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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
Q

Treatment for endocrine disorders are usually (2)

A

Surgery
-more common

Irradiation

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26
Q

Growth hormone (GH or HGH) is also called… Release of growth hormone is controlled by ___, which is made in the ___

A

Somatotrophin

Growth hormone-releasing hormone (GHRH)

Hypothalamus

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27
Q

GH is stored and released from the ___. Excessive growth hormone release is called…

A

Pituitary (anterior)

Acromegaly

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28
Q

GH is usually inhibited by…

A

Glucose

-after eating a meal, GH levels drop

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29
Q

The glucose suppression test indicates whether a person has…

A

Tumor causing acromegaly

  • glucose infusion does not inhibit GH release
  • stimulation test is the opposite of this test
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30
Q

Some hormones are made by dimerization of subunits. When testing for hormones, why should we be careful when measuring a particular subunit?

A

Subunit could be nonspecific to hormone and shared across different hormones

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31
Q

AHD deficiency can cause these 3 conditions…

A

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

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32
Q

What is the ADH stimulation test?

A

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

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33
Q

The condition associated with primary adrenal insufficiency is… Secondary adrenal insufficiency is due to…

A

Addison’s disease

Low cortisol due to decreased ACTH

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34
Q

Addison’s disease vs Cushing’s syndrome - which hormones are elevated and decreased in each? Which electrolytes are elevated and decreased in each?

A

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

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35
Q

Cushing’s syndrome can be ACTH dependent or independent. Explain each

A

ACTH dependent - pituitary tumors produce excess ACTH

ACTH independent - tumors in other locations that produce pseudo-ACTH

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36
Q

What is a pheochromocytoma? What test can we use to screen for it?

A

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
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37
Q

Besides the urinary metanephrine test for pheochromocytomas, this urinary excretion product can be used as an indicator of epinephrine production…

A 
Vanillylmandelic Acid (VMA)
-less sensitive, more specific
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38
Q

What does the clonidine suppression test for? How does clonidine affect a normal vs ill patient?

A

Pheochromocytoma

Clonidine (adrenergic blocker drug) given to patient:
Normal = inhibits release of catecholamines
Patient = catecholamines released due to adrenal tumor (pheochromocytoma)

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39
Q

3 major classes of steroid hormones made by the adrenal cortex… Which class do cortisol and aldosterone fall under?

A

Glucocorticoids (includes synthetics)
-type of corticosteroid

Mineralocorticoids (cortisol/aldosterone)
-type of corticosteroid

Androgens
-sex hormones, anabolic steroids

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40
Q

Function of glucocorticoids

A

Gluconeogenesis

-similar to cortisol, another steroid

41
Q

Explain the entire process to release cortisol

A

Hypothalamus secretes CRH
CRH stimulates pituitary to release ACTH
ACTH stimulates adrenal cortex to release cortisol

42
Q

This peptide causes an antagonistic effect to the angio renin system

A

BNP

  • vasodilation
  • lower blood pressure
  • sodium and water excretion
43
Q

The thyroid requires this additional chemical element to produce T4 and T3…

A

Iodine

-T3 has 3 iodines, T4 has 4

44
Q

Thyroid follicular cells produce what?

A

Thyroglobulin (Tg)

-involved in thyroid hormone production and storage

45
Q

What are the 3 thyroid hormone binding proteins? Which one has the highest affinity for thyroid hormones? Where are they made?

A

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
Q

Explain the process to release thyroid hormones

A

Hypothalamus secretes TRH (thyroid releasing hormone)
TRH stimulates pituitary to release TSH
TSH stimulates thyroid to release thyroid hormones

47
Q

Graves disease vs Hashimoto’s thyroiditis - high or low thyroid hormone?

A

Graves disease - hyperthyroidism

Hashimoto’s - hypothyroidism

48
Q

Non-malignant enlargement of the thyroid gland is called… The condition is due to a deficiency in…

A

Goiter
-TSH mediated

Iodine
-thyroid enlarge to trap more iodine

49
Q

What are the two types of goiter? Cause of each?

