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Fall CLIN MED 1 > Test 2 Endocrine > Flashcards

Test 2 Endocrine Flashcards

1
Q

What inhibits Growth Hormone and TSH release

A

Somatostatin

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2
Q

Pitiuitary adenomas DX/TX

A

dx: MRI
tx: tumor resection
Sx: vision loss/ displopia, H/A

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3
Q

Multiple Endocrine Neoplasia. Tumors are on what endocrine glands?

A 
Pituitary
Parathyroid
Pancreas
GI tumors can cause Zollinger Ellison syndrome- the 
tumor starts secreting hormones
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4
Q

Acromegaly- Adult

MCC / Sx

A

excess GH secretion. common cause somatotroph adenoma

Sx: prognathia (big jaw), bossing of forehead, big hands/feet. NO change in height. HTN, cardiomegaly

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5
Q

Acromegaly- Adult

Lab/ TX

A

labs)

  • Increase GH after glucose intake. (normally glucose intake suppresses GH)
  • High serum GH & IGF-1 (formed when GH stimulates liver)

Tx: pituitary microsurgery

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6
Q

Gigantism- before puberty

A

GH hypersecretion before the closing of epipyseal endplates. height affected

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7
Q

Dwarfism Tx

A

GH deficiency. proportional dwarfism.

tx: recombinant GH

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8
Q

GH deficiency in adults

SX

A

HYPERlipidemia, HTN, Reduced exercise capacity. change in body comp, metabolism, CV fx, reduced lean body mass.

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9
Q

GH deficiency in adults DX/TX

A

DX: give GHRH, if evokes GH < 3, then GH deficiency
TX: GH replacement

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10
Q

Prolactinoma si/sx

A

premenopausal woman: hypogonads= infertility, galactorrhea
Postmenopausal: dx when adenoma gets to big causes vision changes
men: hypogonads, low libido, gynecomastia, galactorrhea

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11
Q

Prolactinoma DX/ TX

A

dx: if serum prolactin is greater than 20
tx: dopamine agonist (Cabergoline) - decreases serum prolactin and size of adenomas

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12
Q

What inhibits and stimulates Prolactin production

A

Inhibits: dopamine
Stimulates: TRH

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13
Q

What does Prolactin inhibit?

A

GnRH …so ultimately this will reduce FSH/ LH

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14
Q

Diabetes Insipidus 2 types

A

they have increased urination and thirst. Caused by decreased ADH. 2 types:

Central: Post pit has decreased ADH release. Serum ADH will be low

Nephrogenic: kidney resistant to ADH. Serum ADH will be high

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15
Q

Diabetes Insipidus DX/TX

A

dx: specific gravity <1.005 (dilute) . urine osmolality of <200
tx: desmopressin or argine vasopressin

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16
Q

SIADH

A

increased ADH secretion, causing dec urination, swelling. dilutional hyponatremia

DX: hyponatremic serum sodium <135 .

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17
Q

Aldosterone what does it do?

A

secreted by Adrenal Cortex (zona glomerulosa), its a mineralcorticoid. Keeps MAP up, secreted when low BP. Takes in Na (and water), lets K+/H+ out. It is stimulated by increased K+ levels in blood.

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18
Q

Adrenal Insufficiency

Addison’s Disease

A

lack of aldosterone and cortisol. hyperKalemia (arrythmias), hypoglycemia, hyponatremia, hypotension, salt cravings

Dx: ACTH stimulation test. give cosyntropin to see if prob is at pit or hypothal

Tx: hydrocortisone

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19
Q

Hypercortisolism

sx/dx

A

increased cortisol secreted from adrenal cortex (zona fasiculata).
sx: moon face, buffalo hump, abdominal purple striae, hair thinning, obesity

dx: high serum cortisol after dexamethasone admin , which normally should shut down cortisol via neg feedback

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20
Q

Hypercortisolism- Cushing syndrome (primary)

A

prolonged exposure to extreme high cortisol. can be caused by gluccocorticoid drugs or disease.
serum ACTH levels is lower

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21
Q

Hypercortisolism- Cushing disease (secondary)

A

a tumor in pituitary causes large amts of ACTH

tx: pituitary resection. ACTH will be higher bc cortisol is stimulated by ACTH, so a tumor would hyper secrete ACTH

22
Q

Pheochromocytoma

A

tumor in adrenal medulla. secretes Epi/NE.

sx: hypertension, tachyarrthmia, H/A, sweating,
dx: elevated plasma free metanephrines
tx: alpha blockers, calcium channel blockers. removal of pheochromacytoma

23
Q

What inhibits and stimulates TSH

A

Inhibits- Somatostatin

Stimulates - TRH

24
Q

What is the active form of Vit D called

A

calcitriol

25
Q

When serum Calcium is high, serum phosphorous is____

A

low.

vice versa. work in opposites.

