Endocrine Disorders Flashcards
(127 cards)
1
Q
What is the focus of geriatrics?
A
Prevention and care of chronic illnesses in the elderly population
Geriatric patients are defined as those aged 65 years and older.
2
Q
What is the expected percentage of the worldwide population that will be 60 years old or older by 2050?
A
22%
This translates to approximately 2 billion people.
3
Q
What is the definition of ‘Oldest Old’ in the geriatric population?
A
Individuals aged 80 years and older
4
Q
What are the major causes of death in the aging population?
A
Non-communicable chronic diseases
5
Q
What is the relationship between the aging population and economic growth?
A
Aging affects economic growth, migration, work patterns, family structures, and health systems
6
Q
What are some common effects of aging on the endocrine system?
A
Multiple co-morbidities, poly-pharmacy, disability/impaired recovery
7
Q
What is meant by ‘physiologic decline’ in aging?
A
Inevitable, irreversible decline in organ function over time
8
Q
Which systems are especially vulnerable to aging?
A
Cardiovascular, renal, and central nervous systems
9
Q
What is poly-pharmacy?
A
The concurrent use of multiple medications
10
Q
How does aging affect drug absorption in geriatric patients?
A
Aging affects absorption, volume of distribution, protein binding, and elimination of drugs
11
Q
What factors contribute to disability in the geriatric population?
A
- Lower body fat composition
- Reduced lean body mass
- Poor nutritional intake
- Neurologic dysfunction
- Cognitive impairment
12
Q
What is the prevalence of thyroid disorders in the geriatric population?
A
Approximately twice that of the non-geriatric population
13
Q
What is the most common thyroid disorder in geriatric patients?
A
Subclinical hypothyroidism
14
Q
Which condition may progress to overt hypothyroidism in geriatric patients?
A
Subclinical hypothyroidism
15
Q
What are common presentations of hypothyroidism in geriatric patients?
A
- Congestive heart failure
- Cognitive impairment
- Depression
- Muscle weakness
16
Q
What is the relationship between age and the prevalence of Graves disease and multinodular goiter?
A
Graves disease prevalence decreases and multinodular goiter prevalence increases with age
17
Q
What is the Jod-Basedow phenomenon?
A
Transient hyperthyroidism due to increased use of radiocontrast imaging in patients with multi-nodular goiter
18
Q
What are the common presentations of hyperthyroidism in geriatric patients?
A
- Atrial fibrillation
- Depression
- Constipation
- Muscle wasting
- Weight loss despite increased appetite
19
Q
What is the risk associated with treating hyperthyroidism in geriatric patients?
A
Risk of developing hyperthyroidism from levothyroxine treatment
20
Q
What is the impact of aging on insulin sensitivity?
A
Increased resistance to insulin and decreased peripheral glucose uptake
21
Q
What syndrome are diabetic geriatric patients at higher risk for?
A
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
22
Q
What are the common comorbidities associated with diabetes in geriatric patients?
A
- Neuropathy
- Retinopathy
- Heart disease
- Kidney disease
23
Q
What is the higher risk condition associated with diabetes in geriatric patients?
A
Higher risk of developing hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
HHNS is a serious complication of diabetes characterized by high blood sugar levels without significant ketones.
24
Q
What cognitive changes are associated with diabetes in elderly patients?
A
Changes in cognitive function
Cognitive dysfunction may manifest as confusion, altered mental status, and coma.
25
True or False: Geriatric patients typically show classic symptoms of hyperglycemia.
False
## Footnote
Symptoms may develop gradually and not be recognized as abnormal.
26
Name a medication that may contribute to hyperglycemia in elderly patients.
Hydrochlorothiazide, statins, glucocorticoids
## Footnote
These medications can affect blood sugar levels.
27
What are common manifestations of retinopathy or neuropathy in geriatric patients?
Recurrent falls or loss of balance
## Footnote
These symptoms may indicate underlying complications of diabetes.
28
What condition makes geriatric diabetic patients more sensitive to hypoglycemia?
Ability to sense hypoglycemia declines with age
## Footnote
This decline affects their ability to take corrective action.
29
Fill in the blank: Hypoglycemia primarily manifests as _______.
cognitive dysfunction
## Footnote
Symptoms include confusion and altered mental status.
30
What age-related changes affect calcium homeostasis?
Higher PTH levels, lower 25-hydroxyl vitamin D levels
## Footnote
These changes contribute to bone health issues.
31
What formula is used to correct serum calcium levels?
Corrected Ca = (0.8 x (4.00 - Plasma albumin)) + serum Ca
## Footnote
This formula adjusts calcium levels based on albumin concentration.
