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CLS 701 > Day 7 - Endocrine, Bone, Tumors > Flashcards

Day 7 - Endocrine, Bone, Tumors Flashcards

1
Q

Define endocrine vs exocrine

A

Endocrine - secrete hormones directly into bloodstream

Exocrine - secrete digestive enzymes outside body

-pancreas can do both

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2
Q

Hormones affect specific cells called… These cells are able to respond to hormones because they have ___ for the hormones

A

Target cells

Receptors

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3
Q

Define hormone

A

Organic compounds produced in one tissue, released into bloodstream to affect another tissue, binding to receptor and producing a specific response

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4
Q

4 main chemical classes of hormones

A

Amino acid derivatives

Peptides, proteins

Steroids (derived from cholesterol, lipids)

Eicosanoids (derived from fatty acids)

-focus on first 3

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5
Q

TRH (thyroid releasing hormone) is made by the ___. Its action is to…

A

Hypothalamus

Stimulate pituitary to release TSH

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6
Q

TSH (thyroid stimulating hormone) is made by the ___. Its action is to… Its chemical class…

A

Pituitary (anterior)

Stimulate thyroid to secrete thyroxine (T4)

Peptide/proteins

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7
Q

T4 (thyroxine) and T3 (triiodothyronine) made by the ___. Their action is to… Their chemical class…

A

Thyroid

Increase metabolism in most tissues

Amino acid derivatives

  • tyrosine derivatives
  • hydrophobic, requires transporter
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8
Q

PTH is made by the ___. Its action is to… Its chemical class…

A

Parathyroids

Stimulate calcium resorption from bone (calcium release from bones)

Peptide/proteins

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9
Q

Catecholamines are made by the ___. Name two catecholamines made there…. Their action is to (2)… Their chemical class…

A

Adrenal medulla

Adrenaline
Epinephrine
-fight or flight

Increase blood pressure
Glycogenolysis in liver

Amino acid derivatives

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10
Q

Insulin is made by the ___, specifically, in the region called… Its action is to… Its chemical class…

A

Pancreas

Islets of Langerhans (beta cells)

Stimulate cells to uptake glucose

Peptide/protein

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11
Q

Glucagon is made by the ___, specifically, in the region called… Its action is to… Its chemical class…

A

Pancreas

Islets of Langerhans (alpha cells)

Stimulate liver to release glucose

Peptide/protein

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12
Q

ACTH (adrenocorticotropic hormone) is made by the ___. It is stimulated by… Its action is to… Its chemical class…

A

Pituitary (anterior)

CRH (corticotropin releasing factor)
-secreted by hypothalamus

Stimulate adrenal cortex to secrete cortisol

Peptide/protein

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13
Q

ADH (anti-diuretic hormone) is also called… It is made by the ___. Its action is to… Its chemical class…

A

Vasopressin

Hypothalamus
-stored in posterior pituitary gland

Stimulate kidneys to reabsorb/retain water, vasoconstriction
-opposite of diuretic peptides (excrete water)

Peptide/protein

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14
Q

Calcitonin (thyrocalcitonin) is made by the ___. Its action is to… Its chemical class…

A

Thyroid parafollicular cells (C cells)

Deposit calcium into bones
-opposite of PTH

Peptide/protein

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15
Q

Aldosterone is made by the ___. Its actions are to (3)… Its chemical class…

A

Adrenal cortex

Stimulate kidneys:
Reabsorb sodium
Reabsorb water
Excrete potassium
-opposite of natriuretic peptides (excrete sodium and water)

Steroid

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16
Q

Cortisol is made by the ___. Its action is to… Its chemical class…

A

Adrenal cortex

Gluconeogenesis in muscle, liver

Steroid

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17
Q

Name two steroids made by the adrenal cortex… Name two catecholamines made by the adrenal medulla…

A

Cortisol
Aldosterone

Adrenaline
Epinephrine
-neurotransmitters
-fight or flight

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18
Q

Peptide/protein hormones - hydrophobic or hydrophilic? Do they require a transporter molecule?

A

Hydrophilic

No
-water soluble

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19
Q

Steroid hormones - hydrophobic or hydrophilic? Do they require a transporter molecule?

A

Hydrophobic

Yes

  • require transport proteins
  • albumin, prealbumin (TBPA), TBG
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20
Q

Which classes of hormones require receptor binding to target cells and which classes of hormones can diffuse through the cell membrane?

A

Peptides/proteins

Steroids

  • hydrophobic, easy to diffuse through cell membrane
  • bind to cytoplasmic receptor within cell instead

-AA derivatives can be hydrophilic or hydrophobic

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21
Q

Do protein based hormones or steroids affect more types of cells? Why?

