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Clin Med- Endo > Made Ridiculously Simple > Flashcards

Made Ridiculously Simple Flashcards

1
Q

What produces releasing hormones?

What releases stimulating hormones?

A

Releasing= hypothalamus

Stimulating= pituitary

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2
Q

Thyroid hormone releasing hormone (THRH) stimulates the thyrotroph cells of the ______ pituitary to release thyroid-stimulating hormone (TSH)

A

ANTERIOR pituitary

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3
Q

TSH stimulates the thyroid gland to release…

A

T4 and T3

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4
Q

The prolactin system is what kind of a system?

A

Inhibitory!

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5
Q

Hypothalamic dopamine inhibits ______ release from the anterior pituitary

A

Prolactin

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6
Q

ADH

Oxytocin

..are released from which part of the pituitary?

A

Posterior pituitary

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7
Q

GH

TSH

Prolactin

ACTH

FSH

LH

A

Released from anterior pituitary

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8
Q

thyroid hormone (T4 and T3) exerts negative feedback on….

A

hypothalamus and pituitary

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9
Q

in a primary hyper- disorder….

the concentration of the hormone secreted by the target gland will be _________

the stimulating hormone concentration (from the pituitary) will be ________

A

hormone secretion HIGH*

stimulating hormone will be LOW* (due to negative feedback from hyperactive target gland)

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10
Q

A primary disorder suggests an issue in the…

A

target gland!

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11
Q

The pituitary/hypothalamus over stimulates the target gland

..what kind of disorder?

A

a secondary disorder

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12
Q

In a secondary hyper-disorder

What will the target gland hormone levels look like?

What will the stimulating hormone levels look like?

A

BOTH target gland hormone and stimulating hormone levels will be high!

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13
Q

A struma ovarii (ovarian tumor) can secrete ectopic….

A

TSH

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14
Q

Small cell lung cancer can ectopically produce..

A

ACTH

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15
Q

Squamous cell carcinoma of the lung can secrete (ectopically)…

A

Parathyroid hormone-related protein (PTHrP)

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16
Q

If the target hormone receptors are hyperactive (ie genetic mutation)…what can happen to hormone secretion?

A

Increased!

hyper- condition

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17
Q

In a primary hypo-disorder

Target hormone level?

Stimulating hormone level?

A

LOW target hormone levels

HIGH stimulating hormone levels (trying to bring up the target hormone levels)

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18
Q

In a secondary hypo- disorder

Target hormone level?

Stimulating hormone level?

A

BOTH DECREASED

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19
Q

The hypothalamus does not secrete enough releasing hormone

A

tertiary disorder

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20
Q

Prolactin is inhibited by..

A

Dopamine

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21
Q

A toxic thyroid nodule

Grave’s Disease

Pituitary tumor

Amiodarone toxicitiy

Struma ovarii

A

HYPERthyroidism

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22
Q

How do you distinguish whether HYPERthyroidism is due to a primary or secondary cause?

A

TSH levels!

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23
Q

TSH levels in primary hyperthyroidism

A

LOW!

(

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24
Q

TSH levels in secondary hyperthyroidism

A

HIGH

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25
Q

A thyroid nodule that becomes dependent of the pituitary and secretes excess thyroid hormone

A

Toxic nodule

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26
Q

Autoimmune disorder that causes HYPERthyroidism

*autoantibodies bind to the TSH receptors in the thyroid and act just like TSH, stimulating the thyroid to release thryoid hormone (T3/T4)

A

Grave’s disease

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27
Q

MC cause of hyperthryoidism?

A

Grave’s disease

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28
Q

Inflammation of extraocular muscles and periorbital tissue leading to bulging of the eyes, called proptosis or exophthalmos

A

Grave’s ophthalmopathy

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29
Q

Pretibial myxedema

A

Non pitting edema on anterior knee

*seen in Grave’s disease

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30
Q

Is Grave’s disease associated with other autoimmune disorders?

