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194 Cards in this Set
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3 layers of the adrenal cortex and what hormones they secrete
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zona glomerulosa (outer): secretes mineralcorticoids (aldosterone)
zona fascicularis: secretes glucocorticoids (cortisol) zona reticularis (inner): secretes androgens |
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what type of fibers synapse directly on the adrenals
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preganglionic sympathetic fibers
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what does the adrenal medulla secrete
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catecholamines
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where do the L and R adrenal veins drain to
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L adrenal vein -> L renal vein -> IVC
R adrenal vein -> IVC |
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where are the anterior and posterior pituitary glands derived from
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anterior pituitary gland: derived from Rathke's pouch (oral ectoderm)
posterior pituitary gland: derived from the neuroectoderm |
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hormones secreted by the anterior and posterior pituitary glands
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anterior pituitary gland: secretes FSH, LH, ACTH, TSH, prolactin, and GH
posterior pituitary gland: secretes oxytocin and ADH |
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what are the different cells of the endocrine pancreas and what hormones do they secrete
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alpha cells: glucagon
beta cells: insulin delta cells: somatostatin |
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effects of insulin
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increased glucose transport
increased glycogen synthesis/storage increased triglyceride synthesis/storage increased Na+ retention in the kidney increased protein synthesis uptake of potassium into the cells causing hypokalemia |
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what is factitious hypoglycemia
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self-induced hypoglycemia by taking purposely taking too much insulin
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which parts of the body do NOT require insulin for glucose uptake
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brain, RBCs, intestine, cornea, kidney, liver
("BRICK L") |
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what glucose transporters are in the kidney
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GLUT-2
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what glucose transporters are in the adipose tissue and skeletal muscle
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GLUT-4
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what glucose transporters are in the brain
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GLUT-1
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what ion channels regulate insulin release
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closing K+ channels causes insulin release
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effects of TRH
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causes release of both TSH and prolactin
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effects of dopamine on the pituitary gland
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inhibits prolactin
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effect of CRH
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causes release of ACTH
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effects of prolactin on hypothalamus
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inhibits GnRH
(*hence why some people believe breastfeeding to be a form of birth control) |
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effects of somatostatin on the pituitary gland
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inhibits both GH and TSH
(*note that it also inhibits insulin and glucagon as well) |
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effects of GnRH
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causes release of FSH and LH
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which pituitary hormones cause an increase in glucose levels
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GH, ACTH, and TSH
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DOC for prolactinoma
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bromocriptine (dopamine agonist)
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what enzyme does ACTH upregulate to increase cortisol production
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desmolase
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what drug blocks the enzyme desmolase thus preventing the synthesis of adrenal hormones
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ketoconazole
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lab findings in 17-alpha hydroxylase deficiency
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decreased sex hormones
decreased cortisol increased aldosterone |
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lab findings in 11-beta hydroxylase deficiency
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increased sex hormones
decreased cortisol decreased aldosterone |
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lab findings in 21-alpha hydroxylase deficiency
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increased sex hormones
decreased cortisol decreased aldosterone |
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only symptom to clinically differentiate 11-beta hydroxylase deficiency from 21-alpha hydroxylase deficiency
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21-alpha hydroxylase deficiency will have HYPOtension and salt wasting (no aldosterone)
11-beta hydroxylase deficiency will have HYPERtension (there is no aldosterone but there is an excess of 11-deoxycorticosterone which has the same physiologic effects as aldosterone, thus will be NO salt wasting either) |
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enzyme that converts testosterone into DHT
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5-alpha reductase
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enzyme that converts testosterone into estradiol
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aromatase
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initial precursor for all adrenal cortex hormones
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cholesterol
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where is DHT made
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prostate
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what disease is caused by deficiencies in the various hydroxylase enzymes in the adrenal cortex
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congenital adrenal hyperplasia (CAH)
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when are cortisol levels highest and lowest
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cortisol levels are highest in the morning and lowest at night
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systemic effects of cortisol
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maintains BP (activates alpha-1 receptors on arterioles)
decreases bone formation anti-inflammatory decrease immune function increase gluconeogenesis (increase risk for type II diabetes) increase lipolysis increase proteolysis (catabolism) (*note that in most regards, cortisol is the counter regulatory hormone of insulin*) |
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what cells secrete PTH
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chief cells of the parathyroid gland
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systemic effects of PTH
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increase bone resorption of calcium and phosphate
increase kidney reabsorption of calcium in the DCT decrease kidney reabsorption of phosphate in the PCT activate 1-alpha hydroxylase to increase calcitriol (vitamin D) formation in the kidney |
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which form of vitamin D is formed from sun exposure
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D3
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25-OH vit D is in what organ
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liver
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1,25-(OH)2 vit D is in what organ
