Term
| What hormones are secreted from the anterior pituitary? |
|
Definition
growth hormone (GH)
thyroid stimulating hormone (TSH)
adrenocorticotropic hormone (ACTH)
follicle stimulating hormone (FSH)
luteinizing hormone (LH)
prolactin (PRL) |
|
|
Term
| Thyrotropin-releasing hormone has what effect on the anterior pituitary? |
|
Definition
| Secrete TSH and Prolactin |
|
|
Term
| Corticotropin-releasing hormone has what effect on the anterior pituitary? |
|
Definition
| Stimulates release of ACTH |
|
|
Term
| Gonadotropin-releasing hormone has what effect on the anterior pituitary? |
|
Definition
| Stimulates release of FSH and LH |
|
|
Term
| Growth hormone-releasing hormone has what effect on the anterior pituitary? |
|
Definition
|
|
Term
Growth hormone-inhibiting hormone (GHIH) or somatostatin
has what effect on the anterior pituitary? |
|
Definition
| Inhibits release of GH, TSH & prolactin |
|
|
Term
| Prolactin-releasing factor has what effect on the anterior pituitary? |
|
Definition
| Stimulates secretion of PRL |
|
|
Term
| Prolactin-inhibiting hormone (PIH) or dopamine has what effect on the anterior pituitary? |
|
Definition
|
|
Term
| What imaging provides the best visualization of pituitary tumors? |
|
Definition
|
|
Term
| What is the tx of a pituitary tumor? |
|
Definition
Transsphenoidal removal
The mainstay of substitution therapy for pituitary insufficiency remains lifetime hormone replacement |
|
|
Term
| In diabetes insipidus, what hormone is deficient? |
|
Definition
| Antidiuretic hormone (ADH) |
|
|
Term
| What is another name for antidiuretic hormone? |
|
Definition
|
|
Term
| What is the function of vasopressin? |
|
Definition
To retain water in the kidneys
Raises blood pressure, slightly |
|
|
Term
| What is the tx of diabetes insipidus? |
|
Definition
|
|
Term
| Excessive GH in the youth is called this, after epiphyses close, it is called this? |
|
Definition
Gigantism - youth
Acromegaly - After |
|
|
Term
| What screening test can you do if you suspect excessive GH secretion? |
|
Definition
|
|
Term
| What imaging would you want to do for a patient with excessive GH secretion? What would imaging show? |
|
Definition
MRI - pituitary tumor
These tumors ordinarily involve the sella and cavernous sinus |
|
|
Term
| What is the treatment for a pt with acromegaly? |
|
Definition
|
|
Term
| Men usually have erectile dysfunction and a decreased libido if they have a hypersecretion of what hormone? |
|
Definition
|
|
Term
| What is the tx for someone with giant prolactinomas or hyperprolactemia? |
|
Definition
Dopamine agonist
Surgery is indicated if visual impairments are noted, or the pt does not respond to dopamine agonist |
|
|
Term
| What is the major product of the thyroid hormone? |
|
Definition
T4 is 90%
T3 is 4x stronger than T4
T4 converts to T3 |
|
|
Term
| What is a large protein specific to the thyroid gland from which thyroxine is synthesized and cleaved? |
|
Definition
|
|
Term
| What is the most common cause of hypothyroidism? |
|
Definition
|
|
Term
| What pharmacological drug causes hypothyroidism is about 20% of people who take it? |
|
Definition
|
|
Term
| What lab would you order for someone that you suspect hypothyroidism? |
|
Definition
|
|
Term
|
Definition
| Life threatening hypothyroidism |
|
|
Term
| What is the tx for hypothyroidism? |
|
Definition
|
|
Term
| What TSH levels are recommended for a patient on thyroxine? |
|
Definition
|
|
Term
| What is the most common thyroid disorder in the US? |
|
Definition
|
|
Term
| What is the imaging study of choice for to visualize the thyroid? |
|
Definition
|
|
Term
| Patients with Hashimoto thyroiditis who have a thyroid nodule should have what procedure done? |
