Endocrinology Flashcards by Ryan Good

Posterior pituitary hormones

Oxytocin, ADH

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Anterior pituitary hormones

TSH, ACTH, FSH/LH, GH, prolactin, endorphins

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Direct secretion of hormones from the hypothalamus

Posterior pituitary - oxytocin, ADH

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Zones of the adrenal gland

Glomerulosa, Fasiculata, Reticularis, Medulla

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Mineralocorticoids

Aldosterone
Secreted by glomerulosa in response to RAS
Increases Na and HCO3, decreases K

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Glucocorticoids

Cortisol (high AM, low at MN)
Secreted by fasiculata in response to ACTH
Increases glucose and BP

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Most common defect in CAH

21-hydroxylase deficiency (95%)

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Classic CAH

salt wasting (no aldo), hypotension (no cortisol), virilization (excess DHEA)

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Primary causes of adrenal insufficiency

Congenital (x-linked)
Adrenal damage
Defects in cholesterol synthesis (Smith-Lemli-Optiz)
Peroxisomal disorders (ALD, Zellweger)

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Secondary adrenal insufficiency

No salt-wasting or hyperpigmentation

Due to lack of ACTH

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Triple A syndrome (Allgrove)

ACTH resistance, achalasia, alacrima

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Autoimmune Polyglandular Syndrome (type 1)

Hypoparathyroidism, adrenal insufficiency, candidiasis

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Autoimmune Polyglandular Syndrome (type 2)

Hypothyroidism, adrenal insufficiency, DM type 1

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Liddle syndrome

Activation of Na channel causes mineralocorticoid excess and hypertension

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Pheochromocytoma rule of 10’s

10% = extra-adrenal, malignant, children, bilateral

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Syndromes associated with pheochromocytoma

MEN 2A, 2B
Von Hippel-Lindau
Neurofibromatosis

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Causes of congenital hypothyroidism

Dysgenesis (75%), enzyme defects (10%), transient (10%), HPT axis (5%)
Only 2% have goiter!

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Diagnosis of Hashimoto’s thyroiditis

anti-microsomal Ab’s

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Diagnosis of euthyroid sick syndrome

low T4, T3, TSH

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% of thyroid nodules that are malignant

33%

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Iodine scan findings

Graves - high update, subacute thyroidisits - low uptake

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Linear growth rate (after 3 years)

5-7 cm/yr

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GH therapy side effects

pseudotumor, SCFE, rapid growth of nevi, worsening scoliosis

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Diagnosis of GH deficiency

low IGF-1

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Pubertal progression (girls)

Breast (8-13) Pubic hair (8-14) Growth spurt (10-14) Menarche (10-16)

Pubertal progression (boys)

``` Growth of testes (10-17) Penis lengthens (11-15) Pubic hair (11-14) Growth spurt (12-17) ```

LH function

Men - stimulates Leydig cell to produce testosterone | Women - ovulation

FSH function

Stimulates Sertoli cell to produce inhibin Women - initiates follicular development Both - stimulates maturation of germ cells

Testosterone production

Testes (Leydig cells), ovaries, adrenal gland

Estrogen production

Granulosa cells of the ovary

Stimulation of FSH/LH

GnRH from hypothalamus

Pubertal delay

Boys - 14 yo | Girls -13 yo

Most common cause of pubertal delay in boys

Constitutional delay

Constitutional delay of puberty findings

Delayed bone age, testes < 4 mL and penis < 7 cm, positive family history

Kallman syndrome

``` Hypogonadotropic hypogonadism (delayed puberty, micropenis, cryptorchidism) Anosmia ```

Swyer syndrome

46 XY but female phenotype due to mutation of SRY gene

Swyer syndrome presentation

Tall women with primary amenorrhea. U/S with normal female internal anatomy. Streak gonads

