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269 Cards in this Set
- Front
- Back
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These glands are ductless and highly vascularized.
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Endocrine glands
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What structure acts as the primary driver (ie. gas and brake) of the endocrine system?
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Hypothalamus
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With respect to the endocrine system, who is Captain Picard and who is Riker?
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"Picard = hypothalamus
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A tertiary endocrine disorder has to do with:"
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"Primary: Glands or hormones.
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What's the scientific name for the posterior lobe of the pituitary gland? What hormones does it secrete?"
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"Anterior lobe = adenohypophysis
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What's the difference between impotence and decreased libido? Oversecretion of what pituitary hormone will cause both of these problems in men?
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"impotence = inability to maintain an erection;
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What is the most common pituitary disorder, by far?
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Prolactinomus
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This hormone promotes metabolism and growth.
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Growth Hormone
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This hormone promotes synthesis and secretion of glucocorticoids. (ie. promotes gluconeogenesis)
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Adrenocorticotropic Hormone
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This hormone promotes release of mineralocorticoids and adrenal androgens.
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Adrenocorticotropic Hormone
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Addison's disease is (hyper-/hypo-)secretion of what hormone?
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Hyposecretion of Adrenocorticotropic Hormone (ACTH)
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This pituitary hormone promotes spermatogenesis in males.
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Follicle-Stimulating Hormone (FSH)
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This pituitary hormone stimulates the growth of ovarian follicles and produces estrogen in women.
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Follicle-Stimulating Hormone (FSH)
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This pituitary hormone stimulates testosterone synthesis in males.
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Lutenizing Hormone (LH)
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This pituitary hormone stimulates the synthesis of estrogen and progesterone from the corpus luteum in women.
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Lutenizing Hormone (LH)
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This pituitary hormone acts on the kidney to promote reabsorption of water into circulation.
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Arginine vasopressin (ADH)
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This pituitary hormone, in very high doses, is a potent vasoconstrictor.
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Arginine vasopressin (ADH)
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What does Diabetes Mellitus and Diabetes Insipidus have in common?
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They're both called Diabetes. …So, nothing.
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This pituitary hormone stimulates uterine contraction.
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Oxytocin
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This pituitary hormone stimulates the ejection of milk in lactating women.
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"Oxytocin
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This pituitary hormone promotes trust in humans.
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Oxytocin
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Thyroid-Stimulating Hormone (TSH)
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Some movie quote about having too much testosterone."
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Follicle-Stimulating Hormone (FSH)
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Lutenizing Hormone (LH)
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Why do folks with ACTH hypersecretion get acne?
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Because the body can't mobilize the white blood cells due to the immune dampening.
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What is the most common cause of hyperpituitarism?
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Pituitary tumor (adenoma)
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Is a pituitary tumor secretory or nonsecretory?
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"Could be either.
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This type of adenoma is one that the pt doesn't notice so much, but results in the pituitary getting huge. Causes a lot of eye signs, so ODs are likely the ones to catch it.
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"Nonfunctional" adenoma, in which hormone release is blocked.
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What age range is the peak incidence for pituitary tumors?
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40-60
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Most pituitary tumors are benign."
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"True.
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If it is less than 1 cm, it's called:"
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"Macroadenomas = > 1 cm
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What is the #1 most common disorder seen due to pituitary adenoma?
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Hyperprolactinemia
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What are the most common disorders (3) seen due to pituitary tumors? What is the result of those disorders?
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"1. Hyperprolactinemia: amenorrhea, galactorrhea, impotence
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Can a person have hypopituitarism with compressive macroadenomas?
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Yep.
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What ocular manifestations will you see with microadenomas?
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None. Pituitary's not big enough to cause any problems.
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What cranial nerves will end up having problems when a macroadenomas pituitary gland encroaches on the cavernous sinus?
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III, IV, VI, and the ophthalmic and maxillary divisions of CN V
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What visual field defects will you find with a macroadenomas pituiatry tumor?
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Bitemporal hemianopsia (usually bitemporal - not necessarily).
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When you get bitemporal hemianopsia from a macroadenomas pituitary tumor, how would you describe the progression of field loss?
