Term
| Endocrine disease stimulation tests evaluate ____________ disorders. |
|
Definition
|
|
Term
| Adrenocorticotropic hormone (ACTH) stimulation test is used in the work up of ____________. |
|
Definition
|
|
Term
| causes of hypofunctioning disorders |
|
Definition
-autoimmune destruction
-infarction
-decreased hormone stimulation
-enzyme deficiency, infection, neoplasia, congenital disorder |
|
|
Term
| Endocrine disease suppression tests evaluate ______________ disorders. |
|
Definition
|
|
Term
| Dexamethasone suppression test evaluates _______________. |
|
Definition
|
|
Term
|
Definition
-adenoma
-acute inflammation
-hyperplasia
-cancer |
|
|
Term
| Secretion of hormones from the anterior pituitary is under strict control by ___________ hormones, referred to as _________ and _________ hormones. |
|
Definition
hypothalamic
releasing; inhibiting |
|
|
Term
| list the anterior pituitary hormones |
|
Definition
TSH
ACTH
FSH
LH
GH
PRL (prolactin)
endorphins |
|
|
Term
| list the posterior pituitary hormones |
|
Definition
oxytocin
vasopressin (ADH) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates GH secretion by stimulating the GHRH receptor |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| The actions of GHRH are opposed by ___________. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates release of TSH and hGH |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates release of FSH and LH |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates release of PRL (prolactin) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| inhibits release of PRL (prolactin) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates release of ACTH |
|
|
Term
| What is the most common type of tumor that alters hypothalamic function? |
|
Definition
| pituitary adenoma (also a cause of primary pituitary disorders) |
|
|
Term
slow-growing, epithelial-squamous tumor arising from remnants of the embryonic structures
causes alteration of hypothalamic function
occasionally behaves like a malignant tumor |
|
Definition
|
|
Term
| Hypothalamic dysfunction will cause... |
|
Definition
|
|
Term
| clinical findings of hypothalamic dysfunction |
|
Definition
-secondary hypopituitarism
-central diabetes insipidus
-increased prolactin
-precocious puberty
-visual field defects
-mass effects (hydrocephalus, etc.) |
|
|
Term
| Why does secondary hypopituitarism occur with hypothalamic dysfunction? |
|
Definition
| no releasing hormones to stimulate the anterior pituitary |
|
|
Term
| Why does central diabetes insipidus (CDI) occur with hypothalamic dysfunction? |
|
Definition
| antidiuretic hormone (ADH) is synthesized in the hypothalamus |
|
|
Term
| Why does hyperprolactinemia occur with hypothalamic dysfunction? |
|
Definition
| loss of dopamine inhibition (PIH) causes galactorrhea |
|
|
Term
| The visual field disturbance associated with hypothalamic dysfunction is usually ___________ ____________. |
|
Definition
|
|
Term
| What mass effect is hypothalmic dysfunction associated with? |
|
Definition
| obstructive hydrocephalus |
|
|
Term
| What is the most common cause of hypopituitarism in adults? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are pituitary adenomas associated with? |
|
Definition
| multiple endocrine neoplasia (MEN) syndrome |
|
|
Term
| Multiple endocrine neoplasia (MEN) syndromes consist of rare, autosomal _________ mutations in genes that regulate cell growth. |
|
Definition
|
|
Term
| Where do most tumors arise with MEN syndrome? |
|
Definition
pituitary gland
pancreatic islet cells |
|
|
Term
| What is the most common manifestation of type 1 MEN? |
|
Definition
| hyperparathyroidism (80% of presentations) |
|
|
Term
| What causes the hyperparathyroidism associated with type 1 MEN? |
|
Definition
| hyperplasia of all 4 parathyroid glands |
|
|
Term
| What is the most common cause of hypopituitarism in children? |
|
Definition
| craniopharyngioma (benign tumor) |
|
|
Term
| pathophysiology of Sheehan's postpartum necrosis (cause of hypopituitarism) |
|
Definition
