Term
| What is the major dysfunction in Diabetes Insipidus? |
|
Definition
Inability for kidneys to increase permeability to H20
-do not concentrate urine as normal, dilute urine is excreted |
|
|
Term
What are the two causes of Diabetes Insipidus?
Which is the most common? |
|
Definition
Central (Neurogenic) Diabetes Insipidus- Failure to produce ADH by the hypothalamus (or failure to release by pituitary)
-most common
Nephrogenic DI: Failure of the kidneys to respond to ADH
-least common |
|
|
Term
| What can precipitate Central (neurogenic) DI? |
|
Definition
Genetic
Head Injury
Infection
Loss of blood supply to gland |
|
|
Term
| What can precipitate nephrogenic DI? |
|
Definition
Damage to the renal tubules (possibly reversible)
-Drugs
-Genetics
-Hypercalcemia
-Kidney Disease |
|
|
Term
| What happens with electrolytes and BP in DI? |
|
Definition
increase in Na+ serum levels
drop in BP
Increase in HR
Increase in temp |
|
|
Term
| How do you differentiate between neurogenic and nephrogenic DI? |
|
Definition
| Administer desmopressin (vasopressin), in neurogenic DI the urine will concentrate |
|
|
Term
|
Definition
|
|
Term
|
Definition
Blood: Na+ and osmolarity
desmopressin challenge
MRI of head
urnalysis
24 hour urine output |
|
|
Term
| Treatment for Central (neurogenic) DI? |
|
Definition
|
|
Term
| Treatment for Nephrogenic DI? |
|
Definition
|
|
Term
| S/S for children with Diabetes Insipidus? |
|
Definition
Fever, vomiting, diarrhea
many wet diapers
dry skin, cool extremities
delayed growth
weight loss
==often a genetic cause in children |
|
|
Term
|
Definition
inability to suppress secretion of ADH (excessive secretion)
excess blood volume leads to decreased sodium concentration in blood |
|
|
Term
| Where is ADH produced and released? |
|
Definition
produced in hypothalamus
released by pituitary gland |
|
|
Term
| Is there edema with SIADH? |
|
Definition
| no edema, but there is volume expansion and hypertension |
|
|
Term
| what are the causes of SIADH? |
|
Definition
small cell lung cancer is common
also related to: infection, trauma, guillan Barre', MS, surgery, Lung Ca, GI Ca, GU Ca, lymphoma, Ewing's Sarcoma, pulmonary infections and asthma, and multiple types of drugs |
|
|
Term
| What is the treatment for SIADH? |
|
Definition
Diet:
fluid restriction
Increased Na+ intake |
|
|
Term
| what is a common cause of irreversible damage related to SIADH? |
|
Definition
| If serum Na+ drops too low, irreversible damage may occur |
|
|
Term
| What is required to diagnose SIADH? |
|
Definition
1. decreased serum osmolality, decreased serum Na+
2. increased urine osmolarity
3. urine Na+ = oral Na+ intake
4. normal renal, adrenal, and tyroid function
5. absence of conditions that cause increased or decreased volume status |
|
|
Term
| What is growth hormone and what does it do? |
|
Definition
| stress hormone that raises concentration of glucose and free fatty acids; stimulates production of IGF-1 |
|
|
Term
| What affects growth hormone secretion? |
|
Definition
| Age, sex, diet, exercise, stress. |
|
|
Term
| What is the rate of secretion per day for adolescents versus adults? |
|
Definition
adolescents secrete more
adolescents: 700mcg/day
adults : 400mcg/day |
|
|
Term
where is growth hormone synthesized?
