Term
| To evaluate hyofunctioning disorders, do a ___ test. Give example. |
|
Definition
- stimulation test
- Adrenocorticotropic hormone (ACTH) stimulation test to work up hypocortisolism |
|
|
Term
| Causes of hypofunctioning disorders: |
|
Definition
- Autoimmune destruction: Addison's disease, Hashitmoto's thyroiditis
Infarction: Sheehans postpartm necrosis, Waterhouse Friderichsen syndrome
- Decreased hormone stimulation (hypopituitarism)
- Enzyme deficiency, infection, neoplasia, congenital disorder |
|
|
Term
| To evaluate a hyper-functioning disorder, do a __ test. Give example. |
|
Definition
- suppression test
- Dexamethasone suppression test to evaluate hypercortisolism |
|
|
Term
| Causes of hyperfuncting include: |
|
Definition
- adenoma
- acute inflammation
- hyperplasia
- cancer
(If its cancer, when you do suppression test, it won't suppress) |
|
|
Term
| Prolactin inhibitiory hormone aka __ from the __ inhibits release of prolactin from the __ __. |
|
Definition
|
|
Term
| 4 causes of hypothalamic dysfunction: |
|
Definition
- Pituitary adenoma (also causes a primary pituitary d/o) is MOST COMMON
- Craniopharyngioma
- Infections
- Inflammation |
|
|
Term
| A __ is a slow-growing, __ __ tumor arising from remnants of embryonic structures. It occasionaly behaves like a malignant tumor. These are most common in children. |
|
Definition
- craniopharyngioma
- epithelial squamous |
|
|
Term
| Clinical findings of hypothalamic dysfunction: |
|
Definition
- Secondary hypopituitarism: No releasing hormones to stimulate anterior pituitary
- Central diabetes insipidus
- Increased prolactin b/c no dopamine to inhibit it
- Precocious puberty
- Visual field defects: bitemporal hemianopia
- Mass effect ( obstructive hydrocephalus) |
|
|
Term
| The __ synthesizes anti-diuretic hormone (ADH), so if there is dysfunction in this organ, __ __ __ is a manifestation. |
|
Definition
- hypothalamus
- central diabetes insipidus |
|
|
Term
| Secondary hypopituitarism means the problem is in the __. |
|
Definition
|
|
Term
| Most common cause of hypopituitarism in adults: |
|
Definition
Nonfunctioning adenoma
less than 10 mm= microadenoma
greater than 10 mm= macroadenoma |
|
|
Term
| Adenomas in the pituitary gland are associated with __ __ __ ___. This is an autosomal __ change in genes that control cell growth. The most common manifestation of this condition is __ which results from hyperplasia of all __ ___ glands. |
|
Definition
- Multiple Endocrine Neoplasia Syndrome
- dominant
- hyperparathyroidism
- 4 parathyroid |
|
|
Term
| Most common cause of hypopituitarism in children: |
|
Definition
|
|
Term
| Sheehans postpartum necrosis is when there is __ __ secondary to __ __. |
|
Definition
- pituitary infarction
- hypovolemic shock |
|
|
Term
| Apoplexy refers to sudden onset of __ __. __ __ is often due to __ or __ of pre-existing pituitary adenoma. |
|
Definition
- neurologic dysfunction
- Pituitary apoplexy
- hemorrhage/infarction |
|
|
Term
| Sickle cell anemia can cause pituiary hypofunction by causing __ due to vascular occlusion. |
|
Definition
|
|
Term
| With primary hypopituitarism the problem is with the __, __% of the gland must be destroyed. |
|
Definition
|
|
Term
| Possible causes of anterior pituitary hypofunction: |
|
Definition
- pituitary adenoma
- craniopharyngioma
- Sheehan's postpartum necrosis
- Pituitary apoplexy
- Sickle cell anemia
- Empty sella syndrome
- Hypothalamic dysfunction |
|
|
Term
Why neurological deficits occur with pit adenomas?