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kidney
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what cells secrete calcitonin
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parafollicular cells (aka C cells) of the thyroid gland
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function of calcitonin
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decrease serum calcium levels
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enzyme responsible for oxidation and organification of iodide as well as coupling MIT and DIT
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peroxidase
(PTU and methimazole block this process) |
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what happens to TBG during pregnancy
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TBG increases during pregnancy because estrogen increases TBG
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3 main causes of Cushing's
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pituitary adenoma (most common)
ectopic ACTH (eg. small cell lung cancer) adrenoma |
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symptoms of Cushing's
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HTN, weight gain, moon face, truncal obesity, buffalo hump, hyperglycemia (secondary to insulin resistance), purple striae, osteoporosis, amenorrhea, and immune suppression
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diagnostic test for Cushing's
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dexamethasone suppression test
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how will the dexamethasone suppression test affect cortisol in the various causes of Cushing's
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Pituitary adenoma: cortisol will increase after a low dose, but decrease after high dose
Ectopic ACTH: increase cortisol after low and high dose Adrenoma: increased cortisol after low and high dose normal person: decreased cortisol after any dose (*To summarize, giving low-dose dexa only determines whether or not the person is healthy or has some form of Cushing's... giving high-dose dexa is used to differentiate different types of Cushing's... giving ACTH is to differentiate between an adrenoma or ectopic cause of Cushing's*) |
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DOC for Conn syndrome
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spironolactone
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lab value to differentiate between primary and secondary aldosteronism
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primary aldosteronism (Conn syndrome): renin will be decreased
secondary aldosteronism: renin will be increased |
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why do people with Addison's disease have hyperpigmentation
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increased ACTH production seen in Addison's disease increases MSH
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lab value to differentiate primary Addison's disease from secondary Addison's disease
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primary Addison's disease: increased ACTH
secondary Addison's disease: decreased ACTH |
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pheochromocytomas are derived from what specific cells
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chromaffin cells from the neural crest
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DOC for pheochromocytoma
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phenoxybenzamine
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what's elevated in the urine in someone with a pheochromocytoma
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VMA and metanephrine
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what diseases are pheochromocytomas associated with
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neurofibromatosis and MEN2A and 2B
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MOST common adrenal tumor in children
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neuroblastoma
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what's elevated in the urine in someone with a neuroblastoma
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HVA
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oncogene associated with neuroblastoma
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N-myc
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difference in the myxedema seen in hypo versus hyperthyroidism
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hypothyroidism: myxedema is facial and periorbital
hyperthyroidism: myexedema is pretibial |
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antimicrosomal and antithyroglobulin antibodies
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Hashimoto's thyroiditis
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MOST common cause of hypothyroidism
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Hashimoto's thyroiditis
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morphologic cells seen in Hashimoto's thyroiditis
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Hurthle cells
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what is cretinism
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congenital hypothyroidism (secondary to lack of dietary iodine in mother or defect in T4)
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self-limited hypothyroidism following flu-like illness
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Subacute de Quervain's thyroiditis
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thyroid becomes replaced by fibrous tissue causing hypothyroidism
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Riedel's thyroiditis
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antibodies against TSH receptor
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Graves disease
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patient presents with proptosis, pretibial myxedema, and recent weight loss despite increased appetite
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Hyperthyroidism (Graves disease)
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serious complication of Graves disease in which a stress-induced catecholamine surge leads to death by arrhythmia
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thyrotoxicosis
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Thyroid cancer characterized by "ground-glass" nuclei (aka Orphan Annie nuclei) and psammoma bodies
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papillary carcinoma
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thyroid cancer originating from the parafollicular C cells (thus they secrete calcitonin)
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medullary thyroid carcinoma
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2 PE findings in someone with hypoparathyroidism
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Chvostek's sign (tapping of facial nerve causes contraction of facial muscles)
Trousseau's sign (occlusion of brachial artery with BP cuff causes a carpal spasm) |
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child presents for a physical and it's noted that he has shortended 4th/5th digits; he is in the 10th percentile for height and the 80th percentile for weight; lab values reveal low calcium
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Pseudohypoparathyroidism (aka Albright's hereditary osteodystrophy)
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MOST common cause of hypoparathyroidism
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accidental surgical excision during thyroid surgery
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female presents with amenorrhea and a low sex drive; PMH is remarkable for galatorrhea and difficulty getting pregnant with her husband for the last year
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pituitary adenoma
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conditions characterized by increased GH in adults versus children
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in adults, it causes acromegaly
in children, it causes gigantism |
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DOC for acromegaly
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octreotide
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patient presents with trouble swallowing; PE reveals a large tongue, deep voice, large hands and feet, and coarse facial features- he has noticed these progressive changes over the last year; last year he was diagnosed with type II diabetes; what's the underlying condition??
