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215 Cards in this Set
- Front
- Back
Thyroid Hormones
-Peroxidase |
-enzyme responsible for oxidation and organification of iodide
-as well as coupling of MIT and DIT |
|
Steroid/thyroid hormone mechanism
-steroid hormones are |
-lipophilic and relatively insoluble in plasma
|
|
Demeclocycline
-mechanism |
-ADH antagonist
|
|
Endocrine Pathology
-Cushing's Syndrome -Etiologies include: -ACTH levels -Adrenal hyperplasia/neoplasia |
decreased ACTH
|
|
Endocrine Pathology
-Cushing's Syndrome -Dexamethasone (synthetic glucocorticoid) suppression test: -if have Ectopic ACTH-producing Tumor (small cell carcinoma), see: |
-increased cortisol after low dose
-increased cortisol after high dose |
|
enzyme that stimulates aldosterone synthase
|
-angiotensin II
|
|
Adrenal Cortex and Medulla
-GFR corresponds with (Zona Glomerulosa, Zona Fasciculata, Zona Reticularis) |
-Salt (Na+)
-Sugar (glucocorticoids) -Sex (androgens) the deeper you go, the sweeter it gets |
|
Glucagon
-MOA |
Binds cell surface glucagon receptor
-activates adenylyl cyclase (increases cAMP) via Gs -cAMP induces PEPCK gene expression PKA activates phosphorylase and inactivates glycogen synthetase in liver |
|
Endocrine Pathology
-Hyperaldosteronism -Secondary -associated with |
-high plamsa renin
|
|
Diabetes Mellitus
-insulin deficiency (and glucagon excess) -leads to |
-Decreased glucose uptake
-Increased protein catabolism -Increased lipolysis |
|
Hypothalamic-Pituitary Hormone Regulation
-GnRH stimulates |
-FSH
-LH |
|
Pheochromocytoma
-Rule of 10's |
-10% malignant
-10% bilateral -10% extra-adrenal -10% calcify -10% kids -10% familial |
|
Steroid/thyroid hormone mechanism
-in men -increased levels of sex hormone-binding globulin (SHBG) causes |
-lower fee testosterone--->gynecomastia
|
|
Hypoparathyroidism
-Chvostek's sign |
-tapping of facial nerve--->contraction of facial muscles
|
|
PTH
-effect on ions |
-increases serum calcium
-decreases serum phosphate -increases urine phosphate |
|
Diabetes Drugs
-Drug Classes -Biguanides -toxicities |
-most grave adverse effect is lactic acidosis
|
|
Meglitinides
-are |
prandial glucose regulators
|
|
Diabetic Ketoacidosis
-labs -decreased insulin causes |
-depleted intracellular potassium due to transcellular shift from decreased insulin
|
|
Diabetic Ketoacidosis
-signs/symptoms |
-Kussmaul respirations (rapid/deep breathing)
-nausea/vomiting -abdominal pain -psychosis/delirium -dehydrations -fruity breath odor (due to exhaled acetone) |
|
Vitamin D
-MOA |
Increases [Ca] plasma
-increases absorption of dietary Ca & PO4--->leads to increased deposition of mineral in bone -increases release of Ca from bone -decreases excretion by kidneys |
|
Brain and RBCs have what type of glucose transporters
|
-GLUT-1
|
|
Cretinism
-findings |
-Pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue
|
|
Vitamin D
-contraindications |
-impaired renal function
-increases the risk of hypercalcemia |
|
Pharmacology of Vitamin D
-half-life |
-stored in body tissues-long periods
-calcitriol-half-life--->1-3 days |
|
Thyroid Hormones
-most T3 formed |
-in blood
|
|
Vitamin D
-regulation -decreased calcium concetration causes |
-increased 1,25-(OH)2 vitamin D production
|
|
Thyroid Hormones
-get increased TBG when |
-in pregnancy (estrogen increases TBG)
|
|
Diabetes Mellitus
-Type 1 vs. Type 2 DM -Type 1 -beta-cell numbers in the islets |
-decreased
|
|
Prolactin Regulation
-Chart |
<img src="591af80b4c873e5ecfbbfcd9830d58ad.jpg" />
|
|
Levothyroxine, triiodothyronine
-clinical use |
-hypothyroidism
-myxedema |
|
SERMS
-adverse effects |
-thromboembolism
-fetal death |
|
Sibutramine
-toxicity |
-hypertension
-tachycardia |
|
Pheochromocytoma
-is the |
most common tumor of the adrenal medulla in adults
|
|
Calcitonin
-adverse effects |
Hypocalcemia - uncommon due to “escape” or loss of effectiveness of calcitonin (in kidney?)