Can compress optic chiasm> visual problems
MASS EFFECT CAUSES THE SUPPRESSION ON THE OPTIC CHIASM> VISUAL PROBLEMS |
|
Definition
|
|
Term
| What kind of tests would you do to find piituitary adenomas? |
|
Definition
|
|
Term
| ACTH acts on the __ __ to stimulate secretion of ___. |
|
Definition
- adrenal cortex
- glucocorticoids |
|
|
Term
| result of children lacking FSH/LH: |
|
Definition
|
|
Term
| what if adult female lacks fsh and lh? |
|
Definition
- secondary amenorrhea
- osteoporosis
- hot flashes (lack of estrogen)
- decreased libido |
|
|
Term
| What if an adult male has deficiency of fsh/lh? |
|
Definition
- impotence
- decreased libido from decreased testosterone |
|
|
Term
| If patient has a low FSH/LH, you would perform the ___ __ __. If there is no significant increase, then the problem is in the __. If there is an increase then the problem is in the ___. |
|
Definition
- GnRH Stimulation Test
- pituitary (hypopituitarism)
- hypothalamus |
|
|
Term
| Deficiency of trophic/growth hormone in kids would result in? |
|
Definition
- delayed growth
- delayed fusion of epiphyses
- bone growth does NOT match age of child |
|
|
Term
| Growth/Trophic hormone deficiency in adults would cause: |
|
Definition
- hypoglycemia
- decreased gluconeogenesis
- loss of muscle mass
- increased adipose around the waist |
|
|
Term
| If growth hormone is low, would perform the __ and __ __ tests. Normally, GH and IGF-1 are released around 5 am, if there is something wrong with the pituitary, there will be __ __. |
|
Definition
- Arginine and Sleep Stimulation Tests
- no increase |
|
|
Term
| Decreased TSH would result in __ ___, meaning both the __ and __ are decreased. |
|
Definition
- secondary hypothyroidism
- TSH and T4 are decreased |
|
|
Term
|
Definition
| cold intolerance, weakness, constipation |
|
|
Term
| If TSH is low and the problem is due to the pituitary, the stimulation test will result in __ __in TSH. |
|
Definition
|
|
Term
| In secondary hypocortisolism, the __ and __ are decreased b/c the problem is in the ___. These patients will have __ b/c of decreased ___ and __ ADH levels leading to ___. These patients will have weakness and fatigue. |
|
Definition
- ACTH
- cortisol
- pituitary
- hypoglycemia
- decreased gluconeogenesis
- increased ADH levels
- hyponatremia |
|
|
Term
| Pts with low ACTH will also have low cortisol. This is called secondary hypocortisolism. Since cortisol normally inhibits release of __, these patients will have high levels of __ known as __ of __ __ __ which results in __. |
|
Definition
- ADH
- ADH
- Syndrom of Inapproapriate ADH secretion
- hyponatremia |
|
|
Term
| If someone has secondary hypocortisolism a short ACTH stimulation test will result in __ __ in serum cortisol over decreased baseline levels. |
|
Definition
|
|
Term
| A Metyrapone test is a stimulation of the pitutiary ACTH reserve. Metyrapone inhibits adrenal 11-hydroxylase which, in a NORMAL individual, should cause a __ in cortisol and an __ in ACTH and ____. In hypopituitarism, neither the _ or __ are __. |
|
Definition
- decrease in cortisol
- increase in ACTH and 11-deoxycortisol
- neither the ACTH or 11-deoxycortisol are increased |
|
|
Term
| __ __ aka __ and __ are synthesized in the __, but stored and secreted by the posterior pituitary. |
|
Definition
- Anti-diuretic hormone (ADH) aka Vasopressin
- Oxytocin
- hypothalamus |
|
|
Term
|
Definition
|
|
Term
| Oxytocin acts on the __ __ and __ __ to cause __ of milk and _ __ . |
|
Definition
- mammary glands
- uterine muscle
- release of milk (milk ejection)
- uterine contractions |
|
|
Term
| ADH acts on the __ __ and __ __ to increase __ __. |
|
Definition
- kidney tubules
- sweat glands
- water retention |
|
|
Term
| presence of ADH __ urine concentration. |
|
Definition
| increases (b/c more is kept in body and less is peed out) |
|
|
Term
| Absense of ADH causes __ of urine. |
|
Definition
|
|
Term
| YOU CAN HAVE AN ADEONMA THAT WILL KEEP THE PITUITARY FROM FUNCTIONING B/C IT TAKES UP SPACE, BUT YOU CAN ALSO HAVE AN ADENOMA THAT HYPERSECRETES. AND IT WILL HYPERSECRETE WHATEVER HORMONE IT IS AN ADENOMA OF. |
|
Definition
|
|
Term
| A prolactinoma is a __ __ and the __ __pituitary tumor. |
|
Definition
- benign adenoma
- most common pituitary tumor |
|
|
Term
| Manifestations of a prolacintoma in women: |
|
Definition
- secondary amennorrhea
- galactorrhea
(the prolactin inhibits the GnRH) |
|
|
Term
| Manifestations of a prolactinoma in men: |
|
Definition
| - impotence due to loss of libido from decreased testosterone |
