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CPD III > Quiz 4- Endocrine Part 1 > Flashcards

Quiz 4- Endocrine Part 1 Flashcards

1
Q

primary endocrine disorders

A

originating in peripheral endocrine gland

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2
Q

Secondary endocrine disorders

A

from over- or under-stimulation by pituitary/HTH

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3
Q

GHRH

  1. Hypothalamic hormones
  2. Pituitary hormones
  3. Target organs
  4. Target organ hormones
  5. Target organ hormones- major actions
A
  1. GHRH: growth hormone-releasing hormone
  2. GH: growth hormone
  3. mainly liver & cartilage
  4. Insulin-like growth factor-1
  5. Linear bone growth and cell proliferation
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4
Q

THRH

  1. Hypothalamic hormones
  2. Pituitary hormones
  3. Target organs
  4. Target organ hormones
  5. Target organ hormones- major actions
A
  1. THRH: thyrotropin releasing hormone
  2. TSH: thyroid stimulating hormone
  3. thyroid gland
  4. T4 (thyroxine) & T3 (triiodothyronin)
  5. thermogenesis growth and CNS maturation
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5
Q

CRH

  1. Hypothalamic hormones
  2. Pituitary hormones
  3. Target organs
  4. Target organ hormones
  5. Target organ hormones- major actions
A
  1. CRH: corticotropin releasing hormone
  2. ACTH: adrenocorticotropic hormone
  3. adrenal cortex
  4. glucocorticoids (cortisol), mineralcorticoids and androgens
  5. stress response and sodium retention
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6
Q

GnHRH

  1. Hypothalamic hormones
  2. Pituitary hormones
  3. Target organs
  4. Target organ hormones
  5. Target organ hormones- major actions
A
  1. GnHRH: gonadotropin-releasing hormone
  2. LH: luteinizing hormone & FSH: follicle stimulating hormone
  3. ovaries and testes
  4. estrogen, progesterone, and testosterone
  5. sexual maturation, menstrual cycle, gamete production, libido and fertility
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7
Q

Dopamine

  1. Hypothalamic hormones
  2. Pituitary hormones
  3. Target organs
  4. Target organ hormones
  5. Target organ hormones- major actions
A
  1. dopamine (inhibitory)
  2. PL: prolactin
  3. breast
  4. PL
  5. milk production
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8
Q

empty sella

A

an enlarged sella turcica isn’t filled with pituitary tissue

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9
Q

what are the two types of empty sella?

A

primary sella: defect allows CSF pressure to enlarge the sella, compressing and flattening the pituitary gland. May cause hormone deficiencies
secondary sella: a mass (like an adenoma) enlarges the sella. Hypopituitarism can result from the mass or its infarction The pituitary tumor may itself secrete GH, prolactin or ACTH, leading to hyperpituitarism

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10
Q

how to DX an empty sella?

A

MRI of brain

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11
Q

SSX of empty sella?

A

h/a or asx

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12
Q

what does hypofunction of the anterior pituitary mean?

A

partial or total loss of anterior lobe function

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13
Q

what causes hypofunction of the anterior pituitary?

A

pituitary tumor
sarcoidosis
vascular causes - arterial aneurysm, thrombosis, subarachnoid hemorrhage

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14
Q

SSX of hypofunction of the anterior pituitary?

A

depends on the hormones that are diminished or absent:
GH: deficiency in children leads to growth retardation and lack of maturation
LH & FSH: loss decreases sexual function
TSH: loss leads to hypothyroid ssx- facial puffiness, bradycardia, cold intolerance
ACTH: loss leads to fatigue, hypotension, intolerance to stress

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15
Q

work up for hypofunction of the anterior pituitary

A 
hormone levels:
serum cortisol
TSH
testosterone 
IGF-1
also do provocative testing (precursors to produce hormones down stream) 
GHRH, CRH, TRH, GnRH given together IV
Measure glucose, cortisol, GH, TSH, prolactin, LH, FSH, ACTH levels at intervals over 180 minutes
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16
Q

Pituitary apoplexy

hypofunction of anterior pituitary

A

sudden hemorrhage of a pituitary adenoma

causing hypofunction

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17
Q

SSX of pituitary apoplexy

A

sudden onset of h/a, stiff neck, and visual field defects

18
Q

complications of pituitary apoplexy

A

With significant enlargement there is potential for coma or death, especially with ACTH and resultant cortisol deficiencies leading to hypotension.

