EER midterm-revised

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how eval excess cortisol production

dextameth supression test, should cause neg feedback--only suppresses ACTH from cushing dz (pit tumor that is releasing ACTH)

sulfonyureas

attach Katp to depolarize and influx ca->insulin release

glyburide
glizpizide
glimepiride

glitinides

attach Katp to depolarize and influx ca->insulin release-shorter HL

nateglinide
repaglinide

sheehans

pit failure, low tropin (LH, prolactin)

larons syndrome?

GH receptor defect

glargine

basal insulin

detemir

basal insulin

lispro

short acting

GLP-1 secreted where? when? actions?

secreted from L-cells with meal ingestion-most responsive to lipid and aa diet..distal/iluem colon

effects: stim insulin secretion, transcription, syn, increase beta cell mass
slow gastric empytying

reduced in DMII
can infuse (extretin) or give DPP4 antag

amylin

"anorexic effects"

secreted from b-cell with insulin slows glucose appearance by inhibiting glucagon (glucogenic),slow gastric emptying, and digestive enzymes

sensed by glucose sentive receptors in postrema brain..may be overriden by hypoglycemia

somatostatin effects on glucagon?

inhibits

GLP1 effects on glucagon?

inhibits

what stimulates the effect of glucagon? what happens when defected?

aa arginine

immob of fats and aa when defected

defects in DM relating to alpha cell

fasting hyperglucagonemia (increases hepatic glucose output)
no insulin to repress the glucagon

blood pressure target for DM?

< 130/80

2 mechanisms for DMI pathophys?

defective clonal deletion in thymus/loss of tolerance ..autoreactive cd8 and cd4 still present

mimicry of cross reactive ag

what causes the lens of eye, nerve sheaths water attraction (cataracts)

sorbitol pathway, aldose reductase converts sugar to sorbitol (later fructose)--pulls water in

thiazolindindiones?

PPAR agonist gamma

inc glucose utilization (uptake), decrease insulin resistance

decrease hepatic output

stabilize beta cell fx

example of PPAR alpha modulator?

PPAR-alpha is the main target of fibrate drugs, a class of amphipathic carboxylic acids (clofibrate, gemfibrozil, ciprofibrate, bezafibrate, and fenofibrate). They were originally indicated for cholesterol disorders

metformin?

biguandide "sensitizer"--"glucophage"

same as PPARgamma
inhibit glycogenolysis and gluconeogenesis
se: dka

exenatide?

analogue glp1

DPP4 inhib

increase GLP1 bc not deactivated

what are the auto ab?

glutamic acid decar (GAD)
islet cell
insulin

somogyi phenom? tx?

excessive insulin during night causing low blood sugar->glucagon, ne, epin is activated so high blood glu in morning--and you wake up with nighmares!

tx: reduce night time insulin dose

dawn phenom? tx?

high cortisol/ne/epin in morning (naturally to wake you up)..increases insulin resis

tx: raise insulin levels to keep sugar down

adiponectin in met syndrome?

low

ghrelin levels in met syn?

low

characteristics and complication of met syn?

honda

acura

what type of receptor insulin? glucagon?

TKR

Gprotein

examples of cAMP

FLAT CHAMP

FSH, LH, ACTH, TSH, CRH, hcG, ADH (V2), MSH, PTH
calcitonin, GHRH, glucagon

examples of cGMP

think vasodilators

NO, ANP

examples of IP3

GOAT

GnRP, Oxytocin, ADH(v1), TRH

histamine, ang II, gastrin, NE

TK (MAP kinase path)

think growth factors (not growth hormone!! jak/stat)

insulin, GH, IGF-1, FGF, PDGF

ex of steroid hormones

think adrenal hormones and vit d (cytosolic)

t3, t4 (nuclear)

ex receptor associated TK (JAK/STAT)

PiCG

prolactin, cytokines ,GH

low TSH
high total T3, T4
high free T3, T4
high RAIU
high scan

graves (aka diffuse goiter, con basedow)
eye sx seen in 25% of them

pathophys: TSH-Receptor ab stimulating throid->thyrotoxic state

(thyrotoxosis if no eye sx)

3 effects of thyrotoxosis in graves?

increased sensitivity to catecholamine
(lid leg, stare, tachy, palpitations, tremor)

increased BMR due to inc na/k atpase
(sweating, vasodilation, causing dec SVR and increased co, widened pulse pressure, can lead to volume depletion)

inc protein syn and turnover rate

what causes graves opthalopathy? mnemonic?

