Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
154 Cards in this Set
- Front
- Back
|
what are the 3 zones of the adrenal cortex?
|
zona glomerulosa, zona fasciculata, zona reticularis
|
|
|
what steroid is produced by the zona glomerulosa?
|
aldosterone
|
|
|
what steroid is produced by the zona fasciculata?
|
cortisol, sex hormones
|
|
|
what steroid is produced by the zona reticularis?
|
sex hormones
|
|
|
What is the primary regulation of the zona glomerulosa?
|
RAA system
|
|
|
What is the primary regulation of the zona fasciculata and zona reticularis?
|
ACTH and hypothalamic CRH
|
|
|
what is the primary regulation of the adrenal medulla?
|
preganglionic SNS
|
|
|
what is the most common adrenal medulla tumor in adults?
|
pheochromocytoma
|
|
|
what is the most common adrenal medulla tumor in children?
|
neuroblastoma
|
|
|
which causes episodic HTN, pheochromocytoma or neuroblastoma?
|
pheochromocytoma
|
|
|
describe the venous drainage of the left adrenal gland
|
left adrenal to left adrenal vein to left renal vein to IVC
|
|
|
describe the venous drainage of the right adrenal gland
|
right adrenal to right adreanl vein to IVC
|
|
|
what hormones are secreted by the posterior pituitary?
|
vasopressin and oxytocin
|
|
|
what is the posterior pituitary derived from?
|
neuroectoderm
|
|
|
what hormones are secreted by the anterior pituitary?
|
FSH, LH, ACTH, TSH, prolactin, GH, melanotropin (MSH)
|
|
|
where is the anterior pituitary derived from?
|
oral ectoderm
|
|
|
Which hormones are produced by basophilic cells of the anterior pituitary?
|
FSH, LH, ACTH and TSH
|
|
|
Which subunit of hormones is common to TSH, LH, FSH and hCG, alpha or beta subunit?
|
alpha is common, beta determines hornome sepcificity
|
|
|
where do pancreatic islets arise from?
|
pancreatic bunds
|
|
|
what hormone is produced by alpha cells of pancreatic islets?
|
glucagon
|
|
|
where are alpha cells located in the pancreatic islet?
|
peripherally
|
|
|
what hormone is produced by beta cells of the pancreatic islet?
|
insulin
|
|
|
where are beta cells of the pancreatic islet located?
|
centrally
|
|
|
what hormone is produced by gamma cells of the pancreatic islet?
|
somatostatin
|
|
|
where are gamma cells located in the pancreatic islet?
|
interspersed
|
|
|
what organs are insulin dependent?
|
skeletal muscle and adipose = insulin is needed to insert GLUT4
|
|
|
which organs are insulin independent?
|
brain and RBCs - take up glucose by GLUT1
|
|
|
can RBCs use ketones for energy?
|
no, RBCs are always dependent on glucose (unlike the brain which can use ketones during starvation)
|
|
|
how is prolactin regulated?
|
prolactin increases dopamine synthesis and dopamine inhibits prolactin secretion
|
|
|
what does prolactin inhibit in women?
|
prolactin inhibits GnRH synthesis and release = thus inhibiting ovulaiton
|
|
|
what hormone levels are seen in 17α-hydroxylase deficiency?
|
↓sex hormones, ↓ cortisol, ↑mineralocorticoids
|
|
|
which of the congenital bilateral adrenal hyperplasias causes hypotension?
|
11β-hydroxylase deficiency - the others cause HTN
|
|
|
a baby is born with external female genitalia and internal male sex organs and has bilateral adrenal hyperplasia. What is the diagnosis?
|
17α-hydroxylase deficiency
|
|
|
what is the most common form of bilateral adrenal hyperplasia?
|
21-hydroxylase deficiency
|
|
|
what are the hormone levels found in 21-hydroxylase deficiency?
|
↓cortisol, ↓ mineralocorticoids, ↑sex hormones
|
|
|
which bilateral adrenal hyperplasia leads to hypotension and salt wasting?
|
21-hydroxylase deficiency
|
|
|
what are the hormone levels found in 11β-hydroxylase deficiency?
|
↓cortisol, ↓ aldosterone and corticosterone, ↑sex hormones
|
|
|
what are the 5 general functions of cortisol?
|
1. anti-inflammatory, 2. increases gluconeogenesis, lipolysis and proteolysis, 3. decreases immune function, 4. maintains BP, 5. decreases bone formation
|
|
|
how is cortisol carried in the blood?
|
bound to corticosteroid binding globulin (CBG)
|
|
|
where is PTH produced?
|
chief cells of the parathyroid
|
|
|
what are the 4 actions of PTH?
