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46 Cards in this Set

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What is the adenohypophysis? What does it release?
It's the anterior pituitary. It releases Lactogenic hormone, Growth hormone, Adrenocorticotrophic hormone, Thyroid-stimulating hormone, Follicle-stimulating hormone, and Luteinizing hormone.
How is the adenohypophysis different from the neurohypophysis?
The posterior lobe (neurohypophysis) is made of modified glial tissue while the anterior lobe (adenohypophysis) is derived from the tissue from the roof of the mouth.
What are some common signs and symptoms of excess prolactin release?
Hyperprolactinemia causes Amenorrhea (no period), Galactorrhea (no milk), loss of libido, temporal VF loss, and headaches
What's the difference between gigantism and acromegaly?
Overproduction of growth hormone causes excessive growth. In children, the condition is called gigantism. In adults, it is called acromegaly.
What is the body's response to ACTH release?
ACTH causes the body to produce more corticosteroids (cortisol).
What are some common signs and symptoms of excess ACTH?
HTN, weight gain, moon face, hyperglycemia, decreased muscle mass, buffalo hump, Hirsutism, cataracts, depression.
What is diabetes insipidus? How is it related to diabetes mellitus?
Diabetes insipidus is caused by insufficient ADH, so you make a lot of water. Only connection to diabetes mellitus is you consume and pee a lot.
What is a pituitary macroadenoma?
A large adrenal tumor exceeding 1 cm in size
What are some common ocular manifestations of an enlarged pituitary?
Headache and compression in the cavernous sinus can cause bitemporal hemianopsia
Why are dopamine agonists frequently used for treating pituitary tumors? Name two dopamine agonists.
Dopamine agonists like Bromocriptine and Cabergoline may decrease the size of the tumor and amount of hormone produced.
What are some common clinical characteristics of acromegaly?
Headache, enlargement of the jaw , hands, feet and tongue, osteoarthritis, entrapment neuropathies (carpal tunnel), abnormal glucose tolerance, heart failure
What are the common causes of Cushing's syndrome? What are the common signs?
Administration of exogenous steroids or due to a tumor. Common signs include HTN, weight gain, moon face, hyperglycemia, decreased muscle mass, buffalo hump, Hirsutism, cataracts, depression.
What is Cushing's disease?
Cushing's disease is a specific type of Cushing's syndrome that caused by a small ACTH-releasing tumor of the pituitary gland.
Your patient presents with Cushing's syndrome. He denies using steroids, and his serum ACTH is low. What is the most likely cause of his Cushing's syndrome?
A cortisol-secreting adenoma
What is Conn's disease? What are some common signs and symptoms?
An aldosterone-secreting adrenal adenoma causes HTN and hypokalemia.
What is Addison's disease? What's the most common cause today? What about 70 years ago?
Progressive destruction of adrenal cortex most common cause by an autoimmune condition but can also be caused by metastatic neoplasms or from removal of the adrenal glands. Used to be caused by TB.
What is a 10% tumor?
Pheochromocytoma is a tumor that is 10% malignant, bilateral, extra-adrenal, and in children.
What are the common clinical features of a pheochromocytoma?
Abrupt elevation of BP with HEADACHES, sweating, palpitations, tachycardia, tremor and sense of apprehension/doom, possible abdominal pain with N&V
What is TBG? What is its role?
TBG is thyroglobulin; it is found in the thyroid follicles and is the precursor for thyroid hormone.
What are the clinical features of thyrotoxicosis?
Increased basal metabolic rate (likely weight loss), nervousness, irritability, tremor, hyperreflexia, tachycardia, diarrhea, staring gaze with lid retraction (Dalrymple's sign), heat intolerance , insomnia, scanty menstrual periods
What are the clinical features of hypothyroidism?
Apathy, mental sluggishness, slow speech, weight gain, fatigue, cold intolerance, bradycardia, heart failure, delayed DTR (reflexes), constipation
What is Grave's disease? What are the clinical features?
Grave's disease is one cause of hyperthyroidism thryotoxicity and is an autoimmune disease with Type 2 Hypersensitivity. It has a classic triad of findings: thyrotoxicosis, infiltrative ophthalmopathy with exophthalmos, and localized, infiltrative dermopathy of the lower legs.
What are the pros and cons to the different therapeutic approaches to hyperthyroid disease?
