Endo- Clinical Approach To Endocrinology- Dr. Pinzur

Front 1

what is endocrinology?

Back 1

-branch of IM
-has to do with endocrine glands

Front 2

how to be a good endocrinologist?

Back 2

be a good internist

Front 3

what are the adrenal glands?

Back 3

-each has different function and hormones
-pituitary
-thyroid
-adrenal
-pancreas
-ovary/ testes
-pineal body

Front 4

alarm reaction

Back 4

-body reacts to stress of trauma, etc. and releases increased levels of hormones
-caused by sepsis, fractures, cardio-respiratory distress

Front 5

metabolic abnormalities caused by chronic renal insufficiency lead to what

Back 5

secondary hyperparathyroidism

Front 6

purpose of hormone replacement tc. during menopause

Back 6

-important role in lipid control, mental functioning, skin condition, bone metabolism in women

Front 7

how is endocrine system arranged

Back 7

-hierarchial manner w/ several levels of control

Front 8

lowest level of endocrine system

Back 8

-glands produce final hormones which affect end organs

Front 9

thyroid gland produces

Back 9

thyroxin-- stimulates cellular metabolism

Front 10

adrenal cortex produces hormones that do what

Back 10

regulate cellular metabolism and renal function

Front 11

reproductive glands produce hormones that affects what

Back 11

secondary sexual characteristics

Front 12

pituitary gland

Back 12

-secrete trophic hormones- stimulate function of other endocrine glands
-sensity to plasma concentration of end-organ hormones and produces more or less trophic hormones in repsonse to falls or rises in activity of glands at lowest level
-secrete TSH, ACTH, gonadotropins

Front 13

TSH

Back 13

regulate thyroid function

Front 14

ACTH

Back 14

regulates adrenal glands

Front 15

gonadotropins

Back 15

modify activity of sexual glands

Front 16

highest level of control is what

Back 16

hypothalamus- secretes releasing factors

Front 17

hypothalamus

Back 17

-sensitiive to conc. of both trophins and end-organ hormones in circulation
-not all organs regulated by hypothalamus

Front 18

-multilevel organization allows for what

Back 18

-amplification of effect

Front 19

secreted by anterior lobe

Back 19

TSH- thyroid
ACTH- adrenal
FSH- testis
LH- ovary

Front 20

examination usually focuses on what

Back 20

-manifestations of hormone excess or deficiency
-direct exam of palpable glands

Front 21

how do patients need to be evaulated

Back 21

-presenting symptoms
-review of symptoms
-family and social history
-exposure to meds

Front 22

clinical appearance of Cushing's syndrome

Back 22

-typical moon face
-plethoric face with acne and hirsutism
-evidence of temporal hair recession
-fat redistribution, striae, proximal muscle weakness

Front 23

insidious onset of hypothyroidism symptoms

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-mental slowing
-fatigue
-dry skin

Front 24

substitution therapy
1. synthroid
2. insulin
3. estrogen and androgen hormones
4. progesterone
5. gonadotropin
6. vasopressin
7. adrenal cortical substances

Back 24

1. in hypothyroidism
2. in DM
3. in female and male hypogonadism
4. in habitual abortion
5. in hypogonadism
6. in diabetes insipidus
7. in Addison disease

Front 25

stimulation therapy

Back 25

-usign gonadotropic hormones to stimulate ovarian and testicular function

Front 26

-suppresion therapy

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-suppression of thyroid secretion with antithyroid drugs (PTU, Tapazole)

Front 27

surgical approach

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-utilized in hypersecretory and neoplastic disturbaces involving glandular structures

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non-operative measures

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-alterations in diet
-irradition
-substitution therapy
-stimulation and suppression of glandular activity

Front 29

dietotherapy

Back 29

-chiefly used for management of DI
-iodine administration- endemic goiter
-calciu and vitamin D- tetany
-NaCl- control adrenal cortical deficiency

Front 30

irradiation

Back 30

-pituitary tumor or thyroid problem
-radioactive iodine- hyperthyroidism and thyroid carcinoma
-x-ray radiation- anterior pituitary tumors and control of hyperplastic tumors

Front 31

step #1 in diabetes treatment

Back 31

diet therapy

Front 32

with a microadenoma- what can be displaced?

Back 32

infundibulum

Front 33

thyroid scan

Back 33

-can see huge area of deficit in uptake
-tells that there is uptake defect, but doesn't give diagnosis
-must use other test to diagnose

Front 34

stimulation tests

Back 34

-used to assess endocrine hypofunction

Front 35

ACTH stimulation test

Back 35

-assess adrenal gland response in patients with suspected adrenal insufficiency

Front 36

diagnostic testing

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-radiologic imaging (CT, MRI, thyroid scan, and ultrasound)
-must have laboratory testing first then imaging

Front 37

1st step to diagnosing

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laboratory testing

Front 38

due to TB infection

Back 38

adrenal insufficiency

Front 39

due to infarction

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-tissue due
Ex. as in postpartum pituitary failure

Front 40

with DM secondary to pancreatitis

Back 40

inflammation

Front 41

autoimmune processes that destroy endocrine organs

Back 41

Hashimoto's
thyroiditis

Front 42

block binding of trophic hormones

Back 42

idiopathic hypothyroidisn

Front 43

hypothyoidism due to what

Back 43

iodine deficiency

Front 44

hormone excess causes pathologic effects except

Back 44

-testoterone and progesterone

Front 45

Type 1 hormone excess

Back 45

-hormone is produced by the gland tha is usual site of its production
-Ex; hyperthyroidism, acromegaly, Cushing's
-failure or circumvention of feedback mech.

