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Flashcards in Exam IV: Endocrine Deck (16):

Where is TSH secreted from?

Anterior pituitary


Types of Insulin: Rapid, Short, and Long Acting

Rapid acting: insulin aspart, lispro, glulidine
onset ranges from 10-30 minutes
peak ranges from 30-90 minutes
duration ranges from 1-5 hours

Short acting: regular/endogenous, intermediate, and NPH (1st type available)
onset ranges from 30 min. - 2 hours
peak ranges from 2-12 hours
duration ranges from 5-24 hours

Long acting: glargine, detemir, degludec, inhaled, and human insulin liquid
onset ranges from 5 min-2 hours
peak ranges from none to 8 hours
duration ranges from 5-24 hours


Insulin Dosage Regimen: Long, Rapid, and NPH

Long-acting insulin (glargine/detemir) once or twice a day

Rapid acting insulin (Aspart, glulisine, lispro) before meals and as need to correct high blood sugars delivered via an insulin pump.

Three small doses of NPH before meals, and a larger dose of NPH at night, with rapid acting insulin (aspart, glulisine, lispro) before meals and, as needed, for snacks and to correct high blood sugars


Regulation of Aldosterone

Ang II to Aldosterone via ARBs (Ang II Receptor Blocker)
Ang II not blocked, but aldosterone levels lowered causing vasoconstriction


Products Used for Thyroid Treatments: Hypothyroidism

T4 only (synthetic): levothryroid, levoxyl, synthroid, unithroid

T3 only (synthetic): liothyronine, cytomel

T4/T3 combo (synthetic): liotrix, euthroid, thyrolar

T4/T3 (bioidentical/natural): armour, nature-thyroid, westhroid, desiccated thyroid


Treatment of Hyperthyroidism

Antithyroid agents, surgery, and RAI (radioactive iodine) low dose treatment
The goal to eliminate excessive thyroid hormone production and to control the symptoms
Antithyroid agents are used short-term either to induce remission of Graves disease or to control the symptoms of hyperthyroidism before thyroid surgery or RAI (high doses)
Either surgery or RAI result in hypothyroidism which necessitates life long thyroid hormone replacement therapy

Thioamide drugs (methimazole and propylthiouracil (PTU)), beta adrenoceptor antagonists, iodide salts, and RAI


Where is TRH secreted from?



What is long acting insulin attached to?

Long acting insulin attached to albumin


Which medication can cause lactic acidosis?

Metformin (Glucophage)


Anti-diabetic med that increases renal excretion of glucose

Selective SGLT2 inhibitors have a novel & unique mechanism of action reducing blood glucose levels by increasing renal excretion of glucose


What is gluconeogenesis?

Glucagon raises blood glucose by increasing the rates of glycogen breakdown (glycogenolysis) and glucose manufacture by the liver (gluconeogenesis)


What is the main characteristic of Type I diabetes?

Type 1 characterized by destruction of beta cells in the pancreas


Acute Addison’s disease treatment

Caused by abrupt stopping of corticosteroid medication
IV administration of hydrocortisone for 48 hours


Signs and Symptoms of Cushing's Disease

General: central obesity, proximal muscle weakness, HTN, headaches

Dermatologic: wide purple striae, spontaneous ecchymoses, facial plethora (moon face), hyperpigmentation, acne, hirsutism, fungal skin infections

Endocrine/Metabolic: hypokalemic alkalosis, hypokalemia, osteopenia, hypogonadism, glucose intolerance, hyperlipidemia, hyperhomocysteinemia, kidney stones, polyuria, hypercoagulability

Neuropsychiatric: insomnia, depression, frank psychosis, impaired cognition and short-term memory


Test to Confirm Cushing's Disease

Low dose dexamethasone suppression test
Free cortisol urine level
A single dose of dexamethasone is given orally at 11pm
Cortisol plasma level is done at 8am the following morning
Dexamthasone will suppress corticotropin secretion by the pituitary and cortisol plasma levels will be under 5mcg/dl
In Cushing syndrome dexamethsone will not suppress corticotropin and the cortisol level will be greater than 10mcg/dl


Type II diabetic oral agent side effects

1. Sulfonylureas: hypoglycemia
2. Alpha Glucosidase Inhibitors: bloating and diarrhea
3. Biguanides: lactic acidosis
4. Glitazones: heart failure