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Flashcards in Endocrinology Deck (181):
1

From what is the anterior pituitary derived?

Rathke's Pouch

2

What is the function of the hypothalamic-pituitary portal plexus in addition to providing blood to the ant. pituitary?

Transmission of hypothalamic peptides w/o systemic dilution

3

What is the function of dopamine release in regulation of prolactin?

Inhibits prolactin

4

What is the function of Somatostatin Releasing Inhibitory Factor (SRIF) in regulation of Growth Hormone?

Inhibits GH

5

What is the function of Gonadotropin Releasing Hormone?

Release of FSH and LH

6

What is the function of Thyrotropin Releasing Hormone?

Release of Thyroid Stimulating Hormone

Release of Prolactin

7

What is the function of Growth Hormone Releasing Factor (GHRF)?

Release of GH

8

What is the function of Somatostatin Releasing Inhibitory Factor (SRIF)?

Inhibits GH release

9

What is the function of Corticotropin Releasing Hormone?

Release ACTH

10

What hormones are in the group Somatomammotropins?

GH

Prolactin

(act on tissue)

11

What hormones are in the group Corticotropins?

ACTH

12

What hormones are in the group Glycoproteins?

TSH

FSH

LH

13

What is the function of GH?

  1. Promote linear growth
  2. Increases free fatty acids
  3. Increases glucose concentratio
  4. Stimulates Immune system

14

What is the function of Prolactin?  How can it effect men?

  • Function
    • Lactation
      • enlargement of mammary glands
    • Disrupts menses
  • Men
    • Hypogonadism

15

What is the function of ACTH?  What stimulates its release?

  • Function
    • Stimulates cortisol production
  • Stimulated by
    • Stress

16

How is TSH regulated?

  • Stimulated by
    • TRH
  • Inhibited by
    • Somatostatin
    • DA
    • Excess glucocorticoids

Sensitivity of thyrotrophs improved by estrogen

17

What is the function of LH and FSH in males?

  • LH
    • Stimulates Leydig = testosterone production
  • FSH
    • Androgen binding
  • Both
    • Sperm maturation

18

In males, what inhibits FSH?

Inhibin, made by Sertoli cells

19

What is the function of LH and FSH in females?

  • LH
    • Estrogen production
    • Progesterone production
    • Ovulation
  • FSH
    • Maturation of follicle
  • Both
    • Estrogen from follicle

20

What regulates the posterior pituitary?

Anterior Hypothalamus

21

What is the most important function of ADH?

Water balance

22

What is the function of Oxytocin?

  • Lactation
  • Contractions (uterus)

23

What are the long and short feedback loops of the hypothalamic-pituitary axis?

  • Long:
    • hormones from target tissue gives feedback (inhibition) to the hypothalamus/pituitary
  • Short: 
    • Pituitary hormones inhibit hypothalamus

24

Cortrosyntropin test

  • Use
  • Significance

  • Use
    • Determine the cause of low hormone 
    • Hypothalamus, pituitary, adrenal
  • Significance
    • Cause is Hypothalamic
      • ACTH and Cortisol / Aldosterone production is normal with CRH
    • Cause is Pituitary
      • Low ACTH production
    • Cause is Adrenals
      • Low cortisol and aldosterone

25

What is the most common presenting symptom of Craniopharyngioma in children?  Adults?

  • Children
    • GH deficiency
    • Growth retardation
  • Adult
    • Visual problems
      • compression of optic chiasm
    • Later have symptoms resulting in Mass Effect

26

What is the most common visual finding in pituitary tumor?

Bitemporal hemianopsia

27

What signs result from encroachment of pituitary tumors into the cavernous sinus?

  • Contents
    • Internal carotid
    • CN III, IV, VI, V1, V2
    • (CN III has parasympathetic fibers)
  • Signs
    • Eye movement problems
    • Pupillary / parasympathetic signs
    • Loss of sensation of face

28

What are the symptoms of spontaneous infarction of a pituitary tumor?

