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73 Cards in this Set
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Endocrine
What are the three layers of the adrenal cortex and what do they regulate and secrete? |
Zona Glomerulosa: Salt (renin-angiotensin --> aldosterone)
Zona Fasiciculata: Sugar (ACTH, hypothalamic CRH --> Cortisol) note: cortisol acts like glucagon Zona Reticularis: Sex (ACTH, hypothalamic CRH) --> androgens |
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Endocrine
What is made in the adrenal medulla? |
Catecholamines (Epi, NE)
(Preganglionic sympathetic fibers) |
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Endocrine
What is the most common adult adrenal medulla? children? Differences? |
Adults: pheochromocytoma
(causes episodic hypertension) Children: neuroblastoma (no hypertension assoc) |
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Endocrine
Explain the adrenal gland drainage: |
Left adrenal --> left adrenal vein --> left renal vein --> IVC
Right adrenal --> right adrenal vein --> IVC |
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Endocrine
What is the inhibitory function of somatostatin? |
(from the hypothalamus)
It is a negative inhibitor of GH and TSH |
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Endocrine
What is the mechanisms of hormone action for: 1. all the hormones in the anterior pt 2. all the hormones in the posterior pt 3. steroid hormones and thyroid horm? 4. insulin 5. NO |
1. ant pit: cAMP --> PKA --> phos
2. post pit: PLC --> IP3 and Ca --> PKC and arachidonic acids (to prostaglandins) 3. steroid/thyroid: intercell binding --> exposes DNA binding domain --> DNA transcription --> mRNA translation --> new protein synth 4. insulin: tyrosine kinases 5. NO: cGMP |
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Endocrine
What two organs depend on insulin for increased glucose uptake? What two organs do not use insulin? |
Skeletal muscle and adipose tissue (GLUT-4)
Brain and RBC's: don't need insulin (GLUT 1) |
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Endocrine
What are the five functions of cortisol? |
1. anti-inflammatory
2. increase gluconeogenesis, lipolysis, and proteolysis 3. decrease immune function 4. maintains blood pressure 5. decreases bone formation |
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Endocrine-HY
What can be used to suppress a prolactinoma? |
Bromocriptine
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Endocrine
What two symptoms do only women get when they have a prolactinoma? |
amenorrhea and galactorhea
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Endocrine-HY
What medications can induce "prolactinoma-like" effects? |
Any drug that interfers with dopamine (prolactin inhibitory factor) and is assoc with estrogen therapy:
OC methyldopa reserpine hydralazine Ca channel blocers |
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Endocrine
Other than general enlargement of jaws, face, hands and feet, what does acromegaly do that is negative? (4) |
Enlargement of the viscera
Hyperglycemia (insulin resistance) Osteoporosis Hypertension |
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Endocrine
What do you use to treat gigantism with? |
Octreotide
(when you are as big as a tree you need 8x as much medication = OCT-TREE-odide |
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Endocrine
Is an increased GH normal with stress? |
Yes! My GH must be through the roof!!
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Endocrine
If a high level of dexamethasone decreases cortisol (and low doesn't) what is the dx? |
Pituitary Cushings
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Endo
What is an example of ectopic ACTH production? |
Small cell CA of the lung
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Endo
How do you distinguish Cushing from Cushing-like obestity? |
Get a 24hr urine cortisol test -- it takes alot of cortisol to make it into the urine (thus it would be Cushings)
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Endo
What does the anterior pituitary gland secrete? |
FLAT PiG
FSH LH ACTH TSH Prolactin GH |
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Endo
What causes Sheehans syndrome? What does it cause? |
Often pregnancy related ischemia of the pituitary gland (hypotension --> vasospasm --> ischemic necrosis)
Causes: anorexia, fatigue, poor lactation, loss of pubic and axillary hair |
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Endo
What is the best way to test for growth hormone deficiency? |
5am blood draw for insulin-like growth factor or arginine stimulation test (this is why weightlifters get arginine tests)
Note: arginine and histadine are absolutely necessary for growth. |
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Endo
Which causes increased skin pigmentation: Primary or Secondary adrenal failure? What is an example of an enzyme that can cause this? |
Primary since it allows for release of both ACTH and beta melanocyte stimulating hormone and since there is no cortisol produced = no inhibition on ACTH => lots of beta melanocyte stim.
