Endocrinology Im Lectures

Front 1

Local Hormones

Back 1

secreted and act on same organ
-Acetyl Choline -m contraction
-CCK - GB contraction
-nervous impulses +synaptic transmission

Front 2

General Hormones

Back 2

epi/NE
TH - works on metabolism, pancreas, testes, ovaries
GH

Front 3

Endocrine Organs

Back 3

Pituitary Gland
Pineal Gland
Thyroid
Parathyroid
Thymus
Adrenal
Pancreas
Ovary/testes
*placenta is endocrine organ when present

Front 4

Pituitary gland

Back 4

master gland
affects thyroid, para, adrenal, panc, testes, ovaries
next to optic chiasm
*can cause too tall/small, hair pattern prob, ha, visual prob

Front 5

Pineal Gland

Back 5

makes serotonin derivative melatonin that affects wake/sleep patterns and seasonal function
reacts to light...works on circadian rhythm

Front 6

Thyroid Gland

Back 6

controls how quickly body uses energy, makes proteins, controls sensitivity to hormones

makes: CALCITONIN, T3, T4

Front 7

Adrenal Cortex zones

Back 7

Zona glomerulosa --> aldosterone, mineralcorticoids
*conn syndrome
zona fasiculata --> cortisol, glucocorticoids
*cushing syndrome
zona reticularis --> androgens, sex hormones

Front 8

When not eating what maintains glucose levels?

Back 8

Glucagon

Front 9

Pancreas

Back 9

Endocrine - insulin, glucagon, somatostatin

Exocrine - pancreatic juice, digestive enz

Front 10

steroid hormones

Back 10

cortisol + aldosterone

Front 11

Tyrosine derivatives are?

Back 11

thyroxine
triiodothyronine
EPI/NE

Front 12

Users of 2nd messenger system?

Back 12

ACTH, TSH, LH, FSH, ADH, PTH, Gulcagon, catecholamines, secretin

*ACTH binds TSH --> activates cAMP --> amplify, enzyme synthesis, enhance reaction, build protein --> feedback shuts it down

*the other 2nd messenger - calmodulin

Front 13

Stimuli for release of GH

Back 13

starvation
protein deficiency
hypoglycemia
low FFA in blood
exercise
excitement/ trauma
deep sleep

Front 14

normals

Back 14

glucose = 100
NA = 125-135
Carbs = 200
TSH = .4-4
prolactin <15
GH = 1
IGF1 <300
Na = 140

Front 15

Hypoglycemia due to

Back 15

high insulin
high oral hypoglycemic
surgery
pentamidine, aspirin, haloperidol
age extremes
insulinoma
renal failure
adrenal insufficiency
alcohol, sepsis, heart failure

Front 16

What is the driver for evaluating endocrine problems?

Back 16

LAB studies

*except Empty Sella syndrome - use MRI

Front 17

Obesity Dx

Back 17

BMI >29
asians > 25

*obesity does accelerate atherosclerosis (more upper body obesity over lower)

Front 18

2nd leading PREVENTABLE cause of death in US

Back 18

obesity

Front 19

Hypothalamic Hormones
Anterior Pit Hormones
Posterior Pit hormones

Back 19

hypo: TRH, CRH, GHRH, somatostatin, GnRH, DA

Ant: TSH, ACTH, GH, FSH, LH, Prolactin

Post: oxytocin, ADH

Front 20

Secreted at midnight? So will see in morning?

