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90 Cards in this Set

  • Front
  • Back
what does each layer make?
1) Glomerulosa
2) Fasiculata
3) Reticularis
4) Medulla
1) aldo
2) Cortisol (can make sex hormones too)
3) androgen
4) Catecholamines (NEURAL CREST ORIGIN for the chromaffin cells)
What is the adenhypophysis derived from
Oral ectoderm (rathkes pouch - choriocarcinoma, rathkes pouch cyst)
Where do the islets arise from?
Pancreatic buds
Where are alpha and beta islet cells located within the islet
Glucagon - peripheral
Insulin - central
What are the 6 anabolic effects of insulin?
1) inc glucose transport
2) Inc glycogen synthesis and storage
3) inc triglyceride syn and storage
4) inc na retention
5) inc prot syn
6) inc cellular uptake of K and aa
Where are the following transporters found?
1) GLUT 1
2) GLUT 2
3) GLUT 3
4) GLUT 4
1) RBCs and Brain
2) Bidirectional - Liver, and B iselt cell, kidney and SI
3) Placenta, brain, kidney
4) mucle and adipose (insulin responsive)

** These channels do facilitated diffusion, they prefer D isomers,
What mediator decreases GH and TSH secretion?
TRH increases the secretion of what two horomones?
Prolactin increases release of what regulatory hormone
What is the enzyme deficiency? Symptoms: Hypotenion, hyperkalemia, inc PRA, volume depletion. Masculinization, female pseudohermaphroditism
This is CAH with a 21 alpha hydroxylase deficiency you would also see a bulid up of 17 hydroxyprogesterone, and progesterone
What is the enzyme deficiency: Hypertension, hypokalemia...XY - pseduohermaphroditis external female, no internal repro orgs due to MIF, XX - eternal femal with normal insides but no secondary sex char
CAH deficiency in 17 alpha hydroxylase no sex hormones or cortisol...lots of aldo
Whats the enzyme deficiency? Hypertension, masculinization see and increase in 11deoxycorticosterone and 11 deoxycortisol,
11 beta hydroxylase (CAH)
What are the five functions of cortisol?
1) Maintains BP (permissive with epi, upregs a1 receptors on arterioles)
2) dec bone formation
3) anti inflamm
4) dec immune function
5) inc gluconeogenesis, lipolysis, proteolysis

* exogenous corticosteriods can cause an increase in serum PMNs due to demarginalization
Where in the kidney does PTH inc reabsorption of calcium
What two ions alter PTH secretion
Mg (dec causes dec pth) causes: alco abuse, diarrhea, aminoglycosides, diuretic
Ca (dec cause inc)
How does PTH cause inc bone reabsorp
Cause inc production of M-CSF and RANKL in OBs that stimbulates OCs
what enzyme does phosphate inhibit (in ca homeostasis)
1 alpha hydroxylase
What hormones use cAMP
"Flat Champ"
What hormones use cGMP
NO (aka EDGF), ANP
What hormones use IP3
What hormones use steriod receptors
1) cytosolic
2) nucelar
1) Vit D, cortisol, aldosterone, Estrogen, Testosterone, Progesterone,
2) T3/T4
Which hormones use intrinsic typrosine kinase receptors
(mapk pathway)
Insulin, IGF-1 , FGF, PDGF

