Leslie's PAVLOV NOTES

In hypothyroidism, what is the expected level of T4 and T3 uptake, respectively?

Both decreased

Hormone(s) produced?

Hypothalamus

TRH, CRH, GnRH, GHRH

SYNTHESIZES ADH and Oxytocin

Hormone(s) produced?

Pineal gland

melatonin

Hormone(s) produced?

Anterior Pituitary Gland

FSH, LH, GH, PRL, TSH, ACTH, MSH

Hormone(s) produced?

Posterior Pituitary Gland

STORES AND SECRETES ADH, oxytocin

Hormone(s) produced?

Adrenal medals

epinephrine, norspinephrine

Hormone(s) produced?

Adrenal Cortex

cortisol, aldosterone, OHEAS

Hormone(s) produced?

Thyroid

T3, T4, and calcitonin

Hormone(s) produced?

Parathyroid

PTH

Pancreas

insulin, glucagon, somatostatin

Hormone(s) produced?

Ovaries

estrogens

Hormone(s) produced?

Testes

testosterone and other androgens

excess hair along the midiine of the female body (i.e., lip, chin, chest), is typically caused by excess androgen production by the ovaries or adrenal glands

Hirsutism

or enlarged ovaries, is associated with infertility and other menstrual irregularities

Polycystic ovary syndrome

is caused by lack of ovulation in women and inappropriate sperm production in men (Hubbard)

Infertility

FSH and LH

Gonadotropins

results in sexual precocity and Is usually a result of brain tumors in the region of the hypothalamus

Hypersecretion of gonadotropins

results in sexual underdevelopment and infertility

Hyposecretion of gonadotropins

Calculated estimate of FT4

T7

Most important thyroid function test

TSH

Distinguishes hyperthyroidism (↑T4, N TBG) from Euthyroidism (↑T4, ↑TBG)

TBG

Confirms euthyroid sick syndrome

rT3 (↑)

Indirect test for TBG; measures available binding sites on TBG

T3 uptake

Hormone with diurnal variation, decrease In the afternoon

Cortisol

Higher in AM

ACTH, cortisol, aldosterone, iron

Higher in PM

Growth hormone, PTH, TSH, ACP (Polansky)

Hormone that Is elevated at 8 am

Cortisol

peaks 6-8am (8-9am)

lowest 8pm-12am (10-11pm)

50% lower at 8pm than 8am;

↑ with stress

Cortisol

higher at 4-8am and 8-10pm

Prolactin

Cholesterol and TG In hypothyroidism

Increased

Cholesterol and TG In hyperthyroidism

Decreased

characterized by enlarged thyroid gland (goiter), impaired speech and memory, fatigue, weight gain, personality changes, cold intolerance, increased serum cholesterol and LDL

Hypothyroidism

is characterized by weight and muscle loss, fatigue, heat intolerance, nervousness, exophthalmos

Hyperthyroidism

refers to a normal functioning thyroid gland in the presence of an abnormal concentration of TBG.

Euthyroidism

Screening test/s for Cushing's syndrome

24-hour urinary free cortisol

Overnight dexamethasone suppression test

PLASMA OR SALIVARY mldnight cortisol level

Confirmatory testing for Cushing's syndrome

Midnight PLASMA cortisol low-dose dexamethasone suppression test performed alone or with the administration of CRH.

What is the effect of increased growth hormone to adults?

Acromegaly

Increased GH in childhood

Gigantism

Enlarged feet, hands, and facial bones, impaired glucose tolerance, hypertension; is generally caused by a growth hormone-secreting pituitary tumor

Acromegaly

Decreased GH in childhood

Dwarfism

Extent of liver damage in cirrhosis to abolish liver function

80%

fibrosis, scarring and destruction of the normal liver architecture (Marshall)

Cirrhosis

A decrease in the albumin level and an incre in a2-globulin region in SPE indicates

Nephrotic syndrome

Sharp ↑ in 1 immunoglobulin ("M spike"). Decrease in other fractions

Monoclonal gammopathy

Diffuse ↑ in gamma

Polyclonal gammopathy

Polyclonal (all fractions) ↑ in gamma with beta-gamma bridging

Cirrhosis

↑ beta or unusual band between alpha-2 beta

Hemolyzed specimen

Extra band (fibrinogen) between beta & gamma

Plasma

↑ alpha-1 & alpha-2

Acute inflammation

↑ alpha-1, alpha-2, & gamma

Chronic Infection

Alpha-1-antitrypsin deficiency (causes emphysema-associated pulmonary disease and severe juvenile hepatic disorders that may result in cirrhosis)

Decreased/absent alpha-1

Decreased gamma

Hypogammagiobulinemia

Single most important and widespread clinical application of serum protein electrophoresis

Detection of monoclonal gammopathles

Monoclonal gammopathy causes B cell production of excessive IgG (most common) or IgA, with decreased production of the other immunoglobulins

Multiple myeloma

chronic progressive Inflammatory disease with demyelinization of the nerves. Most patients with MS have increased igG concentrations in the cerebrospinal fluid (CSF)

Multiple sclerosis (MS)

Oligoclonal bands in CSF on high-resolution electrophoresis

MS, SLE, viral meningitis, neurosyphilis

Neonate bilirubin level of 28 mg/dL. When will you report result?