|
|
Term
|
Definition
- elevated serum prolactin (greater than 200 ng/mL)
- Decreased FSH and LH due to decrease GnRH |
|
|
Term
| Prolactinomas are either treated by __ or __ __ that inhibit prolactin secretion by the tumor. |
|
Definition
- surgery
- dopamine analogues (Bromocriptine or Cabergoline) |
|
|
Term
| You see a pt that is on Bromocriptine or Cabergoline. What are these meds and what is the med likely treating? |
|
Definition
- dopamine analogues
- prolactinoma |
|
|
Term
| A growth hormone adenoma accounts for 20% of all pituitary adenomas. It can be diagnosed via __ __ or __(best study) or __ tests for the hyperfunctioning gland. |
|
Definition
- CT scan
- MRI (best study)
- suppression tests |
|
|
Term
| excess GH manifestations: |
|
Definition
If its before the plates close and kid> gigantism
If after the plates have closed and in adulthood> acromegaly (hands, feet, lower jaw continue to grow) |
|
|
Term
| clinical features of acromegaly: |
|
Definition
Hypertrophy of sweat and sebaceous glands
Galactorrhea
Cardiomegaly
HTN
Visual field defects b/c mass effect
Large nose
Glucose intolerance
Sexual dysfunction
Peripheral neuropathy
Prominent supraorbital ridge
Spade shaped hands/feet
Arthrosis
Teeth are separated or lacking |
|
|
Term
| The thyroid gland has a right lobe and a left lobe connected by a narrow isthmus. |
|
Definition
|
|
Term
An increase in FT4/FT3 should produce a decrease in TSH.
A decrease in FT4/FT3 should produce an increase in TSH. |
|
Definition
|
|
Term
Low TSH> probably hyperthyroidism
High TSH> probably hypothyroidism
If symptoms don’t match above rule, do more tests. Like low TSH and patient has symptoms of hypothyroidism, do more tests and figure out why TSH is low. |
|
Definition
|
|
Term
T4 and T3 bind to thyroid-binding globulin (TBG).
One third of TBG binding sites are normally occupied.
Free T4 (FT4) (a prohormone) is peripherally converted to free T3 (FT3)
FT3 is a metabolically active hormone
Total serum T4
Represents T4 bound to TBG and free (unbound) T4 (FT4) |
|
Definition
|
|
Term
| Estrogen causes and ___in thyroid binding globulin (TBG) which ___ total serum T4, but NOT free T4. |
|
Definition
- increase
- increases
(seen in pregnancy, with OCP, and HRT) |
|
|
Term
| When someone is pregnant, which increases TBG, what happens to total serum T4, free T4, ant TSH? |
|
Definition
- total serum T4 increases
- free T4 remains normal
- TSH remains normal (b/c ft3 and ft4 have negative feedback on TSH) |
|
|
Term
| __ and __ have negative feedback on TSH release from pituitary. |
|
Definition
|
|
Term
| A decrease in TBG would decrease __ __ but not __ __. |
|
Definition
|
|
Term
|
Definition
- anabolic steroids
- nephrotic syndrome (urinary loss) |
|
|
Term
| So if someone is on anabolic steroids, what will happen to their TBG, total T4, free T4, and TSH? |
|
Definition
- decreased TBG
- decreased total T4
- normal free T4
- normal TSH
There would NOT be signs of hypothyroidism b/c FT4 is normal. |
|
|
Term
| Primary hypothyroidism means the problem is with the ___, so TSH would be __. |
|
Definition
|
|
Term
| possible causes of decreased TSH: |
|
Definition
Thyrotoxicosis (e.g., Graves' disease)- increased T4 and T3 > decreased TSH
Hypopituitarism/hypothalamic dysfunction (secondary hypothyroidism) |
|
|
Term
| Primary hypothyroidism would do what to T3, T4, TSH, and TBG? |
|
Definition
problem with thyroid gland so:
- low T3 and T4
- high TSH
- normal TBG |
|
|
Term
| Hyperthyroidism due to Grave's disease or thyroiditis would do what to TSH, FT4 and TBG? |
|
Definition
- low TSH
- high FT4
- normal TBG |
|
|
Term
| Causes of hypothyroidism: |
|
Definition
Hashimoto's thyroiditis (90% of cases)
Subacute painless lymphocytic thyroiditis
Hypopituitarism, iodine deficiency, enzyme deficiency
Drugs
Amiodarone, lithium, sulfonamides, phenylbutazone
Hypothalamic
Congenital
Cretinism: Hypothyroidism in infancy or early childhood |
|
|
Term
| Cretinism is a condition of severely __ __ and __ growth due to untreated congenital deficiency of thyroid hormone (hypothyroidism) due to maternal nutrition iodine deficiency. |
|
Definition
| - stunted mental and physical |
|
|
Term
| With Hashimoto's thyroiditis, the thyroid gland is initially __ with transient __. This is followed by a __ state and then __ and eventual gland __ years later. This is an __disease. |
|
Definition
- enlarged
- hyperthyroidism
- euthyroid
- hypothyroidism
- atrophy
- autoimmune |
|
|
Term
