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159 terms

EER midterm-revised

STUDY
PLAY
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)
HVA
da
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,,?
what effect does lack of insulin have on brain?
NONE, insulin dependent (GLUT1)
everything but muscle, heart and adipocytes(glut4)
cerebellar edema associated with waht in kids?
DKA
review pg 47
tx HHS (HONK)
frist fluid, then insulin
hyperuricemia is seen in what
ACURA
(syndromex)
synonyms of met syndrome?
syndrome x

HAIR-AN
adipo/leptin/ghrelin levels in synx?
low/high/low

p5 50..all opposite of what think
PCOS and insulin level..?
hyperinsulinemia (maybe from adipocytes)..inc LH but low FSH so cant aromatize T->E2
metx glucose requrements?
A1c>6.5 (pitfall AA have higher Aic)
fasting>126
2 hour >200
metX bp goal?
<140/90
sx of hyperparathy
seen in MEN1

bone, groan, moan...psychogen overtones(altered mental status)