Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/87

Click to flip

87 Cards in this Set

  • Front
  • Back
Hormones of the anterior lobe of the pituitary
GH
PRL
ACTH
FSH
TSH
LH
Propriomelanocrtin (POMC)
ACTH
Melanocyte stimulating hormone (MSH)
Beta-lipoprotin
beta-endorphin
Growth hormone secr
Pulsatile Secr
Incr by: sleep, exercise, puberty, starvation, hypoglycemia
(+) GHRH
(-) Somatostatin, somatomedin (IGF)
GH action
decr glucose uptake
incr lipolysis
incr prot synth, incr lean body mass
incr IGF - rec is a tyr kinase
IGF actions:
1. incr prot synth and linear growth
2. incr prot synth in muscle and incr lean body mass
3. incr organ size
PRL secr
lactogenesis
Tonically inhibited by Dopamine (PIF)
Stimulated by TRH
NEG FDBK: via PRL mediated Dopamine rls
PRL -actions
Breast development (with ER)
Lactation
Inhibits ovulation: by decr synth and rls of GnRH
inhibits GnRH actions on ant pit thus inhibiting FSH and LH and ANTAGONIZES them in the ovary
Inhibits spermatogenesis by decr GnRH
PRL excess
cause
sx
tx
Destruction of hypothalamus (loss of PIF) or prolactinoma
Galactorrhea
Failure to ovulate
Tx with bromocriptine (DA analogue)
Match to second messenger system
ACTH GnRH
TRH glucagon
oxytocin
ADH (V1,V2)
CRH MSH
calcitonin TRH
GHRH ATII
HCG FSH
TSH LH
PTH
IP3: CRH, TRH, GNRH, ATII, oxytocin, ADH (V1)

cAMP: ACTH, glucagon, ADH (V2)
MSH, FSH, LH, Calcitonin, PTH
Tyr Kinase ligands
Insulin
IGF
cGMP
EDGF
ANP
NO
ADH
Supraoptic Nuclei
V2 - distal tubule for aqua porins
V1 - constrict vasculature
Oxytocin
paraventricular nuclei
milk ejection reflex
dilation of cervix
orgasm
uterine contraction
reduce post partum bleedin
Process of making thyroid hormone
1. Iodide trapping of I- via iodide pump. Inhibited by thiocyanate, perchlorate anions, and high I-.
2. Peroxidation 2I- -> I2. Via peroxidase (inhibited by PTU)
3. Organification: Tyrosine incorporated in Thyroglobulin on follicular ribosomes
4. Tyr resides on thyroglobulin at follicular cell/lumen jx combine with I2 -> MIT + DIT
5. 2 DIT -> T4, DIT+MIT-> T3
6. Rls - stim from TSH- thyroglobulin rlsed. Excess DIT and MIT deiodinated by Thyroid deoidinase (def of this enzyme mimics I2 def) for recycling.
Peroxidase also involved in peripheral conversion of T4 to T3
TBG
hepatic failure
pregnancy
Hepatic failure - decr TBG-> incr free T3 and T4
Pregnancy: incr TBG -> decr free idodine.
Thyroid regulation
T3 inhibits TRH receptors in pituitary.
Thyroid actions
CNS maturation in perinatal period-> MR if def
Bone growth in combination with GH and somatomedins
acts like beta stimulation
incr synthesis of N/K atpase-> incr O2 consumption
catabolic effects
21 alpha hydroxylase def
decr cortisol, aldosterone, deoxycorticosterone
Incr ACTH, androgens, virulization, HoTN
11 alpha hydroxylase def
decr cortisol and aldo
incr deoxycorticosterone
incr ACTH, androgens, virulization
HTN
Cortisol regulation
CRH found in paraventricular nuc
ACTH: upreg its own rec on adrenals
Cortisol: inhibits CRH and ACTH rls
Dexamethasone suppresion test
Potent glucocorticoid that can't cross bbb - thus tests pituitary suppression.