where is growth hormone stored and released? |
|
Definition
released by somatotropic cells in Anterior Pituitary
-synthesized, stored, and secreted by anterior pituitary |
|
|
Term
| what stimulates growth hormone secretion? |
|
Definition
estrogen
hypoglycemia
deep sleep
niacin (nicotinic acid/B3)
fasting
vigorous exercise |
|
|
Term
| what inhibits growth hormone release? |
|
Definition
hyperglycemia
glucocorticoids
dihydrotestosterone |
|
|
Term
| where is somatostatin and what does it do? |
|
Definition
produced in hypothalamus
INHIBITS release of GH & TSH, as well as glucagon, ACTH, insulin, renin,gastrin, and cholecystokinin
AKA growth hormone release inhibiting hormone |
|
|
Term
| where is growth hormone releasing hormone and what does it do? |
|
Definition
released by hypothalamus and travels to anterior pituitary
stimulates release of GH & TSH |
|
|
Term
| What is the main difference between acromegaly and giantism? |
|
Definition
| Acromegaly occurs after fusion of the epiphyseal plate from puberty |
|
|
Term
| what is the most common cause of acromegaly? |
|
Definition
benign pituitary adenoma in the somatotrophs
-also caused by tumors in lungs, pancreas, and adrenal glands that make GHRH, causing increased GH |
|
|
Term
| what are s/s of acromegaly |
|
Definition
soft tissue swellin gof the hands, feet, nose, lips, ears, skin
soft tissue swelling of internal organs: heart, kidneys, vocal cords
expanded skull, fontanelle, brow, jaw
polyuria/polydipsia |
|
|
Term
| What are lab tests for giantism? |
|
Definition
cortisol
estradiol (girls)
testosterone (boys)
prolactin
thyroid hormone |
|
|
Term
| what can surgical removal of pituitary cause? |
|
Definition
adrenal insufficiency
diabetes insipidus
hypogonadism
hypothyroidism |
|
|
Term
| what are the 2 types of target cell failure? |
|
Definition
receptor-associated disorders
intracellular disorders |
|
|
Term
| What are the 4 types of receptor associated disorders. give examples.. |
|
Definition
1. decreased number of receptors--Huntington's, Parkinson's, hypothyroidism
2. impaired receptor function-- Myasthenia Gravis(receptors can't accept acetylcholine)
3. antibodies -reduce available # of binding sites
-mimic hormone action
--Graves' disease, Hashimoto's
4. Unusual expression of receptor function-tumor- Small cell lung cancer releasing ACTH |
|
|
Term
| Intracellular disorders present due to what two problems? |
|
Definition
-defect in post-recept signaling cascade (Ca2+ levels affected by Phos levels, acts as messenger in/out of cell)
-inadequate synthesis of second messenger |
|
|
Term
| what is ACTH and what does it do? |
|
Definition
Adrenocorticotropic hormone
-stimulates growth of the adrenal cortex and the synthesis and secretion of corticosteroids
-stimulated by stress, fever, hypoglycemia, and major surgery |
|
|
Term
| What is the most common cause of SIADH? |
|
Definition
| ectopic secretion (endocrine paraneoplastic syndrome) |
|
|
Term
| What are examples of ectopic hormone release? |
|
Definition
CUSHING SYNDROME-small cell lung cancer, pancreatic cancer
*SIADH - small cell lung cancer, pulmonary disorders, CNS disorders *****
HYPERCALCEMIA -lung cancer, breat cancer, renal cancer, ovarian cancer
HYPOGLYCEMIA -hepatocellular cancer, fibrosarcoma, insulinoma
POLYCYTHEMIA -secretion of Erythropoetin
HYPERALDOSTERONISM -adrenal adenoma, non-Hodgkins lymphoma, ovarian carcinoma |
|
|
Term
what does prolactin do?
where is it secreted from? |
|
Definition
stimulates milk production
-secreted by anterior pituitary |
|
|
Term
| what is the most common hormonally active pituitary tumor? |
|
Definition
|
|
Term
|
Definition
WOMEN:amenorrhea, galactorrhea, hisuitism, osteoporosis
MEN: erectile dysfunction, oligospermia ( <20million sperm/ml) |
|
|
Term
| prior to diagnosis and treatment of a prolactinoma, what labs should be checked? |
|
Definition
| medications that can cause increased prolactin TSH screen for hypothyroidism |
|
|
Term
| What is the treatment for prolactinoma? |
|
Definition
Dopaminergic Agonists:
-reduce tumor size
-reverse effects on gonads
-surgery radiation |
|
|
Term
what is tertiary hyperparathyroidism?
