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Endocrinological organs?
Heart (BNP), Endothelium, GI, Kidneys, Liver, CNS, and suprarenal glands.
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What kind of blood is used for the glucose test?
Venous blood.
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DM type 1 Etiology?
80% is autoimmune, others idiopathic.
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Type 2 DM etiology?
Decrease in Beta cells, which leads to insulin resistance. Usually begins because of obesity (increased adipose downregulates insulin receptor synthesis)
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Other causes of DM?
- Pancreatic disease (cystic fibrosis, chronic pancreatitis)
- Drugs (glucocorticoid use, thiazides, alfa-interferon)
- Endocrine disease- pheochromocytoma, glucagonoma, Cushing's syndrome
- Infections- mumps, CMV
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What do you test to see the production levels of insulin?
- Peptide C
- Insulin gets 80% metabolized in the liver, but peptide C does not go through First pass metabolism.
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To measure the amount of Growth hormone in the body what does one measure?
IGF-1 (since GH readily absorbed and usually is produced in peaks)
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What is myxedema?
- Deposition of mucopolysaccharides in the dermis. This results in swelling of the affected area. One manifestation of myxoedema occurring in the lower limb is pretibial myxedema (seen in Graves)
- Orbital myxedema seen in hypothryoidism (Hashimotos)
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Acanthosis nigracans suggests what?
Insulin resistance: DM2
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Cushing's syndrome often presents with swollen torso and red striate, what's it called?
Estrias violaces
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Si hay presencia de maculas hiperpigmentadas que dx sugiere?
Addison's
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Child with a large tongue suggests?
Cretinism
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If a px has glossitis, one of the possible causes is?
Vitamin B deficiency
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Hirsutism- Hair over belly button, on back, and under chin. Most commonly occurs in what pathology?
Polycystic ovaries syndrome
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Describe exothalmos.
Edema biparpebral, se hace retractar los parpebrals.
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Maran~on sign
Ask the patient to raise their arms and they turn blue
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Signo de vecindad
large tumor over sella turcica (hemianopsia bitemporal)- ultimo signo que aparece
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Thyroid hormones use what kind of receptors?
They use nuclear receptors.
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Amine Hormones
- Small, only 3-5 AAs, easily giested in pill form.
- Ex. Thyroid hormones, dopamine, and cathecholamines.
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Peptide proteins
- Large molecules. Consist of majority of hormones. When split they lose their function, hence can't be taken orally. Injected only.
- Ex. LH, FSH, GH, PTH, insulin, and glucagon
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Steroids
- Usually suprarenal, or sex hormones.
- Cross membranes freely- enter nuclear receptors (if thyroid) or cytosolic receptors (steroids)
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Free molecules (hormones)
Peptide hormones, proteicas, y catecholamines circulate freely because they are hydrosoluble, or bound to albumin (transporters).
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Endocrine action
Trabaja en la distancia
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Paracrine action
Over neighboring cells that don't produce their own hormones. (sex hormones over ovaries)
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Juxtacrine action
- cuando una hormona actua en una celula yuxtapuesta
- endothelial cells and their action on cells below them. (nitrous oxide?)
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Autocrine action
act on receptors within same cell
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Three types of hormonal receptors
Membranous, cytosolic, and nuclear receptors
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Insulin uses what kind of receptors and goes into what kinds of tissues?
Uses membrane receptors, and enters adipose tissue, liver, and muscular tissue (?)
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GLUT-4 does what?
Insulin dependent, transport glucose.
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MAP kinase function?
Works at nuclear level, in charge of growth and reproduction of cell. GDB2 ?
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What hormones do somatotrophs produce?
Growth hormone
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What hormones do corticotrophs produce?
ACTH (adrenocorticotrophic hormone)
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Lactotrophs?
PRL (prolactin)
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Growth Hormone (GH) 50%
- Produced by stomatotroph cells, GHRH stimulates its synthesis, along with exercise, stress, sleep, and hypoglycemia.
- Decreased by hyperglycemia.
- Increases hepatic synthesis- sometomedin IGF-1
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Empty sell turica syndrome
Area is filled with brain fluid
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If men don't have prolactin then...
Have imbalance in testosterone levels.
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ACTH is...
- Proopiomelanocrotina.
- Stimulates cortisol production from suprarenal cortices.
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How to dx Acromegaly?
If IGF-1 is increased, PRL increased, and TSH/T4 function is increased.
