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PP Endo Flashcards

0
Q

What is a Thyrotrope?

A

TSH

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1
Q

What is a Gonadotrope?

A

LH, FSH

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2
Q

What is a Corticotrope?

A

ACTH

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3
Q

What is a Lactotrope?

A

PRL

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4
Q

What are the steroid hormones?

A 
"PET CAD"
Note: thyroid hormone acts like a steroid
Progesterone 
E2
Testosterone 
Cortisol
Aldo
Vit D
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5
Q

What organs do not require insulin?

A 
"BRICKLE"
Brain
RBC
Intestine
Cardiac, Cornea
Kidney
Liver
Exercising muscle
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6
Q

What does GnRH do?

A

Stimulates LH, FSH

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7
Q

What does GRH do?

A

Stimulates GH

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8
Q

What does CRH do?

A

Stimulates ACTH

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9
Q

What does TRH do?

A

Stimulates TSH

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10
Q

What does PRH?

A

Stimulates PRL

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11
Q

What does oxytocin do?

A

Milk letdown, baby letdown

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12
Q

What does GH do?

A

IGF-1 release from liver

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13
Q

What does TSH do?

A

T3, T4 release from thyroid

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14
Q

What does LH do?

A

Testosterone release from testis, E2 and progesterone release from ovary

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15
Q

What does FSH do?

A

Sperm or egg growth

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16
Q

What does PRL do?

A

Milk production

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17
Q

What does ACTH do?

A

Cortisol release from adrenal gland

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18
Q

What does MSH do?

A

Skin pigmentation

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19
Q

What are the stress hormones?

A 
Epi: immediate
Glucagon: 20min
Insulin:30min
ADH: 30min
Cortisol: 2-4hr
GH:24hr
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20
Q

What is Diabetes Insipidus?

A

Too little ADH=> urinate a lot

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21
Q

What does ADH do?

A

Concentrates urine

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22
Q

What is Central DI?

A

Brain not making ADH

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23
Q

What is nephrogenic DI?

