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79 Cards in this Set
- Front
- Back
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Adrenal gland drainage
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same as left and right gonadal vein
left adrenal to left adrenal vein to left renal vein to IVC right adrenal to right adrenal vein to IVC |
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Acidophils
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GH, prolactin
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Basophils
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B-FLAT
FSH, LH, ACTH, TSH |
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Common subunit to TSH, LH, FSH ad beta HCG
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alpha subunit
beta subunit determines hormone specificity |
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Endocrine calls of pancrease
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in islets of langerhans
alpha- peripheral, glucagon beta- central, insulin delta- interspersed, somatostatin |
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What doesn't need insulin for glucose uptake?
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BRICK L
brain, rbcs, intestine, cornea, kidney, liver |
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Inhibit insulin secretion
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hypoglycemia, somatostatin, cortisol, alpha agonists
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Stimulate insulin secretion
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hyperglycemia, GH, beta agonists
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GLUT 1
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RBCs, brain
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GLUT 2
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bidirectional, in beta islet cells, liver, kidney, small intestine
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GLUT 4
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insulin responsive, in adipose tissue and skeletal muscle
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GH inc
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during exercise and sleep
released in pulses in response to GHRH inhib by glucose and somatostatin inc insulin resistance-diabetogenic |
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All congenital adrenal enzyme def characterized by
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Enlargement of adrenal glands, due to inc ACTH stim because of dec cortisol
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17 alpha hydroxylase def
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inc aldosterone, dec cortisol, dec sex hormones
hypertension, hypokalemia phenotypic female |
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21 hydroxylase deficiency
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dec aldosterone, dec cortisol, inc sex hormones
masculinization hypotension, hyperkalemia |
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11 beta hydroxylase deficiency
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dec aldosterone, dec cortisol, inc sex hormones, inc 11-deoxycorticosterone- hypertension
masculinization |
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Cortisol functions
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maintains bp, dec bone formation, anti inflam/immunosuppressive, inc insulin resistance, inc gluconeogenesis, lipolysis, proteolysis
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PTH effect on bone
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inc bone resorption of ca and phosphate by inc production of M-CSF and RANK-L in osteoBLASTS, stimulating osteoCLASTS
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PTH in kidney
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inc kidney reabsorption of ca in DCT
dec kidney reabsorption of phosphate inc 1,25 OH2 vit D (calcitriol)- active form- production by stim kidney 1 alpha hydroxylase |
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Endocrine hormones with cAMP signaling pathway
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FSH, LH, ACTH, TSH, CRH, hCG, ADH V2 receptor, MSH, PTH, calcitonin, GHRH, glucagon
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cGMP
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ANP, NO
vasodilators |
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IP3
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GnRH, Oxytocin, ADH V1 receptor, TRH, H1, ATII, gastrin
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Cytosolic steroid receptor
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Vit D, Estrogen, Testosteron, Cortisol, Aldosterone, Progesterone
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Nuclear steroid receptor
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T3/T4
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Intrinsic tyrosine kinase (MAP kinase pathway)
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Insulin, IGF-1, FGF, PDGF
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Receptor associated tyrosine kinase (JAK/STAT pathway)
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Prolactin, GH, cytokines- IL 2, IL 6, IL 8
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inc SHBG in men
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lower free testosterone
leads to gynecomastia |
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dec SHBG in women
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inc free testosterone, leads to hirsuitism
SHBG levels inc during pregnancy |
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T3
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mostly formed in blood
brain maturation, bone growth, beta adrenergic effects, inc BMR |
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T4 converted to T3
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in peripheral tissue by 5'-deiodinase
T4 is major product |
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Wolff Chaikoff effect
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transient dec in T3/T4 levels due to excess ingestion of iodide, which inhibits iodide pump activity
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Anti thyroid drugs
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Propylthiouracil inhibits peroxidase and 5'-deiodinase
Methimazole inhib peroxidase- which does oxidation and organification of iodide and coupling of MIT and DIT |
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#1 cause of Cushings
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exogenous steroids
dec ACTH |
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Conn's syndrome
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primary aldosteronism- aldosterone secreting adrenal adenoma
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Addison's dse
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chronic primary adrenal insufficiency due to adrenal atrophy or destruction by disease
def of aldosterone and cortisol, causing hypotension, hyperkalemia, acidosis, skin hyperpigmentation- due to MSH a by product of inc ACTH production from POMC Adrenal Atrophy and Absence of hormone prod, involves all 3 cortical areas, spares medulla |
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Secondary adrenal insufficiency
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dec pituitary ACTH production
no skin hyperpigmentation, no hyperkalemia |
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Waterhouse Friderichsen syndrome
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acute primary adrenal insufficiency due to adrenal hemorrhage ass with Neisseria meningitidis septicemia, DIC, endotoxic shock
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Pheochromocytoma
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MC tumor of adrenal medulla in adults
derived from chromaffin cells- NC origin episodic htn ass with NF, MEN types 2A and 2B tx alpha blockers- phenoxybenzamine non selective, irreversible then surgery to remove the tumor |
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Pheo rule of 10s
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10% malignant, 10 bilat, 10 extra adrenal, 10 calcify, 10 kids, 10 familial
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HVA in urine
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breakdown product of dopamine
elevated in Neuroblastoma N myc overexpression ass with rapid tumor progression |
