Endocrine

Front 1

what are the male and female manifestations of 17-alpha-hydroxylase deficiency

Back 1

Both have HYPERTENSION + HYPOKALEMIA (high aldosterone, low cortisol/sex hormones)

XY: psuedohermaphroditism: externally female (lack of DHT), no reproductive structures because they still have sertoli cells and MIF.

XX: extrenally females with normal internal sex organs but lacking secondary sexual characteristics (sexual infantilism)

Front 2

hypotension, hyperkalemia + masculinization and ambigous genitalia in female

Back 2

21-hydroxylase deficiency

*have decrease aldosterone, cortisol, increased sex hormones.
*increased ACTH

Front 3

hypertension + high sex hormones

Back 3

11-beta-hydroxylase deficiency

*remember 11-DOC is a mineralocoricoid and is ssecreted in excess

*11-DOC also does NOT cause feedback inhibition on ACTH so it will continue to increase.

Front 4

What 3 effects does PTH have on the kidney

Back 4

1. decreased Na/PO4 co-transport in the PCT
2. decrease Ca2+ reabsorption in the DCT
3. stimulate 1-alpha-hydroxylase

Front 5

How does PTH activate osteoclasts?

Back 5

PTH --> osteoblasts --> RANK-L, M-CSF ---> osteoclast differentiation

Front 6

How does Mg2+ affect PTH secretion

Back 6

decrease Mg2+ = decrease PTH

common causes of decreased Mg2+ include diarrhea, aminogylcosides, diuretics, alcohol abuse.

Front 7

what are the steps of vitamin D synthesis starting from sunlight?

Back 7

1. provitamin D3 is converted to vitamin D3 using sunlight
2. vitamin D3 is converted to 25-OH vitamin D using CYP450
3. 25-OH vitamin D is converted to 1,25 vitamin D3 using 1 alpha hydroxylase

*24,25 OH2 vitamin Dis inactive form

Front 8

how do you differentiate PITUITARY adenoma cushing's from ectopic ACTH?

Back 8

dexamethasone test:

pituitary adenoma will decrease cortisol after high dose of dexamethasone (synthetic glucocorticoid)

ectopic ACTH (small cell carcinoma) or ADRENAL adenoma will have high cortisol no matter the dexamethasone dose.

Front 9

explain secondary hyperaldosteronism

Back 9

kidney perception of low intravascular volume (cirrhosis, renal artery stenosis, CHF, nephrotic disease) causes activation of aldosterone.

see high renin levels (as opposed to primary hyperaldosteronism from an alodosterone secreting tumor)

Front 10

what serum levels are expected in addison's disease

Back 10

since there is destruction of all 3 layers of the adrenal cortex- there is no aldosterone or cortisol.

no aldosterone = hyperkalemia, acidosis, hypotension

no cortisol = hypotension also

*treat with steroids ASAP

Front 11

urine levels of ____ are elevated in a child suffering from a tumor of the adrenal medulla (although it can occur anywhere along the sympathetic chain)

Back 11

neuroblastoma

HVA (homovanillic acid) a breakdown product of dopamine

*associated with n-myc

Front 12

potbellied pale puffy faced child with protruding umbulicus and protuberant tongue

Back 12

cretinism

*usually from lack of dietary iodine, sporatically can occur in defect in T4 formation or no thyroid

Front 13

histological findings of person with painful very tender thyroid that developed after a flulike illness.

