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65 Cards in this Set
- Front
- Back
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What's the MCC adrenal tumor in kids, what gene, what breakdown prod? How is it diff than pheo?
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Neuroblastoma, N-myc, elevated HVA from dopamine. Does NOT cause HTN, and in pheo you look for VMA and metanephrines.
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Which cells in ant pit are acidophils? Which are basophils?
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Acid: GH, prolactin
Baso: "B-FLAT" - FSH, LH, ACTH, TSH |
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Alpha subunit is common to what hormones? What determines specificity?
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TSH, FSH, LH, hCG
beta subunit |
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What is post pit derived from? Ant pit?
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Post - neuroectoderm
Ant - ectoderm (Rathke's pouch) |
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What is adrenal cortex derived from? Medulla?
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Cortex - mesoderm
Medulla - neural crest |
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What secretes insulin, glucagon, somatostatin? Location of these cells?
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beta - insulin, inside
alpha - glucagon, outside delta - somatostatin, interspersed |
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How is insulin released from beta cell?
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Glc enters via GLUT-2 (facilitated diffusion). Glucookinase, increase ATP, close K channel, depol, open Ca channel, Ca influx, insulin exocytosis.
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Which tissues can't uptake glc without insulin? What glc transporter?
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Skeletal muscle
Adipose tissue GLUT-4 (insulin responsive) - insulin puts more receptors on cell surface. |
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Which tissues do NOT need insulin to move glc in?
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"BRICK-L"
brain - glut1 RBC - glut1 intestine - glut2 cornea - glut2 kidney - glut2 liver - glut2 |
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Which cells have GLUT-1 receptors? GLUT-2? GLUT-4?
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GLUT-1: brain, RBC
GLUT-2: beta cell, intestine, cornea, kidnea, liver GLUT-4: skeletal muscle, adipose |
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Name the fxns of insulin?
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1. increase glc transport
2. increase glycogen, protein, TG syn/storage 3. increase Na retention 4. increase cellular uptake of K and AA |
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What does somatostatin inhibit from the ant pit?
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GH, TSH
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What stimulates prolactin secretion?
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DA antagonists (antipsych)
estrogens (preg, OCP) TRH |
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What enzyme does ACTH stimulate? Angiotensin II?
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ACTH - cholesterol desmolase
AII - aldosterone synthase |
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What is 17alpha-hydroxylase def?
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High cortisol, aldo --> HTN, hypoK
Low androgens --> XY phenotypic female, XX no secondary sex characteristics. |
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What is 21-hydroxylase def?
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High androgens - female virilization (CAH), male early puberty.
Low cortisol, aldo - saltwasting |
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What is 11beta-hydroxylase def?
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High androgens - female viriilzation, male early puberty.
High 11-deoxycorticosterone - HTN Low cortisol, aldo |
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Name the 5 fxn of cortisol? (think side effects of steroids)
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"BBIIG"
1. BP - upreg alpha receptors 2. decrease Bone formation 3. anti-Inflam 4. decrease Immune fxn 5. increase Gluconeo, proteolysis, lipolysis |
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What is cortisol bound to in the circ?
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Cortisol-binding globulin (CBG)
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How does PTH increase serum Ca on cellular level?
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PTH directly stimulates osteoblasts to secrete M-CSF and RANK-L, which then binds to osteoclasts (indirect, paracrine)
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Conversion of Vit D?
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Vit D3 - sun exposure
Vit D2 - plants Converted to 25OH-VitD in liver, 1,25-(OH)2 vitD in kidney. |
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Which hormones use cAMP as signaling pathway?
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FSH, LH, TSH, hCG
ACTH, CRH, MSH ADH (V2 receptor) PTH, calcitonin GHRH glucagon |
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Which hormones use cGMP as signaling pathway?
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Think vasodilators.
ANP, NO |
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Which hormones use IP3 as signaling pathway?
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GnRH
oxytocin, ADH (V1 receptor) TRH |
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Which hormones use cytosolic steroid receptor as signaling pathway? Nuclear?
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Cyto - progesterone, estrogen, testo, aldo, cortisol, Vit D
Nuclear - T3, T4 |
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Which hormones use intrinsic Tyr kinase (MAP kinase pathway) as signaling pathway?
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Think growth factors.
Insulin, IGF-1, FGF, PDGF |
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Which hormones use receptor-assoc Tyr kinase (Jak/Stat pathway) as signaling pathway?
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GH, prolactin, IL-2
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Why are steroid hormones/thyroid hormones slow acting?
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Activate transcription factors, have to go through whole protein syn process!
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What are the 4 fxn of thyroid hormone?
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"4 B's"
Brain maturation Bone growth (works with GH) Beta-adrenergic effects (increase HR, contractility, gluconeo, lipolysis, glycogenolysis) Basal metabolic rate |
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How is thyroid hormone synthesized?