|
Definition
| U/S guided Fine needle aspiration |
|
|
Term
| What is the most common cause of thyrotoxicosis? |
|
Definition
|
|
Term
| TSH receptor antibody (TRAb) levels are usually detectable in what disease? |
|
Definition
|
|
Term
| Pts with an established diagnosis of thyrotoxicosis should undergo what imaging? |
|
Definition
Radioactive iodine uptake and scan
MRI is study of choice to opthamology manifestations |
|
|
Term
| What is the initial tx of choice for a patient with a thyroid storm? |
|
Definition
|
|
Term
| What are the pharmacologic options for hyperthyroidism before surgery is indicated? |
|
Definition
| Thiourea drugs - PTU and methimazole |
|
|
Term
| What is the thiourea drug of choice for pregnancy or breastfeeding? |
|
Definition
|
|
Term
| What nerve is in the most danger when having a thyroidectomy? |
|
Definition
| Recurrent laryngeal nerve |
|
|
Term
| What levels should be checked post op of a thyroidectomy and why? |
|
Definition
| Calcium levels, because hypoparathyroidism can occur |
|
|
Term
| If you detect a nodule on the thyroid, what should be done? |
|
Definition
Thyroid function tests
Neck U/S
Most are benign |
|
|
Term
| Patients with very small, incidentally discovered, nonpalpable thyroid nodules should follow up how often? |
|
Definition
|
|
Term
| What is the most common thyroid malignancy? |
|
Definition
|
|
Term
| What is the tx for thyroid carcinomas? |
|
Definition
|
|
Term
| What does parathyroid hormone do? |
|
Definition
Increases osteoclasts activity (Takes Ca from the bone to the blood)
Inhibits Bicarbonate and phosphate absorption
Increases Ca reabsorption in the kidneys |
|
|
Term
| Positive Chvostek sign and Trousseau phenomenon occur in what? |
|
Definition
|
|
Term
| bones, stones, abdominal groans, psychic moans, with fatigue overtones, goes with what diagnosis? |
|
Definition
|
|
Term
| What type of imaging can be done for parathyroid adenomas? |
|
Definition
| sestamibi-iodine subtraction scanning and neck ultrasonography can locate parathyroid adenomas |
|
|
Term
| What tx is recommended for patients with symptomatic hyperparathyroidism? |
|
Definition
|
|
Term
| Where is the principle site of action of Aldosterone, and what does aldosterone do? |
|
Definition
Principle site: Distal and collecting tubule
Action: Sodium retention & Potassium elimination, Increases BP |
|
|
Term
| Acute adrenal insufficiency is an emergency caused by insufficient what? |
|
Definition
|
|
Term
| Addison's is characterized by chronic deficiency of what? |
|
Definition
Cortisol
Aldosterone
Adrenal androgens |
|
|
Term
| What is the most common cause of Addison disease in the United States? |
|
Definition
| Autoimmune destruction of the adrenals |
|
|
Term
| What lab tests are diagnostic of Addison's disease? |
|
Definition
Low plasma cortisol at 8 AM
Simplified cosyntropin stimulation test |
|
|
Term
| What is the treatment of Addison's? |
|
Definition
Replacement therapy should include a combination of corticosteroids and mineralocorticoids
Hydrocortisone is the drug of choice |
|
|
Term
| The dose of corticosteroid should be__________in case of infection, trauma, surgery, stressful diagnostic procedures, or other forms of stress, in a patient with Addisons. |
|
Definition
|
|
Term
| What is Cushing's syndrome? |
|
Definition
| Refers to the manifestations of excessive corticosteroids |
|
|
Term
| What screening test should be administered for a patient that you suspect Cushings in? |
|
Definition
| Dexamethasone suppression test |
|
|
Term
| A dexamethasone suppression test is considered negative if serum cortisol levels are what? |
