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Mercy CLS 5: Chemistry > 20) Endocrine > Flashcards

20) Endocrine Flashcards

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1
Q

3 major classes of hormones

A

Polypeptide hormones
Steroid hormones
Hormones derived from
amino acids

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2
Q

polypeptide hormone half-life is usually…

A

short (<30 min)

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3
Q

affect targets via second messenger system

A

polypeptide hormones
amino acid based hormones

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4
Q

steroid hormones are derived from…

A

cholesterol

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5
Q

basic carbon skeleton structure for steroid hormones

A

cyclopentaoperhydrophenanthrene

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6
Q

half-life of steroid hormones

A

30-90 min

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7
Q

forms of circulating steroid hormones

A
  • bound to carrier proteins
  • unbound; able to promote physiological response
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8
Q

examples of steroid hormones

A

Aldosterone
Cortisol
Estradiol (E2)
Progesterone
Testosterone

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9
Q

hormones derived from tyrosine

A

T3
T4
epinephrine
norepinephrine

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10
Q

hormones derived from tryptophan

A

melatonin
serotonin

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11
Q

T4 half-life

A

7-10 days

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12
Q

free catecholamine half-life

A

<1 min

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13
Q

hormones derived from amino acids

A

Dopamine
Epinephrine (also adrenaline)
Norepinephrine (noradrenalin)
Serotonin
Thyroxine (T4)
Triiodothyronine (T3)

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14
Q

act on endocrine glands to release their hormones

A

tropic hormones

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15
Q

act on endocrine tissue to promote growth and function

A

trophic hormones

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16
Q

2 major classes of hormone receptors

A

membrane (protein hormones; 2nd messenger)
nuclear (steroid & thyroid hormones)

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17
Q

releasing factor

A

peptide synthesized by the hypothalamus and released into the portal circulation to affect pituitary hormone synthesis and secretion

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18
Q

affects hypothalamus release of releasing factor

A

levels of circulating target hormone

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19
Q

cortisol negative feedback

A

corticotrophin-releasing hormone (CRH) - hypothalamus
ACHT - anterior pituitary

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20
Q

thyroid hormone negative feedback

A

thyrotrophin-releasing hormone (TRH) - hypothalamus
TSH - anterior pituitary

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21
Q

gonadal steroids negative feedback

A

gonadotropin-releasing hormone (GnRH) - hypothalamus
FSH, LH - anterior pituitary

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22
Q

2 types of assays for measuring hormones

A
  • competitive immunoassays: Ag competes with hormone for sites; hormone-Ag complex forms, inversely proportional to hormone level
  • immunometric assays: Ab used to “sandwich” hormone; complex is directly proportional to hormone level
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23
Q

8pm ——– is approximately 50% of 8am levels

A

cortisol

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24
Q

autonomy

A

syndromes of hormone excess (tumors)
overproduction is not suppressed by feedback

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25
Q

examples of protein-bound hormones in circulation

A

cortisol
T4

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26
Q

heterogeneity

A

hormones that circulate in blood as multiple distinct immunologic forms

ex) PTH

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27
Q

tropic hormone and target hormone both increased or decreased

A

secondary hyper/hypofunction
tropic hormone is first cause

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28
Q

tropic hormone and target hormone in opposite directions

A

primary hyper/hypofunction
target hormone is first cause

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29
Q

standard low levels of activity during total rest

sufficient for dx when disease is severe

A

basal levels

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30
Q

stimulation or suppression tests are required when…

A

excess or deficiency is not severe/definitive

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31
Q

used to document hyposecretion
explain

A

stimulation tests
challenge with tropic hormone, determine if target hormone increases

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32
Q

used to document hypersecretion
explain

A

suppression tests
synthetic target hormone is given, determine if tropic hormone decreases

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33
Q

hormones of posterior pituitary

A

ADH
oxytocin

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34
Q

hormones of anterior pituitary

A

ACTH
FSH
LH
GH
Prolactin
TSH

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35
Q

AKA somatotropin

A

GH

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36
Q

Gh functions

A

promote growth, cause changes in electrolyte metabolism, stimulate uptake of nonesterified fatty acids by muscle, and accelerates fat mobilization from adipose tissue