|
1. increase bone resorption of calcium and phosphate, 2. increase kidney reabsorption of calcium in distal convoluted tubule, 3. decrease kidney reabsorption of phosphate, 4. increase calcitriol production by stimulating kidney 1α-hydroxylase
|
|
|
what causes an increase in PTH?
|
low calcium levels
|
|
|
what causes a decrease in PTH?
|
low Mg levels (caused by diarrhea, aminoglycosdies, diuretics and alcohol abuse)
|
|
|
what cells are stimulated by PTH?
|
osteoclasts AND osteoblasts
|
|
|
what is the function of vitamin D?
|
1. increase absorption of dietary calcium, 2. increase absorption of dietary phosphate, 3. increase bone resopriton of calcium and phosphate
|
|
|
what diseases are caused by inadequate vitamin D?
|
rickets (kids) and asteomalacia (adults)
|
|
|
where is calcitonin produced?
|
parafollicular cells (C-cells) in the thyroid
|
|
|
what is the function of calcitonin?
|
decrease bone resorption of calcium
|
|
|
what causes calcitonin secretion?
|
increased calcium levels
|
|
|
what are the functions of TH?
|
1. bone growth, 2. CNS maturation, 3. increase beta1 receptors in the heart, 4. increase basal metabolic rate by increasing oxygen consumption, 5. increase glycogenolysis, gluconeogenesis and lipolysis
|
|
|
when do you seen a change in TBG levels?
|
decreased TBG in hepatic failure; increase TBG in pregnancy and high estrogen
|
|
|
what enzyme is responsible for oxidation and organification of iodide as well as coupling MIT and DIT?
|
peroxidase
|
|
|
which hormones use cAMP as a signaling molecule?
|
"FLAT CHAMP": FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH, Calcitonin and glucagon
|
|
|
which 3 hormones use cGMP as a signaling molecule?
|
ANP, EDRF, NO
|
|
|
Which 5 hormones use IP3 as a signaling molecule?
|
GnRH, GHRH, oxytoxin, ADH (V1 receptor), TRH
|
|
|
which hormones are a tyrosine kinase?
|
insulin, IGF-1, FGF, PDGF, prolactin and GH
|
|
|
what are the 4 etiologies of cushing syndrome
|
1. pituitary ademina (ACTH), 2. adrenal hyperplasia/neoplasia, 3. ectopic ACTH production, 4. iatrogenic = most common
|
|
|
finding: HTN, weight gain, moon face, truncal obesity, buffalo hump, hyperglycermia, skin changes, osteoporosis, amenorrhea, immune suppression
|
cushing syndrome
|
|
|
What is the cause of Cushing syndrome if the DEX test suppresses cortisol with a high dose?
|
ACTH producing pituitary tumor\
|
|
|
finding: HTN, hypokalemia, metabolic acidosis, LOW plasma renin
|
primary hyperaldosteronism (Conn syndrome)
|
|
|
what causes Conn syndrome?
|
primary hyperaldosteronism is caused by a aldosterone secreting tumor
|
|
|
what is the treatment of hyperaldosteronism?
|
spironolactone - a K sparing diuretic that works by acting as an aldosterone antagonist
|
|
|
finding: HTN, hypokalemia, metabolic acidosis and HIGH renin
|
secondary hyperaldosteronism
|
|
|
what causes secondary hyperaldosteronism?
|
renal artery stenosis, CRF, CHF, cirrhosis or nephrotic syndrome
|
|
|
finding: hypotension and skin hyperpigmentation
|
addison's disease - primary deficiency of aldosterone and cortisol due to adreanl atrophy or destruction
|
|
|
how can you distinguish primary adrenal insufficiency from primary?
|
primary - all three layers are affected = high ACTH and low aldosterone (hyperkalemia); secondary is due to decreased ACTH production - aldosterone levels are normal = no hyperpigmentation or hyperkalemia
|
|
|
acute adrencortical insufficiency due to adrenal hemorrhage associated with meningococcal septicemia
|
Waterhouse-Friderichesen syndrome
|
|
|
what is Waterhouse-Freiderichsen syndrome associated with?
|
meningococcal septicemia
|
|
|
postpartum hypopituitarism
|
Sheehan's syndrome
|
|
|
finding: fatigue, anorexia, poor lactation postpartum, loss of pubic and axillary hair
|
Sheehan's syndrome
|
|
|
what cells are pheochromocytomas derrived from?
|
chromaffin cells (neural crest)
|
|
|
what is the rule of 10s associated with pheochromocytoma
|
10% malignant, 10% bilateral, 10% extra-adrenal, 10% calcify, 10% kids, 10% familial
|
|
|
findings: episodic HTN, urinary VMA, elevated plasma catecholamine levels
|
pheochromocytoma
|
|
|
what diseases are associated with pheochromocytoma
|
NF, MEN type 2A and 2B
|
|
|
how do you treat pheochromocytoma
|
alpha antagonists - phenoxybenzamine, a nonselective irreversible alpha blocker
|
|
|
what are the 5 P's of pheochromocytoma?
