Thomas First Aid Endocrine

Front 1

Adrenal Cortex from what lineage of cells?
Adrenal Medulla?

Back 1

cortex- mesoderm
medulla- neural crest cells

Front 2

What are levels of Adrenal Cortex, and what is produced in each?

Back 2

GFR, "The deeper you go the sweeter it gets"

Zona Glormerulosa - aldosterone (salty)

Zona Fasciculata - cortisol, some sex hormones (sweet)

Zona Reticularis - sex hormones (androgens)

Front 3

primary regulatory control for stimulation for Zona Glomerulosa?

Back 3

RAAS system

Front 4

primary regulatory control for Zona Fasciculata? Reticularis?

Back 4

both - ACTH, CRH

Front 5

Chromaffin cells found where and stimulated by what

Back 5

in adrenal medulla, secrete NE and Epi, stimulated by preganglionic sympathetic fibers

Front 6

Most common adrenal medullary tumor in kids? adults? difference between the two?

Back 6

kids- nephroblastoma

adults- pheochromocytoma

pheochromocytoma causes episodic HTN, nephroblastoma doesn't

Front 7

in adrenal and gonadal veins, what is difference in path b/w left and right side?

Back 7

Right side SKIPS RENAL VEIN

Right - adrenal/gonadal vein, IVC

Left - adrenal/gonadal vein, left renal vein, IVC

Front 8

7 anterior pituitary hormones?

which acidophils? basophils?

Back 8

ACTH
TSH
FSH
LH
GH
MSH
Prolactin

acidophils - GH, prolactin

Front 9

Posterior pituitary derived from what?

anterior pituitary derived from

Back 9

post. pituitary- neural ectoderm

ant. pituitary- Rathke's pounch (oral ectoderm)

Front 10

anterior pituitary hormones have alpha subunit and beta subunit. which subunit is common and which is specific for each hormone?

Back 10

alpha- common among TSH, LH, FSH, hCG

beta- specific for each one

Front 11

endocrine pancreas: most numerous endocrine cells in what part of pancreas? islet cells arise from what?

Back 11

tail of pancreas

pancreatic bud

Front 12

3 endocrine cell populations in pancreas, produce what and which one:
-periphery
-central
-interspersed

Back 12

periphery- alpha cells (glucagon)

central - beta cells (insulin)

interspersed - delta (D) cells (somatostatin)

Front 13

what cellular changes in beta islet cell causes insulin release?

Back 13

inc. ATP from glucose metabolism causes closing of K+ channels and depolarizing cells. this opens calcium membrane channels causing calcium release, which allows insulin vesicle exocytosis

Front 14

What tissues are insensitive to insulin, which means have what glucose transporters (2)

Back 14

BRICK L

Brain (Glut 1)
RBC (Glut 1)
Intestine, small (Glut 2)
Cornea (Glut 2)
Kidney (Glut 2)
Liver (Glut 2)

and also Beta islet cells
Glut-2 is bidirectional

Front 15

what tissues are insulin dependant for glucose uptake

Back 15

muscles and adipose
(Glut 1)

Front 16

Anabolic effects on insulin:
what transported
what molecules allowed into cell (2)
3 substances synthesized
2 substances stored
1 retained substance by kidneys

Back 16

glucose transported
K+ and AAs into
synthesis - proteins, glycogen, TGs
1 retained substance by kidneys - Na+
stored- TGs, glycogen

Front 17

what hormone stimulates TSH? inhibits?

Back 17

stimulates - TRH
inhibits - somatostatin

Front 18

somatostain inhibits what pituitary hormone(s) release?

Back 18

GH
TSH

hormones for pro-growth, just lik it inhibits pro-digestion

Front 19

Prolactin inhibited by? Prolactinoma treated by (2)

Back 19

Dopamine

bromocriptine or cabergoline

Front 20

GnRH inhibited by

Back 20

prolactin (inhibits LH, FSH, estrogen, testosterone)

Front 21

2 classes of drugs that promote prolactin secretion

Back 21

dopamine antagonists (most antipsychotics)

estrogens (OCP, pregnancy)

Front 22

17 apha hydroxylase presentation?

