Term
| These glands are ductless and highly vascularized. |
|
Definition
|
|
Term
| What structure acts as the primary driver (ie. gas and brake) of the endocrine system? |
|
Definition
|
|
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
|
|
Term
| This hormone promotes metabolism and growth. |
|
Definition
|
|
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
|
|
Term
| This pituitary hormone stimulates the synthesis of estrogen and progesterone from the corpus luteum in women. |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| Name the pituitary hormone!! Some movie quote about having too much testosterone. |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| When you suspect a pituitary adenoma, what's the first thing you should ask about? |
|
Definition
|
|
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
|
|
Term
| What is the most common dopamine agonist, by far, used to treat a pt with hyperprolactinemia? |
|
Definition
|
|
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
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
| pegvisomant, it is NOT a somatostatin |
|
|
Term
| What is pegvisomant's mechanism |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the most common cause of Cushing's syndrome? |
|
Definition
|
|
Term
| What % of Cushing's syndrome does Cushing's disease account for? |
|
Definition
|
|
Term
| Who is most at risk for Cushing's dx? |
|
Definition
|
|
Term
| What is the typical onset of cushing's dx? |
|
Definition
|
|
Term
| What is the most common natural cause of Cushing's dx? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What dx presents hirsutism (increased hair production) |
|
Definition
|
|
Term
| Cataracts are signs of what 2 dx's? |
|
Definition
| Cushing's Syndrome and DM |
|
|
Term
| Mental disturbances can be found in: |
|
Definition
|
|
Term
| What is dexamethosone used to diagnose? |
|
Definition
|
|
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
|
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
|
|
Term
|
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
|
|
Term
| What causes 60-70% of Addison's dx? |
|
Definition
|
|
Term
| What are 4 clinical signs of Addison's dx? |
|
Definition
| GI problems, hypotension, hyperpigmentation, fatigue/weakness |
|
|
Term
| Where are chromaffin cells found? |
|
Definition
|
|
Term
| What do chromaffin cells do? |
|
Definition
|
|
Term
| What is pheochromocytoma? |
|
Definition
| chromaffin cell neoplasms |
|
|
Term
| Are pheochromocytoma's common? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| How is pheochromocytoma treated? |
|
Definition
|
|
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
|
|
Term
| What systemic hormones are bound to plasma proteins? |
|
Definition
|
|
Term
| Do thyroid hormones have to be unbound from plasma proteins to trigger a response? |
|
Definition
|
|
Term
| What does T3 and T4 upregulate? |
|
Definition
| carb metabolism, lipid metabolsim, protein synthesis |
|
|
Term
|
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
|
|
Term
| What dx can be caused by weight loss herbal supplements? |
|
Definition
|
|
Term
| What dx presents hypermotility of the gut and lid retraction due to Mueller's muscle? |
|
Definition
|
|
Term
| What is the prevalence of Graves Dx? |
|
Definition
|
|
Term
| Who is most at risk for Graves dx? |
|
Definition
|
|
Term
| What is the peak age for Graves onset? |
|
Definition
|
|
Term
| What gene is Graves dx associated with? |
|
Definition
|
|
Term
| What kind of hypersensitivy is Graves? |
|
Definition
|
|
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
|
|
Term
|
Definition
| lid retraction and lid lag seen in Graves |
|
|
Term
| What is one cause of keratitis dry eye? |
|
Definition
|
|
Term
| What is one cause of compressive optic neuropathy? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What treatment can cause agranulocytosis? |
|
Definition
|
|
Term
| What is a rapid, highly succesful cure for hyperthyroidsim? |
|
Definition
|
|
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
|
|
Term
| What is the disadvantage of radioactive iodine tx? |
|
Definition
|
|
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
|
|
Term
| What is L-thyroxine used to treat? |
|
Definition
| hypothyroidism and Hashimoto's thyroiditis |
|
|
Term
| What is another term for cretinism |
|
Definition
|
|
Term
| What is the historical cause of cretinsim |
|
Definition
|
|
Term
| What dx presents with impaired skeletal development/short stature? |
|
Definition
|
|
Term
| Coarse facial features are caused by what dx? |
|
Definition
|
|
Term
| How does infantile myxedema cause mental impairment? |
|
Definition
| if thyroid deficiency occurs in utero |
|
|
Term
| What is Hashimoto's thyroiditis? |
|
Definition
|
|
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
|
Definition