TSH-R ab also stim fibroblasts in orbit to produce GAG-->inflam, inc pressure

->lympathics compressed->edema,liquid bleb
->veins lead to red eye,
->EOM compress->diplopia,proptosis->optic nerve->blindness

No sx
Only lig/lag etc
Soft tissue invol
Proptosis
Extraocular muscle invol
Corneal invol
Sigh loss

graves dermopathy sx?

pertibial myxedema from GAG
non-inflamed, indurated plaque with deep pink/purple color
"orange" skin

tx graves?

I-131 (radioI ablation): destorys hyperfx cells, causing "hypo"thyroid

propothyiouracil: block tpo and de-iodinase

methimazole: better compliance

propanonol: decrase adrenerg sx (thyroid storm)

thyroidectomy: rare

low TSH
high total T3, T4
high free T3, T4
low RAIU
neg scan

pain

subacute throiditits (aka granulomatous thyroid)
(happens weeks after viral URI)

sx: hyperthy signs, TENDER THYROID/pain, inflam?granulomatous cells on biopsy

causes of thyrotoxisis in subactute thyroiditis?

preformed hormones attaching to thyroglobulin from colloid space lumen released into blood due to damage of gland

hyper->(proteolysis)->hypo->euthy

tx subacute thyroidititis? what is CI?

give THormone during hypo phase (levothy)

aspirin to block inflamm

beta blocker in hyper phase

do NOT give I-131, bc condition is transient..would take up I anyway, (neg scan results seen)

low TSH
high total T3, T4
high free T3, T4
low RAIU
neg scan

no pain

silent thyroidititis (autoimmune), NON-GRANULOMATOUS
can be "post partum thyroiditis)

no englarged thyroid, but small goiter
also shows 3 phases

pathophys silent thyroidititis (autoimmune),

thyrotoxosis facitia: due to over ingestion TH

I-induced causing hyper (jod basedow)..seen in people with I-depleted to I-repleted places

amiodarone (contains I)

silent thyroidititis (autoimmune) tx?

levothy for hypothy
propanolol

normal TSH
high total T3, T4
normal free T3, T4
normal RAUI (little?)
normal scan

dx: euthyroid
increased TBG from estrogen/OC caused less free free causing more TH production to normal free levels and high total

albumin levels can also change free hormones levels b/c binds TH

normal to see preg woman with palpable thyroids

high TSH
low total T3, T4
low free T3, T4
neg RAUI (little?)
neg scan

dx:
primary hypothyroid, (can have goiter present)

hasimoto thyroiditis

since low TSH it cuases + feedback on TSH so high

tx: levothyroxine

hashimoto thyroiditis?

autoimmune ab against many thyroid ag (TSH-R, TPO, TG) leading to lymphocytic infil and destruction of thyroid gland

aka chronic LYMPHOCYTIC thyroiditis

since low TSH it cuases + feedback on TSH so high

low TSH
low total T3, T4
low free T3, T4
neg RAUI (little?)
neg scan

PE: BT Hemianopsia
tx?

2ndary hypothyro due to damge to PITUITARY (so decreased TSH and not respond to feedback)

can be due to tumor (BTH)

tx: remove tumor, give T4

normal TSH
LOW total T3, T4
normal free T3, T4
NORMAL RAUI
postive scan?

#8

euthyroid but LOW TBG due to increased ANDROGENS (steroid use, lowprotein diet, cirrhosis,nephtortic syn-- decreased albumin)

NORMAL TSH
low total T3, T4
low free T3, T4
neg RAUI
postiive scan

(#9) ICU pt

euthyroid sick syndrome due to:

mild to severe endogenous periph conversion to T4 inhibitor

treat underlying cause, do NOT GIVE TH

HIGH TSH
low total T3, T4
low free T3, T4
HIGH RAUI (bc thyroid hunry for I) opp KI
VERY postiive scan

eu or hypothyroid

congential hypothy: under dev thyroid to to genetic AR, "cretinism" (MR, dec growth, puffy face, deaf/mute, neuro-may appear normal in early months)

IODINE DEFICIENCY, not enough to make TH, tryin to stimulate to TSH high (leading to goiter)

tx: I supplement, newborn screening!

neurohypophysis?

post pit

adenohypophysis (ant pit) --a's

mnemonic IP3?

Gnrh
Oxytocin
ADH (v1)
TRH

mnemonic Camp?