|
Definition
|
|
Term
| What is the next step after a patient has a positive dexamethasone test? |
|
Definition
| 24 hour urine collection for free cortisol and creatinine |
|
|
Term
| If you find the patient has hypercortisolism via dexamethasone test, what is the next step? |
|
Definition
Get serum ACTH levels
ACTH <20 indicates adrenal tumor
ACTH >20 indicates pituitary tumor |
|
|
Term
| Cushing disease is best treated by what? |
|
Definition
| Transsphenoidal selective resection of the pituitary adenoma |
|
|
Term
|
Definition
| Unilateral aldosterone-secreting adrenal adenoma |
|
|
Term
| All patients with biochemically confirmed primary aldosteronism require What? |
|
Definition
| A thin-section CT scan of the adrenals to screen for a rare adrenal carcinoma |
|
|
Term
| What is the most common cause of refractory HTN? |
|
Definition
|
|
Term
| Bilateral adrenal hyperplasia is best treated with? |
|
Definition
|
|
Term
| How do you treat Conn Syndrome? |
|
Definition
|
|
Term
| What is the tx for Conn's Syndrome? |
|
Definition
| laparoscopic adrenalectomy |
|
|
Term
|
Definition
|
|
Term
| Enteropancreatic tumors goes with which MEN? |
|
Definition
|
|
Term
| Medullary thyroid carcinomas go with which MEN? |
|
Definition
|
|
Term
| pheochromocytomas and Hirschsprung disease goes with which MEN? |
|
Definition
|
|
Term
| Children harboring an MEN 2A RET gene mutation are advised to what? |
|
Definition
| To have a prophylactic total thyroidectomy by age 6 years. |
|
|
Term
| Mucosal neuromas, Marphan-like habitus goes with which MEN? |
|
Definition
|
|
Term
| Infants having a parent with MEN 2B receive genetic screening; those carrying the RET mutation should do what? |
|
Definition
| Undergo a prophylactic total thyroidectomy by age 6 months. |
|
|
Term
| What is the tx for Conn's Syndrome? |
|
Definition
| laparoscopic adrenalectomy |
|
|
Term
|
Definition
|
|
Term
| Enteropancreatic tumors goes with which MEN? |
|
Definition
|
|
Term
| Medullary thyroid carcinomas go with which MEN? |
|
Definition
|
|
Term
| pheochromocytomas and Hirschsprung disease goes with which MEN? |
|
Definition
|
|
Term
| Children harboring an MEN 2A RET gene mutation are advised to what? |
|
Definition
| To have a prophylactic total thyroidectomy by age 6 years. |
|
|
Term
| Mucosal neuromas, Marphan-like habitus goes with which MEN? |
|
Definition
|
|
Term
| Infants having a parent with MEN 2B receive genetic screening; those carrying the RET mutation should do what? |
|
Definition
| Undergo a prophylactic total thyroidectomy by age 6 months. |
|
|
Term
Alpha cells – ?
Beta cells - ?
Delta cells - ?
F cells – ? |
|
Definition
Alpha - glucagon
Beta - Insulin
Delta - Somatostatin
F cells - Pancreatic polypeptides |
|
|
Term
| What is the most important environmental factor causing insulin resistance? |
|
Definition
|
|
Term
| If fasting glucose is <126, what other tests can you do? |
|
Definition
Glucose tolerance test
Take readings at 0 and 120 minutes after ingestion of glucose |
|
|
Term
| What is considered a normal glucose tolerance test? What are the readings if you have DM? |
|
Definition
Normal is a 2 hour reading of <140
DM is a 2 hour reading of >200 |
|
|
Term
| What is a HbA1c reading that suggests DM? |
|
Definition
|
|
Term
|
Definition
| Stimulate insulin release from pancreatic B cells |
|
|
Term
| Name some sulfonylureas, who should avoid them? |
|
Definition
Glyburide, glipizide, gliclazide, and glimepiride
Cardio disease pts and elderly |
|
|
Term
| What is the main SE of sulfonylureas? |
|
Definition
|
|
Term
| Metformin's primary action is? |
|
Definition
| Is on the liver, reducing hepatic gluconeogenesis |
