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Flashcards in Endocrine Deck (81)
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1

Normal fasting blood glucose values:

72-100 mg/dl (4.0-5.7 mmol/L)

2

Normal Random blood glucose values:

<180 mg/dl (10 mmol/L)

3

Other causes of Diabetes Mellitus

1) Pancreatic disease
2) Hormonal antagonists to insulin
3) Drug & chemical induced
4) Genetic syndromes

4

Hormonal antagonists to insulin

1) Cortisol
2) Growth Hormone
3) Catecholamines

5

Genetic syndromes involved in etiology of Diabetes Mellitus

1) Down's Syndrome
2) Turner's Syndrome

6

Type 1 D.M. etiology (general)

Most cases: 1) immune mediated destruction of pancreas through autoimmune attack on pancreatic B cells
2) Genetics
3) Environmental factors

7

Type 1 D.M. etiology (genetic factors)

Association with:
1) HLA-DR3
2) HLA-DR4/DQA1
3) DQB1

8

Type 1 D.M. etiology (environmental factors)

Association with viruses:
1) Mumps
2) Coxsackie B4
3) Rubella

9

Type 2 D.M. etiology (general)

caused by combination of B cell failure and insulin resistance

10

Type 2 D.M. etiology (genetic factors)

1) Stronger than type 1 (80% concordance in identical twins)
2) No HLA associations
3) Polygenetic disorder (but environmental factors also involved -> obesity)

11

More than half of the patients with D.M. II have BMI between what?

25-29 kg/m2

12

What is the RR for DM II for BMI > 35 kg/m2?

100 fold than BMI <22 kg/m2

13

How does obesity lead to DM?

Increased production of insulin antagonists, such as fatty acids and TNF by adipose tissue, especially in central obesity.

14

Pancreatic Pathology in DM. 1

1) Selective destruction of insulin-secreting beta cells
2) Insulitis, a chronic inflammatory infiltrate of the islets affecting primarily insulin containing islets

15

Pancreatic Pathology in DM 2

1) Moderate reduction islet tissue
2) Variable degrees deposition of amyloid.

16

Long term complications of Diabetes Mellitus

1) Nephropathy
2) Neuropathy
3) Eye disease
4) Heart disease
5) Stroke
6) Problems of feet

17

Clinical symptoms of DM (prominent in uncontrolled type 1)

1) Polyuria
2) Nocturia
3) Thirst
4) Weight loss
5) Tiredness
6) Blurred vision
7) Vomiting
8) Hyperventilation (Kussmaul breathing)

18

Why is there polyuria in DM?

osmotic diuresis

19

Why is there thirst in DM?

dehydration

20

Why is there weight loss in DM?

Catabolic state

21

Why is there blurred vision in DM?

Dehydration of lens, and of aqueous and vitreous humour

22

Why is there vomiting in DM?

Ketones stimulate the area postrema

23

Why is there hyperventilation in DM?

Respiratory compensation to metabolic acidosis

24

What are the biochemical signs in DM?

1) Hyperglycemia
2) Glycosuria
3) Ketoacidosis
4) Ketonuria
5) Hyperlactemia
6) Hyperlipidemia
7) Hypovolemia
8) Hyperosmolarity

25

Why is glycosylated hemoglobin a good monitor to manage DM?

-Hemoglobin reacts with glucose non-enzymatically to produce HcA1.
-HbA1c is the major fraction of glycosylated hemoglobin
-HbA1c levels give an integrated measure of glucose concentrations over the previous 2-3 months

26

Acute complications of DM

1) Hypoglycemia (diabetes treatment complication)
2) Diabetic ketoacidosis
3) Hyperosmolar nonketotic coma
4) Lactic acidosis

27

Precipitating factors of Diabetic Ketoacidosis

1) Infection or acute illness
2) Trauma
3) Emotional disturbance
4) Missed insulin dose