Back 13

subacute thyroiditis (de quervian's) has granulomatous inflammation

*also elevated ESR, jaw pain

Front 14

focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation of TSH receptor

Back 14

toxic multinodular goiter

*different than grave's - no exopthalmos, pre-tibial myxedema

Front 15

3 histologic findings on papillary carcinoma of thyroid

Back 15

1. ground glass nuclei (orphan annie)
2. psamomma bodies (calcified)
3. nuclear grooves

*increased risk with childhood radiation

Front 16

serum levels for primary hyperparathyroidism
-Ca
-PO4
-alk phos
-PTH

Back 16

-Ca = high
-PO4 = low
-alk phos = high
-PTH = high

Front 17

serum levels for secondary hyperparathyroidism
-Ca
-PO4
-alk phos
-PTH

Back 17

secondary is usually due to chronic renal disease and low Vit D --> low Ca2+

-Ca = low
-PO4 = high
-alk phos = high
-PTH = high

Front 18

3 cardinal signs of Albright's hereditary osteodystrophy (psuedohypoparathyroidism)

Back 18

Caused by unresponsiveness to PTH
1. short height
2. hypocalcemia
3. shortened 4th/5th digits

Front 19

two possible treatments for prolactinoma

Back 19

bromocriptine
cabergoline

-both are dopamine agonists

Front 20

how do you diagnose acromegaly (serum)

Back 20

high IGF-1

Front 21

treatment for central DI and nephrogenic DI

Back 21

DI = low ADH effect = peeing all the time dilute urine

central = intranasal desmopressin (ADH)

nephrogenic = need some way to reabsorb water- hydrochlorathiazide, indometacin (inhibits prostaglandins, which normally inhibit ADH), amiloride

Front 22

5 causes of SIADH (too much ADH = too much water reabsorbed)

Back 22

1. ectopic ADH (small cell lung cancer)
2. CNS disorders/head trauma
3. pulmonary disease.
4. drugs - cyclophosphamide

Front 23

histological differences in DM1/DM2

Back 23

DM1 = islet lymphocytic infiltrate

DM2 = islet amyloid deposit

Front 24

what are the 3 rapid acting insulins?

Back 24

Lispro, Aspart (both peak @ 30 mins)
Regular insulin

*remember effects of insulin- increase glycogen storage in liver/muscle, protein synthesis, TG storage, K uptake

Front 25

what are the two long acting insulins

Back 25

Glargine
Detemir

Front 26

mechanism of tolbutamine/chlorprpamide

Back 26

close K+, Ca influx --> release of insulin (only works if you have some working beta cells, so useless in DM1)

Front 27

side effect of first generation sulfonylurease and second generation

Back 27

1st gen = tolbutamine, chloropropamide - disulfiram like effects

2nd gen = glyburide, glimepiride, glipizide - hypoglycemia

*contraindicated in pregnancy can cause insulin release in baby

Front 28

mechanism of metformin

Back 28

deccrease gluconeogenesis, increase glycolysis, increase peripheral glucose uptake (increase insulin sensitivity)

Front 29

diabetes drug that has side effect of lactic acidosis and should be avoided in patient with renal failure

Back 29

metformin (biguanide)

Front 30

mechanism of rosiglitazone

Back 30

increases sensitivity of insulin by binding to PPAR-Y nuclear transcription regulator

Front 31

4 side effects of pioglitazone

Back 31

weight gain
edema
hepatotoxicity
CV toxicity

Front 32

what two drugs can inhibit intestinal brush border alpha glucosidases and decrease postprandial hyperglycemia

Back 32

acarbose
miglitol

side effects = gi distrubances

Front 33

what diabetes drug decreases glucagon

Back 33

pramlintide

side effect = hypoglycemia

Front 34

what diabetes drug is a GLP-1 analog that increases insulin and decreases glucagon

Back 34

exenatide

se = pancreatitis

Front 35

what two steps of T3/T4 synthesis do propylthiouracil/methimazole block?

Back 35

organification (TG + I2 --> MIT+DIT)
coupling (MIT+DIT --> T3/T4)

Front 36

3 side effects of propylthiouracil/methimazole

Back 36

skin rash
agranulocytosis
aplastic anemia

methimazole is a possible teratogen

Front 37

what 4 diseases does somatostatin (octeotride) treat

Back 37

acromegaly
carcinoid
gastrinoma
glucagonoma