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Superior temporal field is usually first affected. Field loss works its way inferior from there.
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Might you experience headache with a macroadenomas pituitary tumor?
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"You bet your sweet muffins you could get a headache from that.
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What's the "only good method to visualize microadenomae"?
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MRI with gadolinium
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Besides imaging, what's the other way to diagnose a pituitary tumor?
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Lab testing for individual hormone levels.
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What is the most common therapeutic approch to a pituitary tumor?
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"Scrub down and gown up.
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What therapeutic approach to pituitary tumors is rarely done alone, and usually combined with some degree of pharacologic treatment?
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Radiotherapy
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What is the most common wat that the hypothalamus puts the brakes on the pituitary?
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"Dopamine
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You can have a virtually destroyed pituitary gland, and it will still be releasing what hormone?
|
"Prolactin.
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What two hormones originate in the posterior lobe of the pituitary gland?
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Arginine vasopressin (ADH) and Oxytocin
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Is it likely that someone would notice a prolactinoma? Under what circumstances?
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If the pt is a women, yes. This is because a prolactinoma will change the menstral cycle.
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Approximately 60% of pituitary adenomas secrete what hormone?
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Prolactin
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Another cause of hyperprolactinemia is hypothyroidism. Why?
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"Since Hypothyroidism is the thyroid slacking off, there tends to be an increase in Thyroid Releasing Hormone (TRH) in an attempt to raise the thyroid's activity. Turns out, TRH also causes prolactin release.
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Why would antidepressants or cimetidine ("Tagamet" - an H2 inhibitor) cause hyperprolactinemia?
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"Because they interfere with dopamine activity.
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What are the clinical features of hyperprolactinemia? What's the big one?
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"Amenorrhea,
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What's the #1 thing that ODs get coming in the door?"
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Headaches
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When you suspect a pituitary adenoma, what's the first thing you should ask about?
|
Menstrual cycle
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What are the two options we got for management (not medical therapy) of hyperprolactinemia?
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Transsphenoidal adenectomy and/or radiotherapy
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What medical therapy approach is used on a pt with hyperprolactinemia in order to potentially decrease the size and hormone production of the pituitary gland?
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Dopamine agonists
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What is the most common dopamine agonist, by far, used to treat a pt with hyperprolactinemia?
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Bromocriptine
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What is cabergoline used for?
|
Tx of hyperprolactinemia @ .25 mg po or vaginally 2x per week
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What is acromegaly?
|
excessive GH in adults
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What are some signs/symptoms of acromegaly?
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HA, hand and feet enlargment, OA, entrapment neuropathies, abnormal glucose tolerance, HF
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What is a tx for acromegaly?
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Transsphenoidal adenectomy and/or radiotherapy
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What are two drugs used to treat acromegaly?
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octreotide, lanreotide
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If the acromegaly is the result of a tumor producing GH, what is a common tx?
|
dopamine agonists (bromocriptine, cabergoline)
|
|
What are GH antagonists used for?
|
acromegaly
|
|
Name a GH antagonist
|
pegvisomant
|
|
What is pegvisomant's mechanism
|
binds to GH receptor
|
|
What is Cushing's dx?
|
hypercortisolism
|
|
What is the most common cause of Cushing's syndrome?
|
exogenous steroid use
|
|
What % of Cushing's syndrome does Cushing's disease account for?
|
> 50%
|
|
Who is most at risk for Cushing's dx?
|
women, 5x > men
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What is the typical onset of cushing's dx?
|
3rd or 4th decade
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|
What is the most common natural cause of Cushing's dx?