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acromegaly
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how do you distinguish between central versus nephrogenic diabetes insipidus
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desmopressin (no response in nephrogenic)
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DOC for nephrogenic diabetes insipidus
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hydrochlorothiazide or indomethacin
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drugs that can cause nephrogenic diabetes insipidus
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lithium or demeclocycline
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DOC for SIADH
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demeclocycline
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cancer drugs that can cause SIADH
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cyclophosphamide and vincristine/vinblastine
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child presents with persistent weight loss in past months even with an increased appetite; PMH is remarkable for polydipsia and polyuria
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type I diabetes
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why does someone in diabetic ketoacidosis have fruity breath
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increased ketone formation- specifically acetone, which is excreted by the body by breathing it out
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what are the nodules in the kidney of someone with diabetic nephropathy called
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Kimmelstiel-Wilson nodules
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what causes cataracts in someone with diabetic retinopathy
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sorbitol accumulation (eye lacks sorbitol dehydrogenase)
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test to assess long-term regulation of glucose levels in a diabetic
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HbA1c -> goal is to be less than 7 in diabetics (less than 4 in non-diabetics)
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what antibodies are found in type I diabetes
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antibodies are found against glutamic acid decarboxylase
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which diabetes is associated with children
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type 1
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which diabetes is associated with obesity
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type II
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which diabetes is associated with a stronger genetic predisposition
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type II
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which diabetes is associated with HLA-DR3 and DR4
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type I
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which diabetes is associated with ketoacidosis
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type I
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which diabetes is associated with amyloid deposits
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type II
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what hypersensitivity is diabetes
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type IV hypersensitivity
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ratio of B-hydroxybutyrate to acetoacetate in ketoacidosis
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20:1
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what is the acid/base dysfunction found in ketoacidosis
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increased anion gap metabolic acidosis
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infection linked to diabetic ketoacidosis
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Mucor and Rhizopus species
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MOST common tumor of the appendix
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carcinoid tumor
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what's found in the urine in someone with Carcinoid syndrome
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5-HIAA
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DOC for carcinoid syndrome
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octreotide
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2 MOST common locations for a gastrinoma seen in Zollinger-Ellison syndrome
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pancreas and duodenum
(*NOT the stomach) |
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conditions linked to MEN1 (Wermer's syndrome)
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parathyroid tumors
pituitary tumors pancreatic tumors (including Zollinger-Ellison, insulinomas, VIPomas, and glucagonomas) |
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conditions linked to MEN2A (Sipple's syndrome)
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parathyroid tumors
pheochromocytomas medullary thyroid carcinoma |
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conditions linked to MEN2B
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pheochromocytomas
medullary thyroid carcinoma ganglioneuromatosis |
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gene mutation causing MEN2A and 2B
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ret gene
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mode of inheritance of all MEN syndromes
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autosomal dominant
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what are the rapid-acting insulins
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Lispro (Humalog), Aspart, Regular insulin, crystalline zinc (Humulin R)
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what are the intermediate-acting insulins
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NPH and Lente
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what are the long-acting insulins
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Glargine (Lantus), Determir, and Ultralente (Humulin U)
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what is NPL
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NPH plus Lispro
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MOA of sulfonylureas
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closes K+ channels which increases calcium influx causing insulin release
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sufonylureas are contraindicated in patients with what dysfunction
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contraindicated in hepatic dysfunction
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commonly used sulfonylureas
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1st generation: Tolbutamide and Chlorpropamide
2nd generation: Glyburide, Glipizide, and Glimepiride |
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physiologic effects of metformin
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decrease gluconeogenesis
increase glycolysis increase peripheral uptake of glucose |
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metformin is contraindicated in patients with what dysfunctions
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contraindicated in renal/cardiac dysfunction
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serious SE of metformin
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lactic acidosis
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MOA of thiazolidinediones