Associated with raised intracranial pressure

  • Headache
  • Nausea/vomiting
  • Ocular palsy
  • Visual field defect
  • May have pituitary failure with adrenal insufficiency

29

Sheehan Syndrome

  • Cause
  • Pop with higher risk
  • Symptoms

  • Cause
    • Pregnancy causes enlarged pituitary w/o change in blood flow
    • Postpartum hemorrhage or shock causes decreased flow to pituitary
      • necrosis
  • Pop
    • Diabetics
  • Symptoms
    • inability to breast-feed
    • Lack of menstrual bleeding
    • Late: loss of pubic and axillary hair

30

What are the most common hypersecreted hormone in Pituitary Adenoma?

  1. Prolactin
  2. GH

31

Hyperprolactinemia

  • Symptoms
  • Treatment

  • Symptoms
    • Galactorrhea
    • Amenorrhea
    • Impotence (men)
  • Treatment
    • Dopamine agonists
    • Trans-shenoidal approach
      • removal
    • Radiation of pituitary

32

Adult Onset Growth Hormone Deficiency

  • Cause
  • Symptoms

  • Cause
    • pituitary adenomas
    • Parasellar tumors (push on stalk)
  • Symptoms
    • Loss of lean muscle
    • Reduced bone mass
    • Altered glucose metabolism
    • Raised LDL

33

What results from Growth Hormone Secreting Adenomas?

  • Children
    • Gigantism
      • Excess IGF-1
      • Delayed closure of epiphysis
  • Adults
    • Acromegaly
      • GH regulation by glucose lost
      • Excess IGF-1
      • Overgrowth of soft tissues and organs

34

What is Pseudoacromegaly?

Acromegaloid features w/o increased GH and IGF-1

Associated with insulin resistance

35

Diagnosis and treatment of Acromegaly

  • Diagnosis
    • IGF-1 levels
    • Glucose suppression test
    • Serial Photographs
  • Treatment
    • Somatostatin analog
    • Transsphenoidal surgery
    • Radiotherapy

36

What are the symptoms of Diabetes Insipidus?  What is the physiologic mechanism leading to these symptoms?

  • Symptoms
    • polyuria
    • polydipsia
  • Physio
    • Kidneys cannot concentrate urine
    • Lack of ADH function

37

What is the difference between Central and Nephrogenic ADH (insensitivity)?

  • Central
    • Partial or total loss of ADH secretion
  • Nephrogenic
    • Renal resistance to ADH

38

What causes Gestational DI?

Degradation of vasopressin by placental vasopressinase

39

What is the initial testing for DI?

Water deprivation test

Failure to concentrate urine suggests DI

40

How can central vs nephrogenic DI be determined clinically?

  • Injection of arginine vasopressin
    • If urine concentrates = Central
    • If it doesn't = Nephrogenic

41

What is primary polydipsia?

Defect in osmoregulation of thirst

 

42

How can Primary Polydipsia be distinguished from DI?

  • DI
    • Urine osm < plasma osm
    • 50% improvement with vasopressin
  • PP
    • Urine osm > plasma osm
    • Little response to vasopressin

43

How are central and nephrogenic DI treated?

  • Central
    • Vasopressin analog
  • Nephrogenic
    • Treat underlying disease
      • hypokalemia or hypercalcemia

44

What are the clinical signs of SIADH?

  • Hyponatremia
  • Elevated urine osmolality
  • Decreased serum osmolality
  • Patient is EUVOLEMIC

 

Excess ADH causes resorption of lots of water, resulting in Dilutional Hyponatremia

45

What is the most common malignant cause of SIADH?

Small Cell Lung Cancer

46

What is the treatment of SIADH?  What severe complication can result?

  • Treatment
    • Long-term water restriction
    • Correct hyponatremia
  • Complication of correcting hyponatremia too rapidly
    • Cerebral edema
    • Central pontine myelinolysis
      • decreased consciousness
      • Quadriparesis
      • Dysphagia
      • Mutism

47

What features differentiate DI and SIADH?

