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125 Cards in this Set
- Front
- Back
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From what embryologic structure is the adrenal cortex derived?
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mesoderm
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From what embryologic structure is adrenal medulla derived?
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neural crest
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What is the primary regulatory control of the adrenal medulla's release of catecholamines (epi, norepi)?
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preganglionic sympathetic fibers
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What is different about adrenal drainage between left and right adrenal glands?
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Left adrenal vein drains to left renal vein before draining into IVC
(just like left gonadal vein!) |
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What anterior pituitary hormones are basophilic?
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FSH
LH ACTH TSH "B-FLAT" |
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What hormones are released from the posterior pituitary?
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oxytocin
ADH (synthesized in the hypothalamus) |
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Where is melanotropin (MSH) made?
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anterior pituituary
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From what embryologic origin is the anterior pituitary derived?
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oral ectoderm
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What pituitary hormones share the same alpha subunit with hCG?
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TSH
LH FSH |
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Where are the following cell types found in a pancreatic islet?
- alpha - beta - delta |
a: outside (glucagon)
B: INSide (INSulin) d: interspersed |
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On what cell types are the following glucose transporters found?
GLUT-1 GLUT-2 GLUT-4 |
GLUT-1: RBCs, Brain
GLUT-2: kidneys, cornea, intestine, liver GLUT-4: adipose, muscle |
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What glucose transporter is bidirectional?
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GLUT-2
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What glucose transporter is insulin-responsive?
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GLUT-4
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How is insulin release from the pancreas triggered by glucose?
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GLUT-2 glucose uptake --> increased ATP from metabolism --> K+ channels close --> Ca channels open --> cell depolarizes --> insulin released
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What effects of insulin are mediated through the RAS/MAPK pathway?
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cell growth
DNA synthesis |
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What effects of insulin are mediated through the P13K pathway?
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glycogen, lipid, protein synthesis
GLUT-4 transport/insertion into membrane |
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What compounds decreased the cellular response to insulin via phosphorylation of serine (instead of tyrosine) residues?
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glucagon
catecholamines TNF-a glucocorticoids |
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What regulates the release of prolactin from the anterior pituituary?
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TRH stimulates
Dopamine inhibits |
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What effect does prolactin have on the release of other pituitary hormones?
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decreases GnRH release
increases dopamine synthesis, thereby decreasing its own release |
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What effect does somatostatin have on the release of other pituitary hormones?
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decreases TSH
decreases GH |
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externally phenotypic female
no internal reproductive structures OR externally phenotypic female with normal internal structures; no secondary sexual characteristics hypertension, hypokalemia |
17a-hydroxylase deficiency
- high aldosterone - low cortisol - low sex hormones |
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masculinization/ female pseudohermaphrodism
hypotension hyperkalemia high renin high ACTH |
21a-hydroxylase deficiency
- low mineralocorticoids - low cortisol - high sex hormones |
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hypertension
high ACTH masculinization |
11a-hydroxylase deficiency
- high deoxycorticosterone (but low aldosterone) - low cortisol - high sex hormones |
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What are the effects of cortisol on the following:
- blood pressure - bone formation - inflammation - immune function - gluconeogenesis - lipolysis, proteolysis |
- increased BP by upregulating a1
- decreased bone formation - decreased inflammation - decreased immune response - increased gluconeogenesis - increased lipolysis, proteolysis |
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What hormones regulate PTH? How?
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Decreased Ca increases PTH
Decreased Mg decreases PTH (diarrhea, aminoglycosides, diuretics, alcohol abuse) |
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cholecalciferol
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D2, from milk and sun
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ergocalciferol
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D3, from plants
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calcitrol
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1,25-(OH)2 vitamin D (synthesized in kidney from liver's storage form)
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What are the products of:
- parathyroid chief cells - thyroid parafollicular cells |
- chief cells: PTH
- parafollicular (C) cells: calcitonin |
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Signaling pathway of:
FSH |
cAMP
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Signaling pathway of:
LH |
cAMP
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Signaling pathway of:
ACTH |
cAMP
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Signaling pathway of:
TSH |
cAMP
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Signaling pathway of:
CRH |
cAMP
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Signaling pathway of:
hCG |
cAMP
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Signaling pathway of:
ADH (V2) |
cAMP
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Signaling pathway of:
MSH |
cAMP
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Signaling pathway of:
PTH |
cAMP
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Signaling pathway of:
calcitonin |
cAMP
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Signaling pathway of:
glucagon |
cAMP
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Signaling pathway of:
ANP |
cGMP
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Signaling pathway of:
NO |
cGMP
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Signaling pathway of:
GnRH |
IP3
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Signaling pathway of:
GHRH |
IP3
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Signaling pathway of:
oxytocin |
IP3
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Signaling pathway of:
ADH (V1) |
IP3
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Signaling pathway of:
TRH |
IP3
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Signaling pathway of:
glucocorticoid |
steroid
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Signaling pathway of:
estrogen |
steroid
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Signaling pathway of:
progesterone |
steroid
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Signaling pathway of:
testosterone |
steroid
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Signaling pathway of:
aldosterone |
steroid
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Signaling pathway of:
vitamin D |
steroid
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Signaling pathway of:
T3/T4 |
steroid
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Signaling pathway of:
insulin |
tyrosine kinase
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Signaling pathway of:
IGF-1 |
tyrosine kinase
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Signaling pathway of:
FGF |
tyrosine kinase
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Signaling pathway of:
PDGF |
tyrosine kinase
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Signaling pathway of:
prolactin |
tyrosine kinase
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Signaling pathway of:
GH |
tyrosine kinase
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How does T3 increase heart rate and CO?
