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148 Cards in this Set
- Front
- Back
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In what part of the cell is the preprohormone synthed and cleaved?
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RER
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Where is the prohormone cleaved?
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Golgi
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What are thyroid, epinephrin and norepi derivatives of?
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Tyrosine
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What is an example of + feedback?
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surge of LH before ovulation
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What is an example of down regulation of receptors? of up-regulation?
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progesterone down regs it's own and estrogen
egen- upregs it's own receptor and LH |
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What hormones are derived from proopiomeanocortin (POMC)?
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ACTH
Melanocyte-stimulateing hormone B-lipotropin B-endorphin |
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What hormone is structurally equivalent to PRL?
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GH
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What icreases the pulsatile release of GH?
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sleep, stres, hormones of puberty, starvation, exercise, hypoglycemia
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What decreases the pulsatile release of GH?
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somatostatin, somatomedins, obesity, hyperglycemia, preggs
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True or false hyperglycemia stims GH release?
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false
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Where is IGF made?
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liver
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What are the direct actions of GH?
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decrease gcose uptake
increase lipolysis increase protein synth increase lean body mass increase IGF |
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What are the actions of GH through IGF?
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Increase protein synth in chondrocytes and linear growth
increase protein synth in muscle and increase lean body mass increase protein synth in most organs and increase organ size |
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What happens in GH deficiency?
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faliure to grown, shor stature, mild obesity, delayed puberty
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What are the causes of GH deficiency?
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lack of pit. growth hormone
hypothalamic ddysfuncion failure of IGF in the liver GH receptor deficiency |
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What are the consequences of GH excess?
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before puberty- gigantism- increased linear growth
after puberty- acromegaly |
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A woman with diffuse goiter and hyperthyroidsim. What are the TSH and T4,3 values?
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low TSH high T3,4
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48 y/o w/ progressive lethargy and sensitivity to cold. WHat is the Dx?
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hypothyroid
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Pt w/ elevated serum cortisol w/ 1 mg dexamethasone suppresion that doesn't decrease cortisol but 8mg does.
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Pituitary tumor
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50 y/o complains of diarrhea. face is plethoric and heart murmur is detected. What is teh Dx?
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Carcinoid syndrome
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Women with short stature and shortened 4th and 5th metacarpals. What is the diagnosis?
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Albright's hereditary osteodystrophy.
pseudohypoparathyroidism |
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nondiabetic pt. w/ hypoglycemia but low c peptide
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Sureptitious insulin injection
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what lab test is the best way to diagnose thyroid disease?
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TSH- first to change.
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What are the three regions of the adrenal cortex? What do they produce?
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GFR- the deeper you go, the sweeter it gets. Salt, Sugar, Sex.
G- glomerulosa F- fasciculata R- reticularis Salt- aldosterone Sugar- glucocorticoids Sex- androgen |
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How does the L and R ovary drain?
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L- Renal
R- IVC Right ain't renal adrenals are teh same. |
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Where does the post. pituitary derive from?
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neuroectoderm
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Which hormones are acidophils?
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PRL, GH
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What hormones have the common alpha?
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TSH and the sex hormones
LH, FSH, hCG |
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Pancreas:
Where are teh islets of langerhans most numerous? What is made in the following Islet cells: Alpha Beta gamma |
tail of pancreas
alpha-glucagon beta-insulin gamma-somatostatin |
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What is the connection between Dopamine and PRL?
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Dopa inhibs PRL
dopa agonists like bromocriptine inhib PRL dopa antags (antipsychotics) stim PRL. PRL stims Dopa release, inhibs GnRH TRH stims PRL release |
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What increases PRL secretion?
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Egen
Breast-feeding Sleep Stress TRH Dopa antags |
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What decreses PRL secretion?
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Dopa
Bromocriptine Somatostatin PRL |
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What is the action of 17-alpha hydroxylase?
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Pregnenolone to 17-hydroxypregnenolone (step towards androgens and cortisol)
Progesterone to 17-hydroxyprogesterone |
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What is consequences of a 17 hydroxylase deficiency?
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decreased sex hormones
decreased cortisol increased mineralocorticoids female pheno type, no matureation. hypertension hypokalemia |
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Where is CRH made?
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paraventricular nuclei of the hypothalamus
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What is cholesterol desmolase?