32
What is the most common cause of hypercalcemia in geriatric patients?
Hyperparathyroidism
## Footnote
Often related to parathyroid adenomas.
33
List common symptoms of hypercalcemia in geriatric patients.
* Lethargy
* Weakness
* Confusion
* Nausea/vomiting
* Abdominal pain
* Anorexia
* Constipation
## Footnote
Symptoms can vary in severity and presentation.
34
What is a major consequence of osteoporosis in elderly women?
Increased risk for fractures
## Footnote
Hip fractures are particularly concerning due to high morbidity and mortality.
35
Fill in the blank: By age 80, almost _______ of women have a hip fracture.
50%
## Footnote
This statistic highlights the prevalence of osteoporosis-related fractures.
36
What factors contribute to developing osteoporosis?
* Low calcium or vitamin D intake
* High caffeine or salt intake
* Excess alcohol
* Smoking
* Inactivity
* Hyperthyroidism
* Medications
## Footnote
These factors can increase the risk of bone density loss.
37
What changes occur in ADH secretion with aging?
Relative ADH excess, decreased renal responsiveness to ADH
## Footnote
These changes can affect water balance and osmolality.
38
What are symptoms of hyponatremia in older adults?
* Nausea
* Vomiting
* Headaches
* Falls
* Weakness
* Delirium
* Seizures
* Coma
## Footnote
Symptoms can vary from mild to severe.
39
What is the effect of aging on growth hormone secretion?
GH secretion declines with age
## Footnote
In men, it decreases by about 14% per decade.
40
What are the consequences of growth hormone deficiency in adults?
* Reduced lean body mass
* Increased body fat
* Reduced muscle strength
* Increased insulin resistance
* Reduced bone density
## Footnote
These changes can significantly affect metabolic health.
41
What is the average age of menopause?
50 years old
## Footnote
Menopause leads to various physiological changes and health risks.
42
List symptoms associated with menopause.
* Accelerated loss of bone mineral density
* Atrophy of urogenital tract
* Urinary incontinence
* Vaginal dryness
* Depression
* Difficulty with sleep
* Increased risk of heart disease
## Footnote
These symptoms can significantly impact quality of life.
43
What is an important consideration when interacting with geriatric patients in an office setting?
Arrange the setting to meet geriatric needs
## Footnote
This includes larger print, moderate temperatures, and quieter environments.
44
What approach should be taken during history taking of geriatric patients?
Use multiple sources of information
## Footnote
This can include family, caregivers, and previous medical records.
45
What might cause patients to underreport symptoms?
* Embarrassment
* Fear of increased costs
* Loss of independence
* Increased need for medications
## Footnote
Understanding these factors can improve patient communication.
46
What may cause patients to underreport symptoms?
Embarrassment or fear of diagnosis
## Footnote
Patients might feel ashamed of their symptoms or worry about the implications of a potential disease.
47
List some consequences of untreated health issues in elderly patients.
* Increased costs
* Loss of independence
* Reliance on others for care
* Increased need for medications or treatments
* Reduced quality of life
48
What factors can lead to atypical presentations of illness in geriatric patients?
* Physiologic changes of aging
* Comorbidities
* Polypharmacy
49
What is geriatrics?
The branch of medicine focusing on the care of the elderly, emphasizing prevention and care of chronic illnesses.
50
At what age is a patient considered a geriatric patient by convention?
≥ 65 years old
51
Define aging in the context of geriatric medicine.
The inevitable, irreversible decline of organs over time, occurring even in the absence of illness, injury, or poor lifestyle choices.
52
What are some changes that occur in the body due to aging?
* Changes in body composition
* Discrepancy in energy production and utilization
* Homeostatic dysregulation
* Neurodegeneration
53
What is frailty in geriatric patients?
Increased susceptibility to disease, reduced functional reserves, and reduced healing leading to failure to thrive.
54
List some common geriatric syndromes.
* Gait disorders/increased falls
* Anorexia/malnutrition
* Disability
* Urinary incontinence
* Delirium
* Sleep disorders
* Cognitive impairment
55
How do multiple concomitant illnesses affect geriatric patients?
They interact to impact the patient's physiology, illness presentation, and recovery from illness.
56
What impact does aging have on medication metabolism?
It affects absorption, distribution, binding, and elimination, leading to fluctuations in therapeutic levels and increased risk of under- or over-dosing.
57
True or False: Cognitive impairment in elderly patients can lead to inaccurate reporting of symptoms.
True
58
Fill in the blank: Geriatrics emphasizes _______ and care of chronic illnesses.
