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Evidence Based Medicine > Week 3: Endocrine > Flashcards

Week 3: Endocrine Flashcards

1
Q

What do the endocrine glands do?

A

Regulate physiologic processes

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2
Q

Name the endocrine glands

A
  • pituitary gland
  • adrenal gland
  • thyroid gland
  • parathyroid gland
  • islet cells of the pancreas
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3
Q

What do troPic hormones do?

A

stimulate the release of other hormones

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4
Q

What do troPHic hormones do?

A

promote the growth, development, and maintenance of tissues and organs

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5
Q

In which bone is the sella turcica found?

pituitary gland sits in the sella turcica

A

sphenoid

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6
Q

What structure sits above the pituitary gland?

A

optic chiasm

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7
Q

Which nerves are found in the cavernous sinus?

A

III, IV, V1, V2 and VI

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8
Q

What visual symptoms can occur if the pituitary gland is enlarged?

A

visual impairment, diplopia, horner’s syndrome

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9
Q

When tropic hormones are released from the hypothalamus, hormones are released from which gland?

A

anterior pituitary

These hormones act on the target gland via hormone receptors

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10
Q

what are the two categories of pituitary hormones?

A

polypeptide and glycoprotein

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11
Q
A
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12
Q

Which hormones are released by the posterior pituitary gland?

A

Antidiuretic hormone and oxytocin

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13
Q

What are the polypeptide hormones?

A

Growth hormone, adrenocorticotropic hormone, prolactin, antidiuretic hormone, oxytocin

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14
Q

Which hormones are the glycoprotein hormones?

A

thyroid stimulating hormone, luteinizing horone, follicle stimulating hormone, human chorionic gonadotropin

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15
Q

Is the cortex the inner or outer layers of the adrenal gland?

A

outer

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16
Q

What hormone regulates the adrenal cortex?

A

ACTH

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17
Q

Match the cell type with its hormone:
a) DHEA
b) Cortisol
c) aldosterone
1) zona fasiculata
2) Zona reticularis
3) zona glomerulosa

A

a2, b1, c3

zona reticularis: DHEA(S); zona fasiculata: cortisol; zona glomerulosa: aldosterone

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18
Q

What produces epinephrine and norepinephrine

A

adrenal medulla

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19
Q

3 conditions that are associated with adrenal gland dysfunction

A
  1. cushing disease
  2. addison disease
  3. pheochromocytoma

cushing: increased cortisol; addisons: decreased cortisol (and aldosterone); pheochromocytoma: von hippel-lindau disease, neurofibromatosis type 1

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20
Q

two unique characteristics of the adrenal medulla

function and regulation

A

functiosn separately from the adrenal cortex; not under pituitary control

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21
Q

What condition is associated with an increased risk of pheochromocytoma along with hemangioblastomas of the brain and spinal cord, renal cell cancer, pancreatic tumors and genital cystadenomas?

A

Von Hippel Lindau Disease

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22
Q

What condition is associated with retinal capillary hemangiomas?

A

Von Hippel Lindau Disease

60% of patients with VHL show retinal capillary hemangiomas and nearly all patients with multiple retinal capillary hemangiomas have VHL

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23
Q

What is an ancilary test that is recommended for patients with VHL?

A

neuroimaging

25% of patients with retinal findings d/t VHL also have hemangiomas of the CNS

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24
Q

What subtype of neurofibromatosis is the most common?

A

NF1

But NF2 does not have a risk of pheochromocytoma like NF1

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25
Q

What are the clinical ocular signs of neurofibromatosis?

A
  • cutaneous neurofibromas (benign masses of nerve tissue)
  • cafe au lait macules (6 or more)
  • freckling in the regions of skin folds
  • bilateral (or unilateral) optic nerve gliomas
  • Lisch nodules of the iris: occur in 95% of pt with NF1
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26
Q

Which thyroid hormone is under hypothalamic control? Which is under pituitary control?