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ACTH stims thsi to trigger converstio nof chol to pregenolone in the first step of adrenal hormone synth.
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What are the mechanisms of action of ACTH?
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stims chol desmolase
upregs the ACTH receptor 2nd messenger is cAMP |
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What are the actions of glucocorticoids
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increase protein catabolism
decrease glucose utilization and insulin sensitivity increase lipolysis Inhibs phospholipase A3 with lipocortin inhibs IL2 Inhibs histamine and serotonin release from mast cells Upregulates Alpha1 receptors |
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What are some causes of 1ry adrenal insufficiency?
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Addison's
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What are the Sx of 1ry adrenal insufficiency?
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decreased glucocorticoids, androgen, aldosterone
increased ACTH hypoglycemia hyperpigmentation ECF volume contraction. hypotension, hyperkalemia adn met acidosis |
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What are the differences between 1ry and 2ry adrenal insufficiency in Sx.
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no hyperpigmentation.
no aldosterone effects (volume contraction, hypotention, hyperkalemia, met acidosis) |
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What are the Sx of adrenocortical excess?
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increased cortisol and androgen
hyperglycemia increased protein catabolism and muscle wasting Central Obesity poor wound healing Virilization HTN Osteoporosis Striae |
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What are the causes of excess adrenal function?
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exogenous glucacorticoids
bilateral hyperplasia of the adrenal glands Pituitary- Cushing's Disease |
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What is the Rx of cushings disease?
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Ketoconozol- inhibs synth.
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What is Conn's syndrome?
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hyperaldosteronism
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What are the symps of hyperaldosteronism?
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aldosterone secreatign tumor
HTN Hypokalemia Met alkalosis decreased renin. |
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What is 21 B hydroxylase deficiency?
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common biochem abnlty of steroidogenic pathway
decreased cortisol and aldosterone increased 17 and progesterone increased ACTH hyperplasia of zona fasciculata and reticularis from high levels of ACTH Increased androgens Virilization of women suppression of gonadal function |
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When is there a + Ca balance? When is there a - Ca balance?
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+ in growing kids
- in preggers, and lactation |
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Where is PTH made?
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Chief cells of the parathyroid
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What stims the secretin of PTH?
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decreased Ca
Decreased Mg (mild, severe inhibit) |
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What is the action of PTH
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icnreased resorption
decreased P reabsorption - proximal tubule(increased urinary cAMP) increasaed Ca reabsorption- distal tubule increased Ca absorption from gut |
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What is hydroxyproline?
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biproduct of the reabsorption of organic matrix of bone- excreted in urine
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what happens in 1ry hyperparathyroidism?
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parathyroid adenoma
icreased Ca decreased P increased urinary P increased urinary Ca excretion increased urinary cAMP increased bone resorp |
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What happens in humoral hypercalcemia of malginancy?
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PTH-rp secreted by breast, lung tumors.
increased serum Ca decreased P decreased PTH incrased urinary P |
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What happens with hypoparathyroid?
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thyroid surgery or congenital
- decrused serum Ca - increased serum P decreased urniary P excretion |
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What is Albright's hereditary osteodystrophy?
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pseudohypoparathyroidsims type Ia
defective Gs protein in kdney and bone-> resistance to PTH HypoCa HyperP elevated PTH |
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How does chronic renal failure affect Ca?
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decreased GFR-> decreased elim of P
incrased P -> decreased ionized Ca Decreased 1,25-dihydroxy decreased Ca-> hyperPTH -> renal osteodystrophy |
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What is the role of Vit D?
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Increases Ca and phosphate absorption to ECF for bone mineralization
Binds to calbindin D-28K (PTH triggers formation of Vit. D) Increases renal absrop of Ca and P Increases bone reasorp |
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What does a deficiency in Vit D cause?
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Rickets
Osteomalacia |
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How is Vit D metabbed?
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Cholecalciferol, 25-hydroxycholcalciferol and 24,25-dihydroxycholcalciferol are inactive
Active form is 1,25-hydroxycholcalciferol is catalized by 1-alpha-hydroxylase |
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What regs 1-alpha-hydroxylase?
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decreased serum Ca
increased PTH decreased serum P |
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What is the source of Vit. D?
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sun exposure and plants
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What is the role of calcitonin?
