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Systemic Exam 2 Dr. Smith
Dr Smith's ppt turned into 300 stupefyingly boring questions
305
Medical
Pre-School
03/02/2011

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Cards

Term
These glands are ductless and highly vascularized.
Definition
Endocrine glands
Term
What structure acts as the primary driver (ie. gas and brake) of the endocrine system?
Definition
Hypothalamus
Term
With respect to the endocrine system, who is Captain Picard and who is Riker?
Definition
Picard = hypothalamus
Riker = pituitary gland
Term
A primary endocrine disorder has to do with:

A secondary endocrine disorder has to do with:

A tertiary endocrine disorder has to do with:
Definition
Primary: Glands or hormones.

Secondary: The pituitary gland not doing its job.

Tertiary: Even further up the chain of command, when the hypothalamus isn't doing its job.
Term
What's the scientific name for the anterior lobe of the pituitary gland? What hormones does it secrete?

What's the scientific name for the posterior lobe of the pituitary gland? What hormones does it secrete?
Definition
Anterior lobe = adenohypophysis
- Lactogenic hormone (aka Prolactin)
- GH
- ACTH
- TSH
- FSH
- LH

Posterior lobe = neurohypophysis
- Vasopressin (ADH)
- Oxytocin
Term
What's the difference between impotence and decreased libido? Oversecretion of what pituitary hormone will cause both of these problems in men?
Definition
impotence = inability to maintain an erection;
decreased libido = lack of sexual desire

Hypersecretion of Lactogenic hormone (prolactin) causes these in men.
Term
What does Lactogenic hormone (prolactin) do? Hypersecretion?
Definition
It aids in the development of mammary glands and physiologic functions of ovary, testes, and prostate. Hypersecretion: Women --> galactorrhea (inappropriate production of milk), amenorrhea ("without monthly flow") Men --> impotence, decreased libido Both --> headaches, infertility, weight gain
Term
Pituitary hormone problem:

Galactorrhea


What hormone?
Hyper- or hyposecretion?
Definition
Galactorrhea
(in women)

Hypersecretion of Lactogenic Hormone (prolactin)
Term
Pituitary hormone problem:

Amenorrhea


What hormone?
Hyper- or hyposecretion?
Definition
Amenorrhea
(in women …obviously)

Hypersecretion of Lactogenic Hormone (prolactin)
Term
Pituitary hormone problem:

Impotence


What hormone?
Hyper- or hyposecretion?
Definition
Impotence
(in men)

Hypersecretion of Lactogenic Hormone (prolactin)
Term
Pituitary hormone problem:

Decreased libido


What hormone?
Hyper- or hyposecretion?
Definition
Decreased libido
(in men)

Hypersecretion of Lactogenic Hormone (prolactin)
Term
Pituitary hormone problem:

Infertility, headaches, and weight gain


What hormone?
Hyper- or hyposecretion?
Definition
Infertility

Hypersecretion of Lactogenic Hormone (prolactin)
Term
Pituitary hormone problem:

Gigantism


What hormone?
Hyper- or hyposecretion?
Definition
Gigantism

Hypersecretion of Growth Hormone
Term
Pituitary hormone problem:

Acromegaly


What hormone?
Hyper- or hyposecretion?
Definition
Acromegaly

Hypersecretion of Growth Hormone
Term
What is the most common pituitary disorder, by far?
Definition
Prolactinomus
Term
This hormone promotes metabolism and growth.
Definition
Growth Hormone
Term
This hormone promotes synthesis and secretion of glucocorticoids. (ie. promotes gluconeogenesis)
Definition
Adrenocorticotropic Hormone
Term
This hormone promotes release of mineralocorticoids and adrenal androgens.
Definition
Adrenocorticotropic Hormone
Term
Pituitary hormone problem:

"Moon face"


What hormone?
Hyper- or hyposecretion?
Definition
Hypersecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

"Buffalo hump"


What hormone?
Hyper- or hyposecretion?
Definition
Hypersecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

Easy bruising


What hormone?
Hyper- or hyposecretion?
Definition
Hypersecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

Acne


What hormone?
Hyper- or hyposecretion?
Definition
Hypersecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

Depression


What hormone?
Hyper- or hyposecretion?
Definition
Hypersecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

Fluid loss with hypotension, hyponatremia, muscle weakness, and skin pigment changes.