|
Pressure (increased BP), Pain (headache), Perspiration, Palpitations, Pallor
|
|
|
what is found in the urine with neuroblastoma?
|
HVA (breakdown product of dopamine)
|
|
|
what gene is associated with neuroblastoma?
|
N-myc oncogene
|
|
|
What are the 3 Ps of MEN I?
|
pancreatic tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, Glucagonomas), Parathyroid tumors, Pituitary tumors (prolactin or GH)
|
|
|
how does MEN type I commonly present?
|
kidney stones and stomach ulcers
|
|
|
What are the 2 Ps of MEN 2A?
|
Pheochromocytoma, parathyroid tumors and medullary thyroid carcinomas (secrete calcitonin)
|
|
|
what is the 1P of MEN 2B?
|
pheochromocytoma, medullary thyroid carcinoma (secretes calcitonin) and oralintestinal ganglioneuromatosis (associated with marfanoid habitus)
|
|
|
what gene is associated with MEN 2A and 2B?
|
ret gene
|
|
|
how are all the MEN syndromes inherited?
|
addison's disease - primary deficiency of aldosterone and cortisol due to adreanl atrophy or destruction
|
|
|
what is the most sensitive test for hypothyroidsm?
|
TSH (increased)
|
|
|
findings: moderaly enlarged, nontender thyroid with lymphocytic infiltration with germinal centers
|
Hashimoto's thyroiditis
|
|
|
what antibodies are associated with Hashimoto's thyroiditis?
|
antimicrosomal and antithyroglobulin
|
|
|
What disease is associated with Hurthle cells
|
Hashimoto's thyroiditis
|
|
|
self-limiting hypothyrodism following a flu-like illness
|
subacute thyroiditis (de Quervain's)
|
|
|
findings: elevated ESR, jaw pain, very tender thyroid gland
|
subacute thyroiditis (de Quervain's)
|
|
|
what type of inflammation is present in subacute thyroiditis?
|
granulomatous inflammation
|
|
|
thyroid replaced by fibrous tissue
|
Riedel's thyroiditis
|
|
|
findings: fixed, hard, painless goiter
|
Riedel's thyroiditis
|
|
|
what type of HS is grave's disease?
|
type II HS
|
|
|
autoimmune hyperthyroidism with thyroid stimulating/TSH receptor Abs
|
Grave's disease
|
|
|
findings: opthalmopathy, peritibial myxedema, hyperthyroidism, with a diffuse goiter
|
Grave's disease
|
|
|
what is a serious complication of grave's disease
|
stress induced catecholamine surge leading to lethal arrhytmia
|
|
|
What is Jod-Basedow phenomenon?
|
thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
|
|
|
what is the most common thyroid cancer?
|
papillary carcionma
|
|
|
finding: thyroid carcinoma with ground glass "orphan Annie" nuclei, psammona bodies, nuclear grooves
|
papillary carcionma
|
|
|
what is a risk factor for papillary carcinoma of the thyroid?
|
childhood radiation
|
|
|
thyroid carcinoma that forms uniform follicles
|
follicular carcinoma - good prognosis
|
|
|
where do medullary thyroid carcinomas arise from?
|
C cells
|
|
|
what hormone do medullary thyroid carcinomas produce?
|
calcitonin
|
|
|
what is associated with medullary thyroid carcinomas?
|
MEN2A and 2B
|
|
|
which thyroid carcinoma is seen in older patients
|
undifferentiated/anaplastic
|
|
|
which thyroid carcinoma is associated with Hashimoto's thyroiditis?
|
lymphoma
|
|
|
finding: pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue and severe mental retardation
|
cretinism
|
|
|
excess GH in adults
|
acromegaly
|
|
|
findings: large tongue with deep furrows, deep voice, large hands and feet, coarse facial features, impaired glucose tolerance
|
acromegaly
|
|
|
excess GH in children
|
gigantism
|
|
|
how do you diagnose excess GH?
|
look at serum IGF-1; failure to suppress serum GH following oral glucose tolerance test
|
|
|
what usually causes primary hyperPTH?
|
an adenoma
|
|
|
findings: hypercalcemia, hypercalciuria, hypophosphatemia, high PTH, high alkaline phosphatase, high cAMP in urine
|
primary hyperPTH
|
|
|
what are the 3 characteristics of hyperPTH?
|
"stones, bones and groans"
|
|
|
cystic bone spaces filled with brown fibrous tissue
|
osteitis fibrosa cystica - caused by hyperPTH
|
|
|
what is renal osteodystrophy?
