Endocrine Quiz #4

Question 1

Where does hypothalamus secrete hormones and what systems do these hormones control?

Answer 1

• to ant pituitary

- control thyroid, adrenals, gonads, growth

Question 2

What is the difference between primary and secondary endocrine disorders?

Answer 2

primary: originating in peripheral endocrine gland.
secondary: from over or under stimulation by pituitary/HTH

Question 3

What questions do you want to be sure to ask in HPI?

Answer 3

HA, heat or cold intolerance, response to exercise, changes in menses, erectile function, skin, vision, weight.

Question 4

Empty Sella

Answer 4

anterior pit lobe disorder

enlarged sella turcica is not entirely filled

Question 5

primary vs secondary empty sella

Answer 5

primary: congenital defect in diaphragm allows CSF pressure to enlarge sella
sec: mass enlarges sells

Question 6

imaging for empty sella

Answer 6

xray

MRI of brain

Question 7

cause of hypofunction of ant pituitary

Answer 7

pituitary tumors, sarcoidosis, thrombosis, traumatic brain injury, ischemic stroke, etc.

Question 8

sx of hypo ant pit

Answer 8

• GH def in children: growth retardation, lack of maturation
• Los of GN (LH and FSH) decreases sexual function
• depends on hormones that are deminished or absent.

Question 9

lab workup and imaging for hypofunction of ant pit

Answer 9

cortisol
TSH
Gonadotropins
GH
CT or MRI

Question 10

What does low cortisol and high ACTH indicate?

Answer 10

adrenal insufficiency

Question 11

Pituitary apoplexy

Answer 11

sudden hem of pituitary adenoma causing edema and hypofunction

Question 12

sx of pituitary apoplexy

Answer 12

sudden onset severe HA
stiff neck
visual field defects

Question 13

complications of pit apoplexy

Answer 13

coma or death

Question 14

DX of pit apoplexy

Answer 14

MRI

lumbar puncture to see if blood in CSF

Question 15

Pituitary infarction (Sheehan syndrome)

Answer 15

pituitary necrosis as a result of postpartum hemorrhage and hypovolemic shock

Question 16

sx of sheehan syndrome

Answer 16

severe: lethargy, anorexia, weight loss, inability to lactate
less severe: failure to lactate, menses do not resume, loss of sexual hair

Question 17

pituitary dwarfism

Answer 17

decreased GH from pit or HTH disease

Question 18

causes of pit dwarfism

Answer 18

idiopathic, emotional deprivation, hereditary

Question 19

PE and lab for pit dwarfism

Answer 19

PE: growth charts
Lab: IGF-1 and GH levels may be low

Question 20

what hormones are over-produced in hyperfunction of ant pit

Answer 20

adenomas over secrete hormones: PRL, GH, ACTH

Question 21

sx of hyperprolactinemia in women

Answer 21

premenopausal: lactation after pregnancy, amenorrhea, menstrual abnormalities
post men: HA, vision impairment,

Question 22

sx of hyperprolactinemia in men

Answer 22

decreased libido, erectile dysfunction, infertility, gynecomastia

Question 23

Acromegaly vs gigantism

Answer 23

acromegaly: start out looking normal and then have changes in adulthood
gigantism: starts as kids

Question 24

sx of acromegaly

Answer 24

enlargement of jaw, hands, feet, coarse facial features, CVD, sleep apnea, DM2, vision loss, carpal tunnel

Question 25

Workup for acromegaly

Answer 25

PE: organomegaly, enlarged tongue Lab: serum IGF-1 elevated glucose test

Question 26

Central Diabetes Insipidus (neurogenic)

Answer 26

deficiency of ADH leads to large amounts of very dilute urein and excessive thirst

Question 27

causes of central diabetes insipidus

Answer 27

hypothalamus or post pit disease, autoimmune, familial

Question 28

sx of central diabetes insipidus

Answer 28

abrupt onset polyuria, poludipsia, nocturia | dry skin, dry mucus membranes, tachycardia

Question 29

****What tests can you run for central diabetes insipidus? How do you run it?

Answer 29

water restriction test: measure urine volume and osmolality every hr and plasma sodium every 2 hrs. In DI: urine is more dilute than plasma

Question 30

SIADH

Answer 30

increased secretion of ADH without stimulus | hyper function of posterior pituitary caused by stroke, head trauma, drugs, pneumonia, HIV

Question 31

sx SIADH

Answer 31

lethargy, HA, difficulty concentrating, gait disturbances, vomiting, coma, seizures

Question 32

insidious progressive weakness, fatigue, anorexia, N/V, diarrhea or constipation, abdominal pain, cold intolerance, dizziness, fainting, low resistance to infection, salt craving, joint pain, gait disturbance?