|
|
Bisphosphonates
-example |
-Alendronate (Fosamax)
|
|
Diabetes mellitis
-diagram |
<img src="c1fcc93ab99b27507bd9ced4724ce10a.jpg" />
|
|
progesterone goes to
|
-17alpha-hydroxyprogesterone
and -11-deoxycorticosterone |
|
11-deoxycorticosterone goes to
|
-corticosterone
|
|
SIADH
-very low sodium levels can lead to |
-seizures (correct slowly)
|
|
Diabetes Drugs
-Drug Classes -alpha-glucosidase inhibitors -toxicities |
-GI disturbances
|
|
Toxic Multinodular Goiter
-caused by |
-iodine deprivation followed by iodine restoration
|
|
enzyme that takes corticosterone to aldosterone
|
-aldosterone synthase
|
|
Carcinoid Syndrome
-mnemonic |
Rule of 1/3s:
-1/3 metastasize -1/3 present with 2nd malignancy -1/3 multiple |
|
Diabetes Mellitus
-Type 1 vs. Type 2 DM -Type 1 -insulin necessary in treatment |
-always
|
|
Steroid/thyroid hormone mechanism
-what delays the onset of action of these hormones |
-the need for gene transcription and protein synthesis
|
|
Insulin-Dependent Organs
-which organs depend on insulin |
-skeletal muscle and adipose tissue depend on insulin for increased glucose uptake
|
|
17alpha-hydroxylase deficiency
-XY: |
-decreased DHT--->pseudohermaphroditism (externally phenotypic female, no internal reproductive structures due to MIF)
|
|
Endocrine Pancreas Cell Types
-delta= -found where |
-somatostatin
-interspersed |
|
Dehydroepiandrosterone (DHEA) goes to
|
Androstenedione
|
|
Neuroblastoma
-less likely to develop |
-less likely to develop hypertension
|
|
Thiamine Deficiency
-Populations at Risk |
<img src="2453a0a75cb1d013e27d05285363c05e.jpg" />
|
|
Vitamin D
-source -D2 |
-ingested from plants
|
|
Insulin-dependent Organs
-muscle and adipose tissue have which types to glucose transporters |
-GLUT-4
-requires insulin |
|
Diabetes Drugs
-Drug Classes -Insulin -action |
-bind insulin receptor (tyrosine kinase activity)
|
|
Diabetes Mellitus
-insulin deficiency (and glucagon excess) -leads to decreased glucose uptake -leads to hyperglycemia, glycosuria, osmotic diuresis, electrolyte depletion -leads to dehydration, acidosis -leads to |
-coma
-death |
|
Therapeutic Use of PTH
-indications |
-osteoporosis
|
|
Meglitinides
-can be used with what other drug for improved glucose control |
-Metformin
|
|
Diabetes Mellitus
-Type 1 vs. Type 2 DM -Type 1 -association with obesity |
-no
|
|
Bone abnormalities
-density -high |
-Paget's disease
-osteopetrosis |
|
17alpha-hydroxylase deficiency
-symptoms |
-HYPERtension
-hypokalemia |
|
Vitamin D
-is |
-a prodrug
-activated by 2 steps of hydroxylation (25 and 1 positions) (liver and kidney, respectively) |
|
Steroid/thyroid hormone mechanism
-diagram |
<img src="1fbc3aabdaa86f881a1c67b9ba327328.jpg" />
|
|
Thiamine Deficiency
|
<img src="f9db4dbae4ea8d66e959bfc7a2f46c78.jpg" />
|
|
Hypoparathyroidism
-findings: |
-Hypocalcemia
-Tetany |
|
Endocrine Pathology
-Hyperaldosteronism -Secondary -due to |
-renal artery stenosis
-chronic renal failure -CHF -cirrhosis -nephrotic syndrome |
|
Hypothalamic-Pituitary Hormone Regulation
-CRH stimulates |
-ACTH
|
|
Other therapeutic uses of glucagon
|
-Cardiovascular disease (sometimes used when elevated beta-blockers present)
-diagnosis--->glycogen storage disease; pheochromocytoma, insulinoma -GI relaxation in radiology |
|
Hashimoto's Thyroiditis
-get |
-lymphocytic infiltrate with germinal centers
|
|
Vitamin D
-source -D3 |
-from sun exposure in skin
|
|
Multiple Endocrine Neoplasias (MEN)
-MEN types 2A and 2B -associated with |
-ret gene
|
|
Propylthiouracil, methimazole
-toxicity |
-skin rash
-agranulocytosis (rare) -aplastic anemia |
|
Pioglitazone
-subjuct to |