Immediately

Test results that indicate a potentially life-threatening situation. Patient care personnel must be notified immediately

includes glucose, Nat, K+, total CO2, Ca2+, Mg2+, phosphorus, total bilirubin (neonates), blood gases

Critical values/Panic values

Person receiving critical values must record & read back patient's name & critical values. Lab must document person who received information & time of notification.

"Read-back" policy

Test for the patency of bile/biliary duct (Calbreath)

Ratio of direct bilirubin to total bilirubin

Fecal color and fat content

Fecal and urine urobilinogen

Urine bilirubin

Overall patency of bile/biliary duct

Serum bile acids and bile salts

Measures abliity to transport/secrete bile and conjugate bilirubin

serum bilirubin

This indicates the function of the biliary epithelium

ALP

Indicator of nutritlonal status and Is one of the protelns that transports thyroid hormones

Prealbumin (transthyretin)

Is synthesized in the Iiver and has the highest concentration of all plasma proteins; binds many analytes for transport; significantly contributes to plasma osmotic pressure.

Albumin

ls an acute-phase reactant and a protease inhibitor that neutralizes trypsin-type enzymes that can damage structural proteins

a1-Antitrypsin

Increased AFP in maternal serum: neural tube defects, spina bifida, and fetal distress

Decreased AFP in maternal serum: Down syndrome, trisomy 18 Increased In non-pregnant: can be indicative of hepatocellular carcinoma and gonadal tumors.

a1-Fetoprotein (AFP)

(AKA orosomucold) Acute-phase reactant; binds to basic drugs

a1-Acid glycoprotein

B-globulin that transports iron

Transferrin

B-globulin that is an acute-phase reactant increased In tissue necrosis rheumatic fever, Infections, myocardial infarction, rheumatoid arthritis, (CRP) and gout

C-reactive protein (CRP)

Assay for urea that is inexpensive but lacks specificity.

Colorimetric, endpoint

Assay for urea that measures ammonia formation

Enzymatic

Simple, nonspecific method for creatinine

Colorimetric, endpoint

Assay for creatinine that is rapid with increased specificity

Colorimetric, kinetic

Assay for creatinine that measures ammonia colorimetrically or with ISE

Enzymatic

Assay for uric acid that has problems with turbidity

Colorimetric

Assay for uric acid that needs special instrumentation and optical cells

Enzymatic, UV

Assay for uric acid with interference from reducing substances

Enzymatic, H2O2

Caused by reduced blood flow, poor perfusion of the kidneys resulting to decrease GFR

Pre-renal Azotemia

is produced by renal failure, damage to filtering structures of the kidney (glomerulus, tubules)

Renal Azotemia

is caused by an obstruction anywhere in the renal system (e.g., tubules, ureter)

Postrenal azotemia

Retention of nitrogenous wastes in the blood

Azotemla

Toxic condition of very high plasma urea concentration accompanied by renal failure; eventually fatal if not treated by dialysis or transplantation. (Bishop and Hubbard)

Uremia or uremic syndrome

Highest concentration of NPN

Major end product of protein catabolism; first to Increase in renal disease

Urea (BUN)

End product of purine catabolism

Uric acid

Waste product of muscle metabolism; index of renal function; completely filtered by the glomerulus

Creatinine

formed by the deamination of amino acids. It Is used by the liver to produce urea

Ammonia

True about serum amyloid A

1000x increase

Are so named because they are Increased In the serum within days following trauma or exposure to inflammatory agents.

Acute-phase reactants

<5x Increase in AST

Physiological (neonates), other liver diseases, pancreatitis, hemolysis, drugs

5-10x increase In AST

Myocardial Infarction, surgery or trauma, skeletal muscle disease, cholestasis, chronic hepatitis

>10x increase in AST

Acute hepatitis and liver necrosis, major crush injuries, severe tissue hypoxia (may be >100x ULN)

Pathogonomic cause of increased GGT

Increased alcohol intake

Enzyme classification of GGT

Transferase

Enzyme classification of LD

Oxidoreductase

Enzyme classification of ALF

Hydrolase

Reaction rate Is directly proportional to substrate concentration

First-order Kinetics

Reaction rate depends only on enzyme concentration

Zero-order kinetics

MICHAELIS - MENTEN EQUATION

E+S -> E-S -> E+P

Vo = Vmax[S] / Km+[S]

Preferred transport for blood gases

Ice slurry