A

It can be!

ie.. vitiligo, pernicious anemia

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31
Q

Amioadrone toxicity can cause…

A

HYPERthyroidism

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32
Q

High metabolism (weight loss)
Tachycardia (a fib)
Dyspnea
Heat intolerance
Hot skin
Increased appetite
Tremor
Nervousness

A

HYPERthyroidism

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33
Q

Ophthalmopathy
Pretibial myxedema
Diffuse goiter and/or thyroid bruit

…will point towards a diagnosis of?

A

Grave’s disease

(HYPERthyroidism)

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34
Q

TSH will be low in what type of hyperthyroidism

A

Primary!

(TSH will be high in secondary hyperthyroidism)

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35
Q

anti-TSH receptor antibodies can be found in serum in many (but not all) cases of….

A

Grave’s disease

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36
Q

Which drug class can be used to tx tachycardia, anxiety, etc. associated with hyperthyroidism

A

Beta blockers

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37
Q

Beta blockers are typically used in cases where teh hyperthyroidism will…..

A

resolve spontaneously (ie thyroiditis)

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38
Q

Methimazole
Propylthiouricil

both of these drugs decrease..

A

Thyroid hormone synthesis

(propylthiouricil also reduces peripheral T4 and T3 conversion)

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39
Q

Surgical removal of thyroid

Destroyed thyroid with radioactive iodine (I-131)

can be used in the tx in..

A

Hyperthyroidism

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40
Q

TSH levels in primary HYPOthyroidism

A

High!

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41
Q

TSH levels in secondary HYPOthyroidism

A

Low

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42
Q

Congenital thyroid problems
Hashimoto’s thyroiditis
Drugs that are toxic to thyroid (ie amiodarone)
Iodine deficiency
Radiotherapy with I-131

…all causes of?

A

Primary Hypothyroidism

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43
Q

An autoimmune disease that causes primary hypothyroidism

Antibodies are directed against thyroid peroxidase (TPO) and thyroglobulin (TG), resulting in a lymphocyte infiltration of the thyroid gland. this causes the thyroid gland to cease functioning partially or entirely

A

Hashimoto’s thyroiditis

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44
Q

Sometimes occurs with other autoimmune disease (ie diabetes Type 1, vitiligo, prematurely greying hair)

A

Hashimoto’s thyroiditis

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45
Q

Why does iodine deficiency cause hypothyroidism?

A

Iodine is necessary for thyroid hormone synthesis

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46
Q

Weight gain
Cold intolerance
Fatigue
Weakness
Bradycardia
Hypoventilation
Constipation
Myalgias
Arthralgias
Anemia
Goiter may be present

A

HYPOthyroidism

47
Q

Serum autoantibodies (anti-TPO and anti-TG) can be present in…

A

Hashimoto’s thyroiditis

48
Q

Thyroxine, a synthetic form of T4, is used in the tx of?

A

Hypothyroidism

49
Q

Inflammation of the thyroid gland

Can cause hyperthyroidism or hypothyroidism

A

Thyroiditis

50
Q

Causes include:

Viral infection (de Quervain’s)
Radiation
Amiodarone
Autoimmunity
Delivery of a baby

A

Thyroiditis

51
Q

Can be neoplasms:
*Adenoma (benign)
*Carcinoma (papillary, follicular, medullary, anaplastic)

Can be non-neoplastic:
*Cyst
*Hyperplasia
*Focal thyroiditis

A

Thyroid nodules

52
Q

How do you diagnose the type of thyroid nodule?

A

Fine needle aspiration

53
Q

Which layer of the adrenal cortex secretes aldosterone?

A

Zona glomerulosa

54
Q

Which layer of the adrenal cortex secretes glucocorticoids?

A

Zona fasciculata

55
Q

Which layer of the adrenal cortex secretes sex hormones?

A

Zona reticularis

56
Q

What part of the adrenal gland secretes epinepherine?

A

Adrenal medulla

57
Q

What causes…

Reabsorption of sodium (Na+)
Secretion of potassium (K+) and hydrogen ions (H+) in the kidneys

A

Aldosterone

58
Q

Renin-Angiotensin
Hyperkalemia
Hyponatremia
Hypotension

..increase/decrease aldosterone secretion?

