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*DOOS 2 > Thyroid > Flashcards

Thyroid Flashcards

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1
Q

what does GH hypersecretion lead to in childhood?

A

gigantism

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2
Q

what does GH hypersecretion lead to in adults

A

acromegaly

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3
Q

what most often causes hypersecretory GH

A

pituitary adenoma

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4
Q

ACTH levels are ________ in adrenal insufficiency because of the primary adrenal disorder.

A

normal to high

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5
Q

ACTH is ___________ in adrenal insufficiency secondary to hypothalamic-pituitary hypofunction

A

low to absent

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6
Q

what metabolism does GH affect?

A

carbohydrate metabolism

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7
Q

How do deficiencies of GH manifest in children?

A

growth delays and fasting hypoglycemia

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8
Q

in adults how do growth hormone deficiencies manifest?

A

abdominal girth
reduce strength
decreased lean body mass

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9
Q

cut off point between micro and macro adenomas

A

<1 cm is microadenoma

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10
Q

An amino acid secreted episodically by pituitary lactotrophs

A

Prolactin

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11
Q

what do estrogens increase?

A

PRL secretion

gluccocorticoids

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12
Q

Is PRL needed to maintain lactation after nursing has begun?

A

No

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13
Q

PRL levels greater than what are highly suggestive of PRL-secreting adenomas

A

> 200 ng/ml

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14
Q

what hormone is checked for growth hormone problems?

A

IGF-1

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15
Q

in men with a prolactinoma what will be suppressed?

A

testosterone

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16
Q

A glycoprotein hormone synthesized & secreted by pituitary thyrotroph cells .

A

Thyroid stimulating hormone (TSH)

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17
Q

Normal TSH level?

A

1.5-5.0

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18
Q

what do anterior pituitary deficiency result in?

A

leads to growth retardation, deficient or absent lactation, hypogonadism, hypothyroidism & adrenal insufficiency.

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19
Q

what are common causes of anterior pituitary deficiency

A

tumor, infarction, necrosis, infection, autoimmune inflammatory processes, certain Rx & genetic anomalies.

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20
Q

2 posterior pituitary hormones

A

oxytocin

ADH

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21
Q

Diagnostics of chronic for anterior pituitary deficiency

A

IGF-1; plasma testosterone, TSH, Free T4, and plasma cortisol response to synthetic ACTH

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22
Q

mot common functioning tumor

A

prolactinoma

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23
Q

Caused by pituitary adenoma causing excess GH or excess GHRH

Link to the MEN-I gene (Multiple Endocrine Neoplasia)