A

Blocks ADH receptors

Can be caused by Li and Domecocucline

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24
What does the water deprivation test tell you?
What're deprivation => DI ( fails to concentrate urine)
25
What does giving DDAVP tell you?
DDAVP => central DI | Concentrates >25%
26
What is SIADH?
To much ADH => expand plasma vol => pee Na
27
What is the difference b/w DI and SIADH?
DI has diluted urine | SIADH has concentrated urine
28
What is Psychogenic Polydipsia?
Pathologic water drinking => low plasma osmolarity
29
What does Aldosterone do?
Reabsorbs Na, secretes H/K
30
What is neuroblastoma?
Adrenal medulla tumor in kids Dancing eyes / feet Secretes catecholamines
31
What is pheochromocytoma?
Adrenal medulla tumor in adults, 5 P's : Pressure, Pain, Perspiration, Palpitation, Pallor Urinary VMA and plasma Catecholamines are elevated Treated first with alpha blocker and then the beta blocker
32
What does the zona Glomerulosa make?
Aldosterone "salt"
33
What does the zona Fasiculata make?
Cortisol "sugar"
34
What does the zona Reticularis?
Androgens " sex"
35
What is Conn's syndrome?
High Aldo ( tumor ) Decrease renin Treated with spironolactone
36
What does ANP do?
Inhibits Aldo | Dilates renal artery ( afferent arterioles)
37
What does Calcitonin do?
Inhibits osteoclasts => low serum Ca
38
What is MEN I?
Parathyroid hyperplasia Pituitary adenomas Pancreatic islet cell tumors ( gastrinomas { ZES}, insulinoma, VIPomas)
39
What is MEN 2A?
Medullary thyroid cancer Pheochromocytoma Parathyroid hyperplasia A/w Marfanoid habitus, RET gene
40
What is MEN 2B?
Medullary thyroid cancer Pheochromocytoma Oral/GI mucosal neuromas A/w Marfanoid habitus, RET gene
41
What does CCK do?
Gallbladder contraction, bile release
42
What does cortisol do?
"BIG FIB" Increase: BP, insulina resistance, gluconeogenesis, lipolysis, proteolysis. Decrease: fribroblast activity, inflammatory & immune response, bone formation.
43
What is Addison's syndrome?
Autoimmune destruction of adrenal cortex => hyperpigmentatio, increase ACTH, hypotension, hyperkalemia
44
What is Waterhouse Friderichsen?
Adrenal hemorrhage Commonly seen in children Associated with Neisseria meningitidis
45
What is Cushing's syndrome?
High cortisol ( pituitary tumor or adrenal tumor or small cell lung CA)
46
What is Cushing's disease?
High ACTH ( pituitary tumor)
47
What is Nelson's syndrome?
Hyperpigmentation after adrenalectomy
48
If the low-dose dexamethasone test suppresses, what does that tell you?
Normal Obese Depressed
49
If the low-dose dexamethasone test does not suppresses, what does that tell you?
Cushing's => do high dose test
50
If the high-dose dexamethasone test suppresses, what does that tell you?
Pituitary tumor => ACTH (call brain surgeon)
51
If the high-dose dexamethasone test does not suppress, what does that tell you?
Adrenal Adenoma => Cortisol (call general surgeon) | Small cell lung cancer => ACTH (call thoracic surgeon)
52
What are the survival hormones?
Cortisol: permissive under stress TSH: permissive under normal
53
What does Gastrin do?
Stimulates parietal cells => IF, H
54
What does GH do?
Growth Sends somatomedin to growth plates Gluconeogenesis by proteolysis
55
What is Achondroplasia = Laron Dwarf?
Abnormal FGF receptor in extremities
56
What is Acromegaly?
``` Adult bones stretch "my hat doesn't fit" Coarse facial features Large furrowed tongue Deep husky voice Jaw protrusion Increase IGF-1 b/c of GH tumor ```
57
What is Gigantism?
Childhood acromegaly
58
What does GIP do?
Enhances insulin action => post-prandial hypoglycemia
59
What does Glucagon do?
Gluconeogenesis Glycogenolysis Lipolysis Ketogenesis
60
What does Insulin do?
Pushes glucose into cells Increase Gycogen synthesis Increase TG synthesis Protein synthesis
61
What is Type I DM?
``` Anti-islet cell Ab GAD Ab Low insulin DKA Polyuria Polydipsia Polyphagia Ketoacidosis ```
62
What is Type II DM?
Insulin receptor insensitivity High insulin HONK coma Acanthosis nigricans
63
How does DKA presents?
Kussmaul respiration Fruity breath (acetone) Altered mental status Abd pain, vomiting * pt severely dehydrated with electrolyte abnormalities * Tx: fluids, k, insulin, bicarbonate
64
What is Factitious hypoglycemia?
Insulin injection ( increase insulin, decrease C-peptide)
65
What is an insulinoma?
Tumor ( increase insulin and C-peptide)
66
What is Erythrasma?
Rash in skin folds | Coral-red Wood's lamp
67
What are foot ulcer risk factor?
DM/ glycemic control Male smoker Bony abnormalities Previous ulcer
68
What conditions cause weight gain?
``` Obesity Hypothyroidism Depression Cushing's Anasarca ```
69
What does PTH do?
Chews up bone
70
What does Vit. D do?
Builds bone
71
What do stomach chief cell secrete?
Pepsin
72
What is the difference between Norepinephrine and Epinephrine?
NE: neurotransmitter EPi:hormone
73
What is 1 hyperparathyroidism?
Parathyroid adenoma
74
What is 2 hyperparathyroidism?
Renal failure
75
What is Familial Hypocalciuria Hypercalcemial?
Decrease Ca excretion
76
What is both serum Ca and PO4 decrease?
Vit D deficiency
77
What if serum Ca and PO4 change in opposite direction?
PTH problem - High Ca => hyper PTH - Low Ca => hypo PTH
78
What is the most common cause of 1 hypoparathyroidism?
Thyroidectomia
79
What is Pseudohypoparathyroidism?
Bad kidney PTH receptor | Decrease urinary cAMP
80
What is Psedopseudohypoparathyroidism?
G-protein defect | No Ca problem
81
What does Secretin do?
Secretion of bicarb Inhibit gastrin Tighten pyloric sphincter
82
What does Somatostatin do?
Inhibits secreting Motilin CCK
83
What do T3 and T4 do?
Growth | Differentiation
84
What disease has Exophthalmos?
Grave's
85
What disease has Enophthalmos?
Horner's
86
What is Plummer's syndrome?
Hyperthyroid Adenoma
87
What does Testosterone do?
Makes internal male genitalia
88
What does Müllerian Inhibiting Factor do?
