Endo Review 3 Flashcards
(28 cards)
Name 4 possible endocrine causes of hypertension.
Cushing's syndrome Hyperthyroidism Adrenal Insufficiency Pheochromocytoma Metabolic syndrome
Pathophysiology of Cushing’s Syndrome? (3)
Loss of diurnal variation (late night salivary cortisol) Autonomy from ACTH control (1mg Dexa test) Excess cortisol (24 hour urine free-cortisol)
What test do you run to test for primary hyperaldosteronism? How do you interpret the results?
Early morninng aldo:renin.
Ratio >20 suggestive (but not diagnostic) of hyperaldo.
If elevated, check 24-hour urine aldo.
Where does amiloride act?
Inhibits the ENaC (inward sodium channel) in kidney. The channel normally causes sodium reabsorption.
Where do spironolactone and eplerenone act?
They block the mineralocorticoid receptor.
3 Tx’s for aldo, in order?
- Correct udnerlying cause
- Surgery (adrenalectomy)
- Medications
What are the Tx’s for Cushing’s?
? Treatment depends on source of Cushing’s:
?Cure likely in a unilateral adrenal adenoma with adrenalectomy
?Trans-sphenoidal hypophysectomy: 60-75% cure
?Other therapies such as ketoconazole, metyrapone, or bilateral adrenalectomy may be required

3 uses of spironolactone? (peripherally mentioned in review)
- Hyperaldo
- Congestive heart failure
- PCOS
How do you test for blood levels of catecholamines?
Plasma free metanephrines (longer half life)
Men 2B affects what organs?
What mutation?
Thyroid C cells Adrenal Medulla Neural tissue of oral and GI systems Skeletal and lens eye abnormalities Mutation in ret protooncogene
Test of choice to assess for secondary adrenal insufficiency IF patient has been on long term steroids?
Cosyntropin stimulation test
What, specifically, does metyrapone do the best job assesssing?
SHORT-TERM secondary adrenal insufficiency
Why is oral hydrocortisone not commonly prescribed for inflammation?
- It does not have potent anti-inflammatory activity
2. It causes the unwanted side effect of edema due to its mineralocorticoid activity
Talk to me about the thyroid receptor
TR can act as a transcriptional activator or repressor [[depending on the target gene and presence or absence of thyroid hormone]]
What catalyzes the organification of iodine?
TPO
Sx of subclinical hypothyroidism? (3)
- Elevated serum TSH level >5.0mU/L (usually
Will you ever see bulging eyes in transient hyperthyroidism?
No, it’s unique to Grave’s
Why may pregnancy cause a low normal TSH in the presence of a high T4?
Pregnancy increases hepatic production of TBG, and hCG has homology to TSH (so you get some T4 stimulation from hCG agonism).
2 conditions which can increase TBG?
4 which can decrease it?
Increase: estrogen (PREGNANCY), hepatic release (hepatitis)
Decrease: androgens, decreased hepatic production (malnutrition, liver disease, illness), congenital (X-linked)
What happens if you lose the function of TR-beta?
TR-b is present on the hypothalamus and pituitary for negative regulation, and on cells that carry out the peripheral actions of T3. But, TRa is present on heart muscle.
Thus pt will present with Tachycardia and Hyperactivity.
What is Luprolide (Lupron)
A GnRH agonist (used to delay puberty).
Most common cause of hyperparathyroidism?
Adenoma (85% of the time)
What is one thing that can cause secondary hyperparathyroidism?
Vitamin D deficiency.
Who should be considered for osteoporosis pharmacotherapy?
•Postmenopausal women and men age 50 and older presenting with the following:
• A hip or vertebral (clinical or morphometric) fracture
• T-score ≤ -2.5 at the femoral neck or spine after appropriate
evaluation to exclude secondary causes
• a 10-year probability of a hip fracture ≥ 3% or a 10-year probability of a major osteoporosis-related fracture ≥20% based on FRAX