28

Most common cause of hypopituitarism

Pituitary adenoma

29

Tumors which cause hypopituitarism

1) Adenoma
2) Craniopharyngioma
3) Cerebral and secondary tumors

30

Vascular causes of hypopituitarism

1) Sheehan's syndrome
2) Severe hypotension

31

Infectious causes of hypopituitarism

1) Meningitis
2) T.B.
3) Syphilis
4) HIV/AIDS

32

Hypothalamic disorders which cause hypopituitarism

1) Tumors
2) Functional disorders
3) Isolated deficiency of GHRH
4) Isolated deficiency of LH/FSH-RH (GnRH secretion)

33

Iatrogenic causes of hypopituitarism

1) Irradiation
2) hypophysectomy

34

Miscellaneous causes of hypopituitarism

1) Sarcoidosis
2) Hemochromotosis

35

Pattern of hormone deficiency of the anterior pituitary

1) LH
2) GH
3) FSH
4) ACTH
5) TSH

36

Which hormone is maintained in anterior pituitary hormone deficiency?

Vasopressin

37

Drugs that cause nephrogenic D.I.

Lithium

38

Metabolic causes of D.I.

1) Hypokalemia
2) Hypercalcemia

39

SIADH will cause?

Water retention and hyponatremia

40

Presentation of SIADH

1) Hyponatremia can be asymptomatic or assoc with nonspecific symptoms
2) Severe hyponatremia, specially if there is rapid fall in serum sodium, can cause neurological symptoms, coma and death.

41

Causes of SIADH

1) Post operative
2) Intra-cranial disease: encephalitis, meningitis, head injury
3) Neoplasms: small cell carcinoma of the lung
4) Pulmonary disease: pneumonia, tuberculosis
5) Drugs/medications

42

Possible mechanisms of non-thyoridal illness (NTI)

1) Decreased peripheral conversion of T4 to T3
2) Abnormality of binding protein
3) Effects of circulating inflammatory mediators on metabolism of thyroid hormones

43

Characterization of papillary carcinoma of the thyroid gland

-presence of papillae
-tend to spread to local lymph nodes

44

Characterization of follicular carcinoma of thyroid gland

-Well differentiated follicles, which can be difficult to differentiate from normal thyroid tissue
-Invade the capsules and spread into blood vessels

45

Disorders that stem from overactivity of adrenal cortex

1) Cushing's syndrome
2) Hyperaldosteronism

46

What are the clinical features of Addison's disease?

1) Tiredness
2) Weakness
3) Anorexia
4) Apathy
5) Abdominal pain
6) hyperpigmentation
7) postural hypotension

47

What precipitates an adrenal crisis?

Infection in a patient with adrenocortical insufficiency.

48

What characterizes an adrenal crisis?

1) Circulatory shock
2) Volume depletion
3) Anorexia
4) Nausea
5) Vomiting

49

What is secondary adrenocortical insufficiency due to?

Pituitary disorders

50

Describe the serum presentation of a person with Addison's disease

Plasma sodium - low
Postassium - high
Serum bicarbonate - low
Urea - high
Morning cortisol - low or normal

51

What is the levels of ACTH in Addison's Disease?

High

52

How do we manage patients with Addisons?

replace glucocorticoids and mineralocorticoids

53

Describe the renin activity and aldosterone levels in pt with Addisons

Renin - high
Aldosterone - low

54

What is the best test for Addisons?

Morning cortisol

55

What is a specific test for Addisons?

Short synacthen test: administration of ACTH analogues to assess the residual capacity of the adrenal glands.

56

What are the causes of Hyperadrenalism : Cushing's syndrome

1) Exogenous steroids
2) Pituitary dependent
3) Adrenal adenoma
4) Ectopic ACTH

57

What are the clinical features of hyperadrenalism: Cushing's syndrome

1) Moon facies, truncal obesity, buffalo hump
2) Hypertension
3) Thin limbs and muscular weakness
4) Purple striae, fragile skin
5) Impaired glucose tolerance
6) Psychiatric disturbances
7) Menstrual disturbances, hirsutism

58

How does one diagnose Cushing's Syndrome?