A image thumb
48

What is the metabolically active form of thyroid hormone?  Where is it produced?

T3

Produced in periphery from deiodination of T4

49

What are the functions of thyroid hormone?

  • Stimulates thermogenesis
  • Metabolism
  • Potentiates action of catecholamines
  • Stimulate growth and development
    • esp brain and skeleton

50

Free T4 (FT4) Test

  • What does it reflect?
  • Normal?

  • Reflects
    • metabolic status
    • Unaffected by serum proteins or non-thyroid illness
  • Normal
    • 0.8-1.6

51

What does the Free T3 (FT3) Test reflect?

Not routinely used

52

For what is the T3 Test used?

Hyperthyroidism

Determines severity and response to treatment

53

What does T3 Uptake measure?

Indirectly measures TBG

Test rarely used

54

For what is Radioactive Iodine Uptake used?

Differentiates between

  • Subacute thyroiditis
    • Always suppressed in acute phase
  • Hyperthyroidism / Graves
    • Elevated

55

Thyroid Peroxidase Abs (TPO) and Anti-Thyroglobulin Abs are most common in what disease?  In what others can it be found?

  • Most common
    • Hashimoto's thyroiditis
  • Others
    • Graves
    • Subacute thyroiditis

56

When are TPO and Anti-thyroglobulin Abs used?

Patient with modest elevation of TSH

57

What is the diagnosis if a patient has normal TSH and Free T4 levels but test positive for TPO and Anti-Thyrglobulin Ab?

Increased risk of developing hypothyroidismin the future

58

Thyroid stimulating Abs are produced in what disease?  Where do they bind, and what are the resulting symptoms?

Graves Disease

  • Binds
    • TSH receptor in thyroid = Increased TH
    • Eyes = exophthalmos
    • Skin surface = myxedema

59

Patient presents with anterior neck pain, myalgia, low fever, and a sore throat.  PE shows a hardness of the thyroid.  Labs results show elevation of ESR, Elevation of T3 and T4, decreased TSH, and suppressed RAIU.  What is the diagnosis?  What is the clinical course of disease?

Subacute Thyroiditis

Initial hyperthyroid w/ decreased TSH, but transient

60

What is the most common Primary Hypothyroidism in the US?

Hashimoto's 

61

What is the most common cause of Acquired primary hypothyroid?

Hashimoto Thyroiditis

62

What antibodies are present in Hashimoto Thyroiditis?

Anti-thyroglobulin

63

WHat is the best screening test for Hypothyroidism?

TSH

64

What is the most common cause of Congenital Hypothyroidism?

Thyroid dysgenesis

May have agenesis, ectopic, or hypoplastic thyroid

65

When is the best time to chech TSH in a newborn?  Why?

After 24 hours

B/c there is a surge of TSH w/i the first 24 hours of delivery

66

What complication of hypothyroidism in an infant can occur if treatment is delayed?

Decreased cognitive abilities, Decreased growth

(TH associated with development of brain & skeleton)

67

What is Euthyroid Sick Syndrome?  What is the treatment?

  • Syndrome
    • Severe Illness causes decreased T3
    • Impaired conversion in the periphery
  • Treatment
    • None
    • Watch levels

68

What is the most common cause of Hyperthyroidism?

Graves Disease

69

Lab results for a patient show the presence of TPO Abs, Low TSH, Elevated Free T4, Elevated T3, Positive TSI, and Increased RAIU.  What is the diagnosis?

Graves disease

Positive TSI = Graves

Increased RAIU = differentiates from subacute thyroiditis or hyperfunctioning nodule

70

What is the most important lab test to determine severity of Graves Disease?

Thyroid Stimulating Immunoglobulin (TSI)

Correlates with severity of disease

71

What HLA type is associated with an increased risk of Graves Disease?

HLA-DR3

72

What is the goal of radioablation?

Induce permanent Hypothyroidism

73

What complications can arise secondary to thyroidectomy?

