Term
| Outer layer of adrenal cortex? |
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Definition
| Zona glomerulosa- secretes aldosterone |
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Term
| Middle layer of adrenal cortex? |
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Definition
| Zona fasciculata- secretes cortisol |
|
|
Term
| Inner layer of adrenal cortex? |
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Definition
| Zona reticularis- secretes Androgens |
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Term
| What does the adrenal medulla secrete? |
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Definition
|
|
Term
| What type of hormone is aldosterone? |
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Definition
|
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Term
| What type of hormone is cortisol? |
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Definition
|
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Term
| Body's main responses to cortisol? |
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Definition
-Decreased immune response
-Increased hepatic glucose production and glycogen breakdown in muscles --> muscle weakness
-Weak mineralocorticoid --> raise BP
-Decrease osteoblast action
-Increased lipolysis in adipose tissue |
|
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Term
| Mineralocorticoid effects? |
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Definition
| Na & H2O retention, excretion of K+ by kidneys |
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Term
| What is hypersecreted in Conn's syndrome? |
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Definition
|
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Term
| What is hypersecreted by pheochromocytoma? |
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Definition
|
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Term
| Labs in adrenal insufficiency? |
|
Definition
| Hyponatremia, hyperkalemia, hypoglycemia |
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Term
| Symptoms of adrenal insufficiency? |
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Definition
| Weight loss, hyperpigmentation, vitiligo, fatigue, dizziness, salt craving |
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Term
| Common cause of pituitary damage? |
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Definition
|
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Term
| Where is the defect in primary, secondary and tertiary insufficiency? |
|
Definition
Primary- in adrenal gland
Secondary- pituitary
Tertiary- hypothalamus
(Secondary & tertiary have low ACTH) |
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Term
|
Definition
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Term
| Tests to determine adrenal insufficiency? |
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Definition
ACTH stim test
Insulin-induced hypoglycemia test (ITT) |
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Term
|
Definition
| IV fluids & glucocorticoids (dexamethasone or hydrocortisone) |
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Term
|
Definition
|
|
Term
| MC cause of Cushing syndrome? |
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Definition
| Iatrogenic- pts taking steroids for other reason (e.g. asthma) |
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Term
| Tests to determine increased cortisol production? |
|
Definition
-24hr urinary free cortisol (3x normal level)
-Midnight salivary cortisol test (2x normal)
-Low dose dexamethasone suppression test
(AM cortisol >1.8 mcg/dL) |
|
|
Term
| Pharmaceutical tx of Cushing's? |
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Definition
|
|
Term
| Where in the body do we find chromaffin cells? |
|
Definition
Adrenal medulla (pheochromocytoma)
Sympathetic chain (paraganglioma) |
|
|
Term
| What do we measure to detect pheochromocytoma? |
|
Definition
Metanephrines (metabolites of catecholamines- longer half-life)
Plasma or 24hr urine- 3x normal |
|
|
Term
| What does MIBG test detect? |
|
Definition
|
|
Term
| How do we prepare pt for pheochromocytoma surgery? |
|
Definition
-Alpha blockers 1st line (phenoxybenzamine, tera or doxazosin)
-Ca channel blockers 2nd line
-B-blockers only in reflex tachy
-Increase salt/fluid intake to offset alpha blocker-induced vasodilation |
|
|
Term
| What happens to renin in primary hyperaldosteronism (Conn's)? |
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Definition
|
|
Term
| What size adrenal incidentaloma should tip you off to malignancy? |
|
Definition
|
|
Term
| Hounsfield units of lipid-rich benign adrenal adenoma? |
|
Definition
|
|
Term
| "lightbulb sign" on contrast CT of adrenal glands? |
|
Definition
|
|
Term
| How do loop and thiazide diuretics affect calcium levels? |
|
Definition
Loop- lower calcium
Thiazide- raise serum calcium |
|
|
Term
| What are the three most common tumor sites in MEN1? |
|
Definition