FSH
LH
ADH (v2)
T(S)H


CRH
Hcg
ACTH
MSH
PTH

mnemonic cGMP?

vasodilators

ANP
NO

mnemonic steroid-cytosol

vit D
Estrogen
Testosterone

Cortisol
Aldosterone
Progesterone

mnemonic steroid-nuclear

t3, t4

mnemonic TK? pathway?

insulin
growth factors (IGF,FGF, PDGF)

autphos->SH2 domain->
->PLC->PIP2->PKC
->P13K->PIP3->PKB->glycogen/lipid/pro syn
->GAP->RAS->MAPK
->IRS (insulin receptor substrate)

mnemonic associated TK?

JAK/STAT path

Prolactin
Cytokines
GH

path serine threonine?

R1->R2

SMAD/co-SMAD

3 hormonal correlates to met syn

adiponectin: adipose derived, low in obese people

leptin: satiety hormone->high in obese ppl, resistant

ghrelin: hunger hormone->lower in obese (desensitized?)

EVERYTHING IS OPPOSITE OF WHAT SEEMS!!!

what cells secrete calcitonin?

parafollicular around follicular cells of the thyroid

mutation of what is associated with congen. hypothy, thryoid agensis, cleft palate?

TTF-2 (transcrip termination factor, rnap II)

spikey hair, narrow jaw, cleft, hypertelirism (eye space)

what causes goiter?

elevated TSH stimulating the thyroid to try to make TH

what causes graves?

TSH-R ab stimulating the thyroid

jod baswdow phenom

excess I->cause hyperthy
(from KI or moving to I deplete to replete area)

wold-chacid effect?

excess I ->inhibits tpo->less TH made->hypothy

metyrapone

inhibts p450c11 and a little p450aldo
reduces CORTISOL

used as depression test to check if ACTH increase, if it doesnt=adrenal insuff (addisons)

or cushings tx

mitotane

block desmolase and p45011c
adrenal carcinoma tx

aminoglutethimide

inhibit desmolase (scc) inhbiting cortisol and aldosterone

height velocity equation?

h2-h1/months x120

bmi?

wt/ht squared

best method to measure fat? adults, child?

adult: BMI
child: wt for stature chart

examples of disproportionate growth

normal weight (fat)..underaccel height
cushings, hypothyroidism, prader willi, biedel bardet

compared with "obese" kids, with accel height (think eat a lot) and normal weight growth

if all under except head circumference-> nutritional growth deficiency

scoliosis, rickets

BA? PAH?

compare to xray

PAH=real height/% on chart

GH deficiency etiologies:

-pit malformation, congenital (hypoplasia)
-tumor (craniophyayngioma)
-genetic defects (GH, PROP, PIT)

GHD how dx neonatal? infant/child?

LOW GH during hypoglycemia

GH level during GH stim test

what give during GH stim test

insulin (but cause seizures)
clonidine
arginine
glucagon
-should spike

benefits of GH tx?

childhood growth (not with ab, larsons)
pos. muscle mass
lipolytic effects

MPH?

(F+M)/2 +- 6.5

boys: ((mother+5)+6)/2

diagnoses for dec ht%, high TSH...

turners
likely to coexsist with subclinical hypothryroidism: normal t4, high TSH because ab (hashimoto) for tsh

what gene cause achrondroplasia/hypochon-?

FGFR3
AD, 80% spot mutation

NSD1 gene?

soto syndrome, cerebral gigantism

beckwith wiedmann syndrome

rapid child growth, adult normal, big at birth

possible cause of giganstism?

pit adenoma, may have bth

examples of child tall stature, with normal/short adult

exogenous obesity (due to hyperinsulinemia)
hyperthyroid
excess androgen (CAH, virilizing tumors,exogenous)
procoious puberty (mccune allbright)

what hormones do ant pit release?

Fsh
LH
Acth
Trh

Prolactin
Gh

doesn flat pig fit into an ant pit..?

causes of precocious puberty

central: tumor, hyper/hypothyroid
2ndary: occurs after period

bromocriptine

DA agonist given for prolactinoma

cabergoline

DA agonist given for prolactinoma

pegvisomant

GH antag given for acromegaly
only good for skrinking tumor

other than pegvisomant, what else can give to shrink pit tumor?

octreotide (somatostatin)
lancreotide

what gene cause MEN2

RET oncogene, chr 10

how check calcitonin levels?

pentagastric stimulation..if increased=medullary thyroid cancer (MEN2a/b)

menin?

associated with MEN1, chr 11

RET?

associated with MEN2A/B
chr 10

side effect of ketoconazole?

gynecomastia
inhibits desmolase and 11 causing increase androgens and doc
-can be used to treat cushings

spirolactone can also cause gynecomastia

metyrapone supressions test? ACTH increase? ACTH not increase?

