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Flashcards in Endocrinology Deck (351)
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1

Hypothalamus

Dopamine-> inhib prolactin
GNRH->Growth hormone
TRH->TSH
CRH->ACTH
GnRH->FSH/LH
Post pit directly releases oxytocin/ADH

2

Screening for Axis fxn

Hypoth-Pit-Gonadal-check serum LH/FSH
Hypothal-Pit-Thyroid -> TSH/T4
Hypothal-Pit-Adrenal Axis->ACTH (serum)

3

Most sensitive determinant of pitutiary fxn?

FSH/LH level

4

Screening for hormone excess

Prolactinoma->prolactin level
Hyperthyroid-<>FTI/T4, TSH
Acromegaly-> IGF-1 (not GH - is pulsatile)
Cushings -> 1mg DMS

5

Pt with MVA - CT head with no bleed but 0.8cm solid mass in pituitary - pt nulliparus, menstation regular wtd?

check prolactin, T4/TSH/IGF-1 and 1mg DMS test (all axises)

6

Things that increase prolactin

Nipple manipulation
Phenothiazines
reserpine
Mehydopa
estrogens
marijuana
prgenancy
hypothyroid

7

Prolactinoma

Prolactin >200 - macroadenoma
failure then surgery

8

Middle aged woman wit dec libiddo adn fatigue test low, FSH low

check prolactin adn TSH

9

Pt wit galactorreha wtd?

check TSH and prolactin

10

Young woman with galactorreha on manipulation of nipple, TSH/prolactin normal

avoid manipulation of nipple

11

35yo F with galactorreha and amenorrhea x 6 months - preg neg prolactin 184 TFT normal wtd?

MRI r/o stalk tumor

12

Pt post partum continues to have galactorrhea fter finishing nursing baby - TSH 2.8, prolactin 281 takes no meds - dx?

prolactinoma - check MRI

13

45yo M c/o fatigue and dec libido - testosterone 18, prolactin 2500 FSH 2.2 cause?

prolactinoma

14

Pt with prolactinoma micro or macro - wants to concive

start dopamin agonist (bromocryptine - reduce prolactin level and induce ovulation

15

Pt tx'd with bromocryptine for macroadenoma and gets pregnant wtd?

d/c bromocryptine
monitor visual fields - only restart if changes

16

Acromegaly

inc'ing shoe size, hat size, ring size, hyperglycemia, prominent jaw, wide space between teeth, big tongue, flshey palms soles, osteoarthritis changes on Xray

17

Screening test for acromegaly

IGF-1 (somatosatin C) - also to follow dz activity

18

Confirm acromegaly (after IGF-1 screening) with...

oral glucose suppression test
failure to suppress GH to <2ng after 100g glucose

19

Tx for Acromegaly

Transphenoid surgery

20

Complciations of acromegaly

HTN, LVH, CHF, OSA, colonic polyps, carpel Tunnel

21

DM

dx FBS>126 - repeat x 1 to confirm
HgA1c>=6.5
Random blood sugar >200 with sx
75g gluc load GTT >200

22

Pt with BP 135/80 or BMI 25 or sedentery lifestyle or >40 wtd?

screen for DM (FSG, HgA1c)

23

Pt with DM (FSG >126) at risk for

DM and retinopathy, nephropathy

24

DM I vs II

check for Ab vs glutamic acid carboxylase, ab to islet cells

25

DM tx

Diet/excercise - 0.4% red A1c
Type I-> insulin
Type II sulfonyureas (hypogly), biguanide (metformin), repaglinide, glitazone, insulin, exenatid(no hypo, incretin (no hypo)

26

Insulin

All Type I DM
Type II not responding to oral hypoglycemics
Type II on oral mes but hospitalized, major surgery, infxn
pregnancy

27

Hospitalized pateint with DM

tx with basal insulin and rapid acting agent

28

Sulfonyureas (glipizide), glyburide, glimeperide

inc'd release insulin form B cells
avoid in obese pts

29

Meglitnide - repaglinid

inc rel insulin from B cells - excreted in bile ok in renal insufficiency - rapid

30

Biguanides - metformin

dec hepatic gluconeogenesis, dec insulin resistantce, dec weight, TG, chol
bestin obese pts with inc TGA
lactic acidosis
avoid in renal failure