Makes internal male genitalia
89
What does VIP do?
Inhibits secretin Motilin CCK
90
How does VIPoma present?
Watery diarrhea
91
Which hormones have the same alpha subunits?
- LH, FSH - TSH - beta-HCG
92
Which is the Triad for Hyperaldosteronismo?
HTN Hypokalmia Metabolic alkalosis
93
How are the TH levels in a pregnant woman?
Increase TBG Increase Total T3 and T4 Normal free T3 and T4
94
Which are the hypothyroidism disease?
Hashimoto's thyroiditis - painless nodule, most common Subacute thyroiditis ( de Quervains) - painful nodule, A/ w viral infection Riedel's thyroiditis - rock hard nodule, macro and eosino Cretinism - fetal hypothyroidism
95
Which are the hyperthyroidism disease?
Toxic Multinodular Goiter - mutation of TSH receptor Grave's disease - autoimmune hyperthyroiditis Thyroid Storm - surge of catecholamines
96
Which are the hyperthyroidism sings/symptoms?
``` Heat intolerance Increase appetite Hyperactivity Diarrhea Warm, moist skin; fine hair Chest pain, palpitation, arrhythmia, increase beta adrenergic receptor ```
97
Which are the hypothyroidism sings/symptoms?
``` Cold intolerance Decrease appetite Hypoactive, lethargic, fatigue, weakness Constipation Dry cool skin; brittle hair Bradycardia ```
98
Primary Hyperparathyroidism disease?
Parathyroid adenoma " Hyperplasia Malignancy
99
Secondary Hyperparathyroidism disease?
``` Chronic hypocalcemia Chronic renal disease Values: Decrease Ca Increase PTH and PO4 ```
100
Tertiary Hyperparathyroidism disease?
``` Chronic renal disease Parathyroid hyperplasia Hypercalcemia Values Increase Ca and PTH ```
101
What is a Somatotrope?
GH
102
Next Tx step for pt. With high TSH & high free T3 & T4?
MRI of pituitary gland * look for a TSH-secreting pituitary adenoma
103
Pt with untreated Hyperthyroid are at risk for?
- increase osteoclasts activity -> increase bone resorption, decrease bone density and increase bone Fx - Hypercalcemia & hypercalciuria fue to bone turnover - cardiac arrhythmia; A-fin
104
3 types of thyroiditis?
1. Chronic autoimmune thyroiditis “Hashimotos” - hypothyroidism features - diffuse goiter 2. Painless thyroiditis ( Silent thyroiditis) - mild, brief hyperthyroid phase - small, nontender goiter 3. Subacute thyroiditis “de Quervain” - post viral - fever & hyperthyroid symptoms - painful/ tender goiter
105
What do you test when evaluating Adrenal insuffficiency?
8am serum cortisol & plasma ACTH
106
MCC of Congenital hypothyroidism?
Thyroid disgenesis - increase TSH - decrease free T4 * Tx: Levothyroxine
107
Metabolic abnormalities in hypothyroidism
HLD - increase cholesterol alone or - increase cholesterol and triglyceride Hyponatremia A symptomatic elevation of - CK - serum transaminase AST, ALT
108
Euthyroid sick syndrome
"Low T3 syndrome " - characterized by: decrease total & free T3 with normal T4 & TSH * seen in pt with an acute, severe illnesse that may have abnormal thyroid function tests
109
Microangiopathy
Microvascular damage due to HYPERGLYCEMIA * eyes * kidney - diabetic microangiopathy due to more than 10 years of DM
110
Acid-base disturbance in Addison's disease
Non-anion gap Hyponatremic metabolic acidosis Hypercalemia
111
Hallmark of carcinoid syndrome?
Episodic flushing | -others: secretory diarrhea, wheezing, murmur from tricuspid regurgitation
112
Antibodies a/w Hashimoto's thyroiditis?
``` Anti thyroglobulin antibodies Antimicrosomal antibodies ( anti-TPO) ```
113
High radioactive iodine uptake suggests?
De Novo hormone synthesis due to: - Graves' disease - Toxic nodular disease
114
Low radioactive iodine uptake suggests?
Release of preformed thyroid hormone ( Thyroiditis) | Exogenous thyroid hormone intake
115
Elevated 17- hydroxyprogesterone level is diagnostic for?
CAH, particularly 21-hydroxylase defi
116
2 important causes of hypoglycemia in non-diabetic pt with elevated insulin level?
Insulinoma ( B cell tumors) Surreptitious use of insulin or sulfonylurea
117
Differential do for the Anterior mediastinal mass
"4T's" - thymoma - teratoma ( other giant cell tumor) - thyroid neoplasms - terrible lymphoma * Middle mediastinum-> Bronchogenic * Posterior mediastinum-> Neurogenic tumors
118
DKA abnormalities?
``` Metabolic acidosis Ketonemia & ketonuria Hyperglycemia Hyperkalemia (k) Hyponatremia ``` * decrease of insulin which results in increase lypolysis and increase ketone production
119
Active form of Vit. D?
Calcitriol
120
Failure to lactate Absent menstruation Cold intolerances Loss of hair
Sheehan syndrome | * ischemic infarcts of pituitary following postpartum bleeding
121
Diagnosis of hyperprolactinemia
1st-> prolactin level ( > 200ng/ml) 2nd but mos accurate -> MRI * get level of TSH to rule out hypothyroidism as the cause
122
High Urine Na (>20) in a pt with hyponatremia is consistent with?
Syndrome of Inappropriate ADH (SIADH)
123
``` Dermatitis ( necrolytic migratory erythema) Diabetes DVT Depression Diarrhea ```
Glucagonoma
124
Histology of DM type 1 & 2?
1-leukocytic infiltrate 2-islet amyloid polypeptide (IAPP) deposits
125
An increase in Estrogen activity ( due to: pregnancy, OCP, post-menopausal hormone replacement therapy) will result in?
Increase circulating TBG --> will decrease free T3 & 4 ( by binding to it) -----> which will signal an increase in TRH and TSH ------->> it will end up in the INCREASE OF TOTAL T3 &4
126
Medullary carcinoma
From parafollicular "c cell" Calcitonin production Amyloid stroma A/w MEN 2A & 2B ( RET)
127
17 alpha - hydroxylase defi.
Hormone: increase ALDO, decrease CORTISOL - increase BP, decrease K, decrease sex hormone - decreases Androstenedione
128
21-hydroxylase defi?
Decrease ALDOSTERONE & CORTISOL - decrease PB, increase K, increase sex hormone
129
Oral GTT is the preferred screening method for?
Gestational diabetes 1hr> 180 2hr> 155 3hr> 140 CF related diabetes

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