What hormone?
Hyper- or hyposecretion?
Definition
Hyposecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

Skin pigmentation changes


What hormone?
Hyper- or hyposecretion?
Definition
Hyposecretion of Adrenocorticotropic Hormone (ACTH)
Term
Addison's disease is (hyper-/hypo-)secretion of what hormone?
Definition
Hyposecretion of Adrenocorticotropic Hormone (ACTH)
Term
Pituitary hormone problem:

Increased metabolic rate, tremor, heat intolerance, weight loss.


What hormone?
Hyper- or hyposecretion?
Definition
Hypersecretion of Thyroid-Stimulating Hormone (TSH)
Term
Pituitary hormone problem:

Decreased metabolic rate, cold intolerance, weight gain, brittle hair, brittle nails.


What hormone?
Hyper- or hyposecretion?
Definition
Hyposecretion of Thyroid-Stimulating Hormone (TSH)
Term
This pituitary hormone promotes spermatogenesis in males.
Definition
Follicle-Stimulating Hormone (FSH)
Term
This pituitary hormone stimulates the growth of ovarian follicles and produces estrogen in women.
Definition
Follicle-Stimulating Hormone (FSH)
Term
This pituitary hormone stimulates testosterone synthesis in males.
Definition
Lutenizing Hormone (LH)
Term
This pituitary hormone stimulates the synthesis of estrogen and progesterone from the corpus luteum in women.
Definition
Lutenizing Hormone (LH)
Term
This pituitary hormone acts on the kidney to promote reabsorption of water into circulation.
Definition
Arginine vasopressin (ADH)
Term
This pituitary hormone, in very high doses, is a potent vasoconstrictor.
Definition
Arginine vasopressin (ADH)
Term
Pituitary hormone problem:

Diabetes insipidus


What hormone?
Insufficiency or excess?
Definition
Arginine vasopressin (ADH) insufficiency

Note: Diabetes = "water running through the body"; Insipidus = "no taste"
Term
What does Diabetes Mellitus and Diabetes Insipidus have in common?
Definition
They're both called Diabetes. …So, nothing.
Term
This pituitary hormone stimulates uterine contraction.
Definition
Oxytocin
Term
This pituitary hormone stimulates the ejection of milk in lactating women.
Definition
Oxytocin

(OHHH!! NOT prolactin! Prolactin results in galactorrhea, which is an inappropriate production of milk, as well as development of the mammary glands. The actual giving of milk to babies is due to our buddy, oxytocin.)
Term
This pituitary hormone promotes trust in humans.
Definition
Oxytocin
Term
Name the pituitary hormone!!

"I have nipples, Greg… Can you milk me?"
~Meet the Parents
Definition
Lactogenic Hormone (Prolactin)
Term
Name the pituitary hormone!!

"Do you trust me?"
"What?"
"Do you trust me?"
~Aladdin
Definition
Oxytocin
Term
Name the pituitary hormone!! Some movie quote about having too much testosterone.
Definition
Luteinizing Hormone
Term
Why do folks with ACTH hypersecretion get acne?
Definition
Because the body can't mobilize the white blood cells due to the immune dampening.
Term
What is the most common cause of hyperpituitarism?
Definition
Pituitary tumor (adenoma)
Term
Is a pituitary tumor secretory or nonsecretory?
Definition
Could be either.

May stimulate release, may block release, may do nothing.
Term
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.
Definition
"Nonfunctional" adenoma, in which hormone release is blocked.
Term
What age range is the peak incidence for pituitary tumors?
Definition
40-60
Term
True or false:
Most pituitary tumors are benign.
Definition
True.

However, continued growth can result in neurologic damage.
Term
If a pituitary tumor exceeds 1 cm, it's called:
If it is less than 1 cm, it's called:
Definition
Macroadenomas = > 1 cm
Microadenomas = < 1 cm
Term
What is the #1 most common disorder seen due to pituitary adenoma?
Definition
Hyperprolactinemia
Term
What are the most common disorders (3) seen due to pituitary tumors? What is the result of those disorders?
Definition
1. Hyperprolactinemia: amenorrhea, galactorrhea, impotence
2. ACTH: Cushing's disease
3. Growth Hormone: acromegaly
Term
Can a person have hypopituitarism with compressive macroadenomas?
Definition
Yep.
Term
What ocular manifestations will you see with microadenomas?
Definition
None. Pituitary's not big enough to cause any problems.
Term
What cranial nerves will end up having problems when a macroadenomas pituitary gland encroaches on the cavernous sinus?
Definition
III, IV, VI, and the ophthalmic and maxillary divisions of CN V
Term
What visual field defects will you find with a macroadenomas pituiatry tumor?
Definition
Bitemporal hemianopsia (usually bitemporal - not necessarily).
Term
When you get bitemporal hemianopsia from a macroadenomas pituitary tumor, how would you describe the progression of field loss?
Definition
Superior temporal field is usually first affected. Field loss works its way inferior from there.
Term
Might you experience headache with a macroadenomas pituitary tumor?
Definition
You bet your sweet muffins you could get a headache from that.

