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ICM II > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

From what is the anterior pituitary derived?

A

Rathke’s Pouch

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2
Q

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

A

Transmission of hypothalamic peptides w/o systemic dilution

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3
Q

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

A

Inhibits prolactin

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4
Q

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

A

Inhibits GH

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5
Q

What is the function of Gonadotropin Releasing Hormone?

A

Release of FSH and LH

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6
Q

What is the function of Thyrotropin Releasing Hormone?

A

Release of Thyroid Stimulating Hormone

Release of Prolactin

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7
Q

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

A

Release of GH

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8
Q

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

A

Inhibits GH release

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9
Q

What is the function of Corticotropin Releasing Hormone?

A

Release ACTH

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10
Q

What hormones are in the group Somatomammotropins?

A

GH

Prolactin

(act on tissue)

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11
Q

What hormones are in the group Corticotropins?

A

ACTH

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12
Q

What hormones are in the group Glycoproteins?

A

TSH

FSH

LH

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13
Q

What is the function of GH?

A
  1. Promote linear growth
  2. Increases free fatty acids
  3. Increases glucose concentratio
  4. Stimulates Immune system
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14
Q

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

A
  • Function
    • Lactation
      • enlargement of mammary glands
    • Disrupts menses
  • Men
    • Hypogonadism
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15
Q

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

A
  • Function
    • Stimulates cortisol production
  • Stimulated by
    • Stress
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16
Q

How is TSH regulated?

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

Sensitivity of thyrotrophs improved by estrogen

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17
Q

What is the function of LH and FSH in males?

A
  • LH
    • Stimulates Leydig = testosterone production
  • FSH
    • Androgen binding
  • Both
    • Sperm maturation
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18
Q

In males, what inhibits FSH?

A

Inhibin, made by Sertoli cells

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19
Q

What is the function of LH and FSH in females?

A
  • LH
    • Estrogen production
    • Progesterone production
    • Ovulation
  • FSH
    • Maturation of follicle
  • Both
    • Estrogen from follicle
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20
Q

What regulates the posterior pituitary?

A

Anterior Hypothalamus

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21
Q

What is the most important function of ADH?

A

Water balance

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22
Q

What is the function of Oxytocin?

A
  • Lactation
  • Contractions (uterus)
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23
Q

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

A
  • Long:
    • hormones from target tissue gives feedback (inhibition) to the hypothalamus/pituitary
  • Short:
    • Pituitary hormones inhibit hypothalamus
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24
Q

Cortrosyntropin test

  • Use
  • Significance
A
  • 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
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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?
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?
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
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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
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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
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What are the side effects of testosterone replacement?
* Fluid retention * HTN * Polycythemia * Gynecomastia * conversion of excess to estrogen * Acne
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What tests must be done annually to monitory testosterone therapy?
* PSA * CBC * check for polycythemia * Liver profile * Thyroid profile
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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
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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

ICM II (12 decks)

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