The test is given at low and high doses of Dexamethasone and the levels of cortisol are measured to obtain the results. A normal result is decrease in cortisol levels upon administration of low-dose dexamethasone. Results indicative of Cushing's disease involve no change in cortisol on low-dose dexamethasone, but inhibition of cortisol on high-dose dexamethasone. If the cortisol levels are unchanged by low and high-dose dexamethasone then a cortisol secreting adrenocortical tumor is highly suspect.
Cortisol actions
stress hormone
stimu gluconeogenesis
1. incr protein catabolism
2. Decr glucose utilization and insulin sensitivity of adipose
3. Incr lipolysis for more glycerol to liver for gluconeogenesis.
Antiinflamm: incr Lipocortin (inhibits PLPA2)
Inhibit production of Il-2 and T cells.
Maintenance of vasc sensitivity to catecholamines.
Addisons dz
primary adrenocortical deficiency: AI destruction
Incr ACTH
Decr glucocorticoids, Mineralcorticoids, androgens
Sx: hypoglycemia (cortisol def), hyperpigmentation, decr pubic and axillary hair in women
ECF vol contraction, HoTN, hyperkalemia, metabolic acidosis
Cushings Syndrome
cause
sx
Tx
Syndrome: 1' adrenal prob or from exogenous steroid excess
Dz: overproduction of ACTh
Hyperglycemia
Incr androgens, cortisol
Incr catabolism and muscle wasting
poor wound healing
Central obesity
Virilization in women
HTN, stiae
Osteoporosis (incr cortisol)
Tx: Ketoconazole (inhibits steroid synth), Metyrapone
Conn's syndrome
Hyperaldosteronism
from ACTH secr tumor
Hypokalemia
Hypervolemia, HTN
metabolic alkalosis
DECR RENIN
21 beta hydroxylase def
Adrenogenital syndrome
virilization in women
incr ACTH
decr Cortisol
decr aldosterone
Metabolic acidosis
early puberty.
Suppression of gonadal fx in both men and women
17 alpha hydroxylase def
Decr androgens and glucocorticoids
Incr Aldo, incr ACTH
lack of pubic hair and axillary hair on women
hypoglycemia
metabolic alkalosis, hypokalemia, HTN
Glut 2 rec
glucose receptor on beta cells
glucose -> ATP which closes K+ channels in cell membrane leading to depol of beta cells opens Ca channels -> insulin secr
Sulfonylureas do the same.
Insulin receptor
tyr kinase -2alpha 2beta subunit
beta subunit has the tyr kinase autophos activity.
Incr downreg its own rec
Starvation= more rec
Obesity= less rec
Glucogon
incr gluconeogenesis: by decr production 2,6 bisphophate -which decr PFK activity
Incr lipolysis and urea production
Insulin and gluconeogenesis
Insulin upregulates production of 2,6 bisphosphate - to incr action of PFK
Insulin actions
glycogenesis, glycolysis
Decr blood FA and ketoacid - stim fat deposition
Incr AA uptake
Stim K+ uptake into cells.
PTH actions
kidny: incr phosphate dumping (incr urinary cAMP bc of PTH), incr Ca reabsorption
incr Ca reabsorption in intestine via conversion to 1,25 vit D in kidney
PTH origin
Chief cells of parathryoid
Albrights syndrome
Pseudohypoparathyroid osteodystrophy
Defective Gs receptor in kidney and bone - rendering PTH ineffective
Hypocalcemia, hyperphosphatemia
elevated PTH
most common Cause of
hyperPTH
hypoPTH
hyperPTH most commonly due to PTH adenoma
HypoPTH most commonly due to thyroid surg.
