Term
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Definition
| Type of endocrine failure where Problem is with the end organ (thyroid, adrenals, gonads) |
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Term
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Definition
| Type of endocrine failure where Problem is with the pituitary |
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Term
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Definition
| Type of endocrine failure where Problem is with the hypothalamus |
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Term
Releasing/inhibiting factors
Vasopressin/Oxytocin |
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Definition
| What does the hypothalamus secrete? |
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Term
ACTH (adrenocorticotropic hormone)
TSH (thyroid stimulating hormone)
FSH/LH (gonadotropins)
Prolactin
Somatotropin (Growth Hormone) |
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Definition
| What does the anterior pituitary secrete? |
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Term
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Definition
Protein hormone produced by specific pituitary cells: somatotropes
Facilitates growth via insulin-like growth factor I (IGF-I)
Stress-reactive functions via glucose metabolism |
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Term
Dwarfism
Nothing (the decline is normal) |
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Definition
Growth hormone deficiency in childhood?
What about adulthood? |
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Term
Giantism/gigantism
Acromegaly |
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Definition
Growth hormone excess in childhood?
What about adulthood? |
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Term
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Definition
Most commonly due to pituitary tumor
Excess GH in adults leads to:
Diabetes
Cardiac enlargement
Soft tissue swelling including:
Increasing head size
Increasing shoe size |
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Term
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Definition
| Treatment for GH deficiency |
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Term
Surgery: excise pituitary tumor
Medications:
Drugs which block GH release (somatostatin***)
Drugs which block GH receptors |
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Definition
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Term
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Definition
| Protein hormone produced by lactotropes |
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Term
Growth hormone releasing hormone (GHRH) to stimulate
Inhibition by somatostain |
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Definition
| How does the hypothalamus control GH? |
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Term
Lactation failure
Galactorrhea
Suppression of gonadal function |
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Definition
Prolactin deficiency leads to what?
Prolactin excess leads to what? |
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Term
| Dopamine agonists: Cabergoline (Dostinex) is the best drug for this |
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Definition
| What is the best treatment for hyperprolactinemia? What is the best drug for this? |
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Term
Production & release inhibited by dopamine***
Release stimulated by TRF (thyrotropin-releasing factor) |
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Definition
Production and release of prolactin inhibited by what?
Stimulated by what? |
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Term
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Definition
| Signs and symptoms due to excess secretion of cortisol by the adrenal gland |
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Term
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Definition
| Where are the adrenal glands located? |
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Term
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Definition
| What are the two parts of the adrenal gland? |
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Term
Secretes epinephrine & norepinephrine
(part of the sympathetic nervous system) |
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Definition
| What is the function of the medulla part of the adrenal gland? |
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Term
| Secretes steroids of three types |
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Definition
| What is the function of the cortex part of the adrenal gland? |
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Term
Glucocorticoid (cortisol)
Androgens (androstenedione, DHEA-S)
Mineralocorticoids (aldosterone) |
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Definition
| What are the three types of steroids secreted by the adrenal gland? |
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Term
Pituitary secretes ACTH which…
Stimulates the adrenal cortex to produce cortisol
Cortisol inhibits ACTH secretion |
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Definition
| Describe the negative feedback loop of the pituitary and adrenal gland |
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Term
Iatrogenic (pharmacologic)
Secondary Adrenal Hyperplasia
Primary adrenal hyperplasia |
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Definition
| What are the three causes of Cushing's syndrome? |
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Term
| An ACTH secreting tumor of the pituitary causes the adrenal cortex to produce more cortisol than normal |
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Definition
| Describe secondary adrenal hyperplasia |
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Term
Enhances glucose production
Improves resistance to stress (raises blood pressure and causes more glucose to be available)
Hematopoietic/Immunologic (lowers lymphocyte and monocyte levels) |
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Definition
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Term
Weight Gain (Central Obesity)
Hyperglycemia
Impaired Healing
Bone Loss/Osteoporosis
Edema
Peptic Ulcers
Euphoria/hallucinations |