(Sweet muffins = headaches caused by pituitary tumors)
Term
What's the "only good method to visualize microadenomae"?
Definition
MRI with gadolinium
Term
Besides imaging, what's the other way to diagnose a pituitary tumor?
Definition
Lab testing for individual hormone levels.
Term
What is the most common therapeutic approach to a pituitary tumor?
Definition
Scrub down and gown up. It's surgery time.
Term
What therapeutic approach to pituitary tumors is rarely done alone, and usually combined with some degree of pharacologic treatment?
Definition
Radiotherapy
Term
What is the most common way that the hypothalamus puts the brakes on the pituitary?
Definition
Dopamine lol. So if the hypothalamus wants the pituitary to slow down, he just dopes him up. :)
Term
You can have a virtually destroyed pituitary gland, and it will still be releasing what hormone?
Definition
Prolactin.

Prolactin is the cockroach of the pituitary hormones.
Term
What two hormones originate in the posterior lobe of the pituitary gland?
Definition
Arginine vasopressin (ADH) and Oxytocin
Term
Is it likely that someone would notice a prolactinoma? Under what circumstances?
Definition
If the pt is a women, yes. This is because a prolactinoma will change the menstral cycle.
Term
Approximately 60% of pituitary adenomas secrete what hormone?
Definition
Prolactin
Term
Another cause of hyperprolactinemia is hypothyroidism. Why?
Definition
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.

Increase in TRH = increase in prolactin = hyperprolactinemia.
Term
Why would antidepressants or cimetidine ("Tagamet" - an H2 inhibitor) cause hyperprolactinemia?
Definition
Because they interfere with dopamine activity.

Without DA working well, the hypothalamus is no longer inhibiting the pituitary so much, so the pituitary gets to secrete more of whatever it wants. And what it wants… is prolactin.
Term
What are the clinical features of hyperprolactinemia? What's the big one?
Definition
Amenorrhea,
Galactorrhea,
Loss of libido,
Visual field defects,
Headaches
Term
(Extra)

What's the #1 thing that ODs get coming in the door?
Definition
Headaches
Term
When you suspect a pituitary adenoma, what's the first thing you should ask about?
Definition
Menstrual cycle
Term
What are the two options we got for management (not pharmacologic therapy) of hyperprolactinemia?
Definition
Transsphenoidal adenectomy and/or radiotherapy
Term
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?
Definition
Dopamine agonists
Term
What is the most common dopamine agonist, by far, used to treat a pt with hyperprolactinemia?
Definition
Bromocriptine
Term
What is cabergoline used for?
Definition

Tx of hyperprolactinemia @ .25 mg po or vaginally 2x per week

 

OR

 

Can be used for acromegaly; shrinks tumor producing GH

 

Is a dopamine agonist

Term
What is acromegaly?
Definition
excessive GH in adults
Term
What are some signs/symptoms of acromegaly?
Definition
HA, hand and feet enlargment, OA, entrapment neuropathies, abnormal glucose tolerance, HF
Term
What are non-pharmalogical tx for acromegaly?
Definition
Transsphenoidal adenectomy and/or radiotherapy
Term
What are two drugs used to treat acromegaly?
Definition
octreotide, lanreotide
Term
If the acromegaly is the result of a tumor producing GH, what is a common tx?
Definition
dopamine agonists (bromocriptine, cabergoline)
Term
What are GH antagonists used for?
Definition
acromegaly
Term
Name a GH antagonist
Definition
pegvisomant, it is NOT a somatostatin
Term
What is pegvisomant's mechanism
Definition
binds to GH receptor
Term
What is Cushing's dx?
Definition
hypercortisolism
Term
What is the most common cause of Cushing's syndrome?
Definition
exogenous steroid use
Term
What % of Cushing's syndrome does Cushing's disease account for?
Definition
> 50%
Term
Who is most at risk for Cushing's dx?
Definition
women, 5x > men
Term
What is the typical onset of cushing's dx?
Definition
3rd or 4th decade
Term
What is the most common natural cause of Cushing's dx?
Definition
ACTH producing adenoma
Term
What is primary adrenocortical hyperplasia?
Definition
ACTH independent Cushing's syndrome
Term
What % of Cushings syndrome is from cortical neoplasm?
Definition

