Endocrine tests-diagnostics

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mrman
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119072
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Endocrine tests-diagnostics
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2011-11-26 20:07:27
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Endocrine tests
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Endocrine tests- diagnostics
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  1. Anterior Pituitary hormones
    FLATPEG

    • -FSH (follicular stimulating hormone)
    • -LH (luteinizing hormone)
    • -ACTH (adrenal corticotropic hormone)
    • -TSH (thyroid stimulating hormone)
    • -Prolactin
    • -endorphins
    • -hGH (human growth hormone)
  2. TSH
    stimulates thryoxin (T4) production in thyroid gland
  3. Increased T4
    • downregulates TSH
    • Hyperthyroidism

    -Grave's disease: increased T4, decreased TSH
  4. Thyrotoxicosis
    hyperthyroidism:

    • -elevated free T4
    • -elevated T3
  5. Grave's disease
    increased T4, decreased TSH

    -anti-thyroid Ab bind TSH receptors on thyroid gland, mimicking TSH action and stimulating T4 production
  6. Pituitary tumor on throid hormones
    increased T4

    increased TSH
  7. Hyperthyroid S/Sx
    • -Heat intolerance/warm
    • -weight loss
    • -exophthalmos (bulging eyes)
    • -diffuse goiter (doesn't decrease after treatment)
    • -anxiety
    • -nervous
    • -irritability
    • -proximal muscle weakness (grip not affected)
    • -tremor, palpitations, tachycardia
    • -oligomenorrhea (light)
  8. Thyroid storm
    crisis levels for hyperthyroidism

    • -severe fever
    • -tachycardia/arrhythmias
    • -altered mental status
  9. Exogenous TSH
    produced by pituitary adenomas

    -shows increased T4 and decreased TSH
  10. women to men hyperthyroidism ratio
    women 10x more common
  11. Hypothyroidism
    decreased T4 produced by thyroid

    -Hashimoto's
  12. Primary thyroid hormone problem
    thyroid problem

    -in hyperthyroid TSH is decreased
  13. Secondary thyroid hormone problem
    pituitary failure; TSH

    -in hyperthyroid TSH is elevated
  14. Hashimoto's
    • hypothyroid
    • -autoimmune anti-thyroid Ab
  15. Congenital hypothyroid
    can cause mental retardation
  16. Hypothyroid S/Sx
    • -Fatigue
    • -Weight gain
    • -Cold intolerance
    • -Dry skin/brittle hair
    • -depression
    • -Myxedema (puffy face, hands, pitting on shins not feet)
    • -goiter
    • -eyebrow loss
    • -constipation
    • -muscle cramps
    • -hypermenorrhea (heavy)

    • bilateral:
    • -delayed ankle reflexes
    • -delayed relaxation phase of reflex
  17. Myxedema coma
    • crisis level for severe prolonged hypothyroid
    • rare/life-threatening

    • -Bradycardia (below 50)
    • -CHF
    • -Hypothermia
    • -Hypoventilation
    • -Paralytic ileus (gut doesn't move)
    • -mental dulling
  18. hGH deficiency
    dwarfism

    • -treat with hGH
    • -may be part of multiple hormone deficiency
  19. hGH excess
    • giantism
    • acromegaly

    • -giantism before growth plate closure
    • -acromegaly after growth plate closure
  20. Acromegaly
    After closure

    • -usually from pituitary adenomas
    • -mean age: 40 men, 45 women
    • -continued growth of hands, feet, facial bones
    • -cartilage in larynx and bronchi grow->voice deepens

    -kyphosis, arthralgias, arthritis, DM symptoms
  21. Complications of acromegaly
    DM symptoms: hGH is insulin antagonist

    • -kyphosis (hunchback)
    • -arthralgias (joint pain)
    • -arthritis
  22. Gonadotropins
    • *are cyclical
    • Anterior pituitary:
    • -LH
    • -FSH
    • -Prolactin

    • Ovaries:
    • -estrogen
    • -progesterone
    • -androgens

    -testosterone
  23. GnRH
    produced in Hypothalamus

    -stimulates anterior pituitary to release FSH, LH, prolactin that stimulate ovaries
  24. Luteinizing hormone
    Anterior pituitary gonadotropin

    -stimulates production of copus luteum in ovary
  25. Follicle stimulating hormone
    Anterior pituitary gonadotropin

    -stimulates production of follicle by ovary
  26. Prolactin
    Anterior pituitary gonadotropin

    -stimulates lactation
  27. Testosterone
    -bound to sex hormone-binding globulin (SHBG) circulating proteins

    • -tested as free and total
    • -monitors hypogonadism, pituitary function, impotence, and cryptorchidism
  28. Increased testosterone
    • -adrenal tumors
    • -CAH
    • -ovarian stromal hyperthecosis
  29. Decreased testosterone
    • -primary hypogonadism
    • -secondary hypogonadism
    • -testes disorders
    • -Klinefelter syndrome
  30. Klinefelter syndrome
    • decreased testosterone
    • XXY
    • typically males
  31. gynecomastia
    excess male mammary tissue
  32. Hirsutism
    • excess hair in women
    • -face, chest, aereola, linia alba, lower back
  33. Galactorrhea
    persistent discharge of milk from breasts without pregnancy
  34. ACTH
    • stimulates adrenal cortex to produce:
    • -cortisol
    • -aldosterone
  35. excess Aldosterone
    causes K+ loss
  36. Addison's disease S/Sx
    Addison's disease