Back 20

GH, ACTH

*all others are opposites

Front 21

GH target

Back 21

IGF1 (insulin growth factor 1)
-no diurnal variation
- half life is longer
-all around better to use then GH because is more representative of pt

Front 22

Acromegaly

Back 22

= pituitary tumor that makes GH
DX: IGF1 + GH
symp: big hand, feet, tongu, jaw, CHF, HTN, HA, hypersomnolence, hyperhydrosis, peripheral non pitting edema, chondroma, hyperpigment
*arthritis = most disabling syndrome
Tx: surgery - stereoscopic pituitary hypophsectomy

Front 23

ACTH activator and inhibitor

Back 23

activator = CRH
inhibitor = Glucocorticoids

Front 24

Main Glucocorticoid
Properties of Glucocorticoid

Back 24

Cortisol
Benificial: anti-inflam
Bad: enhance gluconeogenesis, antagonize glucose, cause hyperglycemia, bread down collagen

Front 25

Adrenal Function Tests

Back 25

1. Rapid ACTH stim test - dec. cortisol to try to stimulate it
2. dexamethasone test

Front 26

Nelson Syndrome

Back 26

due to: removal of adrenal from cushing
*get too much ACTH production
tx: surgery

Front 27

Delphian LN

Back 27

LN that contains metastatic thyroid cancer

Front 28

Thyroglossal duct cyst

Back 28

looks like nodule but it is a cyst on thyroid

Front 29

Pemberton's sign

Back 29

sizeable TG that can float into the sterna notch on hyperextension of the neck and cause asphyxiation

Front 30

Riedel's struma

Back 30

*thyroiditis
= rock hard thyroid gland - fibrous tissue in TG makes it firm due to long term inflammation

Front 31

thyroprovic

Back 31

primary defect in thyroid gland

Front 32

trophoprivic

Back 32

secondary defect in thyroid gland like:
sheehand syndrome, infiltrated disorders of pit or hypothal

Front 33

Kocher-debre semelaingne syndrome

Back 33

*Hashimoto's
in newborn m are atrophied

Front 34

Hoffman's syndrome

Back 34

*Hashimoto's disease
weakness, not hypertrophy of m...but deposition of mucopollysaccharide complex

Front 35

DKA

Back 35

Type 1 DM - emergency
triad = Hyperglycemia + ketosis + acidosis
abrupt, NV, dehydration, eyes sunken, mucous membranes dry, ab pain, KUSSMAULS BREATHING,
the acidosis is what kills + dehydration
dx: glucose >250
tx: need LOTS of insulin

Front 36

Hyperosmolar Nonketotic Coma (HHNKC)

Back 36

type 2 DM - emergency
VERY high glucose levels - thi sis the driver
takes a long time
tx: needs less insulin

Front 37

Hypoglycemia

Back 37

due to: autonomic neuropathy, DM1 on beta blcokers, not eating, too much exercise, ALCOHOL
symp:
1. adrenergic symptoms
2. neuroglycopenic symptoms

Front 38

Reactive Hypoglycemia

Back 38

= insulin and glucose not flowing together
- after eat carbs
Alimentary Hypoglycemia:
bowel surgery - so food absorbed too fast
Functional Hypoglycmemia:
delay of insulin by hours

Front 39

Insulin Resistance contributes to?

Back 39

HTN, obesity, hyperinsulin, DM, hyperTG, low HDL, high small dense LDL

all lead to atherosclerosis

Front 40

Framingham risk score

Back 40

=way to measure CV risk in 10 years
highest risk = 20%

Front 41

Metabolic Syndrome

Back 41

= looks at how at risk you are for CVS problem
5 parameters:
1. ab obesity: M >35 in F > 40 in
2. TG > 150
3. HDL: M< 40 F<50
4. BP: >130/85
5. Fasting Glucose >110

Front 42

3 factors in DM/insulin resistance

Back 42

1. high TG
2. low HDL
3. small dense LDL (subclass B)

all inc atherosclerosis --> inc. CVD

Front 43

ATP Goals

Back 43

1. highest risk LDL < 70
hear prob
2. high risk LDL <100
DM
3. moderate LDL 100-129
4. Low LDL <130

Front 44

Non HDL cholesterol

Back 44

= total cholesterol - HDL = apo B containing proteins

goal: LDL + 30

Front 45

Tx of LDL

Back 45

1. resin- dec. glucose
2. Nicotinic acid - dec. TG, inc. HDL
3. fibrates - dec. TG, inc. HDL
4. statin - dec. CHOL, dec LDL