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ACTH producing adenoma
|
|
What is primary adrenocortical hyperplasia?
|
ACTH independent Cushing's syndrome
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|
What % of Cushings dx is from cortical neoplasm?
|
15-30%
|
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What is ectopic ACTH secretion?
|
when a neoplasm located outside of the pituitary produces ACTH inducing 15% of Cushing's dx cases
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|
What is Cushing's syndrome?
|
A gradual and subtle hypercortisolism
|
|
What are early signs of Cushing's syndrome?
|
HTN and weight gain
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|
What are later signs of Cushing's syndrome?
|
truncal obesity, moon faces, buffalo hump, muscle/strength loss
|
|
What dx has 20% of pt's present with hyperglycemia, glucosuria, and polydipsia?
|
Cushing's Syndrome
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|
What dx presents hirsutism (increased hair production)
|
Cushing's Syndrome
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|
Cataracts are signs of what dx?
|
Cushing's Syndrome
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|
Mental disturbances can be found in:
|
Cushing's Syndrome
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What is dexamethosone used to diagnose?
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Cushing's Syndrome
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What dx has impaired glucose tolerance because of increased insulin resistance?
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Cushing's Syndrome
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Why are adrenal carcinoma's hard to treat
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metastasis to lungs and liver
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What is primary hyperaldosteronism?
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increased aldosterone secretion
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What is the main cause of primary hyperaldosteronism?
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aldosterone secreting adenoma (60-80%)
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What is Conn's syndrome?
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aldosterone secreting adenoma (60-80%)
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What dx causes HTN and hypokalemia?
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primary hyperaldosteronism
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What is secondary hyperaldosteronism?
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aldosterone release due to renin-angiotensin activation
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What is acute adrenal insufficiency?
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sudden withdrawal of exogenous steroids
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What physiolocig change causes acute adrenal insufficency
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adrenal cortex atrophy
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What is Addison's dx?
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autoimmune chronic adrenal insufficiency
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What precipitates Addison's dx?
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autoimmune attack of adrenal cortex
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What used to cause 90% of addison cases?
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TB
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What causes 60-70% of Addison's dx?
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autoimmune adrenalitis
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What are 4 clinical signs of Addison's dx?
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GI problems, hypotension, hyperpigmentation, fatigue/weakness
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Where are chromaffin cells found?
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adrenal medulla
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What do chromaffin cells do?
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secrete catecholamines
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What is pheochromocytoma?
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chromaffin cell neoplasms
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Are pehochromocytoma's common?
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NO
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|
ten percent tumor?
|
pheochromocytoma
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How is pheochromocytoma treated?
|
surgical removal
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|
What are clinical features of pheochromocytoma?
|
"abrupt HTN, tachycardia, palipatations, tremor
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Name the features that occur 10% of the time with pheochromocytoma (7 things)
|
"1. malignant
|
|
What fill the follicles in the thyroid?
|
thyoglobulin
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|
What systemic hormones are bound to plasma proteins?
|
T3 and T4
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Do thyroid hormones have to be unbound from plasma proteins to trigger a response?
|
yes
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|
What does T3 and T4 upregulate?
|
carb metabolism, lipid metabolsim, protein synthesis
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What is thryotoxicosis?
|
hypermetabosim due to T3 and T4
|
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What are common causes of thyrotoxicosis?
|
"Anything that ups thyroid hormone release:
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What is rare cause of pituitary tumor?
|
thyrotoxicosis
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What dx can be caused by weight loss herbal supplements?
|
thyrotoxicosis
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What dx presents hypermotility of the gut and lid retraction due to Mueller's muscle?
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thyrotoxicosis
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|
What is the prevalence of Graves Dx?
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.4-1% of U.S. population
|
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Who is most at risk for Graves dx?
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Women, 7x > men
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What is the peak age for Graves onset?
|
20-40
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What gene is Graves dx associated with?
|
HLA-DR3
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What kind of hypersensitivy is Graves?
|
Type V
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What Ab are present in Graves?
|
"TSH receptors
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What is Grave's dx triad?
|
"thyrotoxicosis
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What dx causes diplopia upon upgaze?
|
Graves
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What is Dalrymples sign?
|
lid retraction and lid lag seen in Graves
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What is one cause of keratitis dry eye?
|
Graves
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What is one cause of compressive optic neuropathy?
|
Graves
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When is medication the best tx for Graves?
|
young pts with mild disease
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when is surgery the best tx for Graves?
|
large goiter or severe dx; unwilling to take meds
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|
What is radioactive iodine used for?
|
to treat Graves in pt's generally older than 30 to 40
|
|
Are beta blockers useful in Graves dx tx?
|
yes
|
|
name two drugs that decrease thyroid hormone synthesis
|
methimazole and propylthiouracil
|
|
What is the timeline for Graves meds?
|
give until euthyroid levels return, then taper to lowest dose. Continue for 1-1.5 yrs and hope for permanent remission
|
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What is the rate of permanent remission in Graves treated with medication?