A

Steroids affect more cells

Steroids do not require receptor to bind and enter cell
-can diffuse straight through

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22
Q

What is ADH stimulated by?

A

Hyperosmolality, hypernatremia

-causes kidneys to retain water to decrease osmolality

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23
Q

Does aldosterone increase or decrease blood pressure? Does AHD/vasopressin increase or decrease blood pressure? Does a natriuretic peptide increase or decrease blood?

A

Increase

  • aldosterone cause kidneys to retain sodium and water
  • angiotensin II precursor cause vasoconstriction
  • renin-angio system

Increase
-vasoconstriction

Decrease

  • opposite of aldosterone
  • vasodilation
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24
Q

What are tropic hormones? What are direct effector hormones?

A

Hormones that affect another endocrine gland
-TSH stimulates thyroid

Hormones that act directly on peripheral tissues
-T4 stimulates peripheral tissues’ metabolism

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25
Treatment for endocrine disorders are usually (2)
Surgery -more common Irradiation
26
Growth hormone (GH or HGH) is also called... Release of growth hormone is controlled by ___, which is made in the ___
Somatotrophin Growth hormone-releasing hormone (GHRH) Hypothalamus
27
GH is stored and released from the ___. Excessive growth hormone release is called...
Pituitary (anterior) Acromegaly
28
GH is usually inhibited by...
Glucose | -after eating a meal, GH levels drop
29
The glucose suppression test indicates whether a person has...
Tumor causing acromegaly - glucose infusion does not inhibit GH release - stimulation test is the opposite of this test
30
Some hormones are made by dimerization of subunits. When testing for hormones, why should we be careful when measuring a particular subunit?
Subunit could be nonspecific to hormone and shared across different hormones
31
AHD deficiency can cause these 3 conditions...
Hypothalamic diabetes insipidus - failure to produce ADH Nephrogenic diabetes insipidus - failure of ADH to act on kidneys or failure to respond to ADH -kidney disease, drugs, metabolic disorders Psychogenic polydipsia - excessive water intake without thirst
32
What is the ADH stimulation test?
Lab test done by overnight water deprivation to induce dehydration and stimulate ADH release -measure plasma and urine osmolality at start and end of 24 hr fast
33
The condition associated with primary adrenal insufficiency is... Secondary adrenal insufficiency is due to...
Addison's disease Low cortisol due to decreased ACTH
34
Addison's disease vs Cushing's syndrome - which hormones are elevated and decreased in each? Which electrolytes are elevated and decreased in each?
Addison's - low cortisol, low aldosterone, low sodium, high potassium -sodium lost in urine and potassium retained due to low aldosterone Cushing's - high cortisol, high sodium
35
Cushing's syndrome can be ACTH dependent or independent. Explain each
ACTH dependent - pituitary tumors produce excess ACTH ACTH independent - tumors in other locations that produce pseudo-ACTH
36
What is a pheochromocytoma? What test can we use to screen for it?
Benign or malignant tumor of cells in the adrenal medulla - excess catecholamines - hypertension, weight loss, sweating, headache, palpitations, anxiety Urinary metanephrine test - metanephrine = main metabolite of catecholamines produced by adrenal medulla - false positives if patient is stressed or taking drugs
37
Besides the urinary metanephrine test for pheochromocytomas, this urinary excretion product can be used as an indicator of epinephrine production...
``` Vanillylmandelic Acid (VMA) -less sensitive, more specific ```
38
What does the clonidine suppression test for? How does clonidine affect a normal vs ill patient?
Pheochromocytoma Clonidine (adrenergic blocker drug) given to patient: Normal = inhibits release of catecholamines Patient = catecholamines released due to adrenal tumor (pheochromocytoma)
39
3 major classes of steroid hormones made by the adrenal cortex... Which class do cortisol and aldosterone fall under?
Glucocorticoids (includes synthetics) -type of corticosteroid Mineralocorticoids (cortisol/aldosterone) -type of corticosteroid Androgens -sex hormones, anabolic steroids
40
Function of glucocorticoids
Gluconeogenesis | -similar to cortisol, another steroid
41
Explain the entire process to release cortisol
Hypothalamus secretes CRH CRH stimulates pituitary to release ACTH ACTH stimulates adrenal cortex to release cortisol
42
This peptide causes an antagonistic effect to the angio renin system
BNP - vasodilation - lower blood pressure - sodium and water excretion
43
The thyroid requires this additional chemical element to produce T4 and T3...
