Nervous system for ______ homeostasis responses
quick
Endocrine system for _______ homeostasis responses
long
Endocrine system is mostly _______ hormones (transferred via the blood).
trophic
Epinephrine, dopamine, T3 and T4 are examples of?
Amines (modified amino acids)
Aldosterone, cortisol, estradiol, and testosterone are examples of?
Steroid hormones
There are two big groups of hormones – ones that come from ________ and ones that come from ________.
amino acids
cholesterol (aka amines/peptides and steroids)
How do modes of action differ between polar and non-polar molecules?
Polar bind to membrane receptors/cell surface receptors and non-polar pass through the membrane and bind to intracellular receptors.
All the lipid soluble molecules are derived from ________.
cholesterol
________ comes from the cortex and the adrenal gland. _________ and _________ come from the adrenal medulla.
Cortisol
Norepinephrine and Epinephrine
Growth hormone stimulates the liver to produce what hormone?
IGF-1
What hormone inhibits the anterior pituitary?
Somatostatin
When is growth hormone secreted and what/when is it inhibited?
Secreted: hypoglycemia, fasting, starvation, stress
Inhibited: increased glucose levels, free fatty acid release, obesity, cortisol
Growth hormone excess before puberty is known as?
Growth hormone after puberty is known as?
Gigantism
Acromegaly
Gigantism effects what type of bones?
Acromegaly effects what type of bones?
Long bones
Bones in the extremities
What inhibits intestinal calcium absorption, inhibits osteoclasts, and stimulates osteoblast activity in bones?
Calcitonin
What is the most common cause of hypothyroidism?
Hashimoto’s (in the US) but i’m pretty sure it’s iodine deficiency world wide
Most common cause of hyperthyroidism?
Graves Disease
What increases catabolism of fat and muscle tissues, free fatty acids and their use for energy, gluconeogenesis, and blood glucose level?
Cortisol
Hypotension, high CRH levels, and hypoglycemia are all symptoms of?
Addison’s
What element is essential for manufacture of thyroid hormones?
Iodine
What are the most informative tests of thyroid function?
TSH (extremely sensitive) and free T4
What is a normal range of thyroid hormone?
0.27-4.2 mU/L
Thyroid stimulating hormone receptor antibodies will be elevated in 80% of patients with ____________.
Graves Disease
What is the definitive test for evaluating thyroid nodules and is essential for diagnosing thyroid cancer?
Fine needle aspiration
What disease will have elevated levels of TPO and Tg antibodies?
Hashimoto’s
Cold intolerance, constipation, dry skin, and hair loss are symptoms of?
Hashimoto’s
What drug do we use to treat hypothyroidism?
Levothyroxine
Is it essential to detect congenital hypothyroidism to prevent?
Cretinism
If you’re trying to determine between a thyroid nodule and Graves disease, what test can we do?
Do a radioactive isotope scan – if there’s a nodule involved, only the nodule will light up
Can we as PA’s treat Graves?
Nah. Have to refer to endooooo
What is a clinical syndrome associated with excessive levels of thyroid hormone?
Thyrotoxicosis
What do we mean by “factitious” hyperthyroidism?
Someone has hyperthyroidism by taking too much thyroid hormone
Hyperactivity, irritability, restlessness, and anxiety are symptoms of?
Graves Disease
Proptosis/exophthalmos and “lid-lag” are symptoms of?
Graves Disease
What drugs do we use to treat hyperthyroidism?
Propylthiouracil (PTU) or Methimazole
What is common side effect of Thiourea drugs?
Pruritis
Important to monitor patients for signs and symptoms of _____ ______ during the initial 6 months of thiourea use
liver injury
Methimazole or PTU is associated with birth defects?
Methimazole
What is the treatment of choice for Graves?
Radioactive Iodine
What is the treatment of choice for Graves in children or hyperthyroidism during pregnancy when symptoms can’t be controlled with drugs?
Thyroid surgery
What does the prognosis look like for Graves patients?
Recurrences common if only treatment is thioureas
If we have a toxic thyroid nodule, how do we treat it?
If the patient is younger than 40 years old surgery is preferred over RAI. If older than 40 RAI is preferred over surgery.
What is the most common type of thyroid cancer?
Papillary
What is a risk factor for thyroid cancer?
Prior head and neck radiation or radiation exposure.
Aldosterone is secreted from where in the kidney?
Outer layer of adrenal cortex
Cortisol is secreted from where in the kidney?
Middle and inner adrenal cortex
Is Cushing’s syndrome more commonly associated with endogenous or exogenous sources?
Exogenous –> glucocorticoid administration
What is the difference between Cushing’s Disease and Cushing’s syndrome?
Cushing’s disease is a tumor on the pituitary secreting excessive ACTH and Cushing’s syndrome is a tumor on the adrenal gland.
Note: there are other causes of cushing’s syndrome –
What are some signs and symptoms of Cushing’s Disease?
“moon facies”, abdominal protuberance, “buffalo hump”, supraclavicular fact.