A

Increase!

59
Q

Stress response hormones

  • *Increase** BP
  • *Increase** gluconeogenesis
  • *Decrease** immune response
A

Glucocorticoids

ie..Cortisol

60
Q

Clinical manifestation of cortisol elevation

A

Cushing’s syndrome

61
Q

Pheochromocytoma occurs in over secretion of…

A

Epinepherine

62
Q

What causes sodium reabsorption (which raises BP) and potassium excretion

A

Aldosterone

63
Q

Can cause:

Hypernatremia

Hypokalemia

Hypertension

A

HYPERaldosteronism

64
Q

What will Renin levels look like in primary HYPERaldosteronism

A

LOW!

(primary means issue to adrenal gland itself…negative feedback loop on Renin being released from kidneys)

65
Q

Causes:

  1. Iatrogenic (long term tx of steroids)
  2. primary oversecretion by 1 or both adrenal glands (adrenal adenoma or carcinoma)
  3. overstimulation of adrenal glands by an ACTH-secreting tumor in pituitary
  4. overstimulation of adrenal gland by ectopic ACTH producing tumor (ie small cell lung cancer)
A

Cushing’s syndrome

66
Q

Overstimulation of adrenal glands by an ACTH secreting tumor in pituitary

A

Cushing’s DISEASE

67
Q

Truncal obesity
Moon face
Buffalo hump
Easy bruising
Osteoporosis and/or osteonecrosis
Hirsutism
Acne
Cognitive effects (mood changes to psychosis)

A

Cushing’s syndrome

68
Q

24-hour urinary collection for free cortisol

Checking level of cortisol in saliva in late evening

Dexamethasone supression test

A

Ways to test if cortisol levels are high..Cushing’s Syndrome

69
Q

How do you determine pituitary vs ectopic cause of Cushings?

A

Dexamethasone Suppression Test

70
Q

Under normal circumstances, dexamethasone should mimic what?

A

Cortisol

(which will exert negative feedback on pituitary, decreasing ACTH production)

71
Q

If a low dose dexamethasone suppression test does NOT suppress ACTH, this indicates…

A

Cushing syndrome exists

(but does not indicate the source of ACTH over production)

72
Q

If the pituitary is over secreting ACTH (Cushing’s disease) and you give high dose Dexamethasone, how will the pituitary respond?

A

Will respond to negative feedback, ACTH level should decrease

*In Cushing’s disease, the pituitary still responds to negative feedback but needs higher levels than normal

73
Q

Will an ectopic production of ACTH respond to high dose dexamethasone?

A

NO

74
Q

Metyrapone inhibits cortisol synthesis and can be used to localize….

A

Cushing’s syndrome

75
Q

Metyrapone will do what to ACTH levels in a normal person? in a person with a pituitary tumor (Cushing’s disease)

A

ACTH levels will be decreased in both

(Metyrapone inhibits cortisol, which will negative feedback decrease ACTH levels)

76
Q

Pathology of one or both adrenal glands (primary adrenal insufficiency), AKA…

A

Addison’s disease

77
Q

Both cortisol and aldosterone secretion are effected in what type of adrenal insufficiency?

A

Primary

*will have signs/symptoms that reflect both aldosterone and cortisol loss

78
Q

Addison’s disease is what type of adrenal insufficiency?

A

Primary

79
Q

Hypotension
Hyperkalemia
Hyponatremia
Salt craving
Hyperpigmentation

A

Can be used to distinguish primary adrenal insufficiency from secondary adrenal insufficiency

80
Q

Polyglandular autoimmune sydrome Type 1 and Type 2

Adrenal hemorrhage

Infection

Tumor metastases

A

Causes of primary adrenal insufficiency

81
Q

Lack of ACTH secretion from the pituitary leads to what type of adrenal insufficiency?

Lack of CRH from hypothalamus leads to what type?

