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93 Cards in this Set
- Front
- Back
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Anabolic effects of insulin?
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Inc glucose transport
Inc glycogen storage & synthesis Inc TG synthesis & storage Inc Na retention Inc protein synth (muscles) Inc cellular uptake of K |
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What organs do NOT need insulin to take up glucose
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Brain
RBC's Intestine Cornea Liver Kidney |
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what organs use glut-1 transporter?
Glut-2 transporter? Glut 4 transporter? |
1- RBC's, brain
2- B islet cells, liver, kidney 4- adipose tissue, skeletal muscle |
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What hormones operate via cAMP pathways?
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FSH
LH ACTH TSH CRH hCG ADH MSH PTH Calictonin Glucagon |
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what hormones operate via cGMP
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ANP
NO (EDRF) think vasodilators! |
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what hormones operate via IP3 mechanism?
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GnRH
GHRH Oxytocin ADH (V1 receptor) TRH |
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What hormones operate via steroid receptors?
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Glucocorticoids
Estrogen Progesterone Testosterone Aldosterone Vitamin D T3/T4 |
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What hormones work via tyrosine kinase?
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Insulin
IGF-1 FGF PDGF Prolactin GH |
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4 B's of T3 fxns
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Bone growth
Brain maturation Beta-adrenergic effects BMR INC (Via Na-K-ATPase) |
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what cushing's syndromes can be suppressed by dexamethasone suppression test?
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ACTH prod pituitary adenoma - suppressed by High dose (not low dose)
Ectopic & Cortisol producing tumor cannot be suppressed |
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what form of cushing's has decreased ACTH?
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Cortisol producing adenoma in adrenal gland
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HTN, hypokalemia, metabolic alkalosis & low plasma renin
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PrimaryCONN) hyperaldosteronism - Rx w/ spirinolactone (aldosterone antagonist)
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What is secondary hyperaldsteronism due to?
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Kidney perceives low intravascular volume from renal artery stenosis, chronic renal failure, CHF, cirrhosis, or nephrotic syndrome --> overactive RAS --> high plasma renin
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Weakness, fatigue, anorexia, wt. loss, skin hyperpigmentation, hypotension
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Addison's disease
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what causes tertiary adrenal insufficiency
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abrupt withdrawl of corticosteroids --> when taking they inhibit feedback on hypothalamus & when you stop you have no CRH so no cortisol being stimulated
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this tumor is derived from chromaffin cells
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pheochromacytoma (neural crest origin)
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episodic headaches, sweating, heart palpitations, pallor, & pressure
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Hyperadrenergic sx of pheochromocytoma
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Rx for pheochromocytoma
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Phenoxybenzamine - irreversible alpha blocker
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adrenal mass with HVA in urine, homer wright pseudorosettes, a/w n-myc oncogene
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Adrenal neuroblastoma
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Tumor marker for adrenal neuroblastoma & stain?
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Marker - bombesin
Neurofilament stain |
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what paraneolastic sign is a/w neuroblastoma?
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opsoclonus, mycolonus, & truncal ataxia
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myxedema
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hypothyroidism
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what is the pathology behind graves ophthalmopathy?
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stimulation of fibroblasts to produce GAGs --> edema & infiltration of lymphocytes & macs into EOM & CT
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hurthle cells
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hashimoto's thyroiditis
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thyroid is replaced by fibrous tissue - fixed, hard (rock-like) & painless goiter
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Riedel's thyroiditis
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thyrotoxicosis if a pt w/ iodine deficiency goiter is made iodine replete
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Jod-Basedow phenomenon
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ground glass nuclei - Orphan anni enuclei, psammoma bodies, inc risk w/ childhood radiation
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Papillary carcinoma - best prognosis
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40% a/w RAS, good prognosis, uniform follicles
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Follicular carcinoma
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from parafollicular C cells - prod calictonin, sheets of amyloid stroma; a/w MEN 2A & B
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medullary carcinoma of thyroid
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Increased PTH --> Inc Ca, Dec PO4
Inc cAMP in urine, inc alk phos |
Primary HyperPTH
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dec Ca & inc PO4 --> inc PTH
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secondary hyperPTH
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Secondary hyperPTH most commonly due to ........
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Chronic renal disease
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cystic bone spaces filled with brown fibrous tissue -bone pain
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osteitis fibrosa cystic -- Von Recklinghausen's syndrome
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Bone lesions due to secondary hyperPTH due in turn to renal disease
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renal osteodystrophy
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kidney unresponsive to PTH --> hypocalcemia, shortened 4th/5th digit, short stature
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PseudohypoPTH
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occlusion of brachial a with BP cuff --> carpal spasm
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Trousseau's sign
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STONES - signs & sx hyperPTH
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Renal stones
Nephrocalcinosis Polyuria/polydipsia Uremia |
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BONES signs & sx of hyperPTH
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Osteitis fibrosa cystica
Osteoporosis Osteomalacia Osteoarthritis |
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abdominal GROANS signs & sx hyperPTH
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Constipation
Indigestion, N/V Peptic ulcer Pancreatitis |
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Pyschic MOANS of hyperPTH
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Lethargy/fatigue
Depression Memory loss Psychosis (paranoia) personality changes confusion/stuper |
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other signs & sx of primary hyper PTH
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Prox muscle weakness
Keratitis, conjunctivitis Hypertension Itching |
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3 major causes of depression
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MDD
hypothyroidism hyperPTH |
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4 causes of pancreatitis
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alcohol induced
gallstone induced hyperPTH hypercalcemia |
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what causes hypercalcemia by direct bone invasion
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multiple myeloma, breast ca mets
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what causes humoral hypercalcemia of malignancy via local osteolytic factors
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Lung ca (squamous), renal CA, head/neck Ca, T-cell leukemia (HTLV1)
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amenorrhea, galactorrhea, low libido, infertility, bitemporal hemaniopsia
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pituitary adenoma
Rx: bromocriptine or cabergoline |
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rx of acromegaly?