| With hashimotos thyroiditis, the thyroid cells cannot regenerate after destruction, so __ replaces the gland. |
|
Definition
|
|
Term
| With Hashimoto's Thyroiditis, ___ are usually present in the plasma. Name the three types. |
|
Definition
- autoantibodies
- Anti-microsomal
- Anti-peroxidase
- Anti-thyroglobulin |
|
|
Term
| Myxoedema is severe ___ with a __ __ face due to a __, ___ edema. These pts will present with __, __ __, __ __, __ __. They will have __ DTRs and __. |
|
Definition
- hypothyroidism
- puffy swollen face
- hard, non-pitting edema
- fatigue
- dry skin
- hair loss
- muscle weakness
- sluggish DTRs
- HTN
(this is a form of primary hypothyroidism) |
|
|
Term
| A __ TSH and __ free T4 confirms the diagnosis of primary hypothyroidism. |
|
Definition
|
|
Term
| With primary hypothyroidism, what effect would a stimulation test of TSH have on free T4 levels? |
|
Definition
|
|
Term
| With primary hypothyroidism, the thyroid gland is inactive so uptake of I131 would be __. |
|
Definition
|
|
Term
| TMT of primary hypothyroidism; |
|
Definition
|
|
Term
The classical hyperthyroidism or thyrotoxicosis (Graves disease): characterized by an abnormal rise in basal metabolic rate, struma and eye signs (thyroid eye disease). The eyes of the patient typically bulge (exophtalmus). Patients with thyrotoxicosis have overwhelmingly high metabolic rates
Another cause: Toxic nodular goiter |
|
Definition
|
|
Term
| Graves disease/thyrotoxicosis and toxic nodular goiter both cause __. |
|
Definition
|
|
Term
| With Grave's Disease and Multinodular Goiter the problem is with the __ __ thus these are __ ___. |
|
Definition
- thyroid gland
- primary hyperthyroidisms |
|
|
Term
| With Grave's disease and Multinodular Goiters, what would you expect to see with regards to TSH, serum T4? |
|
Definition
- decreased TSH
- increased T4
- increased I131 uptake |
|
|
Term
| What kind of autoantibodies are seen with Grave's disease? |
|
Definition
| - TSH-receptor antibodies= IgG antibodies aka long acting thyroid stimulator |
|
|
Term
Increased serum T4, decreased serum TSH, increased 131I uptake
These findings, plus a history of palpitations (sinus tachycardia) and weight loss with no anorexia, suggest: |
|
Definition
|
|
Term
| Grave's disease is a __ __ hypersensitivity reaction. |
|
Definition
|
|
Term
| With secondary hypothyroidism aka hypopituitarism, you would expect TSH, serum T4, and free T4 to all be __. |
|
Definition
|
|
Term
| Where are the parathyroid glands located? |
|
Definition
- 4 of them
- posterior side of the thyroid |
|
|
Term
| Parathyroid hormone (PTH) __ calcium reabsorption in the __ __ tubule and ___ bicarbonate and phosphorus reabsorption in the __ tubule. |
|
Definition
- increases
- early distal tubule
- decreases
- proximal |
|
|
Term
| __ helps maintain ionized calcium in the blood so when calcium is low it __ bone resorption and renal reabsorption of calcium. |
|
Definition
|
|
Term
Parathyroid hormone is the most important endocrine regulator of calcium and phosphorus concentration in extracellular fluid. This hormone is secreted from cells of the parathyroid glands and finds its major target cells in bone and kidney
Stimulated by hypocalcemia and hyperphosphatemia
Suppressed by hypercalcemia and hypophosphatemia |
|
Definition
|
|
Term
| PTH is stimulated by ___ and ___. |
|
Definition
- hypocalcemia
- hyperphosphatemia |
|
|
Term
| Hypofunction of the parathyroid gland leads to ___. |
|
Definition
|
|
Term
| Causes of hypoparathyroidism: |
|
Definition
- autoimmune (most common cause)
- previous thyroid surgery (not common in current day surgery)
- DiGeorge Syndrome |
|
|
Term
| DiGeorge syndrome is a failure of descent of the __ and __ ___ __ meaning that the __ __ and __ are absent. ___ and __ are manifestations of this. These pts will also have impaired immunity since they won't have T cells. |
|
Definition
- 3rd and 4th pharyngeal folds
- parathyroid glands and thymus
- Hypocalcemia and hyperphosphatemia |
|
|
Term
| DiGeorge Syndrome is also associated with __ __ __ disease. |
|
Definition
| cyanotic congenital heart disease |
|
|
Term
| Hypocalcemia causes __, which in newborns is manifested by __, __ __, and __. |
|
Definition
- tetany
- jitteriness, repetitive blinking, and stridor |
|
|
Term
|
Definition
Failure of formation of the third and fourth pharyngeal pouches. This is associated with absence of the thymus (pure T-cell immunodeficiency) and absence of the parathyroid glands, causing primary hypoparathyroidism (decreased PTH and decreased serum calcium).
