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101 Cards in this Set

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What is the order of the layers of adrenal cortex from capsule to medulla?
[GFR]

Zona [G]lomerulosa
Zona [F]asciculata
Zona [R]eticularis
What secretory products are produced in the various layers of the adrenal gland?
["The deeper you go, the sweeter it gets."]

Zona Glomerulosa = Aldosterone (Salt)

Zona Fasciculata = Cortisol (Sugar)

Zona Reticularis = Androgens (Sex)

Medulla = Catecholamines (Epi, NE)
What is the primary regulatory control of the Zona Glomerulosa of the Adrenal gland?
Renin-Angiotensis
What is the primary regulatory control of the Zona Fasciculata of the Adrenal gland?
ACTH
What is the primary regulatory control of the Zona Reticularis of the Adrenal gland?
Hypothalamic CRH
What is the primary regulatory control of the Medulla of the Adrenal gland?
Preganglionic sympathetic fibers
Which adrenal vein drains directly into the IVC?
Right adrenal vein -> IVC

(Left adrenal vein -> Left renal vein -> IVC)
What does the Anterior Pituitary produce?
[FLAT PiG]

[F]SH
[L]H
[A]CTH
[T]SH
[P]rolact[i]n
[G]H
(also Melanotropin = MSH)
Where is Vasopressin & Oxytocin produced?
Made in hypothalamus & shipped to pituitary
Which products of the pituitary gland are acidophils?
GH & prolactin
What is the Posterior Pituitary derived from?
Neuroectoderm
What is the Anterior Pituitary derived from?
Oral ectoderm
What is common about TSH, LH, FSH & hCG?
Alpha subunit
What does the Beta subunit do in hormones?
Determines specificity
What cell types make up the Islets of Langerhans and what do they produce?
alpha = glucagon
beta = insulin
delta = somatostatin
What is the relationship between prolactin & dopamine?
Prolactin increases dopamine synthesis and secretion from hypothalamus

Dopamine inhibits (negative inhibition) prolactin secretion
What substance would be expected to inhibit prolactin secretion?
dopamine agonists (eg bromocriptine)
What substance would be expected to stimulate prolactin secretion?
dopamine antagonists (eg antipsychotics)
What is the relationship between prolactin & GnRH?
Prolactin inhibits GnRH synthesis & release -> inhibits ovulation (why you don't get pregnant while you're breastfeeding)

prolactinomas = Amenorrhea
What enzyme allows the conversion of Cholesterol to Pregnenolone in the Adrenal Glands?
Desmolase (+ACTH, -Ketoconazole)
What does 17Alpha hydroxylase do?
Converts mineralocorticoid pathway to glucocorticoid pathway:

Pregnenolone -> 17-hydroxypregnenolone
Progesterone -> 17alpha-hydroxyprogesterone
What does 21Beta hydroxylase do?
Allows first progression of Mineralocorticoid & Glucocorticoid pathways:

Progesterone -> 11deoxycorticosterone
17alpha-hydroxyprogesterone -> 11deoxycortisol
What does 11Beta hydroxylase do?
Allows second progression of Mineralocorticoid & Glucocorticoid pathways:

11-deoxycorticosterone -> Corticosterone
11-deoxycortisol -> Cortisol
What is the Mineralocorticoid pathway?
Cholesterol -> Pregnenolone -> Progesterone -> 11-deoxycorticosterone -> Aldosterone (C21)
What is the Glucocorticoid pathway?
17-hydroxypregnenolone -> 17alpha-hydroxyprogesterone -> 11-deoxycortisol -> Cortisol (21C)
What is the Androgen pathway?
DHEA -> Androstenedione -> Testosterone -> DHT (C19)
What are the three congenital adrenal hyperplasias?
[] 17-alpha-hydroxylase deficiency
[] 21-beta-hydroxylase deficiency
[] 11-beta-hydroxylase deficiency
What clinical findings are associated with 17alpha-hydroxylase deficiency?
[-] sex hormones -> phenotypical female w/o maturation
[-] cortisol
[+] mineralocorticoids -> Hypertension, hypokalemia
What clinical findings are associated with 21beta-hydroxylase deficiency?
[-] Cortisol -> [+]ACTH
[-] Mineralocorticoids -> Hypotension, hyponatremia, hyperkalemia, [+]renin, hypovolemic shock
[+] sex hormones -> Masculinization, female pseudohermaphroditism
What are the clinical findings associated with 11beta-hydroxylase deficiency?
[-] Cortisol
[-] Aldosterone/Corticosterone BUT
[+] 11-deoxycorticosterone so HYPERtension
[+] sex hormones -> masculinization
Where is PTH produced and what does it do?
[] Chief cells of parathyroid
What lab values are affected in an increase of PTH?
[+] Serum Ca
[-] Serum PO4
[+] Urine PO4
(PTH = Phosphate Trashing Hormone)
What is the function of PTH?
[+] bone resorption of Ca/PO4
[+] kidney reabsorption of Ca in DCT
[-] kidney reabsorption of PO4
[+] vitamin D production in kidney
What does 1alpha hydroxylase do?
production of Vitamin D in kidney
What regulates PTH?
[-] serum Ca -> [+] PTH secretion
What do you get if you are deficient if vitamin D?
rickets in kids
osteomalacia in adults
What is the function of vitamin D?
[+] absorption of dietary calcium
[+] absorption of dietary phosphate
[+] bone resorption of Ca & PO4
What are the Calcium / Phosphate & Alkaline Phophatase levels in Hyperparathyroidism?
Ca [+]
Phos [-]
AlPhos [+]
What are the Calcium / Phosphate & Alkaline Phophatase levels in Paget's disease of bone?
Ca [0/+]
Phos [0]
AlPhos [+++]
What are the Calcium / Phosphate & Alkaline Phophatase levels in Vitamin D intoxication?
Ca [+]
Phos [+]
AlPhos [0/+]
What are the Calcium / Phosphate & Alkaline Phophatase levels in Osteoporosis?
Ca 0
Phos 0
AlPhos 0
!
What are the Calcium / Phosphate & Alkaline Phophatase levels in Renal insufficiency?
Ca [-]
Phos [+]
AlPhos [0]
Where is Calcitonin produced?
C cells of thyroid
What opposes the actions of PTH?
Calcitonin
The need for gene transcription and protein synthesis delays the onset of action of what hormones.
Steroid Hormones

[PET CAT]
[P]rogesterone
[E]strogen
[T]estosterone
[C]ortisol
[A]ldosterone
[T]hyroxine
What would increased levels of SHBG do to you?
lower free testosterone which leads to gynecomastia
What would decreased levels of SHBG do to you?
raises free testosterone which leads to hirsuitism
What are the functions of T3?
[4 B's]

[B]rain maturation
[B]one growth
[B]eta-adrenergic effects (++CO/HR/SV)
[B]MR increased

Also: [+]glycogenolysis/gluconeogenesis/lipolysis
What affects the levels of TBG?
[+] Pregnancy
[-] Anabolic steroids / liver failure
How do skeletal muscle & adipose tissue increase glucose updtake?
insulin
Does the brain & RBC rely on insulin for glucose uptake?
No. They use GLUT-1!
<Buffalo hump & moon facies>
Cushing Syndrome
How does the dexamethosone suppression test work?
Healthy: [-] cortisol after low dose

ACTH-producing tumor: [+] cortisol after low dose

Cortisone-producing tumor: [+] cortisol after low or high dose
What are the four different etiologies of Cushing's syndrome?
[] Cushing disease (primary pituitary adenoma [+]ACTH
[] Primary adrenal hyperplasia/neoplasia [-]ACTH
[] Ectopic ACTH production (SCLC) [+]ACTH
[] Iatrogenic (chronic steroids) [-]ACTH
<purple stria>
Cushing syndrome
<hypertension, hypokalemia, metabolic alkalosis>
Hyperaldosteronism
What is the difference between primary and secondary hyperaldosteronism?
Primary (Conn syndrome) caused by aldosterone secreting tumor -> LOW plasma renin

Secondary caused by kidney perception of low intravascular volume results in overactive R-A-A system therefore HIGH plasma renin
What is the treatment for Conn syndrome?
Conn syndrome = primary hyperaldosteronism therefore use Spironolactone (K+ sparing diuretic) is aldosterone antagonist.
<hypotension w/ skin hyperpigmentation>
Addison's disease
What is the difference between primary and secondary hypoaldosteronism?
skin hyperpigmentation associated with primary hypoaldosteronism [+]ACTH

Secondary: [-]ACTH
What are the characteristics of Addison Disease?
[A]drenal [A]trophy & [A]bsence of hormone production involving [A]ll 3 divisions of gland.
What is the most common adrenal tumor in adults?
Pheochromocytoma
What is the most common adrenal tumor in children?
Neuroblastoma
What type of cells is pheochromocytoma derived from?
chromaffin cells
<intermittant hypertension>
pheochromocytoma
What is the Rule of 10s?
Applies to pheochromocytoma:

10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids
10% familial
What does pheochromocytoma secrete?
[] Epinephrine
[] NE
[] Dopamine
What lab values are associated wih pheochromocytoma?
[+] Urinary VMA levels
[+] plasma catecholamines
What symptoms occur in spells in pheochromocytoma?
hyperadrenergic symptoms (5 P's):

[P]ressure (BP)
[P]ain (Headache)
[P]ersperation (Tachycardia)
[P]alpitations
[P]allor
What is the treatment for pheochromocytoma?
alpha-antagonists (ie phenoxybenzamine)
<ZE + parathyroid & pituitary tumor>
MEN I (Werner)
<Medullary carcinoma of thyroid + pheochromocytoma + Parathyroid tumor>
MEN IIa (Sipple)
<Medullary carcinoma of thyroid + pheochromocytoma + mucosal neuroma>
Men IIb
What gene is associated with MEN IIa & MEN IIb
ret
What is MEN I?
aka Wermer syndrome

[3 P organs]

[P]ancreas (ZE, Insulinoma, VIPoma)
[P]ituitary
[P]arathyroid
What is MEN IIa?
aka Sipple syndrome

[] Medullary carcinoma of Thyroid
[] pheochromocytoma
[] parathyroid
What is MEN IIb?
[] Medullary carcinoma of Thyroid
[] pheochromocytoma
[] mucosal neuroma
What are the clinical features of Hypothyroidism?
"Weight gain w/ decreased appetite"

[] Cold intolerance
[] hypoactivity
[] weight gain
[] fatigue
[] lethargy
[-] appetite
[] constipation
[] weakness
[-] reflexes
[] myxedema (periorbital)
[] dry, cool skin
[] coarse, brittle hair
<Weight gain w/ decreased appetite>
hypothyroidism
What are the clinical features of Hyperthyroidism?
[] Heat intolerance
[] hyperactivity
[] weight loss
[] chest pain/palps
[] arrhythmias
[] diarrhea
[+] reflexes
[] warm, moist skin
[] fine hair
<"Exophthalmos">
Graves disease
What type of Hypersensitivity reaction is associated with Graves disease?
type II (antibody-receptor)
What is Riedel's thyroiditis?
hypothyroid state associated with thyroid replacement with fibrous tissue
What is Hashimoto's thyroiditis?
Autoimmune hypothyroidism disorder. Antibodies against receptor that DEACTIVATE it.

Slow course

Antimicrosomal & Antithyroglobulin antibodies
What is de Quervain's thyroiditis?
Self-limited hypothyroidism following flulike illness
What are the findings in de Quervain's thyroiditis?
[] Elevated ESR
[] Jaw pain
[] very tender thyroid gland
What are the three types of thyroid cancer?
[] Papillary carcinoma
[] Follicular carcinoma
[] Medullary carcinoma
<"Orphan annie eye nuclei">
Papillary Thyroid carcinoma
Which thyroid cancer is associated with amyloid stroma?
medullary carcinoma
Which thyroid cancer is associated with psammoma bodies?
papillary carcinoma
What are the clinical findings associated with cretinism?
Pot-bellied, pale, puffy-faced children with protuding umbilicus & protuberant tongue.
What normal reasons can cause GH to increase?
stress, exercise & hypoglycemia
What is increased GH called?
Acromegaly in adults
Gigantism in children
<"Stones, bones & groans">
Primary hyperparathyroidism
What are the clinical findings in hyperparathyroidism?
[Stones, bones & groans]

renal stones = hypercalcemia/hypercalcuria
bone pain = osteitis fibrosa cystica
groans = weakness & constipation
What is secondary hyperparathyroidism?
hyperplasia of parathyroid gland due to decreased serum Ca. Associated with chronic renal disease.
<"nuckle, nuckle, dimple, dimple">
pseudohypoparathyroidism
<"Hypocalcemia + tetany">
hypoparathyroidism
What is Chvostek's sign?
tap facial nerve -> constraction of facial muscles.

Indicates tetany due to hypoparathyroidism
What is Trousseau's sign?
occlusion of brachial artery with BP cuff -> carpal spasm

Indicates tetany due to hypoparathyroidism
What are the causes of hypercalcemia? (Even a chimp would know this one!)
[CHIMPANZEES]

[C]alcium ingestion
[H]yperparathyroid / [H]yperthyroid
[I]atrogenic (thiazide)
[M]ultiple myeloma
[P]aget disease
[A]ddison disease
[N]eoplasms
[Z]ollinger-Ellison
[E]xcess vitamin D
[E]xcess vitamin A
[S]arcoidosis