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74 Cards in this Set
- Front
- Back
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Pituitary gland
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Post: neurohypophysis; from neuroectoderm
*ADH & oxytocin; made in hypothalamus Ant: adenohypophysis, from oral ectoderm (Rathke's pouch) FLATPG (+MSH) |
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Alpha subunit
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common subunit in:
FSH LH TSH hCG *beta subunit determines hormone specificity |
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POMC
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ACTH
MSH beta-endorphin lipotropins |
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Basophils
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B-FLAT:
FSH LH ACTH TSH ** use cAMP |
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Acidophils
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PRL
GH **use receptor-associated tyrosine kinase messenger (JAK/STAT) |
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Endocrine pancreas cell types
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alpha: glucagon (peripheral)
beta: insulin (INSide) delta: somatostatin (interspersed) *most numerous in tail of pancreas |
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Don't need insulin for glucose uptake
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L BRICK
Liver Brain RBCs Intestine Cornea Kidney |
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GLUT-1
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RBCs
Brain |
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GLUT-2
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Bidirectional
beta-islet cells liver kidney small intestine |
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GLUT-4
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insulin responsive:
adipose tissue skeletal muscle |
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Anabolic effects of insulin
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increase:
1. glucose transport 2. glycogen synthesis/storage 3. TG synthesis/storage 4. Na retention (kidney) 5. Protein synthesis (muscles) 6. uptake of K+ and AA |
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Glucose in beta-cell
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Glucokinase: rate-limiting glucose sensor
*leads to increase in ATP *defects lead to mild hyperglycemia ATP --> closes K-channel Depolarization --> opens Ca+ channel influx Ca2+ --> exocytosis of insulin |
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Insulin second messenger
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Acts via TK mechanism
**activates protein phosphatase to inhibit glycogenolysis and stimulate glycogen synthesis |
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Diazoxide
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keeps K+ open to prevent insulin release
tx insulinoma |
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Prolactin
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Stimulated by: TRH
Inhibited by: DA (and indirectly by PRL, which increases DA) Causes: milk production in breast inhibits ovulation and spermatogenesis (inhibits GnRH) |
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17-alpha hydroxylase def
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Increased MC, no cortisol, no sex hormones
Sx: 1. HTN, hypokalemia 2. males: Pseudohermaphroditism (phenotypic female without internal structures) females: sexual infantilism (no secondary sex characteristics) |
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21-hydroxylase def
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Most common form
decreased aldo, decreased cortisol, increased sex hormones 1. HYPOtension, hyperK 2. Masculinization |
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11-beta hydroxylase def
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Increased mineralocorticoids (in the form of 11-deoxycorticosterone), decreased cortisol, increased sex hormones
1. HTN, hypoK 2. Masculinization |
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Cortisol
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bound to corticosteroid-binding globulin (CBG
BBIIG 1. Blood pressure (permissive effect with EPI & NE on vasc and bronchial s.m.; upregulates alpha1 receptors on arterioles) 2. decrease BONE formation 3. anti-Inflammatory 4. decrease Immune function (1st week, WBCs go up) 5. increase Gluconeogenesis, lipolysis, proteolysis |
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PTH
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chief cells of parathyroid
Phosphate Trashing Hormone 1. increase bone resorption of Ca and Phos 2. Increase kidney reabsorption of Ca 3. Decrease kidney reabsorption of Phos 4. Increase activated vitD production by stimulating kidney 1alpha-hydroxylase *increase production of M-CSF and RANK-L in osteoblasts stimulating osteoclasts *decrease in Mg causes decrease in PTH secretion |
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Vit D
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1. increase absorption of Ca and Phos in gut
2. Increase bone resorption of Ca and Phos macrophages can generate 1alpha hydroxylase (which activates vit D in kidney) --> can see in sarcoid |
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Calcitonin
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Parafollicular C cells of thyroid
*neural crest origin 1. decrease bone resorption of calcium not important in nl calcium homeostasis *medullary thyroid carcinoma |
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cAMP signaling
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cAmp --> Ant pit hormones:
FLAT CHAMP (champ for cAMP) GGC FSH LH ACTH TSH CRH hCG ADH (V2) MSH PTH GHRH glucagon calcitonin |
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cGMP
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Vasodilators:
ANP NO (EDRF) |
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IP3
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Posterior Pit for iP3
GOAT: GnRH Oxytocin ADH (V1) TRH |
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Steroid receptor: cytosolic
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all adrenal hormones + vit D
Vit D Estrogen Testosterone Cortisol Aldosterone Progesterone steroid hormones are lipophilic; so circulate bound to binding globulins (i.e. SHBG) |
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Steroid receptor: nuclear
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nuclear thyroid bomb!