Adrenal cortical deficiency in 21 alpha hydroxylase would cause hyperpigmentation --> no cortisol to inhibit ACTH |
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Endo
What does SIADH do to sodium levels? |
It causes dilutional hyponatremia.
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Endo
What drug is used to treat SIADH? |
Demeclocyline and H2O retriction
(Deme Moore has SIADH) |
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Endo
FA: What drug can induce SIADH? |
Cyclophosphamide
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Endo
What causes diabetes insipidus? |
deficiency of ADH = polyuria, insatiable thirst, and dehydration
Can be caused by trauma, tumors, inflammatory processes, lipid |
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Endo
How can a water deprivation test be used to diagnose Diabetes insipidus vs central diabetes? |
give patient ADH:
Does urine increase in osmolality? Yes = central diabetes insipidus No increase in osmolality = nephrogenic (not DI) |
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Endo
Where does a craniopharyngioma come from? |
Rathke's pouch
It is a benign childhood tumor derived from remnants of the Rathke pouch and is not a true pituitary tumor. |
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Endo
Describe the appearance of craniophayngioma: |
Nest and cords of squamous or columnar cells in a loose stroma, closely resembling the appearance of the embryonic tooth bud enamel organ.
This tumor is often cystic and the lining epithelium of flat or columnar cells often expands into papillary projections. Has keratin. Calcification is common |
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Endo
MC sign of craniopharyngioma? |
Bitemporal hemianopsia
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Endo
Where is the MC location of a craniopharyngioma? |
Suprasellar
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Endo
Cause of empty sella syndrome? |
Any condition that destroys all or part of the pituitary. It leads to a defect in the diaphragm sellae
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Endo
What is Nelson syndrome? |
A large adenoma that develops following bilateral adrenalectomy. This is thought to be due to a loss of feedback inhibition on growth of preexisting pituitary microadenomas.
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Endo
Midline cyst in the neck? |
Thyroglossal duct cyst
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Endo
Where is a brachial cleft cyst found? |
In the anterolateral neck
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Endo-Goljan
Name four things that tyrosine is used to make? |
T4T3 (binds with iodide)
Dopamine NE,Epi Melanin |
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Endo-Goljan
What kind of hypertension is seen in hypothyroidism? |
Diastolic
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Endo
What is two embryologic problems causes hypothyroidism? |
Cretinism caused by failure of the fetal thyroid to descend from its origin at the base of the tongue
Transplacental transfer of antithyroid antibodies from a mother with autoimmune thyroid disease |
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Endo-Goljan HY
What receptors does T4 upregulate? |
Beta1 receptors
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Endo-Goljan HY
Why would you use a beta blocker to treat Grave's disease? |
To block adrenergic response, all symptoms will go away including sweating
If you just used proprothyrutine to inhibit gland you would not stop the sweating. |
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Endo
What type of hypersensitivity reaction is involved in Grave's disease? |
Type II
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Endo-Goljan
What heart problem will "all people with Graves" get? |
A-fib -- if a pt comes in with a-fib you must get a TSH level to rule out Graves dz
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Endo-Goljan
What are three major disorders that involve a deposition of glycosomaminoglycans? |
Mitral valve prolapse (increase in dermatan-sulfate)
Hashimotos Graves |
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Endo
What is a thyroid storm? |
A underlying Graves dz with a stress-induced catecholamine surge leading to death by arrhythmia
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Endo-QBANK
Pt who is pregnant, in labor, with no prenatal care. Pt is noted to very restless, with fever, profuse sweating, tachycardia, and abdominal pain between contractions. Dx? |
Thyrotoxic crisis: untreated Grave's
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Endo
Describe the histo of Hashimoto's thyroiditis? |
Massive infiltrates of lymphocytes with germinal centers; thyroid follicles are atrophic with Hurthle cells (epithelial cells with eosinophilic granular cytoplasm).
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Endo
What chromosomal abnormality is assoc with Papillary CA? |
chr10
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Endo
Where does follicular CA metastasize to? |
It INVADES blood vessels!!! Not lymphnodes!!