-pituitary gland doubles in size during pregnancy due to the synthesis of prolactin
-hypovolemic shock during childbirth can cause pituitary infarction (not enough vascularization for increased size)
-causes sudden cessation of lactation due to loss of prolactin |
|
|
Term
|
Definition
| refers to a sudden onset of neurologic dysfunction |
|
|
Term
| What is pituitary apoplexy most often due to? (cause of hypopituitarism) |
|
Definition
| hemorrhage/infarction of pre-existing pituitary adenoma |
|
|
Term
| What condition can cause hypopituitarism due to pituitary infarction from vascular occlusion by misshaped cells? |
|
Definition
|
|
Term
|
Definition
pituitary dysfunction
approx. 75% of gland must be destroyed |
|
|
Term
| secondary hypopituitarism |
|
Definition
hypothalamic dysfunction
decreased hypothalamic releasing factors |
|
|
Term
| What condition can cause hypopituitarism and is diagnosed by radiologic studies showing an empty sella turcica? |
|
Definition
|
|
Term
| When pituitary tumors enlarge, they can compress structures and cause significant neurologic deficits. The tumor may extend down into the sphenoid sinus and even erode the sphenoid bone, causing headache, epistaxis, or leakage of spinal fluid. As the tumor expands, it can invade the cavernous sinuses and surround the carotid arteries, causing double vision (CN 3,4,6) or facial pain (CN 5). If the tumor grows up, it can compress the optic nerves and chiasm, resulting in a loss of vision. The outside visual field in each eye is usually affected first (tunnel vision); this can progress to complete blindness if left unchecked. |
|
Definition
|
|
Term
| What studies are useful in the diagnosis of a pituitary adenoma? |
|
Definition
MRI
stimulation tests for various deficiencies |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates secretion of T3 and T4 |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stimulates secretion of glucocorticoids (cortisol) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| regulates oogenesis and spermatogenesis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| regulates oogenesis and spermatogenesis |
|
|
Term
| target of PRL (prolactin) |
|
Definition
|
|
Term
| action of PRL (prolactin) |
|
Definition
| stimulates production of milk |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| clinical manifestations of gonadotropin deficiency in children |
|
Definition
|
|
Term
| clinical manifestations of gonadotropin deficiency in adult women |
|
Definition
secondary amenorrhea
osteoporosis, hot flashes (lack of estrogen), decreased libido |
|
|
Term
| clinical manifestations of gonadotropin deficiency in adult males |
|
Definition
| impotence due to decreased libido from decreased testosterone |
|
|
Term
| What would GnRH stimulation test show in a patient with hypopituitarism? |
|
Definition
| no significant increase of FSH/LH |
|
|
Term
| What would GnRH stimulation test show in a patient with hypothalamic disease? |
|
Definition
| eventual increase of FSH/LH |
|
|
Term
| Decreased GH decreases synthesis and release of _____. |
|
Definition
|
|
Term
| clinical manifestations of GH deficiency in children |
|
Definition
growth delay (delayed fusion of epiphyses)
bone growth does not match age of child |
|
|
Term
| clinical manifestations of GH deficiency in adults |
|
Definition
hypoglycemia (decreased gluconeogenesis)
loss of muscle mass
increased adipose tissue around waist |
|
|
Term
| What test would you use to determine the etiology of gonadotropin deficiency? |
|
Definition
|
|
Term
| What tests would you use to diagnose GH deficiency? |
|
Definition
| arginine and sleep stimulation tests |
|
|
Term
| What would arginine and sleep stimulation tests show in a patient with GH deficiency? |
|
Definition
no increase in GH or IGF-1
(normally, GH and IGF-1 are released at 5am) |
|
|
Term
| clinical manifestation of TSH deficiency |
|
Definition
secondary hypothyroidism
decreased serum T4 and TSH
cold intolerance, constipation, weakness |
|
|
Term
| What test would you use to diagnose TSH deficiency? |
|
Definition
|
|
Term
