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161 Cards in this Set
- Front
- Back
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A woman presents with diffuse goiter and hyperthyroidism. What are the expected TSH and thyroid hormone values?
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Low TSH and high thyroid hormones
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A 48-year-old female presents with progressive lethargy and extreme sensitivity to cold temperatures. What is the diagnosis?
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Hypothyroidism
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A pt with elevated serum cortisol levels undergoes a dexamethasone suppression test. 1 mg of dexamethasone does not decrease cortisol levels, but 8 mg does. What is the diagnosis?
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Pituitary Tumor
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A 50-year-old man complains of diarrhea. On physical exam, his face is plethoric and a heart murmur is detected. What is the diagnosis?
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Carcinoid syndrome
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A woman of short stature presents with shortened 4th and 5th metacarpals. What endocrine disorder comes to mind?
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Albright's herditary osteodystrophy, or pseudohypothyroidism
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A nondiabetic pt presents with hypoglycemia but low levels of C peptide. What is the diagnosis?
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Surreptitious insulin injection
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A pt's MRI shows filling of sella tursica with cerebrospinal fluid. What is the most likely clinical presentation?
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Normal. Residula pituitary tissue is functional and can compensate
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The adrenal cortex comes from what embryological cell layer?
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Mesoderm
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The adrenal medulla comes from what embryological cell layer?
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neural crest
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What are the three levels of the adrenal cortex?
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Zona Glomerulosa, zona fasciculata, zona reticularis
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Which hormones are released from the three layers of the adrenal cortex?
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G= aldosterone, F= cortisol,sex hormones, R= sex hormones
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The adrenal medulla secretes what hormones?
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Catecholamines = EPI, NE
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Trace the drainage of the left adrenal gland?
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Left adrenal -> left adrenal vein -> left renal vein -> IVC
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Trace the drainage of the right adrenal gland?
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Right adrenal -> right adrenal vein -> IVC
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What hormones are secreted by the posterior pituitary (neurohypophysis)?
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vasopressin, oxytocin
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The posterior pituitary is derived from what embryolic germ layer?
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neuroectoderm
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The anterior pituitary (adenohypophysis) secretes what hormones?
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FSH, LH, ACTH, TSH, Prolactin, GH
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The anterior pituitary is derived from what embryolic germ layer?
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oral ectoderm
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The a-subunit is common to which hormones?
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TSH, LH, FSH, hCG
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Which subunit determines hormone specificity?
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b-subunit
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What are the endocrine pancreas cell types and for what hormones do they specify?
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a=glucagon, b=insulin, d=somatostatin
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What hormone is required for the anterior pituitary to release prolactin? Where does it come from?
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Throtropin Releasing hormone (TRH) from the hypothalamus
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What hormones inhibit the secretion of prolactin and where do they come from?
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Dopamine from the hypothalamus and prolactin itself by stimulating dopamine
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TRH, released from the hypothalamus stimulates the release of which hormones from the pituitary?
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TSH, prolactin
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Dopamine, released from the hypothalamus inhibits the release of which hormones from the pituitary?
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prolactin
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CRH, released from the hypothalamus stimulates the release of which hormones from the pituitary?
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ACTH
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GHRH, released from the hypothalamus stimulates the release of which hormones from the pituitary?
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GH
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Somatostatin, released from the hypothalamus inhibits the release of which hormones from the pituitary?
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GH, TSH
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GnRH, released from the hypothalamus stimulates the release of which hormones from the pituitary?
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FSH, LH
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What is the rate limiting step in the synthesis of adrenal steroids?
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the conversion of cholesterol to pregnenalone via 20,22 desmolase
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What are the 3 congenital bilateral adrenal hyperplasias?
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17a-hydroxylase deficiency, 21b-hydroxylase deficiency, 11b-hydroxylase deficiency
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What is the most common congenital bilateral adrenal hyperplasia?
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21b-hydroxylase deficiency
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What function does 17a-hydroxlase have in the synthesis of adrenal steroids?
