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84 Cards in this Set
- Front
- Back
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what is the most common tumor of the adrenal medulla in adults?
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pheochromocytoma
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what is the most common tumor of the adrenal medulla in children?
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neuroblastoma
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What are the layers of the adrenal cortex?
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GFR: glomerulosa, fasciculata, reticularis
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what regulates the function of the Zona Glomerulosa and what does it secrete?
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Renin-angiotensin system --> secretes aldosterone
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What regulates the function of the Zona Fasciculata and what does it secrete?
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ACTH, hypothalamic CRH --> secretes Cortisol
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What regulates the function of the Zona Reticularis and what does it secrete?
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ACTH, hypothalamic CRH --> secretes sex hormones
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What is the main secretory cell of the adrenal medulla? What does it secrete?
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Chromaffin cell secretes catecholamines
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What provides the regulatory input to the adrenal medulla?
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preganglionic sympathetic fibers
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Describe the venous drainage of the left adrenal gland?
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left adrenal vein --> left renal vein --> IVC
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Describe the venous drainage of the right adrenal gland?
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right adrenal vein --> IVC
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what hormones are released from the posterior pituitary? where are those hormones made?
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vasopressin (ADH) and Oxytocin; they are made in the hypothalamus and shipped to the neurohypophysis for release
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What hormones are released from the anterior pituitary?
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FLAT PiG: FSH, LH, ACTH, TSH, Prolactin, GH
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from what embryonic structure is the posterior pituitary derived?
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neuroectoderm
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from what embryonic structure is the anterior pituitary derived?
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oral ectoderm
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Which pituitary cells stain acidophilic?
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GH, prolactin
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which anterior pituitary secretory cells stain basophilic?
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B-FLAT: Basophils- FSH, LH, ACTH, TSH
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What are the cell types of the islets of langerhans and what do they secrete?
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Alpha cells secrete glucagon, Beta cells secrete insulin and Delta cells secrete somatostatin
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Where are each of the cell types in the islets of langerhans located?
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alpha cells are peripheral, beta cells are central, and delta cells are interspersed
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how is prolactin secretion regulated differently from the other hormones in the pituitary?
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it is the only hormone that is controlled mainly by inhibition (Dopamine)
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Amenorrhea is commonly seen in tumors secreting what pituitary hormone and why?
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prolactinomas due to an inhibitory effect on the secretion of GnRH
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Somatostatin inhibits the release of which two pituitary hormones?
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GH, TSH
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17 alpha-hydroxylase deficiency has what pathophysiologic mechanism?
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prevention of production of glucocorticoids and androgens --> excess mineralocorticoids and high ACTH
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what are the symptoms of 17-alpha-hydroxylase deficiency?
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hypertension, hypokalemia; phenotypically female, but no sexual maturation
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21-alpha-hydroxylase deficiency has what pathophysiologic mechanism?
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inability to hydrolyze progesterones to synthesize cortisol and aldosterone --> shunts steroid production to androgens
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what are the symptoms of 21-alpha-hydroxylase deficiency?
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masculinization, female pseudohermaphroditism, hypotension, hyperkalemia, increased plasma renin and volume depletion
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11-beta-hydroxylase deficiency has what pathophysiologic mechanism?
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inability to completely synthesize mineralocorticoids and glucocorticoids --> increase in sex hormone production
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what are the symptoms of 11-beta-hydroxylase deficiency?
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masculinization, hypertension (11-deoxycorticosterone is a functional mineralocorticoid)
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Which cells secrete PTH?
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chief cells of the parathyroid
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what are the functions of PTH? (4)
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1. increased bone resorption of calcium and phosphate
2. increased kidney reabsorption of calcium in distal convoluted tubule 3. decreased kidney reabsorption of phosphate 4. increased 1,25-(OH)2 vitamin D production by stimulating kidney 1-alpha-hydroxylase |
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Which cell(s) of the bone do(es) PTH stimulate?
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both osteoblasts and osteoclasts
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what are normal effects of PTH on lab values?
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increased serum Ca, decreased serum PO4 and increased urine PO4
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What are the functions of vitamin D?
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1. increased absorption of dietary calcium
2. increased absorption of dietary phosphate 3. increased bone resorption of Ca and PO4 |
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what factors increase vitamin D production?
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increased PTH and decreased serum calcium and phosphate
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what lab values are changed in hyperparathyroidism?
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increased PTH, Ca, Alk Phos; decreased Phosphate
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what lab values are changed in Paget's disease of bone?
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alk phost greatly increased; Normal PTH, phosphate, Ca
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what lab values are changed in Vitamin D intoxication?
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Increased Ca, Phosphate; Normal Alk-phos; decreased PTH
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what lab values are changed in osteomalacia?
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Decreased Ca, phosphate; Increased PTH, Alk-phos
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what lab values are changed in osteoporosis?
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all are normal
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what lab values are changed in renal insufficiency?
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Decreased Ca; Increased phospate, PTH; Normal alk-phos
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what is the source of calcitonin?
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parafollicular cells (C-cells) of the Thyroid
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what is the function of calcitonin?
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tones down calcium - decreases bone resorption of calcium
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what is the regulation of calcitonin?
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increased serum Ca causes calcitonin secretion
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Which hormones need gene transcription and protein synthesis to execute their effects?