| What would a TRH stimulation test show in a patient with TSH deficiency? |
|
Definition
| no increase in TSH after TRF stimulation |
|
|
Term
| clinical manifestations of ACTH deficiency |
|
Definition
-secondary hypocortisolism (decreased ACTH and cortisol)
-hypoglycemia (decreased gluconeogenesis)
-hyponatremia
-mild SIADH (loss of inhibitory effect of cortisol on ADH)
-weakness, fatigue |
|
|
Term
| What tests would you do to diagnose ACTH deficiency? |
|
Definition
short ACTH stimulation test
prolonged ACTH stimulation test
metyropone test |
|
|
Term
| What would you see with the short ACTH stimulation test in a patient with ACTH deficiency? |
|
Definition
| no increase in serum cortisol over decreased baseline levels |
|
|
Term
| What would you see with a prolonged ACTH stimulation test in a patient with ACTH deficiency? |
|
Definition
| eventual increase in cortisol over the decreased baseline value once the adrenal gland is restimulated |
|
|
Term
| What would you see with a metyrapone test in a patient with ACTH deficiency? |
|
Definition
| no increase in ACTH or 11-deoxycortisol |
|
|
Term
|
Definition
|
|
Term
|
Definition
uterine contractions
release of milk |
|
|
Term
| target of vasopressin (ADH) |
|
Definition
kidney tubules
sweat glands |
|
|
Term
| action of vasopression (ADH) |
|
Definition
| increases water retention |
|
|
Term
| Presence of ADH _________ urine concentration. |
|
Definition
|
|
Term
| Absence of ADH produces _________ of urine. |
|
Definition
|
|
Term
| What is the most common functioning pituitary tumor and is responsible for causing hyperpituitarism? |
|
Definition
| prolactinoma (benign adenoma) |
|
|
Term
| What does a prolactinoma cause in women? |
|
Definition
| secondary amenorrhea and galactorrhea |
|
|
Term
| Why does secondary amenorrhea occur in women and impotence occur in men with a prolactinoma? |
|
Definition
|
|
Term
| What does a prolactinoma cause in men? |
|
Definition
| impotence due to loss of libido due to decrease in testosterone |
|
|
Term
| lab manifestations of prolactinoma |
|
Definition
-elevated serum prolactin level
-decreased FSH and LH levels (due to decreased GnRH) |
|
|
Term
| treatment of prolactinomas |
|
Definition
-surgery
-dopamine analogs that inhibit prolactin secretion by the tumor |
|
|
Term
| What type of adenoma accounts for 20% of all pituitary adenomas and can cause hyperpituitarism? |
|
Definition
|
|
Term
| What studies would you use to diagnose a GH adenoma? |
|
Definition
|
|
Term
| What results from increased GH secretion during childhood (before puberty)? |
|
Definition
|
|
Term
| In gigantism, the ______ bones are stimulated to grow _________. |
|
Definition
|
|
Term
| What results from overproduction of GH after puberty? |
|
Definition
|
|
Term
| What parts of the body is acromegaly apparent in? |
|
Definition
| hands, feet, skull, lower jaw |
|
|
Term
| Why does acromegaly only affect the hands, feet, skull, and lower jaw? |
|
Definition
| At puberty, the epiphyseal plates of the long bones close, so they become unresponsive to GH stimulation. |
|
|
Term
| Free T4 and free T3 have a __________ feedback relationship with TSH. |
|
Definition
|
|
Term
| An increase in free T4/T3 should produce a _________ in TSH. |
|
Definition
|
|
Term
| A decrease in free T4/T3 should produce an __________ in TSH. |
|
Definition
|
|
Term
| What does T4 and T3 bind to? |
|
Definition
| thyroid-binding globulin (TBG) |
|
|
Term
| How many of the TBG binding sites are normally occupied? |
|
Definition
|
|
Term
| Free T4 is a __________ and is peripherally converted to _________. |
|
Definition
|
|
Term
| Which thyroid hormone is metabolically active? |
|
Definition
|
|
Term
| What does total serum T4 represent? |
|
Definition
| T4 bound to TBG and free (unbound) T4 |
|
|
Term
| An increase in TBG synthesis increases _______ serum T4. |
|
Definition
|
|
Term
| What increases the synthesis of TBG? |
|
Definition
|
|
Term
| What conditions and/or medications could cause an increase in TBG synthesis? |
|
Definition
|
|
Term
| With an increase in TBG, _____ T4 increases but ______ T4 does not. |