| a benign nodule that takes up radioactive iodine |
|
|
Term
| What is one of the most common endocrine disorders? |
|
Definition
|
|
Term
| What causes 80-90% of hyperparathyroidsim? |
|
Definition
|
|
Term
| What dx presents increased calcium serum levels? |
|
Definition
|
|
Term
| Where do we see "painful bones, renal stones, abdominal groans, psychic moans" note: "Citek's lectures" is not an acceptable answer |
|
Definition
|
|
Term
| What is a rare cause of hypoparathyroidism? |
|
Definition
| autoimmune attack of parathyroid |
|
|
Term
|
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
|
|
Term
| What is the leading cause of blindness in the US? |
|
Definition
|
|
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
|
|
Term
| What age is highest incidence of DM1? |
|
Definition
|
|
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
|
Definition
| a slowly progressive form of DM1 |
|
|
Term
|
Definition
|
|
Term
| What is a common med to control LADA |
|
Definition
|
|
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
|
|
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
|
|
Term
|
Definition
| antibody positive DM2. This is NOT LADA |
|
|
Term
|
Definition
| majority onset diabetes of the Young |
|
|
Term
| What type of Dm is found in thin, young adults |
|
Definition
|
|
Term
| What kind of DM is easily controlled with low-dose insulin, diet or oral agents? |
|
Definition
|
|
Term
| What DM is a "single gene" disorder |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is gestational diabetes a form of? |
|
Definition
|
|
Term
| What is a risk factor for gestational diabetes? |
|
Definition
|
|
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
|
|
Term
| What are 4 classic signs of DM? |
|
Definition
| polyuria, polydipsia, fatigue, weight loss |
|
|
Term
| What dx triggers fasting metabolism? |
|
Definition
|
|
Term
| Gluconeogenesis and glycogenolysis are seen elevated in what dx? |
|
Definition
|
|
Term
| What is seen in the urine of DM pt's? |
|
Definition
|
|
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
|
|
Term
| What is the fasting glucose level for DM? |
|
Definition
|
|
Term
| 2 hrs after a glucose tolerance test is begun, what level of glucose will indicate DM |
|
Definition
|
|
Term
| Nephropathy is a long term complication of what? |
|
Definition
|
|
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
|
|
Term
| What is microalbuminuria? |
|
Definition
| the first clinical sign of nephropathy, bad sign for DM1 pts |
|
|
Term
| Atherosclerosis in accelerated in what dx? |
|
Definition
|
|
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
|
|
Term
|
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
|
|
Term
| What does protein kinase C activation cause? |
|
Definition
| angiogenesis, vascular permeability |
|
|
Term
| Where is protein kinase C (PKC) related complications seen? |
|
Definition
|
|
Term
|
Definition
| polyADP ribose polymerase |
|
|
Term
|
Definition
| increase apoptosis and increase endothelial damage |
|
|
Term
| What dx are complicated by PARP's? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What dx presents decreased heparin as a compounding problem |
|
Definition
|
|
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
|
|
Term
| What is the goal for HbA1c levels in DM? |
|
Definition
|
|
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
|
|
Term
| What are humulin, iletin, and novolin? |
|
Definition
|
|
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
|
|
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
|
|
Term
| What is the peak of neutral protamine hagedorn? |
|
Definition
|
|
Term
| What is the duration of neutral protamine hagedorn? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What dx presents difficulty going up stairs due to loss of pelvic girdle muscles? |
|
Definition
|
|
Term
|
Definition
| a short acting precipitate of insulin with zinc ions |
|
|
Term
| What type of DM is considerd the 'worst of both worlds'? |
|
Definition
|
|
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
|
|
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
|
|
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
|
Definition
| a drug for DM2 that slows gastric emptying; an incretin that signals "full" to the system |
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
Definition
|
|
Term
|
Definition
|
|
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
|
|
Term
|
Definition
| avg glucose levels over the last 6-8 wks |
|
|
Term
|
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
|
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
|
|
Term
| What insulins are approved for IV administration? |
|
Definition
| Lispro (Humalog) and regular insulin |
|
|
Term
|
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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|