Front 46

Type 2 hormone excess

Back 46

hormone is produced by a tissue that does not synthesize it ordinarily
-Ex. ACTH production by oat cell carcinoma of lung
-Ex. thyroid hormone secretion by strauma ovari

Front 47

Type 3 hormone excess

Back 47

-overproduction of hormones in peripheral tissues from circulating precursors
-Ex: estrogen in liver disease
-Ex. cirrhosis

Front 48

Type 4 hormone excess

Back 48

-iatrogenic causes of hormone excess
-Ex. glucocorticoid therapy, self-administration of hormones
-Ex. pt. takes thyroxin for weight loss

Front 49

Type 1 diabetes

Back 49

-absolute deficiency in insulin
-genetical predisposition, environmental insult, autoimmune destruction, and then diabetes

Front 50

Type 2 diabetes mellitus

Back 50

-body resistant to insulin
-normal or elevated level of insulun

Front 51

primary gonadal problem

Back 51

low testoterone
elevated LH

Front 52

pituitary disorder

Back 52

low testoterone
low LH

Front 53

primary hypothyroidism

Back 53

elevated TSH
low free thyroxine level

Front 54

thyrotoxicosis

Back 54

low TSH
-elevate free thyroxine level

Front 55

primary hyperparathyroidism

Back 55

elevated calcium and PTH

Front 56

malignancy or granulomatous disease

Back 56

elevated calcium
suppresed PTH

Front 57

hyperfunctioning adrenal adenomas

Back 57

suppressed ACTH
increased urine free cortisol

Front 58

suppresion tests used for what

Back 58

-suspected endocrine hyperfunction

Front 59

-used to evaluate Cushing syndrome-

Back 59

-Dexamethasone suppression test
-suppress plasma cortisol < 5 mg/dl

Front 60

overnight suppression test

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failure to suppress- Cushing's syndrome
-false positive-- obesity, alcoholism, depression

Front 61

low dose suppression test

Back 61

-48 hours
-failure to suppress- Cushing's

Front 62

high dose suppresion test

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-do if low dose test fails to suppress cortisol
-if cortisole < 5 mg/dl- Cushing's
-if corisole > 5 mg/dl- adrenal tumor or ectopic ACTH

Front 63

1. Cushing's syndrome
2. Cushing's disease

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1. cortisol excess
2. pituitary ACTH causes cortisol excess

Front 64

most common stimulation test

Back 64

ACTH

Front 65

gain-of-function mutations

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-cause constitutive activity of hormone receptors or cause hormone receptor to loose ligand-binding specificity
-

Front 66

mutations that lead to constitutive activation of LH receptor cause what

Back 66

testitoxicosis (most common cause of premature puberty in boys)

Front 67

mutations of androgen receptor in advanced prostate cancer may allow what

Back 67

-activation of receptor by ligandsthat would normally be ineffective

Front 68

hormone resistence can result from what

Back 68

-mutations that impair hormone action
-acquired defects in rec. and post-recp effector organisms
-development of antibodies that block hormones and hormone receptors
-absence of target cells

Front 69

-failure of hormone action can lead to what

Back 69

increaed hormone production due to feedback control

Front 70

diseases addecting multiple endocrine systems

Back 70

-autoimmunity-- PGAS
-receptor abnormalities- resistance to parathyroid hormone, gonadotropins, and thyrotropin in psuedohypoparathyroidism
-tumors -- multiple endocrine neoplasia
-hereditary disorders of unknown etiology-- lidodistriphies
-more than 1 endocrine gland can be involved

Front 71

MEN=

Back 71

multiple endocrine neoplasia

Front 72

radioimmunoassays (RIAs)

Back 72

-most impt. diagnostic tools
-competitive protein binding assay using antibody to hormone as specific reactant
-measures immunochemical potency of unknown sample relative to standard hormone

Front 73

ELISA

Back 73

enzyme linked immuno-sorbent assay

Front 74

radioreceptor assay

Back 74

-competitive protein biding assay using receptor preparation as specific reactant

Front 75

24 hour urine free cortisole measurement reflects what

Back 75

adrenal cortex function

Front 76

17-hydroxycorticosteroids level used for what

Back 76

diagnosing Cushing's and adrenogenital syndrome

Front 77

17-ketosteroids (androstenedion and DHEA

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pituitary, adrenal, and testicular timors

Front 78

vanillylmandelic acid and matanephrines (metabolites of catecholamines)

Back 78

pheochromocytoma

Front 79

5- hydroxyindolactetic acid (serotonin metabolite)

Back 79

carcinoid