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37
Q

secretion is pulsatile, with greatest levels at night (onset of sleep)

A

GH

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38
Q

Diagnosis of deficiency is usually made by provocative stimuli. (Exercise, insulin-induced hypoglycemia, and other pharmacologic tests that increase hormone)

A

GH

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39
Q

Most validated test to distinguish pituitary-sufficient patients from those with adult GH deficiency

A

insulin-induced hypoglycemia stimulation test

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40
Q

acromegaly characteristics (4)

A

middle-aged pts
elongation and enlargement of bones
somatotrope adenomas
cosecretion of prolactin

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41
Q

pituitary gigantism characteristics (3)

A

children
elevated GH before long bones are finished growing
linear growth

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42
Q

produced by lactotrophs of pituitary

A

prolactin

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43
Q

function of prolactin

A

initiate and sustain lactation
control of osmolality, fat and carbohydrate metabolism,
calcium and vitamin D metabolism, fetal lung development, and steroidogenesis

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44
Q

levels are controlled by dopamine, which inhibits it; if dopamine is absent, levels rise

A

prolactin

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45
Q

sensitive indicator of pituitary disease; first to rise during pituitary infiltrative disease/compression

A

prolactin

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46
Q

Anovulation (infertility)
Amenorrhea and galactorrhea
Galactorrhea alone
Oligospermia or impotence in males

A

hyperprolactinemia

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47
Q

function of ADH

A

maintaining water homeostasis and electrolyte balance
retain water, increase BP

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48
Q

functions of oxytocin

A

Stimulates the contraction of the estrogen-primed uterus (positive feedback)
Also stimulates the lactating mammary gland
Role in mother-infant bonding

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49
Q

Useful as a therapeutic agent in inducing labor

A

pitocin

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50
Q

2 types of DI

A

central
nephrogenic

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51
Q

suspected if urine osmo > plasma osmo without increased urine Na

A

SIADH

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52
Q

areas of adrenal gland and hormones produced (4)

A

Outermost layer (zona glomerulosa)–Produces aldosterone
Broad lipid-filled (zona fasciculata)–Produces cortisol
Dense compact cells (zona reticularis)–Secrete androgens
Adrenal medulla; lies below the zona reticularis–Produces catecholamines

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53
Q

catecholamines

adrenal medulla hormones

A

epinephrine
norepinephrine
dopamine

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54
Q

other sites of catcholamine production

A

Neurons of the sympathetic nervous system, CNS, chromaffin cells found in abdomen and neck

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55
Q

Methoxyhydroxyphenylglycol (MHPG)
Vanillylmandelic acid (VMA)
Homovanillic acid (HVA

A

metabolites of catecholamines

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56
Q

Initiate their respective biological actions via specific cell-membrane receptors:

α-adrenergic and β-adrenergic receptors

A

norephinephrine: α-adrenergic receptors
epinephrine: β-adrenergic receptors

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57
Q

functions of norepinephrine

A

Vasoconstriction, decreased insulin secretion, sweating, and stimulation of glycogenolysis in the liver and skeletal muscle

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58
Q

functions of epinephrine

A

Vasodilation, stimulation of insulin release, increased cardiac contraction rate, relaxation of smooth muscle in the intestinal tract, enhanced lipolysis, bronchodilation

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59
Q

may be significant in drug treatment of mental disorders (Parkinson’s disease and tardive dyskinesias)

A

dopamine

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60
Q

Catecholamine-producing tumors of the neurochromaffin cells

A

pheochromocytoma
neuroblastomas

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61
Q

↑ VMA
↑ Metanephrines
Normal Dopamine
Normal HVA

A

pheochromocytoma

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62
Q

Catecholamine elevation may be induced by stress, upright posture, exercise, hypoglycemia, cold temps, and mental states of anxiety or anger

A

pheochromocytoma

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63
Q

Malignant neoplasm of neural crest origin
Common in pediatric patients

A

neuroblastoma

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64
Q

↑ VMA
↑ Urinary Catecholamines
↑ Dopamine
↑ HVA

A

neuroblastoma

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65
Q

specimen handling for pheochromocytoma and neuroblastoma tests

A

24hour urine properly collected and preserved with hydrochloric acid to maintain acid pH, stored at -80°C