CRF and PTH
Decr GFR -> phosphate retention and incr serum Phos
-> incr complexing with Ca + Decr conversion to Vit D-> decr serum Ca
-> Incr PTH
= Renal osteodystrophy (incr bone resorption + osteomalacia)
1 alpha hydroxylase
found in Kids
converts 25 vit D to 1,25
Upreg by decr serum Ca, incr PTH, decr serum phos
sun and vit D
Sunlight takes 7 dehydrocholesterol to cholecalciferol - which is converted to 25 Vit D in the liver
5 alpha reductase
converts Testosterone to Dihydrotestosterone
Prostate
finasteride is the inhibitor
Stimulation of cholesterol desmolase
Incr by ACTH (adrenals)
Incr by LH (testiclees)
Inhibin
and
Testosteron
secr from Sertoli cells to inhibit FSH
testosterone inhibits secr of LH by inhibits GnRH rls and directtly on ant pit.
GnRH
rls from arcuate nucleus of hypothalamus
stimulates FSH and LH rls from pit.
Leuprolide is a GnRH analogue that initially bumps FSH and LH but then through fdbk lowers both.
FSH
sertoli cells to maintain spermatogenesis which leads to inhibin rls
LH
acts on leydig cells for testosterone production
Dihydrotestosterone
Prenatal differentiation of external genitalia
male hair distrubution
5 alpha reductase is found in peripheral tissues -
Prenatal testosterone
differntiation
Puberty
onset of pulsatile GnRH rls
FSH and LH are in turn rls in pulsatile fashion
GnRH upreg its own rec in ant pit
FSH and LH lifetime levels
prepubertal FSH>LH
pubertal/fertile period LH>FSH
senescence FSH>LH
Theca Cells
Granulosa cells
Theca cells produce testosterone via LH stim
Granulosa cells via aromatase convert local testosterone to 17beta estradiol (stim by FSH)
ER
maturation and maintenance of fallopian tubes, uterus, cervix and vagina.
secondary sex characteristics
breast development
up regulates ER, LH, and PR rec
prolif and development of granulosa cells.
maintains preg
stim PRL secr + blocks its actions on the breast
PR
fdbk involvement
what does it do during cycle and preggar
neg fdbk on FSH and LH during lacteal phase
maintains secretory activity of uterus during luteal phase
maintains pregnancy
helps breast devlopment'
Flutamide
blocks DHT receptor good for BPH
Double uterus, bicorneate nuc etc
due to improper or incomplete fusion of the paramesonephric duct
Sheehan syndrome
Panhypopituitarism
Postpartum pit necrosis
ischemia of the gland ass with hemorrhage and shock during childbirth
Sx -
#1 loss of gonadotrophin then subsequent loss of TSH and ACTH
Nelson syndrome
After bilateral adrenal resection
Large pituitary adenomas due to lack of adrenal inhibition on prexisting pit microadenomas
Nodular goiter
late stage of simple goiter
Most nodules are cold and thus do not take up radioactive iodine
Myxedema
Hashimoto thyroiditis
Iodine def
puffiness of face, eyelids and hands
dry hair, hair loss, brittle hair
slowed DTR
Cretinism
iodine def, def enzymes, developmental def
Transplacental antithryoid abs transfer
Sever MR
darwfism and retarded bone development
large tongue
protuberant abdomen
Menorrhea
thyroid abnormalities
Hypothyroid:
menorrhagia
Hyperthyroid: amenorrhea, oligomenorrhea
Graves Dz
genetics
HLA DR3, HLA B8 association
Thyroid stimulating Ig reacts with thyroid follicle TSH rec.
Struma Ovarii
ovarian tumor made of thyroid tissue - hyperfxing
Hashimoto thyroiditis
antimicrosomal (antimitochondrial are primary biliary cirrhosis)
Slow indolent course
euthyroid at first then hyperthyroid, then hypo
Massive lymph infiltrate with GC in thryoid
Atrophic Follicles and Hurthle Cells
Hashimoto abs
and genetics
Autoantibodies
antithyroglobulin, antithyroid peroxidase, anti TSH rec, antiiodine rec.