15-30%

 

Also called ACTH independent Cushing's Syndrome

Term
What is ectopic ACTH secretion?
Definition
when a neoplasm located outside of the pituitary produces ACTH inducing 15% of Cushing's dx cases
Term
What is Cushing's syndrome?
Definition
A gradual and subtle hypercortisolism
Term
What are early signs of Cushing's syndrome?
Definition
HTN and weight gain
Term
What are later signs of Cushing's syndrome?
Definition
truncal obesity, moon faces, buffalo hump, muscle/strength loss
Term
What dx has 20% of pt's present with hyperglycemia, glucosuria, and polydipsia?
Definition
Cushing's Syndrome
Term
What dx presents hirsutism (increased hair production)
Definition
Cushing's Syndrome
Term
Cataracts are signs of what 2 dx's?
Definition
Cushing's Syndrome and DM
Term
Mental disturbances can be found in:
Definition
Cushing's Syndrome
Term
What is dexamethosone used to diagnose?
Definition
Cushing's Syndrome
Term
What dx has impaired glucose tolerance because of increased insulin resistance?
Definition

Cushing's Syndrome

 

NO, this is not just DM2!  This is a way to clinically diagnose Cushing's

Term
Why are adrenal carcinoma's hard to treat
Definition
metastasis to lungs and liver
Term
What is primary hyperaldosteronism?
Definition
increased aldosterone secretion.  Also called Conn's Syndrome
Term
What is the main cause of primary hyperaldosteronism?
Definition

aldosterone secreting adenoma (60-80%)

 