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Synthed and secreted by parafollicular cells of thyroid (C cells)
secretion stimmed w/ increased Ca Inhibits bone resorp. |
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What are the Ca, P, and alk P in hyperPTH, Paget's, Vit D intox, Osteoporosis and renal insufficiency?
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Ca, P, alk P
hyperPTH- up, down, up Paget's- little up, normal, really up Vit D intox- up, up, littl up Osteoporosis- normal, normal, normal Rnal insufficiency- down, up, normal |
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Breakdown the metab of thyroid synth.
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stimmed by TSH
1. Iodid pump- follicular cells transport iodide- inhibbed by thiocyanate, perchlorate anions, high levels of I 2. Peroxidase enzyme- make I2 (inhibbed by propylthiouracil) 3. Tyrosine is incorporated on the ribosomes of the thyroid follicular cells. Packaged into secretory granules on golgi-> follicular lumen Thyroglobulin reacts w/ I2-> DIT and MIT 4. Two DITs-> T4 1 DIT and 1 MIT-> T3 5. stored in follicular lumen more T4 made than T3 6. When stimmed, taken back in, thyroglobulin is degraded by lysosomes-> T3,T4 Leftovers are deiodinated by thyroid deiodinase 7. T3 and T4 is bound to TBG 8. T4-> T3 or rT3 |
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What is the role of thiocyanate and perchlorate anions?
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inhib the iodide pump
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What happens to TBG in hepatic failure and pregs?
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hepatic failure- TBG levels decrease- decrease in total thyroid hormone levels, normal free hormone
Pregs- TBG increase-> increase in total T. |
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What are the actions of T3,4?
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Growth- bone formation, maturation
Perinatal CNS maturation BMR- increaes BMR and Na/K ATPase CV- increased HR and SV Increased Resp Metabolic- increased glucose absorp, glycogenolysis, gluconeogenesis, glucose oxidation, lypolysis, protein synth and degradation |
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What are some characteristics of steroid hormones?
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lipophilic, insoluble in plasma;, bind to globulins
Increased Sex hormone-binding globulin (SHBG)-> lower free Testosertone-> gynecomastia Decreased SHBG-> hirsuitism |
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What organs are insulin-dependant?
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skeletal muscle and adipose tissue- for gcose uptake
brain and RBCs take up gcose w/ glut-1 |
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What aer some causes of 2ry hyperaldosteronism?
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renal artery stenosis
chronic renal failure CHF Cirrhosis Nephrotic syndrome |
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What is the Rx for hyperaldosteronism?
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spironolactone
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What is the staining of a pituitary PRLnoma?
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chromophobic
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What is the staining of a somatotropic adenoma
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acidophilic
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What is pituitary chachexia (simmonds disease)?
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generalized panhypopituitarism
Caused by: pit tumors postpartum pit necrosis (sheehan) |
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Sheehan syndrome
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ichemic necrosis of pituitary- hemorrhage and schock during child birth
first loss of gonadotropins then TSH and ACTH |
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Craniopharyngioma
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benign childhood tumor derived from Rathke pouch
Nests and cords of squamous or columnar cells in a loose stroma, resembles embryonic tooth but enamel Cystic; lining epithelium of flat or columnar cells often expands into papillary projections Calcification on X-ray |
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Pheochromocytoma
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chromaffin cells of the adrenal medulla
10% malignant 10% bilateral 10% extra-adrenal 10% calcify 10% kids 10% familial incraease catecholamines MEN II and III Spells of: Pressure Pain Perspiration Palpitations Pallor can be associated with NF or von Hippel-Lindau Rx with Phenoxybenzamine |
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Neuroblastoma
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highly malignant, catecholamines of early childhood
HTN adrenal medulla converts into ganglioneuroma amplification of N-myc oncogene |
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MEN type I
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Wermer's- AD
3 Ps Pancreas- ZE, insulinoma, VIPoma Pituitary Parathyroid Kidney stones and stomach ulcers |
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MEN type II
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Sipple- AD
medullary carcinoma of the thyroid pheo parathyroid |
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MEN type III
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medullary carcinoma of the thyroid
pheo pheo oral and intestinal ganglioneuromatosis |
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What is Riedels Thyroiditis?
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thyroid replaced by fibrous tissue- hypothyroid
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What is de Quervain's Thyroiditis?