Hypoparathyroidism

Vocal cord paralysis

74

Neonatal Graves Disease

  • Cause
  • Symptoms
  • Indication of increased risk

  • Cause
    • Passage of maternal anti-thyroid Ab thru placenta
  • Symptoms
    • Tachycardia
    • Goiter
    • Poor feeding
  • Indication of increased risk
    • Elevated TSH receptor Ab in mother during 3rd trimester

75

What characteristics of Thyroid Nodules are most likely to indicate malignancy? What is the next step in diagnosis?

  • Characteristics
    • Size over 1 cm
    • Thick / Irregular halo
  • Diagnosis
    • Biopsy

76

What is the most common type of Thyroid Cancer?  Which type is most associated with a poor outcome?

Most common: Papillary

Poor outcome: Anaplastic

77

How do thyroid tumors typically present with regards to hormone production?

Euthyroid

78

What does the following test result indicate?
 ⇧TSH : ⇩Free T4
 
 

Primary Hypothyroidism

79

What does the following test result indicate?
 ⇧Free T4 :⇩TSH
 

Hyperthyroidism

80

What does the following test result indicate?
 ⇩ Free T4 :⇩TSH
 

Central Hypothyroidism (pituitary origin)

81

What does the following test indicate?
 ⇩ Free T4 : Normal TSH
 

Central Hypothyroidism (pituitary origin)

82

What does the following test indicate?
 ⇧TSH : Normal Free T4
 

Compensated Hypothyroidism

83

What does the following test indicate?
 ⇩ Total T4 : Normal Free T4
 

TBG deficiency

84

What common symptoms occur in Type 1 DM?

Cells are being starved of glucose!!

Hyperglycemia

Polyphagia

Polydipsia

Polyuria

Weight loss

Blurred vision

Fatigue

85

What are the common triggers of Type 1 DM?

Viral illness

Physiologic stressor

86

What auto-Ab are found in DMT1?

  • ICA 512
    • Islet cell cytoplasmic Ab
  • IA-2
    • Islet beta cell Ag
  • IAA
    • Insulin auto-Ab
  • Glutamic Acid Decarboxylase (GAD) Ab
    • makes GABA

87

Glutamic Acid Decarboxylase Ab is seen in what conditions?

  1. DMT1
  2. Thyroiditis (auto-immune)
  3. Stiff Person Syndrome

88

What is the MOA of DMT1?

Autoimmune destruction of beta islet cells

Decreased release of insulin

89

What HLA types are associated with DMT1?

HLA-DR3

HLA- DR4

90

How can one differentiate DMT1 from DMT2 through lab tests?

  • DMT1
    • Autoantibodies = (+)
    • C-peptide assay = (-)
  • DMT2
    • Autoantibodies = (-)
    • C-peptide assay = (+)

91

What compounds need to be replaced in DMT1?

Insulin

Amylin (also from beta cells)

92

What is the function of Amylin?

Glycemic regulation

  • Slows gastric emptying
  • Promotes satiety
  • Result: Prevents post prandial spikes in blood glucose

93

When does screening for gestational diabetes begin?  What is a positive test?

  • Screening
    • 3rd trimester
  • Positive test
    • Glucose > 140

94

Women with gestational diabetes are at an increased risk of what post-gestational complication?

50% will develop type 2 DM

95

What are the components of metabolic syndrome?

  • Obesity
    • Dyslipidemia
      • low HDL 
      • high triglycerides
      • Causes Atherosclerosis
    • Hypertension
  • DM type 2
    • Glucose intolerance
    • Hyperinsulinemia
  • Elevation of inflammatory markers
  • Hyperuricemia 

96

What concurrent disease may be present at the time of diagnosis of DMT2?  How can it manifest in men?

Cardiovascular disease

Men: Erectile dysfunction

97

What are the four main mechanisms of Type 2 DM?

  1. Insulin Resistance
  2. Beta cell Dysfunction
  3. Dysregulated Hepatic Glucose Production
  4. Abnormal Intestinal Glucose Absorption

98

What risk factors are associated with development of Type 2 DM?

