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step 1 - physiology > endo > Flashcards

endo Flashcards

1
Q

steps of insulin synthesis?

A

1) RER: preproinsulin synth
2) presignal cleaved –> proinsulin
3) storage in secretory granules
4) proinsulin cleaved –> exocytosis of insulin + C peptide

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2
Q

insulin intracellular signalling pathway?

A

1) binds tyr-kinase receptors –> tyr phosphorylation
2a) activates PI3 kinase pathway –> glucose uptake through GLUT-4, glycogen/lipid/protein synth
2b) activates RAS/MAP kinase pathway –> cell growth, DNA synthesis

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3
Q

how does insulin affect the kidneys?

A

causes increased Na retention

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4
Q

where do you find GLUT4 receptors?

A 
adipose tissue
striated muscle (exercise also increases GLUT4)

** ONLY insulin dependent glucose transporter

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5
Q

where do you find GLUT1?

A

brain, RBCs, cornea

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6
Q

where do you find GLUT2?

A

beta cells, liver, kidney, SI

** bi-directional

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7
Q

where do you find GLUT3?

A

brain

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8
Q

where do you find GLUT5?

A

spermatocytes
GI tract

** FRUCTOSE transport

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9
Q

regulators of insulin release?

A

1 = glucose

GH causes insulin resistance –> increased insulin release
beta2-agonists –> increased insulin release

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10
Q

glucose –> insulin release pathway in pancreas?

A

1) enters via GLUT2
2) glycolysis –> increased ATP
3) ATP-sensitive K channels close
4) depolarization –> voltage-gated Ca channels open
5) intracellular Ca –> insulin exocytosis

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11
Q

CRH has what downstream effects?

A

ACTH secretion
MSH secretion
beta-endorphin secretion

** CRH decreased in chronic exogenous steroid use

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12
Q

dopa/prolactin/GnRH/TRH interaction?

A

dopa inhibits prolactin
prolactin inhibits GnRH, stimulates dopa
TRH stimulates prolactin (and TSH)

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13
Q

what is tesamorelin?

A

GHRH analog

used to tx HIV-associated lipodystrophy

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14
Q

GH functions?

A

stimulates IGF-1 secretion –> linear growth and muscle mass

increases insulin resistance

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15
Q

GH regulation?

A

pulsatile release in response to GHRH
increased secretion in exercise and sleep
inhibited by glucose and somatostatin release

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16
Q

stimulates hunger and GH release?

A

ghrelin
made in stomach

** increased with sleep loss and Prader Willi

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17
Q

stimulates satiety?

A

leptin
made in adipose

    • decreased in starvation and sleep deprivation
    • mutation –> congenital obesity
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18
Q

V1 vs V2 receptors?

A

V2: ADH receptor for regulation of serum osmolarity
V1: ADH receptor for regulation of BP

** V2 mutation can cause nephrogenic DI

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19
Q

cholesterol desmolase fn?

A

conversion of cholesterol –> pregnenolone
first step in mineralocorticoid/glucocorticoid/sex hormone synthesis pathway

    • inhibited by ketoconazole
    • stimulated by ACTH
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20
Q

increased mineralocorticoids, decreased cortisol and sex hormones, hyperT, decreased androstenedione?

A

17-alpha hydroxylase deficiency

XY: pseudohermaphroditic
XX: no 2ary sex characteristics

21
Q

increased sex hormones, decreased mineralocorticoids and cortisol, hypoT, increased K, increased renin and 17OHP?

A

21-hydroxylase deficiency - MC CAH

salt wasting or precocious puberty
XX: virilization

22
Q

decreased aldo and increased 11-deoxycorticosterone, decreased cortisol, increased sex hormone, hyperT, decreased renin?

A

11beta hydroxylase deficiency

XX: virilization

** 11-deoxycorticosterone is cause of hyperT

23
Q

cortisol immune functions?

A 
inhibits leukotriene and PG production
inhibits WBC adhesion --> neutrophilia
inhibits mast cell histamine release
reduces eos
blocks IL-2 production --> reactivation of TB and candidiasis
24
Q

pH and calcium levels?

A

increased pH –> increased albumin affinity for Ca –> hypocalcemic sx

25
D3 vs D2?
D3 from sun | D2 from plants
26
where is active form of vit D made, and what enzyme?
proximal tubule of kidney | 1 alpha hydroxylase
27
vit D functions?
increased dietary Ca and P absorption | increased bone resorption --> Ca and P release
28
regulation of vit D production?
PTH stimulates low Ca and low P stimulate active vit D exhibits negative feedback
29
what is 24,25-OH2-D3?
an inactive form of vitamin D
30
where is PTH made?
chief cells of parathyroid gland
31
function of PTH?
increased bone resorption --> increased Ca and P increased kidney Ca reabsorption (DCT) decreased kidney P reabsorption (PCT) increased active vit D conversion
32
mechanism of PTH stimulation of bone resorption?
increased production of macrophage CSF and RANKL | RANKL (made by OBs and osteocytes) --> RANK on OCs --> stimulates bone resorption
33
what does intermittend PTH release do?
stimulates bone formation
34
how does Mg affect PTH?
low Mg --> increased PTH release VERY low Mg --> decreased PTH release ** causes of low Mg: diarrhea, aminoglycosides, diuretics, alcohol
35
where is calcitonin made?
parafollicular cells (C cells) of thyroid
36
which endocrine hormones signal via cAMP?
``` FSH LH ACTH TSH CRH hCG ADH (V2) MSH PTH calcitonin GHRH glucagon ``` ** FLATChAMP (cgg)
37
which endocrine hormones signal via cGMP?
ANP BNP NO ** vasodilators!
38
which endocrine hormones signal via IP3?
``` GnRH oxytocin ADH (V1) TRH histamine (H1) angiotensin II gastrin ``` ** GOATHAG
39
which endocrine hormones signal via intracellular receptors?
``` estrogen testosterone cortisol aldosterone progesterone vit D T3/T4 ``` ** adrenals + thyroid + vit D
40
which endocrine hormones signal via intrinsic tyrosine kinases?
``` insulin IGF1 FGF PDGF EGF ``` * * activate MAP kinase pathway * * growth factors!
41
which endocrine hormones signal via receptor-associated tyrosine kinases?
``` prolactin immunomodulators GH G-CSF EPO thrombopoietin ``` * * activate JAK/STAT pathway * * acidophils and cytokines
42
T3/T4 effects on heart?
increase B1 receptors --> increased CO, HR, SV, contractility
43
T3/T4 effects on BMR?
increase BMR via increased Na/K ATPase activity
44
what increases SHBG or TBG?
pregnancy, OCP use
45
what is the Wolff Chaikoff effect?
excess iodine temporarily inhibits thyroid peroxidase --> decreased iodine organification --> decreased T3/T4 production
46
what enzyme oxidizes/organifies iodide, couples MIT and DIT?
peroxidase
47
what drugs inhibit peroxidase?
PTU | methimazole
48
what converts T4 to T3?
5' deiodinase
49
what drugs inhibit 5' deiodinase?
PTU

step 1 - physiology (8 decks)

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