A

TRH: hypothalamus; TSH: pituitary

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27
Q

Which type of feedback does the thyroid gland provide in order to decrease stimulatory hormone release?

A

negative feedback

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28
Q

Which hormones are low in hypothyroid and hyperthyroid?

A

Hypothyroid: T3, T4
Hyperthyroid: TSH

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29
Q

Which hormones are elevated in hypothyroid? Hyperthyroid?

A

Hypothyroid: TSH
Hyperthyroid: T3/ T4

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30
Q

Along with high T3 and T4, what are other signs of Graves Disease?

A

presence of a goiter, thyroid eye disease

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31
Q

How long does the active phase of thyroid eye disease last for nonsmokers vs smokers?

A

nonsmokers: 1 year; smokers 2-3 years

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32
Q

When can surgical correction of residual eyelid misalignment or strabismus be pursued?

A

after 6 months of stability (Quiescent phase)

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33
Q

What is the first FDA approved pharmacologic immunotherapy for adults with TED?

A

Teprotumumab

34
Q

Since parathyroid hormone does not have a tropic hormone to trigger its release, what is the stimulates the release of parathyroid hormone?

A

low blood calcium levels

35
Q

What are the 3 functions of parathyroid hormone?

A
  1. increase calcium resorption from the bones
  2. stimulate renal tubular calcium resorption by kidneys
  3. stimulate renal hydroxylation of vitamin D: increase blood calcium levels
36
Q

Ionized calcium is involved in what three physiologic processes?

A

muscle contraction (including the heart); neurological transmission, blood coagulation

37
Q

What maintains calcium homeostasis?

A

PTH, calcitonin, Vitamin D

38
Q

What are the functions of activated vitamin D?

A

increase calcium absorption from the intestines, regulate bone turnover; provide negative feedback tot the parathyroid glands to decrease PTH production

39
Q

Which cells secrete calcitonin from the thyroid gland?

A

parafollicular cells

40
Q

What are the 3 functions of calcitonin in the bones?

A

slows bone turnover, maintain calcium stores, slow bone loss

41
Q

What ocular condition forms from calcium salt deposits across the interpalpebral cornea?

A

Corneal band keratopathy

42
Q

What systemic condition is associated with corneal band keratopathy?

A

sarcoidosis

43
Q

What calcium related disorder is a cause of papilledema (especially chronic)

A

hypocalcemia

responsive to calcium supplementation

44
Q

Does the pancreas have exocrine or endocrine functions?

A

both

45
Q

What do beta cells of the pancreas secrete?

A

insulin

46
Q

What do alpha cells of the pancreas secrete?

A

glucagon

47
Q

What do delta cells of the pancreas secrete?

A

somatostatin

decreases smooth muscle contraction

48
Q

What do gamma cells in the pancrease secrete?

A

pancreatic polypeptide

49
Q

Which pancreatic cells secrete ghrelin, the hormone that stimulates hunger?

A

epsilon cells

50
Q

What does the destruction of beta cells in type 1 diabetes lead to?

A

absolute insulin deficiency

51
Q

What is the diagnostic criteria for fasting blood glucose and HbA1c?

A

FBG: > 126 mg/dL
HbA1c: >/=6.5%

52
Q

What are the 3 mechanisms that cause damage to the retina in diabetic retinopathy?

A

microvascular injuries, inflammation and glutamate excitotoxicity

this damage exacerbates neuronal dysfunction, retinal hypoxia and increases VEGF

53
Q

How does VEGF lead to angiogenesis?

A

by stimulating endothelial cell proliferation, migration and tube formation

54
Q

True or False:
VEGF only released by the RPE

A

False

Other retinal cell types that produce and secrete VEGF are: Muller cells; astrocytes, ganglion cells and vascular endothelium

55
Q

Which types of cells produce the greatest amount of VEGF under hypoxic conditions?

A

muller cells and astrocytes

56
Q

What triggers muller cell proliferation and thus the production of VEGF?