What hormones are secreted in excess? |
|
Definition
long-standing secondary hyperparathyroidism that results in autonomous secretion of PTH even after withdrawal of calcium and calcitriol therapy
-etiology unknown
-excessive PTH and hypercalemia |
|
|
Term
| what are the normal levels of TSH and T4? |
|
Definition
TSH; 0.3-3.0 mg/dl
(free) T4: 5.0-12.0 mg/dl |
|
|
Term
| Explain the negative feedback system involved with TH (thyroid hormone) |
|
Definition
Hypothalamus secretes TRH
=>Anterior pituitary secretes TSH
==>thyroid gland secretes T3/T4
===>T3/T4 inhibit release of TRH in the hypothalamus and TSH in the anterior pituitary |
|
|
Term
| Is TH water or lipid soluble? |
|
Definition
|
|
Term
| TSH at the binding site in the thyroid causes: |
|
Definition
1.immediate release of stored thyroid hormones
2.increase in thyroid hormone synthesis
3. iodide uptake and oxidation
4. synthesis of prostaglandins
5. secretion of prostaglandins |
|
|
Term
| What effect does high T3 have on metabolism? |
|
Definition
high thyroid hormone means increased metabolism
-increased fate, protein, and glucose metabolism
-increased heat generation and O2 consumption |
|
|
Term
| What is synthesized in greater amounts in the thyroid gland, T3 or T4? |
|
Definition
| 90% is T4; in tissue, T4 converts to T3 which binds to receptors |
|
|
Term
| Where is calcitonin produced and what does it do? |
|
Definition
Calcitonin is produced in the thyroid
-reduces serum Ca2+ levels by inhibiting osteoclasts (which absorb bone) |
|
|
Term
|
Definition
| dangerous, rare disorder caused by excessive stress |
|
|
Term
| what causes thyroid storm and what are the S/S? |
|
Definition
elevated levels of T4/T3 caused by:
infection
trauma
pulmonary/vascular/cardiac disorders
burns
seizures
surgery
emotional distress
dialysis
OB complications
S/S: high temp, high HR, dysrhythmias, agitation and delirium, N/V, diarrhea, low circulating Volume |
|
|
Term
| What is the treatment for thyroid storm? |
|
Definition
1. propyltiouracil/methamazole
2. beta-blockers
3. steroids |
|
|
Term
| What is more common, primary thyroid disorders or central (secondary) hypothyroidism? |
|
Definition
| Primary thyroid disorders |
|
|
Term
| What is the effect on TSH during primary hyperthyroidism? |
|
Definition
| Increased thyroid hormone results in decreased TSH |
|
|
Term
| what are some examples of primary hyperthyroidism? |
|
Definition
Graves' Disease
toxic granular goiter
solitary toxic adenoma |
|
|
Term
| Thyrotoxicosis results in... |
|
Definition
increased metabolic rate
heat intolerance
increased sensitivity of tissue to sympathetic division of ANS
Goiter
Other S/S: bone resorption (hypercalcemia), increased catabolism, hypermetabolism, increased CO, restlessness, insomnia, decreased vital capacity (weakness of respiratory muscles) |
|
|
Term
| What is the cause of Graves' Disease? |
|
Definition
Type II sensitivity
stimulation of thyroid by autoantibodies (TSI-thyroid stimulating immunoglobulins) directed at TSH receptor |
|
|
Term
| How do the TSIs affect the thyroid and TH? |
|
Definition
-hyperplasia of thyroid (goiter)
-increased synthesis of TH (esp T3)
(decreased TSH) |
|
|
Term
| what are the 2 key S/S for graves' disease. |
|
Definition
-exopthalmos
-pretibial myxedema
=NOT REVERSIBLE with treatment |
|
|
Term
| Treatment for Graves' disease? |
|
Definition
antithyroid drugs
radioactive iodine
surgery |
|
|
Term
| what is the major complication for treatment of thyrotoxicosis? |
|
Definition
|
|
Term
| what is the difference between primary and secondary (central) hypothyroidism? |
|
Definition
primary hypothyroidism relates to the loss of functional thyroid tissue
secondary hypothyroidism relates to the pituitary's failure to synthesize adequate TSH |
|
|
Term
What causes primary hypothyroidism?