Hypertension, oligomenorrhea, osteopenia and osteporosis
What tests do we do to diagnose Cushing’s?
Dexamethasone suppression test
can also do a 24 hour urine free cortisol/creatinine
If you have a patient with fatigue, weakness, and hypotension – what must you keep in your DDx?
Adrenal insufficiency
What patients are at risk for adrenal insufficiency?
those taking exogenous corticosteroids
Chronic adrenal insufficiency —- you think of?
Addison’s disease
and JFK. my he RIP.
Signs and symptoms of Addison’s?
Weakness, fatigue, wt. loss, myalgias – symptoms are very non-specific.
Low BP, orthostasis, hyperpigmentation of skin
Low AM cortisol level – think of?
Addison’s
What is a diagnostic test we can do for Addison’s?
Cosyntropin (synthetic ACTH) stimulation test – provides measure of renal reserve
What is the name of a tumor of the adrenal medulla that releases excessive amounts of norepineprhine/epinephrine into the circulation?
Pheochromocytoma
What is the hallmark of Hypoparathyroidism?
Low ionized Ca
What is the hallmark of hyperparathyroidism?
elevation of serum total and ionized Ca
Does hyperparathyroidism cause chronic trabecular or cortical bone resorption?
Cortical
If i say “moans, groans, stones, and bones” you say?
Hyperparathyroidism
What has to be on you DDx with hypercalcemia?
Malignancy – tumor mets to bone (breast, lung, pancreas, kidney)
What is the most common metabolic bone disease?
Osteoporosis
Osteoporosis leads to breakdown of trabecular or cortical bone more?
Trabecular
What drug is the best at rebuilding bone density?
Teriparatide
What percentage of Trabecular bone is lost over 10 years?
25-30%
What percentage of Cortical bone is lost over 10 years?
10-15%
What is first line therapy for osteoporosis?
Calcium and Vitamin D
What bones does a DEXA scan look at?
Spinal bone, proximal femur, and other bones risk for fracture
How do bisphosphonates work?
They inhibit osteoclastic bone resporption
When we prescribe Fosamax what instructions do we have to give?
Take 30 minutes before AM meal with eight ounces of water and remain upright for 30 minutes to prevent esophagitis and do the chicken dance and chug a PBR.
Serum IGF-1 5x normal is associated with?
Acromegaly
How do we treat acromegaly?
Transsphenoidal microsurgery
What is the most common cause of hyperprolactinemia?
Pituitary microadenoma
In resting state, muscle energy is supplied by?
Fatty acids
Circulating _______ will prevent ketosis not hyperglycemia?
insulin
What is a major factor in insulin resistance?
Central/visceral obesity
What range of A1c is considered pre-diabetes?
5.7-6.4%
Why do we put diabetics on aspirin?
Because they have abnormal platelet function
What are the ABC’s of diabetes?
- Aspirin
- Blood pressure
- Cholesterol
What drug do we use as adjunct therapy to metformin, and has adverse effects such as hypoglycemia and weight gain?
Second generation Sulfonylureas – Glipizide
What drug to treat diabetes causes flatulence and diarrhea and 60% of people d/c the drug because of these problems?
Alpha-Glucosidase Inhibitors (acarbose)
What drugs act primarily on peripheral tissues, decrease insulin resistance and increase insulin sensitivity?
TZD’s (pioglitazone)
Is hypoglycemia associated with TZDs? Is weight gain?
No hypoglycemia, but yes weight gain
What oral diabetic agent causes weight loss?
SGLT2-inhibitors (Canaglifozin, Dapaglifozin)
Are GLP-1 Receptor Agonists an oral medication?
No! Injection – alternative to insulin. Do not cause weight gain and show to have a decreased incidence of hypoglycemia.
What is the best way to prevent retinopathy?
Tight glycemic control
Nephropathy develops as a result of chronic ________ and uncontrolled _________.
hyperglycemia, hypertension
What is the test of choice for Nephropathy?
Spot AM urine for albumin/Cr
If our patient is only losing a teeny tiny bit of protein in their urine do we have to start an ACE?
What if their BP is normal, do we still start an ACE?
YUP
YEAH DOG
Decreased sensation in “stocking glove” distribution should make you think of?
Neuropathy
What happens to your lipids with hyperthyroidism?
Low HDL and high total triglycerides
“Fruity breath” should make you think of?
DKA
DKA will result in ________ acidosis with an _________ anion gap.
Metabolic, increased
When referring to glycemic control in type 2 diabetes, we want their postprandial plasma glucose to be less than….
180
When referring to glycemic control in type 2 diabetes, we want their preprandial plasma glucose to be between…
80 and 130
What drug decreases hepatic glucose production and increase insulin sensitivity?
Metformin
What class of drugs increase insulin sensitivity, glucose uptake, and improves metabolism?
TZD’s
which is confusing because modest weight gain is associated with TZDs
What kind of patients can we not use TZD’s in?
Those with CHF and hepatic disease
Fluid retention should make you think of what class of drugs?
TZD’s