
Symptoms=hyperactivity, irritability, restlessness, anxiety, HEAT INTOLERANCE, sweating, palpitations, INCREASED APPETITE, WEIGHT LOSS
A
Grave’s Disease
20
Q
Often presents with VERY LOW TSH
A
Hyperthyroidism
21
Q
May include Ophthalmology/dermopathy; proptosis/exophthalmos, “lid-lag”, conjunctival inflammation/edema, corneal drying (lymphocytic infiltration of the orbit, muscles, eyelids; may cause diplopia and compression of optic nerve
A
Grave’s Disease
22
Q
May include non-inflammatory induration and plaque formation of pre-tibial areas leading to edema, thicker skin with “orange skinned” appearance; “pre-tibial myxedema”
A
Grave’s Disease
23
Q
Complications include cardiac arrhythmias s/a new onset afib*; high output cardiac failure-toxic, dilated cardiomyopathy; thyroid storm and crises (extreme thyrotoxicosis with delirium, high fever, dehydration and death)
A
Hyperthyroidism
24
Q
Definitive therapy; used to destroy overactive thyroid tissue; Tx of choice for Grave’s
A
Radioactive iodine
25
May hypersecrete thyroid hormone leading to thyrotoxicosis; Usually a benign adenoma or colloid cyst, but cancer is a possibility
Thyroid Nodule
26
Most thyroid cancers are what kind?
Papillary cancers
27
Outer layer of adrenal cortex secretes this:
Aldosterone
28
Major glucocorticoid secreted by middle and inner adrenal cortex: secretion regulated by ACTH release from pituitary
Cortisol
29
Inhibits insulin secretion; increases hepatic gluconeogenesis, decreases protein stores; dampens defense mechanisms; inhibits production/action of mediators of inflammation
Cortisol
30
Required for production of Angiotensin II; lowers serum calcium; Necessary for normal bodily function
Cortisol
31
Secreted in response to stress, trauma, infection, and major surgery; plays major role in supporting normal circulatory function and hemodynamic stability; "the permissive hormone"
Cortisol
32
Clinical syndrome/disease resulting form excessive systemic corticosteroids; Endogenous (overproduction) from tumors secreting cortisol or ACTH; Exogenous (glucocorticoid administration; superphysiologic)
Cushing's Syndrome/Disease
33
Most common cause of Cushing's Syndrome:
Exogenous: superphysiologic doses of glucocorticoids over prolonged time
34
Endogenous glucocorticoid excess; Pituitary adenoma secreting excessive ACTH
Cushing's disease
35
Central obesity; "moon facies", abdominal protuberance, "buffalo hump", supraclavicular fat; Catabolic effect; thin skin with easy bruising/striae, thin extremities, muscle wasting
Cushing's syndrome
36
Lab findings: hyperglycemia, glycosuria, leukocytosis; elevated cortisol levels with loss of diurnal pattern (in excess ACTH states, increased mineralocorticoid can lead to hypokalemia)
Cushing's syndrome
37
Complications if untreated: Significant morbidity from diabetes, HTN, osteoporosis, susceptibility to infections, compression and pathologic fractures, femoral neck aseptic necrosis
Cushing's syndrome
38
Glucocorticoid deficiency: fatigue, weakness, and hypotension NOT responding to IV fluids
Adrenal Insufficiency
39
Uncommon disease; autoimmune destruction of the adrenal cortex that can develop over time resulting in chronic deficiency of cortisol, aldosterone and adrenal androgens
Addison's Disease
40
May result in hyper pigmentation of skin
Adrenal insufficiency
41
Dx: Abdominal CT (small non-calcified adrenals)
Addison's; Adrenal insufficiency
42
High ACTH levels may be seen in:
Addison's
43
A rare cause of secondary HTN; tumor of adrenal medulla releasing excessive amounts of norepinephrine/epinephrine into the circulation
Pheochromocytoma
44
HTN with paroxysms of severe HA's, sweating and palpitations; Dx w/ 24H urine for catecholamines & metanephrines
Pheochromocytoma
45
Tx of choice for Pheochromocytoma
Laparoscopic removal of the tumor
46
Maintains calcium homeostasis in body; increases osteoclastic activity in bone resulting in delivery of Ca and PO4 into ciruclation
Parathyroid hormone (PTH)
47
Increases renal tubular reabsorption of Ca and increases PO4 excretion in urine
PTH
48
Regulates and maintains normal levels of serum ionized calcium
PTH
49
Hallmark is low ionized Ca; most common scenario is post-thyroidectomy or post removal of parathyroid adenoma; may develop with chronic magnesium deficiency which can impair PTH release
hypoparathyroidism
50
Muscles cramps, irritability, carpopedal spasm, tetany, seizures, paresthesias of hands and feet; decr cognitive function; Chvostek's & Trousseaus's sign; dry, thin nails, hyperactive reflexes
hypoparathyroidism
51