Anti-thyroid medications don't require hospitalization but have SEs and a high chance of remission. Subtotal thyroidectomy has a high cure rate but requires hospitalization and may damage the laryngeal nerve. Radioactive iodine has a 100% cure rate and requires no hospitalization but may require hospitalization and likely progresses into hypothyroidism.
What is cretinism?
Infantile myxdema develops in infancy or early childhood due to lack of iodine in the pregnant mom's diet causing impaired skeletal and CNS development .
What is Hashimoto's thyroiditis?
Hashimoto's is an autoimmune hyperthyroidi disease with autoantibodies that block the TSH receptors, destroying thyroglobulin. It usually causes a diffuse, symmetrical goiter.
What's the most common cause of goiters?
Hashimoto's Disease
What is metabolic syndrome?
Metabolic syndrome is a pre-diabetic state showing signs of insulin-resistance that can easily be treated with diet, exercise, smoke cessation, and control of BP.
What are the most common symptoms of DM?
Elevated BP, central body obesity, high triglycerides and cholesterol
What is the current cut-off for normal fasting plasma glucose?
FGP ≥ 126 mg/dL on 2 or more occasions is abnormal
What are the common long-term complications of DM?
Nephropathy, cerebrovascular disease, heart disease, and peripheral vascular disease.
What is the most common cause of death in DM1? Second most common cause?
Nephropathy is the most common cause. Heart disease is the second most common cause of death.
What are some of the common signs of diabetic peripheral vascular disease?
Leg pain relieved by rest, cold feet with reduced or absent pulses, nocturnal leg pain relieved by dangling legs over side of bed or walking, and loss of hair on the foot and toes.
What are AGEs, and what role do they play in the pathogenesis of DM complications?
Advanced glycosylated end products are the result of nonenzymatic binding of glucose to proteins at the level of plasma glucose and accumulate over the life of the cell or tissue. They contribute to developing thickened, leaky BM in capillaries and glomeruli, leading to heart and kidney issues.
What role does sorbitol play in DM complications?
Sorbitol accumulation increases intracellular osmolarity, influx of water, and oxidative stress. It also impairs the ion pumps leading to damage of Schwann cells and pericytes.
Which insulins have been approved for i.v. administration?
Regular Insulin, Insulin Lispro (Humalog), Insulin aspartate (NovoLog) and insulin glulisine (Apidra)
What is Oral-lyn?
Oral-lyn is an oral insulin spray absorbed through the side of the cheek that is approved to treat DM1 and DM2.
What is Humalog, and what is the advantage of its use?
Humalog is extremely fast action and most closely matches normal insulin response. It can be administered by IV.
What are Lente insulins and how are they different from NPH?
NPH is Neutral Protamine Hagedorn insulin, which is a mix of regular insulin with protamine zinc insulin compounds which allows a slower release of the insulin. Lente insulin is the regular insulin alone. ?
What is insulin glargine, and how is it administered?
Insulin Glargine (Lantus) is very acidic and makes crystals in the body. The insulin is released as crystalline bodies, which cause patients to have pain so injection given at bedtime.
What are incretin mimetics?
Incretin mimetics (Byetta, Victoza) are a new class of injectable drugs that squeeze a little more insulin out of the pancreas for DM2. It also promotes satiety.
What is amylin and how does it affect glucose levels?
Amylin is a pancreatic hormone secreted with insulin that slows gastric emptying. It's used for patients on insulin as Symlin (synthetic amylin) for better appetite control.
How do the thiazolidinediones work? What concern exists with this drug class?
Thiazolidinediones improve action of insulin in liver and skeletal muscles, but it's not used as much any more due to the cardiovascular side effects.
How do the DPP-4 inhibitors work?
DPP-4 degrades enzyme GLP-1. Blocking this enzyme prolongs the action of this incretin.
How do the sulfonylureas work? How are they different from the biguanides?
Sulfonylureas stimulate the release of insulin from pancreatic beta-cells and enhance beta-cell sensitivity to glucose. Biguanides decrease gluconeogenesis by the liver and increases glucose uptake by skeletal muscles.
What is glycated hemoglobin? What is the expected level? How frequently should it be assessed?
Glycated Hb is hemoglobin that is attached to glucose. Testing this percent measures the lifetime of those RBCs. The expected level is 5% and is assessed over 6-8 weeks.
How is HbA1c different from fructosamine? When would one be used rather than the other?
Fructosamine determines the amount of glycation on albumin to detect how a treatment plan is working over 2-3 weeks. Glycated Hb is Hb attached to glucose to evaluate patient compliance over 6-8 weeks and requires no patient preparation.