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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
Q

D3 vs D2?

A

D3 from sun

D2 from plants

26
Q

where is active form of vit D made, and what enzyme?

A

proximal tubule of kidney

1 alpha hydroxylase

27
Q

vit D functions?

A

increased dietary Ca and P absorption

increased bone resorption –> Ca and P release

28
Q

regulation of vit D production?

A

PTH stimulates
low Ca and low P stimulate

active vit D exhibits negative feedback

29
Q

what is 24,25-OH2-D3?

A

an inactive form of vitamin D

30
Q

where is PTH made?

A

chief cells of parathyroid gland

31
Q

function of PTH?

A

increased bone resorption –> increased Ca and P
increased kidney Ca reabsorption (DCT)
decreased kidney P reabsorption (PCT)
increased active vit D conversion

32
Q

mechanism of PTH stimulation of bone resorption?

A

increased production of macrophage CSF and RANKL

RANKL (made by OBs and osteocytes) –> RANK on OCs –> stimulates bone resorption

33
Q

what does intermittend PTH release do?

A

stimulates bone formation

34
Q

how does Mg affect PTH?

A

low Mg –> increased PTH release
VERY low Mg –> decreased PTH release

** causes of low Mg: diarrhea, aminoglycosides, diuretics, alcohol

35
Q

where is calcitonin made?

A

parafollicular cells (C cells) of thyroid

36
Q

which endocrine hormones signal via cAMP?

A 
FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2)
MSH
PTH
calcitonin
GHRH
glucagon

** FLATChAMP (cgg)

37
Q

which endocrine hormones signal via cGMP?

A

ANP
BNP
NO

** vasodilators!

38
Q

which endocrine hormones signal via IP3?

A 
GnRH
oxytocin
ADH (V1)
TRH
histamine (H1)
angiotensin II
gastrin

** GOATHAG

39
Q

which endocrine hormones signal via intracellular receptors?

A 
estrogen
testosterone
cortisol
aldosterone
progesterone
vit D
T3/T4

** adrenals + thyroid + vit D

40
Q

which endocrine hormones signal via intrinsic tyrosine kinases?

A 
insulin
IGF1
FGF
PDGF
EGF
    • activate MAP kinase pathway
    • growth factors!
41
Q

which endocrine hormones signal via receptor-associated tyrosine kinases?

A 
prolactin
immunomodulators
GH
G-CSF
EPO
thrombopoietin
    • activate JAK/STAT pathway
    • acidophils and cytokines
42
Q

T3/T4 effects on heart?

A

increase B1 receptors –> increased CO, HR, SV, contractility

43
Q

T3/T4 effects on BMR?

A

increase BMR via increased Na/K ATPase activity

44
Q

what increases SHBG or TBG?

A

pregnancy, OCP use

45
Q

what is the Wolff Chaikoff effect?

A

excess iodine temporarily inhibits thyroid peroxidase –> decreased iodine organification –> decreased T3/T4 production

46
Q

what enzyme oxidizes/organifies iodide, couples MIT and DIT?

A

peroxidase

47
Q

what drugs inhibit peroxidase?

A

PTU

methimazole

48
Q

what converts T4 to T3?

A

5’ deiodinase

49
Q

what drugs inhibit 5’ deiodinase?

A

PTU

step 1 - physiology (8 decks)

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