74 - Post pit and HPL axis Flashcards
OXY and AVP are transcribed as preprohormones. In the prohormone form, what is the associated co-peptide with each?
- Neurophysin I + OXY
- Neurophysin II + AVP
How many amino acids is AVP?
Nonapeptide, 9 AAs
How many amino acids is OXY?
Nonapeptide, 9 AAs
What’s another name for AVP?
ADH
When is neurophysin cleaved from the prohormone (AVP or OXY)?
In the secretory granules during axonal transport
In what hypothalamic nuclei that release AVP (released from the posterior pituitary)?
PVN, SON
PVN has 2 types of cells, magnocellular and parvocellular. Which project to the posterior pit?
Magnocellular (fluid balance)
While the magnocellular neurons of the PVN are important for fluid balance, what are the parvocellular neurons of the PVN important for?
Regulating mood (anxiety) and stress
Increasing plasma osmolality has what effect on osmoreceptors?
Shrinkage (release of inhibition, AVP released)
How does low blood volume affect AVP release?
Makes AVP sensitivity increase
Decreased mean arterial BP causes a decrease in baroreceptor stretch and firing. How does this affect AVP sensitivity?
Increases AVP sensitivity
What is AVP’s general effect on the vasculature?
Vasoconstriction
What type of receptor does AVP bind?
What is the 2nd msger cascade?
GPCR
GPCR -> PLC -> IP3/DAG -> Ca2+/PKC -> MLC kinase -> vasoconstriction
What is the name of the GPCR that AVP binds to initiate vasoconstriction?
V1 (V1R)
What cells does AVP affect in the kidney, and which part of the kidney?
Principle cells of DT
*What is the affect that AVP has on principle cells in the kidney? (what is the 2nd msger?)
Aquaporin 2 (AQP2) channels are P'lated by PKA - AQP2 traffics to luminal membrane, and what is reabsorbed
What is the major symptom of diabetes insipidus?
Excessive urine production (polyuria)
- High osmolality also leads to polydypsia
What common psychiatric medication can lead to diabetes insipidus? How?
Lithium treatment
- Interferes w/AQP2 trafficking in some way
What are the 2 main etiological causes of diabetes insipidus?
Which is more common?
- Decreased AVP release (most common)
2. Decreased renal responsiveness to AVP
What are common causes of diabetes insipidus due to decreased AVP release?
“Central” hypothalamic or pituitary defect due to trauma, CA, infectious dz
What are common causes of diabetes insipidus due to decreased renal responsiveness to AVP?
Are AVP levels increased, decreased or nl in these cases?
- Genetic X-linked AVP type-2 receptor (V2 or V2R) mutation (90% males)
- Acquired thru Li tx or hypokalemia
Normal AVP levels in these cases
OXY is released from magnocellular neurons whose cell bodies are in the _______ (nucleus).
PVN
What are the main functions of OXY?
Induce smooth m. cell contraction in breast and uterus (positive feedback loops)
What is pitocin?
Synthetic oxytocin used to induce labor
What is the positive feedback stimulus that causes more more OXY release in terms of the breast?
In terms of the cervix/uterus?
- Suckling of lactating breast
- Stretch of cervix
What type of receptor does OXY bind?
GPCR
What is the second msger system for OXY?
GPCR -> PLC -> Ca+ -> Ca/Calmodulin -> MLCK -> P’late myosin -> smooth m. contraction.
What is the primary clinical presentation of syndrome of inappropriate vasopressin secretion? (SIADH)
Hyponatremia (low Na levels) in the absence of edema.
What are some of the major causes of SIADH? (just read)
- Primary pituitary disorder (33% pts)
- CNS disorders (lesions, infections, trauma)
- Lung dz (infections
- Extrapituitary tumors
- Low Na+ (*low Na dues to low aldosterone will cause hypovolemia; AVP is triggered by low blood volume and will be secreted despite the decrease in plasma osmolality)
How many AAs long is GHRH?
44 AAs
From which hypothalamic nucleus is GHRH released?
Arcuate nucleus
What does GHRH stimulate the release of?
GH from anterior pituitary
What are the 3 target organs of GH?
Liver, adipose tissue, muscle
What protein whose synthesis is stimulated by GH is responsible for many peripheral growth effects?
IGF-1
What are GH’s effects on fat tissue?
- Increased lipolysis
- Decreased glucose uptake
What are GH’s effects on muscle?
- Increased protein synthesis
- Decreased glucose uptake
- Increased AA uptake
What are GH’s effects on the liver?
- Increased IGF-1 and IGF-BP
- Increased GNG
- Increased protein and RNA synthesis
What is the inhibitory hormone for somatotrophs?