Also called Conn's Syndrome

Term
What is Conn's syndrome?
Definition
aldosterone secreting adenoma (60-80%)
Term
What dx causes HTN and hypokalemia?
Definition
primary hyperaldosteronism
Term
What is secondary hyperaldosteronism?
Definition
aldosterone release due to renin-angiotensin activation
Term
What is acute adrenal insufficiency?
Definition
sudden withdrawal of exogenous steroids
Term
What physiolocig change causes acute adrenal insufficency
Definition
adrenal cortex atrophy
Term
What is Addison's dx?
Definition
autoimmune chronic adrenal insufficiency
Term
What precipitates Addison's dx?
Definition
autoimmune attack of adrenal cortex
Term
What used to cause 90% of addison cases?
Definition
TB
Term
What causes 60-70% of Addison's dx?
Definition
autoimmune adrenalitis
Term
What are 4 clinical signs of Addison's dx?
Definition
GI problems, hypotension, hyperpigmentation, fatigue/weakness
Term
Where are chromaffin cells found?
Definition
adrenal medulla
Term
What do chromaffin cells do?
Definition
secrete catecholamines
Term
What is pheochromocytoma?
Definition
chromaffin cell neoplasms
Term
Are pheochromocytoma's common?
Definition
NO
Term
ten percent tumor?
Definition
pheochromocytoma
Term
How is pheochromocytoma treated?
Definition
surgical removal
Term
What are clinical features of pheochromocytoma?
Definition
abrupt HTN, tachycardia, palpitations, tremor Also has increased risk of stroke, myocardial ischemia, renal failure
Term
Name the features that occur 10% of the time with pheochromocytoma (7 things)
Definition
1. malignant
2. bilateral
3. extra adrenal
4. in children
5. familial
6. recur
7. Present w/ stroke
Term
What fills the follicles in the thyroid?
Definition
thyroglobulin
Term
What systemic hormones are bound to plasma proteins?
Definition
T3 and T4
Term
Do thyroid hormones have to be unbound from plasma proteins to trigger a response?
Definition
yes
Term
What does T3 and T4 upregulate?
Definition
carb metabolism, lipid metabolsim, protein synthesis
Term
What is thyrotoxicosis?
Definition
hypermetabolism due to T3 and T4
Term
What are common causes of thyrotoxicosis?
Definition
Anything that ups thyroid hormone release:
Graves dx
goiter
thyroid adenoma
Term
What is rare result of a pituitary tumor?
Definition
thyrotoxicosis
Term
What dx can be caused by weight loss herbal supplements?
Definition
thyrotoxicosis
Term
What dx presents hypermotility of the gut and lid retraction due to Mueller's muscle?
Definition
thyrotoxicosis
Term
What is the prevalence of Graves Dx?
Definition
.4-1% of U.S. population
Term
Who is most at risk for Graves dx?
Definition
Women, 7x > men
Term
What is the peak age for Graves onset?
Definition
20-40
Term
What gene is Graves dx associated with?
Definition
HLA-DR3
Term
What kind of hypersensitivy is Graves?
Definition
Type V
Term
What Ab are present in Graves?
Definition
TSH receptors
T3, T4 receptors
Term
What is Grave's dx triad?
Definition
thyrotoxicosis
infiltrative opthalmopathy
infiltrative dermopathy (pretibial myxedema)
Term
What dx causes diplopia upon upgaze?
Definition
Graves
Term
What is Dalrymples sign?
Definition
lid retraction and lid lag seen in Graves
Term
What is one cause of keratitis dry eye?
Definition
Graves
Term
What is one cause of compressive optic neuropathy?
Definition
Graves
Term
When is medication the best tx for Graves?
Definition
young pts with mild disease
Term
when is surgery the best tx for Graves?
Definition
large goiter or severe dx; unwilling to take meds
Term
What is radioactive iodine used for?
Definition
to treat Graves in pt's generally older than 30 to 40
Term
Are beta blockers useful in Graves dx tx?
Definition
yes
Term
name two drugs that decrease thyroid hormone synthesis
Definition
methimazole and propylthiouracil
Term
What is the timeline for Graves meds?
Definition
give until euthyroid levels return, then taper to lowest dose. Continue for 1-1.5 yrs and hope for permanent remission
Term
What is the rate of permanent remission in Graves treated with medication?
Definition
<20%
Term
What treatment can cause agranulocytosis?
Definition
Graves medication
Term
What is a rapid, highly succesful cure for hyperthyroidsim?
Definition
subtotal thyroidectomy
Term
What are collateral risks of subtotal thyroidectomy?
Definition
pt must be hospitalized, risk of hypothyroidism, damage to laryngeal nerve
Term
What is radioactive iodine's cure rate?
Definition
Almost 100%
Term
What is the disadvantage of radioactive iodine tx?
Definition
hypothyroidism risk
Term
What % of radioactive iodine pt's present with hypothyroidism? (Hint: changes with time)
Definition
10% after 1 year,
increases by 2-3% each year,
by 10-15 yrs post tx, >70% hypothyroid
Term
What are the 3 most common causes of primary hypothyrodism
Definition
surgical ablation of thyroid
Hashimoto's thyroiditis
primary idiopathic hypothyrodism
Term
What causes secondary hypothyroidism?
Definition
pituitary or hypothalamus dx
Term
How do hormone levels present in primary vs secondary hypothyroidism?
Definition
Primary: high TSH, low T3/T4
Secondary: low TSh, low T3/T4
Term