Premature puberty definition

Boys < 9 yo | Girls < 8 yo

Precious puberty findings

Bone age > chronological age

Causes of precocious puberty

Hypothalamic hamartoma, CAH, ovarian cyst, McCune-Albright, adrenal tumors

Premature thelarche age

bimodal (< 2 yo and > 6 yo)

McCune-Albright Syndrome

cafe-au-lait macules, fibrous dysplasia of bone, peripheral precocious puberty

Vitamin D forms

D3 formed in skin 25-D3 in liver 1,25-D3 in kidney (stimulates intestinal absorption of Ca)

PTH function

Stimulated by drop in iCa | Causes Ca mobilization from bones, increased vit D production, decreased PO4 absorption

Rickets findings

tetany, growth retardation, frontal bossing, rachitic rosary, widening of wrists

X-ray findings in Rickets

widening and fraying of epiphyses

Causes of Rickets

Vitamin-D deficiency Vitamin-D dependent Hypophosphatemic (vitamin-D resistant) Renal failure

Causes of vitamin D deficiency

Lack of sunlight, vitamin D, phenobarb, malabsorbtion

Hypophosphatemic rickets cause

phosphate leak in the proximal tubule

Findings of renal failure rickets

Elevated PO4 (failure of vitamin D and PTH systems)

MEN type 1

Hyperparathyroidism, pancreas islet cell tumor, pituitary tumors

Findings of vitamin D deficiency

Low/normal Ca, PO4, elevated AP, PTH

Most common cause of acquired adrenal insufficiency

Autoimmune adrenalitis

2nd most common cause of CAH

11-hydroxylase deficiency

11-hydroxylase deficiency findings

virilization, HTN, hypokalemia

CAH genetics

MEN type 2A

Pheochromocytoma, hyperparathyroidism, medullary cell thyroid cancer

MEN type 2B

Pheochromocytoma, medullary cell thyroid cancer, mucosal neuromas

Rate of congenital hypothyroidism

1 in 4000 births

Factors associated with decreased IQ in congenital hypothyroidism

Low T4 at birth, delayed bone age at birth, delayed treatment, low T4 during first year of therapy

Pseudohypoparathyroidism

Genetic resistance to PTH (low Ca, high PO4 and PTH)

Pseudohypoparathyroidism findings

Round facies, spade-like hands, short stature, DD

Causes of hyperparathyroidism

Sarcoidosis, immobilization, Vit D intoxication, cancer, Williams syndrome

Familial hypocalciuric hypercalcemia genetics

Familial short stature findings

Bone age = chronological age, normal onset of puberty

Tumor associated with GH deficiency

craniopharyngioma

Diagnosis of Cushing syndrome

urinary free cortisol

Most common cause of Cushing syndrome in infants

adrenocortical tumor

Septo-optic dysplasia findings

panhypopituitarism, hypoplastic optic discs, microphallus (boys)

Treatment of choice for Grave's disease

Methimazole

Pubertal trigger

pulsatile release of GnRH

Premature adrenarche onset

6 to 8 years

Premature adrenarche management

follow-up every 4-6 months to confirm non-progressive nature

CNS lesion causing central precocious puberty

hypothalamic hamartoma (benign - no resection), septo-optic dysplasia, neurofibroma

Causes of peripheral precocious puberty

CAH, McCune-Albright, severe primary hypothyroidism, adrenal tumor

PE findings of estrogen stimulated vaginal mucosa

pinkish (glistening red = non-estrogen stimulated)

Areolar breast mounding - Tanner Stage

Androgenic changes

body odor, body hair, acne

Gynecomastia seen during what Tanner Stage

II/III

1st sign of puberty in boys

testicular enlargement (4 cc!)

Diagnosis of PCOS

amenorrhea/oligomenorrhea, elevated serum androgen/hirusitism/acne, polycystic ovaries on U/S

Mid-parental height calculation

(maternal height + paternal height +/- 5 in)/2

Endocrinology Flashcards

(82 cards)