what is most common in the US? In the world? |
|
Definition
autoimmune thyroidosis (Hashimoto disease)=most common in US
iatrogenic loss, from surgery
-medications
-iodine deficiency=most common in the world
-congenital defects |
|
|
Term
| what effect does primary hypothyroidism have of TSH? |
|
Definition
| decreased TH leads to elevated TSH |
|
|
Term
| what effect does secondary hypothyroidism have on TSH? |
|
Definition
| decreased TSH leads to decreased TH |
|
|
Term
| what are causes of secondary hypothyroidism? what is the most common cause? |
|
Definition
tumor-most common cause
TBI
subarachnoid hemorrhage
infarction |
|
|
Term
| what effect does postpartum thyroiditis have for future illness? |
|
Definition
| more likely to get Hashimoto's in the future |
|
|
Term
| Is hypothyroidism an acute illness or over a period of time? |
|
Definition
| insidious-over months/years |
|
|
Term
| what are some manifestations of hypothyroidism? |
|
Definition
low BMR, cold intolerance, lethargy, low basal temp, DIASTOLIC HTN
myxedema (non-pitting boddy edema) -alteration of dermis in eyes, hands, feet, tongue
myxedema coma |
|
|
Term
|
Definition
diminished level of consciousness related to hypothyroidism precipitated by infection, stopping supplements, or overuse of narcotics
s/s: hypothermia WITHOUT shivering, hypoventilation, hypotension, hypoglycemia, lactic acidosis, coma |
|
|
Term
| what is the treatment of choice for hypothyroidism? |
|
Definition
| hormone replacement therapy |
|
|
Term
What are S/S of hypothyroidism?
Neuro:
Reproductive sys:
Cardiac:
Pulmonary:
GI;
Musculo-skeletal:
Integumentary/skin: |
|
Definition
-slow speech, memory loss, lethargy, decreased blood flow
-oligospermia, low libido, low androgens, high estradiol, menorrhagia
-low cardiac output, low HR, cold skin, diastolic hypertension (increased peripheral resistance, increased circulating Vol)
-dyspnea
-decreased peristalsis, decreased blood flow, increased fluid retention
-stiffness/aches, decreased bone formation
-decreased sweat, decreated temp, brittle hair, dry/flaky skin |
|
|
Term
what is the most common endocrine malignancy?
aka "the best cancer you can get" |
|
Definition
|
|
Term
what are risk factors for Hashimoto's?
What type of hypersensitivity is it? |
|
Definition
genetic predisposition + environment
-increased iodine intake, smoking, hep C, selenium deficiency
=type IV hypersensitivity |
|
|
Term
| What is Parathyroid hormone? |
|
Definition
| works to increase serum Calcium |
|
|
Term
| what are the 3 ways PTH works to increase serum calcium? |
|
Definition
1. BONE: increased PTH leads to activation of osteoclasts to remove Ca2+ from bone
2. KIDNEY: increased PTH leads to :
-increased Ca2+ resorption in distal tubules of kidney
-decreased Phos and HCO3 resorption in proximal tubules
3. INTESTINES:
(Vit D) + (PTH) = increased Ca2+ resorption |
|
|
Term
| hyperparathyroidism is caused by what 2 mechanisms? |
|
Definition
-increased parathyroid cells with high threshold for calcium feedback
-growth of parathyroid tissue |
|
|
Term
| Increased Calcium levels have what effect of Phosphorus? |
|
Definition
high Ca2+ = low Phos
low Ca2+ = high Phos |
|
|
Term
| what is the cause of secondary hyperparathyroidism? |
|
Definition
CKD, usually
-high Phosphorus
=>low Vit D
==>low Ca2+
===>high PTH |
|
|
Term
| What are S/S of hyperparathyroidism? |
|
Definition
| HTN, fatigue, kyphosis, fractures, insulin resistance |
|
|
Term
what are S/S of hypoparathyroidism?