A

Secondary adrenal insufficiency= lack of ACTH

Tertiary adrenal insufficiency= lack of CRH

82
Q

Rare but dangerous cause of hypertension

*catecholamine secreting tumor that most commonly occurs in the adrenal medulla
causes vasoconstriction, and thus HTN

A

Pheochromocytoma

83
Q

Elevated urine levels of catecholamines and their metabolic by-products, metanephrines

A

Confirm diagnosis of Pheochromocytoma

84
Q

Dopamine release from the hypothalamus inhibits _______ release from the anterior pituitary

A

Prolactin

85
Q

The endocrine cells of the pancreas secrete…

A

Insulin

Glucagon

*which regulate glucose level

86
Q

INsulin drives glucose….

A

INto cells

87
Q

Causes release of glucose into blood for tissue that need it

(used when no circulating glucose)

A

Glucagon

88
Q

A normal blood glucose concentration

A

Euglycemia

89
Q

Insulin and glucagon work in concert to maintain….

A

Euglycemia (normal blood glucose concentration)

90
Q

When there is lots of glucose around (ie after big meal), insulin is release from….

A

Beta cells of pancreas

91
Q

Insulin stimulates glucose uptake into cells and its storage as….

A

Glycogen (glycogenesis)
Fat
Protein

92
Q

How is glucose stored?

A

Glycogen

93
Q

Biosynthesis of glycogen, the storage form of glucose

A

Glycogenesis

94
Q

Glucose breakdown for energy

A

Glycolysis

95
Q

Glycogenesis and glycolysis are both stimulated by…

A

Insulin!

the goal of insulin is to REDUCE BLOOD SUGAR LEVELS, so insulin promotes both glucose storage and breakdown

96
Q

________ is secreted during a fast when blood sugar is low

A

Glucagon

97
Q

________ decreases glycolysis and increases gluconeogenesis (glucose formation) and glycogenolysis (breakdown of glycogen to release glucose)

A

Glucagon

98
Q

Goal of _____ is to mobilize glucose stores from the liver so that this glucose can be sent to the brain and heart and used for energy production in those organs

A

Glucagon

99
Q

Result from an autoimmune process that destroys the beta cells of the pancreas, leading to loss of insulin production

A

Type 1 diabetes

100
Q

Underlying pathophysiology is insulin resistance

*risk is correlated with:
age
obesity
family hx

A

Type 2 diabetes

101
Q

Elevated blood sugar causes serum hyper-osmalarity, which can cause:

A
  1. polydypsia
  2. polyuria
102
Q

Extreme hyperglycemia can cause massive fluid shifts. This can result in massive osmotic diuresis (renal water loss) and subsequent hypotension

*can lead to coma

A

Hyperosmolar nonketotic state

more likely in type 2

103
Q

Fasting plasma glucose >126

Random glucose >200 with polyuria and polydipsia

2 hours post glucose tolernce test plasma glucose >200

A

Diabetes diagnosis

104
Q

Common diabetic drug treatment that decreases hepatic gluconeogenesis

A

Metformin

105
Q

Sulfonylureas increase….

A

insulin secretion

106
Q

Thiazolinediones decrease…

A

insulin resistance

107
Q

Glucagon
Epinepherine/Norepinepherine
Glucocorticoids
Growth hormone

..all do what to blood sugar levels?

A

INCREASE

108
Q

Anxiousness
Diaphoresis
Tachycardia

…signs of?

A

HYPOglycemia

109
Q

________ is defined by Whipple’s triad

A

Hypoglycemia

110
Q

Low plasma glucose
Symptoms of hypoglycemia
Response to carbohydrates

A

Whipple’s triad

seen in hypoglycemia

111
Q

What do PTH and vitamin D do to calcium levels?

What about calcitonin?

A

PTH and Vit D increase calcium levels

Calcitonin decrease calcium levels

112
Q

Stimulate osteoclasts to break down bone

increase reabsorption of calcium by kidneys

increase conversion of inactive vitamin D to active vitamin D

A

ways PTH increases calcium

113
Q

Vitamin D increases absorption of _______ and ______ from gut

A

calcium and phosphate

Clin Med- Endo (7 decks)

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