[prevention]
59
What are the modes of inheritance that can be identified using family history or pedigree information?
Autosomal dominant, autosomal recessive, and X-linked.
60
What are the most common genetic causes of endocrine disorders?
Congenital hypothyroidism, congenital adrenal hyperplasia, diabetes insipidus, congenital hyperinsulinism.
61
How is congenital hypothyroidism correlated with thyroid hormone synthesis?
It can be due to gland dysgenesis or genetic defects in thyroid hormone synthesis.
62
What are the most common modes of inheritance for congenital nephrogenic diabetes insipidus (NDI) and central diabetes insipidus (CDI)?
Autosomal dominant for CDI and X-linked for NDI.
63
What is the role of genetic testing in congenital adrenal hyperplasia?
To identify mutations in the CYP21A2 gene and assess carrier status.
64
What are the mechanisms of inheritance for diffuse and focal congenital hyperinsulinism?
Diffuse is autosomal recessive; focal is sporadic with a '2-hit hypothesis'.
65
What is the mode of inheritance and associated genetic testing for MEN1?
Autosomal dominant inheritance; single-gene testing is used.
66
What are the consequences of genetic defects in GH or IGF-1 deficiency?
Short stature and growth hormone deficiency.
67
Fill in the blank: Congenital hypothyroidism is mostly due to gland _______.
dysgenesis.
68
True or False: Congenital hypothyroidism can lead to goiter if untreated.
True.
69
What are the common symptoms of diabetes insipidus?
Polyuria, polydipsia, chronic dehydration.
70
What differentiates central diabetes insipidus from nephrogenic diabetes insipidus?
Central responds to desmopressin; nephrogenic does not.
71
What genetic mutations are associated with nephrogenic diabetes insipidus?
Mutations in AVPR2 (X-linked) and AQP2 (autosomal recessive/dominant).
72
What is the inheritance pattern for congenital adrenal hyperplasia primarily caused by 21-hydroxylase deficiency?
Autosomal recessive.
73
What are the features of classical congenital adrenal hyperplasia?
Ambiguous genitalia, early virilization, salt wasting.
74
What are the two histological forms of congenital hyperinsulinism?
Diffuse and focal.
75
What is the common treatment for diffuse congenital hyperinsulinism?
Pancreatectomy.
76
What is the incidence of classic congenital adrenal hyperplasia?
1 in 15,000 worldwide.
77
Fill in the blank: Multiple endocrine neoplasia type 1 (MEN1) is characterized by the presence of _______ tumors.
endocrine.
78
What is the mean life expectancy for patients with MEN1?
47 years.
79
What is the inheritance pattern for the majority of MEN1 cases?
Autosomal dominant.
80
What is the first clinical sign of primary hyperparathyroidism in MEN1?
Hypercalcemia.
81
What are the two types of tumors commonly associated with MEN1?
Parathyroid adenomas and pituitary adenomas.
82
What is the common approach for genetic testing in congenital adrenal hyperplasia?
Single gene testing of CYP21A2 first.
83
What is the typical presentation for focal congenital hyperinsulinism?
Seizure and severe hypoglycemia.
84
True or False: Congenital hyperinsulinism can be due to perinatal stress.
True.
85
What is the chromosomal location for the genes associated with congenital hyperinsulinism?
11p15.1.
86
What is the FDA definition of short stature?
<2.25 SD for age
## Footnote
This definition is used for assessing growth in children.
87
What are common reasons for short stature?
* Dependent on uterine growth conditions
* Environment during childhood
* Significant genetic component
## Footnote
Each of these factors can contribute to a child's growth potential.
88
What should be obtained if short stature is accompanied by dysmorphic features?
Karyotype
## Footnote
This is to rule out chromosomal anomalies.
89
What is IGF-1's function?
* Functions both pre and postnatally
* Mutations result in both uterine growth restriction and significantly reduced growth postnatally
## Footnote
IGF-1 is crucial for normal growth patterns.
90
What is the genetic etiology percentage of isolated GHD according to recent research?
Approx. 75%
## Footnote
This indicates that most cases are due to genetic factors rather than physical anomalies.
91
What is IGHD type 1a characterized by?
No GH in serum, GH1 mutation
## Footnote
This type of IGHD is severe and follows an autosomal recessive inheritance pattern.
92
What is Laron syndrome?
Body is unable to use growth hormone
## Footnote
It leads to symptoms like hypoglycemia, delayed puberty, and short limbs.
93
What are the characteristics of Laron syndrome?