Somatostatin (inhibits FSH and LH release)
Besides GH providing negative feedback on its HPA axis, what other hormone can do this?
IGF-1
How many AAs long is SS?
14 or 28 AA’s, depending on where it’s made
SS28 predominates in the ________ and SS14 predominates in the ________.
- Intestines
- Brain
How does somatostatin decrease GHRH release in the hypothalamus?
Decreases pulse frequency
What endopeptidases are important for the formation of SS28?
SS14?
- SS28: Furin
- SS14: PC1/PC2
In what pattern/fashion is GH released?
Pulsatile release (mostly at night)
What is the overall goal of GH release?
Anabolism–conserve protein
GH is structurally similar to what protein?
PRL
What activities stimulate GH release?
Stress, exercise, starvation
What activities inhibit GH release?
Aging, high blood glucose, obesity
Does NE/E stimulate or inhibit GH release?
Stimulate (exercise, stress)
Does glucose stimulate or inhibit GH release?
Inhibit (hypoglycemia)
Do AA’s stimulate or inhibit GH release?
What about FFAs?
- AAs: stimulate
- FFAs: Inhibit (obesity)
Does TH stimulate or inhibit GH release?
Stimulate
How are GH and insulin connected?
GH considered a counter-regulatory hormone for insulin (can’t be starving and have growth at the same time)
Is IGF independent or dependent on insulin?
Dependent
When during the lifetime does IGF-1 peak?
During critical growth periods (youth)
What organs/cells does IGF-1 stimulate to grow?
Kidney, pancreas, intestines, islets, parathyroids, skin, CT, bone, heart, lung, chondrocytes
What are 2 dz’s due to GH excess or a somatotrope tumor?
What’s the differentiating factor b/w the 2?
- Gigantism (tumor in childhood- before epiphyseal growth plates finish)
- Acromegaly (tumor in middle ages)
What are the sx of gigantism?
Extreme height due to increased long bone growth
What are the sx of acromegaly?
What’s the most common cause?
- Gradual enlargement of the hands and feet (arthritis)
- Facial changes: protruding lower jaw, enlarged lips, tongue, nose
- Possible increase in organ size
- Most common cause is pituitary adenoma
What hormone is childhood dwarfism related to?
GH deficiency
What are 2 forms of childhood dwarfism?
- Laron syndrome
2. African Pygmy
What causes Laron syndrome?
How is it treated?
Are GH levels increased, decreased, or nl?
- Genetic defect in GH receptor, therefore no production of IGF-I.
- Tx w/ IGF-I can prevent dwarfism
- Plasma GH levels are normal to high (lack of feedback)
What causes African Pygmy?
Are GH levels increased, decreased, or nl?
- Partial defect in GH receptor; some IGF-I response.
- Plasma levels of GH nl; no pubertal increase in IGF-I.
What can cuause adult GH deficiency?
What are the signs/sx?
Caused by pituitary tumor/surgery or treatment (76%)
- Increased fat deposition, muscle wasting
- Reduced bone density, risk of fractures
- Higher LDL, triglycerides
What is unique about lactotrophs compared to others?
What stimulates them from hypothalamus?
Not part of an HPA axis
- Dopamine (tonically inhibited)
Increased PRL causes what major symptom?
Galactorrhea (milk from breast)
What is the half-life of PRL?
20 min (not bound to proteins)
What are the physiological effects of PRL?
- Mammary gland development
- Breast differentiation
- Milk production
What specific parts of breast differentiation does PRL stimulate?
- Duct proliferation and branching
- Glandular tissue development
What specific parts of milk production does PRL stimulate?
- Synthesis of milk proteins (beta-casein and alpha-lactalbumin)
- Synthesis of milk sugar (lactose)
- Synthesis of milk fats in epithelial cells
Prolactin is in the same family as what hormone?
GH (very structurally similar)
What’s the usual cause of PRL excess?
Prolactinoma (30-40% of all pituitary adenomas)
What are the sx of prolactinoma?
- Hyperprolactinemia
- Galactorrhea
- Reproductive dysfunction
Why does excess PRL cause reproductive dysfunction?
*PRL Inhibits GnRH release
What’s the dz of PRL deficiency?
Sheehan’s syndrome
What causes Sheehan’s syndrome (low PRL)?
What are the sx?
- Occurs as a result of excessive blood loss/shock during childbirth
- Partial pituitary destruction
- Usually affects other pituitary cell types: loss of axillary and pubic hair
How much all hormones be measured? (might need to read)
- Must measure in pairs
- Appropriate time and longitudinally
Insulin-induced hypoglycemia should result in __________ GH levels.
Increased
Administration of IGF-1 should result in __________ GH levels.
Decreased