Term
| what is the definition of clinical endocrinology? |
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Definition
| clinical endocrinology provides a systematic approach to the dx and tx of conditions resulting from alterations of normal hormone physiology. these alterations may consist of an excess or deficiency of hormone actions which are evaluated with the intent to restore normal quantitative amounts, activity, and biological effects. |
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Term
| what characterizes the importance of the H+P in endocrine pts? |
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Definition
| in the hx, you have to know what to ask about and in the PE, you need to know what to look for |
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Term
| what role do lab results play in treating pts with endocrine pathology? |
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Definition
| the lab results are the "driver", as opposed to an imaging study, therefore a pituitary tumor seen on imaging - but not correlated with lab abnormalities is termed "incidental". or there may be an abnormal lab where there is no visible tumor = "non-imaged tumor". |
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Term
| what are the common endocrinopathies? |
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Definition
| DM 1/2, hyper/hypothyroidism, thyroid nodule, obesity, metabolic syndrome, gestational DM, prolactinoma, PCOS (insulin resistance), osteoporosis/-penia, hyperparathyroidism, GH deficiency |
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Term
| what are the uncommon endocrinopathies? |
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Definition
| *hypoparathyroidism, addison's, acromegaly, adrenal CA, klinefelter's, cushing's, pheochromocytoma, hermaphroditism, osteomalacia, DM insipidus, and craniopharyngioma |
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Term
| what vague symptoms are often associated with endocrinopathies? |
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Definition
| weakness, tiredness, cold intolerance, fatigue, warm intolerance, dizziness, headache, blurred vision, depression, inability to concentrate, constipation, and frequent bowel movements |
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Term
| what specialties do endocrinologists have to interact with commonly? |
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Definition
| OB/GYN, ortho, PCPs, internists, surgery, psychiatry, and cardiology |
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Term
| what is the second leading cause of preventable death in the US? |
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Definition
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Term
| what other endocrine conditions is obesity linked with? |
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Definition
| polycystic ovarian disease, insulin resistant type II diabetes and cancer |
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Term
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Definition
| in terms of BMI, where a 27-29: overweight and a BMI > 29: obese (for whites in the US). waist circumference % body fat may also be used |
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Term
| what populations have the highest rates of obesity? |
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Definition
| mexican american and african american women |
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Term
| how do the different kinds of obesity affect disease risk? |
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Definition
| upper body obesity (apple distribution) is associated with more disease because abdominal fat is more bioactive, leading to accelerated atherogenesis (*increased inflammation) while hip fat (pear distribution) is less prothrombotic. |
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Term
| what disorders are associated with obesity? (*know these*) |
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Definition
| insulin resistance, DM type II, HTN, dyslipidemia, CAD, gallbladder disease, CA (prostate, endometrial, uterine, ovarian, colon, gallbladder), osteoarthritis, sleep apnea, hirsutism, and psychological distress |
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Term
| what are the 5 concerns in endocrinology? |
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Definition
| lab selection (try to get most bang for buck), awareness of test limitations (may need to be fasting or not etc), utilization of screening tests, 2 premises (if the hormone level is high, try to suppress it/if the level is low, try to stimulate it), and recall the influence of medications/nutritional state when interpreting lab results |
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Term
| what are the major anterior pituitary hormones? |
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Definition
| TSH, ACTH, GH, FSH, LH, prolactin |
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Term
| what are the major posterior pituitary hormones? |
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Definition
| ADH, oxytocin, and brain natruretic peptide - however in terms of these, endocrinologists tend to look at the *effects* of water metabolism. |
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Term
| what are the hypothalamic hormones? |
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Definition
| TRH (thyrotropin releasing hormone), CRH (corticotropin releasing hormone), GHRH (growth hormone releasing hormone), somatostatin (growth hormone releasing inhibiting hormone), GnRH (gonadotropin releasing hormone), and dopamine (prolactin releasing inhibiting hormone) |
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Term
| what is a pituitary micro/macroadenoma? |
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Definition
| microadenoma: an enlargement <10 mm. macroadenoma: an enlargement >10 mm. |
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Term
| what is now considered an abnormally high prolactin level? |
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Definition
| >15 (number has come down with improvement of test) |
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Term
| what is the importance of prolactin? |
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Definition
| prolactin initiates/maintains lactation (increases significantly w/pregnancy and other altered metabolic states). prolactin is also an acute phase reactant (elevates w/stress, sepsis and during sleep). prolactin is also subject to the circadian rhythm. |
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Term
| what is the most common *hormone-secreting* pituitary tumor (vs a non-secreting pituitary adenoma)? how does this present? |
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Definition
| a prolactinoma, which in females presents as amenorrhea/galactorrhea and in males as ED (tumor size usually larger in males: less likely to get it checked out). |
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Term
| how are prolactinomas commonly found in the absence of a serum prolactin? |
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Definition
| via incidental findings on MRI, which may have been conducted for head/neck ache |
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Term
| what is tx for prolactinomas? |
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Definition
| ID, determine size, then tx w/medication that will decrease prolactin levels such as *bromocriptine mesylate (warn pt this may *increase fertility). if bromocriptine doesn't work or causes too much nausea (due to dopamine increase), then cabergoline may be used. if the prolactinoma grows further to the level of a macroadenoma and causes visual disturbances = sx/radiotherapy. |
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