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it converts pregnenalone to 17-OH-pregnenalone and progesterone to 17-OH-progesterone producing cortisol and sex hormones
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What are the signs and symptoms of 17a-hydroxylase deficiency?
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decreased sex hormones, decreased cortisol high aldosterone (mineralcort); sx: HTN, hypokalemia; phenotypically female but no maturation
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What function does 20b-hydroxlase have in the synthesis of adrenal steroids?
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converts progesterone to 11-deOH-corticosterone and 17a-OH-progesterone to 11-deOH-cortisol
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What are the signs and symptoms of 20b-hydroxylase deficiency?
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decreased cortisol, increased ACTH, decreased mineralcorticoids, increased sex hormones; Sx: masculinization, femal pseudohermaphrodism, hypotension, hyponatremia, hyperkalemia, increased PRA, volume depletion
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What function does 11b-hydroxlase have in the synthesis of adrenal steroids?
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converts 11-deOH-corticosterone to corticosterone and 11-deoxycortisol to cortisol
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What are the signs and symptoms of 11b-hydroxylase deficiency?
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decreased cortisol, decreased aldo and corticosterone, increased sex hormones; Sx: masculinization, HTN
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What structures are insulin-dependent?
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skeletal muscle and adipose tissue
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What structures are insulin-independent?
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RBC and Brain
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What glucose uptake receptors are in skeletal and adipose tissue?
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GLUT-4 (insulin-dependent)
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What glucose uptake receptors are in the brain and RBCs?
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GLUT-1 (insulin independent)
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What does the brain use for metabolism in episodes of starvation?
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ketone bodies
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From where in the adrenal gland does cortisol come?
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adrenal fasciculata
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What are the 5 main functions of cortisol?
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(1) anti-inflammatory, (2) increase gluconeogenesis, lipolysis, proteolysis, (3) decrease immune function, (4) maintain BP, (5) decrease bone formaiton
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What stimulates the production of cortisol in the adrenal fasciculata?
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CRH (hypothalamus) -> ACTH (pituitary) -> cortisol
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What are the 4 main causes of Cushing's Syndrome? What would ACTH levels look like in each case?
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(1) Cushing's Dz (1' pit adenoma, increased ACTH), (2) 1' adrenal (decreased ACTH), (3) Ectopic ACTH production (increased ACTH), (4) iatrogenic (chronic steroids, decreased ACTH)
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What is the clinical picture of Cushing's Syndrome?
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wt gain, moon fascies, buffalo hump, truncal obesity, supraclavicular fat, purple striae, hyperglycemia, osteoporosis
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Describe the cortisol levels following a dexamethasone supression test in the following conditions: healthy, ACTH-producing tumor, Cortisone-producing tumor
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healthy: decreased cortisol after low dose; ACTH tumor: high cortisol after low dose/low after large dose; Cortisone tumor: high after low and high dose
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Primary hyperaldosteronism (Conn's syndrome) is the result of what?
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aldosterone secreting tumor
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What are the signs and sx of Conn's syndrome?
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HTN, hypokalemia, metabolic alkalosis, low plasma renin
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What is the treatment for Conn's syndrome?
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Spironolactone, a K-sparing diuretic and aldo antagonist
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What are some of the main causes of secondary hyperaldosteronism?
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renal artery stenosis, chronic renal failure, CHF, cirrhosis, nephrotic syndrome
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What is the MOA behind secondary hyperaldosteronism?
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kidney perceives low intravascular volume -> overactive renin-angiotensin system (high plasma renin)
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What is Addison's Dz?
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primary deficiency of aldo and cortisol due to adrenal atrophy
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What are the signs and SX of Addison's Dz?
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hypotension, skin hyperpigmentation (due to MSH) Atrophy of all 3 adreal cortical divisions
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What is the distinguishing feature between 1' and 2' adrenal insufficiency?
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2' insufficiency does not have hyperpigmentation of skin (decreased pit ACTH production)
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What is the most common tumor of the adrenal medulla in adults?