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PET CAT: Progesterone, Estrogen, Testosterone, Cortisol, Aldosterone, Thyroxine and T3
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Will increases in the steroid binding globulins affect the amount of free hormone in the serum?
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only transiently. an increase in steroid binding globulins will create a transient decrease in free hormone, which will result in synthesis of that hormone to maintain steady-state levels
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What is the function of T3/T4?
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Bone growth; CNS maturation; Beta-adrenergic effects; increased basal metabolic rate; increased glycogenolysis, gluconeogenesis, and lipolysis
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skeletal muscle and adipose tissue have which glucose receptor?
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GLUT 4
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Brain and RBCs have which glucose receptor?
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GLUT-1
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What is the source of cortisol?
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adrenal fasciculata
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what are the functions of cortisol? (5)
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1. anti-inflammatory; 2. increased gluconeogenesis, lipolysis, proteolysis; 3. decreased immune function; 4. maintains blood pressure; 5. decreased bone formation
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what effect does chronic stress have in cortisol levels?
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chronic stress induces prolonged cortisol secretion
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Which hormones activate cGMP?
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ANP, EDRF, NO
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Which hormones activate the IP3 pathway?
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GnRH, TRH, GHRH, ADH (V1), Oxytocin
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Which hormones activate the tyrosine kinase pathway?
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Insulin, IGF-1, FGF
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What are the etiologies of cushing's syndrome?
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cushing's disease (primary ACTH production); primary adrenal hyperplasia (decreased ACTH); ectopic ACTH production; Iatrogenic (decreased ACTH)
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What are the symptoms of cushing's syndrome?
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hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia, skin changes (striae, thinning), amenorrhea, osteoporosis, immune suppression
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What are symptoms of primary hyperaldosteronism?
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hypertension, hpyokalemic metabolic alkalosis, low plasma renin
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what are causes of secondary hyperaldosteronism?
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renal artery stenosis, chronic renal failure, CHF,cirrhosis, or nephrotic syndrome
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What is the pathogenesis of secondary hyperaldosteronism?
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kidney perception of low intravascular volume results in overactive renin-angiotensin system --> high plasma renin
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how do you distinguish between primary and secondary addison's disease?
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primary results in an over-production of ACTH, so it causes hyperpigmentation. Secondary addison's has a decrease in ACTH, so no skin pigmentation
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what causes the hyperpigmentation in addison's disease?
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MSH, a biproduct of ACTH from POMC
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what appears in the urine of patients with neuroblastoma?
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HVA
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what appears in the urine of patients with pheochromocytoma?
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VMA
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what other disorders is pheochromocytoma associated with?
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neurofibromatosis, MEN II and MEN III
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neuroblastoma is caused by a mutation in what gene?
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N-myc oncogene
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how is pheochromocytoma treated?
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phenoxybenzamine, an irreversible alpha blocker
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Describe MEN I
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3 P's: Pancreas, Pituitary, and Parathyroid; presents with kidney stones and stomach ulcers
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Describe MEN II
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medullary carcinoma of thyroid, pheochromocytoma, parathyroid tumor
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describe MEN III
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pheochromocytoma, oral mucosal neuromas, medullary carcinoma of the thyroid
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what gene is mutated in MEN II and MEN III
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ret oncogene
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symptoms of hypothyroidism?
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cold intolerance, hypoactivity, weight gain, fatigue, lethargy, decreased appetite, constipation, decreased reflexes, myxedema, coarse, brittle hair
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symptoms of hyperthyroidism?
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heat intolerance, hyperactivity, weight loss, chest pain, arrhythmias, diarrhea, warm, moist skin, fine hair.
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what is graves' disease?
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autoimmune hyperthyroidism with thyroid-stimulating/TSH antibodies
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what is thyroid storm?
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underlying graves' disease with a stress-induced catecholamine surge leading to death by arrhythmia
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what is hashimoto's thyroiditis?
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autoimmune disorder resulting in hypothyroidism. lymphocytic infiltrate with germinal centers. antimicrosomal and antithyroglobulin antibodies
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self-limited hypothyroidism following a flu-like illness. elevated ESR, jaw pain, early inflammation and tender thyroid gland
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subacute thyroiditis (de Quervain's)
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most common thyroid cancer?
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papillary carcinoma
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describe medullary carcinoma
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from parafollicular C cells. produces calcitonin, sheets of cells in amyloid stroma. MEN II and MEN III
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lymphoma of thyroid associated with what?
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hashimoto's thyroiditis
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pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue. what is the underlying cause?
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cretinism --> lack of dietary iodine in child or defect in thyroid hormone synthesis
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what is Chvostek's sign? what does it mean?
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tap facial nerve --> contraction of facial muscles. signifies hypoparathyroidism
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What is Trousseau's sign? What does it mean?
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occlusion of brachial artery with BP cuff --> carpal spasm
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what are the clinical manifestations of a prolactinoma?
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amenorrhea, galactorrhea, low libido, infertility.
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what is a pharmacological treatment for prolactinoma?
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bromocriptine --> dopamine agonist
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what are complications of diabetic ketoacidosis?
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life-threatening mucormycosis, rhizopus infection, cerebral edema, cardiac arrhythmias, heart failure
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