Endocrine Flashcards

Question

Riedel thyroiditis

Answer 1

Fibrosis due tochronic inflammation Low or euthyroid Painless goiter Local compressive sx

Answer 2

Preferredantithyroid drug except in pregnancy Inhibits iodine → tyrosine and iodotyrosine coupling

Answer 3

2nd choiceantithyroid Preferred inpregnancy first tri Similar Mx to methimazole Plus 5' deiodlinase inhibition of t4→t3

Answer 4

Agranulocytosis Liver damage Anca - antineutrophö cytoplasmic ab Vasculitis with glomerular injury More common ptu

Answer 5

Generally benign Most nonfunctional, some secretory No tumor capsule invasion or blood vessel invasion

Answer 6

Most commonmalignancy of thyroid Great prognosis Likely t4 secretory

Answer 7

Ret or braf Or childhood radiation

Answer 8

Mostly PVN of ht

Answer 9

Posterior pituitary

Answer 10

Reduces GnRH Thus _ low T and E Implicated in infertility

Answer 11

Postpartum hemmorhage- → pituitary infarction → low prolactin → lactation failure, menstrual irregularities

Answer 12

TRH, - → TSH and prolactin Primary hyperthyroid eg graves or secondary hypothyroid → low prolactin

Answer 13

Hyper prolactinemia Interrupts inhibitory dopamine signal

Answer 14

Dopamine blockers eg. Antipsychotics Prolactinomas Pituitary stalk compression Pregnancy Primary hypothyroid dt TRH increase End stage renal disease unknown why

Answer 15

Directly increases

Answer 16

Inhibits milk production effects eg pregnancy

Answer 17

-increased t o stabilize blood sugar By ghrelin

Answer 18

Poor linear growth after first few months Delayed motor muscle Devi

Answer 19

Similar to manifestations ofcongenital gh deficiency but gh not → IGF So high gh low IGF

Answer 20

Short stature, doll-like or infantile facial features Check IGF levels ( more consistent than_gh), bone Age Ro causes of failure

Answer 21

Oral glucose boles would normally decrease gh but not in true gigantism Dd: marfan, precocious puberty, normal genes

Answer 22

Adult high gh Joint pain, muscle aches, gradualoftenunnoticable while happening hand and foot growth c coarse facies Diabetes, atherosclerosis dt glucose and lipid fx Causes: - tumor - mccune Albright - men-1 - carney complex - x linked acrogigantism

Answer 23

Octreotide - somatostatin analog

Answer 24

Secreted by ht to decrease gh

Answer 25

Cabergoline Bromocriptine Note these ore also implicated in hypo when taken for other reasons eg. Pd Or removal - based on severity. of visual field defects

Answer 26

Mild: postural hypotension and pots Severe: weight loss, fatigue, low libido, hypoglycemia Extra bad: fatal vascular collapse - shock

Answer 27

Central di High volume dilute urine Dehydration, thirst, dizziness

Answer 28

Sudden pituitary hemorrhage Trauma, aneurysm Emergency Low ACTH → shock Sudden excruciating headache, diploma, progressive hypopituitarism Immediate tx: stabilize bp with fluids and cortisol Also Tx hypoglycemia

Answer 29

Increased blood calcium Low bone density Low phosphate -renal exchange Gut uptake, urine reuptake, vitamin D production i bone breakdown

Answer 30

Asymptomatic at first Then: Fatigue Irritability Depression Memory problems Decreased bone density if dt high PTH Then: Shortened qt_interval Arrhythmia Fractures Kidney stones Acute pancreatitis Ulcers Ab pain, constipation Stupor, confusion Seizures, coma

Answer 31

Hypercalcemia Pain Bones, kidney stones, ab groans, psych moans

Answer 32

High PTH → cystic bone lesions Brown color tumors dt hemorrhage → hemosiderin deposits Rank-l expression on osteoblasts, rank on osteoclasts

Answer 33

Dt chronically * low calcium Most common CKD dt low vitamin D conversion to active form in renal tubules by 1-a-hydroxylase Other causes _ malabsorption, vitamin D deficiency