A

acromegaly

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24
Q

⇑ growth of jaw, hands, feet & internal organs

occurs if disease hits before closure of epiphyses

A

Gigantism

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25
other random features of acromegaly
moist palms CTS deep, coarse voice sleep apnea
26
most reliable lab study for possible acromegaly
IGF-1
27
most common presentation of prolactinoma
amenorrhea
28
Tx for acromegaly
endoscopic trans-sphenoidal surgery remains the treatment of choice tx failure- sterotactic radiosurgery used in tx failures
29
is most galactorrhea due to prolatcinoma
no, only 40-45%
30
other txs besides surgery for acromegaly
dopamine agonists (bromocriptine, pergolide, cabergoline) somatostatin radidation
31
Short limbs & long narrow trunks, lg. head & mid-face hypoplasia & prominent brow Intelligence is normal
achondroplastic dwarfism :)
32
complications of achondroplastic dwarfism
leg bowing obesity dental problems frequent otitis media
33
Tx for prolactinoma
dopamine agonist- bromocriptine (qhs), cabergoline (2x weekly)
34
main side effect of dopamine agonists
naseau
35
signs of pituitary dwarfism
not apparent at birth | signs- micro-penis and hypoglycemia
36
gene mutation with achondroplastic dwarfs
mutations in FGFR3 gene
37
what does a lack of ADH cause
diabetes insipidus
38
diagnosis of diabetes insipidus
``` high serum osmolality >290 dilute and copious urine output polydipsia dehydration hypernatremia ```
39
tx for SIADH
DDAVP (synthetic vasopressin) intranasally that causes a 50% or greater increase in urine osmolality is diagnostic for diabetes insipidus
40
signs of prolactinoma in men
low sex drive low energy hot flashes
41
lab workup for men w/ low sex drive
total and free testosterone LH/ FSH prolactin TSH
42
what may nephrogenic diabetes insipidus respond to
HCTZ or in combo w/ indomethacin
43
Syndrome of high plasma ADH levels decreasing the serum osmolality ( <280mOsm/kg) , high urine osmolality
SIADH
44
what must you exclude before a dx of SIADH
Diagnosis must first exclude nephrotic syndrome, CHF, & cirrhosis by confirming thyroid, adrenal, renal & cardiac status.
45
what happens during a glucose tolerance test w/ acromegaly
growth hormone doesn't drop
46
The most common cause of ACTH-independent Cushing’s Disease
adrenal adenoma (<3 cm in diameter)
47
3 hormones released by adrenal
aldosterone cortisol epinephrine
48
what is cortisol involved in
stress hormone | sleep
49
what 3 hormones are involved in circadian rhythms
cortisol growth hormone adrenaline
50
common characteristics of cushings
truncal obesity, hypertension, striae, ecchymoses, proximal muscle weakness, hypokalemia, osteoporosis, and infertility.
51
what can cause false + labs for cushing's?
anti-seizure Rx oral contraceptives rifampin spironolocatone
52
first test is suspecting cushings
24 urinary free cortisol
53
if you order a 24 urine what else do you need to order
creatinine to know it it was an adequate collection
54
2nd screening test for cushing's
2mg dexamethasone suppression test | if it hasn't suppressed that is abnormal
55
3rd screening test for cushing's
8 mg dexamethasone and then check if it is suppressed (points to adrenal source)
56
if suppression did occur with high dexamethasone test where do you suspect the tumor to be?
pituitary
57
other conditions that can create a hypercortisol state
Depression, Alcoholism, Anorexia Nervosa, Panic disorder, & Withdrawal syndromes (from drugs of abuse - narcotics & alcohol)
58
what is cosyntropin
synthetic ACTH
59
with primary adrenal insufficiency what hormone will be high?
ACTH and MSH | will have hyperpigmentation
60
present w/ HTH difficult to control Persistent hypokalemia Impaired glucose tolerance
hyperaldosteronism
61
workup of hyperaldosteronism
Aldosterone suppression test combined with increased NaCl (po or IV) Spironolactone relieves - is diagnostic too CT of adrenals (hyperplasia or carcinoma)
62
who are most affected by hyperaldosternism
women
63
most common cause of primary adrenal insufficiency worldwide
``` TB autoimmune adrenalitis (industralized nations) ```
64
what conditions is prednisone use chronically and can lead to iatrogenic cushings
asthma RA IBD
65
what is myxedema
dough consistency due to high TSH (hypothyroidism)
66
other manifestations of myxedema
lethargy thick tongue slow mental functioning coarse hair
67
diagnostics for panhypopituiarism
``` IGF-1 (low) plasma testosterone (low) TSH (normal-low) Free T4 (low) plasma cortisol response to synthetic ACTH ```
68
benign tumor but when removed could possibly affect pituitary
craniopharyngioma
69
what usually causes hyperaldosteronism
adenoma
70
screening test for hyperaldosteronism
normalize the K+ then plasma, renin serum aldosterone (want ratio, will be high) 24 hour urine (look for aldosterone) CT scan of adrenal glands (no contrast)
71
test for hyperaldosteronism
saline suppression test | check aldosterone level before and after, confirmed if it doesn't suppress
72
what can cause hyperaldosteronism
bilateral adrenal hyperplasia or carcinoma
73
tx for hyperaldosteronism
spironolactone
74
what causes secondary hyperaldosteronism
from failure of pituitary secretion of ACTH | women affected more
75
main dx lab for addison's
Low 8AM plasma cortisol (< 5mg/dL) with elevated ACTH (> 200mg/dL) high ACTH level high plasma renin/low plasma aldosterone
76
test for pheochromocytoma
plasma free metanephrine and 24 hour urine catecholamines confirm w/ CT or MRI
77
Tumor producing excess of catecholamines & their metabolites
pheochromocytoma
78
how do patients w/ a pheochromocytoma present
Nearly all affected pts have episodic hypertension while over 50% have sustained HTN with associated headache, sweating, & palpitations.
79
what are pheos associated w/?
Neurofibromatosis Von Hippel-Lindau retinal angiomatosis Cerebellar hemangioblastoma Multiple endocrine neoplasia
80
treatment of choice for pheo
surgery
81
what must be done before surgery for a pheo
B/P controlled for1-2 weeks | use alpha-adrenergic blockers (sins) and beta blockers
82
Crisis tx for pheochromocytoma
regitine or nitroprusside to control BP

*DOOS 2 (11 decks)

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