Goes to lung and bone |
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Endo
Which thyroid CA has the poorest prognosis? |
Follicular CA
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Endo
What CA originates from the C cells of the thyroid? What does this produce? |
Medullary CA of the thyroid
Produces calcitonin, a calcium lowering hormone |
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Endo
What histo distinguishing characteristic do medullary CA of the thyoid tumor cause? |
Amyloid-containing stroma
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Endo
What endocrine disorder is in MEN I and MEN IIa? |
Hyperparathyroidism
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Endo
What bone disorder is seen in hyperparathyroidism? |
Osteitis fibrosa cystica (cystic changes in bone due to osteoclastic resorption; aka von Reckinghausen disease = fibrous replacement of bone leads to "brown tumors")
"Bones, stones, groans" |
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Endo
In hyperparathyroidism there are increased levels of circulating Ca: what main problem can this cause? |
Ca can deposit in any organ (esp the kidney) = renal stones
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Endo
MCC of hypoparathyroidism? |
Accidental surgical excision during thyroidectomy
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Endo
What is the major sign of hypoparathyroidism? |
Hypocalciemia induced tetany
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Endo
What is Chovostek's sign and Trosseau's sign? |
Chovosteks: tap facial n --> contraction of facial m.
Trosseaus: occlusion of brachial a with BP cuff causes carpal spasm |
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Endo
Describe psuedohyperparathyroidism: |
Autosomal dominant kidney unresponsiveness to PTH. Characteristics include hypocalcemia, shortened 4th/5th digits, short stature.
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Endo
Why do you get tetany with primary aldosteronism? |
Primary aldosteronism:
Overproduction of adrenal minerocorticoid by adrenal glands causes hypertension, sodium and water retention, hypokalemia and hypercalcemia. However because of increased H excretion there is a metabolic alkalosis --> this causes albumin to take on an increased negative charge -> bind more Ca = hypcalcemia!!! TETANY! |
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Endo:
Compare primary and secondary aldosteronism in terms of renin levels: |
Primary: decreased renin
Secondary: increaed renin |
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Endo - ON TEST!!! HY
What is the most likely cause a baby with ambiguous genitalia? |
21-hydroxylase deficiency: which is salt wasting and hypotensive.
Adrenal virilism produces virilism in females and precocius puberty in males. (other cause: 11-hydroxylase def) |
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Endo
What is the cause of Addison's disease? |
Idiopathic adrenal atrophy (autoimmune destruction of gland)
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Endo
What are the four characteristic features of Addison's disease? (and 5 lab values) |
1. hypotension
2. increased pigmentation of skin 3. decreased serum Na, Cl, glucose, and bicarbonate, and potassium 4. peaked t waves |
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Endo
How many of the regions of the adrenal cortex are involved in addison's? |
All three!!!
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Endo
How do you distinguish primary Addison's with secondary? |
secondary has no skin pigmentation
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Endo
What findings of an ACTH stimulation test lead to a dx of Addisons and lead to hypopituitarism? |
ACTH stim test --> give ACTH and test urine for 17-hydroxycorticoids
Day 1-5 --> nothing happens = Addison's disease (gland was destroyed) If days 2-3 there was an increase in 17-hydroxycorticoids --> hypopituitarism (gland was atropic because it wasn't being stimulated by ACTH) |
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Endo
What will blood pH be in a patient with Addisons? |
acidic --> no aldosterone = no excretion of H = acidotic
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Endo
Pheochromocytoma: origin, effects |
Pheochromocytoma: neural crest origin that causes HTN
Tumor of chromaffin cells of the adrenal medulla |
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Endo-Goljan
How do you distinguish a pt with regular HTN with a pt with Pheochromocytoma? |
In pheochromocytoma the HTN is unstable and stress related; comes when they are very anxious; accompanied with sweat.
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Endo
What is a neuroblastoma? |
A highly malignant neural crest tumor in children.
Present as a large abdominal mass. FA: It can occur anywhere along the sympathetic chain; will have HVA in the urine; less likely to cause HTN (compared to pheochromcytoma) |
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Endo
What oncogene is assoc with neuroblastoma? |
N-myc oncogene
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Endo
What are the 3P's of MEN I? |
Pituitary, Parathyroid, Pancreatic islets - can also include hyperplasias or tumors of thyroid or adrenal cortex.
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Endo
What MEN syndrome can manifest as Zollinger-Ellison syndrome? |
MEN I (4 P's - last one for peptic ulcer)
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Endo
Tumors assoc with MEN IIa and IIb? |
IIa: pheochromo, medullary thyroid CA, and hyperparathyroid due to hyperplasia or tumor
IIb: pheochromo, medullary CA, oral and intestinal mucus neuromas (no parathyro) Both are linked to the ret oncogene but linked to different mutations! |