Labs: low serum total and ionized Ca, elevated PO4; ECG: prolonged QT interval
hypoparathyroidism
52
Hyper secretion of PTH, most often a parathyroid adenoma; Hallmark is elevation of serum total and ionized Ca
hyperparathyroidism
53
Increased excretion of Ca and PO4 by the kidney-> hypercalciuria; cortical bone resorption, osteopenia, osteoporosis
hyperparathyroidism
54
Hypercalcemia/hypercalciuria results in nephrogenic DI (decr sensitivity to ADH)
hyperparathyroidism
55
Labs: increased ionized calcium and PO4 often low (enhanced renal excretion)
hyperparathyroidism
56
A skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture
Osteoporosis
57
MC metabolic bone disease; decreased bone matrix and mineral-> "thin bones"
Osteoporosis
58
Increased bone resorption, esp. trabecular bone*
Osteoporosis
59
Increases dramatically in puberty in response to gonadal steroids; peaks in young adults
Bone density (BD)
60
Bone thinning=
osteopenia
61
Etiologies include: Sex hormone deficiency, post-menopause, hypogonadism, excess glucocorticoids (Cushing's), hyperparathyroidism, thyrotoxicosis (incr bone metabolism), Vit D deficiency
Osteoporosis
62
Bone mineral density 1-2.5 SD below peak bone density
Osteopenia
63
Bone mineral density >2.5 SD below peak bone density
Osteoporosis
64
For managing osteoporosis, use in pts with hypogonadism or premature menopause
Estrogen replacement for prevention
65
Inhibit osteoclastic bone resorption; Incr bone density (a little), decr fx; Long half life once in bone (10yrs)
Bisphosphonates
66
Alendronate (Fosomax): take 30min before AM meal with water and remain upright for 30min to prevent esophagitis
Bisphosphonates
67
What is important for patients taking bisphosphonates?
Dental care
68
Increase bone density, but less than estrogen (less effective), less risk of adverse effects; Decr bone loss and incr bone density (less than estrogen); blocks estrogen effects on breasts and uterus*
SERMS
69
Synthetic analog of PTH; targets bone formation; indicated for post menopausal women with osteoporosis and risk factors for fracture & hypogonadal men with osteoporosis
Teriparatide
70
Islets of Langerhans: Beta cells secrete=
insulin
71
Islets of Langerhans: Alpha cells secrete=
glucagon
72
Major stimulus of insulin secretion is ___ absorbed from food
glucose
73
Following a high carb meal, ____ secretion leads to rapid uptake, storage and use of glucose by all tissues, esp the liver, muscle and fat
Insulin
74
Following a high carb meal, most absorbed insulin rapidly stored in liver as _____
glycogen
75
Once glycogen stores are full--> insulin converts excess glucose to ___
fatty acids
76
Inhibits gluconeogenesis in the liver
Insulin
77
"spares" fat-inhibits breakdown; inhibits hormone sensitive lipase-> inhibits excessive fat cell breakdown and release of FA
Insulin
78
Following a meal ____ promotes synthesis and storage--> stimulates transport of amino acids into cells
Insulin
79
Decreases catabolism of protein; decreases gluconeogenesis in liver
Insulin
80
Brain is dependent on ___ for energy
glucose
81
Is the signal that determines energy source in the body
glucose
82
When CHO present and glucose levels increase, ___ is used for energy and requires insulin
CHO
83
When glucose (and insulin) levels decrease, ___ is broken down for energy
fat (lipids)
84
Absence of insulin leads to excessive fat breakdown and abnormal FFA metabolism
Type 1 DM
85
Secreted by alpha cells; increases glucose levels when needed; breaks down glycogen, increases gluconeogenesis; requires glycogen stores for major effects
Glucagon
86
A syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or a combo of insulin resistance and inadequate secretion to compensate
Diabetes Mellitus
87
Primarily autoimmune mediated with presence of islet cell antibodies; destruction of beta cells in pancreas; onset in juveniles; ketosis common if untreated
Type 1 DM
88
Catabolic disorder; absence of insulin in response to glucose leads to hyperglycemia, and fat and protein breakdown (ketoacidosis)
Type 1 DM
89
Infectious of toxic insult in genetically predisposed individuals; autoimmune response against altered pancreatic B cell antigens
Type 1 DM
90
Circulating insulin prevents ketosis, not hyperglycemia; tissue insensitivity to circulating insulin (insulin resistance)
Type 2 DM
91
Combination of insulin resistance and defect of B cells to secrete adequate insulin in response to glucose; aggravated by increased hyperglycemia; decreased insulin production develops over time
Type 2 DM
92