|
bone lesions due to secondary hyperPTH caused by renal disease
|
|
|
what causes secondary hyperparathyroidism
|
decreased gut Ca absorption and increased phophorus - most often in chronic renal disease
|
|
|
findings: hypocalcemia, hyperphosphatemia, incresaed alkline phosphatase, increased PTH
|
secondary hyperPTH
|
|
|
what causes hypoparathyroidism?
|
most often due to accidental surgical excision, autoimmune destruction or DiGeorge syndrome
|
|
|
findings: hypocalcemia, tetany
|
hypoparathyroidism
|
|
|
AD kidney that is unresponsive to PTH
|
pseudohypoparathyroidism
|
|
|
findings: hypocalcemia, shortened 4th/5th digits, short stature
|
pseudohypoparathyroidism
|
|
|
what is Chvostek's sign?
|
tapping of faical nerve causes contraction of facial muscle
|
|
|
What is Trousseau's sign?
|
occlusion of brachial artery with BP cuff causes carpal spasm
|
|
|
what disease has positive Chvostek and Trousseau's sign?
|
hypoparathyroidism
|
|
|
What are the 11 causes of hypercalcemia?
|
"CHIMPANZEES": Calcium ingestion, HyperPTH, Hyperthyroid, Iatrogenic (thiazides), Multiple myeloma, Paget's disease, Addison's disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D, Excess vitamin A, Sarcoidosis
|
|
|
what is the most common pituitary adenoma?
|
prolactinoma
|
|
|
findings: amenorrhea, glactorrhea, low libido, infertility
|
pituitary adenoma (prolactinoma)
|
|
|
how do you treat a prolactinoma?
|
bromocriptine or cabergoline (dopamine agonists)
|
|
|
findings: polydipsia, polyuria, weight loss, DKA, unopposed secretion of GH and epinephrine
|
DM- type 1 acute manifestation
|
|
|
what are the 2 effects of nonenzymatic glycosylation?
|
1. small vessel disease - retinopathy, glaucoma, nephropathy; and 2. large vessel atherosclerosis, CAD, peripheral vascular occlusive diseae and gangrene, cerebrovascular disease
|
|
|
what are the 2 effets of osmotic change due to DM?
|
1. neuropathy, 2. cataracts (sorbitol accumulation)
|
|
|
findings: Kussmaul respirations, N&V, abdominal pain, psychosis/delirium, dehydration, fruity breath odor
|
DKA
|
|
|
what are the 5 complications of DKA?
|
1. life-threatening mucormycosis, 2. Rhiopus infection, 3. cerebral edema, 4. cardiac arrhythmias, 5. heart failure
|
|
|
findings: intense thirst, poluria, an inability to concentrate urine
|
Diabetes insipidus
|
|
|
what can cause secondary diabetes insipidus?
|
hypercalcemia, lithium, demeclocycline
|
|
|
findings: urine specific gravity > 1.006, serum osmolality >290 mOsm/L
|
Diabetes insipidus
|
|
|
how do you treat central diabetes insipidus?
|
intranasal desmopressin (ADH analog)
|
|
|
how do you treat nephrogenic diabetes insipidus?
|
hydrochlorothiazide, indomethacin or amiloride
|
|
|
findings: excessive water rentention, hyponatremia, urine osmolarity>serum osmolarity
|
SIADH
|
|
|
what can happen with low sodium levels?
|
seizures - correct slowly
|
|
|
how do you treat SIADH?
|
demeclocycline or water restriction
|
|
|
what are the 4 causes of SIADH?
|
1. ectopic ADH (small cell lung cancer), 2. CNS disorder/head trauma, 3. pulmonary disease, 4. drugs - cyclophosphamide
|
|
|
what do carcinoid tumors secrete?
|
high levels of serotonin
|
|
|
when would you see a carcinoid syndrome wihtout high levels of serotonin?
|
if the tumor is limited to the GI tract due to first pass metabolism of 5HT
|
|
|
finding: diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease
|
carinoid syndrome
|
|
|
what is the most common tumor of the appendix?
|
carinoid tumors
|
|
|
what type of cells are carcinoid tumors derived from?
|
neuroendocrine cells of the GI tract
|
|
|
what is the rull of 1/3s for carcinoid syndrome?
|
1/3 metastasize, 1/3 present with 2nd malignancy, 1/3 are multiple
|
|
|
how do you treat carcinoid syndrome?
|
octreotide
|
|
|
gastrin secreting tumor of pancrease or duodenum
|
Zollinger-Ellison syndrome
|
|
|
what endocrine tumor would cause recurrent ulcers?
|
Zollinger-Ellison syndrome
|
|
|
what disease is associated with Zollinger-Ellison syndrome?
|
MEN type 1
|