HLA-DR5, HLA-B5
incr incidence with pernicious anemia, DM, sjogrens
Subacute (de Quervain granulomatous) Thyroiditis
Post viral - mumps/coxsackie
Focal destruction and granulomas
Transient flulike illness and thyroid pain
Reidels
thryoid tissue replaced with fibrosis
Papillary Carcinoma
Good prognosis, most common thyroid cancer
Ground galss orphan annie nuclei
Psammoma bodies (calcified spheres), papillary projections into glandlike spaces
Ass with prior radiotherapy
Follcular Carcinoma
uniform follicles
poorer prognosis than papillary
Medullary Carcinoma of thyroid
pathophys
associations
C cells of thyroid
Makes calcitonin
sheets of tumor cells with amyloid containing stroma
Ass with MEN II a + b
Cause of Primary HyperPTH
#1 parathyroid adenoma
#2 paraneoplastic syndrom
Lung SCC and Renal CC
#3 MEN I and MEN IIa
HyperPTH
sx
Metastatic calcification in tiss, esp kids (nephrocalcinosi)
Incr Alk Phos
Osteitis fibrosa cystica
Renal calculi
Peptic duodenal ulcer (hypercalcemia)
Causes of secondary hyperPTH
CRF - vit D conversion impaired
PseudohypoPTH
cause
pathophys
sx
Mutation in GNAS1 - imprinting
Decr Ca, incr phos, incr PTH
Multihorm resistance involving PTH and TSH, LH, FSH
Kidney doesn't respond to PTH
Shortened 4th and 5th metacarpals/tarsal, short stature etc
Primary vs Secondary hyperaldosteronism
renins levels
causes
Primary hyperaldo: Renin low
Secondary hyperaldo: renin high
secondary to renal ischemia, tumors and edema (CHF, cirrhosis_
Pheochromocytoma associations
MEN IIa, IIb
NF
vHL
Tx - phenoxybenzamine, phentolamine
Neuroblastoma genetics
N-myc
severity related to amount of amplified copies of the gene
Homologous staining regions and double minutes
Can differentiate in to ganglioneuroma
HTN, catechols in urine
large abdominal mass
DM1 genetic ass
Pt mutation in HLA DQ
HLA DR4 + HLA DR5
less ass with familial than DM2
insulinitis
DM2
islets
focal islet fibrosis and hyalinization
amylin deposition interfers with conversion of proinsulin to insulin or with sensing of insulin by beta cells
Secondary diabetes
hemochromatosis
pancreatitis
carcinoma of the pancreas
GH excess
Gluconoma
Cushing
acromegaly
MEN I
Hyperplasia/tumor of:
Pituitary
Parathyroid
Pancreatic:
Thus ZE syndrome, insulinomas, VIPomas
Cr 11 - menin tumor supressor
MEN II a
Ret oncogene mutation (tyr kinase)
Pheochromocytoma
medullary carcinoma
hyperPTH
MEN IIb
ret mutation (tyr kinase)
pheo
medullary carcinoma
oral and intestinal ganglioneuromas/neuromas
NO hyperPTH
Cause of juvenile diabetes
Rubella mumps and coxsackie
can trigger and abs response to pancr beta cells.
Metformin
decr hepatic gluconeogeneis
lactic acidosis is rare SE
Pioglitazone
Rosiglitazone
insulin sensitization
can exacerbate CHF
Sulfonureas
decr K+ efflux and incr Ca influx
incr pancreatic insulin rls
can lead to hypoglycemia
Paragangliomas
extraadrenal chromaffin cell tumors.
(tumors originating in the organ of zuckerland)
Granulosa-Theca tumor vs
Theca Fibroma vs
Sertoli-Leydig cell tumor
Granulosa-Theca tumor - lipid laden cells that secret ER - benign but leads to precocious puberty or endometrial hyperplasia
Theca fibroma: Meigs syndrome - ascites and hydrothorax
Sertoli-Leydig - virilization - makes testosterone