Endocrinology 2

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Endocrinology 2
2011-07-18 23:44:26
DPAP2012 Endocrinology

Endocrinology flashcards made by previous students.
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  1. Refers specifically to an ACTH secreting pituitary adenoma with resultant cortisol secretion
    Cushing's Disease
  2. General term for hypercortisolism at any level including adrenal, ectopic, or pituitary source
    Cushing's Syndrome
  3. Diagnosis of Cushing's syndrome involves a __
    24-hour urine free cortisol
  4. increased hair growth (chin, upper lip, abdomen, chest)
  5. Polycystic Ovarian Syndrome can lead to
    Hirsutism and Virilization
  6. refers to the biological development of sex differences, changes which make a male body different from a female body
  7. menstrual irregularity, infertility, androgen excess, hirsutism, and sometimes obesity and insulin resistance
    Polycystic Ovarian Syndrome
  8. abrupt onset of Hirsutism and Virilization is an indication of
    an androgen-secreting adrenal carcinoma
  9. Life long problem with hirsutism and virilization is an indication of __, and is also the rarer form
    Androgen-secreting adrenal adenomas
  10. Enzymatic defects in the adrenal steroid hormone synthesis pathways leading to: inadequate cortisol +/-mineralocorticoid, classically with an associated androgen excess
    Congenital Adrenal Hyperplasia
  11. mucle symptoms due to hypokalemia
    cramping, weakness, periodic paralysis
  12. Clinical findings of primary hyperaldosteronism
    hypertension, muscle symptoms (due to hypokalemia. Often there are few clinical findings at all.
  13. with primary hyperaldosteronism there will be high aldosterone but low __
  14. a patient with primary hyperaldosteronism will have metabolic __
  15. Primary Hyperaldosteronism. Solitary/Unilateral Aldosterone-Producing Adenoma
    Conn's Syndrome
  16. the adrenal medulla produces __
  17. epinephrine, norepinephrine, dopamine
  18. clinical findings of pheochromocytoma
    the five P's:Pain (headaches), Pallor (orthostatic hypotension), Palpitations (catecholamine release), Pressure (hypertension), Perspiration
  19. the thyroid has a __ day reserve supply of thyroxine
  20. the thyroid synthesizes __ mcg of thyroxine per day
  21. thyroid hormone synthesis requires a minimum of __mcg of elemental iodine/day
  22. recommended daily intake of elemental iodine __mcg
  23. in the thyroid thyroglobulin is stored in __
  24. severe illness or starvation decreases
    total T3, and free T3
  25. __ is increased by estrogen, decreased by androgen
  26. imaging modality used to monitor thyroid cancers
    PET scan
  27. What can a thyroid do
    overact, under-perform, enlarge
  28. weight loss, heat intolerance, palpitations/tachycardia
    hyperthyroid history
  29. weight gain, fatigue, lethargy, cold intolerance
    hypothyroid history
  30. rapid pulse, onycholysis, exophthalmos, thyroid enlargement, bruit, tachycardia, brisk DTR relaxation phase
    hyperthyroid examination
  31. bradycardia, dry skin and hair, periorbital edema, delayed DTR relaxation phase
    hypothyroid examination
  32. exophthalmos is seen only in __
    Graves Disease
  33. Etiology: Auto-antibody reacting with the TSH receptor. Symmetric non-tender goiter (80%) (bruit is pathognomonic), Ocular findings (30%), Pretibial myxedema exam:
    Graves Disease
  34. medical treatment for Graves Disease
    PTU, Methimazole, Beta-blocker (propranolol, or atenolol)
  35. no increased cancer risk after 50 years of __ use
    radioactive iodine
  36. favorable prognosticators for remission
    small goiter, free T3 predominance, negative TSI titer, decrease in goiter size with ethionamide therapy
  37. toxic nodule can lead to what type of fingernail pathology
  38. when the finger nail peels away from the nail bed in the absence of trauma
  39. Thyroid hormone leakage from destruction of the thyroid gland secondary to a viral infection (? Mumps), pain in the thyroid, fever, enlarged, very tender thyroid gland
    subacute thyroiditis
  40. Transient autoimmune dysfunction, sudden onset of hyperthyroidism, can be seen post-partum, enlarged, nodular thyroid
