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172 Cards in this Set

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where is EPO made?
renal parenchymal cells (JG cells)
what's the signal for EPO release?
hypoxi
what's the inhibitor of EPO release?
inc O2
where does EPO go to act?
bone marrow
what's the 2nd messenger for EPO?
tyrosine kinase
inc RBC, inc O2, decr EPO - where's the problem?
bone marrow
inc RBC, decr O2, inc EPO, where's the problem?
lungs - can't pick up O2
inc RBC, inc O2, inc EPO - where's the problem?
kidneys
sign of chronic hypoxia
clubbing, polycythemia
where is aldosterone made?
zona glomerulosa
stimulus for aldosterone formation
hypovolemia, hyponatremia, hyperkalemia
inhibition of aldosterone formation
hypervolemia
where aldosterone goes to act
early collecting duct
action of aldosterone
inc Na in serum (inc water and volume and bp), decr K and H
2nd messenger for aldosterone?
none - it's a steroid
low K affects which 2 organs
heart (bradycardia) and skeletal muscle (weakness)
effects of inc aldosterone
inc Na, inc bp, decr K, decr H
2 enz deficiencies that can cause decr aldosterone
21 hydroxylase, 11hydroxylase
effects of 21hydroxylase def
decr Na (decr, water, decr bp), inc K, inc H, ambiguous genitalia in females
effects of decr 11OH def
inc Na (inc water, inc bp), decr K, decr H, ambiguous genitalia in females
2 causes of adrenal insufficiency in adults
abrupt withdrawal from steroids
autoimmune (Addisons)
where is cortisol made?
zona fasciculata
stimulus for cortisol release
stress, hypoglycemia
inhibition of cortisol release
hyperglycemia
where does cortisol go to act?
everywhere - it's a permissive hormone
4 fxns of cortisol
upregulates all receptors during stress
inc glc via lipolysis, proteolysis, glycogenolysis
decr inflammation
maintain bp by adjusting TPR
2nd messenger for cortisol?
none - it's a steroid
what is waterhouse friedrichson syndrome?
meningitis leading to sepsis leading to adrenal hemorrhage
things causing cushing's syndrome
adrenal adenoma
small cell carcinoma
things causing cushings dz
pituitary adenoma
what's the dexamethasone suppression test? how does it work?
to figure out what is causing the inc in cortisol
give low dose - suppressed? then obesity, depression or NL variant
not suppressed? give high dose - suppressed? then pituitary adenoma
not suppressed? check ACTH - low? adrenal adenoma - high? small cell carcinoma
where is testosterone made?
zona reticularis
what is the stimulus for testosterone production?
ACTH
fxn of testosterone
in utero, it's for external genitalia
also causes inc in appetite, aggression, volence, libido, and RBCs
what controls manliness in utero? at puberty?
testosterone in utero and DHT at puberty
DOC for prostate cancer
leuprolide
where is epinephrine made?
adrenal medula
what's the stimulus for epinephrine?
stress/hypoglycemia
what inhibits epi production?
hyperglycemia
where does epinephrine work?
liver and adrenal cortex
2nd messenger for epi
cAMP
what's the rule of 10s for pheochromocytoma
10% malignant
10% bilateral
10% in kids
10% familial
10% metastatic at dx
pt comes in with lots of sweating, a headache and HTN - has inc urinary VMA - you have a suspicion of what it could be - what can you give to confirm your suspicion?
phentolamine
how do you treat a pheo?
phenoxybenzamine
what is a pheo?
inc in NE and epi
what's the difference between pheo and neuroblastoma
neuroblastoma has hypsarrythmia and opsoclonus
what are the 6 stress hormones and when do they work?
epi - works immediately
glucagon - works w/in 20min
insulin, ADH - work w/in 30min
cortisol - works w/in 2-4 hrs
GH - works w/in 24hrs
where is glucagon made?
pancreatic alpha cells
what's the stimulus for glucagon?
hypoglycemia and stress
what in inhibits glucagon
hyperglycemia
where does glucagon act?
adrenal cortex, liver, adipose tissue
what does glucagon do?
inc glc by stimulating GNG, glycogenolysis, lipolysis and ketogenesis
pt comes in w/ inc glc, inc lipids and inc ketones - dx?
glucagonoma
what is always the outcome of a glucagonoma?
