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70 Cards in this Set
- Front
- Back
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Neurohypophysis
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Posterior pituitary
made in hypothalamus, shipped to pituitary: vasopressin ADH oxytocin ADH & oxytocin have carrier proteins = neurophysins - act as shuttles to posterior pit from hypothal - if point mut's in neurophysins --> dec ADH avail for release --> Diab insipidus |
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Adenohypophysis
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Derived from oral ectoderm
FSH, LH, ACTH, TSH, prolactin, GH, melanotropin (MSH) Most common cell: somatrotropes (GH cells) Alpha subunit - TSH, LH, FSH, hCG Beta subunit - determines hormone specificity |
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Acidophils
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GH
Prolactin |
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Basophils
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BFLAT:
FSH LH ACTH TSH |
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Prolactin control
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DA (-)
TRH (+) |
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Somatostatin
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Dec GH, TSH
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GH actions
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Dec glucose uptake into cells
Inc lipolysis Inc protein synth in muscle Inc lean body mass Inc prod of IGF - prod by liver, increases linear growth of long bones |
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Neuroblastoma
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Better px if pt <1 year old
Bad if a lot of n-myc copies nonthymic conjugate eye movements assoc w/ myoclonus --> opsoclonus-myoclonus syndrome (paraneoplastic syndrome) |
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17 hydroxylase
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female phenotype
Fluid/Na+ retention HTN Inc. mineralcorticoids Dec sex hormones and corticosteroids |
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Desmolase
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Enzyme for:
cholesterol --> Pregnenolone (+) ACTH (-) Ketoconazole |
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Aldosterone synthase
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Corticosterone --> Aldosterone
(+) Angiotensin II |
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Aromatase
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Testosterone --> Estradiol
Aromatase def: - early embryonic life - high androgen, low estrogen - can affect PG female (virilization during PG due to transfer of excess androgens into maternal circ via placenta) - Female infants have ambiguous genitalia (pseudohermaphrodism) = 1* amenorrhea + tall stature (lack estrogen to fuse epiphyses) - Male infants --> tall stature, osteoporosis, no genital abnorm's |
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Cortisol
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Bound to CBG
Prolonged secretion induced by stress 1. Anti-inflamm (lipocortin prod, dec IL-2, inhib histamine and serotonin release) 2. Inc gluconeogen, lipolysis, proteolysis 3. Dec immune fxn 4. Maintains BP via augmenting vasoconstriction effects of catecholamines 5. Dec bone function |
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Causes of dec Mg2+
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1. PTH
2. diarrhea 3. aminoglycosides 4. diuretics 5. EtOH abuse |
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PTH renal tubular cell stimulation
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increases urinary cAMP
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Celiac Dz
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Causes VitD malabsorption --> rickets, osteomalacia
Dec Ca2+, PO4 absorption Inc PTH |
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Familial hypocalciuric hypercalcemia
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AD
Defective Ca2+sensing R on parathyroid cells - def receptor does not allow PTH to be appropriately suppressed by inc Ca2+ serum levels - hypercalcemia with high PTH levels Urinary Ca2+ excretion = key feature that differentiates familial dz from hyperparathyroidism |
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Cholecalciferol
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Vit D:
D3 = sun exposure D2 = ingested from plants Both converted to 25-OH VitD (liver) and to 1,25-(OH)2 VitD (kidney) |
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Parafollicular C cells of thyroid
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Produce calcitonin
Dec bone resorption of Ca2+ |
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SHBG
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Males: Inc SBHG = less free testosterone --> gynecomastia
Females: Dec SHBG = raises free testosterone --> hirsutism |
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rT3
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Reverse T3
T4 --> T3 T4 --> rT3 Exogenous T3 is NOT converted to T4 or rT3! |
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Antithyroid drugs
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1. Perchlorate, Pertechretate
- decrease thyroid I- uptake from blood via Na+ iodide symporter (NIS, loc in basolateral mem of thyroid follicular cell) - competitive inhibitors 2. Thionamides: Methimazole, Propylthiouracil (dec thyroid hormones by inhib thyroid peroxidase) - inhibits I- --> I* - Inhibits Iodide --> MIT/DIT - inhibits Iodides --> proteolysis 3. Beta-blockers (Ipodate) - inhib T4 --> T3 |
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Thyroid hormone
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Increases B1 receptors in heart