DiGeorge syndrome is the only syndrome associated with absence of the thymus, hypocalcemia, and cyanotic congenital heart disease.
Hypocalcemia causes tetany, which in newborns is manifested by jitteriness, repetitive blinking, and stridor. |
|
|
Term
| PTH release is controlled by __ calcium levls. |
|
Definition
|
|
Term
| Five Major Actions of PTH: |
|
Definition
1. Activates and increases osteoclasts, which mobilize calcium from bone
2. Increases renal tubular absorption of calcium
3. Increases conversion of vit. D to active dihydroxy in kidneys
4. Increases urinary phosphate excretion, which reduces calcium loss
5. Increases GI absorption of calcium |
|
|
Term
| Primary Hyperparathyroidism: Excessive secretion of PTH leads to: bone resorption, high [Ca2+] in plasma (hypercalcemia), high Ca2+ -excretion in the kidneys with renal stone formation (hypercalciuria), bone lesions, and metastatic calcification; hypercalcemia with low plasma phosphate, increased urine phosphate/calcium excretion, and raised PTH levels in plasma |
|
Definition
|
|
Term
| Causes of hyperparathyroidism: |
|
Definition
- adenoma (80%)
- primary hyperplasia (20%)
- carcinoma (uncommon) |
|
|
Term
With hyperparathyroidism:
adenomas- single lesion
hyperplasia- all 4 enlarged
KNOW THIS DIFFERENCE |
|
Definition
|
|
Term
| Primary hyperparathyroidism lab findings: |
|
Definition
Laboratory findings
Increased serum PTH, increased calcium, decreased phosphorus
Hypercalcemia, hypercalciuria, hypophosphatemia, and hyperphosphaturia (added)
Intact serum PTH (iPTH): best initial screen for primary HPTH
Intact serum PTH is best initial screening test
Distinguishes it from hypercalcemia related to malignancy |
|
|
Term
| Most common cause of hypercalcemia in the hosptial is ___. With __ hypercalcemia, serum PTH is __ instead of __ as it is with adenomas/hyperplasia. |
|
Definition
- malignancy
- malignancy
- decreased
- increased |
|
|
Term
Secondary HPTH: compensation for hypocalcemia
Hyperplasia of all four parathyroid glands
Compensation for hypocalcemia as in hypovitaminosis D due to renal failure and malabsorption
Decreased calcium, increased PTH
May develop tertiary hyperparathyroidism
Glands become autonomous regardless of calcium level.
May bring serum calcium into a normal or increased |
|
Definition
|
|
Term
| Secondary hyperparathyroidism is an adequate physiological response to hypocalcaemia by any cause such as renal failure or malabsorption. Parathyroid hyperplasia is shown here. Three and one-half glands have been removed (only half the gland at the lower left is present). |
|
Definition
|
|
Term
|
Definition
Due to these causes of hypocalcaemia: renal failure with phosphate retention, vitamin D deficiency or resistance to vitamin D, or calcitonin administration.
Iatrogenous (during thyroidectomy or parathyroidectomy). After seemingly successful surgery there is a dramatic fall in plasma [Ca2+] and a rise in [phosphate], leading to hypocalcaemia cramps.