Back 22

ONLY MAKE ALDOSTERONE

hypertension
hypokalemia
lack of androgens (externally female males with no internal sturctures, females normal but have no 2ndary female characteristics)

Front 23

21 alpha hydroxylase deficiency

Back 23

ONLY increased andogens

HYPOtension
HYPERkalemia
masculinization with pseudohermaphroditism in females

increased renin, but salt wasting can lead to hypovolemic shock in newborn

Front 24

11 beta hydroxlylase deficiency

Back 24

Make 11-deoxycortisone (aldosterone precursor) and sex hormones

hypertension
masculinization

Front 25

aromatase deficiency

Back 25

turns testosterone into estrogen

will be masculinization of female fetus with virilization of mother. if male, will have precocious puberty

when older, females will have oligomenorrhea and increased height because decreased estrogen can't close epiphyseal plates

Front 26

what drug blocks cortisol by blocking 11 beta hydroxylase?

Back 26

metyrapone

Front 27

Cortisol functions

Back 27

think BBIIG

control Bp (upregulates alpha 1 receptors on arterioles)
decrease Bone growth
anti-Inflammatory
decreased Immune function
increases Gluconeogenesis, lipolysis, proteolysis (for more energy)

Front 28

How does cortisol travel through bloodstream? what induces secretion?

Back 28

cortisol-binding globulin

chronic stress

Front 29

2 physiologic conditions that can cause decreased Mg2+, and 3 substances that can

Back 29

PTH and diarrhea decrease Mg2+

diuretics, aminoglycosides, alcohol abuse

Front 30

what cells release PTH?

Back 30

Chief Cells of Parathyroid (by Calcium-sensing receptor)

Front 31

PTH acts on osteoblasts directly, which stimulate them to increase (2) which activate osteoclasts

Back 31

M-CSF (macrophage colony stimulating factor)

RANK-L

Front 32

cholecalciferol is what?

Back 32

vitamin D

D3 - from skin

D2 - from plants

Front 33

Vitamin D function in:
GI
Bone

activated where?

what is regulation?

Back 33

GI - absorbs more Ca and P04
Bone - resorbs more Ca and P04

first hydroxylation in liver, second in kidney

stimulated by low Ca, P04, high PTH

inhibited by high 1,25(OH)2 Vitamin D

Front 34

what cells produce calcitonin?

high levels can be marker for what cancer?

Back 34

Parafollicular (C) cells of thyroid

Medullary Thyroid Cancer

Front 35

endocrine hormones that act by cAMP

Back 35

FLAT CHAMP

FSH
LH
ACTH
TSH
CRH
hCG
ADH(v2)
MSH
PTH

calcitonin
glucagon
GHRH

Front 36

hormones that act by cGMP

Back 36

ANP
NO

Front 37

hormones that act by IP3

Back 37

GOAT

GnRH
Oxytocin
ADH(v1)
TRH

Front 38

hormones that act by cystosolic steroid receptor

Back 38

sex and adrenal hormones

estrogen
testosterone
progesterone
aldosterone
cortisol
vitamin D (random, I know)

Front 39

hormones that act by nuclear steroid receptor

Back 39

T3/T4

Front 40

hormones that act by MAP kinase (intrinsic) tyrosine kinase

Back 40

growth factors

(maps chart GROWTH)

Insulin
IGF-1
FGF
PDGF

Front 41

hormones that act by JAK/STAT tyrosine kinase

Back 41

acidophils of ant. pituitary

GH
Prolactin

Front 42

Since steroid hormones are lipophilic, they need carrier-binding proteins. Increased steroid binding proteins in males causes?

decreased steroid-binding globulins in females causes?

Back 42

in males, INCREASED steroid hormone binding globulin--> gynecomastia (decreases free testosterone)

in females, DECREASED steroid hormone binding globulin causes--> hirsutism (because increased free testoterone)

Front 43

steroid hormones bind to receptors in cytosol (or if thyoid hormone, nucleus). then in nucleus hormone receptor complex binds to what part of DNA?

Back 43

enhancer-like element (to increase gene transcription)

Front 44

4 functions of T3

Back 44

4 B's of thyroid hormone

Brain maturation
Bone growth
Beta adrenergic effects (inc. B1 stimulation in heart)
Basal Metabolic rate (via inc. Na/K ATPase)

also glycogenolysis, lipolysis, gluconeogenesis

Front 45

which is main active product, T4 or T3 and each made where?

Back 45

T3 major active product, more T4

T4 made in thyroid
most T3 made peripherally

Front 46

In Thyroid Follicular cell, what allows iodide into lumen? out of lumen? what is made in follicular cell?