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Iodide goes into follicular cell from blood, oxidation and binding to thyroglobulin (MIT, DIT) by peroxidase, proteolysis back in cell, out to blood.
**TG comes from Tyrosine |
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What do anions like perchlorate and pertechnetate do to thyroid hormone syn?
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inhibit, compete with I to get into cell, can be used to tone down radioactive iodine ablation results
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Which divisions of the adrenals does Addison's affect?
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All 3 of them!
Low aldo, cortisol, and androgens. Hyperpig and hyperK distinguish it from secondary adrenal insuff. |
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What can cause Waterhouse-Friedrichsen syndrome?
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Neisseria meningitidis
DIC endotoxic shock (gram neg) |
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What is pheo assoc with?
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MEN 2A/2B
neurofibromatosis Type I |
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What are the breakdown prods of DA, NE, Epi? Which are elevated in pheo?
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DA-->HVA
NE-->VMA Epi-->metanephrines VMA and metanephrines. |
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Histo of Hashimoto's thyroiditis?
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Hurthle cells, lymph infiltrate with germinal centers
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How do you get sporadic cretinism?
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Defect in T4 formation, developmental failure in thyroid formation
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Histo of subacute thyroiditis (deQuervain's)?
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granulomatous inflam
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What causes hyperT4 in toxic multinodular goiter?
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Mutation in TSH receptor of these nodules makes them hyperfxn and work independently of TSH
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When does Grave's often present?
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Times of stress (eg childbirth)
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What is Jod-Basedow phenomenon?
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GIve iodine to a pt with cretinism (I def) and suddenly get thyrotoxicosis.
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Histo of papillary thyroid cancer?
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Ground-glass nuclei (Orphan Annie), psammoma bodies, nuclear grooves
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What is pseudohypoPTH? (Albright's hereditary osteodystrophy)
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AD kidney unresponsive to PTH due to mutation in Gs receptor. HypoCa, short 4th/5th digits, short stature.
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Name some causes of SIADH?
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Malig - small cell lung ca
CNS, head trauma Lung disease Drugs - cyclophosphamide |
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What does insulin def and glucagon excess cause in DM?
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1. Decreased glc uptake
2. Increased protein catabolism - loss of AA and nitrogen in urine 3. Increased lipolysis - plasma FFA, ketones |
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Which chronic DM manifestations are due to nonenzymatic glycosylation?
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retinopathy
nephropathy glaucoma large vessel disease |
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Which chronic DM manifestations are due to osmotic damage
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neuropathy (sorbitol)
cataracts (sorbitol) |
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What is the histo of DM1 vs DM2?
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DM1-islet cell leukocytic infiltrate
DM2-islet amyloid deposit |
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Which ketone do you get more of in DKA? Which shows up on urine test?
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Get more beta-hydroxybutryate, but acetoacetate is what is picked up on urine test.
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What is the rule of 1/3's for carcinoid syndrome?
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1/3 metastatize
1/3 present with 2nd malig 1/3 multiple |
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Which kinds are rapid insulin? Slow insulin?
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Rapid - aspart, lispro
Slow - glargine, detemir |
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Which are the first gen sulfonylureas? 2nd gen?
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1st: tolbutamide, chlorpropromide
2nd: glipizide, glyburide, glimepiride |
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1st and 2nd gen sulfonylureas - toxicity?
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1st: disulfiram-like (1st Can Make Puke)
2nd: hypoglycemia |
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What do biguanides (metformin) do?
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Decrease hepatic gluconeo
Increase glycolysis, periph glc intake (insulin sensitizer) |
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MOA of glitizones?
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Bind PPAR-gamma nuclear transcription regulator to increase insulin sen in periph tissue.
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Glitizones - toxicity?
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Wt gain
edema hepatotox CV tox |
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What are alpha-glucosidase inhibitors used for? (miglitol, acarbose)
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decrease postprandial hyperglycemia
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MOA of pramlintide?
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Amylin analog, decreases glucagon secretion and slows emptying of stomach
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MOA of exenatide?
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GLP-1 analog, increase insulin and decrease glucagon release.
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Toxicity of exenatide?
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N/V, pancreatitis
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MOA of propylthiouracil and methimazole? What does PTU additionally do?
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inhibit peroxidase so no organification of iodide or coupling of thyroid hormones. PTU also decreases periph conversion T4-->T3.
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PTU - toxicity?
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Skin rash
agranulocytosis aplastic anemia heptatotox |
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Methimazole - toxicity?
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skin rash
agranulocytosis aplastic anemia cutis aplasia - teratogen! |
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Demeclocycline - toxicity?
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This is a tetracycline!!
photosen discolored teeth, growth abnl nephrogenic DI |
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MOA of corticosteroids?
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Inhibit phopholipase A2 to decrease prod of leukotrienes and PG's
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