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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---&gt;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---&gt;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---&gt;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---&gt;decrease Ca2+ reabsorption
-Thiazide diuretics---&gt;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---&gt;increased PTH secretion
-decreased free serum magnesium---&gt;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---&gt;increases intestinal calcium absorption---&gt;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---&gt;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 &lt; 1.006
-serum osmolality &gt; 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---&gt;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---&gt;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---&gt;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---&gt;Exenatide
-Dipeptidyl-peptidase-4 inhibitors---&gt;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)---&gt;increased ACTH
-Adrenal hyperplasia/neoplasia---&gt;decreased ACTH
-Ectopic ACTH production (ex small cell lung cancer)---&gt;increased ACTH
-Iatrogenic (chronic steroid use)---&gt;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
Insulin Adjustment
-diagram
<img src="8df4b805e174e9ed2d0dc5131b79596a.jpg" />
Vitamin D
-function
-increases absorption of dietary calcium
-increases absorption of dietary phosphate
-increases bone resorption of calcium and phosphate
Calcium Homeostasis
-PTH
-increased 1,25-(OH)2D
-does what
increases intestinal calcium absorption
-leads to increased serum calcium
Demeclocycline
-member of
-tetracycline family
Problems of Osteoporosis
-low osteoblast activity
-high osteoclast activity
Diabetes Mellitus
-Chronic Manifestations
-Nonenzymatic glycosylation
-damages
-Small vessel disease (diffuse thickening of basement membrane)---&gt;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
Pheochromocytoma vs. Neuroblastoma
-difference
-Pheochromocytoma (adults) causes episodic hypertension
-Neuroblastoma (children) does not cause episodic hypertension
Posterior Pituitary
-derived from
-derived from neuroectoderm
Endocrine Pathology
-Addison's Disease
-hypotension caused by
-hyponatremic volume contraction
Phosphate Homeostasis
-increased 1,25-(OH)2D
-leads to
-Release of phosphate from bone matrix
-increases calcium and phosphate absorption from the gut
Diabetes Mellitus
-Type 1 vs. Type 2 DM
-Type 1
-classic symptoms of polyuria, polydipsia, thirst, weight loss
-common
In females, prolactin inhibits
-GnRH synthesis and release, which inhibits ovulation

*amenorrhea is commonly seen in prolactinomas
Calcitonin MOA
-direct actions
Direct actions
-decreased activity of osteoclasts (decreased bone resorption)
-increased excretion of Ca &amp; PO4 (&amp; Na, Mg, Cl)
Somatostatin
-aka
ocreotide
Signaling Pathways of Endocrine Hormones
-cGMP
-ANP
-EDRF
-NO
Pituitary Adenoma
-cause shrinkage
-Bromocriptine or cabergoline (dopamine agonists)
Thyroid Hormones
-get decreased TBG when
-in liver failure
Graves' Disease
-death by arrhythmia
-seen as a serious complication of Graves' and other hyperthyroid disorders