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<20%
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What treatment can cause agranulocytosis?
|
Graves medication
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What is a rapid, highly succesful cure for hyperthyroidsim?
|
subtotal thyroidectomy
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What are collateral risks of subtotal thyroidectomy?
|
pt must be hospitalized, risk of hypothyroidism, damage to laryngeal nerve
|
|
What is radioactive iodine's cure rate?
|
Almost 100%
|
|
What is the disadvantage of radioactive iodine tx?
|
hypothyroidism risk
|
|
What causes secondary hypothyroidism?
|
pituitary or hypothalamus dx
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What endocrine dx can cause bradycardia
|
hypothyroidsm
|
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What is L-thyroxine used to treat?
|
hypothyroidism and Hashimoto's thyroiditis
|
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What is another term for cretinism
|
infantile myxedema
|
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What is the historical cause of cretinsim
|
iodine deficiency
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What dx presents with impaired skeletal development/short stature?
|
cretinism
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Coarse facial features are caused by what dx?
|
cretinism
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What does infantile myxedema cause mental impairment?
|
if thyroid deficiency occurs in utero
|
|
What is Hashimoto's thyroiditis?
|
Type V hypersensitivity
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What is the demographic most affected by Hashimotos?
|
women 10-20x . Men; age 45-65
|
|
What is a "hot" nodule?
|
a benign nodule that takes up radioactive iodine
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What is one of the most common endocrine disorders?
|
hyperparathyroidism
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What causes 80-90% of hyperparathyroidsim?
|
parathyroid adenoma
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What dx presents increased calcium serum levels?
|
hyperparathyroidism
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Where do we see "painful bones, renal stones, abdominal groans, psychic moans" note: "Citek's lectures" is not an acceptable answer
|
hyperparathyroidism
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What is a rare cause of hypoparathyroidism?
|
autoimmune attack of parathyroid
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|
What is Trousseau's sign?
|
Inflation of BP cuff for 3 minutes causes carpal spasm
|
|
What is diabetes mellitus?
|
absolute lack of insulin
|
|
What causes 11% of vascular deaths?
|
DM
|
|
What is the leading cause of virus in the US?
|
DM
|
|
What are two other terms for metabolic syndrome?
|
synrdome X, insulin resistance syndrome
|
|
What risks are increased by metabolic syndrome?
|
DM increases 5x; cerebrovascular dx increases 3x
|
|
What are ways to control metabolic syndrome?
|
control BP, FPG, stop smoking
|
|
Who are most likely to get DM1?
|
northern europeans
|
|
What age is highest incidence of DM1?
|
10-14 yrs
|
|
What is suspected to trigger DM1?
|
beta cell viral infection
|
|
What does LADA stand for?
|
Latent Autoimmune Diabettes in Adults
|
|
What is LADA?
|
a slowly progressive form of DM1
|
|
Where is LADA seen most?
|
non obese pt's over 35
|
|
What is a common med to control LADA
|
sulfonylureas
|
|
What is more common, DM1 or DM2?
|
DM2 by far. 160/100k vs 6670/100k
|
|
What % of DM2 pts' are obese?
|
>80%
|
|
What is the physiologic cause of DM2
|
tissue resistance to insulin
|
|
What control sugar and fat entry into cells?
|
peroxisome proliferator-activated receptors (PPAR)
|
|
What presents with increased hepatic glucose production and impaired insulin secretion?
|
Obese DM2
|
|
What is DM1.5?
|
antibody positive DM2. This is NOT LADA
|
|
What is MODY?
|
majority onset diabetes of the Young
|
|
What type of Dm is found in thin, young adults
|
MODY
|
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What kind of DM is easily controlled with low-dose insulin, diet or oral agents?