  • Age
  • Obesity
  • Sedentary lifestyle
  • Gestational DM

99

Blood Sugars:

  • Normal fasting plasma glucose
  • Fasting plasma glucose that indicates DM?
  • Random blood glucose that indicates DM?

  • Normal fasting plasma glucose
    • < 110
  • Fasting plasma glucose that indicates DM?
    • > 126
  • Random blood glucose that indicates DM?
    • > 200

100

What is the function of HgbA1c testing?  What should the goal be for a patient with DM?

Monitor control of DM

Do NOT use for diagnosis!!

Goal: < 7.0

101

What is the Somogyi Effect?

Rebound hyperglycemia that follows undetected hypoglycemia

Usually in the early AM

102

What is the Dawn Phenomenon?

Rise in sugars during the night to early AM

Related to nocturnal secretion of GH (anti-insulin)

103

What does a positive Microalbumin test indicated in a patient with DM?

Microvascular damage

Increased CV risk

104

What is the pathophysiology of diabetic ketoacidosis?

  • Hyperglycemia
    • Absence of insulin
    • No glucose uptake
  • Acidosis
    • metabolism of fat for energy
  • Ketosis
    • Excess free FA converted into ketone bodies
  • Dehydration
    • increased protein catabolism

105

What are the symptoms of DKA?

  • Kussmaul breathing (hyperventilation)
  • Fruity breath
  • Abdominal pain
  • Cerebral edema (children)
  • Confusion

106

What are some precipitating causes of DKA?

  • Illness
  • Insulin omission
  • MI (Elderly)

107

What are the early symptoms of DKA?

High blood glucose

Thirst / dry mouth

Frequent urination

Ketonuria

108

How is DKA treated?

Fluid replacement

Insulin

109

How do Diabetic Ketoacidosis and Hyperosmolar Nonketotic Syndrome differ in the following respects?

  • Plasma glucose
  • Serum Ketones
    • beta hydroxybutyrate
  • Serum osmolarity

  • Plasma glucose:  HHS much higher!
    • DKA: > 250
    • HHS: > 600
  • Serum Ketones: beta hydroxybutyrate:  DKA much higher!!
    • DKA: > 8 mmol/L
    • HHS: Normal (< 0.6)
  • Serum osmolarity:  HHS much higher!
    • DKA: Varies
    • HHS: > 320

110

What is the leading cause of renal failure?

Nephropathy resulting from microvascular complications of Diabetes

111

Symptoms of Hypoglycemia

  • Sweating
  • Shakiness
  • Anxiety
  • Tachycardia
  • Weakness
  • Confusion
  • Headache
  • Visual disturbances

112

Morning headaches, Night sweats, Difficulty waking, and restless sleep may be associated with what disease?

Nocturnal Hypoglycemia

113

What are the differences between MEN 1, MEN 2A, and MEN 2B?

A image thumb
114

Which MEN syndrome can cause fasting hypoglycemia?  How?  How can this be diagnosed?

MEN 1

  • Pancreatic tumors, such as Insulinoma, are common
    • Elevated fasting insulin
    • Elevated c-peptide lvls (indicates endogenous)

115

How does Hypopituitarism lead to hypoglycemia?

Low GH and Cortisol

These are "anti-insulin" hormones that protect against hypoglycemia

116

How does Kidney Failure cause hypoglycemia?

  1. Impairs gluconeogenesis
  2. Insulin circulates longer
    • Slow clearance
  3. Reduces appetite
    • Decreased intake

117

How does Ethanol Ingestion (alcoholism) cause hypoglycemia?

Inhibits hepatic gluconeogenesis

118

What is the most common cause of Postprandial Hypoglycemia?  How does this occur?

Gastric Surgery

  • Rapid emptying of stomach
    • Fast glucose absorption
    • Excess Insulin reslease
  • **Hypoglycemia w/i 4 hours after high carb meal
  • aka: Dumping Syndrome

119

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

  • Disease
    • oversecretion of ACTH from the pituitary
  • Syndrome
    • Excess cortisol from any other cause

120

What is the most common cause of Cushing's Syndrome?