blocks cortisol

inc in ACTH and no rise in DOC->adrenal dysfx

no inc in ACTH or DOC->hypothal or pit problem of realeasing CRH or ACTH

two causes of primary hyperaldo? dx criteria?

hyperplasia of glomerulosa (inc aldo)
adenoma producing excess aldo

should have low renin (PA/PRA)

where is AMH from?

sertoli cells

noonans syndrome

(occurs in both males and females) the patient may have dysfunctional gonads that would cause elevated FSH in male in patients after the age of puberty

where does DA come from?

hypothalamus

somatotropin?

aka GH
decreases insulin sensitivity (inc resistance)

what does TRH stimulate release of?

TSH, prolactin

what is secondary hyperaldo caused by?

kidney perception of low blood perfusion (RAS, renal fail, CHF. cirhrhosis, etc)-->cause in RAAS

what increases in urine with pheochromo?

VMA (breakdown of NE)
metanephrines

what increases in urine in neuroblastoma?

HVA (da)

kallman?

defect in hypothalamus causing decrease release of GnRH

why do u see amenorrhea in prolactinomas?

prolactin suppresses GnrH

craniopharyngioma

causes hypopituitary (mc in kids?)

random- gitelman syndrome?

similar to taking TZD

liddles syndrome?

increases ENac "pseudoaldosteronism"
but causes aldo decrease

mnemonic for VIPoma?

WDHA
water diarrea, hypoL, achlorydia

part of MEN1

what increases p value

Sample size
Alpha level
Effect size

when start to have sx hypoglycemic?

<53
epin kicks in at 69

where are GLP-1 secreted from?

L cells of GI
enchances insulin, dec glucagon, flow stomach emptying, dec apetite, and inc beta cell mass

where is amylin secreted from?

beta cells on pancreas (same as insulin)
it also inhibits glucagon release

examples of incretins?

GLP1 and GIP

abrupt change in ht velocity at 9 years old?

craniopharyngioma

what is impt in linear of growth at fetal/neonatal?

insulin/IGF/nutrition

childhood growth dep on factors..? vs puberty?

thyroid and GH-dep IGF

puberty: gonadal steroids help grow..(estrogen..?)

2 uses of metyrapone? moa?

moa: 11beta hydroylase blocker

used to tx cushings
used to dx adrenal insufficieny (if give it and ACTH increase DOC increase problem
if give it and only ACTH increases..problem with addrenal=addisons)

what can metformin toxicity cause?

high AG acidosis (blocks gluconeogen/glycogenolysis so reallllyyyyy low blood glucose levels)

what r the glucose sensors in beta pancreatic cells?

glucokinase

how treat 11beta defic that wants to stay xx

give dexomethasone to repress androgen production

what are the GH secretologues used for GH stim testing?

insulin
clonidine (alpha2 ago)
glucagon
arginine

causes of short stature in TS

shox
lack of estrogen

treatment of GH for what is not FDA approved

achondroplasia

FBN1?

marfans
tall stature

NSD1?

sotos, tall stature
big head

what is and how treat central prococious puberty? ex?

premature thelarch breasts (de-repressed FSH) or adrenarch in guys due to inc DHEA....

GnRH AGONIST to neg feedback forwardly

leuprolide, histrelin

how treat peripheral precicious pub

aromatase inhib (estro)

estrogen-R antag

androgen inib (bicalutamide)

inhib androgen syn (ketonazole)

bicalutamide?

androgen inhibitor

hirstrelin?

Gnrh agoist-used for central PP

leuprolide?

GnrH agonist-used for central PP

testolactone?

aromatase inhbitors

what labs do u see in MAS?

high estrogen, low LH/FSH but can trigger central so high FSH/LH

letrozole?

e2 syn inhib

testolactone?

e2 syn inhib

tamoxifen?

e2-R antag

secondary diabetes?

cushings due to cortisol increases BG
acromegaly due to GH increases BG (think pcos)
pancreatic trauma

drugs: GC, protease inhibitors, atypical AS, niacin, immunosuppressants

diabetes treatment plan..

pg 43

annual eye
annual lipo
annual microalbum

fundo/foot quarterly
hba1c quarterly

how treat dawn phenom

raise evening insulin

how treat somogi

dec evening insulin, getting hypogly

to who does hypoglycemia unawareness happen to?

ppl who lack glucagon unawareness

inc coag in diabetics..why?

PAI-1 increased, give aspirin a day

TNF also invovled,,?

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