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66
Q

major glucocorticoid

A

cortisol

67
Q

functions of cortisol

A

promotes gluconeogenesis, glycogenesis, lipolysis
decreases glucose use
suppresses immune system
anti-inflammatory

68
Q

CBG

A

coristol-binding globulin

69
Q

explain RAAS

A

Renin (secreted by renal cells) acts on its substrate to produce angiotensin I, which is rapidly converted to angiotensin II in the lung by angiotensin-converting enzyme. Angiotensin II stimates aldosterone production.

Aldosterone acts on the renal distal tubules to
increase sodium retention and volume repletion, thus shutting off renin.

70
Q

3 adrenal androgens, precursors to each other

A

Dehydroepiandrosterone (DHEA)
Androstenedione
Testosterone

71
Q

stimulates hypothalamus to produce CRH

A

stress

72
Q

no diurnal variation in cortisol

A

adrenal disorders such as adenomas and Cushing’s

73
Q

primary adrenal insufficiency

A

Addison’s disease

74
Q

Destructive events in the hypothalamus or pituitary gland that result in a decreased ability to secrete ACTH (secondary) or CRH (tertiary)

A

secondary or tertiary adrenal insufficiency

75
Q

sx of Addison’s

A
  • bronzing of skin
  • postural HTN
  • hypoglycemia
  • changes in body hair
  • GI disturbances
  • weakness/muscle wasting
  • weight loss
  • hyponatremia
  • hyperkalemia
76
Q

test used to dx Addison’s

A

ACTH stimulation test (Cortrosyn test)

77
Q

normal response to ACTH stimulation test

A

> 20ug/dL of cortisol from the baseline

78
Q

test used to dx secondary/tertiary adrenal insufficiency

A

Metyrapone stimulation

79
Q

2 types of adrenal hyperfunction

A
  • Cushing’s syndrome: primary, low ACTH
  • Cushing’s disease: secondary, high ACTH
80
Q

70% cases caused by pituitary tumor

A

Cushing’s disease (secondary)

81
Q

Elevated levels of cortisol due to either medications or the presence of an adrenal tumor (adrenal adenoma)

A

Cushing’s syndrome (primary)

82
Q

17-OHCS test (urine)

A

Cushing’s
measures cortisol metabolites

83
Q

Sensitive indicator of Cushing’s because the increase is rapid as soon as plasma cortisol exceeds the binding capacity of CBG

A

urine free cortisol

84
Q

sx of Cushing’s

A
  • buffalo hump
  • moon face
  • weight gain, thin extremities, edema
  • purple striae
  • male gynecomastia
  • facial acne
  • hyperglycemia
  • personality changes
  • amenorrhea, hirsutism
  • osteoporosis
85
Q

used initially to establish true hypersecretion of cortisol

A

low dose dexamethasone suppression test

86
Q

used to differentiate diagnosis of an ACTH-secreting pituitary adenoma

A

high-dose dexamethasone suppression test

87
Q

adrenal aldosterone-producing adenoma

A

Conn’s syndrome

88
Q

hyperaldosteronism responsive to surgery

A

Conn’s syndrome

89
Q

adrenal hyperplasia, treated with drugs

A

idiopathic hyperaldosteronism

90
Q

differentiate Conn’s syndrome from IHA

A

Posture stimulation
- Conn’s/APA: Declining values on standing
- IHA: Normal postural rise

Most reliable: Adrenal bilateral vein catheterization and measuring serum aldosterone

91
Q

Renal artery stenosis or renin-producing juxtaglomerular cell tumor of the kidney

A

causes secondary hyperaldosteronism

92
Q

hallmark of secondary hyperaldosteronism

A

↑ urinary aldosterone in the presence
of ↑ plasma renin activity

93
Q

enlarged adrenal glands at birth
decreased cortisol and aldosterone

A

congenital adrenal hyperplasia (CAH)

94
Q

21-hydroxylase deficiency (most common)
11-hydroxylase deficiency (2nd most common)