Insensitivity to insulin contributed to by obesity, central fat distribution, storage of fat in muscle and inactivity; post-receptor defect in insulin action
insulin resistance
93
Hepatic insensitivity results in increased gluconeogenesis-hyperglycemia
Type 2 DM
94
Chronic hyperglycemia inhibits increase of insulin secretion normally seen in response to elevation of glucose; eventually destroys B cells permanently
Glucotoxicity
95
AKA insulin resistance syndrome; constellation of findings that increase risk of atherosclerosis (3x); often associated with T2DM
Metabolic syndrome
96
Findings include: (3 of 5 needed)= central obesity, hyperglycemia, HTN, incr TG, decr HDL
Metabolic syndrome
97
Polyuria, thirst, wt loss, weakness, dehydration, polyphagia, ketoacidosis, hyperosmolality
Type 1 DM
98
Often no sx early; polyuria, thirst, skin infection, vulvovaginitis, central obesity, hyperglycemia
Type 2 DM
99
Reflects state of glycemia over 8-12 weeks; measure every 3-4 months in diabetic
HbA1C
100
Diabetic dyslipidemia, high TG, low HDL
Type 2 DM
101
Growth hormone, Prolactin, ACTH, TSH, LH, FSH
Anterior pituitary
102
Arginine Vasopressin (ADH, AVP), Oxytocin
Posterior pituitary
103
Prolactin release is inhibited by ____
dopamine
104
Abnormal function of the pituitary
hypopituitarism
105
Decr in LH/FSH (decr sex hormones)
Hypogonadism
106
Lack all of the anterior pituitary hormones:
panhypopituitarism
107
Deficiency of AVP/ADH (posterior pituitary)
Central Diabetes Insipidus
108
Autoimmune; familial/genetic forms rare; no visual lesions of pituitary on MRI
Primary Diabetes Insipidus
109
Damage to pituitary or pituitary stalk by tumor, surgery, anoxia
Secondary Diabetes Insipidus
110
Inability of the kidneys to respond to ADH; congenital (lack ADH receptors) and acquired forms
Nephrogenic Diabetes Insipidus
111
Excessive GH release, almost always from a pituitary adenoma
Acromegaly and Gigantism
112
Tumor develops before closure of epiphyses; very tall=
Gigantism
113
Tumor develops after epiphyseal closure; enlargement of hands, jaw, feet, bones of skull enlarge=
Acromegaly
114
IGF-I increased 5x nl with=
acromegaly
115
A somatostatin analog; suppresses GH secretion/ used in pts who continue to have excessive GH release post-op; shrinks some tumors
Octreotide
116
MC cause is pituitary microadenoma
Hyperprolactinemia
117
High levels of _____ suppress GnRH which decreases LH/FSH, resulting in hypogonatropic hypogonadism
Prolactin
118
Rapid acting insulin
Lispro Insulin
119
Intermediate acting insulin; requires 2-3 injections daily for sustained effect
Neutral insulin (Humulin N)
120
Long acting Insulin; insulin analog; 24hr coverage with steady-state insulin levels; bedtime dosing
Insulin Glargine
121
Insulin with very rapid onset; ideal pre-meal; rapidly deals with glucose load of meal (less post-meal hypoglycemia); Must correlate dose with CHO load; also used with insulin pump
Lispro Insulin
122
Short-Acting insulin; take before meals
Regular (Humulin R)
123
Incretin mimetics; potentiate insulin secretion; $$$; SubQ injection; suppress post-prandial glucagon; delay gastric emptying, promotes satiety; decr fasting and post meal glucose
GLP-1 Receptor Agonists
124
According to data, what is more effective: Metformin + Insulin OR Metformin+ sulfonylurea + pioglitazone
Metformin + Insulin (& less expensive)
125
MC complication seen with insulin and sulfonylurea use:
HYPOGLYCEMIA (BS
126
What can mask hypoglycemia?
Beta blockers (esp non-selectives)
127
Retinopathy, Nephropathy, and Neuropathy=
microvascular complications of diabetes
128
Atherosclerosis (CHD, CVD, PAD)=
macrovascular complications of diabetes
129
In diabetes, develops as a result of chronic hypErglycemia and contributed to by uncontrolled HTN
Diabetic nephropathy
130
Leading cause of ESRD in U.S.
Diabetic nephropathy
131
Losing 30-300mg albumin in urine=
mircroalbuminuria
132
Initiatie in Type 1 & Type 2 diabetics in presence of microalbuminuria even if BP normal
ACE-I
133
Life-threatening medical emergency primarily in T1DM; triggers from infection, trauma, surgery, MI which cause increased insulin requirements
Diabetic Ketoacidosis (DKA)
134
Polyuria, polydipsia, abdominal pain, N/V, weakness, fatigue; stupor and coma may occur; Incr Pulse and decr BP; "fruity" breath, rapid breathing
DKA
135
Inadequate insulin resulting in increased BS and increased FAT (& PROTEIN) breakdown
DKA
136
Lipolysis leads to production of FFA and conversion to acetoacetic (ketoacid) and beta-hydroxybutyric acid leading to acidosis
DKA
137
Results in metabolic acidosis with increased anion gap
DKA