|
Definition
total serum T4 increases
free T4 does not |
|
|
Term
| With increased TBG, why is TSH normal? |
|
Definition
| because free T4 is normal |
|
|
Term
| Are signs of thyrotoxicosis present in a patient with increased TBG? |
|
Definition
|
|
Term
| A decrease in TBG synthesis decreases _________. |
|
Definition
|
|
Term
| What can cause a decreased TBG level? |
|
Definition
anabolic steroids
nephrotic syndrome (urinary loss) |
|
|
Term
| A decreased TBG level will cause a decrease in ____________ but not in _______. |
|
Definition
total serum T4
not free T4 |
|
|
Term
| What happens to free T4 and TSH in a patient with a decreased TBG level? |
|
Definition
| nothing; they remain normal |
|
|
Term
| Are signs of hypothyroidism present in a patient with a decreased TBG level? |
|
Definition
|
|
Term
| What is the best overall screening test for thyroid dysfunction? |
|
Definition
|
|
Term
| What diagnosis can be given in a patient who has increased TSH? |
|
Definition
|
|
Term
| What is the differential for a patient that has decreased TSH? |
|
Definition
-thyrotoxicosis (Graves' disease)
-hypopituitarism/hypothalamic dysfunction (secondary hypothyroidism) |
|
|
Term
| What causes the decreased TSH level in Graves' disease? |
|
Definition
|
|
Term
| What lab findings are consistent with primary hypothyroidism? |
|
Definition
increased TSH
normal TBG
decreased free T4 |
|
|
Term
| What lab findings are consistent with hyperthyroidism due to Graves' disease or thyroiditis? |
|
Definition
decreased TSH
normal TBG
increased free T4 |
|
|
Term
| What causes 90% of hypothyroidism cases? |
|
Definition
|
|
Term
|
Definition
hypothyroidism in infancy or early childhood
due to maternal nutritional deficiency of iodine
causes severely stunted physical and mental growth |
|
|
Term
| What is an autoimmune disease that eventually leads to atrophy of the thyroid and therefore hypothyroidism? |
|
Definition
|
|
Term
| What antibodies are usually demonstrable in the plasma of a patient with primary hypothyroidism? |
|
Definition
anti-microsomal
anti-peroxidase
anti-thyroglobulin |
|
|
Term
| What is the term for the non-pitting edema associated with severe hypothyroidism? |
|
Definition
|
|
Term
| timeline of Hashimoto's thyroiditis |
|
Definition
starts out as hyperthyroidism
eventually develop atrophy of thyroid
ends as either hypothyroidism or euthyroid |
|
|
Term
| What happens when hypothyroidism is congenital? |
|
Definition
| cretinism (impaired physical and mental development) |
|
|
Term
| What may result in a cretin or a mentally retarded hypothyroid dwarf? |
|
Definition
| iodide deficiency during childhood |
|
|
Term
|
Definition
|
|
Term
| What will happen if a test dose of TSH is given to a patient with primary hypothyroidism? |
|
Definition
|
|
Term
| What is the result of a radioactive iodine reuptake study in a patient with primary hypothyroidism and why? |
|
Definition
| decreased uptake of radioactive iodine because the thyroid gland is inactive and iodine is a component of thyroid hormone |
|
|
Term
| treatment of primary hypothyroidism |
|
Definition
|
|
Term
| clinical manifestations of Graves' disease (thyrotoxicosis) |
|
Definition
-abnormal rise in basal metabolic rate
-struma
-exopththalmos |
|
|
Term
| What is another cause of hyperthyroidism besides Graves' disease? |
|
Definition
|
|
Term
| What lab findings are consistent with hyperthyroidism? |
|
Definition
increased serum T4
decreased TSH
TSH-receptor antibodies |
|
|
Term
| What would a radioactive iodine reuptake study show in a patient with hyperthyroidism? |
|
Definition
|
|
Term
| What does an increased serum T4, decreased serum TSH, increased 131-I uptake with a history of palpitations and weight loss with no anorexia suggest? |
|
Definition
|
|
Term
| What type of hypersensitivity reaction is associated with the autoimmune response found in Graves' disease? |
|
Definition
| type II hypersensitivity reaction |
|
|
Term
| Why does the radioactive iodine uptake increase in a patient with Graves' disease? |
|
Definition