-subject to interactions due to CYP3A4 metabolism
-may lower oral contraceptives levels containing ethinyl estradiol and norethindrone -may interact with many other drugs metabolized by CYP3A4 |
|
Cortisol
-Regulation |
-CRH (hypothalamus) stimulates ACTH release (pituitary), causing cortisol production in adrenal zona fasciculata
|
|
Diabetes Mellitus
-insulin deficiency (and glucagon excess) -leads to decreased glucose uptake -leads to hyperglycemia, glycosuria, osmotic diuresis, electrolyte depletion -leads to |
-dehydration
-acidosis |
|
Diabetes Drugs
-Drug Classes -Insulin -action -in muscle |
-increased glycogen and protein synthesis
-potassium uptake |
|
Thyroid Hormones
-what is the major product |
-T4 is the major product
-it is converted to T3 by peripheral tissue |
|
Graves' Disease
-what type of hypersensitivity |
-Graves' is a type II hypersensitivity
|
|
Thyroid Hormones
-source |
-follicles of thyroid
-most T3 formed in blood |
|
Brain Energy requirements
-under normal conditions, uses... -during starvation, uses... |
-glucose
-ketone bodies in starvation |
|
Endocrine Pathology
-Hyperaldosteronism -Secondary -kidney thinks -results in |
-kidney thinks there is low intravascular volume
-results in an overactive renin-angiotensin system |
|
Risk factors for T2DM
-diagram |
<img src="151defa883bfe7b945b05d83b3f2ab35.jpg" />
|
|
Thyroid Hormones
-aka |
T3/T4
|
|
Hyperparathyroidism
-Secondary -most often in |
-renal disease (causes hypovitaminosis D--->decreased calcium absorption)
|
|
Diabetic Ketoacidosis
-you see -which are then |
-excess fat breakdown and increased ketogenesis from increased free fatty acids
-which are then made into ketone bodies |
|
Pharmacology of Vitamin D
-absorption imparied with |
-biliary cirrosis
-steatorrhea (malabsorption of fats) |
|
Thyroid Cancer
-Medullary Carcinoma -see |
-sheets of cells in amyloid stroma
|
|
corticosterone goes to
|
aldosterone
|
|
Rosiglitazone
-metabolized by |
-liver CYP2C8
|
|
Thyroid Hormones
-which binds receptors with greater affinity |
-T3 binds receptors with greater affinity than T4
|
|
chlorpropamide can cause
-Side effect |
cholestatic jaundice
|
|
Diabetic Ketoacidosis
-Complications |
-life-threatening mucormycosis
-Rhizopus infection -cerebral edema -cardiac arrhythmias -heart failure |
|
Diabetes Insipidus
-Central DI -causes |
-pituitary tumor
-trauma -surgery -histiocytosis X |
|
Graves' Disease
-stress-induced catecholamine surge leads to |
-death by arrhythmia
|
|
Pheochromocytoma
-most secrete |
-epinephrine
-NE -dopamine |
|
Diuretics
-effect on calcium |
-Loop diuretics--->decrease Ca2+ reabsorption
-Thiazide diuretics--->increase Ca2+ reabsorption -thiazides used in hypercalceuria |
|
Thyroid Cancer
-Follicular carcinoma |
-good prognosis
-uniform follicles |
|
Diabetes Drugs
-Drug Classes -Mimetics -clinical use |
-type 2 DM
|
|
Graves' Disease
-is |
-An autoimmune hyperthyroidism with thyroid-stimulating/TSH receptor antibodies
|
|
enzyme that takes prgesterone to 17alpha-hydroxyprogesterone
|
-17alpha-hydroxylase
|
|
PTH
-regulation |
-decreased free serum calcium--->increased PTH secretion
-decreased free serum magnesium--->decreased PTH secretion ***common causes of decreased magnesium include diarrhea, aminoglycosides, diuretics, and alcohol abuse |
|
Glucagon
-3 main actions |
-stimulates liver carbohydrate metabolism (increases glycogenolysis and gluconeogenesis, decreases glycogen synthesis)
-stimulates insulin release (adrenaline with higher doses) -cardiac stimulation (increases contractility, little effect on rate) |
|
SERMS
-example |
-Raloxifene (Evista)
|
|
Demeclocycline
-clinical use |
