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Flashcards in Midterm Review Deck (46)
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1

What is the rate limiting step for all steroidogenic pathways?

StAR (steroidogenic acute regulatory) mediation of cholesterol uptake from cytosol to inner mitochondrial membrane

2

What determines the major steroid production of each gland?

Enzyme expression

3

Thyroid hormones act via _______ receptors to increase _________________(2).

Nuclear
Transcription and translation (slow)

4

Steroid hormones act on _________ or _________ receptors to increase ___________________(2).

Cytoplasmic - cortisol
Nuclear - estrogen
Transcription and translation

5

Peptide hormones and catecholamines act on ______________ receptors and activate _________________.

Cell surface
Secondary messengers (fast)

6

Glycoproteins (LH, FSH, TSH, and hCG) specificity comes from which subunit?

Beta
Alpha is the same

7

What is the order of longest half life to shortest between steroid hormones, peptides and proteins, and thyroid hormone?

Thyroid hormone (>99.5% bound)
Steroid hormone (90-98% bound)
Peptides/Proteins (free)

8

In a woman with a mildly elevated prolactin level what is the most likely cause?

Non-secreting pituitary adenoma

9

What is the first line treatment for prolactinoma with vision changes?

Dopamine agonists - Cabergoline

10

If you suspect GH deficiency what test should you administer?

Arginine Clonidine Stimulation test

11

What are the main causes of primary adrenal insufficiency?

AI destruction, Adrenal leukodystrophy, CAH, Infiltrative, Adrenal Hemorrhage, Drugs

12

What 4 drugs can cause primary adrenal insufficiency?

Ketoconazole, etomidate, metryapone, mitotane

13

What is adrenoleukodystrophy?

X linked
Accumulation of Long chain fatty acids in adrenal gland and brain

14

If you are concerned for Cushing's what test do you order? What is the confirmatory result?

2 elevate late night salivary cortisol

15

In ACTH dependent Cushings, without an obvious tumor (small cell lung) elsewhere, and a normal pituitary MRI, what is the next step?

Bilateral inferior petrosal sinus sampling - tumors are most often in the pituitary

16

If you suspect primary hyperaldosteronism what test do you order? What is the confirmatory result?

Plasma Aldosterone Conc:Plasma Renin Activity
~20-30

17

What are the 2 main causes of primary hyperaldosteronism

Aldosterone secreting adenoma
Bilateral Adrenal Hyperplasia

18

What two drugs do you use to treat Primary Hyperaldosteronism? What is the main side effect?

Spironolactone and Eplerenone - Block Aldosterone/MC receptor
Hyperkalemia

19

What is Liddle's Syndrome and how do you treat it?

Constitutively active ENaC - Amiloride and triamterene

20

What is the first test to order when a patient presents with elevated calcium, fatigue, nausea, and polyuria?

Serum PTH

21

After surgery, what is the next best choice to treat primary hyperparathyroidism?
What if the patient had renal failure?
What if it was due to a parathyroid adenoma?

Cinacalcet - CaSR Agonist
Always Cinacalcet

22

What are the two most common causes of PTH-independent hypercalcemia?

Cancer and Granulomatous Disease

23

What are the 3 most common causes of secondary hyperparathyroidism?

Kidney failure, vitamin D deficiency, or bowel disease

24

What types of patients are bisphosphonates contraindicated in?

GFR < 35

25

How do you follow up on a patient w/ Hashimoto's Thyroiditis after starting levothyroxine?

Check serum TSH 6 weeks after starting - time to reach steady state - half life is about 1 week

26

How do you follow up on a patient w/ secondary or tertiary hypothyroidism beginning levothyroxine?

T4/T3 - aim for middle of normal

27

What is the goal A1c for diabetics?

<7%

28

What is the longest acting insulin?

Glargine - pH sensitive

29

Glipizide, glyburide and glimepiride belong to which class of drugs? What is their mechanism of action?

Sulfonylureas
Stimulate insulin secretion from the pancreas?

30

What is the difference between Meglitinide and Glipizide?

Meglitinide is shorter acting - both bind the same receptor and inc. insulin secretion