Exogenous glucocorticoids

121

What are the clinical features of Pseudo Cushing's Syndrome?

  • Severe Obesity
  • Polycystic Ovary Syndrome
  • Alcoholism
  • Acute illness
  • Depression

122

What are the clinical features of Cushings?

  • Weight Gain
    • Truncal Obesity
    • Buffalo Hump
    • Moon Face
    • Abdominal Striae
  • Hyperpigmentation
    • if elevated ACTH
  • Hypertension
  • Non Pitting Edema
  • Hyperlipidemia
  • Osteoporosis
  • Weakness of proximal mm

123

In Cushings, which type of fiber is most affected by atrophy?

Dark, fast twitch fiber

(Type IIA)

124

What is the most common screening test for Cushings?  What other tests can be done?

  • Most common:
    • 11 PM salivary cortisol
  • Others
    • 24 hr urine for free cortisol
    • Overnight dexamethasone suppression test
    • Midnight serum cortisol and ACTH level

125

If ACTH is very high in Cushings (> 200), what is the likely cause?

Ectopic ACTH Syndrome

126

What can be diagnosed using an Octreotide Scan?

  • Carcinoid
  • Pancreatic neuroendocrine tumors
  • Sarcoidosis

***Analog of somatostatin

127

What is the test of choice for differentiating Ectopic source vs Pituitary Adenoma causing increased ACTH?

Bilateral Inferior Petrosal Sinus Sampling

128

What test should be done is plasma ACTH is found to be extremely high?

Assume EAS (ectopic source)

Test: CT chest / abdomen

129

What test should be done if the plasma ACTH is found to be low?

Assume Adrenal Tumor

Test: CT abdomen

130

What test should be done if the plasma ACTH is normal or slightly higher following a positive screening for urine cortisol?

48 Hr High Dose Dexa

Distinguish between Cushings, EAS, or Pituitary tumor

131

Patient's plasma ACTH is normal, but urine cortisol is elevated.  A 48 hr High Dose Dexa test is performed and suppression results.  What is the likely diagnosis?  What test should be performed?

Diagnosis: Cushing's disease

Test: brain MRI

132

Patient's plasma ACTH is normal, but urine cortisol is elevated.  A 48 hr High Dose Dexa test is performed and there is failure of suppression.  What is the next test that should be performed?

Octreotide Scan

or

CT of chest and abdomen

133

Patient's plasma ACTH is normal, but urine cortisol is elevated.  A 48 hr High Dose Dexa test is performed and there is failure to suppress.  Results of the Octreotide test are positive.  What is the likely diagnosis?  What test should be performed?

EAS (ectopic source)

Test: CT of abdomen / chest

134

Patient's plasma ACTH is normal, but urine cortisol is elevated.  A 48 hr High Dose Dexa test is performed and there is failure to suppress.  Results of the Octreotide test are equivocal.  What is the likely diagnosis?  What test should be performed?  What do the results indicate?

Diagnosis: EAS vs Pituitary tumor

Next test: Inf Petrosal sampling

Gradient present: MRI of brain

No gradient: EAS and do CT of abdomen / chest

135

What two clinical features of ectopic ACTH syndrome differentiate it from Cushings?

Rapid onset

Hypokalemic Alkalosis

136

What type of tumor is most associated with ectopic ACTH syndrome?  What is the prognosis?

Small Cell Lung Cancer

Prognosis: Poor due to opportunistic infxn and increased resistance to chemo

137

What is Addison's Disease?

Adrenocortical insufficiency

Cause: destruction / dysfunction of adrenal cortex

138

What syndrome is a combination of Addison's plus Hashimoto's thyroiditis?

Schmidt Syndrome

139

What syndrome is a combination of Addison's, Hypoparathyroidism, and mucocutaneous candidiasis?