26
Q

Where is calcitonin produced and what does it do?

A

produced by thyroid gland
It is secreted when Ca level is too high. LOWERS Ca. target is bone (promotes osteoblasts, inhibits osteoclasts) and kidneys (inhibits Ca reabsorption, inc Ca excretion)

27
Q

PTH is secreted from where and what does it do?

A

secreted from Parathyroid glands when hypocalcemia

bones: inc osteoclast
kidneys: inc Ca reabsorption, and phosphorous excretion. Activates Vit D to calcitriol
small intestine: INDIRECT action to inc Ca absorption due to calcitriol

28
Q

You must have enough of this ion to stimulate PTH

A

Magnesium .

Low Mg could be a result from puking

29
Q

Normal iPTH values are (serum PTH)

A

10-65 ng/L

30
Q

HYPOparathyroid causes

A

rare.

Iatrogenic, autoimmune, Mg deficiency

31
Q

HYPOparathyroid symptoms

A

all related to hypocalcemia
-osteoblasts continue doing their work= brittle bone
-muscle cramps, tetany, impaired muscle contraction/relax
-impaired cardiac contraction/relax
+Chovstek’s sign ( twitch when tap over facial n)
+Trousseau’s sign (wrist/finger flexion after BP cuff inflation)

32
Q

HYPOparathyroid DDX/ Labs/ TX

A

DDX: diagnosis made in the absence of CKD

Labs: low iPTH, low serum Ca

Tx: Acute - admit now to ICU
Chronic- take Vit D and Ca, live in sunny place, normalize Mg levels

33
Q

Hyperparathyroid: primary etiology /cause

A

older women. people with past neck irradiation

parathyroid itself hyper secretes PTH from pit adenoma

34
Q

Hyperparathyroid : primary ssx

A
  • inc osteoclast activity- brittle bones
  • inc kidney reabsorption and excretion- hypercalciuria and kidney stones
  • decreased deep tendon reflex, will have abd pain, constipation, impaired muscle contraction
35
Q

Hyperparathyroid : primary labs, tx

A

labs: inc iPTH, inc serum Ca
tx: avoid diuretics like Thiazides, avoid antacids, and too much Vit D, Biphosphates (will decrease PTH activity)

36
Q

Hyperparathyroid : secondary cause

A

PTH oversecretes due to long standing hypocalcemia, seen in CKD and in malabsorption ( bariatric surgery)

37
Q

Hyperparathyroid : secondary ssx/labs/tx

A

ssx: bone/joint pain
labs: inc iPTH
tx: CKD see nephrologist. bariatric pts take lifelong calcium and vit D

38
Q

Drugs that cause HYPOcalcemia

A 
Rifampin (for TB)
Phenytoin (antiseizure) 
Furosemide- Loop diuretic inhibits Ca reabsorption
Biphosphates- tx for osteoporosis
Gluccocorticoids- dec Ca reab
39
Q

Drugs that cause Hypercalcemia

A

Thiazide diuretics- Ca reabsorption
Antacid
Vit D intox

40
Q

Primary hypothyroidism test results

A

Low T3/T4

High TSH

41
Q

Secondary Hypothyroid test

A

low TSH,

low T3/T4

42
Q

Primary Hyperthyroid test

A

high T3/ T4

low TSH

43
Q

Secondary Hyperthyroid test

A

High TSH

high T3/T4

44
Q

Normal TSH value

A

4-5

45
Q

Causes of Hypothyroid primary/secondary

A

primary: Autoimmune Hashimotos , iodine def, post surgical
secondary:

46
Q

Hyperthyroid primary

A

causes: pregancy, autoimmune Graves, thyroiditis

47
Q

Thyroid Crisis “storm”

A

delirium, severe tachycardia, vomit, dehydration, fever

48
Q

Thyrotoxicosis

A

sweating, weight change, diarrhea, dehydration, moist skin

49
Q

Hyperthyroid tx

A

PTU, Dexamethasone, beta blockers

avoid NSAIDS

50
Q

hypothyroidism tx

A

Levo-thyroxine replacement (Synthroid)

51
Q

Myxedema crisis

A

sever hypothyroidism- emergency
severe hypothermia, hypotension (CO2 retention), hypoventilation, hypoglycemia

altered mental status is hallmark!

Fall CLIN MED 1 (3 decks)

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