| because the gland requires more iodine to keep pace with the synthesis of thyroid hormone |
|
|
Term
| serum T4 in Graves' disease |
|
Definition
|
|
Term
| free T4 in Graves' disease |
|
Definition
|
|
Term
| serum TSH in Graves' disease |
|
Definition
|
|
Term
| serum T4 in a patient taking excess hormone |
|
Definition
|
|
Term
| free T4 in a patient taking excess hormone |
|
Definition
|
|
Term
| serum TSH in a patient taking excess hormone |
|
Definition
|
|
Term
| serum T4 in the initial phase of thyroiditis |
|
Definition
|
|
Term
| free T4 in the initial phase of thyroiditis |
|
Definition
|
|
Term
| serum TSH in the initial phase of thyroiditis |
|
Definition
|
|
Term
| serum T4 in primary hypothyroidism |
|
Definition
|
|
Term
| free T4 in primary hypothyroidism |
|
Definition
|
|
Term
| serum TSH in primary hypothyroidism |
|
Definition
|
|
Term
| serum T4 in secondary hypothyroidism (hypopituitarism) |
|
Definition
|
|
Term
| free T4 in secondary hypothyroidism (hypopituitarism) |
|
Definition
|
|
Term
| serum TSH in secondary hypothyroidism (hypopituitarism) |
|
Definition
|
|
Term
| serum T4 in a patient with increased TBG (excess estrogen) |
|
Definition
|
|
Term
| free T4 in a patient with increased TBG (excess estrogen) |
|
Definition
|
|
Term
| serum TSH in a patient with increased TBG (excess estrogen) |
|
Definition
|
|
Term
| serum T4 in a patient with decreased TBG (anabolic steroids) |
|
Definition
|
|
Term
| free T4 in a patient with decreased TBG (anabolic steroids) |
|
Definition
|
|
Term
| serum TSH in a patient with decreased TBG (anabolic steroids) |
|
Definition
|
|
Term
| ______ _________ and _______ ________ __________ cells secrete thyroid hormone without inhibition from the hypothalamo-pituitary axis. |
|
Definition
| toxic goiter; toxic solitary adenoma |
|
|
Term
| PTH _________ calcium reabsorption in the early distal tubule. |
|
Definition
|
|
Term
| PTH _________ bicarbonate reclamation in the proximal tubule. |
|
Definition
|
|
Term
| PTH ___________ phosphorus reabsorption in the proximal tubule. |
|
Definition
|
|
Term
| PTH _______ ionized calcium level in the blood. |
|
Definition
|
|
Term
| PTH __________ bone resorption and renal reabsorption of calcium. |
|
Definition
|
|
Term
| What is the most important endocrine regulator of calcium and phosphorus concentration in extracellular fluid? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is PTH stimulated by? |
|
Definition
hypocalcemia
hyperphosphatemia |
|
|
Term
| What is PTH suppressed by? |
|
Definition
hypercalcemia
hypophosphatemia |
|
|
Term
| Hypofunction of the parathyroid glands leads to __________. |
|
Definition
|
|
Term
| What are the 3 possible causes of hypoparathyrodism? |
|
Definition
autoimmune (most common)
previous thyroid surgery
DiGeorge syndrome |
|
|
Term
| What is the most common cause of hypoparathyroidism? |
|
Definition
|
|
Term
|
Definition
-failure of descent of 3rd/4th pharyngeal pouches
-absent parathyroids and thymus
-causes hypoparathyroidism |
|
|
Term
| What lab findings are consistent with hypoparathyroidism? |
|
Definition
hypocalcemia
hyperphosphatemia
decreased PTH |
|
|
Term
| What is the only syndrome associated with absence of the thymus, hypocalcemia, and cyanotic congenital heart disease? |
|
Definition
|
|
Term
| Hypocalcemia causes __________, which in newborns is manifested by jitteriness, repetitive blinding, and stridor. |
|
Definition
|
|
Term
| What controls the release of PTH? |
|
Definition
| ionized calcium level in the blood (negative feedback system) |
|
|
Term
| Binding of PTH to its receptor stimulates _____ and __________ _________. |
|
Definition
| cAMP; phosphatidylinositol diphosphate |
|
|
Term
| What are the 5 major actions of PTH? |
|
Definition
1. activates and increases the number of osteoclasts, which mobilizes calcium from bone
2. increases renal tubular reabsorption of calcium
3. increases conversion of vitamin D to active dihydroxy form in kidneys
4. increases urinary phosphate excretion, which reduces calcium loss
5. increases GI calcium absorption |
|
|
