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Chatterjee Exam 3 > Rest of Endocrine > Flashcards

Rest of Endocrine Flashcards

1
Q

What does posterior pituitary secrete?

A

Vasopressin (ADH)

Oxytocin

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2
Q

Why is GnRh special?

A

Inhibited by prolactin

Pulsatile release, effects LH & FSH

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3
Q

Where does progesterone come from>

A

Corpus luteum

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4
Q

S/S of pituitary issue?

A

Headache
Seizure
Vision changes

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5
Q

What else do you order if suspect pituitary mass?

A
  • Serum prolactin
  • IGF 1 (growth hormone)
  • LH / FSH
  • TSH / Free T4
  • 24hr free cortisol
  • Testosterone
  • Estradiol
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6
Q

What are the parts of the adrenal gland?

A
  • Medulla: Epi & NE

- Cortex

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7
Q

What does cortex parts secrete?

A

Glomerulosa: mineralcorticoid (aldoesterone)
Fasiculata: glucocorticoids
Reticulata: androgens

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8
Q

What are the nonfunctioning pituitary masses? What do you do if you find them?

A

Macro: 1cm or higher, refer for visual field testing

Micro: less than 1cm, repeat in 1 year

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9
Q

What are the functioning pituitary masses?

A

Prolactinoma (treat with dopamine agonist) or GH / ACTH secreting tumor (refer to neuro

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10
Q

What serum prolactin level suggests prolactinoma?

A

250 mcg / L

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11
Q

What serum prolactin level suggests macroprolactinoma?

A

> 500 mcg / L

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12
Q

What is stalk effect

A

under influence of Releasing Hormones (from hypothalamus) the pituitary works. If compression of stalk, this does not occur.

EG block dopamine then you will have hyperprolactinemia

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13
Q

What is refractory HTN?

A

patient on 3 drugs, 1 must be diuretic, but still have HTN. You must test for Cushing

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14
Q

If cortisol saliva is normal, what do you do? What if high?

A

Repeat no matter what

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15
Q

What is after repeat saliva is high?

A

Low dose dexamethasone suppression test: take 1mg at 11pm, measure at 8am

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16
Q

What should normal result of DST be?

A

Cortisol should be LOW (feedback loop is working properly so decrease steroid production)

17
Q

What if DST result is abnormal?

A

Order Adrenocorticotrop Hormone (ACTH)

Tells you pituitary

18
Q

What are the values of ACTH? What do they mean?

A

Less than 5 pg/mL: ACTH independent, adrenal gland issue so get adrenal MRI

Less than 200 pg/mL: ACTH dependent, pituitary issue so get MRI

More than 200 pg/mL: Ectopic ACTH so get MRI of pituitary

19
Q

What do you do for diagnostic if on tumor or prior to neurosurgery?

A

Inferior petrosal sinus sampling

20
Q

Diabetes Insipidus:

Urinary Output?
ADH Levels?
Na levels?
Hydration?
Fluid lost or retained?
A
  • High urinary output
  • Low levels ADH
  • Hypernatremia
  • Dehydrated
  • Lose too much fluid

SIADH is just the opposite

21
Q

Which ADH issue presents with excessive thirst?

A

BOTH DI & SIADH?

22
Q

What is hyponatremia levels?

A

serum plasma sodium

23
Q

What HbA1c level is DM? What is not?

A

6.5%

Less than 6 is normal

24
Q

What fasting plasma glucose is DM?

A

126 mg/dL

25
Q

What is 2 hour plasma glucose level of DM for 75g OGTT?

A

200 mg/dL

26
Q

What random plasma glucose level in patient with s/s of hyperglycemia?

A

200 mg/ dL

27
Q

DKA is not diagnosed by what?

A

ketones in the urine

28
Q 
For DKA
Bood glucose
pH
Bicarb
K
Na
A 
- more than 250 mg/dL
pH less than 7.3
bicarb less than 15
high K 
low Na
29
Q

What level do you supplement K?

A

less than 5

30
Q

What blood sugar do you give insulin with D5W?

A

250

31
Q

What if you have 21 hydroxylase deficiency?

A

Hypoaldosteronism
Hypocortisol
Increased estrogen & testosterone

32
Q

Who get screened for primary aldosteronism?

A
  • Stage 2 (>160–179/100–109 mm Hg)
  • Stage 3 (>180/110 mm Hg)
  • Refractory hypertension
33
Q

What is the PAC/PRA ratio in primary aldosteronism?

A

Increased, over 30

34
Q

What if the PAC/ PRA ratio is less than 10?

A
  • Renin secreting tumor
  • Diuretic use
  • Renovascular HTN
  • Coarctation of aorta
  • Malignant phase of HTN
35
Q

How do you determine adrenal insufficiency?

A

8am cortisol, confirmed with less than 3 and ruled out if greater than 15

36
Q

What do you do if cortisol is between 3 and 15?

A

cosyntropin stimulation test

if less than 18 there is AI

37
Q

What do you do if you suspect pheochromocytoma?

A

1) Plasma metanephrines

2) Urinary metanephrines and plasma catecholamines

Chatterjee Exam 3 (4 decks)

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