19
Q

Pituitary infarction caused by what

aka Sheehan syndrome

A

pituitary necrosis due to postpartum hemorrhage

20
Q

SSX of pituitary infarction

A

Severe: lethargy, anorexia, weight loss, inability to lactate
Less severe: failure to lactate, menses do not resume, loss of sexual hair

21
Q

pituitary dwarfism is due to a deficiency in what?

hypofunction of anterior pituitary

A

GH from the pituitary or HTH

22
Q

what’s the hallmark of pituitary dwarfism?

A

growth retardation with normal proportions

23
Q

what PE should you use if you suspect pituitary dwarfism in a child?

A

growth charts

24
Q

what labs might you draw for someone you suspect has pituitary dwarfism?

A

IGF-1 and GH (if abnormally low it’s definitive for diagnosis, but often times they are borderline normal)

25
Q

say the IGF-1 and GH levels are borderline normal in someone you suspect has pituitary dwarfism. what else can you do to dx?

A

x-ray of hands (bone age delayed)

26
Q

what should your DDX be for a child with delayed growth?

A 
physiological delay
pituitary dwarfism 
undernutrtion 
chronic kidney disease
cystic fibrosis
27
Q

what causes hyperfunction of the anterior pituitary?

A

adenomas!

over secretion of any of the hormones secreted by the pituitary

28
Q

hyperprolactinemia- what causes it?

hyperfunction of pituitary

A

antidepressants
adenomas
stress
pregnancy

29
Q

in hyperprolactinemia what is the excess hormone and what effect does it have on other hormones?

A

prolactin; inhibits FSH/LH

30
Q

hyperprolactinemia: SSX

A

premenopausal women: persistent lactation after pregnancy, amenorrhea, infertility
post-menopausal women: h/a, vision impairment
males: decreased libido and erectile dysfunction, gynecomastia, galactorrhea

31
Q

PE for hyperprolactinemia

A

HEENT, visual fields, signs for hypothyroidism or hypogonadism

32
Q

acromegaly/gigantism: which hormone is being excrete in excess?
hyperfunction of pituitary

A

GH from the pituitary most likely due to pituitary adenoma

33
Q

acromegaly/gigantism

hyperfunction of pituitary

A

rare in children, in adults:

slow enlargement of the jaw, hands and feet, upper incisors spaced far apart,

34
Q

PE for acromegaly

A

organomegaly, enlarged tongue

35
Q

labs for acromegaly

A

serum IGF-1 elevated

Oral glucose tolerance test–75g oral glucose fails to suppress GH to

36
Q

labs for hyperprlactinemia

A

elevated prolactin levels, if elevated check estrogen and progesterone

37
Q

in central diabetes insipidus (nuerogenic) what hormone is deficient? what effect does it have?

A

deficient ADH, results in large amounts of dilute urine with excess thirst

38
Q

SSX for central diabetes insipidus?

A

most commonly an abrupt onset
If idiopathic the only symptoms are polyuria (>3L/d), polydipsia, nocturia
If secondary there may be the signs and symptoms of the inciting disease
Dry skin, dry mucus membranes, irritability

39
Q

what’s the test for suspected central DI?

A

water retention test

urine more dilute than plasma (the opposite for a healthy person)

40
Q

what’s the DDX for central DI and what’s the question you want to ask?

A

psychogenic polydipsia

want to ask: do you have polyuria?!

41
Q

SIADH

A

inappropriate release of ADH in the absence of a signal

due to trauma, drugs, stroke

42
Q

SSX of SIADH

A

lethargy, h/a, difficulty concentrating, gait disturbances, tendency to fall, vomiting, coma, and seizures as the patient becomes overloaded with fluids.

CPD III (7 decks)

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