Term
| What does hyperparathyroidism cause? |
|
Definition
bone resorption
hypercalcemia
hypercalciuria
renal stone formation
bone lesions
metastatic calcification
hypophosphatemia
hyperphosphaturia
elevated plasma PTH |
|
|
Term
| What is the most common cause of primary hyperparathyroidism? |
|
Definition
|
|
Term
| What are the other causes of primary hyperparathyroidism besides adenoma? |
|
Definition
primary hyperplasia (20% of cases)
carcinoma (uncommon) |
|
|
Term
| What lab findings are consistent with primary hyperparathyroidism? |
|
Definition
hypercalcemia
hypercalciuria
hypophosphatemia
hyperphosphaturia
increased serum PTH |
|
|
Term
| What is the best initial screening tests for primary hyperparathyroidism? |
|
Definition
|
|
Term
| Why is an intact serum PTH test the best initial screen for primary hyperparathyroidism? |
|
Definition
| distinguishes it from hypercalcemia related to a malignancy |
|
|
Term
| What else might cause hypercalcemia besides hyperparathyroidism? |
|
Definition
cancer with bone metastases
malignant tumors producing PTH |
|
|
Term
| What is the most common cause of hypercalcemia in the hospital? |
|
Definition
|
|
Term
| Serum PTH is _____ in primary hyperparathyroidism whereas it is _________ due to a malignancy. |
|
Definition
|
|
Term
| Hypercalcemia due to a malignancy is a ___________ syndrome. |
|
Definition
|
|
Term
| Secondary hyperparathyroidism is a compensation for ___________. |
|
Definition
|
|
Term
| What undergoes hyperplasia in secondary hyperparathyroidism? |
|
Definition
| all four parathyroid glands |
|
|
Term
| What might cause the hypocalcemia that leads to secondary hyperparathyroidism? |
|
Definition
| inadequate vitamin D due to renal failure and malabsorption |
|
|
Term
| What lab findings are consistent with secondary hyperparathyroidism? |
|
Definition
hypocalcemia
increased PTH |
|
|
Term
| A patient with secondary hyperparathyroidism may develop... |
|
Definition
| tertiary hyperparathyroidism |
|
|
Term
| tertiary hyperparathyroidism |
|
Definition
glands become autonomous regardless of calcium level
may bring serum calcium into a normal or increased range |
|
|
Term
| What is the most likely cause of hypoparathyroidism? |
|
Definition
| prior thyroidectomy or parathyroidectomy |
|
|
Term
| What is an extremely rare autoimmune disease that can cause hypoparathyroidism and is often found in combination with other autoimmune disorders? |
|
Definition
| primary idiopathic hypoparathyroidism |
|
|
Term
| What are the layers of the adrenal cortex from outermost to innermost? |
|
Definition
glomerulosa
fasciculata
reticularis |
|
|
Term
| What does the zona glomerulosa of the adrenal cortex produce? |
|
Definition
| mineralocorticoids (aldosterone) |
|
|
Term
| What does the zona fasciculata of the adrenal cortex produce? |
|
Definition
| glucocorticoids (cortisol) |
|
|
Term
| What does the zona reticularis of the adrenal cortex produce? |
|
Definition
| sex hormones (testosterone) |
|
|
Term
| What are the potential causes of acute adrenocortical insufficiency? |
|
Definition
abrupt withdrawal of corticosteroids
Waterhouse-Friderichsen syndrome |
|
|
Term
| What is the most common cause of acute adrenocortical insufficiency? |
|
Definition
| abrupt withdrawal of corticosteroids |
|
|
Term
| What organism usually causes the septicemia associated with Waterhouse-Friderichsen syndrome? |
|
Definition
|
|
Term
| What happens in Waterhouse-Friderichsen syndrome? |
|
Definition
| N. meningitidis endotoxic sepsis --> DIC --> bilateral adrenal hemorrhage |
|
|
Term
| What condition causes chronic adrenal insufficiency? |
|
Definition
|
|
Term
| What is the most common cause of Addison's disease in the U.S.? |
|
Definition
|
|
Term
| What is the most common cause of Addison's disease in developing countries? |
|
Definition
|
|
Term
| What type of cancer most commonly results in Addison's disease? |
|
Definition
primary lung cancer
(often metastasizes to the adrenals) |
|
|
Term
| What clinical findings are consistent with Addison's disease? |
|
Definition