A

High glucose levels

57
Q

What is the pathway involved in the development in diabetic cataracts?

A

Sorbitol pathway

58
Q

What converts glucose into sorbitol?

A

Aldose reductase

59
Q

How does the lens swell in diabetes?

A

Sorbitol accumulates in the lens, increasing the osmolarity of the lens and drawing more water in

60
Q

How can the swelling of the lens be reduced?

A

lowering glucose levels

61
Q

All management for NPDR is observation, what is the follow up schedule?

A
  • mild: 12 months
  • moderate: 6 months
  • Severe: 4 months
  • Very severe: 2 months
62
Q

All PRD management is specialty care by retina, when should patients be seen?

A
  • early: 1 month: decide treatment vs observation
  • High-risk: 24-48 hours: prompt treatment
  • CSME (any stage): within 2 weeks: decide treatment vs observation
63
Q

standard photo 2A is used to differentiate between which classifications of NPDR?

photo 2A is used for hemorrhages and microaneurysms

A

Mild, Moderate and Severe NPDR

Mild: < photo 2A
Moderate: > photo 2A in 1-3 quadrants
Severe: > photo 2A in all 4 quadrants

64
Q

What is standard photo 6B used for?

A

Venous Beading

severe: venous beading in 2+ quadrants

65
Q

What is standard photo 8A used for?

A

IRMA

the presence of IRMA in any quadrant is automatically severe NPDR

66
Q

What is often found along with IRMA in severe NPDR

A

cotton wool spots

67
Q

What is standard photo 10A used for?

A

neovascularization of the disk

neo > 10A is high risk PDR

68
Q

What is the most common cause of diabetic retinopathy related vision loss?

A

diabetic macular edema

may be present with any level of retinopathy; can be focal or diffuse

69
Q

What is the goal of panretinal photocoagulation?

A

lowering VEGF levels, vascular permeability, and angiogenesis

best when patient is between severe NPDR and early PDR

70
Q

what is a benefit of pattern scan laser vs PRP?

A

shorter treatment time with reduced pain and less collateral damage

71
Q

what are two laser treatments used for dme?

A

focal/grid laser and subthreshold diode micropulse laser photocoagulation

72
Q

Which laser treatment can be combined with anti-VEGF therapy in severe DME?

A

subthreshold diode micropulse laser photocoagulation

73
Q

When would we want to use an intravitreal steroid in DME treatment?

traimcinolone acetonide

A

diffuse edema throughout the macula

74
Q

Which pathway is affected in horner syndrome?

A

oculosympathetic pathway

75
Q

oculosympathetic pathway

what is the path of the first-order (central) neuron?

A

posterior hypothalamus
-> ciliospinal center of Budge

76
Q

oculosympathetic pathway

What is the path of the second-order (preganglionic) neuron?

A

spinal cord -> stellate ganglion at pulmonary apex ->superior cervical ganglion (C3 to C4)

77
Q

oculosympathetic pathway

What is the path of the 3rd order (postganglionic)?

A

superior cervical ganglion -> cavernous sinus -> superior orbital fissure

78
Q

What is the relationship between axial length and the development of proliferative diabetic retinopathy?

Why is myopia believed to be protective against diabetic retinopathy?

A

increase axial length, decrease risk of diabetic retinopathy

79
Q

Why is longer axial length associated with lower VEGF levels in the eye?

A

VEGF in the anterior chamber and in the vitreous cavity may be diluted due to the longer axial length leading to increased intraocular volume

80
Q

Waht are 3 anatomical changes in myopia that are protective against diabetic retinopathy?

A
  1. longer axial length
  2. chorioretinal thinning
  3. altered blood flow
81
Q

How is the chorioretinal thinning that happens as a result of myopia associated with lower VEGF production?

A

Thinning reduces metabolic demand and facilitates oxygen diffusion throught the retina via increased choroidal perfusion; this leads to decreased risk of retinal hypoxia

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