|
|
Term
| What patients should not take Metformin? |
|
Definition
| CKD patients, Liver failure pts, or alcohol abusers |
|
|
Term
| Thiazolidinediones MOA is? |
|
Definition
| Sensitize peripheral tissues to insulin |
|
|
Term
| Name some Thiazolidinediones |
|
Definition
Rosiglitazone (Avandia)
Pioglitazone (Actos) |
|
|
Term
| What are the main SE of Thiazolidinediones? |
|
Definition
|
|
Term
| What type of pts is Thiasolidinediones contraindicated in? |
|
Definition
| Cardiac class 3 and 4 patients |
|
|
Term
| a-Glucosidase inhibitors MOA is? |
|
Definition
| Competitively inhibit the -glucosidase enzymes in the gut that digest dietary starch and sucrose |
|
|
Term
| What are the two a-glucosidase inhibitors? |
|
Definition
|
|
Term
| What is the main SE in a-glucosidase inhibitors? |
|
Definition
|
|
Term
| Name the GLP-1 receptor agonist. How is it administered? |
|
Definition
Exenatide (Byetta)
SubQ injection |
|
|
Term
| What is the main SE of Exenatide? |
|
Definition
Nausea
Possible pancreatitis |
|
|
Term
| What is the DPP-4 inhibitor? |
|
Definition
|
|
Term
| What is Sitaglitpin main SE? |
|
Definition
|
|
Term
| What DM med can possibly cause Steven Johnson's Syndrome? |
|
Definition
|
|
Term
| What are your rapid acting insulins? |
|
Definition
|
|
Term
| What are your intermediate acting insulins? |
|
Definition
|
|
Term
| What are your long acting insulins? |
|
Definition
|
|
Term
| How do you prevent lipohypertrophy? |
|
Definition
| Rotation of injection sites |
|
|
Term
| Nocturnal hypoglycemia leads to a surge of counterregulatory hormones to produce high blood glucose levels by 7 AM, this is known as what? |
|
Definition
|
|
Term
| How do you treat a thyroid storm? |
|
Definition
B-blockers & hydrocortisone
Thiourea drugs are used to control the hyperthyroidism, followed by iodide |
|
|
Term
| What is the tx of hypoparathyroidism? |
|
Definition
Calcium and vitamin D
Keep Ca between 8-8.6 |
|
|
Term
| What is the tx of hypoparathyroidism? |
|
Definition
Calcium and vitamin D
Keep Ca between 8-8.6 |
|
|
Term
| Osteomalacia and rickets is caused by a deficiency in what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| When should you start screening patients for dyslipidemia? |
|
Definition
|
|
Term
| Vitamin A deficiency leads to what? |
|
Definition
|
|
Term
| Vitamin D deficiency leads to what? |
|
Definition
|
|
Term
| Vitamin E deficiency leads to what? |
|
Definition
| Hemolytic anemia, nerve changes |
|
|
Term
| Vitamin K deficiency leads to what? |
|
Definition
|
|
Term
| Thiamin deficiency leads to what? |
|
Definition
|
|
Term
| Riboflavin deficiency leads to what? |
|
Definition
| Oral inflammation, eye disorders |
|
|
Term
| Niacin deficiency leads to what? |
|
Definition
|
|
Term
| Pantothenic acid deficiency leads to what? |
|
Definition
|
|
Term
| Biotin deficiency leads to what? |
|
Definition
| Dermatitis, tongue pain, anemia, depression |
|
|
Term
| B6 (pyridoxine) deficiency leads |
|
Definition
|
|
Term
| Folate deficiency leads to what? |
|
Definition
|
|
Term
| Vitamin B12 deficiency leads to what? |
|
Definition
|
|
Term
| Vitamin C deficiency leads to what? |
|
Definition
|
|
Term
| Child comes in with his mother. His mother states he has had bad colicky abdominal pain. She states his stooles appear to be like currant jelly. On PE you feel a sausage like mass on the abdomen. What imaging would you like to do for this pt? What is the tx? |
|
Definition
Barium or air enema can be therapuetic and diagnostic
CT Scan is needed for adults
ALL patients should be hospitalized
Surgery is needed for adults |
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|