-weakness and hypotension
-diffuse hyperpigmentation |
|
|
Term
| What does a patient with Addison's disease have weakness and hypotension? |
|
Definition
| due to sodium loss from mineralocorticoid and glucocorticoid deficiency |
|
|
Term
| Why does a patient with Addison's disease have diffuse hyperpigmentation? |
|
Definition
| increased plasma ACTH stimulates melanocytes |
|
|
Term
| What areas is the diffuse hyperpigmentation most apparent in a patient with Addison's disease? |
|
Definition
buccal mucosa
skin
skin creases |
|
|
Term
| What lab findings are consistent with Addison's disease? |
|
Definition
decreased serum sodium, cortisol, bicarb
increased serum potassium, ACTH |
|
|
Term
| What electrolyte findings are consistent with Addison's disease? |
|
Definition
hyponatremia
hyperkalemia
metabolic acidosis |
|
|
Term
| Why would a patient with Addison's disease be hypoglycemic? |
|
Definition
| decrease in cortisol (cortisol is gluconeogenic) |
|
|
Term
| What results in Cushing's syndrome? |
|
Definition
| excess cortisol secretion |
|
|
Term
| What are the potential etiologies of Cushing's syndrome? |
|
Definition
-primary abnormality in the steroid hormone production by the adrenal cortex
-result of overproduction of ACTH by the pituitary resulting in excessive stimulation of the adrenal cortex |
|
|
Term
|
Definition
| pituitary disorder with increased secretion of pituitary ACTH |
|
|
Term
|
Definition
| term for all clinical cases of abnormally high glucocorticoid concentration (cortisol) in the plasma |
|
|
Term
| What type of Cushing's is caused either by pituitary disorder or by an ectopic ACTH-producing tumor? |
|
Definition
|
|
Term
| What is the ACTH concentration in the plasma of a patient with ACTH-dependent Cushings? |
|
Definition
|
|
Term
| What type of Cushing's is caused by glucocorticoid administration for long periods or an adrenal tumor that is producing excess glucocorticoid? |
|
Definition
| non-ACTH-dependent Cushing's |
|
|
Term
| What is the ACTH concentration in the plasma of a patient with non-ACTH-dependent Cushing's? |
|
Definition
|
|
Term
| What is the most common pathologic cause of Cushing disease? |
|
Definition
|
|
Term
| What lab findings are consistent with Cushing disease? |
|
Definition
increased ACTH
increased cortisol |
|
|
Term
| What is the most common cause of adrenal Cushing syndrome? |
|
Definition
|
|
Term
| What lab findings are consistent with adrenal Cushing syndrome? |
|
Definition
decreased ACTH
increased cortisol |
|
|
Term
| What is the most common cause of ectopic Cushing syndrome? |
|
Definition
| small cell carcinoma of the lung |
|
|
Term
| What lab findings are consistent with ectopic Cushing syndrome? |
|
Definition
markedly increased ACTH
increased cortisol |
|
|
Term
| What result would you get with a 24 hr urine free cortisol in a patient with Cushing's? |
|
Definition
|
|
Term
| What result would you get with a 48 hr dexamethasone test in a patient with Cushing's? |
|
Definition
| fail to suppress cortisol levels |
|
|
Term
| What finding related to the circadian rhythm would you find in a patient with Cushing's? |
|
Definition
| abnormally high evening cortisol level |
|
|
Term
| What would you find with an insulin tolerance test in a patient with Cushing's? |
|
Definition
| no cortisol rise with hypoglycemia |
|
|
Term
| What type of Cushing's could a high-dose dexamethasone suppression test suppress cortisol? |
|
Definition
| pituitary Cushing syndrome (but not any other types) |
|
|
Term
| iatrogenic Cushing's syndrome |
|
Definition
| caused by long-term use of corticosteroids (prednisone) |
|
|
Term
| What is a normal response to dexamethasone? |
|
Definition
suppression of ACTH
decrease in cortisol production |
|
|
Term
| Cortisol enhances _______________ and stimulates the release of _________. |
|
Definition
|
|
Term
| Why might a patient with Cushing's be in hypokalemic metabolic alkalosis? |
|
Definition
| due to increased weak mineralocorticoids |
|
|
Term
| serum cortisol in pituitary Cushing's |
|
Definition
|
|
Term
| serum cortisol in adrenal Cushing's |
