Endocrine

Question 1

Metformin MOA

Answer 1

1. Does’t stimulate insulin production
2. Reduce hepatic glucose production
3. Increase insulin sensitivity
4. Increase insulin receptor, so insulin can be used more efficient
5. Help with basal and post- prandial glucose
6. Help with platelet aggregation and lipid profile

Question 2

Sulfonylureas MOA

Answer 2

Insulin secretaogous. Stimulate pancreas to secrete insulin & increase insulin sensitivity

Question 3

DPP-4 inhibitor MOA

Answer 3

DPP is an enzyme that inactivate GLP-1 (help to reduce postprandial glucose). So this male more GLP-1 available to reduce glucose

“Gliptin”

Question 4

SGLT-2 inhibitor MOA

Answer 4

Let glucose excreted in urine

Gliflozin

Question 5

Amylin

Glucagon

Grelin

Incretin

Answer 5

Amylin: Hormone increase satiety & suppress glucagon release

Glucagon: hormone to increase glucose production (opposite of insulin)

Grelin: hormone release from stomach and pancreas to regulate food intake. Energy, and hormone secretion (low in Grelin cause insulin resistance)

Incretin: hormone to synthesize & insulin in H1 tract

Question 6

Parathyroid hormone

Answer 6

Help with Ca concentration

Low Ca–> increase PTH—> increase Ca
High PTH–> increase Ca + reduce phosphate

Question 7

Thyroid hormone function

Answer 7

Affect
1. Growth
2. Ca metabolism (high thyroid hormone, high Ca)
3. Metaboism

Question 8

Thyroid hormone production process

Answer 8

Basically needs amino acid+ iodine to make thyroglobulin

Then when TSH stimulate–> thyroglobulin become T3 & T4

Question 9

T3 T4

Answer 9

T3 is more active

T4 is more common

Difference: T3 has 3 iodine molecules; T4 has 4

Question 10

Grave’s disease vs Hashimoto thyroiditis

Answer 10

Grave: Trab autobody binds to TSH–> increase thyroid hormone

Hashimoto: deformation of autoantibodies to thyroglobulin (TgAb), cause gradual inflammation of thyroid tissue–> lead to hypothyrodism

Question 11

Thyroid hormone from TSH…process

Answer 11

Thyroid releasing hormone (TRH: from hypothalamus)

TSH (from anterior pituitary)

T3, T4: from thyroid

Question 12

Hyperthyrodism’s S&S

Answer 12

1. High metabolism (high HR, O2 neeed, BP), diarrhea, weight loss
2. Palpitation
3. Reduce muscle tissue
4. Exophthalmia (ekseuf’ thomia): eyeball protrusion
5. Sex: irregular menses

Question 13

Primary vs secondary thyroid disorder

Answer 13

Primary is loss of thyroid function

Secondary is pituitary fail to synthesize TSH or lack of TRH

Question 14

Hypothyrodism’s S&S

Answer 14

Weight gain
Weak
Tired
Cold
Myxedema (non-pitting, boggy edema around eyes, hand, feet and supraclavicular fossae: indicate severe or long standing hypothyrodism)

Hoarseness voice

Question 15

Primary, secondary. Tertiary hypothyrodism

Answer 15

Primary: thyroid sy function
Secondary: anterior pituitary problem
Tertiary: hypothalamus problem

Question 16

When treating hypothyrodism

Answer 16

T4 is preferred;

Combination of T3 & T4 is not better than T4 alone

Question 17

Treat hyperthyrodism

Answer 17

1. Methimazole is preferred: normalize T3 T4 within a week (inhibit an enzyme that synthezie thyroid hormone )
2. Radioiodine: radioactive sodium iodine: everybody responses it differently; can become hypothyrodism later
3. Symptoms control: BBB
4. Iodine: inhibit T3T4 release for days to weeks, then stop: only used at ER for thyrodism storm

Question 18

Thyroids storm

Answer 18

Sudden release and increase action of T3 T4

Can die 48 hr without treatment (heart failure, delirisium, high vital signs, N/V/D)

Question 19

Cortisol

Answer 19

Hormone secreted by adrenal cortex

What trigger cortisol release: unpleasant, suddenness, degree of discomfort

Reduce when watching a pleasant movie

Question 20

Adrenal cortex secret hormone

Answer 20

Hypothalamus (CRH: corticosteroid release hormone)–> anterior pituitary (ACTH: adrenocorticotropin hormone)—> adrenal gland (release mineralcorticoid cortisol, androgen).