A

congenital adrenal hyperplasia (CAH)

95
Q

increased 17-OH progesterone, andostenedione, testosterone, estriol

A

congenital adrenal hyperplasia (CAH)
causes virilization

96
Q

sx of congenital adrenal hyperplasia

A

water wasting
dehydration with hypotension
hyponatremia
hyperkalemia
virilization
failure to thrive

97
Q

proteins that carry sex hormones

A

sex-hormone binding globulin (SHBG)
cortisol-binding globulin (CBG)
albumin

98
Q

C18 sterol compounds

A

estrogens

99
Q

Steroid hormone with 21 carbons

A

progesterone

100
Q

Basal body temperature rises after… due to…

A

ovulation
progesterone

101
Q

any of the C19 sterols synthesized from cholesterol in the testes and adrenal glands

A

androgens

102
Q

Primarily secreted by Leydig cell in male testes and female ovaries

A

testosterone

103
Q

primary precursor of natural estrogens

A

DHEA (androgen)

104
Q

test used to establish hypogonadism in males

A

hCG Stimulation Test

105
Q

hCG should make testosterone —

A

↑

106
Q

Responsible for secretion of both gonadotropic hormones, LH and FSH

A

GnRH

107
Q

binds to Leydig cell receptors to enhance conversion of cholesterol to testosterone

A

LH

108
Q

activates the seminiferous tubules for sperm production (in males)

A

FSH

109
Q

Male has XXY chromosomes (47 karyotype), infertile, small testicles, sparse facial and body hair, reduced muscle mass, and enlarged breasts, low IQ

A

Klinefelter’s syndrome

110
Q

deficiency of GnRH during embryonic development in both males and females. Characterized by hypogonadism and lost sense of smell (anosmia).

A

Kallmann’s syndrome

111
Q

Defect in androgen receptor gene (testosterone level is normal/elevated)

Female body build and development of breast tissue, intra-abdominal testes

A

Androgen Insensitivity Syndrome (AIS)

112
Q

reduced efficiency of the conversion of testosterone to the more potent DHT.

Males are born with ambiguous genitalia

A

5a-Reductase Deficiency (5-ARD)

113
Q

↑ testosterone:DHT ratio

A

5a-Reductase Deficiency (5-ARD)

114
Q

Increased estrogen:androgen ratio in males

A

gynecomastia

115
Q

3 types of gynecomastia

A
  1. Transient: 60-90% of all newborns from estrogen crossing the placenta (males and females)
  2. Puberty: 50-70% of healthy boys.
  3. Adults: 50-80 yrs old from testicular failure or ↑ body fat
116
Q

enhances the effects of FSH on a maturing follicle

A

estradiol

117
Q

A glycoprotein hormone that is secreted during pregnancy by the placenta

A

hCG

118
Q

hcG first detected in maternal serum — days following conception

A

6-9

119
Q

Absence of menstruation by age 16, fail to develop secondary sex characteristics

A

primary amenorrhea

120
Q

45 X karyotype (monosomy)
Non-functioning ovaries
By age 2, no eggs are left

A

Turner’s syndrome

121
Q

46 XX or XY karyotype (Swyer Syndrome)

A

pure gonadal dysgenesis

122
Q

menstruation ceases for at least 6 months

A

secondary amenorrhea

123
Q

infrequent menstruation that occurs < 9 times/year

A

oligomenorrhea

124
Q

Genetically female, but phenotypic male characteristics

Enzyme deficiency in pathway: 21-hydroxylase or 11β-hydroxylase which results in virilization

A

female pseudohermaphroditism

125
Q

Characterized by infertility, hirsutism, obesity, irregular vaginal bleeding, and acanthosis nigricans (dark pigmentation of spiny layer of skin)

A

PCOS

126
Q

Greater frequency of both hyperinsulinism & insulin resistance

A

PCOS

127
Q

LH:FSH ration >2

A

PCOS

128
Q

developmental anomaly of the placenta made up of trophoblastic tissue

A

Hydatidiform Mole

129
Q

Leading cause of pregnancy-related, first-trimester death

A

ectopic pregnancy

130
Q

main methods for measuring most hormones and metabolites

A

immunoassay techniques
chromatography
mass spectrometry

131
Q

components of total testosterone measurement

A
  • free (bioavailable)
  • albumin-bound (bioavailable)
  • SHBG-bound (unavailable)
132
Q