T3/T4 |
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Intrinsic tyrosine kinase
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MAP kinase pathway
Growth factors: Insulin IGF-1 GFG PDGF receptor autophosphorylates and triggers phosphorylation of Ras protein *need GTP |
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Receptor-associated tyrosine kinase
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JAK/STAT pathway:
ant pit acidophils: PRL GH also cytokine IL-2 receptor activates Janus Kinases, which phosphorylates STATS (signal transducers and activators of transcription) |
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Thyroid hormones
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made in thyroid follicles; most T3 made in blood
4B's: 1. Bone growth (synergism with GH) 2. Brain maturation 3. B1 receptors in heart 4. BMR (via increased Na/K-ATPase activity --> increased O2 consumption, body temp 5. Increase glycogenolysis, GNG, lipolysis T3: more potent; converted peripherally from T4 T4: longer t1/2 |
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Thyroxine-binding globulin
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binds most T3/T4 in blood
*only free hormone is active less TBG in liver failure more TBG in pregnancy or OCP (estrogen increased TBG) |
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Peroxidase
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oxidation and organification of iodide and coupling of MIT and DIT
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Cushing's
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1. exogenous steroids (#1 cause)
2. Cushing's disease: ACTH from pit adenoma 3. Ectopic ACTH: small cell lung ca 4. Adrenal cortisol (adenoma, CA) Dx: dexamethasone suppression test pituitary ACTH suppressible with high dose (ectopic and cortisol-producing tumor not) |
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Addison's
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Adrenal insufficiency:
1. Primary: atrophy- TB, mets, autoimmune 2. secondary: decreased pituitary ACTH; no skin hyperpigmentation and no hyperK (still have aldo production regulated by RENIN) 3. Tertiary: abrupt withdrawal of corticosteroids (hypothal stops making CRH) -nl Aldo and K -hypoNa from increased ADH |
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Pheochromocytoma
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from chromaffin cells of adrenal medulla
**NEURAL CREST assoc with MEN2a and 2b; neurofibromatosis Tx: phenoxybenzamine (alpha blocker) surgery P's: Pressure Pain (HA) Perspiration Palpitations Pallor Panic attacks Polycythemia (increased EPO) Dx: VMA and urine metanephrines |
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Neuroblastoma
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Homo(vanillic acid) Homer caused the Bomb(esin) to blast!
MC adrenal medulla tumor in children -anywhere along sympathetic chain Dx: HVA in urine (DA breakdown product) no HTN *assoc with N-myc oncogene, assoc with rapid tumor progression *Homer-wright pseudorosettes -radial arrangement of tumor cells around a central tangle of fibrils *tumor marker: Bombesin with neurofilament stain |
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Hashimoto's
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MCC hypothyroidism
antimicrosomal anti-TGB anti-peroxidase HLA-DR5 may be hyperthyroid early in course (during follicular rupture) *Hurthle cells: enlarged epithelial cells with eosinophilic granular cytoplasm *lymphocytic infiltrate --> increased risk for thyroid lymphoma |
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Cretinism
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fetal hypothyroidism
-pot-bellied, pale, puffy-faced, protruding umbilicus and tongue, short, MR |
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Subacute thyroiditis (de Quervain's)
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self-limited hypothyroidism often following flulike illness
*granulomatous inflammation *increased ESR, jaw pain, very tender *may be hyperthyroid early in course |
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Riedel's thyroidits
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Thyroid replaced by fibrous tissue --> hypothyroid or euthyroid
fixed, rock hard, painless goiter |
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Graves
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autoimmune hyperthyroidism
*anti-TSH receptor *anti-TSI *type II hypersensitivity specific to graves: pretibial myxedema, diffuse goiter ophthalmopathy: proptosis, EOM swelling (infiltration of WBCs and macs, retroorbital fibroblasts) *infiltrative accum of glycosaminoglycans in dermis (of tibia, eyes) Tx: high dose steroids |
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Thyrotoxicosis
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thyroid storm
stress-induced catecholamine surge --> death by arrhythmia *serious complication of Graves' and other hyperthyroid disorders Tx: propanolol |
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Toxic multinodular goiter
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focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation of TSH receptor
-increase T3 and T4 release **hot nodules rarely malignant |
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Jod-Basedow phenomenon
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thyrotixicosis in a patient with iodine deficiency goiter is made iodine replete
(i.e. patient that receives radiocontrast dye with iodine) |
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Papillary CA
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MC, good prognosis
ground-glass nuclei: orphan annie psammoma bodies: calcified bodies nuclear grooves increase risk with childhood irradiation mutations: **assoc with activation of receptor TK (also medullary) **Ret oncogene or NTRK1 **BRAF gene (Ser/Thr kinase) Variant: follicular hyperplasia with tall cells; more invasive, older ppl |
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Follicular CA
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good prognosis
uniform follicles can be assoc with Ras mutation iodine def areas |
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Medullary CA
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from parafollicular C cells
produces calcitonin sheets of polygonal or spindle-shaped cells with extracell AMYLOID deposits (stains with Congo red) *assoc with MEN2a and 2b; but usually sporadic |
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Anaplastic CA
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older patients, poor prognosis
*large pleomorphic giant cells |
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Primary Hyperparathyroidism
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adenoma