Polyglandular autoimmune syndrome type 1

140

What syndrome is a combination of Addison's, Type I DM, and Hashimoto's or Graves?

Polyglandular autoimmune syndrome type 2

141

What is Allgrove Syndrome?  What is the pathophysiology?

  • Allgrove Syndrome: Triple A Syndrome
    • Achalasia
    • Addisonianiasm
    • Alacrima
  • Pathophys:
    • Unresponsive to ACTH (lack of receptors)

142

What are the symptoms of Acute Adrenal Crisis?

Shock!

143


•65 year old male with a history of DM, hypertension, and hyperlipidemia presented with 2 day history of abdominal pain, emesis, confusion, and fever. One week ago he had started flu symptoms, he did not get a flu shot this winter. You examined the patient, what is the most likely finding on examination?

•A   Dark skin pigmentation
•B  Target lesion
•C  Vitiligo
•D  Cellulitis
•E  Hives
 


•For diagnosis, what would be the least useful test from the list below?

•A  ACTH stimulation test
•B  Sed rate
•C  Cortisol level
•D   Electrolytes
•E   Glucose level
 

First Answer: A

Second Answer: B

144

Waterhouse - Friderichsen Syndrome

  • Common Cause
  • Symptoms

  • Hemorrhagic adrenalitis / Fulminant meningococcemia
  • Cause
    • Neisseria meningitidis
  • Symptoms
    • Hypotension (from bleeding)
    • DIC
    • Septicemia
      • fever, vomiting, chills
    • Rash

145

Addison's Disease

  • Physical findings
  • Lab findings
  • Evaluation

  • Physical findings
    • Hyperpigmentation of skin
    • Dark spots on mucous membranes
    • Orthostasis
    • Muscle wasting and loss of body fat
    • Decreased body hair
  • Lab findings
    • Hyponatremia
    • Hyperkalemia
    • Hypoglycemia
  • Evaluation
    • ACTH stimulation test
    • Negative test with Addison's
      • no change in cortisol or aldosterone :(

146

What is the treatment for Addisons Disease?

Replacement of glucocorticoids and mineralocorticoids

147

What is a pheochromocytoma?  What does it excrete if it is in the adrenals?  Extra adrenal?

  • Pheochromocytoma
    • Neuroendocrine tumor
    • Chromaffin cell origin
  • Adrenal
    • excretes epinephrine
  • Extra adrenal
    • excretes norepinephrine

148

With which forms of MEN is pheochromocytoma associated?

MEN 2A and 2B

149

What are the characteristics of MEN 1?

  1. Pituitary adenoma
  2. Parathyroid hyperplasia
  3. Pancreatic tumors

150

What are the characteristics of MEN 2A?

  1. Parathyroid hyperplasia
  2. Medullary thyroid carcinoma
  3. Pheochromocytoma

151

What are the characteristics of MEN 2B?

  1. Mucosal neuromas
  2. Marfanoid body habitus
  3. Medullary thyroid carcinoma
  4. Pheochromocytoma

152

What are the symptoms of Pheochromocytoma?

Think excess catecholamines!!

  • Tachycardia
  • Hypertension
  • Sweating
  • Elevated glucose
    • stimulation of lipolysis

153

Finding VMA and HVA in the urine indicates what disease process?

(metabolites of norepinephrine and epinephrine)

Pheochromocytoma

154

Finding metanephrine in the blood indicates what disease process?

Pheochromocytoma

155

If a patient with pheochromocytoma is going to undergo surgery, what types of medications should they be given as a pretreatment?

  • Alpha blocker
  • Mixed alpha / beta blocker

156

What are the components of lipoproteins?

Cholesterol ester + TG in core

157

What is the traditional measure of LDL?

LDL-C

Measures amount of cholesterol

(core of cholesterol + TG)

158

Which LDL test is recommended in management of patients with cardiovascular risk?

LDL-P

LDL particle number

159

LDL can be estimated by measurement of what apolipoprotein?

apolipoprotein B

160

How is LDL calculated?