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Definition
| Adverse effects of cortisol |
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Term
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Definition
| The vast majority of pituitary tumors are what? |
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Term
Prolactin (most common)
ACTH
Growth hormone |
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Definition
| What are the three secretory types of pituitary tumors? |
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Term
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Definition
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Term
T3: triodothyroinine
Amino acid tyrosine with 3 iodine groups
Is the main functional hormone |
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Definition
| What is T3 and what does it do? |
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Term
T4: tetraiodothyroinine, thyroxine
Amino acid tyrosine with 4 iodine groups
T4 is converted to T3 in peripheral tissues
Pharmacologic preferred form, easier to administer (once per day vs. 3 times per day/ less expensive) |
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Definition
| What is T4 and what does it do? |
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Term
Virtually all tissues (Especially concentrated in brain, heart, muscle, kidneys, gonads)
Activated receptors increase…
Energy utilization
Protein synthesis
Sensitivity to other hormones |
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Definition
| Where are T3 receptors located and what do they do? |
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Term
| Thyrotropin-releasing hormone (TRH) or factor (TRF) |
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Definition
| Stimulates the release of TSH and prolactin |
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Term
| Thyrotropin, Thyroid stimulating hormone (TSH) |
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Definition
| Stimulates the thyroid to produce T3 & T4 |
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Term
Endemic Goiter
Caused by low dietary iodide availability*** |
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Definition
| What is the most common type of goiter and where is it located? |
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Term
| exposure to ionizing radiation*** |
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Definition
| What is the main risk factor of thyroid cancer? |
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Term
Palpable, non-tender nodule***
Other symptoms only for large tumors:
Neck discomfort
Trouble with swallowing (dysphagia)
Hoarseness: injury to recurrent laryngeal nerve |
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Definition
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Term
| FNA – Fine needle aspiration biopsy |
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Definition
| How do you diagnose thyroid cancer? |
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Term
Papillary
Follicular
Medullary
Anaplastic |
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Definition
| Four Main Types of Thyroid Cancer |
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Term
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Definition
| What is the Most common & most benign form of thyroid cancer? |
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Term
Surgical excision (thyroidectomy)
Radioactive iodine for metastatic disease
Lifelong thyroid hormone replacement
Thyroxine |
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Definition
| Treatment of thyroid cancer |
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Term
Excellent (>90% 5 year survival) for:
Papillary, follicular & medullary if tumor limited to the thyroid at diagnosis
Poor for anaplastic thyroid cancer
One year survival: 10%
Five year survival: 5% |
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Definition
| Prognosis for thyroid cancer |
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Term
Graves’ Disease
Toxic nodular goiter |
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Definition
| What are the two main types of hyperthyroidism? |
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Term
TSH very low or non-detectable***
T4 level very high
Sometimes auto-immune disorder tests are positive |
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Definition
| How does a laboratory confirm hyperthyroidism? |
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Term
Restlessness
Insomnia
Tremor
Weight loss
Heat intolerance
Weakness
Fatigue
Muscle cramps
Menstrual irregularities |
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Definition
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Term
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Definition
| Most common type (60-80%) of hyperthyroidism |
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Term
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Definition
| Results from auto-antibodies that bind to and activate TSH receptors |
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Term
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Definition
| Female to male ratio of Graves' Disease |
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Term
Exophthalmos***
(Protrusion of eyes) |
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Definition
| Unique Symptom for Graves’ |
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Term
Control symptoms
Prevent thyroid storm ***
Lower blood levels of T3 and T4 with anti-thyroid drugs
Thyroid excision or destruction |
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Definition
| Hyperthyroidism Treatment |
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Term
| Use drugs that block beta adrenergic (sympathetic) receptors: “beta blockers” |
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Definition
| Controlling Symptoms of hyperthyroidism |
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Term
| Requires thyroid excision or ablation (destruction)!*** |
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Definition
| Definitively curing hyperthyroidism requires what? |
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Term
| failure of the thyroid gland |
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Definition
| What is primary hypothyroidism? |