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VMA in urine
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breakdown product of NE
elevated in pheo plasma catecholamines elevated too sx occur in spells- relapse and remit |
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Cortisol not suppressed on low dose of dexamethasone, but suppressed on high dose
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ACTH pituitary tumor- Cushing's dse
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MCC of hypothyroidism
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Hashimoto's thyroiditis
autoimmune dso- antimicrosomal, antithyroglobulin ab, ass with HLA-DR5 Hurthle cells, lymphocytic infiltrate with germinal centers |
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Subacute thyroiditis
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de Quervains
self limited hypothyroid following flulike illness granulomatous inflam, inc ESR, jaw pain, very tender thyroid |
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Reidel's thyroiditis
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thyroid replaced by fibrous tissue, fixed rock like painless goiter
hypothyroid |
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Cretinism
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due to severe fetal hypothyroidism
pot bellied, pale, puffy face child with protruding umbilicus and protuberant tongue |
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Graves dse
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autoimmune hyperthyroidism with TSH receptor ab
ophthalmopathy, pretibial myxedema, inc connective tissue deposition, diffuse goiter |
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Thyroid storm
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stress induced catecholamine surge leading to death by arrhythmia
complication of hyperthyroid dsos |
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Toxic multinodular goiter
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patches of hyperfunctioning follicular cells working independently of TSH due to mutated TSH receptor
inc release of T3 and T4 |
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Jod Basedow phenomenon
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thyrotoxicosis if pt with iodine def goiter made iodine replete
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MC thyroid cancer
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Papillary carcinoma
excellent prog, ground glass nuclei- Orphan annie, psammoma bodies, nuclear grooves inc risk with childhood irradiation |
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Medullary carcinoma of thyrid
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form parafollicular C cells- NC origin
produces calcitonin, sheets of cells in amyloid stroma ass with MEN 2A and 2B |
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NHL ass with
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Hashimotos thyroiditis
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Primary hyperparathyroidism
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stones bones and groans
inc PTH, inc alk phos, inc cAMP in urine hypercalcemia and hypercalciuria |
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Osteitis fibrosa cystica
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cystic bone spaces filled with brown fibrous tissue
bone pain due to primary hyperparathyroidism |
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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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Secondary hyperparathyroidism
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due to dec gut ca absorption and inc phosphorus, most often in chronic renal disease- causes hypovitaminosis D; hypocalcemia, hyperphos, inc alk phos, inc PTH
tertiary is refractory, from chronic renal dse, high high PTH, INC ca |
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Chvostek's sign
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tapping of facial nerve, get contraction of facial mm
from hypocalcemia |
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Trousseau's sign
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occlusion of brachial artery with BP cuff- get carpal spasm
from hypocalcemia |
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Albright's hereditary osteodystrophy
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pseudohypoparathyroidism
AD kidney unresponsiveness to PTH hypocalcemia, shortened 4th/5th digits, short staturs |
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Acromegaly
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excess GH in adults
insulin resistance inc serum IGF-1, failure to suppress serum GH following oral glucose tolerance test tx pituitary adenoma resection followed by octreotide administration |
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Demeclocycline
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ADH antagonist
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tx for central DI
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intranasal desmopressin- ADH analog
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tx for nephrogenic DI
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HCTZ, indomethacin, or amiloride
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What drug can cause SIADH
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cyclophosphamide
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Sheehan's syndrome
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hemorrhagic or ischemic infarct of pituitary following postpartum bleeding
presents with failure to lactate |
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Marfanoid habitus
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marfans, MEN 2B, homocystinuria
locus heterogeneity |
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DM type 1 ass with what HLA system
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HLA DR3 and 4
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Carcinoid tumors
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1/3 metastasize, 1/3 present with 2nd malignancy, 1/3 multple
derived from neuroendocrine cells of GI tract secrete high levels of serotonin 5-HIAA in urine tx octreotide |
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ZE syndrome
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gastrin secreting tumor of pancreas or duodenum
stomach shows rugal thickening with acid hypersecretion causes recurrent ulcers may be ass with MEN 1 |
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Metformin contraindicated in
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renal failure
can cause lactic acidosis |
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Sulfonylureas
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close K channel in beta cell membrane so cell depolarizes, triggers release of insulin via inc Ca influx
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Biguanide
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Metformin
dec gluconeogenesis, inc glycolysis, inc peripheral glucose uptake |
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Glitazones/thiazolidinediones
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Pioglitazone, Rosiglitazone
inc insulin sensitivity in peripheral tissue binds PPAR gamma nuclear transcription regulator- which inc insulin sens and levels of adiponectin |
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alpha glucosidase inhibtors
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Acarbose, Miglitol
inhibit intestinal brush border alpha glucosidase dec postprandial hyperglycemia |
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GLP 1 analog
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Exenatide
inc insulin, dec glucagon release SE NV pancreatitis |
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Pramlintide
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insulin mimetic, dec glucagon
SE hypoglycemia, N D |
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Demeclocycline
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ADH antagonist, member of tetracycline family
tx SIADH tox nephrogenic DI, photosensitivity, abnormalities of bone and teeth |
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Glucocorticoids
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dec prod of leukotrienes and prostaglandins by inhib phospholipase A2 and expression of COX2
tx addisons, inflamm, immune suppression, asthma tox cushings, adrenal insuff when stop |