Iodine | -T3 has 3 iodines, T4 has 4
44
Thyroid follicular cells produce what?
Thyroglobulin (Tg) | -involved in thyroid hormone production and storage
45
What are the 3 thyroid hormone binding proteins? Which one has the highest affinity for thyroid hormones? Where are they made?
TBG = thyroxine binding globulin (60-70%) TBPA = thyroxine binding pre-albumin aka transthyretin (15-30%) Albumin (10%) TBG -binds the most thyroid hormone Liver
46
Explain the process to release thyroid hormones
Hypothalamus secretes TRH (thyroid releasing hormone) TRH stimulates pituitary to release TSH TSH stimulates thyroid to release thyroid hormones
47
Graves disease vs Hashimoto's thyroiditis - high or low thyroid hormone?
Graves disease - hyperthyroidism Hashimoto's - hypothyroidism
48
Non-malignant enlargement of the thyroid gland is called... The condition is due to a deficiency in...
Goiter -TSH mediated Iodine -thyroid enlarge to trap more iodine
49
What are the two types of goiter? Cause of each?
Non-toxic goiter = lack of dietary iodine Toxic goiter = Graves disease (hyperthyroidism)
50
The negative feedback control on the thyroid is mediated by (2)...
Iodine -high iodide levels shuts down thyroid gland, inhibits iodide uptake Thyroid hormones -high concentration inhibits TRH/TSH
51
T3 and T4 - how do they enter cells?
Diffusion | -hydrophobic amino acid derivatives
52
Bound vs free T3/T4 - which form is the metabolically active form? Is there a greater percentage of free T3 or free T4?
Free Free T3 > free T4
53
The most common cause of hypothyroidism is... Mechanism of hypothyroidism...
Hashimoto's thyroiditis - may/may not have enlargement of thyroid (goiter) - treat with T4 Autoimmune: antibodies destroy thyroid cells
54
In Hashimoto's thyroiditis, what are the levels of free T4 and TSH?
Free T4 is low TSH elevated -trying in vain to produce more T4
55
The most common cause of hyperthyroidism is... It is this type of goiter... Mechanism of hyperthyroidism...
Graves disease (thyrotoxicosis) Toxic goiter -thyroid enlargement Autoimmune: antibodies mimic TSH and bind to TSH receptors
56
In Graves disease, what are the levels of T3 and T4? Levels of TSH?
All elevated -includes T3, T4, free T3, free T4 TSH low
57
The most severe form of hyperthyroidism is called... Excessive release of...
Thyroid storm (thyrotoxic crisis) T4
58
TSH and T4 levels in nontoxic goiter and toxic goiter
Nontoxic goiter - TSH high, T4 low - not enough iodine in diet or Hashimoto's - enlargement of thyroid gland Toxic goiter - TSH low, T4 high - Graves disease - enlargement of thyroid gland
59
What is primary and secondary hypothyroidism?
Primary = Iodine deficiency, Hashimoto's - thyroid related - impaired T3/T4 synthesis Secondary = decreased TSH and/or TRH -as a result of deficiency further up the chain
60
Amino acid derivative hormones - hydrophobic or hydrophilic? Do they require a transporter molecule?
Catecholamines are hydrophilic, do not require transporters Thyroid hormones are hydrophobic, require transporters
61
The Metyrapone stimulation test is to determine the functional status of which endocrine organ?
Pituitary gland - Metyrapone inhibits cortisol - measure rise in ACTH if pituitary is functional
62
A decrease in corticosteroid levels results in a __ in potassium levels. Why?
Increase Aldosterone causes K excretion. No aldosterone, no K excretion and elevated blood K -Addison's disease
63
Does administering potassium iodide increase or decrease thyroid function?
Decrease - blocks T4 release from gland - inhibits thyroid storms (thyrotoxic crisis)
64
Low serum calcium triggers the ___ gland to release more ___. High serum calcium triggers the ___ gland to release more ___
Parathyroid PTH Thyroid Calcitonin
65
What are the 3 states that calcium is found in the blood? Which is the biologically active form?
Free (ionized, unbound) - 45% Bound (albumin) - 45% Bound (anions - bicarbonate, citrate, lactate, phosphate, etc) - 10% Free/ionized
66
Does acidosis or alkalosis increase free calcium? Why?
Acidosis Excess H+, displaces calcium bound to protein
67
This molecule can displace calcium bound to albumin... Patients with impaired ___ have more free calcium... Patients with impaired ___ have lower total calcium
Bilirubin Liver - ie liver cirrhosis causes bilirubin to build up in blood - excess bilirubin = more free calcium Kidneys - renal disease lowers albumin in blood due to excretion in urine - total calcium (including calcium bound to albumin) drops as a result
68
The main cause of hypercalcemia is due to...
Primary hyperparathyroidism | -rest of causes due to cancer
69
How does cancer cause hypercalcemia?