    • -hyperpigmentation
    • -impaired Na retention
    • -impaired K and H+ secretion

    • 1. decreased Na
    • 2. increased K, H+
    • 3. decreased pH
  37. Adrenal cortex hormones
    • -cortisol
    • -aldosterone
  38. Cushing's syndrome S/Sx
    Cushing's syndrome

    • -more common in females
    • -Moon face
    • -central obesity
    • -carbohydrate intolerance
    • -proximal muscle weakness
    • -osteoporosis
    • -easy bruising
    • -abdominal striae
    • -hypertension
    • -depression
    • -hirsutism, acne, amenorrhea

    • 1. increased Na
    • 2. decreased K
    • 3. increased pH
  39. Causes of Cushing's syndrome
    excess cortisol

    • 1. most common ACTH-producing pituitary adenomas
    • 2. ectopic secretion from tumors; small cell of lung carcinomas
    • 3. primary adrenal tumors
    • 4. iatrogenic due to predisone treatment
  40. Causes of decreased cortisol levels
    • -adrenal hyperplasia
    • -Addison's disease
    • -Anterior pituitary hyposecretion
    • -hypothryroidism
    • -hepatits and cirrhosis
  41. Causes of increased cortisol levels
    • -hyperthyroidsim
    • -stress from trauma/surgery
    • -carcinoma
    • -Cushing's syndrome
    • -tumor production of ACTH
    • -adrenal adenoma
    • -obesity
  42. Triad of Aldosterone hyperfunction
    • 1. HTN
    • 2. Hypokalemia (decreased K)
    • 3. Decreased renin
  43. cause of aldosterone hyperfunction
    adenoma producing aldosterone
  44. Aldosterone hyperfunction S/Sx
    • -HTN
    • -decreased K+
    • -metabolic alkalosis
    • -edema (increased Na and water retention)
    • -decreased magnesium
    • -muscle weakness
  45. Pheochromocytoma
    • catecholamine secreting tumor of adrenal medulla
    • (epinephrine, NE, dopamine)

    RARE

    fatal if untreated
  46. Pheochromocytoma S/Sx
    Triad:

    • 1. HA
    • 2. Sweating
    • 3. episodic Tachycardia

    *24-hr urine catecholamine
  47. Cortisol laboratory tests
    • -Diurnal cortisol levels
    • 8AM = high
    • 4PM = low

    • -cortisol supression w/dexamethasone
    • -cortisol stimulation (tests adrenal function)
  48. Cortisol suppression w/dexamethasone
    tests pituitary function
  49. Posterior pituitary hormones
    • -ADH (arginine vasopression/antidiuretic hormone)
    • -oxytocin
  50. ADH deficiency
    • -diabetes insipidus: inability to concentrate urine
    • (specific gravity is stable)
  51. Oxytocin
    • -release of breast milk
    • -promoted uterine contraction during labor
  52. PSA
    • Prostate specific antigen
    • -screening test for prostate cancer
    • -monitor disease recurrence after treatement
  53. PAP
    Prostatic acid phosphatase

    • -diagnose metastatic protate cancer
    • -monitors effectiveness of treatment
  54. Parathyroid hormone
    reflects calcium metabolism

    parathyroid increase = Ca increase = P decrease

    -measure n-terminal in renal failure pts
  55. Beta HCG
    qualitative = postive/negative

    quantitative = miscarriage
  56. Diabetes Mellitus
    • -Abnormal carbohydrate metabolism
    • -results in hyperglycemia
    • -imparied insulin production
    • -insulin resistance

    90-95%= type 2

    #4 cause of death
  57. DM diagnosis
    -fasting blood sugar twice; >126 mg/dL

    -any blood sugar >200 w/symptoms

    -blood sugar >200 at 2 hrs after glucose load on 2 occasions
  58. Type I DM
    • -insulin dependent
    • -immune mediated
    • -lack appropriate insulin = insulin deficient
    • ABSOLUTE impaired insulin production
  59. Type II DM
    • -insulin controlled
    • -insulin resistant
    • -RELATIVE impaired insuline production
    • -also lifestyle controlled
  60. DM complications
    • -end organ damage: eyes, extremeties, CHF, renal
    • -Ketoacidiosis (acute)
    • -Hyperosmolar non-ketotic coma (acute)
  61. S/Sx Type I DM
    • -young
    • -thin
    • -orthostatic hypotension (orthostasis)
    • -Kussmaul respirations
    • -acetone smell
    • -N/V
    • -polyphagia
    • -abdominal pain
  62. S/Sx Type II DM
    • -obesity
    • -family history
    • -thirst
    • -fatigue
    • -parathesias
    • -chronic cutaneous infections
    • -impotence
    • HTN

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