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Pheochromocytoma
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What other dzs may be associated with pheochromocytomas?
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Neurofibromatosis, MEN types II and III
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Chromaffin cells in the adrenal medulla are derived from what embryological precursor?
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neural crest cells
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What is the most common tumor of the adrenal medulla in children?
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neuroblastoma
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What is Sheehan's syndrome?
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postpartum hypopituitarism caused by infarction of the pituitary gland following severe bleeding and hypoperfusion during delivery
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What are the signs of Sheehan's syndrome?
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fatigue, anorexia, poor lactation and loss of pubic and axillary hair
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What is the tx for pheochromocytomas?
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irreversible, nonselective, a-blockers (phenoxybenzamine)
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What are the five most common symptoms of pheochromocytoma?
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Pressure, Pain, Perspiration, Palpitations, Pallor
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What is the 10% rule in regards to pheochromocytomas?
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10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcify, 10% kids, 10% familial
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What organs are affected in MEN Type I (Multiple endocrine Neoplasias)?
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Pancreas, Parathyroid, Pituitary tumors
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What is the other name for MEN type I?
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Werner's Syndrome
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MEN type II are what types of tumors?
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medullary carcinoma of the thyroid, pheochromocytomas, parathyroid tumors
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What is the other name for MEN type II?
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Sipple's Syndrome
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MEN type III involve what types of tumors?
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medullary carcinoma of the thyroid, pheochromocytomas, oral and intestinal ganglioneuromatosis (mucosal neuromas)
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Which MEN types are associated with the ret gene?
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types II and III
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All MEN syndromes have what pattern of inheritance?
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autosomal-dominant
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What are the relative lab values associated with hypothyroidism?
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increased TSH, decreased toal T4 and free T4, decreased T3 uptake
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What are the sx of hypothyroidism?
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cold intolerance, hypoactivity, wt gain, fatigue, lethargy, decreased appetite, decreased reflexes, myxedema (facial/periorbital), dry skin, brittle hair
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What is Riedel's thyroiditis and with what dz?
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thyroid is replaced with fibrous tissue; found in hypothyroidism
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From what cells in the parathyroid is PTH produced?
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Chief cells
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What are the 4 main functions of PTH?
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(1) increase bone reabsorption, (2) increase kidney reabsorption of Ca, (3) decrease kidney reabsorption of phosphate, (4) increased 1,25 Vitamin D prdxn by stimulating kidney 1a-hydroxylase
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How is PTH regulated?
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increases in serum Ca decreases PTH release and vice versa
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How many parathyroid glands are there?
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4
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1,25-(OH)2vitamin D has what effects on bones?
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releases phosphate from the matrix of bone
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1,25-(OH)2vitamin D has what effects on intestines?
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increases calcium and phosphate reabsorption
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From what two sources do human receive vitamin D?
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(1) D3 from sun exposure, (2) D2 from plants
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Describe how Vitamins D3 and D2 get converted to active form of Vitamin D?
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Both D3 and D2 are converted to 25-OH vit D in liver and to active form 1,25-OH2 vit D in the kidney
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What are the three main functions of active Vitamin D?
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(1) increase absorption of dietary calcium, (2) increased absorption of dietary phosphate, (3) increased bone reabsorption of Ca and phosphate
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What are the four main regulators of active vitamin D?
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all of the above increase active vit D: (1) increased PTH, (2) decreased [Ca], (3) decreased phosphate; Active vit D inhibits its own production
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What are the clinical results in childhood and adulthood from a deficiency of Vitamin D?
