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101 Cards in this Set
- Front
- Back
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What is the only steroid hormone with a cytoplasmic receptor?
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cortisol
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Where is erythropoetin made?
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kidney- renal parenchymal cells
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What is the signal for erythropoetin?
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hypoxia
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What inhibits erythropoetin?
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increased oxygen
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Where does erythropoetin act?
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bone marrow
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What is the second messenger for erythropoetin?
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tyrosine kinase
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How do you calculate hematocrit based off of hemoglobin?
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hemoglobin x 3
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How do you calculate hematocrit based off of RBCs and volume?
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ht = RBC/volume
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What is the normal RBC range?
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3.5-4.5 million
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What is considered polycythemia?
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> 6 million
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If you suspect polycythemia, but the erythropoietin levels are normal, what is the problem?
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Gaisbock, stress polycythemia, or spurious- all due to a loss of volume
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Is Gaisbock, what levels would be increased?
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hemoglobin
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Why does stress cause polycythemia?
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cortisol causes increased cell dividing
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Increased erythropoietin with polycythemia is due to?
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hypoxia
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What symptoms does acute hypoxia present with?
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tachypnea and dyspnea
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What is the clue to chronic hypoxia?
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clubbing
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What cancer in adults can cause chronic hypoxia?
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renal cell carcinoma
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What cancer in children causes chronic hypoxia?
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Wilm's tumor
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What is the difference between Wilm's and neuroblastoma?
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Wilm's is unilateral and neuroblastoma is bilateral
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What does having polycythemia and decreased erythropoietin mean?
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you have cancer- bone marrow is acting on its own
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What are the 3 layers of the adrenal cortex?
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GFR- glomerulosa, fasciculata, reticularis
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The zona glomerulosa produces what?
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aldosterone
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The zona fasciculata produces what?
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cortisol
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The zona reticularis produces what?
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sex steroids
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What does the adrenal medulla produce?
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catecholamines
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What is the stimulus for aldosterone secretion?
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hypovolemia, hyponatremia, hyperkalemia
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What inhibits aldosterone secretion?
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hypervolemia
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Where does aldosterone act?
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late DCT
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What is the second messenger for aldosterone?
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none
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Too much aldosterone is what syndrome?
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Conn's
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What are the 4 signs of Conn's?
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hypernatremia, hypokalemia, alkalosis and hypertension
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What is the side effect of spironolactone?
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gynocomastia
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What is too little aldosterone called?
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adrenal insufficiency
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What enzyme deficiency causes adrenal insufficiency?
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21 beta hydroxylase and 17 alpha hydroxylase
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What is the number 1 cause of adrenal insufficiency in adults? Number 2?
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abrupt withdrawal of steroids, second is autoimmune
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What is the rule for steroid hormone synthesis and enzyme deficiencies?
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begins with a 1 (17, 11)- hypertension
begins with a 2 (21)- hypotension |
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Why does a 17 alpha hydroxylase deficiency cause hypertension?
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because 11-deoxycorticosterone causes salt retention
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What is cortisol release stimulated by?
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stress, hypoglycemia
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What inhibits cortisol release?
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hyperglycemia
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What is the function of cortisol?
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permissive- upregulates all receptors
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What are the physiological effects of cortisol?
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proteolysis and gluconeogenesis
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What are the antinflammatory effects of cortisol?
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KISSI- kills T-cells and eosinophils
inhibit macrophage migration stabilizes endothelium stabilizes mast cells inhibits phospholipase-A |
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Too little cortisol is called what?
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adrenal insufficiency- Addisons
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Too much cortisol is called what?
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Cushing's Syndrome
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What is the difference between Cushing's disease and Cushing's syndrome?
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disease effects 1 organ
syndrome effects more than 1 organ |
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An alpha enzyme deficiency causes what sex to look like what?
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male that looks female
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A beta enzyme deficiency causes what sex to look like what?
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female that looks male
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In the dexamethasone test, if cortisol production is suppressed from a low dose, what does the patient have?
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obesity, depression, or normal variant
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In the dexamethasone test, if cortisol production is suppressed from a high dose, what does the patient have?