-Diabetes insipidus
-SIADH |
|
diagnosis of diabetes
-chart |
<img src="c45fb3a29218b6e5063216e89d0891bd.jpg" />
|
|
Diabetes Mellitus
-Type 1 vs. Type 2 DM -Type 1 -ketoacidosis |
-common
|
|
Calcium Homeostasis
-PTH -Effect on Renal Tubular Cells |
-Stimulates reabsorption of calcium
-Inhibits phosphate reabsorption -increases urinary cAMP -Stimulates production of 1,25-(OH)2D--->increases intestinal calcium absorption--->increases serum calcium |
|
Adrenal steroids
-estrogens in |
periphery
|
|
Subacute thyroiditis
-get |
-elevated ESR
-Jaw pain -early inflammation -very tender thyroid gland |
|
Acromegaly
-findings: |
-Large tongue with deep furrows
-deep voice -large hands and feet -coarse facial features -impaired glucose tolerance (insulin resistance) |
|
the most common cause of hyperpituitarism
|
pituitary adenoma
|
|
SIADH
-stands for |
-Syndrome of Inappropriate Antidiuretic Hormone secretion
|
|
Toxic Multinodular Goiter
-nodules |
-nodules are not malignant
|
|
The most common tumor of the adrenal medulla in children
|
-Neuroblastoma
|
|
Endocrine Pathology
-Addison's Disease -is |
-a primary deficiency of aldosterone and cortisol
|
|
Diabetes Insipidus
-Nephrogenic DI -causes |
-hereditary
-secondary to hypercalcemia, lithium, demeclocycline [ADH antagonist] |
|
Signaling Pathways of Endocrine Hormones
-IP3 |
GGOAT
<span style=" font-weight:600;"><span style="font-weight:400;">-G<span style="font-weight:400;">nRH -GHRH -Oxytocin -ADH (V1 receptor) -TRH |
|
Vitamin D
-24,25-(OH)2 vitamin D |
-an inactive form of vitamin D
|
|
Causes of Cushing's
|
-Pituitary adenoma
-Adrenal hyperplasia/neoplasia -Ectopic ACTH production (ex small cell lung cancer) -Iatrogenic (chronic steroid use) |
|
Vitamin D
-regulation -1,25-(OH)2 vitamin D feedback |
-inhibits its own production
|
|
11-deoxycortisol goes to
|
-cortisol
|
|
Pituitary Adenoma
-can impinge on |
-can impinge on optic chiasm--->bitemporal hemianopia
|
|
Thyroid Cancer
-Undifferentiated/anaplastic -seen in |
older patients
|
|
Diabetes Drugs
-Drug Classes -Sulfonylureas -clinical use |
-stimulate release of endogenous insulin in type 2 DM
-require some islet funciton, so useless in type 1 DM |
|
Diabetes Insipidus
-findings |
-urine specific gravity < 1.006
-serum osmolality > 290 mOsm/L |
|
Carcinoid Syndrome
-you see |
-increased 5-HIAA in urine
|
|
Calcium Homeostasis
-PTH -works on |
-Renal Tubular Cells
-Bone |
|
Cretinism
-Cretin means |
-Christlike
-Those affected were considered so mentally retarded as to be incapable of sinning -still common in China |
|
Pituitary Adenoma
-findings: |
-Amenorrhea
-Galactorrhea -Low libido -Infertility |
|
Diabetes Drugs
-Drug Classes -Insulin -action -in fat |
-aids triglyceride storage
|
|
PTH
-function |
-increases bone resorption of calcium and phosphate
-increases kidney reabsorption of calcium in distal convoluted tubule -decreases kidney reabsorption of phosphate -increases 1,25-(OH)2 vitamin D (calcitriol) production by stimulating kidney 1alpha-hydroxylase |
|
Endocrine Pathology
-Cushing's Syndrome -Etiologies include: -ACTH levels -Iatrogenic (chronic steroid use) |
-decreased ACTH
|
|
Hypothalamic-Pituitary Hormone Regulation
-Dopamine inhibits |
-prolactin
|
|
Glucocorticoids
-effect on Ca2+ levels |
-increased Calcium
-decreased gut Ca absorption |
|
Orlistat
-mechanism |
-alters fat metabolism by inhibiting pancreatic lipases
|
|
Hashimoto's Thyroiditis
-is |
-an autoimmune disorder resulting in hypothyroidism (can have thyrotoxicosis during follicular rupture)
|
|
Initial Blood Glucose Control
-diagram |
<img src="fa19c693777e9440b8faa67e2eb367df.jpg" />