    silent thyroiditis
  41. Pre-existing untreated or inadequately treated thyrotoxicosis, Precipitating event: infection, trauma,fever, profuse sweating, tachycardia, tremulousness/restlessness, delirium/psychosis, N/V, later stupor, coma, hypotension
    Thyrotoxic Crisis (Thyroid Storm)
  42. Insufficient amount of thyroid hormone, elevated TSH, hypometabolic, increased cholesterol
  43. __ hypothyroidism, loss of functioning thyroid tissue
  44. __ hypothyroidism- impairment of hormone biosynthesis with compensatory thyroid enlargement, lithium therapy, iodine deficiency or excess
  45. __ hypothyroidism- lack of TSH, pituitary or hypothalamic failure
  46. thyroxine therapy dose is constant except with __, at which time the dose is increased by at least 50%
  47. thyroxine therapy dose is constant except with __, at which time the dose is decreased by 20-30%
    age greater than 65
  48. thyroxine therapy dose is constant except with __
  49. side effects of thyroxine therapy
    osteoporosis, increased cardiac contractility, increased risk of atrial fibrillation, allergic reaction to dye in tablets
  50. general term for enlargement of the thyroid gland
  51. diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function
    nontoxic goiter
  52. -- thyroid enlargement that occurs in more than 10% of a population
    endemic goiter
  53. result of environmental or genetic factors that do not affect the general population
    sporadic goiter
  54. __% of the world’s population lives in a region that has iodine deficiency (primarily in Asia, Latin American, central Africa, and regions of Europe)
  55. treatment for thyroid carcinoma
    thyroidectomy by experienced surgeon
  56. Liothyronine
  57. Liotrix
  58. Synthroid, Unithroid, Levoxyl, Levothroid
  59. Methimazole
  60. Propylthiouracil (PTU)
    Generic, know abbreviation
  61. Insulin Lispro
  62. Insulin Aspart
  63. Insulin Glulisine
  64. Insulin Glargine
  65. Insulin Detemir
  66. Glyburide
  67. Glipizide
  68. Glimepiride
  69. Repaglinide
  70. Nateglinide
  71. Metformin
  72. Rosiglitazone
  73. Pioglitazone
  74. Acarbose
  75. Miglitol
  76. Sitagliptin
  77. Saxagliptin
  78. Exenatide
  79. Liraglutide
  80. Pramlintide
  81. CLASS: Liothyronine
    Hypothyroid Agent
  82. CLASS: Liotrix
    Hypothyroid Agent
  83. CLASS: Levothyroxine
    Hypothyroid Agent
  84. CLASS: Methimazole
    Hyperthyroid Agent
  85. CLASS: Propylthiouracil (PTU)
    Hyperthyroid Agent
  86. CLASS: Insulin Lispro
    Rapid acting insulin
  87. CLASS: Insulin Aspart
    Rapid acting insulin
  88. CLASS: Insulin Glulisine
    Rapid acting insulin
  89. CLASS: Insulin Glargine
    Long acting insulin
  90. CLASS: Insulin Detemir
    Long acting insulin
  91. CLASS: Glyburide
  92. CLASS: Glipizide
  93. CLASS: Glimepiride
  94. CLASS: Repaglinide
  95. CLASS: Nateglinide
  96. CLASS: Metformin
  97. CLASS: Rosiglitazone
  98. CLASS: Pioglitazone
  99. CLASS: Acarbose
    Alpha-glucosidase Inhibitor
  100. CLASS: Miglitol
    Alpha-glucosidase Inhibitor
  101. CLASS: Sitagliptin
    Dipeptidyl peptidase-4 (DPP-4) inhibitor
  102. CLASS: Saxagliptin
    DPP-4 inhibitor
  103. CLASS: Exenatide
    Incretin mimeticGlucagon-like peptide-1 (GLP-1) agonist
  104. CLASS: Liraglutide
    Incretin mimetic GLP-1 agonist
  105. CLASS: Pramlintide
    Amylin analog
  106. CM complications: chronic hyperglycemia leads to:
    nonenzymatic glycation of proteins & produces tissue damage
  107. DM dx criteria
    1 of these (A1c ≥6.5% ; FPG ≥ 126 mg/dL; 2 hour GTT ≥ 200 mg/dL (75g load); RPG ≥ 200 mg/dL PLUS DM sx (polyuria, polydipsia, wt loss, blurred vision), w/ confirmation of other criterion on another day (required for first 3)
  108. Alert Values: FBS (female)
    < 40 and > 400 mg/dL (DUMC = <50 and >350)
  109. Prediabetes / IFG lab
    FPG 100 - 125 mg/dL
  110. Impaired glucose tolerance
    2 hr plasma glucose (75g GTT) 140 – 199 mg/dL
  111. Values assoc w/ diabetic retinopathy
    FBS 126 mg/dL; 2 hr GTT 200 mg/dL; HgbA1c of 7%
  112. Created when proinsulin splits into insulin & this product
    C-peptide (connecting peptide)
