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Clin Med II > Endo > Flashcards

Endo Flashcards

1
Q

four types of hormones

A

polypeptides (insulin and ADH)

glycoproteins (FSH and LH)

amines (AcH, dopamine)

steroids (test, estradiol)

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2
Q

hormones released by the hypothalamus

A

GHRH

thyrotropin releasing hormone

corticotropin releasing hormone

gonadotropin releasing hormone

gonadotropin inhibiting hormone

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3
Q

how does the hypothalamus control the anterior pituitary

what about the posterior

A

anterior → nerves

posterior → capillary plexus

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4
Q

what hormones are stored in the pituitary gland

A

oxytocin and ADH

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5
Q

what does oxytocin do

A

love, bonding

uterine contraction in response to the onset of labor

milk ejection/let down

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6
Q

what does ADH do

A

closes renal collecting ducts to retain water

decreased secrete will lead to excretion of water

in high doses it can increase BP and lead to vasoconstriction

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7
Q

what does ETOH do to ADH release

A

it decreases it

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8
Q

two causes of diabetes insipidus

A

central → pituitary doesn’t release

nephrogenic → kidney doesn’t react

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9
Q

what is SIADH

A

an excess of ADH caused by cancer, infection, brain bleeds, antidepressants, quinolones`

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10
Q

hormes secreted by anterior pitutitary

A

ACTH

GH/somatostatin

MSH

TSH

FSH/LH

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11
Q

What stimulates GH release

inhibits

A

androgens during puberty, levodopa, nicotine, fasting

↑GH or IGF, hyperglycemia, glucocortcoids, DHT

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12
Q

is GH released constantly or intermittently

when is it the highest

A

intermittent (pulsatile)

deep sleep

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13
Q

too much GH leads to

A

acromegaly and pituitary gigantism (jaw, fingers, toes)

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14
Q

too little GH as a kid leads to what

too little was an adult (rare, pituitary adenoma) leads to what

A

dwarfism

decreased energy and quality of life

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15
Q

describe the feedback look that controls cortisol release

A

cortisol will inhibit both ACTH and CTRH

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16
Q

Too much ACTH leads to what

too little leads to what

A

cushings disease

addisons

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17
Q

describe addisons disease (too little ACTH)

A

bronze skin

hypoglycemia

postural hypotension

weight loss

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18
Q

describe cushings disease (too much ACTH)

A

moon face

abominal fat

hyper glycemia

thin skin

osteoporosis

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19
Q

Describe the feed back mechanism of TSH

A

↑T3/4 = ↓TSH

↓T3/4 = ↑TSH

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20
Q

TSH labs are base line at what time

what are they used for

A

10am

hyper/hypothyroid, monitoring thyroxine therapy

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21
Q

Diseases with a high TSH

A

primary hypothyroid

thryroiditis

severe chronic illness

lithium

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22
Q

conditions with a low TSH

A

secondary hypothyroid (the pituitary is not making TSH)

teritary (hypothalamic dysfunction)

hyperthyroidism

thyroid suppression

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23
Q

what is the advantage of checking T4

disadvantage

A

you can see bound T4 (to albumin) and unbound metabolically active T4

it doesn’t take into account differences in albumin

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24
Q

conditions with a high T4

A

hyperthyroid

thyroiditis

extraneous use

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25
Q

conditions that would decrease T4

A

hypothyroid (primary, secondary, or teritary)

hypoalbuminemia

low iodine

26
Q

what is T3 testing best used for

A

testing for hyperthyroid

27
Q

what does a T3 resin uptake lab do

A

to distinguish high or low thyroxine binding globulin from hypo/hyperthyroid

28
Q

what is the thyroxine binding globulin used for

A

to determine if abnormal T3/4 is true elevated or if there is excess TBG

29
Q

what is used for thyroid hormone stimulation

A

differentiate between primary (high) and secondary/tertiary (low) hypothyroid

30
Q

general symptoms to hypothyroid

A

cold intolerance

face edema

anorexia

brittle hair and nails

31
Q

general symptoms of hyperthyroid

A

heat in tolerance

exopthalmos

tachycardia

weight loss

32
Q

conditions with high LH/FSH

A

precocious puberty

premature menopause

turner syndrome

PCOS

33
Q

conditions with low FSH/LH

A

hypothalmic suppression

hypopituitary

eating disorder

anorexia

34
Q

LH surge predicts what

A

ovulation

35
Q

FSH in women controls what

A

menstruation and egg production

36
Q

LH and FSH in men does what

A

LH stimulates leydig cells to produce testosterone

FSH contoles production of sperm

37
Q

prolactin does what

A

lactation, counter acts the effects of dopamine

38
Q

hyperprolactinemia is usually caused by what

what are the most common symptoms

A

anterior pitiuitary tumor (prolactinoma)

lactaion and amenorrhea

39
Q

the adrenal cortex produces what

A

corticosteroids

aldosterone

androgens

40
Q

the adrenal medulla produces what

A

epi/norepi

41
Q

primary hypoadrenalism (addisons) is caused by what

A

autoimmune attach on the adrenal gland

42
Q

what is the most common cause of secondary adrenal insufficiency

how can you differentiate between primary and secondary adrenal insufficiency

A

Low ACTH caused by exogenous steroid use

no hyperpigmentation or dehydration

43
Q

what causes an adrenal crisis

A

when a person with primary renal insufficiency (addisons) has a serious infection or acute stress

a person on cortisol replacement isn’t keeping up with loss

damage to the adrenal gland

44
Q

what are the clinical features of an adrenal crisis

A

volume depletion and hypotension

45
Q

acute treatment for an adrenal crisis

A

IV fluids with electrolyte monitoring

draw blood for plasma cortisol or ACTH

give 4mg dexamethasone over 1-5 minutes and every 12 hours after

46
Q

why is dexamethasone the drug of choice for an adrenal crisis

A

it doesn’t interfere with plasma cortisol

47
Q
A
48
Q

what labs would you order for asymptomatic hypopitutiary

A

Prolactin

coritsol

ACTH

TSH

T4

FSH/LH

estradiol, total test

IGF-1

49
Q

when would you order the labs?

A

fasting no later than 9am

50
Q

what determines if a nonfunctioning pituitary adenoma needs to be operated on

A

size (larger than 1cm)
↓
visual field testing
↓

no visual deficits or <1cm, serial MRI

51
Q

what type of vision loss would be expected with a pititary adenoma

A

bitemporal hemianopsia (loss of bilateral temporal fields)

52
Q

unilateral vision loss would mean what

how would stroke present

A

compression at the optic nerve

homonymous hemianopsia (losing one side of vision, left or right not temportal vs nasal)

53
Q

why would a pt with a pitutary adenoma resection continue to have symptoms

A

they couldn’t take everything out because it was too invested around the internal carotids

54
Q

effect of carbs on GH and insulin

fasting

protein

A

GH ↓, insulin ↑

↑GH, ↓insulin

↑GH, ↑insulin

55
Q

describe a insulin induced hypoglycemia test of low GH

A

give them insulin which will lower blood sugar

measure glucose, GH, cortisol every 30 mins for 3 hours

should spike GH

56
Q

effect of SIADH on NA, blood and urine osmolality

A

decreased, NA, decreased serum osm, increased urine osm

57
Q

effect of dehydration on NA, blood and urine osmolality

A

they all go up

58
Q

effect of Diabetes insipidus on NA, blood and urine osmolality

A

serum NA ↑, serum osm ↑, urine osm ↓

59
Q

when running pituitary panel should patients take steroids

A

no, hold off until after the blood draw

60
Q
A

Clin Med II (6 decks)

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