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IFM > Hormones > Flashcards

Hormones Flashcards

1
Q

Conjugated equine estrogen (CEEs) have been shown to:

A

increase inflammation (hsCRP) and (IL-6)

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2
Q

A female PTC with concerns of breast cancer risk due to family history, and she has a low urinary 2/16OH ratio. what would you recommend?

A

increasing cruciferous vegetables which can increase the 2:OH ratio and decrease breast cancer risk

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3
Q

What laboratory finding would you expect to see in a patient who has decreased levels of sex hormone-binding globulin (SHBG)?

A

high levels of insulin

There is a significant inverse relationship between levels o SHBG and fasting serum insulin in both genders

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4
Q

Sex hormone binding globulin can be increased by?

A

Thyroxine, estradiol, caffeine, and many medications increase SHBG

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5
Q

Sex hormone binding globulin can be decreased by?

A

Testosterone, insulin, growth hormone, prolactin, cortisol, obesity

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6
Q

Natural aromatase inhibitors include

A

Flax seed, soy - as well as resveratrol (grape seed)

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7
Q

patient with RPL, h/o heavy menses, and a diagnosis of luteal phase dysfunction - what sex hormone pattern would you expect on labs?

A

luteal phase dysfunction (LDP) is associated with lower E2, LH, FSH, and progesterone compared to a normal cycle

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8
Q

what action of estrogen explains why estrogens are pro inflammatory?

A

Estrogen stimulates COX-2 which promotes inflammation

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9
Q

Which derivatives/metabolites of estrogen have anti-cancer effects?

A

The methoxy estrogen derivatives appear to have a protective effect in the breast and CVD system, while the hydroxyl metabolites contribute to tumorigenesis

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10
Q

which estrogen metabolites are associated with potential for carcinogenic effect?

A

4-OH becoming quinones, low 2:16 OH ratio

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11
Q

Which estrogen metabolite has an estrogenic effect similar to estradiol?

A

16-OH

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12
Q

Excess estrogen is associated with increased incidence of autoimmunity

A

question

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13
Q

What is the most likely effect seen on thyroid function in crash dieters?

A

low calorie diets increase conversion of T4 to its metabolism-slowing molecule rT3. this also occurs in the setting of stress/cortisol, trauma, inflammation, toxins, infxn

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14
Q

Why do patients in the “exhaustion phase” of adrenal dysfunction often present with low blood pressure?

A

“cortisol steal” - aldosterone levels may decrease from chronically elevated cortisol through the cortisol steal leading to hypotension

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15
Q

An adrenal stress profile of the “adaption” phase shows:

A

depressed DHEA, while cortisol at 1 or more time points is elevated

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16
Q

What amino acid is the precursor for catecholamines?

A

tyrosine

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17
Q

Which nutraceutical and lifestyle intervention would be most appropriate for “hypercortisol state”?

A

phosphatidylserine and yoga

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18
Q

Prolonged cortisol elevations can lead to what?

A

immune suppression and adiposity

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19
Q

40-yo F c/o constipation, cold intolerance, chronic fatigue, and insomnia. she believes the insomnia is the cause of her sx. Your testing reveals elevated salivary cortisol and abnormal thyroid function. which results in her thyroid testing might you expect to see?

A

elevation in RT3 - elevated cortisol generally leads to a decline in T3 and an increase in rT3.

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20
Q

What is the normal action of 17, 20 lyase?

A

17,20 lyase converts 17-OH pregnenolone into DHEA.

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21
Q

What circumstances down regular 17,20 lyase?

A

acute stress, hyperinsulinemia, inflammation

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22
Q

What lab findings would be most correct in a “cortisol steal”

A

decrease in DHEA and sex hormones

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23
Q

3-yr h/o elevated TPO on T4 which initially helped, not increased fatigue, PMS, forgetfulness - what should your next step be?

A

order an RT3

24
Q

Why is chronically elevated cortisol is problematic?

A

it leads to brain hippocampus atrophy

25
Q

A 57-yr old female w/ chronic insomnia, wakes early and can’t get back to sleep. what finding on a salivary hormone test would best explain her early morning awakenings?

A

elevated morning cortisol

26
Q

55 yo male with erectile dysfunction, central adiposity, dry scaling on elbows. other than free testosterone, what lab would you order?

A

insulin

27
Q

42 y/o F PTC with 5 yr h/o fatigue. no specific trigger. sleeps 12-14 hours per day and finds even modest exercise exhausts her. decide to order salivary cortisol and DHEA and expect to find?

A

reduced levels of cortisol and DHEA

28
Q

what decreases SHGB (think to support mens health)

A

Stinging Nettle (Urtica dioica)
EPA/DHA
Whey protein

29
Q

what decreases SHBG in PCOS?

A

insulin

30
Q

44-yo F PMS, abdominal obesity, and increased heavy menses. She is a single parent, drinks 3-4 cups of coffee daily to keep going, a 4-point cortisol indicated elevated cortisol on all but first morning measures. what is happening in terms of the steroid pathway?

A

17-OH progesterone is being shunted to cortisol, results in abdominal weight gain, lower progesterone, and estrogen dominance.

31
Q

what are the primary biotransformation pathways and nutrient/food cofactors that detoxify xenoestrogens?

A

CYP-P450 hydroxylation, sulfating, glucuronidation, glucosinolates, and methyl factors

32
Q

what labs would you order for a real with ovarian cysts, welling and tenderness in the breasts, low libido, irregular menses, anxiety. her diet avg of 10 grams of fiber

A

estrogen, estrogen metabolites, progesterone

33
Q

41 yo F single mother of 3 with an autistic child she cares for 24 hours per day PTC with chronic depression, insomnia, weight loss, and recent osteopenia. what functional lab finding would you expect?