*hypercalcemia, stones, hypophos Labs: increase PTH, Alk phos; decrease cAMP in urine stones, bones, groans, psychic moans CXR: subperiosteal thinning with cystic degneration; erosion; granular "salt & pepper" calvarium |
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Osteitis fibrosa cystica
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cystic bone spaces filled with brown fibrous tissue (bone pain)
can be caused by hyperparathyroidism |
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Secondary hyperparathyroidism
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hyperplasia due to decreased Ca absorption and increased phosphorus
**due to chronic renal disease (which leads to low vitD) Decreased Ca, increased Phos, increased alk phos, increased PTH |
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Renal osteodystrophy
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bone lesions due to secondary or tertiary hyperparathyroidism due in turn to renal disease
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Tertiary hyperparathyroidism
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refractory hyperparathyroidism (autonomous) resulting from chronic renal disease
**elevated PTH and Ca |
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Hypoparathyroidism
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usually due to accidental surgical excision, autoimmune, DiGeorge
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Chvostek's sign
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CH for CHEEK
tap facial nerve --> contraction of facial muscles when Ca <7.0 |
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Trousseau's sign
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T for Tighten the cuff
occlusion of brachial artery with BP cuff --> carpal spasm |
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Pseudohypoparathyroidism
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Albright's hereditary osteodystrophy
auto dom kidney unresponsiveness to PTH get hypoCa, shortened 4th and 5th digits, short stature |
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Acromegaly
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excess GH in adults
impaired glucose tolerance *gigantism in children dx: increased serum IGF-1; failure to supress GH after glucose tolerance test tx: resection, then octreotide |
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NDI
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1. hereditary
2. hyperCa 3. Lithium 4. Demeclocycline (ADH antagonist) *water deprivation test: urine osmolality does not increase spec grav <1.006 serum osmolal >290 *Desmopressin: no response means NDI; response means CDI tx: HCTZ, indomethacin, amiloride |
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CDI
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pituitary tumor
trauma surgery histiocytosis X Tx: intranasal desmopressin |
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SIADH
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causes:
1. ectopic ADH: small cell lung cancer 2. CNS/head 3. Pulm disease 4. Drugs: cyclophosphamide urine osmolarity > serum osmolarity **hyponatremia!!! *decreased aldo tx: demeclocycine (ADH antag); H2O restriction |
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Sheehan's syndrome
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postpartum hypopit
enlargement of pituitary during pregnancy due to estrogen -los blood in labor --> hypoperfusion --> infarction sxs: fatigue, anorexia, poor lactation, loss of pubes and axillary hair |
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Autoimmune hypophysitis
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late pregnancy or postpartum
acute presentation: HA, visual field defects, cortisol deficiency |
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Craniopharyngioma
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5-10yo
tumor remnants of Rathke's pouch (forms ant pit); suprasellar 3 parts: solid , cystic, calcified sxs: HA, bitemp hemianopsia, hypopit (growth retardation); hyperPRL |
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Diabetes
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decreased glucose uptake, increased protein catabolism
increased lipolysis *leads to glycosuria, ketogenesis, dehydration, acidosis Nonenzymatic glycosylation: 1. small vessels: retinopathy, glaucoma, nephropathy, HTN 2. large vessels: atherosclerosis, CAD< PVD, gangrene Osmotic damage: cells w/o sorbitol DH 1. neuropathy 2. cataracts |
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type 1 vs type 2 DM
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type 1:
HLA-DR3&4 -weak genetic predisposition -islet leukocytic infiltrate DKA Type 2: strong genetic predisposition islet amyloid depositi nonketotic hyperosmolar coma |
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Carcinoid tumor
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rule of 1/3s:
1/3 mets 1/3 present with 2nd malignancy 1/3 multiple *derived from neuroendocrine cells of GIT (ECL) tx: octreotide |
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Hypoglycemia
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early sxs:
adrenergic: from increased EPI, glucagon, cortisol, GH (sweating, tremor, palps, hunger, nervousness) late sxs: CNS: decreased brain center activity to decrease glu req **non-selective BB (N->Z) inhibit EPI and NE-mediated compensatory reactions B2 block also inhibits hepatic GNG and peripheral glycogenolysis and lipolysis *use selective BB in DM |
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Men 1
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Wermer's syndrome
3 P's: Pituitary Parathyroid Pancreatic: ZE *often presents with kidney stones and ulcers |
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Men 2a
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Sipple's syndrome
Ret gene (affects neural crest cells --> adrenal medulla, parafollic thyroid) auto dom Parathyroid Pheochromocytoma Medullary thyroid cancer |
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Men 2b
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Ret gene; auto dom
Medullary thyroid cancer Pheochromocytoma Marfanoid Mucosal neuromas (oral and intestinal ganglioneuromatosis) |
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Glucagonoma
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necrolytic migratory erythema, hyperglycemia, stomatitis, cheilosis, abd pain
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VIPoma
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intractable diarrhea, metabolic acidosis, hypoK, hypotension (dehydration, vasodilation)
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Somatostatinoma
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abd pain, gall stones, constipation, steatorrhea
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