- inc CO, HR, SV, contractility Inc BMR via inc Na+/K+-ATPase activity = inc O2 consumption, RR, body temp except in brain, gonads, spleen Inc glycogenolysis, gluconeogen, lipolysis T3 functions: brain maturation, bone growth, beta-adrenergic effects, inc BMR |
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TSI
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like TSH stimulates receptor cells (Graves' Dz)
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TBG
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hepatic failure - dec TBG
PG (inc estrogen) - inc TBG |
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Peroxidase
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Responsible enzyme for oxid/organ of iodide and coupling MIT and DIT
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Thyroid follicular epithelial cell
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Tyrosine --> Thyroglobulin --> TG
(I-) --> Oxidation --> I2 TG + I2 = MIT/DIT COUPLING: 2 DIT --> 1 T4 DIT + MIT --> 1 T3 |
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cAMP
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FSH Calcitonin
LH Glucagon ACTH TSH CRH hCG ADH (V2) MSH PTH FLATCHAMP |
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cGMP
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ANP
EDRF NO |
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IP3
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GnRH
GHRH Oxytocin ADH (V1) TRH GGOAT |
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Steroid receptor
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Glucocorticoid
Estrogen Progesterone Testosterone Aldosterone VitD T3/T4 |
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Tyrosine Kinase
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Insulin
IGF-1 = somatomedin FGF PDGF Prolactin GH = somatotropin |
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ADH
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Act on G-protein coupled V2 receptors in kidney
Act on V1 receptors in BV walls --> Inc BP |
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Diabetes Insipidus
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1. Central DI - ADH defic
2. Nephrogenic DI - resist. to ADH in kidneys ** Identical sx's; dx via exog ADH ** |
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Kallmann's syndrome
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Failure of GnRH secreting neurons to migrate from their origin in CNS to hypothalamus
Central hypogonadism + anomsia (can't smell) |
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ADH
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Act on G-protein coupled V2 receptors in kidney
Act on V1 receptors in BV walls --> Inc BP |
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Diabetes Insipidus
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1. Central DI - ADH defic
2. Nephrogenic DI - resist. to ADH in kidneys ** Identical sx's; dx via exog ADH ** |
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Kallmann's syndrome
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Failure of GnRH secreting neurons to migrate from their origin in CNS to hypothalamus
Central hypogonadism + anomsia (can't smell) |
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Hyperaldosteronism
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1* = Conn's syndrome = low renin
- hypernatremia is rare b/c intravascular hypervolemia --> ANP release --> diuresis --> eventual Na+ loss (compensatory) --> no edema 2* = high renin (b/c kidney perception of low intravasc vol) differentiate by renin levels |
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Addison's Dz
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1* = skin hyperpigmentation, hyperkalemia, adrenal atrophy
2* = no skin hyperpigmentation |
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MEN I
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** all MEN = AD **
3P's: Parathyroid tumors Pituitary tumors Pancreatic endocrine tumors (ZE syndrome, insulinomas, VIPomas, glucagonomas) |
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MEN IIA
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2P's:
Pheochromocytoma Parathyroid Medullary thyroid carcinoma (secrete calcitonin) ret gene mut = germline mutation allows multiple endocrine organs to be affected b/c all share SAME ORIGIN (neural crest cells - 4 pharyngeal pouches + adrenal medulla) |
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MEN IIB
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1P:
Pheochromocytoma Medullary thyroid carcinoma Oral/intestinal ganglioneuromatosis (assoc w/ marfanoid habitus) ret gene |
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Hypothyroidism & CPK
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Atrophy of type II muscle fibers --> inc CPK
* Recall, CPK exists in 3 isoforms: MM = skel m MB = cardiac m BB = N.S. |
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Hashimoto's Thyroidits
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Lymphocytic infiltrate + germinal centers
Thyrotoxicosis possible during follicular rupture Moderately enlarged NONTENDER thyroid Hurthle cells Antimicrosomal + antithyroglobulin + antithyroid peroxidase antibodies |
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Subacute Thyroidits = De Quervain's
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Thyroid inflammation --> transient thyrotoxicosis (release of stored hormone)
Post-flu like illness Inc ESR, jaw pain, VERY TENDER gland Patchy granulomatous inflammation |
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Graves' Dz
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HLA-DR3 asoc
Type II HSR Stress-induced catecholamine surge --> death via arrhythmia (most serious complication) Columnar epithelium w/ papillary infoldings and SCALLOPING of colloid |