Answer 34

Bisphosphanates eg alendronate decrease bone loss Cinacalcet mimics ca to turn off PTH Surgery possible but often fails, tricky

Answer 35

High Ca → polyuria via inhibition of action of ADH in renal tubules = nephrogenic di Also potentially type I renal tubular acidosis, AKI

Answer 36

Most often dt cancer dt: - pthrp production - metastasis bone - ectopic1-a-hydroxylas e→ excess calcitrol vitamin D

Answer 37

Parathyroid Cancer Granuloma- 1 alpha hydroxylse production Meds: -Lithium - thiazide diuretics - excess Ca or vit Dsupplement -Familial hypocalcuric hypercalcemia - defects in ca receptors inparathyroid and kidney

Answer 38

Blocks sodium channels Raises threshold Weakness

Answer 39

ReCduced Na movement de Ca blocking channels Less depolarization → shorter depolarization Shortened q T interval Later arrhythmia, St changes Cv. calcium deposits → valve stenosis, HTN, cardiomyopathy

Answer 40

Decrease Loops lose ca Used in symptomatic hypercalcemia t x

Answer 41

#1 fluids 2. Loop diuretics 3. Bisphosphanates Calcitonin if severe but resistance if long term Cancer: denosumab anti-rank-l High pth: cinacalcet Granulomatous and lymphoma: prednisone

Answer 42

Breakdown of bone

Answer 43

Acute pancreatitis can cause low Ca dt deposits forming High Ca can cause pancreatitis - one of the "groans"

Answer 44

Loop diuretics eg furosemide Bisphosphonates Cinacalcet Foscarnet_antiviral

Answer 45

Na-k-2cl transporter thick ascending loop of henle

Answer 46

Hypocalcemia Tap facial nerve → twitching

Answer 47

Hypocalcemia Inflate bp cuff 3 min → hand twitching and contracture

Answer 48

Laryngospasm Bronchospasm Seizures Life threatening

Answer 49

Hyperreflexia

Answer 50

Irritability of nerves, muscles, heart M sk: Numb/tingle Twit ching Hyperreflexia Tetany PsyCch: Anxiety Depression Psychosis Am s .chronic: Parkinsonism , dementia, cataracts Heart Prolonged qt interval Torsdades de pointes- potentially fatal

Answer 51

Transports Standard Ca lab is total including albumin bound but only free is active Free isphysiollogically important So low albumin means total Ca will be low or normal even if free is normal or high

Answer 52

Iv calcium gluconate then transition to oral Ca with vit D Underlying cause

Answer 53

Prevent bone resorption Lower serum Ca Induce apoptosis in osteoclasts - dronate AES: -N/v - esophageal erosions - iv: jaw osteonecrosis

Answer 54

Hyper - Ca of malignancy Prevents resorption Decreases serum Ca Anti-rank-l Blocks osteoclast maturation

Answer 55

Causes hypo-ca Reduces PTH release Poor diet, alcohol

Answer 56

Gut phosphate binder For hyper. Phosphate → hypo-ca of CKD

Answer 57

- Gut phosphate binder Good if Ca supplement also needed but use caution in CKD

Answer 58

Outermost Mineralocorticoid'S

Answer 59

Middle layer of cortex Less staining due to high lipid content Glucocorticoids

Answer 60

Innermost oadvenal cortex Androgens

Answer 61

Adrenal medulla Catecholamine'S

Answer 62

Upregulate StAR - steroidogenic acute regulatory protein - rate limiting incortisol formation - transferscholesterol into mitochondria StimulatesCholesterol desmolase - convertscholesterol to pregnenolone

Answer 63

Cortisol binding globulin Transports most of cortisol in blood, prolongs t 1/2

Answer 64

Intracellular gr-glucocorticoid receptor Complex directly binds glucocorticoid response element of gene

Answer 65

Decreases osteoblast ' activity excess → less new bone generation i i weaker bones

Answer 66

Demargination Artificially increases count but decreases function

Answer 67

Cushing syndrome caused by an ACTH- secreting pituitary adenoma Syndrome: all cause

