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Adrenal Flashcards

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1
Q

what 6 hormones are released by anterior pituitary

A
  1. TSH
  2. FSH
  3. LH
  4. GH
  5. ACTH
  6. Prolactin

posterior

  • ADH
  • oxytocin
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2
Q

where is GnRH produced and what does it cause

A

produced by hypothalamus

causes production of FSH and LH

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3
Q

what is the GnRH stimulation test the gold standard for

A

reveals premature activation of HPG axis in precocious puberty (early onset of secondary sex characteristics)

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4
Q

what is GnRH and analogs / antagonists of it used to treat

A

infertility
endometriosis
precociuous pubtery
cancer

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5
Q

what are the two gonadotropins

A

LH

FSH

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6
Q

what do FSH and LH do in males

A

FSH: stimulates sertoli cells to procduce sperm
LH: stimulates Testosterone secretion by leydig cells of testes

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7
Q

what do FSH and LH do in females

A

FSH= stimulates growth and development of ovarian follicles

LH= stimulates ovulation and changes in follicle->corpus luteum , secretion of estrogen and progesterone

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8
Q

when does typical menarche typically occur

A

age 11-15

pituitary starts secreting LH/FSH more around 8-12

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9
Q

what is the ovulation prediction tests (OPK)

A

enables women to dectect LH in urine test at about day 10 of cycle to see if it will most likely result in ovulation

at home kits

$$$

97% accurate

limited in just gives ballpark of when ovulating

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10
Q

what are the three phases of the ovarian endometrial cycle

A
  1. proliferative: estrogen promotes growth
  2. secretory: progesterone and estrogen levels high and prepare endometrium for fertilization
  3. menstruation: reduction of estrogen and progesterone = necrosis of endometrium
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11
Q

what is estrogen

A

steriod hormone responsible for development of female sexual characterisitics

forms: estrone, estradiol, estriol

negative feedback

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12
Q

why do we evaluate estrogen in man and women

A

men: help explain gynecomastia and feminization
women: evaluate sexual maturity, menses, fertility probs

important in milk lactation, uterus endometrial cell proliferation, long bone developmnet, increases HDL / decreases LD for total chol

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13
Q

what is premature adrenarche

A

maturation of the zonal reticularis resulting in pubic hari gorwth (pubarche= pubic hari before age 9)

assocaited with insulin resistance, metabolic syndrome, polycystic ovary syndrome

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14
Q

what causes high estrogen levels

A

ovulation
preg
choriocarcinoma
molar preg

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15
Q

decreased level of estrogen

A 
preeclampsia
threatened abortion
placental failure
fetal death 
amennorrhea
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16
Q

what are the indication for getting progesterone labs

A

eval women with difficulty getting pregnant or maintaining preg
montior high risk preg

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17
Q

high progesterone

A

ovulation
preg
choricoarcinoma
molar preg

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18
Q

decreased progesteron

A

preeclampsia
threatened abortion
placental failure
fetal death

same as estrogen

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19
Q

what is menopausal transition

A

change in intermentraul interval with or without menopausal symptoms

no reliable method to predict final menstraul period

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20
Q

define menopause

A

12 months of amenorrhea in absence of other biologic or physiologic causes for women over age 45

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21
Q

how to diagnose menopausal transition

A

measure FSH
if FSH level >25 indicated pt likely entered transition

if pt 40-45 should look at other reasons for menstrual dysfunction

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22
Q

as women age, what increases and what decreases

Study These Flashcards
A

older women have higher FSH and estradiol

lower LH and progesterone

23
Q

what is testosterone boudn to

Study These Flashcards
A

sex hormone binding globulin (SHBG)!!!