DM2
which hormone is responsible for DKA?
glucagon
Treatment for a glucagonoma?
octreotide
which organs do not depend on insulin for glc uptake?
BRICKLE
B = brain
R = RBC
I = Intestine
C = cornea/cardiac
K = kidney
L = liver
E = exercising muscle
where is insulin made?
pancreatic beta cells
stimulus for insulin
stress
hyperglycemia
fxn of insulin
inc ANABOLIC processes
2nd messenger for insulin
tyrosine kinase
what's the difference between an insulinoma and a nessidioblastosis?
insulinoma is in adults
nessidioblastosis is in infants
what will be the levels of insulin and c-peptide in:
insulinoma
sulfonylurea
exogenous injection
insulinoma and sulfonylurea will have inc in both
exogenous will have inc insulin, but decr c-peptide
where is somatostatin made?
pancreatic delta cells and duodenum
what's the stimulus for somatostatin?
insulin and glucagon and other duodenal hormones
what is the fxn of somatostatin?
inhibits things such as insulin and glucagon
MOA of octreotide?
somatostatin analog so slows gastric emptying
what will someone with a somatostatinoma present w/?
severe constipation
where is secretin made?
duodenum S cells
what's the stimulus for secretin release?
low pH
what is the fxn of secretin?
stimulates production of bicarb from pancreas and gallbladder - inhibits gastrin and slows gastric emptying
what is the 2nd messenger of secretin?
cAMP
where is CCK made?
duodenum Icell
what's the stimulus for CCK release?
food, especially fats
what inhibits CCK release?
high pH
where does CCK act?
pancreas (digestive enzs)
gallbladder (bile)
what does CCK do?
fat and protein digestion
2nd messenger for CCK?
IP3/DAG
which type of opioid can you give to someone w/ abdominal pain?
meperidine - doesn't work on CCK
where is GIP made?
duodenum
what is the fxn of secretin?
stimulates production of bicarb from pancreas and gallbladder - inhibits gastrin and slows gastric emptying
what is the 2nd messenger of secretin?
cAMP
where is CCK made?
duodenum Icell
what's the stimulus for CCK release?
food, especially fats
what inhibits CCK release?
high pH
where does CCK act?
pancreas (digestive enzs)
gallbladder (bile)
what does CCK do?
fat and protein digestion
2nd messenger for CCK?
IP3/DAG
which type of opioid can you give to someone w/ abdominal pain?
meperidine - doesn't work on CCK
where is GIP made?
duodenum
what is the stimulus for GIP?
glucose
what inhibits GIP?
high pH
fxn of GIP?
enhances insulin secretion
where does GIP act?
beta cells of the pancreas
what is the 2nd messenger for GIP?
c-GMP
what is a pt w/ a hx of gastrectomy at inc risk for over time if they keep having osmotic diarrhea?
DM2
what causes osmotic diarrhea if pt has history of gastrectomy?
dumping syndrome - timing is off for insulin secretion from GIP - will get transient hyperglycemia followed by hypoglycemia
where is VIP made?
duodenum (Auerbach's plexus)
what stimulates VIP release?
duodenal hormones
what inhibits VIP release?
high pH
fxn of VIP?
inhibition
2nd messenger for VIP
cAMP
which GI hormonal problem cuases watery diarrhea? osmotic diarrhea?
watery = VIP
osmotic = GIP
where is gastrin made?
antrum of stomach (G cells) and from duodenum and pancreas
stimulus for gastrin release?
high pH
where does gastrin go to act?
parietal cells of stomach
fxn of gastrin?
make HCl and intrinsic factor
2nd messenger for gastrin
Calcium
patient comes in w/ stomach pain upon eating - lab values show hypercalcemia as well - what are you thinking?
Zollinger-Ellison syndrome (inc gastrin)
MCC macrocytic anemia
pernicious anemia
where is ANP made?
right atrium
stimulus for ANP release?
high volume (stretches R atrium)
where does ANP act?
kidney
fxn of ANP
dilates afferent renal artery and inhibits aldosterone
2nd messenger for ANP
NO (which causes an inc in cGMP)
from which embryological origin are the superior parathryoids? inferior?
superior is from 4th pharyngeal pouch
inferior from 3rd pharyngeal pouch
stimulus for PTH release
low Ca, high P
where does PTH go to act?
osteoclasts of bone and kidney (PCT and late DCT)
fxn of PTH?