1) Exclude exogenous glucocorticoids
2) Perform one of the following tests to confirm hypercortisolism:
- 24 hour urinary free cortisol (common)
-1 mg overnight DST (Dexamethasone suppression test)
- Late night salivary cortisol: new test

59

Describe the overnight Dexamethasone suppression test for Cushing's syndrome.

Involves taking a small dose of a cortisol-like drug called dexamethasone (1 mg) at 11 p.m. and having blood drawn for cortisol the following morning.

Normal individuals typically have very low levels of cortisol in these samples (s disease.

60

Physiological causes of hyperprolactinemia

Stress

61

Drugs that cause hyperprolactinemia

1) Anti-psychotics
2) Oral Contraceptive Pill
3) Antidopamine

62

What are the associations with MEN2A

1) Medullary Thyroid Cancer
2) Pheochromocytoma
3) Parathyroid Adenoma

63

What are the associations with MEN2B

1) Medullary Thyroid Cancer
2) Marfanoid habitus/mucosal neuroma
3) Pheochromocytoma

64

What is characteristic of Papillary Carcinoma of the thyroid gland?

1) Presence of papillae
2) Orphan Annie eye nuclei
3) Spread via lymphatics

65

What is characteristic of Follicular Carcinoma of the Thyroid gland?

1) Well differentiated
2) Encapsulated
3) Hematogenous spread
4) Can only be diagnosed via visualization of capsular invasion. (Tissue biopsy, not aspiration)
5) Hurthle cells

66

Mutation of medullary carcinoma of the thyroid

RET

67

Age of presentation of Medullary Carcinoma of the thyroid?

Sporadic and Inherited are above 50, except MEN syndrome assoc, which is an early presentation.

68

What is the difference between Cushing's Syndrome and Cushing's Disease?

Disease is due to pituitary adenoma
Syndrome is ectopic ACTH caused by non-pituitary tumor (i.e. small cell carcinoma of lung)

69

First functional change in Diabetic Nephropathy

Hyperfiltration

70

First morphological change in Diabetic Nephropathy

Basement membrane thickening and mesangial expansion.
-subsequentyl nodular deposits and diffuse glomerulosclerosis

71

What is associated with established Diabetic Nephropathy?

Proteinuria (urinary albumin >300 mg/day)

72

Diabetic Neuropathy causes:

1) Pain
2) Impotence
3) Orthostatic hypotension
4) Muscle atrophy
5) Weakness

73

Two main causes of hypercalcemia:

1) Hyperparathyroidism
2) Malignant diseases

74

Other causes of Hypercalcemia

1) Excessive vitamin D: Vit. D intoxication
2) Granulomas (tuberculosis, lymphoma, sarcoidosis) because they activate vitamin D
3) High bone turnover
- thyrotoxicosis
-Paget's disease

75

What are the clinical features of hypercalcemia on the renal system?

– Polyuria and thirst
– Stones
– Nephrocalcinosis; deposition of calcium crystals in kidney
– May lead to renal failure

76

What are the associations with Primary Adrenal Insufficiency (Addisons)

Autoimmunity of other organs such as:
1) Thyroid disease
2) Premature ovarian failure
3) DM 1

77

Secondary Adrenal Insufficiency is NOT associated with:

1) Hyperpigmentation
2) Electrolyte balances

78

Adrenal crisis is characterized by:

1) Circulatory shock
2) Volume Depletion
3) Anorexia
4) Nausea
5) Vomiting

79

The low dose (2mg/day for 2 days) DST is given to rule out hypercortisolism due to what?

1) Alcoholism
2) Depression
3) Obesity

80

Conn's syndrome (hyperaldosteronism) causes what? Leading to what?

Causes: Na retention

Leading to:
1) hypertension
2) hypokalemia
3) metabolic alkalosis

81

Secondary Hyperaldosteronism is caused by what? In response to what?

- Overactivity of the RAS system

In response to: dec in blood volume due to:
1) Liver cirhossis
2) Heart failure
3) Nephrotic syndrome


or, dec renal blood flow due to hypertension