  113. C-peptide: used mostly in:
    newly diagnosed diabetics
  114. C-peptide: Type 1 diabetes:
    decreased levels
  115. C-peptide: Type 2 diabetes:
    normal or high levels
  116. C-peptide: can be used to identify:
    gastrinoma spread or malingering (low C-peptide with hypoglycemia may reflect abuse of insulin)
  117. Glucose Testing: Venous serum: benefits / reflects
    Benefit of independence from hematocrit
  118. Glucose Testing: Venous serum: reflects:
    reflects tissue glucose
  119. Glucose Testing: Capillary: benefits
    Rapid, no centrifugation required, home monitoring
  120. Glucose Testing: Urine: Requires:
    normal renal glucose threshold
  121. Random plasma glucose (RPG or RBS):
    Any time of day without regard to last meal
  122. Fasting blood glucose (FPG or FBS):
    No caloric intake for at least 8 hours
  123. Oral glucose tolerance testing (OGTT or GTT):
    Timed blood draw after oral load of a specific amount of glucose
  124. Meds that increase glucose
    diuretics, estrogens, beta blockers, corticosteroids
  125. Meds that decrease glucose:
    acetaminophen, alcohol, propanolol, anabolic steroids
  126. Factors affecting Glucose & Glucose Tolerance
    Meds; Activity level; stress; Liver dz; Hormonal tumors; Pancreatic disorders; PG
  127. Types of stress that increase glucose
    trauma, acute illness, general anesthesia, burns
  128. O’Sullivan or 1 hour GTT
    50g oral glucose with blood draw in 1 hour (normal < 140 mg/dL)
  129. 2 hour GTT
    75g oral glucose with blood draw in 2 hours
  130. 3 hour GTT
    100g oral glucose with blood draw just prior to oral load (fasting) and then at 1, 2 & 3 hours
  131. 2 hour GTT Interp: FPG (mg/dL)
    Normal GTT <100; Impaired Glucose Tolerance 100-125; DM ≥ 126
  132. 2 hour GTT Interp: 2 hrs after glucose load
    Normal GTT <140; Impaired Glucose Tolerance 140-199; DM ≥ 200
  133. 3 hour GTT Interp: Normal
    Fasting <95 mg/dL ; 1 hr <180 mg/dL; 2 hr <155 mg/dL; 3 hr <140 mg/dL
  134. 3 hour GTT Interp: Abnormal =
    2 or more values above reference range
  135. 3 hour GTT Interp: Equivocal =
    1 value above reference range
  136. Diabetic control correlates highly with:
    pt education & motivation
  137. Monitoring Diabetic Ctrl: Urine testing (downside):
    Delayed information
  138. Monitoring Diabetic Ctrl: Blood glucose testing
    Current status; Self-monitoring recommended by ADA; Continuous monitoring systems available
  139. Monitoring Diabetic Ctrl: Glycosylated hemoglobin (A1c): upside:
    Long term control
  140. Monitoring Diabetic Ctrl: Fructosamine
    Good for some populations
  141. Home Blood Glucose Monitoring: most common =
    Fingerstick; Other sites (forearm/thigh) used, but may have 20 min lag time compared to finger
  142. Home Blood Glucose Monitoring: Helps guide self mgmt of:
    exercise, diet & meds
  143. Home Blood Glucose Monitoring: upside:
    Improves blood glucose control through immediate patient feedback
  144. HbA1c: In normal people:
    3-6% of hemoglobin is glycosylated in the form A1c
  145. HbA1c: Provides info:
    that spot blood checks may miss; info about LT glycemic ctrl (previous 8-12 wks)
  146. HbA1c: Normalizes:
    within 3 weeks of normoglycemic levels
  147. HbA1c & RBCs:
    Older RBCs have higher HbA1c levels; pts w/ episodic or chronic hemolysis who have larger proportion of young RBCs might have spuriously low levels
  148. HbA1c monitoring
    Does not require fasting; Goal < 7% HbA1c; Lowering by any amount will improve health outcomes
  149. If HbA1c if > 7% :
    adjust therapy
  150. HbA1c: If good DM control:
    check HbA1c 1-2 times yearly
  151. HbA1c: If suboptimal DM control:
    check HbA1c every 3 months
  152. Fructosamine reflects:
    hyperglycemic period within the last few weeks
  153. Fructosamine gives info about:
    short term glycemic control
  154. Fructosamine: useful for:
    patients with chronic hemolytic anemias that cause shortened RBC life span; Limited use in pts w/ low serum albumin (nephrotic state or hepatic disease)
  155. Fructosamine: Normal values:
    vary in relation to serum albumin (1.5-2.4 mmol/L when serum albumin is 5 g/L)