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Increases # of B1 receptors on heart
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What conditions change the amount of TBG?
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hepatic failure - decreased
pregnancy - increased |
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What does thyroid peroxidase do?
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Oxidation of I-
Coupling of MIT and DIT (TG + I2) |
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HTN, buffalo hump, moon facies, hyperglycemia, osteoporosis
high ACTH increased cortisol after low lose of dexamethasone decreased cortisol after high dose of dexamethasone |
pituitary ACTH-secreting adenoma (Cushing disease)
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HTN, buffalo hump, moon facies, hyperglycemia, osteoporosis
high ACTH increased cortisol after low lose of dexamethasone increased cortisol after high dose of dexamethasone |
ectopic ACTH-secreting tumor
(SCLC, bronchial carcinoid) |
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HTN, buffalo hump, moon facies, hyperglycemia, osteoporosis
low ACTH increased cortisol after low lose of dexamethasone increased cortisol after high dose of dexamethasone |
adrenal adenoma/ carcinoma/ nodular adrenal hyperplasia
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Causes of HTN, hypokalemia, metabolic alkalosis, episodic weakness, low plasma renin
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Conn syndrome (hyperaldosteronism)
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Causes of HTN, hypokalemia, metabolic alkalosis, episodic weakness, high plasma renin
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CHF
renal artery stenosis cirrhosis nephrotic syndrome chronic renal failure |
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Causes of hypotension, low cortisol, skin hyperpigmentation
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Addison's disease:
autoimmune TB metastasis |
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Organism responsible for adrenal hemorrhage, acute adrenocortical insufficiency, septicemia, DIC, endotoxic shock
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Neisseria meningitides
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Treatment for:
episodic pressure, pain, perspiration, palpitations, pallor elevated urine VMA |
Phenoxybenzamine: irreversible a-antogonists
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Cells of origin for:
episodic pressure, pain, perspiration, palpitations, pallor elevated urine VMA |
chromaffin cells from neural crest
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Syndromes with:
episodic pressure, pain, perspiration, palpitations, pallor elevated urine VMA |
MEN 2A, 2B
neurofibromatosis type I Von-Hippel Lindau Sturge-Weber |
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N-myc oncogene
urine HVA elevated anywhere along sympathetic chain or adrenal medulla |
neuroblastoma
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pretibial myxedema
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Grave's disease
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facial/periorbital myxedema
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hypothyroidism
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warm, most skin
fine hair |
hyperthyroidism
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dry, cool skin
coarse, brittle hair |
hypothyroidism
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moderately enlarged, non-tender thyroid
Hurthle cells antimicrosomal (anti-thyroid peroxidase) antibodies antithyroglobulin antibodies HLA-DR5 lymphocytic infiltrate |
Hashimoto's thyroiditis
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pot-bellied
pale puffy-faced protruding umbilicus protuberant tonue |
cretenism (lack of dietary iodine or defect in T4 formation)
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after flulike illness
granulomatous inflammation elevated ESR jaw pain early inflammation tender thyroid gland |
subacute thyroiditis
(deQuervain's) |
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non-tender, fixed, hard thyroid
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Riedel's thyroiditis (fibrotic tissue replaces thyroid)
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proptosis
EOM swelling presents during stress pitting edema and thickening over tibia stress-induced catecholamine surge --> arrythmia ---> death |
Grave's disease (thyroid receptor Ig/TSI)
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patches of hyperfunctioning follicular cells
mutation in TSH receptor |
toxic multinodular goiter
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most common thyroid cancer
"ground glass nuclei" "solid balls" of follicular cells with vessels and fibrous stroma in center psammoma bodies nuclear grooves |
papillary carcinoma (increased risk with childhood irradiation)
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uniform follicles, good prognosis
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follicular carcinoma
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from parafollicular cells
produces calcitonin sheets of cells in amyloid stroma associated with MEN 2A, 2B |
medullary thyroid carcinoma
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thyroid cancer associated with Hashimoto's
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thyroid lymphoma
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thyroid cancer in older pts with poor prognosis
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undifferentiated/ anaplastic
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What can cause hypercalcemia?