|
MODY
|
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What DM is a "single gene" disorder
|
MODY
|
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MODY is a variant of:
|
DM2
|
|
What is gestational diabetes a form of?
|
DM2
|
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What is a risk factor for gestational diabetes?
|
obesity
|
|
What is the first and second tx for gestational diabetes
|
diet, but may require insulin
|
|
Gestational diabetes increases the risk of what later in life?
|
DM2
|
|
What are 4 classic signs of DM?
|
polyuria, polydipsia, fatigue, weight loss
|
|
What dx triggers fasting metabolism?
|
DM
|
|
Gluconeogenesis and glycogenolysis are seen elevated in what dx?
|
DM
|
|
What is seen in the urine of DM pt's?
|
glucose, excess H2O
|
|
What systemic effects can increased glucose levels cause?
|
decreased WBC activity, increased microorganisms
|
|
What does the body do if no insulin can be utilized?
|
turns to glycogen for fuel. Liver metabolizes FFA into ketones
|
|
What is the result of excess ketone body metabolism?
|
ketoanemia, ketonuria, ultimately ketoacidosis
|
|
What is the classic plasma glucose level that indicates DM?
|
>200 mg/dL
|
|
What is the fasting glucose level for DM?
|
>126 mg/dL
|
|
2 hrs after a glucose tolerance test is begun, what level of glucose will indicate DM
|
>200 mg/dL
|
|
Nephropathy is a long term complication of what?
|
DM
|
|
What is the major cause of DM1 death?
|
kidney failure
|
|
What is the 2nd leading cause of DM1 death?
|
MI
|
|
What is microalbuminuria?
|
the first clinical sign of nephropathy, bad sign for DM1 pts
|
|
Atherosclerosis in accelerated in what dx?
|
DM2
|
|
What is macrovascular dx?
|
leading cause of death in DM2
|
|
What is peripheral vascular dx?
|
poor circulation in peripheral tissues
|
|
What causes >50% of amputations in DM pts?
|
peripheral vascular dx (PVD)
|
|
How much more likely is a DM pt to get PVD?
|
4x
|
|
What are irreversible advanced glycosylated end products (AGE's)
|
nonenzymatic binding of glucose to proteins
|
|
What do AGE's accelerated?
|
atherogenesis and trapped LDL
|
|
What causes thickened, leaky BM in capillaries and glomeruli?
|
advanced glycosylated end products (AGEs)
|
|
What does aldose reductase do?
|
In hyperglycemia, it metabolizes glucose to sorbitol and then fructose
|
|
What does increased fructose and sorbitol do to a cell?
|
increases osmolarity, cell sweels
|
|
What does cellular swelling increase risk for?
|
oxidative stress and damage to the cell
|
|
What compound can impair ion pumps and lead to damage of Schwann cells and pericytes?
|
sorbitol
|
|
What does protein kinase C activation cause?
|
angiogenesis, vascular permeability
|
|
Where is protein kinase C (PKC) related complications seen?
|
DM
|
|
What are PARP's?
|
polyADP ribose polymerase
|
|
What do PARP's do?
|
increase apoptosis and increase endothelial damage
|
|
What dx are complicated by PARP's?
|
DM
|
|
What does heparin do?
|
anti atherogenic
|
|
What dx presents heparin as a compounding problem
|
DM
|
|
What is associated with poor control of Dm?
|
depression
|
|
What is the goal for HbA1c levels in DM?
|
<7.0%
|
|
What are downsides to insulin tx
|
injections, can cause hypoglycemia, weight gain
|
|
Humulin, iletin and Novolin are used to treat what disease?
|
DM
|
|
What are humulin, iletin, and novolin?
|
insulin
|
|
What are the fastest acting insulins?
|
insulin aspartate (Novolog) and insulin glulisine (apidra)
|
|
What are long acting insulins?
|
insulin glargine and detemir
|
|
What is a thrice weekly insulin tx that is still being evaluated?
|
insulin degludec
|
|
What is Neutral Protamine Hagedorn?
|
A mix of regular with protamine zinc insults (PZI's)
|
|
What is the onset of Neutral Protamine Hagedorn?