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Px with crecimiento oseo acral excesivo, hyperhidrosis, voz profunda y cavernosa, piel gruesa, artropatia, y cifosis. Develop DM, HTN, and ischemic cardiopathies. Dx?
- Acromegaly
- Complication of Colon polyps, colon cancer, or CV (mortal)
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Prolactinoma has proliferation of what kind of cells?
Lactotrophic cells.
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Sheehan's syndrome
Hypopituitarism due to post-partum ischemia of the pituitary (watershed area). Lactotrophic cells hypertrophy during pregnancy needing more irrigation. If there's hemorrhage postpartum-> severe hypotension-> hypoxia-> ischemia
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Agalactia, amenorrea post-partum (no FSH or LH), bello se cae del pubis y axilar. Great weakness, arterial hypotension, weight loss (from lack of hormones), symptoms of hypothyroidism.
Sheehan Syndrome
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Tx for Sheehan's?
Levotiroxina (oral), analogo de GH (IV), FSH y LH (steroids oral okay), prenidsona y methlprenidsolona (smaller dosis so lasts longer effects), no need to give PRL (since will increase since there will be lack of feedback to control it)
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If prev. px with Sheehan's wishes to get pregnant again, tx?
Cabergolina (dopamine agonist to suppress PRL production)
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2 Hr glucose over what level is diagnostic of diabetes?
over 200 mg/dl
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DM1 autoimmune can be diagnosed with which antibodies?
- Anti-GAD >20%
- Antibody antiglot ICA (30-90%)
- IAA 40-70%
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Px with polyuria, polyphagia, polydypsia, weight loss and is at risk for ketoacidosis, has what?
Diabetes mellitus type 1
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DM1 associated diseases?
Celiac disease, Addison's, Graves, Vitiligo, hipothyroidism, and pernicious anemia.
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Chronic hyperglycemia, con alteracion de los hidratos de carbon, lipidos, y proteinas, debido a un defecit en insulina o un defecto en su accion. Syndrome de condicion de vida.
Syndrome endocrino metabolico de etiologia multifactorial
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Insulin sensibilizadores- two groups
Biguanides (metformin) and Tiazolidinediones (pioglitazone)
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Metformin (biganide)
- Increases insulin sensitivity
- 1st line tx along with diet change.
- Dose 500mg to 2.5 g
- Side effects: GI disturbance, interferes with B12 absorption so take with Ca2.
- Can decrease px weight, also has anti-coagulant and anti-inflammatory effects.
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Tiazolidinediones: 2 types
Pioglitazone and rosiglitazon
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Pioglitazone
- Binds to PPAR gamma nuclear transcription regulator: increases insulin sensitivity in peripheral tissue.
- side effects: osteoporosis, osteopenia, weight gain, edema, heart failure
- 15-30mg per day
- used if too much resistance to isulin and
- metformin isnt’ doing the job
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Rosiglitazone
- Can cause lower extremity edema, and CHF
- Helps lipid profile, and peroxisome nucleus receptor in tissues-> increase insulin sensitivity.
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Sulfonylureas for tx DM do what?
Generally stays in blood 24-48hrs. Closes K+ channel in Beta-cell membrane, so cell depolarizes->triggering release of insulin through increase of Ca influx.
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Tolbutamide is what kind of pharm?
It is a first generation sulfonylurea to help in tx of DM type 2. Helps release of endogenous insulin.
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Glibenclamida- small doses one to 2 per day. What type of pharm and tx what?
Second generation sulfonylurea, can lead to hypoglycemia if not careful. Aumenta riesgo de muerte subita. Debe ser combinada con insulino-desensibiladores
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Alpha-glucosidase inhibitors delay sugar hydrolysis and glucose asorption which leads to decrease in postprandial hyperglycemia. Types?
- Acarbose and Miglitol
- used with px that eat too much, but leads to a lot of flatulence and diarrhea depending on how much the person eats.
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GLP-1 analogs: Exenatide
- Increases insulin and decreases glucagon release.
- Helps px feel fuller, is cardioprotective, decreases apoptosis of Beta cells, helps with weight loss, and decreases apetite.
- Injected only.
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Inhibidores de transportador GCT2 like Invokana do what?
- Inhibit glucose reabsorption in the proximal tubule of kidneys.
- Can cause UTIs
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When a px first finds out they are diabetic they go through these steps:
Niega (deny), rebeldia (rebel/reject), negociacion (negotiate), y acceptan
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