| 3 P's- Parathyroid, pancreas, pituitary |
|
|
Term
| What does necrolytic migrating erythema potentially indicate? |
|
Definition
|
|
Term
| What gene is defective in MEN1? |
|
Definition
|
|
Term
| Medullary carcinoma + hyperparathyroidism + pheochromocytoma in what disorder? |
|
Definition
|
|
Term
| What endocrine disorder is associated with mucosal neuromas and Marfanoid body habitus? |
|
Definition
|
|
Term
| What cells secrete calcitonin? |
|
Definition
| Parafollicular C cells of thyroid |
|
|
Term
| 3 common sxs of pheochromocytoma? |
|
Definition
PHE:
Palpitations
Headache
Excessive sweating |
|
|
Term
| Increased reverse T3 is associated w/ what disorder? |
|
Definition
|
|
Term
| What is pretibial myxedema? |
|
Definition
Nonpitting, edematous, pink to brown plaques/nodules on shin
Associated w/ Graves disease |
|
|
Term
| What case of clinical hyperthyroidism might present w/ bitemporal hemianopsia? |
|
Definition
| TSH-secreting pituitary adenoma |
|
|
Term
| What disorder can present w/ hyper or hypothyroidism, depending on what time they present? |
|
Definition
| Silent (lymphocytic) thyroiditis |
|
|
Term
| What medications can induce hypothyroidism? |
|
Definition
| Amiodarone, lithium, alpha interferon |
|
|
Term
| What disorder presents w/ a firm hard "woody" thyroid nodule due to fibrosis? |
|
Definition
|
|
Term
| Which type of thyroid nodules are more indicative of malignancy- cold or hot? |
|
Definition
|
|
Term
| What is the MC type of thyroid cancer? |
|
Definition
|
|
Term
| What type of thyroid cancer is MC in males >65? |
|
Definition
| Anaplastic- worst prognosis |
|
|
Term
| MC cause of secondary hyperparathyroidism? |
|
Definition
| Kidney failure --> vitamin D deficiency |
|
|
Term
| What happens to DTRs in hyperparathyroidism? |
|
Definition
|
|
Term
| What mineral is required for production of PTH? |
|
Definition
|
|
Term
| How does hypocalcemia affect the QT interval? |
|
Definition
|
|
Term
| 1st line tx for hypercalcemia? |
|
Definition
| Loop diuretics (furosemide) |
|
|
Term
| What disease state is associated w/ hyperpigmentation (pt appears very tan) |
|
Definition
|
|
Term
| Screening test for adrenal insufficiency? |
|
Definition
| High dose ACTH (cosyntropin) stim test |
|
|
Term
|
Definition
|
|
Term
| MC cause of secondary hyperaldosteronism? |
|
Definition
| Increased renin due to renal artery stenosis |
|
|
Term
| What does a U wave on ECG indicate? |
|
Definition
|
|
Term
| What is neonatal hypothyroidism called? |
|
Definition
|
|
Term
| MC type of anterior pituitary tumor? |
|
Definition
|
|
Term
|
Definition
| Enlargement of hands, feet, skull & jaw |
|
|
Term
|
Definition
| Histamine H2 antagonist (used to suppress gastric acid secretion) |
|
|
Term
|
Definition
| Selective estrogen modulator (SERM) |
|
|
Term
| First sign of diabetic nephropathy? |
|
Definition
|
|
Term
| Examples of GLP-1 agonists? |
|
Definition
|
|
Term
| Examples of DPP-4 inhibitors? |
|
Definition
|
|
Term
|
Definition
| Increased insulin sensitivity at peripheral sites (adipose/muscle tissue) |
|
|
Term
| Which class of antihyperglycemic drugs causes periph edema? |
|
Definition
|
|
Term
| Which class of antihyperglycemic drugs causes delayed gastric emptying? |
|
Definition
| GLP-1 agonists (exenatide, liraglutide) |
|
|
Term
|
Definition
| Inhibition of DPP, which breaks down GLP-1 |
|
|
Term
| Which insulin type has no peak? |
|
Definition
|
|
Term
| ATP III criteria to dx metabolic syndrome? |
|
Definition
At least 3 of the 5:
Increased BP (>135/85)
Decreased HDL (<40)
Increased fasting TG (>150)
Increased fasting glucose (>100)
Abdominal obesity |
|
|
Term
| What medication can increase HDL? |
|
Definition
|
|
Term
|
Definition
CGRP Ab
Used in migraine prophylaxis |
|
|
Term
| When do we use WHO vs. CDC growth charts |
|
Definition
|
|
Term
| A child w/ short palpebral fissures, thin vermilion border, and smooth philtrum probably has what disorder? |
|
Definition
|
|
Term
| How do we split up hydrocortisone dose in Addison's tx and why? |
|
Definition
| 2/3 in morning, 1/3 at night (mimics diurnal secretion) |
|
|
Term
| Diagnostic tests for Conn's syndrome? |
|
Definition
PAC:PRA ratio = high suggests primary hyperaldosteronism - not confirmatory w/o other test listed:
Captopril suppression = aldosterone not suppressed = confirmatory
24-hour urinary excretion = high salt diet x 5 days. High aldosterone in urine = confirmatory
Saline suppression test = salt solution IV. High aldosterone and low renin means confirmatory |
|
|
Term
| Examples of alpha-gluconidase inhibitors? |
|
Definition
|
|
Term
| What antihyperglycemic drug can cause increased LFTs and possible hepatitis? |
|
Definition
| alpha-glucosidase inhibitors (acarbose, miglitol) |
|
|
Term
| What is Lugol's solution? |
|
Definition
|
|
Term
| Rotterdam criteria to dx PCOS? |
|
Definition
-Oligo- and/or anovulation
-Clinical and/or biochemical signs of hyperandrogenism
-Polycystic ovaries (ultrasound) |
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