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pituitary adenoma resection followed by octerotide administration (stomatostatin analogue)
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anti gut & anti pituitary homrone made by D cells of pancreas
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somatostatin
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decreases splachnic circulation so used for portal HTN, bleeding peptic ulcer
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Octreotide
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causes of nephrogenic diabetes insipidus
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hereditary of secondary to hypercalcemia, lithium, demeclocyline (ADH antagonist) - kidneys is nonresponsive to ADH
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other signs & sx of primary hyper PTH
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Prox muscle weakness
Keratitis, conjunctivitis Hypertension Itching |
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3 major causes of depression
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MDD
hypothyroidism hyperPTH |
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4 causes of pancreatitis
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alcohol induced
gallstone induced hyperPTH hypercalcemia |
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what causes hypercalcemia by direct bone invasion
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multiple myeloma, breast ca mets
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what causes humoral hypercalcemia of malignancy via local osteolytic factors
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Lung ca (squamous), renal CA, head/neck Ca, T-cell leukemia (HTLV1)
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amenorrhea, galactorrhea, low libido, infertility, bitemporal hemaniopsia
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pituitary adenoma
Rx: bromocriptine or cabergoline |
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rx of acromegaly?
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pituitary adenoma resection followed by octerotide administration (stomatostatin analogue)
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anti gut & anti pituitary homrone made by D cells of pancreas
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somatostatin
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decreases splachnic circulation so used for portal HTN, bleeding peptic ulcer
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Octreotide
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causes of nephrogenic diabetes insipidus
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hereditary of secondary to hypercalcemia, lithium, demeclocyline (ADH antagonist) - kidneys is nonresponsive to ADH
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MEN I
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Pancreas - ZE, insulinoma, VIPoma, glucagonoma
Pituitary Parathyroid COMMONLY PRESENTS WITH KIDNEY STONES & STOMACH ULCERS |
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MEN 2A Sipple's syndrome
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Medullary thyroid ca (sec calictonin)
Pheochromocytoma (HTN) Parathyroid |
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MEN 2B
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Medullary thyroid
Pheochromacytoma Oral/intestinal ganglioneuromatosis (marfanoid habitus) |
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Rx of DKA
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IV fluids
Insulin --> short acting bolus then IV infusion Fix electrolytes (K) |
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Binds the insulin receptor (TK activity)
Liver: inc glucose stored as glycogen Muscle: inc glycogen & protein synthesis, K uptake Fat: aids TG storage |
Insulin
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Short acting insulins
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Lispro, Aspart, Regular
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intermediate insulins
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NPH
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long acting insulin
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Glargine, Detemir
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Closes K channel in B cell membrane so cell depolarizes --> triggering of insulin release via inc in Ca influx
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Sulfonylureas - requires some islet functions useless in DMI
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Causes disulfram like reaction
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1st generation sulfonylureas
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First generation sulfonylureas
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Tolbutamide
Chlorpropamide |
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Second generation sulfonylureas
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Glyburide
Glimepiride Glizide |
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SE of hypoglycemia
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Sulfonylureas
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Possibly dec gluconeogenesis, inc glycolysis, dec serum glucose levels, overall acts as an insulin sensitizer
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Metformin
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SE - lactic acidosis, dec absorption of folate & B12, GI problems
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Metformin
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Can be used in pts w/o islet fxn
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Metformin
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increases insulin sensitivity in peripheral tissues by binding to PPAR (tx gene regulation) inc levels adinopectin
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Glitazones/Thiazolidinediones - Pioglitazone & Rosiglitazone
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SE of wt gain, edema, hepatotoxicity, CV toxicity
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Glitazones
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inhibits intestinal brush border a-glucosidases, delayed sugar hydrolysis & glucose absorption lead to dec postprandial hperglycemia
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A-glucosidase inhibitors - Acarbose, Miglitol
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Used as monotherapy in type 2 DM or combo
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a-glucosidase inhibitors
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SE GI distrubances & inc transaminase levels
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a-glucosidase nhibitors
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decreases glucagon/amylin analog
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Mimietics - Pramlinitide - severe hypoglycemia, nausea, diarrhea
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increases insulin & decreases glucagon release- prolongs incretin
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GLP-1 mimetics - exenatide
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SE pancreatitis
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Exenatide - GLP 1 mimetics
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alters fat metabolism by inhibit pancreatic lipases
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Orlistat - used for long term obesity amangement
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Steatorrhea, GI discomfort reduced absorption of fat-soluble vitamins, headache
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Orlistat
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Sympathomimetic serotonin & NE reuptake inhibitor used for short & long term obesity
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Siburtamine - toxicity include HTN & tachycardia
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inhibits organification of iodide & coupling of TH synthesis & dec conversion of T4 to T3
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Propylthiouracil & methimazole
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SE of propylthiouracil & methimazole
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skin rash, agranuloctyosis, aplastic anemia
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Uses for somatostatin
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Acromegaly, carcinoid, gastrinoma, glucagonoma
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Uses for oxytocin
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sitmulates labor, uterine contaractions, milk let down, controls uterine hemorrhage
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ADH antagonist- member of TCN family
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Demeclocycline
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SE of glucocorticoids
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Iatrogenic cushing's syndrome - buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers, diabetes if chronic, psychosis, insomnia, glaucoma, acne
Inc protein synthesis in liver --> + proteins ynthesis --> + gluconeogenesis |