Back 46

into lumen- oxidation (peroxidase) of I-
made in follicular cell and secreted into lumen - thyroglobulin
to exit lumen and cell to blood - proteolysis

Front 47

Most thyroid T3/T4 carried by thyroid binding globulin. Condition that decreases thyroid binding globulin?
Increases?

Back 47

decrease- liver failure

increase- estrogens (OCP, pregnancy)

Front 48

weight gain, HTN, skin thinning and striae, osteoporosis, amenorhhea associated with

Back 48

Cushing's syndrome

Front 49

most common cause of Cushing's syndrome

Back 49

iatrogenic

Front 50

2 tumors that can cause cushing's by ectopic ACTH secretion

Back 50

small cell carcinoma, bronchial carcinoids

Front 51

3 causes of adrenal Cushing's syndrome

Back 51

adenoma, carcinoma, nodular adrenal hyperplasia

Front 52

2 causes of negative dexamethasone test at both low and high levels

Back 52

ectopic ACTH-producing tumor, Cortisol-producing tumor

Front 53

Conn's syndrome

treatment (2)

Back 53

primary hyperaldosteronism
(will have low renin, unlike 2ndary)

surgery, spironolactone (for HTN and hypokalemia)

Front 54

what causes 2ndary hyperaldosteronism

Back 54

overactive RAAS system (due to CHF, renal artery stenosis, cirrhosis, nephrotic syndrome.

Front 55

2 changes between primary and secondary adrenal insufficiency and cause of each

Back 55

primary (Addison's disease) - decrease in all 3 zones of adrenal cortex) due to TB, metastasis, autoimmune-

2ndary- decreased ACTH production (so aldosterone still ok)
-no hyperpigmentation
-no hyperkalemia

Front 56

3 causes of Waterhouse-Friedrichsen syndrome

Back 56

N. Meningitidis septicemia, septic shock, DIC

Front 57

Pheochromocytoma
rule of 10
usually secrete what
what seen in urine
treatment (2)

Back 57

10s
10% bilateral
10% metastatic
10% calcify
10% children
10% familial
10% extra-adrenal
secrete NE, Epi, dopamine
VMA (breakdown of NE) seen in urine
treatment- phenoxybenzamine (or other alpha-antagonist) and surgeyr

Front 58

what are pheochromosytomas associated with beside MEN syndromes? (3)

Back 58

MEN 2A and MEN 2B

neurofibromatosis

sturge-webber

VHL

Front 59

Neuroblastoma

occurs where?
what seen in urine?
mutation?

Back 59

most common adrenal medulla tumor in kids, but can be anywhere in sympathetic chain

HVA (homovanilic acid, breakdown of dopamine) seen in urine

N-myc mutation

Front 60

hyperthyroidism findings:
TSH
total T4
free T4
T3 uptake

Back 60

TSH decrease
total T4 increase
free T4 increase
T3 uptake increase

Front 61

Hyperthyroidism findings:
cold/heat intolerance
GI disturbance
reflexes
myxedema
brittle/fine hair
dry/moist skin
Heart findings

Back 61

heat intolerance
diarrhea
increased reflexes
fine
moist skin
chest pain, palpitations, arrhythmias

Front 62

where is myxedema found in:
hypothyroidism
hyperthyroidism

Back 62

hypothyroidism- periorbital/facial

hyperthyroidism- tibia

Front 63

child with pot belly, pale puffy face, protdruging umbilicus, protuberant tongue

Back 63

congenital hypothyroidism ("cretinism")

Front 64

Very tender thyroid, jaw pain, increased ESR rate
is what
what on histo
usually follows

Back 64

Subacute (de Quervian's) Thyroiditis, a self-limiting hypothyroidism

granulomatous inflammation
usually follows flu-like infection
can be hyperthyroid early in course

Front 65

how can thyrotoxicosis develop in Hashimoto's?

Back 65

early in disease, follicle can rupture and cause it

Front 66

fixed, rock-like, painless goiter

is what, what is change

Back 66

Riedel's thyroiditis

hypothyroidism where thyroid tissue replaced by fibrous tissue

Front 67

Grave's disease
what are abs to
hypersensitivity type

Back 67

abs= Thyroid Stimulating ab (TSI) or to TSH-R

type II

Front 68

Grave's Disease Often Presents during

Back 68

stress (like Childbirth)

Front 69

pathopneumonic finding for Graves, and myxedema where

Back 69

Proptosis

pretibial myxedema

Front 70

Thyrotoxicosis is a serious complication of hyperthyroid conditions that causes catecholamine release stimulated by ____ and can cause death by ____

Back 70

stimulated by stress

cause death by arrhythmia

Front 71

perchlorate and pertechnatate use for what?