Primary, idiopathic hypoparathyroidism is an extremely rare autoimmune disease often found in combination with other autoimmune disorders |
|
|
Term
| The adrenal cortex is made of the __, __, and ___. The __ makes mineralocorticoids like __. The __ makes glucocorticoids like __. The reticularis makes __ __. |
|
Definition
- glomerulosa, fasciculata, reticularis
- glomerulosa makes mineralocorticoids like aldosterone
- fasciculta makes glucocorticoids like cortisol
- reticularis makes sex hormones
(remember GFR: salt, sugar, sex) |
|
|
Term
| In a patient with meningococcemia that is septic (Neisseria meningitidis), __ __ syndrome can occur, this is bilateral hemorrhage of the adrenal glands. |
|
Definition
| Waterhouse-Friderichsen Syndrome |
|
|
Term
| Chronic adrenal insufficiency is called __ __. This is an __ __ in the US (80% of cases). __ __ is the most common cause of Addison's in developing countries. ___ from primary lung cancer can also cause this. |
|
Definition
- Addison's disease
- autoimmune disease
- Miliary TB
- Metastasis |
|
|
Term
| Addison's Disease clinical findings include __ and __ due sodium loss from __ and __ deficiency and __ ___ b/c increased plasma ___ stimulates __ (buccal mucosa, skin, skin creases) |
|
Definition
- weakness and hypotension
- glucocorticoid and mineralocorticoid deficiency
- diffuse hyperpigmentation
- ACTH stimulates melanocytes |
|
|
Term
| The Metyrapone test is a short and prolonged __ stimulation test. If a pt has Addisons,the __ will go up, but will not result in an increase of __ or ___. |
|
Definition
- ACTH
- ACTH
- cortisol or 11-deoxycortisol
(Addison's and these test results= primary adrenal gland insufficiency) |
|
|
Term
| If you give the Metyrapone stimulation test, and ACTH does not go up, then it is __ aka __ __ __ insufficiency. |
|
Definition
| - hypopituitarism aka secondary adrenal cortex insufficiency |
|
|
Term
| Schematic of the metyrapone test: a normal response: Metyrapone test: stimulation test of pituitary ACTH reserve; metyrapone inhibits adrenal 11-hydroxylase, which causes a decrease in cortisol and a corresponding increase in plasma ACTH (pituitary) and 11-deoxycortisol (adrenal), which is proximal to the enzyme block |
|
Definition
|
|
Term
| Schematic of the metyrapone test: expected in hypopituitarism: Metyrapone test: stimulation test of pituitary ACTH reserve; metyrapone inhibits adrenal 11-hydroxylase, which causes a decrease in cortisol neither ACTH or 11-deoxycortisol are increased |
|
Definition
|
|
Term
| Addison's disease pts will have __ sodium, __ potassium, and be in __ __. |
|
Definition
- low sodium
- high potassium
- metabolic acidosis |
|
|
Term
| Addison's disease pts will get fasting hypoglycemia in which you will see __, __, __, and __. This is all due to the decrease in __. |
|
Definition
- hypoglycemia
- eosinophilla
- lymphocytosis
- neutropenia
- cortisol |
|
|
Term
| Adrenocortical hyperfunction is excess __ production which results in __ __. |
|
Definition
- cortisol
- Cushing's Syndrome |
|
|
Term
| Primary adrenocortical hyperfunction (Cushing's disease), can occur as a primary abnormality when there is a problem with __ __ production by the __ __. |
|
Definition
- steroid hormone
- adrenal cortex |
|
|
Term
| Secondary Cushing's Syndrome/Adrenocortical Hyperfunction occurs as a result of __ of __ by the __ __ resulting in excessive stimulation of the adrenal cortex. |
|
Definition
| - overproduction of ACTH by the pituitary gland |
|
|
Term
Reasons for too much cortisol:
Pt taking steroids
Adrenal producing too much all by itself
Adrenal produciing too much b/c pituitary gland is tell it to produce too much |
|
Definition
|
|
Term
| Cushing's Disease is a __ _ with increased __. Cushing's Syndrome is a clnical term used to describe all cases of abnormally high __ concentration. |
|
Definition
- pituitary disorder with increased ACTH
- glucocorticoid (cortisol) |
|
|
Term
| ACTH dependent Cushings is either caused by a __ disorder (Cushing's disease), or by an __ __ __ __. |
|
Definition
- pituitary disorder
- ectopic ACTH producing tumor |
|
|
Term
| Non-ACTH-dependent Cushings is usually caused by __ administration for long periods. __ __ can also cause this by producing excess glucoroticoids. The ACTH secretion is suppressed. |
|
Definition
- glucocorticoid
- Adrenal tumors (adenomas and carcinomas) |
|
|
Term
Too much cortisol and too much acth= ACTH dependent cushings
Too much cortisol which turns off acth= Non-ACTH dependent cushings (acth independent cushings) |
|
Definition
|
|
Term
| Pituitary Cushing's Syndrome aka __ _ is 60% of cases. It is most commonly due to a __ __ which increaes the levels of __ and in turn __. |
|
Definition
- pituitary adenoma
- ACTH and cortisol |
|
|
Term
| Ectopic Cushing syndrome is 15% of cases, usually caused by __ __ __ of the __, and sometimes the __ and __. There is an increase in __ and __. |
|
Definition
- small cell carcinoma of the lung
- thymus and thryoid
- ACTH and cortisol |
|
|
Term
| Addison's and long term steroid use would cause adrenal cortex __. |
|
Definition
|
|
Term
| Cushing's disease/syndrome would cause adrenal cortex __. |
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Definition
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Term
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Definition
24 hour urinary free cortisol will be raised
48 hour dexamethasone test - will fail to suppress cortisol levels
Circadian rhythm - there will be an abnormally high evening cortisol level
Insulin tolerance test - no cortisol rise with hypoglycaemia |
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Term
| Cushings Laboratory Findings: |
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Definition
Increased urine free cortisol
Very high positive and negative predictive value
Low-dose dexamethasone (cortisol analogue) suppression test
Cannot suppress cortisol in all types