Major circulating estrogen after menopause

A

estrone/E1

133
Q

Most active of endogenous estrogens

A

estradiol/E2

134
Q

Predominant urinary estrogen during pregnancy

A

estriol/E3

135
Q

routinely used for identifying a fetus with Down Syndrome

A

unconjugated estriol/uE3

136
Q

Any disruption in the biosynthetic pathway will lead to very low maternal serum ————– levels.

A

unconjugated estriol

137
Q

produced exclusively during pregnancy by the fetal liver

A

unconjugated estetrol/E4

138
Q

No Estrogen
↑↑ LH & FSH

A

menopause

139
Q

basic function of thyroid

A

Control basal metabolic rate and calorigenesis through increased oxygen consumption in tissue

140
Q

secretory units of the thyroid gland that contain colloid

A

follicles

141
Q

Amorphous material composed of thyroglobulin (Tg) and iodinated thyroalbumin

A

colloid

142
Q

—— is ingested and converted to ——- by the thyroid, which is attached to tyrosine residues to give…

A

iodide
iodine
monoiodotyrosine (MIT) and diiodothyronine (DIT)

143
Q

2 MIT

A

T4

144
Q

MIT + DIT

A

T3

145
Q

Once produced, T3 & T4 are stored as ——- in the colloid

A

thyroglobulin

146
Q

Only about 20% of —— is glandular, the rest is derived outside the thyroid gland through deiodination of —–, which takes place in the liver, kidney, and muscle

A

T3
T4

147
Q

carriers of thyroid hormone

A

Thyroid-binding globulin (TBG)
Thyroid-binding prealbumin (TBPA)
Transthyretin (TTR)
Serum albumin

148
Q

major biologically active thyroid hormone

A

T3

149
Q

Causes an increase in number and size of follicular cells (hyperplasia) so they can trap more iodide to synthesize more thyroid hormones

A

TSH

150
Q

bradycardia, hoarseness, cold sensitivity, dry skin, and muscle weakness

A

hypothyroidism

151
Q

Diagnostic Test: Thyroid peroxidase (TPO) and antithyroglobulin antibodies

A

Hashimoto’s thyroiditis

152
Q

hypothyroidism with ↑ TSH and goiter

A

Hashimoto

153
Q

Causes mental and physical restriction (cretinism)
Must be detected early in newborns (first 3 months)

A

congenital hypothyroidism

154
Q

Heat intolerance
Tachycardia
Weight loss
Weakness/tremors
Emotional lability/anxiety

A

hyperthyroidism

155
Q

Thyroid Receptor Antibody (TRAb)
Thyroid-Stimulating Antibody (TSI)

A

Graves disease

156
Q

Graves disease triad

A

Exophthalmic eye (Eye bulging)
Tremors
Weight Loss

157
Q

TT4

A

T4 bound (99.97%)

158
Q

FT4 index purpose

A

measures the degree of unsaturation of TBG

159
Q

T3 is helpful in confirming diagnosis of —–thyroidism, but not —–thyroidism

A

hyper-
hypo-

does not reflect glandular secretion and often are normal

160
Q

useful in patients who show equivocal signs and symptoms of thyroid dysfunction and when thyroid-function test results are not clearly diagnostic

A

Thyrotropin-Releasing Hormone Stimulation

161
Q

Used clinically to differentiate nonthyroidal illness (NTI) from hypothyroidism

A

reverse T3

162
Q

Directed against the thyroglobulin protein located within the thyroid colloid

A

Thyroglobulin Antibodies (TgAb)

163
Q

Directed against a protein component of thyroid cell microsomes.

A

microsomal Ab

164
Q

protection from radiation in nuclear disaster/atomic bomb

A

oral dose of potassium iodide before and/or after (<3-4 hours) exposure to saturate the thyroid-uptake system and prevent uptake of radioactive iodine

Mercy CLS 5: Chemistry (24 decks)

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