Back 71

competitively inhibit uptake of iodide for hyperthyroidism

Front 72

Toxic Multinodular Goiter

mutation in what?
increase release of what?
Are hot nodules malignant?

Back 72

mutation in TSH receptor
increase release of both T4 and T3
Only Rarely

Front 73

Jod-Basedow Phenomenon

Back 73

thyrotoxicosis if iodine-depleted person becomes iodide replete

Front 74

thyroid cancer
ground glass nuclei, nuclear grooves, calcium inclusion bodies

Back 74

Papillary Thyroid Cancer

"Little Orphan Annie Cancer"
like Annie, papillary cancer is
1. slow growing (stays around for years and doesn't get bigger)
2. well-behaved (very good prognosis)
3. has "Orphan Annie" (large, hollow like empty eyes)
4. has psammoma bodies (from greek psammos--> sand = Annie's dog's name was Sandy)

Front 75

thyroid cancer:
uniform follicles

Back 75

Follicular carcinoma, good prognosis

Front 76

thyroid cancer:
sheets of cells in amyloid stroma

Back 76

Medullary Thyroid Cancer

seen in MEN 2A and MEN 2B

many times secretes calcitonin from Parafollicular C cells

Front 77

thyroid cancer:
anaplastic

Back 77

Undifferentiated/anaplastic thyroid cancer

usually older people, bad prognosis

Front 78

Cancer associated with Hashimoto's Thyroiditis

Back 78

Thyroid Lymphoma

Front 79

what is saying for Hyperparathyroidism?

Back 79

"Stones, Bones, Groans, Psychiatric overtones"

renal Stones
Bone resorption (can develop Osteitis Fibrosa Cystica- brown tumors)
Groans - Constipation
Psychiatric overtones - depression, confusion, lethargy

Front 80

for hyperparathyroidism, what 2 substances elevated in urine? 2 hormones elevated in blood?

Back 80

urine - hypercalcemia (can cause kidney stones), increased cAMP

blood- PTH, alkaline phosphatase

Front 81

Osteitis Fibrosa Cystica
seen in what
what fills area

Back 81

hyperparathyroidism
spaces filled with brown fibrous tissue

Front 82

2ndary hyperparathyroidism due to what, and what lab values are different than in primary hyperparathyroidism

Back 82

Renal Osteodystrophy

hypocalcemia in 2ndary (until final stage, where is increased), also phosphate is increased

Front 83

cause of tertiary hyperparathyroidism

findings for
Ca
P04
PTH

Back 83

consitutive PTH secretion from chronic renal disease
Calcium elevated
P04 decrease
PTH highly elevated

Front 84

hypocalcemia, short 4th& 5th digit, short stature is what?
cause?
inheritance?

Back 84

Albright's Hereditary Osteodystrophy
Pseudohypoparathyroidism (PTH secreted, but tissues do not respond)

AD inheritance

Front 85

3 causes of hypoparathyroidism

2 signs seen

Back 85

surgical excision, autoimmune destruction, DiGeorge

hypocalcemia signs
Chvostek's sign - tapping on facial nerve causes contraction of facial muscles
Trousseau's sign- occlusion of brachial artery with BP cuff causes carpal spasm

Front 86

bitemporal hemianopsia usually caused by? fertility and sexual findings?
tx (2)

Back 86

usually prolactinoma

galactorrhea, amenorrhea, low libido, infertility (dec. GnRH)

dopamine agonists for treatment (cabergoline, bromocriptine)

Front 87

Acromegaly:
diagnose how?
treat how (2)?

Back 87

diagnosis - increased IGF-1; giving glucose fails to suppress GH temporarily

treat: excise pituitary adenoma, octreotide

Front 88

large tongue, deep furrows, large hands and feet, impaired glucose intolerance

Back 88

Acromegaly

Front 89

4 causes of Central Diabetes inspidus

Back 89

Trauma, surgery, pituitary tumor, histiocytosis X

Front 90

3 substance causes of Nephrogenic Diabetes Insipidus

Back 90

hypercalcemia, lithium, demeclocycline (ADH antagonist)

Front 91

for Diabetes Insipidus, what is urine specific gravity cutoff? how distinguish between central and nephrogenic?

Back 91

<1.006

give desmopressin, if responds= central

Front 92

Treatment of Central Diabetes inspidus? Nephrogenic?

