Classify the ACTH-dependent and ACTH-independent endogenous causes of Cushing syndrome. (SIGs 7.2b)
Dependent: high ACTH, high cortisol (Cushing Disease)- pituitary adenoma ; Indep: low ACTH, high cortisol (Cushing's syndrome)- adrenal adenoma/corticosteroids)
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15
Review pharmacological agents to manage osteoporosis in patients with hyperparathyroidism and hypoparathyroidism. (SIGS 7.1a)
hyper: bisphosphonate (pyrophosphate analogs that bind to hydroxyapatite binding sites to reduce bone resorption); Hypo: teriparatide- promotes bone growth; PTH
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15
Relate the physiologic process of bone resorption to the management of osteoporosis with parathyroidโฏhormoneโฏanalogues (teriparatide). (SIGS 7.1a)
synthetic PTH; regulates calcium metabolism from bone to promote bone growth (other meds promote bone density by prohibiting bone resorption); intermittent use
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15
Explain how hypercortisolism led to the development of thin extremities and easy bruising (Wild Card WFA 7.3)
Glucocort-protein metabolism: decr protein synthesis& incr protein breakdown;Chronic + ->lean muscle loss;cortisol inhibits fibroblast prolif & collagen->bruise
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15
Contrast the indications for and efficacy of surgery and pharmacologic androgen inhibitors in the treatment of Cushing syndrome. (SIGS 7.2b)
Surgery always recommended to remove hormone producing tumor to decr excess hormone production; pharm if surgery is contraindicated (ketoconazole; metyrapone)
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15
Contrast the MOA of octreotide with that of pegvisomant (Wild card WFA 7.1).
O: long-acting somatostatin analog--> decreased secretion of GH; P: GH receptor antagonist; GH analog structurally altered to bind GH receptor w/o activating it
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15
Identify the associated clinical features in patients with T1DM and DKA. (SIGS 7.2a)
Describe the effect of an anterior pituitary adenoma on regulation of the hypothalamic-pituitary (HP) axis (SIGS 7.1b).
producing tumors = effects of the overproduced hormone, smaller size (i.e. prolactinoma); non-producing tumors = mass effects, larger size
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15
Evaluate lifestyle and integrative approaches to bone health, including vitamins, minerals, specific medicinal foods (fish; soy; tea), weight-bearing exercise, and mind-body techniques.
See image
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15
Characterize the utility of imaging techniques in the evaluation of parathyroid disease (Sigs 7.1a).
US: quick/easy/cheap to check size; Nuclear med: Tc-99m test of choice to characterize hot/cold lesion based on metabolic activity; DEXA: bone density