Cancers produce parathyroid hormone-related protein (PTHrP), which acts like PTH - note: this is different from cancers causing excess thyroid hormones (Graves), which is due to antibodies mimicking TSH - aka hypercalcemia of malignancy or non-parathyroid-related reasons
70
Difference between hypoparathyroidism and pseudo-hypoparathyroidism
Decrease in PTH levels Impaired response to PTH
71
Where is most phosphorus/phosphate found in the body? Does hemolysis increase or decrease phosphate levels?
Bones -as calcium phosphate Increase -PO4 is predominantly intracellular
72
PTH causes serum calcium levels to ___ and causes serum phosphate levels to ___.
Increase Decrease -inverse relationship
73
PTH levels are regulated by...
Free calcium - high free calcium = no PTH secretion - low free calcium = PTH secretion
74
PTH has these 3 effects on the kidneys
Increase calcium reabsorption in renal tubules Inhibits phosphate reabsorption, increases its excretion Stimulates renal hydroxylation of 25-(OH)Vitamin D to 1,25-(OH)2 Vitamin D -1,25-(OH)2 is the active form of Vitamin D
75
PTH has these effects on the bones... PTH has these effects on the gut/intestines...
Increase calcium and phosphate release - stimulates osteoclast formation and osteolysis - PTH tell kidneys to dump phosphate Increases calcium absorption -dumps phosphate
76
Primary hyperparathyroidism - calcium levels are... PTH levels are...
Increased Increased -as calcium increase, PTH should decrease, but it isn’t
77
Hyperparathyroidism of malignancy - calcium levels are... PTH levels are...
Increased Decreased - pseudo-PTH protein keeps calcium elevated - due to malignancy/caner - also called hypercalcemia of malignancy
78
Hypoparathyroidism - calcium levels are... PTH levels are...
Low Low
79
Pseudo-hypoparathyroidism - calcium levels are... PTH levels are...
Low Normal or low -PTH not responding correctly
80
The most effective treatment for hyperparathyroidism is...
Surgical removal of glands | -send PTH levels to lab during surgery until desirable level of PTH is achieved
81
Vitamin D is technically not a vitamin but a...
Hormone | -body can make it (sunlight)
82
Vitamin D2 vs D3 - which is made in plants/fish/fungus? Animals? Which can be made by the skin?
D2 - Ergocalciferol D3 - Cholecalciferol D3 -all inactive forms
83
Vitamin D2/D3 first goes to the ___ and then to the ___ to become metabolically active
Liver = 25-(OH) Kidneys = 1,25-(OH)2 -PTH aids kidneys in making active form
84
1,25-(OH)2 vitamin D helps the intestines, bones and kidneys to... It is essential in this body system..
Absorb, release, and reabsorb calcium Neuromuscular -prevents falls
85
Vitamin D deficiency causes this disease...
Rickets
86
Which form of vitamin D should be given to patients to liver disease? Kidney failure?
25-OH -functional kidneys can convert to 1,25-OH 1,25-OH -need active form as supplement for non-functional kidneys
87
Calcitonin works by inhibiting... It is regulated by...
Actions of PTH and vitamin D -opposite effect of PTH Ionized/free calcium - high calcium = calcitonin release - causes calcium and phosphate levels to decline
88
New bone is made by these cells... These cells respond to PTH for resorption...
Osteoblasts Osteoclasts -have enzymes that demineralize and digest bone -osteocytes regulate bone
89
Paget's disease is due to the aggressive actions of these bone cells...
Osteoclast-mediated bone resorption - thickening and hypertrophy of long bones - deformity of flat bones - osteoblast-mediated bone repair is imperfect - localized to a few bones
90
The primary cause of osteoporosis is...
Post-menopausal - treat with calcium and Vitamin D - exercise, diet, medication - more systemic than Paget's disease
91
Calcium and phosphate assays have this common interference when collected in tubes containing (3)...
EDTA, citrate, oxalate | -collected in tubes in incorrect anticoagulants
92
BRCA1 is a marker for this cancer... BRCA2 is a marker for this cancer...
Breast Ovarian
93
PSA is a marker for this cancer... Why is it not a good screening marker alone?
Prostate Difficult to establish reference range with good sensitivity and specificity -at >10 ng/mL, 50% chance of having cancer
94
CEA is a marker for this cancer... Why should this marker not be used for screening?
Colorectal - high at birth but decline rapidly - appearing later in life indicates reactivation, cancer Elevated in many non-cancer conditions, nonspecific -used for therapy and monitoring
95
hCG is a marker used to detect... Which subunit is specific and which is non-specific?
Pregnancy Alpha = nonspecific -in FSH, LH Beta = specific to hCG
96
AFP is a marker for this cancer...
Liver
97
CA 125 is a carbohydrate marker for this cancer...
Ovarian
98
Thyroid hormone boosts metabolism and keeps the level of this lipid down...
Cholesterol

CLS 701 (10 decks)

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