Answer 68

Diastolic htn

Answer 69

Cortisol synthesis inhibitors Metyrapone Ketoconazale Mitotane

Answer 70

Metabolic alkalosis- excess H+ loss

Answer 71

Benign aldosterone-secreting adenoma of adrenal gland

Answer 72

T wave inversion Prominent U waves

Answer 73

Plasma renin Renin →aldosterone So elevated in secondary and low in primary

Answer 74

Underlying cause K sparing diuretics - spironolactone and eplerenone

Answer 75

Competitive aldosterone receptor antagonist Cortical collecting duct K sparing diuretic AES - androgen t progesterone - gynecomastia

Answer 76

More specific aldosterone receptor antagonist K sparing diuretic Alternative to spironolactone No gynecomastia

Answer 77

Renal artery stenosis - impaired read blood flow J G cell tumors Liver cirrhosis Hear t failure Nephrotic syndrome

Answer 78

Refractory hypertension Labs then show hypokalemia and metabolic alkalosis

Answer 79

Autosomal recessive Usually low cortisol and aldosterone but high sex steroids Generally masculinizing - external genital ambiguity in female

Answer 80

21 -hydroxylase

Answer 81

Classic - salt-wasting, dehydration, adrenal crisis - most common. Non-classic- non-salt wasting - partial enzyme fx makes aldosterone but still no cortisol → less severe → may be silent till puberty → generally nogenital ambiguity but will have precocious virilizing puberty Simple virilizing -cortisol andaldosterone present but high DHEA i

Answer 82

Types 2a and 2b

Answer 83

Abdominaltumor arising from neuralcrest cells Generally along sympathetic chain or in adrenal medulla Usually kids <4 Rapid growth Hypertension from renal artery compression or catecholamine secretion Rapid involuntary eye movements Muscle twitchin Abdominal distention Palpable mass

Answer 84

Usually MYCN Amplification If present isassociated with more aggressive course with 50%mortality Without mutation better px with chance of spontaneous regression

Answer 85

Homer-wright rosettes Small, round blue cells in circular patterns Eosinophilic neuropil IHC bombesin

Answer 86

ClonidineSuppression testing if 24 h urine catacholemine and metarephrines is indeterminate

Answer 87

Inhibits insulin and gh release Chronic hypoglycemia Acromegaly Esophageal bleed Hepatorenal syndrome

Answer 88

Dr3 and dr4

Answer 89

Mostly non-enzymatic glycosylation of various cellular proteins. - ages In eye and Schwann cells - osmotic and oxidative injury from glucose → sorbitol

Answer 90

Lispro, aspart, glulisine

Answer 91

detemir, glargine

Answer 92

Class: biguanide Mx: glut 4 phosphorylation → glucose uptake Also reduced gluconeogenesis and reduced gutreabsorption. Ae: lactic acidosis. Gi Ci: renal failure, CHF, hypoxia

Answer 93

Class: thiazolidinediones Mx: ppar- gamma activation → fatty acid storage → insulin sensitivity Ae: fluid retention, liver damage, weight gain, low bone density Ci: CHF

Answer 94

Class: sulfonylureas Mx: stimulate pancreatic insulin release by closing atp-sensitive k channels Ae: hypoglycemia, weight gain Ci: sulfa allergy

Answer 95

Class: meglitinides Mx:similar tosulfornylureas Ok in sulfa allergy

Answer 96

Class: sglt-2 inhibitors Mx: inhibit renal glucose reabsorption Æ: UTI, dehydration, fatigue

Answer 97

Class: amyline-anoloague Mx: slow gastric emptying, promote fullness Use: prevent hyper and hypoglycemia, weight loss, also T1DM

Answer 98

Class; GLP -1 agonist Mx: endogenous incretin mimic - Increasedpostprandial insulin -Less glucagon - delayed gastric emptying -Fullness - weight loss Route: sub Q A E: gi upset, acute pancreatitis

Answer 99

Class: Dpp4 inhibitor Mx: inhibits degradation of glp-1 Similar fx to glp-1 agonists Route: oral

Answer 100

Glp- 1 and GIP

Answer 101

Diabetes Depression Declining weight DVT Dermatitis - migratory necrolyticerethema

Answer 102

"Pancreatic cholera"

Endocrine Flashcards

(131 cards)