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binds to PPAR-y which increases insulin sensitivity in peripheral tissues
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thiazolidinediones are contraindicated in patients with what dysfunctions
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contraindicated in liver/cardiac dysfunction
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common alpha-glucosidase inhibitors
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acarbose and miglitol
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this drug inhibits the organification of iodide and the coupling of thyroid hormone synthesis and can treat various causes of hyperthyroidism
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propylthiouracil (PTU) and methimazole
(*note that these are slow, long-term acting drugs... for a more acute response, DOC is propanolol) |
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lab values of cortisol, aldosterone, androgens are all decreased; DHEA is increased; whats the enzyme deficiency
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3B-hydroxysteroid dehydrogenase deficiency
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MOA of methimazole
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prevents addition of iodine to tyrosine (prevents organification)
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metabolite that exerts the physiologic effects of GH
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IGF-1 (aka somatomedin C)
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when is GH secreted the most in children
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during deep sleep (stages 3,4)
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function of prolactin
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stimulates synthesis and secretion of breast milk
(*note that oxytocin triggers milk letdown) |
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site of action of ADH
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collecting tubules of the nephrons
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oxytocin causes contraction of which cells in the breast
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myoepithelial cells
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the pituitary gland sits in what bony landmark and what covers it
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pituitary gland sits in the sella turcica (sphenoid bone) and is covered by the diaphragma sella
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morphologic feature that distinguishes a pituitary adenoma from normal pituitary tissue
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adenomas have a reticulin network of cells
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which pituitary hormones use cAMP in their signaling pathway
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FSH, LH, ACTH, TSH
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which pituitary hormones use JAK/STAT in their signaling pathway
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prolactin and GH
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which pituitary hormones use IP3 in their signaling pathway
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ADH and oxytocin
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postpartum necrosis of the pituitary
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Sheehan syndrome
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DOC for Sheehan syndrome
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hydrocortisone
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why must extreme care be taken when correcting the hyponatremia caused by SIADH
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rapid correction of hyponatremia can cause central pontine myelinosis
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characterized by focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation in the TSH receptors
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toxic multinodular goiter
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HLA allele associated with Hashimoto's
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HLA-DR5
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HLA allele associated with Graves disease
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HLA-B8
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which form of hypothryoidism is extremely painful
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Subacute de Quervain's thyroiditis
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genetic disease characterized by hypothyroidism and sensorineural deafness
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pendred syndrome
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MOST common congenital anomaly of the thyroid gland
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thyroglossal duct
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clinical triad of diabetes
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polyphagia (with weight loss)
polydipsia polyuria |
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glucose levels needed to diagnose someone with diabetes
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fasting glucose > 126
or any random glucose (fasting or non-fasting) > 200 |
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major difference between endogenous and synthetic insulin
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synthetic insulin has no C-peptide
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features of diabetic retinopathy
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neovascularization
retinal detachment flame hemorrhage microaneurysms exudates |
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initial symptom of diabetic nephropathy
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microalbuminuria
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characteristic pattern of peripheral neuropathy seen in diabetes
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"glove-in-stocking" pattern
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special respiration pattern in someone with DKA
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Kussmaul respiration
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time frame in which someone taking corticosteroids MUST taper the dosage to prevent possible Cushing's syndrome
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5-7 days
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acid/base abnormality seen in hyperaldosteronism
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metabolic alkalosis
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enzyme deficiency in CAH that most commonly causes FEMALE pseudohermaphroditism
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21-alpha hydroxylase deficiency
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enzyme deficiency in CAH that most commonly causes MALE pseudohermaphroditism
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17-alpha hydroxylase deficiency
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enzyme deficiency in CAH that most commonly causes sexual infantilism in females
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17-alpha hydroxylase deficiency
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sudde, acute adrenal hemorrhage coupled with N. meningitidis infection
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Watrehouse-Friderichsen syndrome
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disease characterized by chronic adrenocortical insufficiency