Back 92

Both - adequate fluid intake

Central- give intranasal desmopressin

Nephrogenic- give HCTZ, amiloride, or Indomethacin

Front 93

SIADH

1 ectopic cause
1 drug cause
2 organ dysfxn causes

Back 93

ectopic- small cell lung carcinoma

drug- cyclophosphamide

organs - CNS, pulmonary disorder

Front 94

SIADH
is body volume status highly elevated?

hyponatremia can cause?

rapid correction can cause?

treatment (2)

Back 94

body volume water usually about normal because aldosterone decreased

hyponatremia can cause seizures

rapid correction = Central Pontine Myelinolysis

treatment = water restriction, desmeclocycline

Front 95

Acute DM complications:
type 1
type 2
acute unopposed secretion of what (2)

Back 95

type 1 = DKA

type 2 = hyperosmolar coma

unopposed secretion of GH, Epi (exacerbate hyperglycemia)

Front 96

what type of nephropathy seen in diabetes patients

Back 96

nodular sclerosing with hyaline arteriosclerosis

has KW nodules

Front 97

Diabetes causes chronic damage to large or small vessels, how?

Back 97

BOTH through nonenzymatic glycosylation

small vessel (diffuse thickening of BM) - retinopathy, glaucoma, nephropathy

large vessel atherosclerosis- limb loss, cerebrovascular disease

Front 98

2 osmotic problems caused by DM

Back 98

cataracts

neuropathy (motor, sensory, autonomic)

Front 99

retinopathy with hemorrhage, exudates, microaneurysms, vessel proliferation seen in

Back 99

diabetic retinopathy

Front 100

what component of BVs change in small vessel disease of diabetics?

Back 100

nonenzymatic glycosylation thickens BM

Front 101

What is seen on histo of Beta islet cells for:
Type 1 DM
Type 2 DM

Back 101

Type 1 - leukocytic infiltrate
Type 2 - amyloid deposits

Front 102

what is HLA association with DM Type 1?

Back 102

HLA DR3 and DR4

Front 103

is genetic component stronger in Type 1 or Type 2 DM?

Back 103

Type 2 (but both polygenic influenced)

Front 104

Kussmaul breathing associated with

Back 104

DKA (rapid deep breathing)

Front 105

DKA characteristics:
4 elevated lab serum levels

Back 105

glucose, ketones, hyperkalemia, leukocytosis

also increased H+ and decreased HC03-

Front 106

4 complications of DKA

Back 106

-mucor/rhizopus (black eschar on turbinates or other mucosal area)
-arrhythmia
-heart failure
-cerebral edema

Front 107

DKA: what causes increased ketones

Back 107

increased insulin requirement from stress (like infection) causes increased lipoylsis and ketogenesis from FFAs--> beta hydroxybutyrate>acetoacetate and acetone

Front 108

treatment for DKA

Back 108

fluids, insulin, K+ stabilization (may need as K+ goes into cell), glucose to avoid hypoglycemia

Front 109

Carcinoid syndrome:
what type of cell derived from
can get what type of cardiovascular disease
what in urine
treatment

Back 109

neuroendocrine cells
right-sided valvular disease
5-HIAA
octreotide

Front 110

diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular diseaes: rule of 3s

Back 110

1/3 metastasize
1/3 present with second malignancy
1/3 multiple

Front 111

Zollinger Ellison Syndrome
-tumor secretes what and found where (2)
-1 association

Back 111

gastrin secreting tumor in pancreas or duodenum

MEN1

Front 112

MEN 1
components, 2 common findings

Back 112

3 Ps
parathyroid tumor (hypercalcemia)
pituitary adenoma (Prolactin, GH)
pancreatic tumor (Zollinger Ellsion, VIP, Insulinomas, glucagonomas)

kidney stones, stomach ulcers

Front 113

MEN 2A components, gene

Back 113

ret gene

2 P's
Parathyroid tumors
Pheochromocytoma
Medullary Thyroid Cancer (secretes calcitonin, sheets of cells with amyloid)

Front 114

MEN 2B components, gene

Back 114

ret gene

Pheochromocytoma
Medullary Thyroid Cancer (secrete calcitonin, sheets of cells with amyloid)
marfanoid habitus
oral/intestinal ganglioneuromatosis

Front 115

Marfanoid habitus found with (3)

Back 115

Marfan's syndrome
Homocysteinuria
MEN 2B