High-dose dexamethasone suppression test
Can suppress cortisol in pituitary Cushing syndrome but not the other types |
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Term
| Cushing's patients have an increase in fat in the face, the trunk, across the shoulder blades, and at the base of the neck. Connective tissue is lost from the skin, causing it to become thinner. As a result, blood vessels are located closer to the surface making the skin have a slight red appearance. |
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Definition
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Term
| Cushing's patients have thin arms and legs, due in part to the loss of muscle mass as a result of the protein-catabolic effects of excess cortisol, and also as fat is redistributed from the extremities to the trunk |
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Definition
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Term
| Iatrogenic Cushing's syndrome: exogenous Cushing syndrome is a form of Cushing syndrome that occurs in people taking glucocorticoid (also called corticosteroid) hormones, such as prednisone, used for a wide range of inflammatory, autoimmune, and neoplastic disorders (added) |
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Definition
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Term
| Dexamethasone suppression test: |
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Definition
Suppression of cortisol with high-dose dexamethasone:
Dexamethasone, a cortisol analogue, is used as a suppression test to differentiate pituitary Cushing’s syndrome from adrenal Cushing’s syndrome (cortisol-secreting adenoma) or ectopic Cushing’s syndrome (e.g., ACTH-secreting small cell carcinoma of the lung).
A normal response to dexamethasone is suppression of ACTH (negative feedback) and a decrease in cortisol production in the adrenal cortex. |
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Term
A low dose of dexamethasone is used as a screening test for hypercortisolism. It does not suppress cortisol production in pituitary, adrenal, or ectopic Cushing’s syndrome.
A high dose of dexamethasone suppresses ACTH production in pituitary Cushing’s syndrome leading to a drop in cortisol levels. Cortisol remains increased in adrenal and ectopic Cushing’s syndromes. |
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Definition
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Term
| Pts with Cushings disease will have ___ b/c cortisol enhances ___ and stimulates the release of __. They will also have __ __ __ due to increased __ __. |
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Definition
- hyperglycemia
- gluconeogenesis
- insulin
- hypokalemic metabolic akalosis due to increased weak mineralocorticoids |
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Term
| 3 conditions of Cushings syndrome: |
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Definition
- hyperglycemic
- hypokalemic
- metabolic alkalosis |
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Term
| A Glucagonoma is a malignant tumor of __ cells of the pancreas that causes ___. |
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Definition
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Term
| An insulinoma is a __ tumor of beta cells of the pancreas, this is the most common islet cell tumor. Pt will have __ _ causing __ __ abnormalities. Lab studies will show: |
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Definition
- beta
- fasting hypoglycemia causing mental status abnormalities
- Lab stuides will show: fasting hypoglycemia, increase in insulin and C-peptide |
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Term
| A somatostatinoma is a __ tumor of __ islet cells of the pancreas. Somatostatin is an inhibitory hormone. Manifestation include: |
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Definition
- malignant
- alpha
- inhibits gastrin> achlorhydria
- inhibits cholecystokinin> cholelithiasis and steatorrhea
- inhibits gastric inhibitory peptide causes diabetes mellitus |
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Term
| VIPoma is aka __ __. This is a __ tumor with excessive secretion of __ __ _, which causes __ __ and __. |
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Definition
- pancreatic cholera
- malignant
- vasoactive inhibitory peptide
- secretory diarrhea and achlorhydria
Labs: hypokalemia, normal anion gap metabolic acidosis (loss of bicarb in stool) |
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Term
| Zollinger- Ellison is a __ __ cell tumor that secretes __ proudcing __. __ __ is associated with 20-30% of cases. Clincal manifestations include __ __, __, and __ of food. Serum gastrin will be greater than 1000 pg/mL. |
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Definition
- malignant islet
- gastrin
- hyperacidity
- MEN1 syndrome
- peptic ulcerations
- diarrhea
- maldigestion of food |
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Term
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Definition
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Term
| Gastric Hyperacidity and Excess Production of Gastrin: Zollinger-Ellison syndrome is a disorder where increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. Often the cause is a tumor (gastrinoma) of the duodenum or pancreas producing the hormone gastrin. Gastrin then causes an excessive production of acid which can lead to peptic ulcers (in almost 95% of patients) |
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Definition
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Term
| a deficiency in insulin or deficits in insulin responsiveness lead to diabetes mellitus |
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Definition
Pathologic processes and complications in diabetes mellitus
Poor glycemic control
Hyperglycemia is the key factor that produces organ damage.