** The insulin Y kinase phosphorylates insulin response substrates and activates them, things that P serine residues on the same targets will block the effects of insulin. TNF alpha is a serine kinase.
Which hormones use receptor associated tyrosine kindases
In men what does increased levels of sex hormone binding globulin do?
It lowers free testosterone --> gynectomastia
In women what does decreased SHBG do?
Raises free testosterone --> hirsutism (think menopause - dec estrogen --> dec binding globins from liver --> hirsutism in menopause)
Where is most t3 formed
what are the 5 functions of thyroid homrone
1) Bone growth (synergistic with GH)
2) CNS maturation (think cretenism)
3) inc B1 receptors in the heart
4) inc BMR via inc na/k transporter activity
5) inc glycogenolysis, gluconeogenesis, lipolysis
what decreases TBG and what increases it
Dec - liver failure
Inc - Pregnancy and OCP (free t4 will be the same, total T4 will increase)
What are the three functions of thyroid peroxidase
Oxidation and organifiation of iodide, as well as coupling of MIT and DIT
What cell makes thyroglobulin? What hormone increases its production?
Thyroid epithelium, TSH
#1 cause of cushings syndrome
Exogenous (iatrogenic) steroids
What is cushings DISEASE
due to ACTJ secretion from a pituitary adenoma (inc ACTH)
What type of cushings does not respond to dexamethasone suppression at high or low doses
Ectopic CTH (small cell lung cacer, bronchial carcinoids
Endogenous causes of Cushings (3)
1) cushings disease (pituitary will respond to high dose of dex)
2) ectopic ACTH
3) adeoma (dec acth)
What are the S/Sx of Conn syndrome
Hyperaldosteronism: Hypokalemia (muscle weakness, parasthesia, acidosis (transcellular shift)) low plasma renin, hypertension...aldo secreting tumor. Can be bi or unilateral.
**Hypernatremia is rare due to aldo escape
What hormone is responsible for the aldosterone escape in conns
ANP (promotes naturiesis)
What are the S/Sx of Addisons disease?
Def of aldo and cortisol causing hypotension, hyperkalemia, acidosis, skin hyperpigmentation,, involves all 3 cortical divisions but spares the medulla. Secondary adrenal insufficiency should have dec pituaitary acth prouction and should have no skin hyperpigmention or hyperkalemia
What happens in adrenal crisis
You get hypotension, tachycardia, hypoglycemia in someone with a history consistent with adrenal insufficiency (see vomiting abd pain, weight loss, and hyperpigmentation)
What are causes of addisons
Autoimmune destruction of the adrenal, TB, metastasis, Waterhouse-fridreichsen
What are the three components of a craniopharyngioma (grossly)
Solid (actual cells), filled with a machinery oil like liquid, and calicifications. Tumor of rathkes pouch(oral ectoderm)
What do most Pheochromocytomas secrete
NE, Epi, and DA see and increase in urinary VMA, and elevated plasma catecholamines
What is the treatment for Pheo
a1 block followed by surgery....I remember they said you could use a BB after a1 but first aid only mentions the alpha block. SHould use phenoxybenzamine (irreverse) but can use phentoamine (revers)
what are the 5 ps of episodic symtoms of pheo?
Pressure (^ bp)
Pain (HA)
Palpitations (tachy)
What is the most common tumor of the adrenal medulla in children? What is the Urine marker for it?
Neuroblastoma, HVA. Due to urine overexpression of N-myc
What are the break down products of DA, NE, and Epi
HVA, VMA, Metanephrine
Constipation, dec reflexes and nyxedema (facia/periorbital) are seen in what thyroid disorder?
How do you treat radiation poinsoning
KI, perchlorate they use the same transporter as Radioactive I so they competitively inhibit one another
What is the antibody seen in hashimotos
What is the HLA association with Hashimotos?
HLA DR5 (also pernicious anemia)
What is the histo finding in hashimotos
Hurthle cells lymphocytic infilatrate with germinal centers
What are the s/sx of cretinism
Pot belly, pale, puffy face kid with protruding umbilicus and protuberant tongue (also MR, and I think growth retarded)
Subacute thyroiditis s/sx
Painful thryoid, granulomatous inflamm
What is the etiology of riedels thyroiditis
Thyroid replaced by fibrous tissue
Why type of hypersensitivity is Graves
Catecholamine surge leadsto death by arrhythmia (Inc thyroid increases the B receptors if you surge the epi then you will get over stimulation!) Can tx wtih B blockers
What symptom of graves will not resolve with BB
What is the pathophys of toxic multinodular goiter
Focal patches of Hyperfunctioning follicular cells working indp of TSH due to a mutation of the TSH recepto. ***Hot nodules are rarely malignant
What is the jod basedow phenomenon
Thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
Most common thyroid tumor? What are the histo signs?
Papillary carinoma...Ground glass nuclei (orphan annie) psammoma bodies, inc risk with childhood irradiation.
What thyroid cancer has uniform follicles
Follicular (dur) you cannot diagnose this by cytology (IF?)
What thyroid carcinoma originates from C cells? What are the histo signs?
Medullary, makes calcitonin, sheets of cells in amyloid stroma. Assoc w/ Men 2a and 2b (ret gene muts)
What thyroid cancer has a very poor prognosis?
Undifferentiated/anaplastic (often see n in the elderly)
What thyroid cancer is associated with hashimotos
Whats the common cause of primary hyperparathyroidism
What is osteitis fibrosa cystica
Cystic bone spaces filled with brown fibrous tissue (chronically elevated PTH)
What is renal osteodystrophy
Bone lesions due to 2 or 3 hyperparathyroidism due in turn to renal disease.
What is the cause of tertiary hyperparathyroidism
Refractory hyperparathyroidism resulting form chrnic renal disease - see inc PTH inc CA
What are the labs in secondary Hyperparathyroidism
Inc PTH, hypocalcemia, hypophos, this is due to hypovitaminosis D
Causes of hypoparathyroidsim
accidental surgical excision, AI destruction, or digeorge
Albrights hereditary osteodystrophy - autodom kidney unresponsiveness to PTH, hypocalc shortened 4th and 5th digits, short stature
Whats is chvosteks sign and what does it suggest
Tapping of facial nerve = contraction of facial muscles sign of hypocalcemia
how do you treat a prolactinoma
Bromocriptine or cabergoline (DA agonists)
What happens to the glucose in acromegaly
Impaired glucose tolerance (insulin resistance)
Tx for acromegaly
resection followed by octreotide
What are some causes of central DI
Trauma, pit tumor, surgery, or histiocytosis X
What are some causes of nephrogenic DI
Hereditary, hypercalcemia, lithium,demeclocycline (ADH antag), hypokalemia (mostly cAMP inhibition is the key)
What are the urine osm and spec gravity for DI
<1.006, and >290
How do you treat central and peripheral DI
1) central - intranasal desmopressin
2) peripheral - HCTZ, indomethacin, amiloride (esp good for Li tox)
What are the signs of SIADH
excessive water retention, hyponatremia, urine osmolarity>serum osm...Body responds with dec aldo (hyponat) to maintain near normal vol status. Very low serum sodium levels can lead to seizure
How do you treat SIADH
Demeclocyline or H2O restriction
What are some causes of SIADH
Small cell lung cancer, CNS disorders/head trauma, pulmonary disease, drugs (CYCLOPHOSPHAMIDE)
What are the acute manifestations of DM1 and DM2
DM2 - hyperosmolar coma (inc hemoconcentration and volume depletion, don't see elevated ketones) Ketosis is absent bc there is insulin inhibiting lipolysis