|
|
Enzyme that takes testosterone to Estradiol
|
-Aromatase
|
|
Graves' Disease
-often presents |
-often presents during stress (ex childbirth)
|
|
Hyperparathyroidism
-Secondary -is |
-secondary hyperplasia due to decreased gut calcium absorption and increased phosphorus
|
|
Carbohydrate Counting Hand Guide
-diagram |
<img src="90e373afa229cafcaa0ca42badb04b40.png" />
|
|
Diabetes Mellitus
-Type 1 vs. Type 2 DM -Type 2 -beta-cell numbers in the islets |
-variable (with amyloid deposits)
|
|
In the presence of endogenous or exogenous insulin
-glitazones will: |
-decrease gluconeogenesis, glucose output, triglyceride production in liver
-increase glucose uptake and utilization in skeletal muscle -increase glucose uptake and decrease fatty acid output in adipose tissure -effects on insulin secretion unclear (may re-sensitize beta-cells to glucose) |
|
Adrenal Cortex and Medulla
-Primary regulatory control--->Renin-angiotensin -anatomy -secretory products |
-Zona Glomerulosa
-Aldosterone |
|
Hyperthyroidism
-get |
-decreased TSH (if primary)
-increased total T4 -increased free T4 -increased T3 uptake |
|
Carcinoid Syndrome
-derived from |
-neuroendocrine cells of GI tract
|
|
Hyperthyroidism
-findings |
-Heat Intolerance
-Hyperactivity -Weight loss -Chest pain/palpitations -Arrythmias -Diarrhea -Increased reflexes -Warm, moist skin -Fine Hair |
|
Pituitary Gland
-Basophils |
B-Flat:
-Basophils- -FSH -LH -ACTH -TSH |
|
Calcitonin
-function |
-decreases bone resorption of calcium
|
|
Diabetes Insipidus
-2 Types |
-Central DI
-Nephrogenic DI |
|
Vitamin D
-regulation -decreased phosphate causes |
-increased 1,25-(OH)2 vitamin D production
|
|
Endocrine Pathology
-Waterhouse-Friderichsen Syndrome -due to |
-adrenal hemorrhage associated with meningococcal septicemia
|
|
Diabetes Drugs
-treatment strategy for type 1 DM |
-low-sugar diet
-insulin replacement |
|
Phosphate Homeostasis
-Low serum phosphorus -stimulates -leads to |
-Renal tubular cells
-increased conversion of 25-(OH)D--->1,25-(OH)2D |
|
Endocrine Pathology
-Hyperaldosteronism -Primary -results in |
-hypertension
-hypokalemia -metabolic alkalosis -low plasma renin |
|
Hypoparathyroidism
-Trousseau's sign |
-occlusion of brachial artery with BP cuff--->carpal spasm
|
|
Glitazones
-do not cause |
lactic acidosis
-even in patients with renal impairment |
|
Diabetes Mellitus
-insulin deficiency (and glucagon excess) -leads to decreased glucose uptake -leads to |
-hyperglycemia
-glycosuria -osmotic diuresis -electrolyte depletion |
|
Thyroid Hormones
-T3 functions mnemonic |
4 B's
-Brain maturation -Bone growth -Beta-adrenergic effects -BMR increased |
|
Endocrine Pathology
-Sheehan's Syndrome -is |
-postpartum hypopituitarism
|
|
Calcium salts
-indications |
-hypocalcemia
-osteoporosis -osteomalacia -hypoparathyroidism -renal failure -intestinal osteodystrophy |
|
Androstenedione goes to
|
-Estrone
and -Testosterone |
|
Carcinoid Syndrome
-results in |
-recurrent diarrhea
-cutaneous flushing -asthmatic wheezing -right-sided valvular disease |
|
11beta-hydroxylase deficiency
-get build-up of |
-11-deoxycorticosterone
and -11-deoxycortisol |
|
Pituitary Gland
-acidophils |
-GH
-prolactin |
|
Vitamin D
-source |
-Both Vitamin D2 and D3 converted to 25-OH vitamin D in liver
-and converted to 1,25-(OH)2 vitamin D (active form) in kidney |
|
Steroid/thyroid hormone mechanism
-MOA |
-hormone enters into cell
-binding to receptor located in nucleus or cytoplasm -transformation of receptor to expose DNA-binding domain (in nucleus) -binding to enhancer-like element in DNA (in nucleus) -affects gene expresion |
|
Incretin-related drugs