most bound to this protein but 2% actually active free form

24
Q

when should you draw for a testosterone test

Study These Flashcards
A

in morning when values are lowest

venous blood draw

red top tube

25
what is testosterone/ where produced
steriod hormone 95% produced in leydig cells stimulate spermatogenesis in males, influences development of secondary sex characteristics
26
what does overproduction of Testosterone do to females and males
males: result in precocious puberty (usually tumor cause) female: masculinizatin
27
how do females get testosterone
dehydroepiandrosterone (DHEA) an androgen->androstenedion -> testosterone 30% from adrenal gland 50% in peripheral fat 20% made directly by ovaries
28
what do low testosterone indicate in men
klinefelter syndrom cryptorchidism hypogonadism cirrhosis trisomy 21 orchiectomy
29
what do high testosterone levels in men indicate
``` sexual precocity pinealoma encephalitis CAH adrenocortical tumor testicular tumor hyperthyroidism ``` she did not get into this mostly focused on low
30
what inidcates that low testosterone is due to primary hypotestosterone
LH and FSH are elevated
31
what indicated that low testosterone is due to secondary hypotestosterone
low LH and FSH
32
increase in testosterone in females indicates
ovarian tumor adrenal tumor congenital adrenal hyperplasia (CAH)- this is what a heel stick at delivery is for polycystic ovaries!!! trophoblastic tumor
33
hyperandrogenism in females
manifests as acne or hirsutism
34
how to rule out polycystic ovary syndrome in females with high testosterone
do an early morning early follicular phase plasma level of 17-hydroxyprogesterone (17OHP) if less than 200 = rule it out !!!
35
what is hyperandogenism
elevated serum androgen levels in women manifests in acne or hirsutism (male pattern hair growth)
36
where are glucocorticoids released (cortisol)
adrenal cortex
37
what does cortisol do
``` increases gluconeogeesis protein breakdown lipolysis required for mobilizing energy stores inhibits insulin and glucose transport into cells ``` increases with preg
38
what happens with excess cortisol
fat distributed around body differently straie HTN hyperglycemia aka cushings
39
how to collect cortisol
urine collection 24 hours increases with pregnancy, emotion, stress
40
what is ACTH do
adrenocortiicotropic hormone (ACTH) stimulated by CRH from hypothalamus released into circulation to adrenal cortex stimulates adrenal cortex to secrete cortisol
41
What are the levels of Cortisol and ACTH in Cushing Syndrome adrenal?
Cortisol: HIGH ACTH: Low aka the adrenal c=gland is the issue
42
What are the levels of Cortisol and ACTH in Cushing Syndrome pituitary?
cortisol high ACTH high pituitary tumor produces ACTH ectopic ACTH are commonly in the lungs and produce ACTH = circulating ACTH is high adrenal glands are doing fine and producing cortisol
43
hat are the levels of Cortisol and ACTH in Addison's?
cortisol: low ACTH: high hypocorticolism: msucle wasting, salt cravings, n/v, this tells us that adrenal gland not wrking autoimmune disorder
44
What are the levels of Cortisol and ACTH in Hypopituitarism
cortisol: low ACTH: low prob with pituitary gland = domiino
45
why would you order a ACTH stimulation test
used to diagnose adrenal insufficiency help differentiate between primary and secondary if you think hypocortisol give them synthetic ACTH, measure cortisol before and after normal response= rise in cortisol if stays where it was= consider addisions or secondary adrenal insufficency
46
what is the dexamethasone suppression test
measure cortisol levels after administering dexamethasone (dexamethasone is a potent glucocorticoid that should suppress CRH / ACTH) used to diagnose adrenal hyperfunction and helps to determine cause
47
what is prolactin
polypeptide hormone responsible fo r lactation, breast development, hundreds of actions of homeostasis other things like CNS and immune system can also produce this on otp of pituitary (Ant)
48
why would you order a prolactin test (PRL)!!!!!!!!!!!!!
to diagnose/monitor prolactin secreting pituitary adenoma !!!!!!!!!!!!!!!!!!!!!! this is the most common cause for increased prolactin levels
49
what hormone helps regulate prolactin
dopamine
50
increased PRL
``` glactorrhea amenorrhea prolactin secreting pituitary tumor stress empty sellae syndrome PCOS renal failure ```
51
what causes decreased PRL
pituitary adoplexy (sheehan syndrome) pituitary destruction by tumor
52
how do you do a PRL test
draw blood sample in morning with red top tube transfer immeadiately to lab or put on ice !!!!!!!!!
53
what is the most common cause of hyperprolactinemia
prolactin secreting pituitary adenoma
54
what provides negative feedback for prolactin
dopamine

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