|
Definition
|
|
Term
| serum cortisol in ectopic Cushing's |
|
Definition
|
|
Term
| urine free cortisol in pituitary Cushing's |
|
Definition
|
|
Term
| urine free cortisol in adrenal Cushing's |
|
Definition
|
|
Term
| urine free cortisol in ectopic Cushing's |
|
Definition
|
|
Term
| low-dose dexamethasone test in pituitary Cushing's |
|
Definition
|
|
Term
| low-dose dexamethasone test in adrenal Cushing's |
|
Definition
|
|
Term
| low-dose dexamethasone test in ectopic Cushing's |
|
Definition
|
|
Term
| high-dose dexamethasone test in pituitary Cushing's |
|
Definition
|
|
Term
| high-dose dexamethasone test in adrenal Cushing's |
|
Definition
|
|
Term
| high-dose dexamethasone test in ectopic Cushing's |
|
Definition
|
|
Term
| plasma ACTH in pituitary Cushing's |
|
Definition
|
|
Term
| plasma ACTH in adrenal Cushing's |
|
Definition
|
|
Term
| plasma ACTH in ectopic Cushing's |
|
Definition
|
|
Term
| What is a malignant tumor of the alpha-islet pancreatic cells that causes hyperglycemia? |
|
Definition
|
|
Term
| clinical manifestation of a glucagonoma |
|
Definition
|
|
Term
| What is a benign tumor of the beta-islet pancreatic cells? |
|
Definition
|
|
Term
| What is the most common islet cell tumor? |
|
Definition
|
|
Term
| clinical manifestation of an insulinoma |
|
Definition
| fasting hypoglycemia causing mental status abnormalities |
|
|
Term
| What lab findings are consistent with an insulinoma? |
|
Definition
fasting hypoglycemia
increased serum insulin
increased C-peptide |
|
|
Term
| What is a malignant tumor of the alpha-islet pancreatic cells that causes achlorhydira, cholelithiasis, steatorrhea, and diabetes mellitus? |
|
Definition
|
|
Term
| What is a malignant tumor with excessive secretion of vasoactive intestinal peptide (VIP)? |
|
Definition
| VIPoma (pancreatic cholera) |
|
|
Term
| clinical manifestations of VIPoma (pancreatic cholera) |
|
Definition
secretory diarrhea
achlorhydria |
|
|
Term
| What is a malignant islet cell tumor that secretes gastrin producing hyperacidity and has a MEN type 1 association? |
|
Definition
Zollinger-Ellison syndrome
(usually gastrinoma) |
|
|
Term
| clinical manifestations of Zollinger-Ellison syndrome |
|
Definition
peptic ulceration
diarrhea
maldigestion of food |
|
|
Term
| What lab finding is consistent with Zollinger-Ellison syndrome? |
|
Definition
| serum gastrin >1000 pg/mL |
|
|
Term
| What are the acute regulators of blood glucose concentration? |
|
Definition
|
|
Term
| What is the key factor that produces organ damage in diabetes mellitus? |
|
Definition
|
|
Term
| What lab findings are consistent with diabetes mellitus? |
|
Definition
hyperglycemia
increased HbA1c (>6%) |
|
|
Term
| diagnostic criteria for DM |
|
Definition
-random plasma glucose >199 plus classic symptoms
-fasting plasma glucose >125
-2 hr glucose level after 75-g glucose challenge >199
-one of these 3 criteria must be present on a subsequent day to confirm the diagnosis |
|
|
Term
|
Definition
-glycosylated hemoglobin
-evaluates long-term glycemic control
-represents mean glucose value for preceding 8-12 weeks
-goal is <7% (some use 6.5%) |
|
|
Term
| What causes the glucose intolerance during pregnancy in gestational diabetes? |
|
Definition
| anti-insulin effect of human placental lactogen (HPL), cortisol, and progesterone |
|
|
Term
| When should a pregnant woman be screened for gestational diabetes? |
|
Definition
|
|
Term
| What is a positive screen for a 1-hr glucose tolerance test during pregnancy? |
|
Definition
|
|
Term
| How is a positive 1-hr glucose tolerance test confirmed? |
|
Definition
|
|
Term
|
Definition
MEN-1
rare heritable disorder |
|
|
Term
| What endocrine tissues are affected by MEN-1? |
|
Definition
parathyroid
pancreas
pituitary |
|
|
Term
|
Definition
|
|
Term
| What type of tumors are associated with MEN-2a? |
|
Definition
pheochromocytoma
medullary carcinoma
parathyroid hyperplasia |
|
|
Term
| What type of tumors are associated with MEN-2b? |
|
Definition
medullary thyroid coarcinoma
pheochromocytoma
neuroma
ganglioneuroma |
|
|