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Addison disease
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MSH is formed DIRECTLY from what intermediate
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POMC
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main hormone secreted by the pineal gland and its function
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secretes melatonin which regulates circadian rhythm and sleep
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pineoblastomas are linked to what gene mutation
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RB gene mutation
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cause of tetany
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hypocalcemia
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PTH binds to which ligand to activate osteoblasts
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RANK
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first-line recommended treatment for hypoparathyroidism
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vitamin D injections
(NOT PTH because vitamin D will last a lot longer than PTH and have similar effects) |
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why can children who are not exposed to much sunlight develop rickets
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they will not absorb much calcium from the GI tract because they will have low Vit. D levels secondary to the lack of sunlight
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lab values in euthyroid
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increased thyroid hormone
normal TSH |
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which hormone is anabolic at physiologic concentrations but is catabolic at very high levels
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thyroid hormone (T4)
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how do sympathetics affect insulin and glucagon
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sympathetics increase glucagon and decrease insulin
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what's the thyroid's effect on cholesterol levels
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hypothyroidism increases serum cholesterol
hyperthyroidism decreases serum cholesterol |
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which endocrine hormone utilizes nuclear steroid receptors in its signaling pathway
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thyroid hormone
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this substance provides a negative feedback mechanism on GH
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somatomedins
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which hypothalamic hormones utilize cAMP in their signaling pathway
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CRH, GHRH, MSH
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which hypothalamic hormones utilize IP3 in their signaling pathway
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GnRH and TRH
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what do ANP and NO use for their signaling pathway
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cGMP
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what do insulin and IGF-1 use for their signaling pathway
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MAP kinase
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"insulitis" is associated with which type of diabetes
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type 1
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cause of mature onset diabetes in the young (MODY)
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caused by mutations in either hepatocyte or pancreatic nuclear factors, as well as mutations in glucokinase
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autoimmune condition sometimes associated with Addison's disease
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Hashimoto's thyroiditis
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genetic mutations (2) linked to parathyroid adenomas
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MEN1 and cyclin D gene mutations
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does Sheehan syndrome almost always affect the anterior or posterior pituitary gland
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usually affects the anterior pituitary only
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SE of corticosteroids
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adrenal suppression
growth inhibition muscle wasting (protein catabolism) osteoporosis salt retention glucose intolerance (repeated gluconeogenesis causes decreased sensitivity to insulin) behavioral symptoms fat deposition immune inhibition (with increased neutrophils but decreases in all other WBCs) |
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glucocorticoid given to promote fetal lung development in premature births
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betamethasone
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glucocorticoid that can help treat asthma
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beclamethasone
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MOA of mifepristone (RU486)
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glucocorticoid antagonist
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main clinical use of mifepristone
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medical abortion
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MOA of fludrocortisone and what's its main clinical use
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mineralcorticoid agonist used in Addison's disease
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aldosterone precursor that exerts the same same functional effects as aldosterone
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Deoxycorticosterone
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3 major precursors for gluconeogenesis
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lactate, glycerol, alanine
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irreversible enzyme unique to glycolysis
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glucokinase, PFK-1, pyruvate kinase, and pyruvate dehydrogenase
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irreversible enzymes unique to gluconeogenesis
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glucose-6-phosphatase, fructose bis-phosphatase, PEP carboxykinase, and pyruvate carboxylase
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why does alcohol cause hypoglycemia
|
Alcohol increases NADH which inhibits the conversion of malate to oxaloacetate in the cytosol- therefore, the carbons from OAA can’t be converted into glucose causing hypoglycemia
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heart defect most commonly associated with carcinoid syndrome
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tricuspid regurgitation
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patient presents complaining of color blindness; labs reveal a decreased sperm count; it's also noted that his puberty is delayed; he is diagnosed with a deficiency in GnRH
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Kallman syndrome
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What causes K+ channels to close in the beta cells of the endocrine pancreas
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high ATP/ADH ratio
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radioactive iodine therapy is usually combined with what
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potassium perchlorate
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