stimulate osteoclastic activity (brkdn bone and inc serum Ca) - inc secretion of P and activate 1alpha hydroxylase
MCC of hypOparathyrodism?
thyroidectomy
what's the difference b/t pseudo hypOparathyroidism and pseudo-pseudo hypOparathyroidism?
pseudo is linked to albright's syndrome - severe receptor resistance
pseudo pseudo has NL Ca, and mild resistance to the receptor
MCC of isolated hypercalcemia in adults?
parathyroid adenoma
cause of 1ry hyperparathyrodism?
parathyroid adenoma
cause of 2ry hyperparathyroidsm
renal failure
can also be due to renal osteodystrophy
how can you tell the difference b/t 1ry and 2ry hyperparathyroidism?
2ry will have inc PTH w/ decr Ca
1ry will have inc PTH and Ca
name the bone problem:
decr mineralization and soft bones
osteomalacia
name the bone problem:
osteoclastic activity > osteoblastic activity
decr bone matrix
osteoporosis
name the bone problem:
decr osteoclastic activity - bone thick and inflexible
osteopetrosis
name the bone problem:
decr bone mass
decr bone matrix and mineralization
osteopenia
name the bone problem:
inc alk phos and Ca
inc osteoclastic activity
osteitis deformans
name the bone problem:
scarred bone
osteosclerosis
where is Vit D made?
skin > liver > kidney
stimulus for Vit D release?
decr Ca and P
where Vit D acts
kidney and GI
fxn of Vit D
makes CaATPase and CBP - stimulates osteoblastic activity
fxn of CBP (Ca bisphosphanate)
build bone - activates osteoclasts and then osteoblasts
vit D deficiency in adults? kids?
osteomalacia in adults
rickets in kids
where is calcitonin made?
parafollicular cells
stimulus for calcitonin release?
high Ca
where calcitonin acts
bone
fxn of calcitonin
inhibit osteoclastic activity and then stimulate osteoblastic activity to make bone
syndromes involved in MEN I
pancreatic adenoma, parathyroid adenoma, pituitary adenoma
syndromes involved in MEN II
pheochromocytoma, parathyroid adenoma, medullary carcinoma of thyroid
syndromes involved in MEN III
same as MEN II (pheo and medullary carcinoma of thyroid) - plus neuroma/ganglioneuroma
fxn of bisphospanates
inhibit osteoclastic activity
which drugs for bone issues do you have to take standing up and with a huge glass of water? why?
bisphosphonates b/c they're very corrosive in the GI
MC pituitary tumors
nonfxnl adenomas
MC FXNL pituitary tumors
prolactinoma
Rx for pituitary tumors
bromocryptine
Rx for GH tumors
Octreotide
MCC of hypothyroidism in US
hashimoto's
MCC of hypothyroidism worldwide
iodine deficiency
hypothyroidism w/ painful jaw
DeQuervain's
hypothyroidism that can be drug induced or after pregnancy
lyphocytic thyroiditis
which drugs can cause hypothyroidism
amiodarone and IFN alpha
hypothyroidism w/ "woody neck" (why is it woody?)
riedel's struma - woody b/c of fibrosis
hypothyroidism in kids
cretinism
MCC hyperthyroidism in US
Grave's
benign adenoma in an older person w/ hyperthyroidism
plummer's syndrome
aka toxic multinodular goiter
this treatment of hyperthyroidism can cause oral ulcers
PTU
this treatment for hyperthyroidism is contraindicated in pregnancy
Methimazole
when do you give T3 (instead of T4) to ppl w/ hypothyroidism?
T3 to those w/ liver dzs
which hormones are basophils?
FSH, LH, TSH, ACTH

(B-flat)
which hormones are acidophils?
Prolactin, GH

(GAP)
Which hormones are secreted by the posterior pituitary?
ADH and Oxytocin
Where does ADH act?
collecting duct of the kidney and endothelial vessels
fxn of ADH
inc volume, inc secretion of vWF and factor 8
where does oxytocin act?
mammalary glands and uterus
what does oxytocin do?
eject milk
eject baby
what are 6 fxns of thyroid hormone?
bone growth
CNS to inc symps
ANS to inc beta fxns
inc basal metabolic rate
inc HR, inc RR
inc catabolic brkdn to get ATP
what substance inhibits PRH release from the hypothalamus?
dopamine
what substance inhibits GHRH release from the hypothalamus
Somatostatin