* Hypoglycemia
* Delayed puberty
* Short limbs
* Obesity
* GHR gene mutations
* AR inheritance pattern
## Footnote
These features help in diagnosing Laron syndrome.
94
What is the adult height in Laron syndrome?
5 SD below mean
## Footnote
This indicates severe short stature in affected individuals.
95
Which genes are associated with multiple endocrine hormone disorders leading to short stature?
* SOX3
* PITX2
* Prop1
* PouF1
## Footnote
These genes are critical for normal endocrine function and growth.
96
What is the main enzyme deficiency associated with the case of the 6-year-old boy?
21-hydroxylase
## Footnote
This deficiency is related to congenital adrenal hyperplasia (CAH).
97
How is GH associated with short stature?
GH/IGF-1 axis growth failure
## Footnote
GH functions postnatally and is essential for normal growth.
98
What are the clinical features of the boy in the case study?
* Height in the 98th percentile
* Strong body odor
* Darkened skin patches
* Axillary and pubic hair growth
* Increased renin, potassium, and 17-hydroxyprogesterone concentrations
## Footnote
These features are indicative of hormonal imbalances.
99
What is the inheritance pattern of GHR mutations?
Mostly AR, very rare
## Footnote
This indicates an autosomal recessive pattern for most GHR mutations.
100
What is the significance of genetic testing in growth disorders?
Not widely available, case-by-case basis
## Footnote
Testing is often limited to specific research centers.
101
What is the presenting feature of IGHD type Ib?
Some GH response
## Footnote
This type is considered more mild compared to type 1a.
102
T or F: symptoms of endocrine disease often present in the most compromised organ system in geiatric pts.
true
hyperthyroid w/ a fib.
hypothyroid w/ fecal impaction
103
lacunar infarcts in geriatric pts. can cause what
loss of balance
104
T or F: ADH decreases w/ increasing age
false
it is the other way around
105
what medications can casue hypothyroidism
amiodarone
lithium
alpha-interferon
106
describe the Jod-basedow phenomenon.
increased use of radiocontrast imaging causes transient hyperthyroidism w/ multi-nodular goiter
107
how does hypoglycemia present in geriatric pts.
cognitive dysfunctions such as confusion, altered mental status, obtundation, coma
108
how does hypernatremia typically present in geriatric pts.
falls, delirium, hypotension
109
T or F: hyponatremia in older adults in usually mild and asymptomatic.
True
very worst symptoms are HAs & N/V
110
Why does GH secretion decrease w/ increasing age?
primarily due to decreased hypothalamic secretion of GHRH and an increase is hypothalamic somatostatin release
111
T or F: GH deficiency can increase insulin resistance
true
112
why are creatinine levels not reliable for the geriatric pt. for assessing renal function
natural aging process is assoc. w/ decreased muscle mass which reduces the demand for creatine synthesis
113
what are the effects of testosterone decline in the geriatric male pt.
decreased muscle mass and strength
decreased bone mass
increased fat and insulin resistance
erectile dysfunction
114
what a valid tools for psychologic disorders in the geriatric pt.
10 minute geriatric screener
Beck Depression INventory
Alzheimer's disease assessment scale
115
What are the lab values of a + newborn screening for hypothyroidism?
Initial T4 <10% normal range
TSH increase
116
what would you expect the lab values to be of a newborn suspected to have congenital hypothyroidism?
elevated TSH
decreased free T4
117
what would you expect to be the lab values for susspected secondary hypothyroidsm
low or normal TSH
decreased free T4
118
how can nephrogenic DI be distinguished from central causes?
if it is nephrogenic, pt. will not respond to desmopressin
119
what are symptoms of congenital adrenal hyperplasia in pediatric pts.
ambiguous genitalia, early virilization and salt wasting due to excess androgen
in females: puberty w/ virilization or oligomenorrhea
120
what steroid hormones does 21-hydroxylase produce?
aldosterone
cortisol
121
CYP17 is involved in the production of what adrenal hormones?
cortisol
Androgens
122
CYP11 is involved in the synthesis of what steroids?
cortisol
123
what are the most common mutations involved in congenital hyperinsulinism
SUR1
Kir6.2
(these are K-ATP channels
124
T or F: preeclampsia can cause non-genetic congenital hyperinsulinism?
True
125
T or F: for diffuse HI, all pancreatic beta-cells are affected?
true
126
compare and contrast the different clinical presentations b/t diffuse HI & focal HI
diffuse: presents earlier w/ babies being heavier and larger in size
focal: more commonly presents w/ seizures
127
females w/ short-stature should still be karyotyped for this disorders even w/o the classical symptoms
Turner's