What endocrine dx can cause bradycardia
Definition
hypothyroidsm
Term
What is L-thyroxine used to treat?
Definition
hypothyroidism and Hashimoto's thyroiditis
Term
What is another term for cretinism
Definition
infantile myxedema
Term
What is the historical cause of cretinsim
Definition
iodine deficiency
Term
What dx presents with impaired skeletal development/short stature?
Definition
cretinism
Term
Coarse facial features are caused by what dx?
Definition
cretinism
Term
How does infantile myxedema cause mental impairment?
Definition
if thyroid deficiency occurs in utero
Term
What is Hashimoto's thyroiditis?
Definition
Type V hypersensitivity
Term
What is the demographic most affected by Hashimotos?
Definition
women 10-20x than Men; age 45-65
Term
What kind of thyroid noduless are more likely to be neoplasms?
Definition
solitary nodules,
nodules found in younger pt's
nodules found in male pt's
Term
What is a "hot" nodule?
Definition
a benign nodule that takes up radioactive iodine
Term
What is one of the most common endocrine disorders?
Definition
hyperparathyroidism
Term
What causes 80-90% of hyperparathyroidsim?
Definition
parathyroid adenoma
Term
What dx presents increased calcium serum levels?
Definition
hyperparathyroidism
Term
Where do we see "painful bones, renal stones, abdominal groans, psychic moans" note: "Citek's lectures" is not an acceptable answer
Definition
hyperparathyroidism
Term
What is a rare cause of hypoparathyroidism?
Definition
autoimmune attack of parathyroid
Term
What is Chvostek's sign?
Definition
tap on facial nerve and facial muscles contract in upper lip. Found in hypoparathyroidism
Term
What is Trousseau's sign?
Definition
Inflation of BP cuff for 3 minutes causes carpal spasm
Term
What is diabetes mellitus?
Definition
a relative or absolute lack of insulin
Term
What causes 11% of vascular deaths?
Definition
DM
Term
What is the leading cause of blindness in the US?
Definition
DM
Term
What are two other terms for metabolic syndrome?
Definition
syndrome X, insulin resistance syndrome
Term
What risks are increased by metabolic syndrome?
Definition
DM increases 5x; cerebrovascular dx increases 3x
Term
What levels of triglycerides and HDL indicate metabolic syndrome?
Definition
TG > 150 mg/dL
HDL < 40 mg/dL in men, <50 mg/dL women
Term
What are ways to control metabolic syndrome?
Definition
control BP, FPG, stop smoking
Term
Who are most likely to get DM1?
Definition
northern europeans
Term
What age is highest incidence of DM1?
Definition
10-14 yrs
Term
What is suspected to trigger DM1?
Definition
beta cell viral infection
Term
What does LADA stand for?
Definition
Latent Autoimmune Diabetes in Adults
Term
What is LADA?
Definition
a slowly progressive form of DM1
Term
Where is LADA seen most?
Definition
non obese pt's over 35
Term
What is a common med to control LADA
Definition
sulfonylureas
Term
What is more common, DM1 or DM2?
Definition
DM2 by far. 160/100k vs 6670/100k
Term
What % of DM2 pts' are obese?
Definition
>80%
Term
What is the physiologic cause of DM2
Definition
tissue resistance to insulin
Term
What control sugar and fat entry into cells?
Definition
peroxisome proliferator-activated receptors (PPAR)
Term
What presents with increased hepatic glucose production and impaired insulin secretion?
Definition
Obese DM2
Term
What is DM1.5?
Definition
antibody positive DM2. This is NOT LADA
Term
What is MODY?
Definition
majority onset diabetes of the Young
Term
What type of Dm is found in thin, young adults
Definition
MODY
Term
What kind of DM is easily controlled with low-dose insulin, diet or oral agents?
Definition
MODY
Term
What DM is a "single gene" disorder
Definition
MODY
Term
MODY is a variant of:
Definition
DM2
Term
What is gestational diabetes a form of?
Definition
DM2
Term
What is a risk factor for gestational diabetes?
Definition
obesity
Term
What is the first and second tx for gestational diabetes
Definition
diet, but may require insulin
Term
Gestational diabetes increases the risk of what later in life?
Definition
DM2
Term
What are 4 classic signs of DM?
Definition
polyuria, polydipsia, fatigue, weight loss
Term
What dx triggers fasting metabolism?
Definition
DM
Term
Gluconeogenesis and glycogenolysis are seen elevated in what dx?
Definition
DM
Term
What is seen in the urine of DM pt's?
Definition
glucose, excess H2O
Term
What systemic effects can increased glucose levels cause?
Definition
decreased WBC activity, increased microorganisms
Term
What does the body do if no insulin can be utilized?
Definition
turns to glycogen for fuel. Liver metabolizes FFA into ketones
Term
What is the result of excess ketone body metabolism?
Definition
ketoanemia, ketonuria, ultimately ketoacidosis
Term
What is the classic plasma glucose level that indicates DM?
Definition
>200 mg/dL
Term
What is the fasting glucose level for DM?
Definition
>126 mg/dL
Term
2 hrs after a glucose tolerance test is begun, what level of glucose will indicate DM
Definition
>200 mg/dL
Term
Nephropathy is a long term complication of what?
Definition
DM
Term
What is the major cause of DM1 death?
Definition