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child: rickets adult:osteomalacia
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State the Ca, phosphate, and alk phos levels for the following disease state: hyperparathyroidism
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Ca: increased, Phosphate: decreased, Alk Phos: increased
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State the Ca, phosphate, and alk phos levels for the following disease state: Paget's Disease of Bone
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Ca: nl/high Phos: nl, Alk phos: very high
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State the Ca, phosphate, and alk phos levels for the following disease state: Vitamin D intoxication
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Ca: high Phos: high Alk Phos: nl/high
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State the Ca, phosphate, and alk phos levels for the following disease state: Osteoporosis
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Ca: nl, Phos: nl, Alk Phos: nl
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State the Ca, phosphate, and alk phos levels for the following disease state: Renal Insufficiency
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Ca: low, Phos: high, Alk Phos: nl
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What hormone opposes the actions of PTH?
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Calcitonin
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Where is the source of calcitonin?
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Parafollicular cells (C cells) of the thyroid
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What is the function of calcitonin?
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decreased bone reabsorption of calcium
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How is calcitonin regulated?
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increased serum [Ca] increases calcitonin secretion
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What is the role of binding globulins in steroid hormone maintenance?
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increases solubility and allows for increase delivery of hormone to the target organ
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Increased levels of sex hormmone binding globulin leads to what condition?
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gynecomastia (lowered free testosterone)
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Decreased levels of sex hormmone binding globulin leads to what condition?
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hirsutism (increased free testosterone)
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Where are the target organ steroid hormone receptors found?
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nuclear membrane
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Where is most T3 formed?
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in the blood/periphery
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What are the 5 main functions of TH?
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(1) aid in bone growth, (2) CNS maturation, (3) b-adrenergic effects, (4) increased BMR, (5)_increased glycogenolysis, gluconeogenesis, lipolysis
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What protein binds to T3/T4 in the blood?
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Thyroxine Binding Globulin (TBG)
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In what conditions do you see high/low TBG levels?
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high: pregnancy low: hepatic failure
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What factors increase the release of TH?
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TRH stimulates TSH from pit which stimulates follicular cells
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What factor inhibits TH secretion?
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T3 decreases anterior pit sensitivity to TRH
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What are the signs and sx of subacute thyroiditis?
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hypothyroidism that often follows a flu-like illness; elevated ESR; painful thyroid gland; may present hyper- early in the course
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What is the etiology of toxic multinodular goiter?
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Iodine restoration following a period of deprivation; causes a release of T3 and T4
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Papillary carcinoma of the thyroid is characterized by what features?
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ground glass nuclei (Orphan Annie eyes), psammoma bodies;good prognosis
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An increased risk of papillary carcinoma of the thyroid is associated with what treatment?
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irradiation in childhood
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Medullary carcinoma of the thyroid is associated with what other comorbidities?
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MEN Types II and IIb (III)
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What cells are affected by medullary carcinoma of the thyroid?
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parafollicular "C cells"
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What is the demographic and prognosis for anaplastic/undifferentiated cancer of the thyroid?
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Older pts; poor prognosis
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Thyroid lymphoma is associated with what comorbidity?
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Hashimoto's
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What is the etiology of endemic cretinism?
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lack of dietary iodine (endemic goiter)
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What is the etiology of sporadic cretinism?
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defect in T4 formation or developmental failre in thyroid formation
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How will a patient with cretinism appear?
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pot-bellied, pale, puffy-faced child with protruding tongue and umbilicus
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What is excess GH in adults called? Children? how do you treat it?
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adults: acromegally
children: gigantism Treat with Octreotide |
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How do you test for excessive GH?
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oral glucose tolerance test
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What is the etiology of primary hyperparathyroidism?
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adenoma
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What are the signs and sx of primary hyperparathyroidism?
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hyper-Ca, hypercalciuria (renal stones), hypo-P, increase PTH and cAMP in urine, constipation
"Stones, bones and groans" |
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Secondary hyperparathyroidism is seen most often in with other illness?
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chronic renal dz; decreased serum Ca (Hypo-Ca, Hyper-P, increased PTH)
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What is a common sequelae of secondary hyperparathyroidism?
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renal osteodystrophy - bone lesions
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What are the two most common causes of hypoparathyroidism?
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DiGeorge and accidental surgical excision in thyroid surgery
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What are the two signs one can test for hypoparathyroidism?