LDL = TC -- HDL-C -- TG/5

161

Which pattern of LDL are most atherogenic?

Pattern B

Large particle number b/c more dense

162

What is the primary lipoprotein in chylomicrons and LDL?

Apo B

163

How does weight loss affect endothelial function?  Plasma lipids?

Increased endothelial function with weight loss

Plasma lipids improve with weight loss

164

What are the three components of total daily energy expenditure?

  1. Resting energy expenditure
  2. Thermic effect of feeding
  3. Energy expenditure of physical activity

165

How many extra calories per day must be consumed in order to gain 1 lb in 1 month?

100 extra cal / day

166

What are the 8 pathological contributions to hyperglycemia in type 2 Diabetes?


1.  Decreased pancreatic insulin secretion
2.  Increased glucagon
3.  Decreased glucose uptake by muscle
4.  Increased hepatic glucose production
5.  Gut Carb Absorption
6.  Fat-increased Free Fatty Acid
7.  Brain: Appetite, insulin resistance, decreased GLP – 1
8.  Kidney: Increased glucose reabsorption
 

167

Clinical expression of diabetes (T2DM) requires dysfunction of which processes?

Insulin resistance

Beta cell dysfunction

Both due to predisposed genetic info

168

What is the difference between Primary and Secondary Hypogonadism regarding organ affected and hormone levels?

  • Primary
    • Testicular disorder
    • Elevated FSH and LH
  • Secondary
    • Hypothalamic or Pituitary disorder
    • Low or normal FSH and LH

169

Eunuchoidism

  • Cause
  • Signs and Symptoms

  • Cause
    • Testosterone deficiency
    • Prior to puberty
  • S & S
    • Increased height
    • Lack of adult hair distribution
    • High pitched voice
    • Small testes, penis, scrotum

170

What are the signs and symptoms of hypogonadism after puberty?

  • Prostate smaller
  • Less beard and body hair
  • Decreased libido and impotence

171

What does Low T with elevated FSH and LH indicate?

Testicular Disorder

Hypergonadotropic Hypogonadism

Common cause: Klinefelter's syndrome

172

Klinefelter's Syndrome

  • Type of hypogonadism
  • Cause
  • Signs

  • Type of hypogonadism
    • Primary
  • Cause
    • XXY
  • Signs
    • Gynecomastia
    • Small testes
    • Infertility
    • Long legs

173

What does Low T with normal or low FSH and LH indicate?

Secondary hypogonadism

Hypothalamic or Pituitary cause

174

Kallman's Syndrome

  • Type of hypogonadism
  • Cause
  • Signs

  • Type of hypogonadism
    • Secondary
    • Hypogonadotropic Hypogonadism
  • Cause
    • Inherited
    • X-linked recessive
    • Abnormal secretion of GnRF from Hypothalamus
  • Signs
    • Anosmia
    • Hypogonadism
    • Infertility

175

What can help restore fertility to patients with secondary hypogonadism?

Pergonal = stimulate FSH

hCG = stimulate LH

176

Why should oral testosterone be avoided?

Toxic effect on the liver

177

What are the side effects of testosterone replacement?

  • Fluid retention
  • HTN
  • Polycythemia
  • Gynecomastia
    • conversion of excess to estrogen
  • Acne

178

What tests must be done annually to monitory testosterone therapy?

  • PSA
  • CBC
    • check for polycythemia
  • Liver profile
  • Thyroid profile

179

What side effects may occur with synthetic androgen use?

  • SE
    • Atrophic testes
    • Infertility
  • Cause?  
    • Suppression of gonadotropins

180

What does normal testosterone, normal LH, elevated FSH, and normal sex characteristics indicate?

Sertoli cell only syndrome

181

Sertoli Cell Only Syndrome

  • Signs and Symptoms
  • Histo on biopsy

  • Signs and Symptoms
    • Azoospermia
    • Normal sex characteristics
    • Normal T and LH
    • Elevated FSH
  • Histo on biopsy
    • Absence of germinal cells