1. Mineralcorticoid (aldosterone is the most potent mineralcorticoid: Na retention, K secretion)
2. Adrenal androgen (androgen then become estrogen or testosterone)
3. Glucocorticoid: cortisol, corticosteroid (RBC, appetite, fat deposit, reduce Ca, growth)

Question 21

Cushing syndrome vs Cushing disease vs Cushing- like syndrome

All three Cushing has?

Answer 21

Cushing syndrome: excessive cortisol

Cushing disease: excessive ACTH

Cushing like syndrome: side effect of log term use glucocorticoid (cortisol, corticosterone)

same S&S:
1. Weight gain (water & Na retention)
2. Diabetes (glucose intolerance)
3. Protein wasting
4. HTN: vasoconstriction (increased catecholamine)
5. Change in mental status: learning, memory, depression, irritability
6. Infertility, grow facial hairs, oliomenorrhea (ess period)

Question 22

Hypercortisolism

Answer 22

High cortisol

Risk for HD, CAD, stroke

Question 23

Diagnostic test for Cushing syndrome

Answer 23

1. 24 hr urine test: stop the drug that affect cortisol, then collect 24 hr urine; if urinary free cortisol > 120mcg/hr hour: Cushing syndrome
2. Dexamethasone suppression test: give decadron 11pm and measure cortisol in 8 am (if cortisol > 1.8 mcg/dL–> Cushing syndrome); in normal people, decadron will suppress cortisol level (should be < 1.8)

Question 24

Treatment of Cushing syndrom

Answer 24

Depends on what causes it

1. Tumour: remove or radiation
2. Excessive ACTH: dopamine agonist glucocorticoid receptor antagonist
3. Severe S&S: block cortisol secretion: metyrapone

Question 25

Hyperfunction of adrenal cortex

Answer 25

Hyper: Cushing syndrome (excessive cortisol) Hypo: Addison disease (can't secret adrenocortical hormone: low cortisol & aldosterone)

Question 26

Addison's S&S

Answer 26

Think of the hormone it affect: 1. Low cortisol: tired, weak, 2. Low aldosterone: hypovolemia, postural hypertension, dizziness, dehydration, high K 3. Low androgen: not obvious in men, but in women (low sex desire, loss pubic & axillary hair)

Question 27

Treatment of Addison disease

Answer 27

Lifelong gucocorticoid & mineralcorticoid replacement

Question 28

When to taper steroid hormone

Answer 28

Osteoporosis Low cortisol/Cushing look Hyperglycemia DLP Mental problem: learning agitation Low immune Cataract and glucose: corticosteroid can increase intraocular pressure Growth suppression

Question 29

Pancreas secrete

Answer 29

1. Islets of langerhans: produce insulin 2. Islet amyloid: appetite, gastric empty, glucagon, insulin 3. Glucagon: increase glucogenesis 4. Pancreatic somatostatin: inhibit alpha, beta pancreatic cells' secretion 5. Pancreatic peptide: help digestion

Question 30

Diabete Prediabetes

Answer 30

A1C> 6.5 DM; Prediabete: 6-1.4 Fasting glucose: >7: DM; 6-7: prediabete

Question 31

Hypothyrodism treatment

Answer 31

Only treat if TSH> 10+ symptomatic

Question 32

Hypothyrodism diagnostic tests

Answer 32

T4 TSH If T4 low, TSH high--> 1st degree; if both low: central hypothyrodism TPO antibody: hashimoto's disease; TRab: Grave's disease Anti- TPO: check if caused by autoimmune

Question 33

Celiac disease diagnostic test

Answer 33

IgA- TTG antibodies: must have gluten containing diet for a month (if not, 3 slices of wheat bread daily x 1 month before the test)