A

Non-toxic goiter = lack of dietary iodine

Toxic goiter = Graves disease (hyperthyroidism)

50
Q

The negative feedback control on the thyroid is mediated by (2)…

A

Iodine
-high iodide levels shuts down thyroid gland, inhibits iodide uptake

Thyroid hormones
-high concentration inhibits TRH/TSH

51
Q

T3 and T4 - how do they enter cells?

A

Diffusion

-hydrophobic amino acid derivatives

52
Q

Bound vs free T3/T4 - which form is the metabolically active form? Is there a greater percentage of free T3 or free T4?

A

Free

Free T3 > free T4

53
Q

The most common cause of hypothyroidism is… Mechanism of hypothyroidism…

A

Hashimoto’s thyroiditis

  • may/may not have enlargement of thyroid (goiter)
  • treat with T4

Autoimmune: antibodies destroy thyroid cells

54
Q

In Hashimoto’s thyroiditis, what are the levels of free T4 and TSH?

A

Free T4 is low

TSH elevated
-trying in vain to produce more T4

55
Q

The most common cause of hyperthyroidism is… It is this type of goiter… Mechanism of hyperthyroidism…

A

Graves disease (thyrotoxicosis)

Toxic goiter
-thyroid enlargement

Autoimmune: antibodies mimic TSH and bind to TSH receptors

56
Q

In Graves disease, what are the levels of T3 and T4? Levels of TSH?

A

All elevated
-includes T3, T4, free T3, free T4

TSH low

57
Q

The most severe form of hyperthyroidism is called… Excessive release of…

A

Thyroid storm (thyrotoxic crisis)

T4

58
Q

TSH and T4 levels in nontoxic goiter and toxic goiter

A

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
Q

What is primary and secondary hypothyroidism?

A

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
Q

Amino acid derivative hormones - hydrophobic or hydrophilic? Do they require a transporter molecule?

A

Catecholamines are hydrophilic, do not require transporters

Thyroid hormones are hydrophobic, require transporters

61
Q

The Metyrapone stimulation test is to determine the functional status of which endocrine organ?

A

Pituitary gland

  • Metyrapone inhibits cortisol
  • measure rise in ACTH if pituitary is functional
62
Q

A decrease in corticosteroid levels results in a __ in potassium levels. Why?

A

Increase

Aldosterone causes K excretion. No aldosterone, no K excretion and elevated blood K
-Addison’s disease

63
Q

Does administering potassium iodide increase or decrease thyroid function?

A

Decrease

  • blocks T4 release from gland
  • inhibits thyroid storms (thyrotoxic crisis)
64
Q

Low serum calcium triggers the ___ gland to release more ___. High serum calcium triggers the ___ gland to release more ___

A

Parathyroid
PTH

Thyroid
Calcitonin

65
Q

What are the 3 states that calcium is found in the blood? Which is the biologically active form?

A

Free (ionized, unbound) - 45%
Bound (albumin) - 45%
Bound (anions - bicarbonate, citrate, lactate, phosphate, etc) - 10%

Free/ionized

66
Q

Does acidosis or alkalosis increase free calcium? Why?

A

Acidosis

Excess H+, displaces calcium bound to protein

67
Q

This molecule can displace calcium bound to albumin… Patients with impaired ___ have more free calcium… Patients with impaired ___ have lower total calcium

A

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
Q

The main cause of hypercalcemia is due to…

A

Primary hyperparathyroidism

-rest of causes due to cancer

69
Q

How does cancer cause hypercalcemia?

A

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
Q

Difference between hypoparathyroidism and pseudo-hypoparathyroidism

A

Decrease in PTH levels

Impaired response to PTH

71
Q

Where is most phosphorus/phosphate found in the body? Does hemolysis increase or decrease phosphate levels?

A

Bones
-as calcium phosphate

Increase
-PO4 is predominantly intracellular

72
Q

PTH causes serum calcium levels to ___ and causes serum phosphate levels to ___.