|
2 hrs onset
|
|
What is the peak of neutral protamine hagedorn?
|
6-14 hrs
|
|
What is the duration of neutral protamine hagedorn?
|
24 hrs
|
|
What are lente insulins?
|
zinc-insulin mixtures
|
|
What dx presents difficulty going up stairs due to loss of pelvic girdle muscles?
|
Cushing's Syndrome
|
|
What is semilente?
|
a short acting precipitate of insulin with zinc ions
|
|
What type of DM is considerd the 'worst of both worlds'?
|
DM1.5
|
|
Why are insulins often sold in different mixtures?
|
To alter duration and dosing times
|
|
What are the common methods of insulin delivery?
|
"injection: allows mixing of insulin
|
|
What is the most comfortable, but expensve way to dose insulin, a method only appropriate for responsible, compliant pts?
|
insulin pump
|
|
What are alternative (less common) insulin delivery methods
|
"Oral, uses 'microsphere' to avoid gastric denaturing
|
|
What is buccally absorbed insulin approved for?
|
DM1 AND DM2
|
|
What are two kinds of insulin delivery that have NOT had good results
|
nasal insulin and insulin patches
|
|
What is pramlintide acetate?
|
a synthetic hormone that slows gastric emptying
|
|
What pramlintude aceteate used for?
|
To help pt's who need to control their DM1 and DM2 more effectively
|
|
What is exanatide?
|
a drug for DM2 that slows gastric emptying; an incretin that signals "full" to the system
|
|
What is liraglutide?
|
used if metformin fails for DM2 pt's
|
|
What are biguanides used for?
|
first line for obese DM pt's
|
|
What two phsyiological processes do biguanides effect?
|
decrease gluconeogenesis in liver; increase skM glucose uptake
|
|
What are common biguanides?
|
metformin, glucovance, avandamet
|
|
What biguanide is mixed with a thiazolidinedione?
|
avandamet = metformin + rosiglitazone
|
|
What are thiazolidinediones
|
Insulin sensitizer
|
|
What is an important side effect of rosiglatazone?
|
Cardiac risk! May be recalled
|
|
What do alpha glucosidase inhibitors do?
|
slow down carb breakdown, decrease glucose absorption
|
|
Name 2 alpha glucosidase inhibitors
|
acarbose, miglitol
|
|
What are oral sulfonylureas?
|
Stimulate release of insulin
|
|
Name 3 second generation sulfonylureas
|
glipizide, glyburide, glimepiride
|
|
Do sulfonylureas increase cardiac related death?
|
yes
|
|
What is meglitinide?
|
stimulates insulin release from functioning beta cells
|
|
What does nateglinide do?
|
It is an amino acid derivatve that stimulates rapid, short insulin secretion
|
|
Dipeptidyl peptidase: What is it?
|
triggers more insulin release, decreases liver production of glucose
|
|
What is a DPP-4 inhibitor
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dipeptidyle peptidase inhibitor
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What kind of messenger tells us the stomach is full?
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incretins
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What is an alternative speculation on the cause of DM?
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malfunctioning pain neurons in pancreas
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What was used to treat pancreatic neuropathy to restore insulin production in mice?
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Capsaicin. It killed the sensory nerves in the pancreas
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What does FPG stand for?
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fasting plasma glucose
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What does FPG monitor?
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glucose levels
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When is a fasting plasma glucose (FPG) test administered?
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After an 8-16 hr fast (only water permitted)
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When is urine testing used to monitor glucose levels?
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when pt's wont use home blood tests, it is less accurate.
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What is the common abbreviation for the glycosylated hemoglobin test?
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HbA1c
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What does hbA1c measure?
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avg glucose levels over the last 6-8 wks
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What is fructosamine?
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Used to find glucose levels over previous 2-3 weeks.
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When is fructosamine used?
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to monitor glucose levels when a shorter window needs to be assessed, often after a change in the tx plan is made.
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What does HBGM stand for?
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home blood glucose monitoring
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What does the Guardian Real-Time system monitor?
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glucose levels every 5 minutes
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What is the glucowatch?
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a new glucose monitoring system that measures through the skin
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