A

elevated salivary cortisol

34
Q

What is the rate-limiting step in steroid hormone synthesis?

A

transporting cholesterol to the inner membrane of the mitochondria

35
Q

menopausal hot flashes, night sweats, high stress, high job travel that has disrupted sleep, and family h/o breast cancer. what are two best interventions to consider?

A

melatonin and black cohosh

36
Q

adequate melatonin decreases the risk of estrogen-related disease primarily by

A

acting as an antioxidant

37
Q

A 44‐year‐old female presents with concerns about premenstrual mood changes, abdominal obesity, and increasingly heavy menstrual periods. She is a single parent, works two jobs, and drinks 3‐4 cups of coffee daily to “keep going.” A 4‐point salivary cortisol test indicates elevated cortisol on all but the first morning measure. Which statement best describes what is happening to this patient’s cortisol:

A

17‐OH progesterone is being shunted to cortisol, resulting in abdominal weight gain, lower progesterone, and estrogen dominance.

38
Q

Licorice therapies can complicate cardiovascular health by:

A

Inhibition of 11‐beta‐hydroxysteroid dehydrogenase, leading to increased blood pressure.

39
Q

A 47‐year‐old female presents with the following signs and symptoms: frequent ovarian cysts, swelling and tenderness in the breasts, low libido, irregular menstrual periods, anxiety, insomnia, headaches, weight gain, fatigue, and bloating. Her diet contains a daily average of 10 grams of fiber and an emphasis on meals high in animal fat. What laboratory tests would be most appropriate to order?

A

Estrogen, estrogen metabolites, progesterone

40
Q

A 50‐year‐old female presents with a diagnosis of metabolic syndrome. She is 40 pounds overweight. She reports she frequently uses food to manage her stress. She would benefit from utilizing mindfulness meditation while eating because it

A

Normalizes the HPA axis and may allow for new choices and insights to emerge in the moment.

41
Q

41‐year‐old female single mother of three with an autistic child that she cares for 24 hours a day presents to your practice with chronic depression, insomnia, weight loss, and a recent DEXA scan that shows osteopenia in her right hip and lumbar spine. Which of the following lab findings would best explain her signs and symptoms?

A

Elevated salivary cortisol

42
Q

A 55‐year‐old male came to you for treatment of erectile dysfunction. On exam, you noticed central adiposity and dry scaling on his elbows. The most likely objective abnormality OTHER than low free testosterone is:

A

Insulin resistance

43
Q

The rate‐limiting step in steroid hormone synthesis is

A

Transporting cholesterol to the inner membrane of the mitochondria.

44
Q

59‐year‐old female comes in with complaints of hot flashes that wake her three to four times a night. She mentions she is under a great deal of work‐related stress and that her job requires travel two to three times a month. She feels this has also caused problems with sleep. Additionally, she reports a family history of breast cancer. The two best interventions to consider are:

A

Melatonin and black cohosh

45
Q

Adequate melatonin decreases the risk of estrogen‐related diseases primarily by

A

acting as an antioxidant

46
Q

Transport of fatty acids into the mitochondria is facilitated by which nutrient?

A

carnitine

47
Q

Chronically elevated cortisol is problematic in which of the following ways:

A

It leads to brain hippocampus atrophy

48
Q

A 57-year-old female comes into your practice with complaints of chronic insomnia. She wakes early and can’t get back to sleep. You suggest salivary hormone testing. Which of the following would best explain her early morning awakenings?

A

Elevated morning cortisol

49
Q

What is the relationship between exogenous estrogens and thyroid function?

A

Estrogens stimulate the production of TSH through feedback to the pituitary.

50
Q

A 42-year-old female presents with a five-year history of fatigue. She cannot recall a specific triggering event. She sleeps 12-14 hours/day and finds that even modest exercise exhausts her. You decide to order a salivary cortisol and DHEA test. Given her presentation, you would expect:

A

Reduced levels of cortisol and DHEA

51
Q

What are estrogen’s three major phase II detoxification pathways?

A

Glucuronidation, sulfation, and methylation

52
Q

Select the correct statement about methylenetetrahydrofolate reductase (MTHFR)

A

MTHFR polymorphisms affect more than 40% of the population.

53
Q

What is true about the relationship between thyroid function and lipids?

A

In patients with hypothyroidism and secondary hyperlipidemia, treatment with levothyroxine alone may be sufficient to normalize lipid levels

54
Q

A 56-year-old male returns to your office with a low free testosterone. Before considering hormone replacement therapy, you suggest that one can increase testosterone levels by

A

Decreasing 5-alpha reductase

55
Q

A 42-year-old female presents with a one-year history of weight gain, generalized fatigue, thinning hair, and tingling in her hands at night. Her periods have become irregular and lighter. On examination,
10she is overweight with dry skin and thinning, coarse hair. She has evidence of bilateral carpal tunnel syndrome. Your laboratory investigation finds thyroid-stimulating hormone (TSH) elevated and total serum thyroxine (T4) below the reference range. Antibodies to thyroid peroxidase are present at high titer, consistent with primary autoimmune hypothyroidism. You treat her with oral thyroxine at 100μg daily. Over the next three months, her TSH and free thyroxine normalize, TPO decreases, and her skin, hair, and hands normalize. However, she loses only two pounds, andher fatigue is only partially improved. Your next laboratory test(s) will be

A

Free T3, RT3

56
Q

factors that improve cellular sensitivity to thyroid hormones?

A

vit A, exercise, zinc

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