A

Increase

Decrease
-inverse relationship

73
Q

PTH levels are regulated by…

A

Free calcium

  • high free calcium = no PTH secretion
  • low free calcium = PTH secretion
74
Q

PTH has these 3 effects on the kidneys

A

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
Q

PTH has these effects on the bones… PTH has these effects on the gut/intestines…

A

Increase calcium and phosphate release

  • stimulates osteoclast formation and osteolysis
  • PTH tell kidneys to dump phosphate

Increases calcium absorption
-dumps phosphate

76
Q

Primary hyperparathyroidism - calcium levels are… PTH levels are…

A

Increased

Increased

-as calcium increase, PTH should decrease, but it isn’t

77
Q

Hyperparathyroidism of malignancy - calcium levels are… PTH levels are…

A

Increased

Decreased

  • pseudo-PTH protein keeps calcium elevated
  • due to malignancy/caner
  • also called hypercalcemia of malignancy
78
Q

Hypoparathyroidism - calcium levels are… PTH levels are…

A

Low

Low

79
Q

Pseudo-hypoparathyroidism - calcium levels are… PTH levels are…

A

Low

Normal or low
-PTH not responding correctly

80
Q

The most effective treatment for hyperparathyroidism is…

A

Surgical removal of glands

-send PTH levels to lab during surgery until desirable level of PTH is achieved

81
Q

Vitamin D is technically not a vitamin but a…

A

Hormone

-body can make it (sunlight)

82
Q

Vitamin D2 vs D3 - which is made in plants/fish/fungus? Animals? Which can be made by the skin?

A

D2 - Ergocalciferol

D3 - Cholecalciferol

D3

-all inactive forms

83
Q

Vitamin D2/D3 first goes to the ___ and then to the ___ to become metabolically active

A

Liver = 25-(OH)

Kidneys = 1,25-(OH)2

-PTH aids kidneys in making active form

84
Q

1,25-(OH)2 vitamin D helps the intestines, bones and kidneys to… It is essential in this body system..

A

Absorb, release, and reabsorb calcium

Neuromuscular
-prevents falls

85
Q

Vitamin D deficiency causes this disease…

A

Rickets

86
Q

Which form of vitamin D should be given to patients to liver disease? Kidney failure?

A

25-OH
-functional kidneys can convert to 1,25-OH

1,25-OH
-need active form as supplement for non-functional kidneys

87
Q

Calcitonin works by inhibiting… It is regulated by…

A

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
Q

New bone is made by these cells… These cells respond to PTH for resorption…

A

Osteoblasts

Osteoclasts
-have enzymes that demineralize and digest bone

-osteocytes regulate bone

89
Q

Paget’s disease is due to the aggressive actions of these bone cells…

A

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
Q

The primary cause of osteoporosis is…

A

Post-menopausal

  • treat with calcium and Vitamin D
  • exercise, diet, medication
  • more systemic than Paget’s disease
91
Q

Calcium and phosphate assays have this common interference when collected in tubes containing (3)…

A

EDTA, citrate, oxalate

-collected in tubes in incorrect anticoagulants

92
Q

BRCA1 is a marker for this cancer… BRCA2 is a marker for this cancer…

A

Breast

Ovarian

93
Q

PSA is a marker for this cancer… Why is it not a good screening marker alone?

A

Prostate

Difficult to establish reference range with good sensitivity and specificity
-at >10 ng/mL, 50% chance of having cancer

94
Q

CEA is a marker for this cancer… Why should this marker not be used for screening?

A

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
Q

hCG is a marker used to detect… Which subunit is specific and which is non-specific?

A

Pregnancy

Alpha = nonspecific
-in FSH, LH
Beta = specific to hCG

96
Q

AFP is a marker for this cancer…

A

Liver

97
Q

CA 125 is a carbohydrate marker for this cancer…

A

Ovarian

98
Q

Thyroid hormone boosts metabolism and keeps the level of this lipid down…

A

Cholesterol

CLS 701 (10 decks)

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