** Presence of unopposed secretion of GH and epi can exacerbate hyperglycemia
what are the HLA association in DM1
DR3 and DR4
In what condition do you see amyloid deposits in the B islets
DM2, not seen in one
What are the S/Sx of DKA
Kussmaul resp (rapid deep breathing due to reflex response of the chemo receptors to acidosis), N/V, abd pain, psychosis/delirium, fruity breath. Hyperkalemia but there is depleted intracellular K due to transcellular shift from dec insulin (BE CAREFUL WHEN GIVING INSULIN WATCH K)
S/SX of carcinoid syndrome
Diarrhea, cutaneous flushing, asthmatic wheezing, and right sided valvular dz, most common tumor of the appendix!!!!!!!!!!!!!!
Men 1 characteristics
Parathyroid tumors
Pituitary tumor (PRL or GH)
Pancreatic endocrine (ZE, vipoma, glucagonoma)
Men 2A
Parathyroid, Pheochromocytoma, Medullary thyroid
Men 2B
Pheo, Medullary thyroid, Marfainoid habius and ORAL/INTESTINGAL GANGLIONEUROMATOSIS (flesh colored nodules)
What are the signs and symptoms of zollinger ellison
Stomach shows rugal thickening with acid hypersecretion. Causes recurrent ulcers - may be associated wtih MEN I