how is it treated? |
|
Definition
Chvostek-upper lip twitch to tapping the cheek
Trosseau- painful carpal spasm in inflated BP cuff (for 3 min)
Treatment: Phosphate binders, oral calcium replacement |
|
|
Term
| Beta cell destruction is related to what disorder and what type of hypersensitivity? |
|
Definition
Type 1 DM
Type IV hypersensitivity |
|
|
Term
| What is the process of beta cell destruction in Type1a DM? |
|
Definition
-genetic predisposition + environment
-Autoantigens form on insulin-producing beta cells and circulate in blood
-processing and presentation of antigen
-activation of macrophages, autoantigen (t-cytotoxic cells), and B-lymphocytes |
|
|
Term
| What are the 2 types of DM Type 1? |
|
Definition
-Autoimmune-beta cell destruction, loss of insulin, and EXCESS OF GLUCAGON
-infection/pancreatitis causes decreased release of insulin; duration <7days, normal HgbA1c, no C-peptide, no anti-islet antibodies |
|
|
Term
| What are the 3 requirements and their lab values to diagnose DMT1? |
|
Definition
1. HgbA1c >6.5%
2. 2hour FPG >126mg/dl
3. 2-hr plasma glucose >200mg/dl
3. random glucose >200mg/dl if symptomatic
--repeat step 2 to confirm |
|
|
Term
| What is the best way to diagnose DMT1? |
|
Definition
|
|
Term
| what are the normal values for HbA1c? |
|
Definition
HbA1c:
Normal= 4.0-5.6
PreDM= 5.7-6.4
DM= 6.5+ |
|
|
Term
| what are the normal values for FPG? |
|
Definition
FPG:
Normal= 70-100
PreDM= 101-125
DM= 126+ |
|
|
Term
| What % of function must be lost from the beta cells before S/S of DM occur? |
|
Definition
80%-90%
-this can take a long time |
|
|
Term
| what effect does glucagon have of insulin levels? |
|
Definition
| high glucagon means low insulin |
|
|
Term
| low levels of insulin result in what effect on BG and ketone bodies? |
|
Definition
low insulin
=>increased fat use, decreased fat genesis
==>glucagon release by liver
===> increased BG, increased ketone bodies |
|
|
Term
|
Definition
polydipsia
polysuria
weight loss
hyperglycemia |
|
|
Term
| is a common s/s of DMT1 in children? |
|
Definition
|
|
Term
| What is the best treatment for DMT1 |
|
Definition
insulin
meal plans
exercise
self monitoring of BG |
|
|
Term
| what can be measured as a surrogate for insulin levels that indicates residual function of beta cells? |
|
Definition
|
|
Term
| What does metabolic syndrome lead to? |
|
Definition
DMT2 (and DMT1)
Heart Disease
stroke |
|
|
Term
| what are criteria for metabolic syndrome? |
|
Definition
3/5 diagnoses:
1-waist circumference
2-plasma triglycerides
3-plasma HDL
4-blood pressure
5-fasting plasma glucose |
|
|
Term
|
Definition
| only those who are genetically predisposed to beta cell dysfunction will develop DMT2 |
|
|
Term
|
Definition
abnormal insulin molecules
increase of insulin antagonists
down-regulation of insulin receptors
decreased post-receptor kinases
alteration in glucose transporters |
|
|
Term
| what has the highest rate for DMT2? |
|
Definition
|
|
Term
| Obesity contributes to DMT2 how? |
|
Definition
1. increased leptin in serum and decreased adiponectin--related to adipokines and treated with thiazolinediones
2. increased free fatty acids, triglycerides
3. incrased inflammatory cytokines FROM ADIPOCYTES
4. altered oxidating phosphorylation in mitochondria
5. obesity is correlated with:
-hyperinsulinemia