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Calcium ingestion (milk-alkali)
Hyperparathyroidism Hyperthyroid Iatrogenic (thiazides) Multiple myeloma Paget's disease Addison's disease Neoplams Zollinger-Ellison Excess vitamin A Excess viamin D Sarcoidosis |
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cystic bone spaces filled with brown fibrous tissue
subperiosteal reabsorption |
osteitis fibrosa cystica (hyperparathyroidism)
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hypocalcemia
shortened 4th/5th digits round face short stature |
Albright's hereditary osteodystrophy
(pseudohypoparathyroidism) |
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tapping of facial nerve --> contraction of facial muscles
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hypocalcemic tetany
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occlusion of brachial artery with BP cuff --> carpal spasms
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hypocalcemic tetany
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Treatment for:
- amenorrhea - galactorrhea - low libido - infertility - bitemporal hemianopia |
pituitary prolactinoma:
- Bromocriptine - Cabergoline |
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Treatment for:
- large tongue - deep voice - large hands/feet - coarsened facial features - high IGF-1 - failure to suppress serum GH with oral glucose |
acromegaly:
- octreotide - resection |
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fatigue
anorexia poor lactation loss of public and axillary hair post-partum |
Sheehan's syndrome (hypopituitarism due to infarct)
Replace cortisol and TSH |
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Causes of:
- dilute urine (specific gravity <1.006) - serum osmolality > 290 - dilute urine after water deprivation - dilute urine after desmopressin |
nephrogenic diabetes insipidus:
- hereditary - hypercalcemia - lithium - demeclocycline Treat with: amiloride, hctz, indomethicin |
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Causes of:
- dilute urine (specific gravity <1.006) - serum osmolality > 290 - dilute urine after water deprivation - concentrated urine after desmopressin |
central diabetes insipidus
- pituitary tumor - histiocytosis X - trauma - surgery Treat with intranasal desmopressin |
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Causes of:
- water retention - hyponatremia - urine osmolality > serum osmolality |
SIADH:
- ectopic secretion (SCLC) - head trauma - pulmonary disease - cyclophosphamide Treat with demeclocycline (ADH antagonist) |
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In diabetes, what process are the following attributable to?
- cataracts - glaucoma - retinopathy (hemorrhage, exudate, microaneurysm, angiogenesis) |
- cataracts: osmotic damage (sorbitol)
- glaucoma: non-enzymatic glycosylation - retinopathy: non-enzymatic glycosylation |
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Which form of DM is associated with:
- HLA D3/D4 - amyloid deposition in B cells - strong genetic predisposition - common polyuria, polydipsia, thirst, weight loss |
- HLA D3/D4: DM1
- amyloid deposition in B cells: DM2 - strong genetic predisposition: DM2 - common polyuria, polydipsia, thirst, weight loss: DM1 (more often) |
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management of DKA?
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- fluids
- potassium (to replete intracellular stores) - insulin - glucose afterwards if necessary |
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increased urine 5-HIAA
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carcinoid tumor
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increased urine HVA
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neuroblastoma (dopamine breakdown)
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increased urine VMA
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pheochromocytoma (NE breakdown)
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inheritance pattern of MEN1, 2A, 2B
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autosomal dominant
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associated with ret oncogene
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MEN 2A, MEN 2B
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tumors in MEN 1
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parathyroid (--> kidney stones)
pituitary pancreatic (ZE --> ulcers, insulinoma, VIPoma, glucagonoma) |
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tumors in MEN2
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parathyroid
pheochromocytoma medullary thyroid carcinoma |
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tumors in MEN 2B
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parathyoid
medullary thyroid carcinoma oral/intestinal ganglioneuromatosis (marfanoid habitus) |
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Lispro
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short-acting insulin
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Aspart
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short-acing insulin
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NPH
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intermediate-acting insulin
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glargine
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long-acting insulin
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detemir
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long-acting insulin
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tolbutamide
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1st generation sulfonylurea
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chlorpropamide
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1st generation sulfonylurea
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glyburide
glipizide glimepiride |
2nd generation sulfonylureas
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metformin
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biguanide
can cause lactic acidosis in renal failure |
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pioglitazone
rosiglitazone |
thiazolindeinediones:
PPAR-gamma induction |
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acarbose
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a-glucosidase inhibitor (brush border)
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miglitol
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a-glucosidase inhibitor (brush border)
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pramlintide
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mimetic (decreases glucagon)
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exenatide
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GLP-1 mimentic
can cause pancreatitis |