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Chvostek's sign - contraction of facial muscles with tap
Trousseau's sign - occlusion of brachial artery with BP cuff -> carpal spasm |
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What causes pseudohypoparathyroidism?
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AutoDom kidney unresponsiveness to PTH
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What is the most common pituitary adenoma?
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Prolactinoma
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What are the acute manifestations of diabetes mellitus?
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polydypsia, polyuria, polyphagia, weight loss, DKA (type 1), coma (type 2)
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What tests are used to diagnose diabetes mellitus?
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fasting serum glucose, glucose tolerance test, HbA1c
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What is the primary defect in Type 1 DM?
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viral or autoimmune destruction of B-cells
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What is the primary defect in Type II DM?
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increased resistance to insulin
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Which Type of DM has a strong genetic predisposition?
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Type II
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Which HLA's are associated with Type I DM?
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DR3 and DR4
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In which Type of DM is DKA common?
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Type I
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What are the signs and sx of DKA?
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Kussmaul respirations (rapid deep breathing), hyperthermia, n/v, dementia, dehydration, fruity breath odor
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What fungal infection is a potential complication of DKA?
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Rhizopus causing mucormycosis (fungal infection of the sinuses)
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What is the treatment for DKA?
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Fluids, insulin, potassium
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What characterized diabetes insipidus?
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intensive thirst and polyuria with an inability to concentrate urine (lack of ADH, or lack of kidney response to ADH)
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Central DI has what etiologies?
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pituitary tumor, trauma, surgery, histiocytosis X)
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What test is used to diagnose DI?
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water deprivation test - urine osmolality doesn't change
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What is the treatment for DI?
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Fluids; intranasal desmopressin for central DI; for nephrogenic DI - hydrochlorothiazide, indomethacin, amiloride
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What are the three features of SAIDH?
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1. excessive water retention
2. hyponatremia 3. urine osmols > serum osmols |
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What are the 4 main causes of SIADH?
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1. ectopic ADH (small cell lung cancer)
2. CNS disorders/head trauma 3. Pulmonary dz 4. drugs (cyclophosphamide) |
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What is the diagnostic lab for carcinoid syndrome?
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increased 5-HIAA in the urine
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What is the rule of 1/3s for carcinoid syndrome?
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1/3 metastasize
1/3 present with 2nd malignancy 1/3 multiple |
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Carcinoid syndrome is derived from what type of cells?
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Neuroendocrine cells of the GI tract
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What is the treatment for carcinoid syndrome?
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Octreotide
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carcinoid syndrome is the most common tumor of which organ?
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appendix
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What is the sx of Zollinger-Ellison syndrome?
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recurrent ulcers
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Zollinger-Ellison is associaed with what other comorbidity?
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MEN Type I
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What is the mechanism of sulfonylureas in the treatment of DM?
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close K channels in B-cell membrane -> depolarization -> Ca influx into cell triggers insulin release
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Sulfonylueas have what suffix?
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-ide (tolbutamide, glyburide, Glipizide)
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Orlistat inhibits fat metabolism via what mechanism?
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inhibits pancreatic lipases
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What are the side fx of orlistat?
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steatorrhea, GI discomfort, loss of fat soluble vitamins, headache
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What is the MOA of sibutramine (obesity management)?
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sympathomimetic serotonin and NE reuptake inhibitor
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Whic drugs, used in the tx of hyperthyroidism inhibit the organification and coupling of TH synthesis
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Propylthiouracil, methimazole
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What are the side fx of Propylthiouracil and methimazole?
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skin rash, agranulocytosis, aplastic anemia
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Which drug is used to stimulate labor, uterine contractions?
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Oxytocin
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Desmopressing (ADH) is used for the treatment of what disease?
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Central DI
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What is the MOA of glucocorticoids?
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decreases the production of leukotrienes and PGs by inhibiting phospholipase A2 and expression of COX2
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Glucocorticoids are used to treat what conditions?
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Addison's, inflammation, immune suppression, asthma
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