* always tx LDL first...unless TG >500

Front 46

CVS Markers

Back 46

1. hs-CRP
2. Lpa

Front 47

Main cause secondary hyperparathyroidism

Back 47

renal insufficiency

Front 48

Osteoporosis score

Back 48

greater than - 2.5

Front 49

Raloxifen

Back 49

dec hip fractures
doesnt affect breast

Front 50

Nasal calcitonin

Back 50

dec. vertebral fractures only

Front 51

bisphosphonates

Back 51

repair osteoclastic function
dec. vertebral, nonvertebral, and hip

adr: dry socket

Front 52

PTH

Back 52

dec. osteoporosis
inc. bone resorption

Front 53

denosumab

Back 53

monoclonal ab
stops RANKL ligand binding

ADR: hypocalcemia

Front 54

somatotroph makes

Back 54

Prolactin + GH

Front 55

papillary genes

Back 55

MAP kinase - BRAF or NKT1

Front 56

Follicular genes

Back 56

PIC3

Front 57

Medullary genes

Back 57

RET

Front 58

Insulinitis

Back 58

MHC class 2

Front 59

pheochromocytoma

Back 59

SDHB

Front 60

parathyroid tumor

Back 60

PTHrP

Front 61

Important factors determining testosterone levels

Back 61

1. chornic illness
2. meds
3. obesity

Front 62

Klinefelter syndrome

Back 62

XXY, Barr Body
infertile, dec. sperm, gynecomastia, mental prob, high FSH/LH

Front 63

Kallman's syndrome

Back 63

inability to smell odors

Front 64

Most common cause impotence

Back 64

Diabetes

Front 65

Myotonic Dystrophy

Back 65

= neuromuscular failures with primary gonadal failure
premature baldness, mental retardation, Auto Dom, lenticular opacities

Front 66

Noonans syndrome

Back 66

karyotype is normal but look like turner's

-webbed neck, low ears, shield like chest, ptosis, pulmonic stenosis, cubitus,

Front 67

testosterone replacement therapy

Back 67

1. pellets
2. patch
3. IM injection
4. Gel
5. Buccal

Front 68

most common cause hyperthyroid in old

Back 68

toxic multinodular goiter

Front 69

LADA

Back 69

Latent AI DM in aultes
develops in adulthood like 2 but has pattern of 1

Front 70

Double Diabetes

Back 70

have 1 and fave family member with 2

Front 71

Type 1 and 1/2

Back 71

have 2 and develop ab and become picture of 1

Front 72

MODY

Back 72

maturity onset diabetes of youth
obese
mild dm

Front 73

impaired glucose tolerance

Back 73

pts at risk for dm
have abnormal glucose levels but not enough for dm
lined to metabolic syndrome

Front 74

Dx DM

Back 74

HGA1C= >7%
Fasting Glucose >126
Postprandial glucose >200

Front 75

Normal levels

Back 75

fasting glucose <100
Postprandial <140

Front 76

Insulin Resistance

Back 76

reduced ability of sugar to go into insulin sensitive cells - skel m + liver

inflam cytokines
FFA
risk: age, med, obese, inactive, gene

Front 77

type 1 vs. 2

Back 77

1 - beta cell function dec due to auto ab
2 - acanthosis nigricans
no phase 1

Front 78

target in glycemic control

Back 78

HGA1C - because linked to complications
if red to <7% you dec risk of retinopathy, nephropathy, bneuropathy

Front 79

Amylin

Back 79

co secreted with Insulin
from islet
will dec glucagon

Front 80

long acting insulin

Back 80

glargine
detmir
give 1x day

Front 81

steps to DM care

Back 81

1. lifestyle
2. oral agents
3. insulin
4. inc. insulin