Flashcards in Midterm Review Deck (46)
What is the rate limiting step for all steroidogenic pathways?
StAR (steroidogenic acute regulatory) mediation of cholesterol uptake from cytosol to inner mitochondrial membrane
What determines the major steroid production of each gland?
Thyroid hormones act via _______ receptors to increase _________________(2).
Transcription and translation (slow)
Steroid hormones act on _________ or _________ receptors to increase ___________________(2).
Cytoplasmic - cortisol
Nuclear - estrogen
Transcription and translation
Peptide hormones and catecholamines act on ______________ receptors and activate _________________.
Secondary messengers (fast)
Glycoproteins (LH, FSH, TSH, and hCG) specificity comes from which subunit?
Alpha is the same
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)
In a woman with a mildly elevated prolactin level what is the most likely cause?
Non-secreting pituitary adenoma
What is the first line treatment for prolactinoma with vision changes?
Dopamine agonists - Cabergoline
If you suspect GH deficiency what test should you administer?
Arginine Clonidine Stimulation test
What are the main causes of primary adrenal insufficiency?
AI destruction, Adrenal leukodystrophy, CAH, Infiltrative, Adrenal Hemorrhage, Drugs
What 4 drugs can cause primary adrenal insufficiency?
Ketoconazole, etomidate, metryapone, mitotane
What is adrenoleukodystrophy?
Accumulation of Long chain fatty acids in adrenal gland and brain
If you are concerned for Cushing's what test do you order? What is the confirmatory result?
2 elevate late night salivary cortisol
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
If you suspect primary hyperaldosteronism what test do you order? What is the confirmatory result?
Plasma Aldosterone Conc:Plasma Renin Activity
What are the 2 main causes of primary hyperaldosteronism
Aldosterone secreting adenoma
Bilateral Adrenal Hyperplasia
What two drugs do you use to treat Primary Hyperaldosteronism? What is the main side effect?
Spironolactone and Eplerenone - Block Aldosterone/MC receptor
What is Liddle's Syndrome and how do you treat it?
Constitutively active ENaC - Amiloride and triamterene
What is the first test to order when a patient presents with elevated calcium, fatigue, nausea, and polyuria?
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
What are the two most common causes of PTH-independent hypercalcemia?
Cancer and Granulomatous Disease
What are the 3 most common causes of secondary hyperparathyroidism?
Kidney failure, vitamin D deficiency, or bowel disease
What types of patients are bisphosphonates contraindicated in?
GFR < 35
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
How do you follow up on a patient w/ secondary or tertiary hypothyroidism beginning levothyroxine?
T4/T3 - aim for middle of normal
What is the goal A1c for diabetics?
What is the longest acting insulin?
Glargine - pH sensitive
Glipizide, glyburide and glimepiride belong to which class of drugs? What is their mechanism of action?
Stimulate insulin secretion from the pancreas?