Endocrine (Kaplan)

GnRH (gonadotropin-releasing hormone)


TRH (thyrotropin releasing hormone)



antidiuretic hormone (vasopressin)Only hormone made by posterior pituitary


A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.NOT made by the posterior pituitary, only stored

LH (luteinizing hormone)

a hormone that causes the secretion of sex hormones by the testes and ovaries

GH (growth hormone)

Secreted by pituitary --> stimulates growth

ACTH (adrenocorticotropic hormone)

Stimulates adrenal cortex to release glucocorticoids (cortisol)

hyperparathyroidism etiology

Excess secretion of PTH:Increased absorption of calcium from bones, kidneys, and GI systemsPrimary:Middle-aged to older adults, women>menEtiology: hyperfunction benign parathyroid adenoma (most common), MEN 1 and MEN 2aSecondary:Chronic renal diseaseMetastatic bone diseaseOsteomalacia

Hyperparathyroidism s/sx

Clinical:Bones: bone painStones: kidney stonesGroans: abdominal painPsychiatric overtones: neuro-psych changesLabs:Increased calciumDecreased phosphateIncreased PTH(increased phosphate in renal disease)x-ray: demineralization, cystsTx:Surgical removal of glandSupportive (calcitonin, bisphosphonates)


deficient production of parathyroid hormoneFollows parathyroid or thyroid surgeryAutoimmune, congenital (DeGeorge syndrome)Clinical:Acute: circumoral tingling, tetany, muscle cramps, irritabilityChronic: lethargy, personality changesLabs: Low calciumHigh Phosphate

DeGeorge Syndrome

What is a congenital cause of hypocalcemia due to parathyroid hypoplasia, thymic hypoplasia and cardiac outflow track defect called?Chromosome 22

Graves Disease

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos:Women>menPretibial myxedemaGoiter with bruitLid lag


Hypermetabolic state:Appetite changeExertional SOBDiarrheaFatigueHeadacheHeat intoleranceHyperactivityIrritabilityMenstrual disturbances

Hyperthyroidism treatment

Antithyroid drugs:methimazole, propylthiouracilInhibit hormone synthesis, watch for low WBCRadiactive iodine:Decrease thyroid activityAvoid in pregnancyMonitor for hypothyroidismBeta blockers (symptom relief):

Thyrotoxic Crisis (Thyroid Storm)

Overwhelming release of thyroid hormones that exerts an intense stimulus on the metabolism. This is a life-threatening condition most commonly precipitated by surgery, trauma, or infection.s/sx:high fever, tachy, vomiting, diarrhea, dehydration, delirium, heart failure

etiology of hypothyroidism

Autoimmune thyroiditis (Hashimoto's)Most common causeWomen>menPainless goiterPE:dry, coarse skinThinning lateral half of eyebrowsSlow, prolonged relaxation phase of DTRsBradycardiaThin, brittle nailsThinning hairTreatment:Thyroid replacementLabs:Monitor TSH levelCheck q 6 weeks until stableOnce stable, check annually

Thyroiditis clinical

Painful thyroid, swollenSubacute-antibiotics-surgical drainage

Thyroid cancer

Papillary carcinomas/sx:painless single, hard, massHx of radiation therapyLink to MEN 2a and 2bThyroid function usually normalWomen 2-3 times more common than menDiagnosis:-thyroid scan: cold nodule (non-function nodule)-Fine needle aspirationTx:Radioiodine ablationSurgical removal

Adrenocortical Function Tests

- Commonly performed- Dysfunction is increasingly common.- Misuse of corticosteroids.

Cushing's syndrome etiology

Exogenous:-too much steroid medicationEndogenous:-Adenoma of adrenal gland-Adenoma of pituitary

Cushing's syndrome s/sx

Clinical obesitythin skin, acne, hirsutism, amenorrheafatigue, proximal muscle weakness, PIGMENTED SKIN, striaedecreased libidoHTNLabs:- dexamethasone suppression test- increase free cortisol in urine- ACTH level elevated in the pituitary source of disease and decreased in adrenal source- Hyperglycemia and hypokalemia- MRI for pituitary tumorTx:- transphenoidal resection and replacement therapy- Radiation therapy- Adrenal inhibitors:Metyrapone: inhibits 11 beta hydroxidaseAminoglutethimideKetoconazole (antifungal agent)

Primary corticoadrenal insufficiency (Addison's disease)


Addison's disease symptoms

chronic fatigue, muscle weakness, anorexia, nausea, vomiting, diarrhea, hypotension, hypoglycemia, sweating, irritability, weight loss


Tumor of the adrenals:Increase in urine catecholamines (metanephrine & VMA)Increase in plasma catecholamines (epi and noreip)Tx:Surgical removalAlpha block THEN beta blockers

Primary hyperaldosteronism

Conn's syndromeLabs:Stop all hypertensive medications firstincreased plasma/urine aldosterone levelLow plasma reninHypokalemia, metabolic alkalosisTx:AdrenalectomySpironolactone


enlargement of the extremitiesspace between teethMetabolic: DM, weight gainKidney stonesHA, visual field defect (bitemporal hemianopsia)Tx:Surgical removal of the tumorDopamine agonists

Familial short stature

14 y/o boy, always been below 5% in height. Father is 5'2" and mom is 4'10"Bone age = Real age.Establish growth curves at or below 5th percentile by age 2Healthy, normal PENormal bone age and puberty at expected timeConstitutional delay:-at or below 5th percentile at normal growth velocity-Delay in puberty

Short stature: etiologies

Growth hormone deficiency; growth at diminished velocityPrimary hypothyroidismChronic disease: due to lack of caloric intake or absorptionmedications: methylphenidate


Prototype is achondroplasiaClinical features:- short limbs; long, narrow trunk; large head with midface hypoplasia; prominent brows- delayed motor milestones- normal intelligence- neurologic complicationsLabs:- mutations in the FGFE3 geneTx:

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effectDecrease in ADH (give vasopressin, desmopressin)Central: decreased production vasopressin from posterior pitNephrogenic: treat underlying process, give thiazide diuretics, limit renal water loss


- DI = High and dry (hypernatremia, dehydration)- SIADH = Low and wet (hyponatremia, water retention)

Screening for diabetes

No risk factors: age 45

Symogyi effect

Rebound hyperglycemia in AM in response to counterregulatory hormone release after episode of hypoglycemia in the middle of the night

Dawn phenomenon

Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release.

ATP IV guidelines

ASCVD: high dose statin = dec LDL >50%LDL >190mg/dL: high dose static = dec LDL >50%DM age 40-75yr, LDL 70-189mg/dL: mod dose statin = de LDL >30%CVD or DM and ASCVD 10y risk >7.5%, LDL 70-189mg/dL: high dose statin = dec LDL >50%