Good glycemic control prevents complications of diabetes.
Glucose control reduces onset and severity of complications.
Complications are related to retinopathy, neuropathy, and nephropathy in descending order. |
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Term
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Definition
Laboratory Findings
Hyperglycemia
Glucose ranges from 250 to 1000 mg/dL.
Increased HbA1c≥ 6%
Nonenzymatic glycosylation (NEG)
Glucose combines with amino groups in proteins.
Produces advanced glycosylation products
Role in diabetes: production of glycosylated HbA1c |
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Term
DM Laboratory diagnosis
Criteria
Random plasma glucose ≥ 200 mg/dL plus classic symptoms
Fasting plasma glucose ≥ 126 mg/dL (Set for high sensitivity)
Two-hour glucose level after 75-g glucose challenge ≥200 mg/dL.
One of the preceding three criteria must be present on a subsequent day to confirm the diagnosis of diabetes. |
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Definition
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Term
Glycosylated hemoglobin (HbA1c)
Evaluates long-term glycemic control
Represents the mean glucose value for the preceding 8 to 12 weeks
Test is currently not/is used to diagnose diabetes.
Goal in therapy is <7% (some use 6.5%). |
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Definition
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Term
| Gestational diabetes is glucose intolerance during pregnancy due the anti-insulin effects of __ ___ __, __, and __. |
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Definition
- human placental lactogen (HPL)
- cortisol
- progesterone |
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Term
| Gestational Diabetes screening: |
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Definition
All pregnant women are screened between 24 and 28 weeks' gestation.
50-g glucose challenge followed by 1-hour glucose level
Above 140 mg/dL is a positive screen.
Positive screen is confirmed with a 3-hour oral glucose tolerance test. |
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Term
The MEN syndromes are a group of genetically inherited diseases resulting in proliferative lesions (hyperplasia, adenomas, and carcinomas) of multiple endocrine organs.
Like other inherited cancer disorders, endocrine tumors arising in the context of MEN syndromes have certain distinct features that contrast with their sporadic counterparts… |
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Definition
Occur at a younger age than sporadic tumors.
Arise in multiple endocrine organs, either synchronously (at the same time) or metachronously (at different times).
Even in one organ, the tumors are often multifocal.
Usually preceded by an asymptomatic stage of endocrine hyperplasia involving the cell of origin.
Usually more aggressive and recur in a higher proportion of cases than do similar sporadic endocrine tumors. |
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Term
| MEN-1 aka __ syndrome is a rare heritable d/o characterized by abnormalities in the __, __, and __ __ (3Ps). |
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Definition
- Wermer Syndrome
- parathyroid, pancreas, pituitary glands
Parathyroid: Primary hyperparathyroidism, both hyperplasia and adenomas.
Pancreas: Endocrine tumors of the pancreas such as gastrinomas (Zollinger-Ellison syndrome) and insulinomas (hypoglycemia)
Pituitary: prolactinoma |
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Term
| MEN-2A (Sipple syndrome): pheochromocytoma, medullary carcinoma, and parathyroid hyperplasia |
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Definition
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Term
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Definition
| medullary thyroid carcinomas and pheochromocytomas; neuromas or ganglioneuromas |
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Term
MEN:
1: PPP: pancreas, pituitary, parathyroid
2. PMP: parathyroid, medullary carcinoma, pheochromocytoma
3: MNP: medullary thyroid carcinomas, neuromas and ganglioneuromas, pheochromocytoma |
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Definition
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