-2 Types |
-Incretin mimetics--->Exenatide
-Dipeptidyl-peptidase-4 inhibitors--->Sitagliptin (enhances effect of incretins) |
|
SIADH
-causes include |
-ectopic ADH (small cell lung cancer)
-CNS disorders/head trauma -pulmonary disease -drugs (ex cyclophosphamide) |
|
Diabetes insipidus
-characterized by |
-intense thirst and polyuria together with an inability to concentrate urine owing to:
-lack of ADH or -lack of renal response to ADH |
|
Thyroid Cancer
-Medullary Carcinoma -associated with |
-MEN types 2A and 2B
|
|
Meglitinides
-MOA |
-inhibit ATP-sensitive K+-channels on beta-cells
|
|
Diabetes Drugs
-Drug Classes -Glitazones -toxicities |
-weight gain
-edema -hepatotoxicity -CV toxicity |
|
Therapeutic Uses of Glucagon
|
To treat hypoglycemia
-recommended for comatose patients, preferably Type-I -not effective in hypoglycemic crisis because of depleted glycogen stores -short half-life mitigates use in chronic hypoglycemic conditions |
|
Thiazolididinediones (glitazones)
-MOA |
-bind to peroxisome proliferator-activated receptor-gamma
|
|
Cortisol
-source -bound to -what induces prolonged secretion |
-Adrenal Zona Fasciculata
-bound to corticosteroid-binding globulin (CBG) -chronic stress |
|
Endocrine Pancreas Cell Types
-Islets of Langerhans -arises from |
-arise from pancreatic buds
|
|
Vitamin D
-If you dont get enough Vitamin D -in adults causes |
-osteomalacia
|
|
Diabetic Ketoacidosis
-labs -blood ketone levels |
-increased
|
|
Calcitonin
-indications |
decrease Ca loss from bone or bone turnover
-Paget’s disease -Osteoporosis Hypercalcemia of malignacy - slow response |
|
21alpha-hydroxylase deficiency
-in newborns |
-salt wasting can lead to hypovolemic shock in the newborn
|
|
Osteoporosis
-treatment b) |
-calcitonin, bisphosphonates, SERMS, calcitonin, and PTH
-also, inhibit osteoclasts? |
|
11beta-hydroxylase deficiency
-see |
-decreased cortisol
-decreased aldosterone and corticosterone -increased sex hormones |
|
Orlistat
-clinical use |
-long-term obesity management (in conjunction with modified diet)
|
|
Hyperparathyroidism
-Primary -characteristics |
-usually an adenoma
-Hypercalcemia -Hypercalciuria (renal stones) -Hypophosphatemia -Increased PTH -Increased alkaline phosphatase -Increased cAMP in urine |
|
Diazoxide
-MOA |
-inhibits insulin release
-stimulates catecholamine release -increases hepatic glucose production |
|
Neuroblastoma
-see |
-HVA in urine
|
|
PTH
-mnemonic |
PTH=Phosphate Trashing Hormone
|
|
Pharmacology of Vitamin D
-is absorbed |
-readily absorbed in GI tract
-if bile salts are present |
|
SERMS
|
women lacking estrogen (ex postmenopause, post-hysterectomy) have increased bone resorption
|
|
Hyperparathyroidism
-Secondary -get |
Renal osteodystrophy-bone lesions due to secondary hyperparathyroidism due in turn to renal disease
|
|
RBC Energy Requirements
|
-RBCs always depend on glucose
|
|
Diabetes Drugs
-Drug Classes -Insulin -Lispro -duration |
-short-acting
|
|
Thyroid Cancer
-Papillary carninoma |
-Most common
-excellent prognosis -"ground-glass" nuclei (Orphan Annie) -psammoma bodies -nuclear grooves |
|
Endocrine Pathology
-Cushing's Syndrome -Etiologies include: |
-Pituitary adenoma (Cushing's disease)--->increased ACTH
-Adrenal hyperplasia/neoplasia--->decreased ACTH -Ectopic ACTH production (ex small cell lung cancer)--->increased ACTH -Iatrogenic (chronic steroid use)--->decreased ACTH |
|
Multiple Endocrine Neoplasias (MEN)
-MEN 2B -mnemonic |
MEN 2B=1 P
-Pheochromocytoma |
|
Hypothyroidism
-findings |
-Cold Intolerance
-Hypoactivity -Weight Gain -Fatigue -Lethargy -Decreased appetite -Constipation -Weakness -Decreased reflexes -Myxedema (facial/periorbital) -Dry, cool skin -Coarse, brittle hair |