Myocardial infarction

(kidney failure is 2nd leading cause)

Term
What is the 2nd leading cause of DM1 death?
Definition
kidney failure (MI #1)
Term
What is microalbuminuria?
Definition
the first clinical sign of nephropathy, bad sign for DM1 pts
Term
Atherosclerosis in accelerated in what dx?
Definition
DM2
Term
What is an important form of macrovascular dx?
Definition
Heart disease, the leading cause of death in DM2
Term
What is peripheral vascular dx?
Definition
poor circulation in peripheral tissues
Term
What causes >50% of amputations in DM pts?
Definition
peripheral vascular dx (PVD)
Term
How much more likely is a DM pt to get PVD?
Definition
4x
Term
What are signs of PVD?
Definition
leg pain
cold feet
nocturnal leg pain
loss of hair on foot and toes
Term
What is symptomatic peripheral neuropathy?
Definition
paresthesia of lower extremities
loss of vibration sense
decreased knee/ankle deep tendon reflex
decreased nerve velocity
Term
What are the 4 main ocular complications of DM?
Definition
1. cataracts
2. retinopathy
3. glaucoma
4. signs of heart failure
Term
What are irreversible advanced glycosylated end products (AGE's)
Definition
nonenzymatic binding of glucose to proteins
Term
What processes do AGE's accelerate?
Definition
atherogenesis and entrapment of LDL
Term
What causes thickened, leaky BM in capillaries and glomeruli?
Definition
advanced glycosylated end products (AGEs)
Term
What does aldose reductase do?
Definition
In hyperglycemia, it metabolizes glucose to sorbitol and then fructose
Term
What does increased fructose and sorbitol do to a cell?
Definition
increases osmolarity, cell swells
Term
What does cellular swelling increase risk for?
Definition
oxidative stress and damage to the cell
Term
What compound can impair ion pumps and lead to damage of Schwann cells and pericytes?
Definition
sorbitol
Term
What does protein kinase C activation cause?
Definition
angiogenesis, vascular permeability
Term
Where is protein kinase C (PKC) related complications seen?
Definition
DM
Term
What are PARP's?
Definition
polyADP ribose polymerase
Term
What do PARP's do?
Definition
increase apoptosis and increase endothelial damage
Term
What dx are complicated by PARP's?
Definition
DM
Term
What does heparin do?
Definition
anti atherogenic
Term
What dx presents decreased heparin as a compounding problem
Definition
DM
Term
What are common tx of DM?
Definition

low dose ASA (acetylsalicylic acid or aspirin) 75-162 mg/day

good sleep

exercise

depression tx

Term
What mental issue is associated with poor control of Dm?
Definition
depression
Term
What is the goal for HbA1c levels in DM?
Definition
<7.0%
Term
What are downsides to insulin tx
Definition
injections, can cause hypoglycemia, weight gain
Term
Humulin, iletin and Novolin are used to treat what disease?
Definition
DM
Term
What are humulin, iletin, and novolin?
Definition
insulin
Term
What are the fastest acting insulins?
Definition
insulin aspartate (Novolog) and insulin glulisine (apidra)
Term
What are long acting insulins?
Definition
insulin glargine and detemir
Term
What is a thrice weekly insulin tx that is still being evaluated?
Definition
insulin degludec
Term
What is Neutral Protamine Hagedorn?
Definition
A mix of regular with protamine zinc insulins (PZI's)
Term
What is the onset of Neutral Protamine Hagedorn?
Definition
2 hrs onset
Term
What is the peak of neutral protamine hagedorn?
Definition
6-14 hrs
Term
What is the duration of neutral protamine hagedorn?
Definition
24 hrs
Term
What are lente insulins?
Definition
zinc-insulin mixtures
Term
What dx presents difficulty going up stairs due to loss of pelvic girdle muscles?
Definition
Cushing's Syndrome
Term
What is semilente?
Definition
a short acting precipitate of insulin with zinc ions
Term
What type of DM is considerd the 'worst of both worlds'?
Definition
DM1.5
Term
Why are insulins often sold in different mixtures?
Definition
To alter duration and dosing times
Term
What are the common methods of insulin delivery?
Definition
injection: allows mixing of insulin

Insulin pens: more portable, but can't mix insulins. More comfortable to inject

Continuous subcutaneous insulin infusion (CSII): insulin pump
Term
What is the most comfortable, but expensve way to dose insulin, a method only appropriate for responsible, compliant pts?
Definition
insulin pump
Term
What are alternative (less common) insulin delivery methods
Definition
Oral, uses 'microsphere' to avoid gastric denaturing