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Graves ophthalmopathy
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Inflammation --> fibrosis --> diplopia
- edema, infilt lymphocytes, macrophages into EOMs & CT - excess glycosaminoglycane prod --> inc retroorbital tissue |
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Toxic multinodular goiter
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Iodine deprivation followed by iodine restoration --> Rel of T3/T4
NON MALIGNANT NODULES |
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Jod-Basedow phenomenon
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Thyrotoxicosis if pt w/ iodine defic goiter becomes iodine replete
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Papillary CA
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RET mut
Most common, good px ground glass nuclei psamomma bodies inc risk w/ childhood irradiation may initially present as metastases in local lymph nodes |
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Follicular CA
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RAS mut
Good px uniform follicles |
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Medullary CA
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RET mutation - Assoc w/ MEN IIA/B
from parafollicular C-cells produces calcitonin sheets of cells Congo Red amyloid stain |
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Undiff/Anaplastic CA
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Older pts
Poor px |
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Lymphoma
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Hashimoto's thyroiditis assoc
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Acromegaly
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Dx:
Inc IGR-1 level Failure to suppress GH levels post oral glucose tolerance test Tx: pit adenoma resection, octreotide admin |
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Hyperparathyroidism
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1* = adenoma, hypercalcemia/calciuria (=renal stones), hypophosphatemia, inc PTH/ALP, inc cAMP in urine
- sx's : weakness, constipation, osteitis fibrosa cystica 2* = dec Ca2+ gut absorption, inc phosphorus, usu in CRF (renal osteodystrophy) |
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Hypoparathyroidism
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Chvostek's sign - tapping facial nerve --> facial muscle contraction
Trousseau's sign - occlusion of brachial a w/ BP cuff --> carpal spasm |
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Pseudohypoparathyroidism
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AD kidney unresponsiveness to PTH
Sx's: hypocalcemia, shortened 4th/5th digits, short stature |
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Craniopharyngioma
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3 components:
1. solid 2. cystic - machinery oil liquid 3. calcified |
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Pituitary apoplexy
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Most serious complication: develop CV collapse b/c of ACTH deficiency --> adrenocortical insufficiency
Tx: neurosurg + glucocorticoids |
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DM
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1. Dec glucose uptake
- hyperglycemia - glycosuria - osmotic diuresis - electrolyte depletion 2. Inc protein catabolism - inc plasma AA's - nitrogen loss in urine 3. Inc lipolysis - inc plasma FFAs - ketogenesis - ketonuria - ketonemia |
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DM Osmotic damage
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1. Neuropathy
- motor, sensory, autonomic degen 2. Cataracts - sorbitol accumulation |
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Diabetic ketoacidosis
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Type 1 DM complication
Inc stress (i.e. infection) --> Inc insulin req Excess fat breakdown --> inc FFAs --> Inc ketogenesis --> inc ketone bodies (Bhydroxybutyrate > acetoacetate) Sx's: KUSSMAUL BREATHING! leukocytosis , hyperkalemia |
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Diabetes insipidus
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Central DI - intranasal desmopressin
Nephrogenic DI - HCTZ, indomethacin, amiloride |
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SIADH
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Drugs that can cause it: cyclophosphamide
tx (in general, not just for drug-induced): demecylocycline or H20 restriction |
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Carcinoid syndrome
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degree of endocardial fibrosis correlates w/ plasma levels of serotonin + urinary excretion of serotonin metabolite, 5-H1AA
- fibrosis ltd to Rheart b/c serotonin & bradykinin inactiv by distally loc. pulm vascular endothelial/monoamine oxidase - ultimately cause pulm stenosis and restrictive cardiomyopathy |
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Stalk section effect
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Loss of hypothalamic-inhibitition
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Effects of Corticosteroids on CBC
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Inc neutrophils
Dec eosinophils, basophils (via prev histamine release) Dec lymphocytes (T cells dec > B cell dec) - via redistributing of lymphocytes from intravasc to spleen/lymph nodes/BM; inhib of Ig synth & stim. of lymphocyte apoptosis - dec monocyte --> macrophage (thus dec rate of Ag presentation to T lymphocytes) |
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Corticosteroid metabolic effects
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Catabolic
Inc liver protein synth (incl enzymes for glycogen synth and gluconeogenesis) --> hyperglycemia inhibit fibroblast prolif & collagen formation in skin |