-insulin receptor density |
|
|
Term
| hyperinsulinemia prevents clinical appearance of DM for years. T or F? |
|
Definition
|
|
Term
|
Definition
produced by alpha cells
-acts on liver to increase BG
-acts as an insulin antagonist
*in DM, glucagon inhibition is less responsive causing increased glucagon levels |
|
|
Term
|
Definition
beta cell hormone
decreased in both T1 and T1 DM
increased satiety
suppresses glucagon secretion
increases islet cell destruction |
|
|
Term
|
Definition
peptides from GI tract in response from food intake
increase sensitivity to berta cells (improve insulin responsiveness)
induces satiety
will not cause hypoglycemia |
|
|
Term
|
Definition
| elevated lipids, elevated insulin elevated BP, fatinue, neuropathy |
|
|
Term
|
Definition
diet
exercise
ORAL HYPOGLYCEMICS are the treatment of choice |
|
|
Term
| What promotes insulin release |
|
Definition
-increased in glucose, amino acids, GI hormones
-beta cell stimulation by parasympathetic system |
|
|
Term
| what diminishes insulin release |
|
Definition
-decreased blood glucose, elevated insulin levels
-alpha cell stimulation by sympathetic system |
|
|
Term
| What is the role of insulin? |
|
Definition
stimulates protein and fat synthesis
decreases BG levels
facilitates intracellular transport of K+ and Mg
--metabolized by liver and by kidney enzymes
--antagonized by glucagon |
|
|
Term
|
Definition
increased stimulation of insulin secretion elicited by ORAL glucose
-increase the sensitivity of beta cells to improve insulin responsiveness to meals
MEDS: januvia, Galvus, Onglyza |
|
|
Term
| What is the difference between Somogyi Effect and Dawn Phenomenon? |
|
Definition
| There is hypoglycemia in the Somogyi effect, but both result in early AM hyperglycemia |
|
|
Term
| what is the strongest association between genetic suscepitiblity and DMT1? |
|
Definition
| strongest association is between MHC class II alleles (HLA) |
|
|
Term
| what is the most common cause of secondary hypertension? |
|
Definition
| Conn syndrome-excessive excretion of aldosteron |
|
|
Term
| what are the risk factors for Conn Syndrome? |
|
Definition
associated with metabolic syndrome:
HTN, obesity, dyslipidemia, insulin resistance, hyperglycemia |
|
|
Term
| what are the S/S of Conn Syndrome |
|
Definition
decreased K+
increased Na+
==>increased circulating volume, elevated BP; weakness, paralysis, polyuria
*edema is NOT a side effect |
|
|
Term
| what is the treatment for Conn Syndrome? |
|
Definition
Diet: regulate Na+ and K+ intake
manage: HTN, hypokalemia
Meds: aldosterone receptor agonists, and
spironolactone or eplerenone |
|
|
Term
| what is the most common cause of hyperthyroidism? |
|
Definition
|
|
Term
what is the purpose of aldosterone?
(midterm) |
|
Definition
| acts on the kidney to incrse Na+ resorption and decrease K+ resorption |
|
|
Term
what are chromaffin cells?
(midterm) |
|
Definition
=fight or flight
found in adrenal glands-secrete adrenaline and noradrenaline
innervated by splanchnic nerve
they PROMOTE HYPERGLYCEMIA, increased glucagon |
|
|
Term
| c-peptide is a marker for what? |
|
Definition
|
|
Term
| microalbuminuria is a indicator for |
|
Definition
|
|
Term
| best way to differentiate between DMT1 and DMT2? |
|
Definition
| post-prandial BG tells us how beta cells work |
|
|