Buccal: oral spray for inside of cheek
Term
What is buccally absorbed insulin approved for?
Definition
DM1 AND DM2
Term
What are two kinds of insulin delivery that have NOT had good results
Definition
nasal insulin and insulin patches
Term
What is pramlintide acetate?
Definition
a synthetic hormone that slows gastric emptying
Term
What pramlintide acetate used for?
Definition
To help pt's who need to control their DM1 and DM2 more effectively
Term
What is exanatide?
Definition
a drug for DM2 that slows gastric emptying; an incretin that signals "full" to the system
Term
What is liraglutide?
Definition
used if metformin fails for DM2 pt's
Term
What are biguanides used for?
Definition
first line for obese DM pt's
Term
What two phsyiological processes do biguanides effect?
Definition
decrease gluconeogenesis in liver; increase skM glucose uptake
Term
What are common biguanides?
Definition
metformin, glucovance, avandamet
Term
What biguanide is mixed with a thiazolidinedione?
Definition
avandamet = metformin + rosiglitazone
Term
What are thiazolidinediones
Definition
Insulin sensitizer
Term
What is an important side effect of rosiglitazone?
Definition
Cardiac risk! May be recalled
Term
What do alpha glucosidase inhibitors do?
Definition
slow down carb breakdown, decrease glucose absorption
Term
Name 2 alpha glucosidase inhibitors
Definition
acarbose, miglitol
Term
What is the function of oral sulfonylureas?
Definition
Stimulate release of insulin
Term
Name 3 second generation sulfonylureas
Definition
glipizide, glyburide, glimepiride
Term
Do sulfonylureas increase cardiac related death?
Definition
yes
Term
What does meglitinide do?
Definition
stimulates insulin release from functioning beta cells
Term
What does nateglinide do?
Definition
It is an amino acid derivatve that stimulates rapid, short insulin secretion
Term
Dipeptidyl peptidase: What is it?
Definition

An enzyme that degrades GLP-1

 

DPP inhibitors cause insulin release and liver to produce less glucose

Term
Name two dipeptidyl peptidase inhibitors
Definition
sitagliptin

saxagliptin
Term
What is a DPP-4 inhibitor
Definition
dipeptidyl peptidase inhibitor
Term
What are some surgical tx for DM?
Definition
1) artificial pancreas
2)islet cell transplant into liver
3)stem cell generation of islet cells
Term
What kind of messenger tells us the stomach is full?
Definition
incretins
Term
What is an alternative speculation on the cause of DM?
Definition
malfunctioning pain neurons in pancreas
Term
What was used to treat pancreatic neuropathy to restore insulin production in mice?
Definition
Capsaicin. It killed the sensory nerves in the pancreas
Term
What does FPG stand for?
Definition
fasting plasma glucose
Term
What does FPG monitor?
Definition
glucose levels
Term
When is a fasting plasma glucose (FPG) test administered?
Definition
After an 8-16 hr fast (only water permitted)
Term
When is urine testing used to monitor glucose levels?
Definition
when pt's wont use home blood tests, it is less accurate.
Term
What is the common abbreviation for the glycosylated hemoglobin test?
Definition
HbA1c
Term
What does hbA1c measure?
Definition
avg glucose levels over the last 6-8 wks
Term
What is fructosamine?
Definition
Used to find glucose levels over previous 2-3 weeks.
Term
When is fructosamine used?
Definition
to monitor glucose levels when a shorter window needs to be assessed, often after a change in the tx plan is made.
Term
What does HBGM stand for?
Definition
home blood glucose monitoring
Term
What does the Guardian Real-Time system monitor?
Definition
glucose levels every 5 minutes
Term
What is the glucowatch?
Definition
a new glucose monitoring system that measures through the skin
Term
What is the precursor of T3?
Definition
Thyroglobulin, converted in follicles of thyroid into triiodothyronine (T3)
Term
What is the precursor of T4
Definition
thyroglobulin, it is converted in the follicles of the thyroid into thyroxine (T4)
Term
Where is hypercalcemia seen?
Definition
Hyperparathyroidism
Term
What insulins are approved for IV administration?
Definition
Lispro (Humalog) and regular insulin
Term
What is Oral-Lyn?
Definition
buccally absorbed insulin spray
Term
What are the advantages of Humalog?
Definition

IV administration

 

fast acting

 

Closest to endogenous insulin

 

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