|
Vitamin D
-PTH vs 1,25-(OH)2 vitamin D |
-PTH increases calcium reabsorption and decreases phosphate reabsorption
-1,25-(OH)2 vitamin D increases absorption of both calcium and phosphate |
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Insulin Adjustment
-diagram |
<img src="8df4b805e174e9ed2d0dc5131b79596a.jpg" />
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Vitamin D
-function |
-increases absorption of dietary calcium
-increases absorption of dietary phosphate -increases bone resorption of calcium and phosphate |
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Calcium Homeostasis
-PTH -increased 1,25-(OH)2D -does what |
increases intestinal calcium absorption
-leads to increased serum calcium |
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Demeclocycline
-member of |
-tetracycline family
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Problems of Osteoporosis
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-low osteoblast activity
-high osteoclast activity |
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Diabetes Mellitus
-Chronic Manifestations -Nonenzymatic glycosylation -damages |
-Small vessel disease (diffuse thickening of basement membrane)--->retinopathy (hemorrhage, exudates, microaneurysms, vessel proliferation
-glaucoma -nephropathy (nodular sclerosis, progressive proteinuria, chronic renal failure, arteriosclerosis leading to hypertension, Kimmelstiel-Wilson nodules) -Large vessel atherosclerosis -CAD -peripheral vascular occlusive disease and gangrene -cerebrovascular disease |
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Pheochromocytoma vs. Neuroblastoma
-difference |
-Pheochromocytoma (adults) causes episodic hypertension
-Neuroblastoma (children) does not cause episodic hypertension |
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Posterior Pituitary
-derived from |
-derived from neuroectoderm
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Endocrine Pathology
-Addison's Disease -hypotension caused by |
-hyponatremic volume contraction
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Phosphate Homeostasis
-increased 1,25-(OH)2D -leads to |
-Release of phosphate from bone matrix
-increases calcium and phosphate absorption from the gut |
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Diabetes Mellitus
-Type 1 vs. Type 2 DM -Type 1 -classic symptoms of polyuria, polydipsia, thirst, weight loss |
-common
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In females, prolactin inhibits
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-GnRH synthesis and release, which inhibits ovulation
*amenorrhea is commonly seen in prolactinomas |
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Calcitonin MOA
-direct actions |
Direct actions
-decreased activity of osteoclasts (decreased bone resorption) -increased excretion of Ca & PO4 (& Na, Mg, Cl) |
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Somatostatin
-aka |
ocreotide
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Signaling Pathways of Endocrine Hormones
-cGMP |
-ANP
-EDRF -NO |
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Pituitary Adenoma
-cause shrinkage |
-Bromocriptine or cabergoline (dopamine agonists)
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Thyroid Hormones
-get decreased TBG when |
-in liver failure
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Graves' Disease
-death by arrhythmia |
-seen as a serious complication of Graves' and other hyperthyroid disorders
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