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self-limited hypothyroidism- follows flu-like illness
elevated ESR jaw pain early inflamm tender thyroid hyperthyroid early in course mononuclear cell infiltrate, follicular dysruption, loss of colloid |
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What is the most common congenital anomaly of the thyroid?
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thyroglossal duct cyst
from thyroglossal duct no alterations in thyroid function |
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What HLAs is Graves' associated with?
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DR3
B8 |
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What is plummer disease?
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hyperthyroidism, nodular goiter, no exophthalmos
hot nodules- adenomas or nono-neoplastic |
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What is struma ovarii
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ovarian teratoma made of thyroid tissue.
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What HLAs is Hashimotos associated with?
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DR5, B5
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Papillary carcinoma of the thyroid
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most common cancer
papillary projections into gland-like spaces ground-glass nuclei. spammoma bodies better prognosis prior radiotherapy is a risk factor |
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Follicular Carcinoma of the thyroid
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histo - uniform follicles
poor prognosis |
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Medullary carcinoma of the thyroid
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from C cells
produce calcitonin, (lowers Ca) MEN II and III |
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Undiffed carcinoma of the thyroid
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old pts. poor prognosis
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when is an increase in GH normal?
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stress, exercise, hypoglycemia
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What is Osteitis fibrosa cystica?
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von Recklinghausen syndrome
cystic bone spaces filled with brown fibrous tissue (bone pain) |
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What is renal osteodystrophy?
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bone lesions due to 2ry hyperPTH
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What does Stones, Bones, and Groans refer to?
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hyperparathyroid
hypercalicuria-stones bones are depleted Groans- constipation |
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What are the causes of hyperparathyroid?
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CHIMPANZEES
Calcium injestion HyperPTH/HyperTH Iatrogenic (thiazides) Multiple Myeloma Paget's Addisons Neoplasms Zollinger-Ellison Excess Vit D Excess Vit A Sarcoid |
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What is Chvosteks sign?
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tap facial nerve-> contraction of facial mucles
Hypocalcemia |
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What is Trousseau's sign?
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occlusion of brachial artery w/ BP cuff-> carpal spasm
Hypocalcemia |
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When can you develop pseudohypoparathyroidism?
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AR kidney unresponsive to PTH
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What are some growth defects in HypoCa?
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shortened 4th/5th digit
short stature |
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What MEN syndromes is hyperPTH associated with?
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I and II
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What is the major cause of 2ry hyperPTH?
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renal disease-> hypocalcemia
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what HLA is DM associated with?
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DR 3,4
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What are kussmaul respirations?
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rapid/deep breathing
w/ ketoacidosis |
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What is diabetic ketoacidosis?
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most important complication of DM1
increase in insulin requirements from increased stress (infection) excess fat breakdown and increased ketogenesis from increase in FFAs used to make ketones |
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What are the Sx of diabetic ketoacidosis?
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Kussmaul resps
hyperthermia nausea/vomit abdominal pain psychosis/dementia dehydration fruity breath |
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What are the labs in diabetic ketoacidosis?
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hyperglycemia
increase H, decrease HCO3 *anion gap increased blood ketone levels leukocytosis hyperkalemia |
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What are the complications of ketoacidosis?
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mucormycosis
Rhizopus infection cerebral edema cardiac arrhythmias heart failure |
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What is the Rx for Ketoacidosis?
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Fluids
Insulin K glucos if necessary to prevent hypoglycemia |
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What is Diabetes Insipidus?
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intesive thirst and polyuria
can't concentrate urine (no ADH) no ADH, ore no response to ADH- lithium Dx- water deprivation test Labs- low specific gravity, high osms Rx- adequate fluid intake; intranasal desmopressin- central hzt, indomethacin, or amiloride- nephrogenic |
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What is SIADH?
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inappropriate ADH secretion
water retention hyponatremia urin osm>serm osm can cause seizure (treat slowly) Rx- demeclocycline, H2O restriction |
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What are the causes of SIADH?
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ectopic- lung cancer
head trauma pulm disease drugs- cyclophosphamide |
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What is carcinoid syndrome?