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Pituitary adenoma
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In the dexamethasone test, if cortisol production is not suppressed from a high dose, what does the patient have?
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check ACTH levels-
high ACTH- small cell carcinoma low ACTH- adrenal adenoma |
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What controls the development of male external genitalia in utero?
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testosterone
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Where is testosterone converted to DHT?
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testes
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WHat enzyme converts testosterone to DHT?
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5 alpha reductase
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What leads to secondary male characteristics?
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DHT
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What does too much DHT lead too?
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hair loss
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What two drugs are used to treat male pattern baldness?
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fenestride and flutamine
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How does fenestride work?
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5 alpha reductase inhibitor
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How does Flutamine work?
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blocks DHT receptors
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What is the main form of testosterone in women?
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DHEA
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What is male internal genitalia controlled by?
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MIF
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Where is epinephrine produced?
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adrenal medulla
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What stimulates epinephrine release?
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stress/hypoglycemia
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What inhibits epinephrine release?
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hyperglycemia
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Where does epinephrine go?
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liver and adrenal cortex
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What does epinephrine stimulate?
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gluconeogenesis and glycogenolysis
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What is the second messenger for epinephrine?
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cAMP
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Who gets a pheochromocytoma and neuroblastoma?
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pheo- adults
neuro- children |
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What is produced as excess in a pheochromocytoma and neuroblastoma?
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NE and EPI
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What are the symptoms of neuro and pheo?
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intermittent palpitations, HTN, diaphoresis, and headache
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Is a neuroblastoma unilateral or bilateral?
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unilateral
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What do you measure to check for the breakdown of NE and EPI?
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urinary VMA and metanephrines
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How do you differentiate between a benign or malignant pheochromocytoma or neuroblastoma?
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biopsy
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What is the most common abdominal mass in children?
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neuroblastoma
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What is the rule of 10 for pheochromocytoma?
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10 % malignant
10 are bilateral 10 are in children 10 are familial 10 are metastatic at diagnosis |
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What is the first hormone to show up with stress? Timeframe?
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EPI- immediately
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What is the second hormone to show up with stress? Timeframe?
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Glucagon- 20 min
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What is the third hormone to show up with stress? Timeframe?
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insulin and ADH- 30 min
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What is the fourth hormone to show up with stress? Timeframe?
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cortisol- 2-4 hours
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What is the fifth hormone to show up with stress? Timeframe?
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GH- 24 hours
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Glucagon is produced by what cells?
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alpha pancreatic cells
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Somatostatin is produced from what cells?
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delta pancreatic cells
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What stimulates glucagon release?
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hypoglycemia, stress
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What inhibits glucagon release?
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hyperglycemia
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Where does glucagon go?
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adrenal cortex, liver, adipose tissue
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What does glucagon stimulate?
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gluconeogenesis, glycogenolysis, lipolysis, and ketogenesis
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What is the second messenger for glucagon?
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cAMP
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What is responsible for DKA? How?
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glucagon- no insulin to shut off glucagon release
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What 3 levels would be high with a glucagonoma (pancreatic tumor)?
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high glucose, high lipids, high ketones
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What is the pneumonic for the tissues that don't need insulin for glucose uptake?
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BRICKLE
B- brain R- RBC I- intestinal wall C- cardiac vasculature K- kidney L- liver E- exercising muscle |
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What is the stimulus for insulin release?
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hyperglycemia
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What is the stimulus for inhibition of insulin?
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hypoglycemia
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Where does insulin go?
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everywhere but BRICKLE
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What does insulin do?
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increases all anabolic processes
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What is the second messenger for insulin?
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tyrosine kinase
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What is the major difference between an insulinoma and nessidioblastosis?
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insulinoma- adults
nessidioblastosis- infants |
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What are the measured insulin and c-peptide levels with an insulinoma or messidioblastosis?
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high insulin, high c-peptide
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Somatostatin is made where?
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delta cells of pancreas
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What stimulates the release of somatostatin?
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insulin and glucagon
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Where does somatostatin go?
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it's paracrine
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What does somatostatin do?
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inhibits insulin and glucagon
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What is the second messenger for somatostatin?
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cAMP
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