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Term
| failure of pituitary to release normal amounts of TSH |
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Definition
| What is secondary hypothyroidism? |
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Term
| Primary (99+% of all cases) |
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Definition
| What is the most common type of hypothyroidism? |
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Term
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Definition
| How would a laboratory confirm hypothyroidism? |
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Term
Poor memory
Inability to concentrate
Hair loss
Weight gain
Cold intolerance
Weakness
Fatigue
Dry skin
Menstrual irregularities |
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Definition
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Term
Iatrogenic
Hashimoto’s thyroiditis
Drug induced (uncommon)
Dietary iodide deficiency (uncommon) |
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Definition
| Four Causes of hypothyroidism |
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Term
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Definition
| Fairly common (1-4/1,000) type of hypothyroidism resulting from an autoimmune disorder |
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Term
First Choice: Thyroxine (T4) Daily
Adjust Dose by Symptoms and TSH levels
Age Factor:
Low & Slow for >65 y/o
Dose typically 75% of young adults |
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Definition
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Term
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Definition
| Produce parathyroid hormone (PTH) |
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Term
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Definition
Increases osteoclastic activity in bone
Increases calcium reabsorption in the kidneys
Stimulates the synthesis of vitamin D
Increases calcium absorption in the small intestine |
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Term
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Definition
| So the Parathyroids Are All About… |
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Term
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Definition
What releases calcium in bone?
What stores it? |
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Term
Low calcium
High phosphorus
Low PTH |
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Definition
| How does a laboratory diagnose hypoparathyroidism? |
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Term
| PTH secreting parathyroid adenoma |
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Definition
| What usually causes primary Hyperparathroidism |
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Term
Hypercalcemia
High levels of PTH
Low levels of phosphorus
Diagnostic imaging may be needed |
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Definition
| Diagnosis of primary Hyperparathroidism |
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Term
Surgical excision of adenoma or of the glands (for hyperplasia)
Medications to prevent further bone reabsorption (bisphophonates)
Vitamin D analog if needed post-operatively |
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Definition
| Treatment of primary Hyperparathroidism |
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Term
Seen frequently with chronic renal disease
Main problem is falling vitamin D production
Falling Ca++ levels stimulate the parathyroids to secrete PTH |
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Definition
| Secondary Hyperparathyroidism cause |
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Term
High PTH level
Variable calcium & phosphorus levels
In setting of renal failure |
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Definition
| Diagnosis of Secondary Hyperparathyroidism |
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Term
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Definition
| Disorder characterized by chronic hyperglycemia which is caused by… Relative or absolute deficiency of insulin OR a deficiency of insulin action (“insulin resistance”) Results in “Glucose Intolerance” |
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Term
| Islets of Langerhans (Beta cells specifically) |
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Definition
| In the pancreas, what produces insulin? |
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Term
| Islets of Langerhans (Alpha cells specifically) |
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Definition
| In the pancreas, what produces glucagon? |
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Term
Inhibits Catabolic Actions
Inhibits glycogen breakdown
Inhibits amino acids & fatty acid breakdown into ketones
Promotes Anabolic Actions
Promotes glycogen production & storage
Promotes triglyceride synthesis in fat cells
Promotes protein synthesis in muscle cells |
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Definition
|
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Term
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Definition
| What is virtually the opposite of insulin? |
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Term
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Definition
Autoimmune disorder
Rapid loss of beta cells
Trigger may be virus or toxin |
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Term
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Definition
Very slow loss of beta cells
Genetic predisposition
Obesity |
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Term
The “three P’s”:
Polydipsia
Polyuria
Polyphagia |
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Definition
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Term
Significant hyperglycemia (>300 mg/dl) causes…
Keto acids (acetoacetate, B-hydroxybutyrate) to accumulate which results in acidosis (ph 6.8 – 7.3) |
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Definition
| Describe Diabetic Ketoacidosis |
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Term
| Most commonly used: Metformin (Glucophage) |
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Definition
| Most commonly used drug for reducing lnsulin resistance in type II diabetes |
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