Answer 32

Addisons Disease (primary adrenal insufficiency)

Question 33

etiology of Addisons disease

Answer 33

70% idiopathic (autoimmune) atrophy of adrenal gland

Question 34

What is the gold standard test for Addisons disease?

Answer 34

ACTH stimulation test: IV cortisol administered and measured at baseline, 30 min, 60 min - if elevated, primary adrenal insufficiency - not elevated, secondary to pituitary insufficiency

Question 35

profound weakness, peripheral vascular collapse, renal failure/azotemia, pain in legs, back, abdomen

Answer 35

Adrenal Crisis (emergency)

Question 36

What is the difference between primary and secondary adrenal insufficiency with low cortisol?

Answer 36

secondary has no hyperpigmentation

Question 37

what is the mechanism of the problem with secondary adrenal deficiency with low cortisol?

Answer 37

secondary to low ACTH stimulation which is a result of destructive pituitary or pituitary lesion *issue with pituitary (not adrenal).

Question 38

permanently high ACTH levels due to defects in cortisol hydroxylation with accumulation of precursors of cortisol.

Answer 38

Congenital adrenal hyperplasia (CAH)

Question 39

sx of congenital adrenal hyperplasia

Answer 39

F: masculinization of fetus in utero, ambiguous genitalia males: infant hercules syndrome * adrenal crisis in early two weeks of age from salt loss

Question 40

workup for congenital adrenal hyperplasia

Answer 40

very high serum 17 hydroxyprogesterone | increased testosterone

Question 41

excess ACth production leads to hyper pigmentation (80% due to tumors of pituitary gland)

Answer 41

Cushing's Disease

Question 42

due to longterm use of corticosteroids or cortisol secreting tumors

Answer 42

Cushings syndrome

Question 43

sx of cushing disease/syndrome

Answer 43

``` moon face buffalo hump truncal obesity skinny limbs easy bruising purple striae poor wound healing ```

Question 44

adrenal adenoma/hyperplasia leads to increased aldosterone

Answer 44

primary hyperaldosteronism (conn syndrome)

Question 45

sx of primary hyperaldosteronism

Answer 45

hypervolemia, muscle weakness, parasthesias, transient paralysis, personality disturbances

Question 46

tumor of sympathetic ganglia or adrenal medulla with excess catecholemines.

Answer 46

pheochromocytoma

Question 47

sx of pheochromocytoma

Answer 47

``` sudden increases in BP with severe HA diaphoresis flushing cold clammy skin angina palpitations tremor N/V epigastric pain visual disorders dyspnea parasthesias panic attack ```

Question 48

what are actions of parathyroid hormone?

Answer 48

increased bone, tubular, and intestinal resorptions of Ca. | Decreased tubular resorption (increased excretion) of PO4 and activation of Vit D.

Question 49

What is normal serum Ca level?

Answer 49

8.5-10.5 (40% bound to serum protein)

Question 50

hypo secretion of PTH leading to hypocalcemia.

Answer 50

hypoparathyroidism

Question 51

sx of hypoparathyroidism

Answer 51

``` asymptomatic tetany numbness tingling carpo-pedal spasm laryngeal stridor seizure psychiatric findings (depression, confusion, psychosis) ```

Question 52

lab findings for hypoparathyroid

Answer 52

low ca (les than 8.5mg) low PTH high PO4 hypomagnesemia

Question 53

what causes pseudohypoparathyroidism?

Answer 53

end organ insensitivity to PTH | lab: hypercalcemia

Question 54

excess PTH secretion high Ca low PO4 bone resorption

Answer 54

hyperparathyroid

Question 55

causes of hyperparathyroid

Answer 55

adenoma PTH producing carcinoma hypercalcemia

Question 56

sx of hyperparathyroid

Answer 56

``` kidney stones constipation anorexia N/V with abdominal pain muscular weakness renal impairment ```