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rare syndrome caused by carcinoid tumores, especially metastatic small bowel tumors, secreete Serotonin. Not seen if tumor is limited to GI tract.-> diarrhea, cutaneous flushing, asthmatic wheezing, Rsided vasc disease
33% mets 33% 2nd malig 33% multiple Rx- octreotide |
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What is the Rx for Carcinoid syndrome?
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octreotide
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What are some 2ry causes of DM?
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pancreatic disease
- hereditary hemochromatosis - Pancreatitis - Carcinoma of the pancreas Other endocrine - cushings - acromegaly - glucagon hypersecretion - pheo - hyperthyroid Pregnancy |
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What anatomic changes occur to the pancreas in type 2 diabetes?
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amylin deposis, fibrosis, hyalinization
not specific interferes w/ insulin sensing by B cells |
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What are the anatomic kidney changes seen in diabetes?
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increased width of glomerular BM earlies and most common renal change
diffuse glomerulosclerosis, nodular, arteriolar lesions, exudative lesions, fibrin cap, capsular drop armanni-ebstein lesioin- tubular deposition of glycogen pyelonephritis |
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What changes occur in the capillaries in DM?
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nonenzymatic glycosylation of membrane protein
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Insulineoma
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most common
benign or malignant increased insulin. circulating C-peptide is increased in insulinoma Whiple triad: episodic hyperinsulin, hypoglycemia; CNS dysfunction temporally to hypoglycemia; dramatic reversal of CNS issues. |
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What is the Rx strategy for type 1 DM
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- low-surgar diet, insulin replacement
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What is the Rx strategy for DM type 2.
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dietary modification adn exercise for weight loss.
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What is the mechanism of action for Insulin?
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increase glucose stored as glycogen
increase glycogen and protein synth, K uptake aids TG storage |
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What is the mechanism of action for sulfonylureas?
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Close K channel in B-cell membrane. cell depolarizes-> trigger of insulin release via increased Ca flux.
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What are the SEs of Insulin?
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hypoglycemia
hypersensitivity |
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What are the SEs of sulfonylurea?
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disulfiram-like effects
2nd generation: hypoglycemia |
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What is the effect of biguanides?
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decreased gluconeogenesis
increased glycolysis decreased serum glucose |
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What are the SEs of biguanides?
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lactic acidosis
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What is the mechanism of Glitazones?
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increase target cell response to insulin
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What are the SEs of Glitazones?
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weight gain
hepatotoxicity |
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What is the mechanism of action of alpha-glucosidase inhibitors?
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Inhibit brush border alpha-glucosidases.
Delayed sugar hydrolysis and glucose absorption lead to decreased postprandial hyperglycemia |
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What are the SEs of alpha-glucosidase inhibitors?
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GI disturbances.
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What is Orlistat?
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alters fat metab by inhibiting pancreatic lipases
for long term obesity management |
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What are the SEs of Orlistat?
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Steatorrhea, GI discomfort, reduced absorption of fat-soluble vitamins, headache
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What is Sibutramine?
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Sympathomimetic serotonin and NE reuptake inhibitor
Short-term and long-term obesity management. |
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What are the SEs of Sibutramine?
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Hypertension and tachycardia
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What is the mechanism of action of propylthiouracil adn methimazole?
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Inhibit thyroid hormone synth.
inhibit conversion of T4 to T3 |
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What are the SEs of propylthiouracil?
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skin rash, agranulocytosis, aplastic anemia
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When is GH used clinically?
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GH deficiency
Turners |
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When is Octreotide used clinically?
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Acromegaly
carcinoid gastrinoma glucagonoma |
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When is Oxytocin used clinically?
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Stims labor
uterine contractions milk let-down controls uterine hemorrhage |
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When is desmopressin used clinically?
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Pituitary Diabetes Insipidous
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What is the mechanism of action of Levothyroxine and triiodothyronine
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Thyroxine replacement
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What are the SEs of thyroid hormone replacement?
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Tachycardia, heat intolerance,
tremors |
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What is the mechanism of action of glucocorticoids?
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decrease the production of leukotrienes and prostaglandins by inhibiting Phospholipase A2 and expression of COX-2
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What is the clinical use of glucocorticoids?
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Addisons, inflam, immune suppression, asthma
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What is the toxicity of glucocorticoids?
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chushings- buffalo hump, moon facies, truncal obesity, muscle wasting, think skin, easy bruisability, osteoporosis
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