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Endo Flashcards

1
Q

Most common tumor of ad med in kids?

- can it cause episodic HTN?

A

Neuroblastoma

- No, but a pheo in adults can

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2
Q

Post pit:

  • derived from?
  • how to hormones get to it?
A
  • neuroectoderm

- via neurophysins (carrier pr’s), from the hypo

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3
Q

Ant pit is derived from?

  • a-subunit of hormone is same in?
  • which hormones are acidophils?
  • which are basophils?
  • what are the hormones it secretes?
A

Oral ectoderm (Rathke’s pouch)

  • TSH, LH, FSH, hCG
  • GH, PRL
  • B-FLAT: Baso’s-FSH, LH, ACTH, TSH
  • FLAT PiG: FSH, LH, ACTH, TSH, GH, PRL
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4
Q

Islet of Langerhans in panc contain what 3 cells? which make what?

A

a-cells: glucagon (on periph)
b-cells: insulin (centrally located)
gamma-cells: somatostatin (interspersed)

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5
Q

How does Glc stim insulin release?

A

Glc metab’n -> ATP which closes K+ ch’s and depol’s b-cell mem -> opens V-gated Ca ch’s -> Ca influx stim’s exocytosis of insulin granules

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6
Q

Which body parts don’t need insulin to take up Glc?

- GLUT-1, 2, 4 =

A

BRICK L: Brain, RBCs, Intestine, Cornea, Kidney, Liver

  • 1=insulin indepen. (RBCs, brain)
  • 2=bidirec (b-cells, liver, kidney, smI)
  • 4=insulin dep (adipose, SkM)
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7
Q

How do these affect insulin release:

  • high Glc
  • somatostatin
  • b2-agonists
  • GH
  • a2-agonists
A
  • incr insulin
  • decr
  • incr
  • incr (bc incr’s insulin resistance)
  • decr
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8
Q

What 2 paths does insulin binding its R take?

A

1) TK phos’n -> PI3-kinase pthwy -> GLUT-4 to surface, also syn of glycogen, lipids and pr
2) RAS/MAP kinase pthwy -> cell growth, DNA syn

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9
Q

Somatostatin inhib’s which 2 hormones?

A

TSH and GH release from ant pit

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10
Q

PRL

  • stim’d by?
  • inhib’d by?
A
  • TRH

- DA from hypo, PRL also stim’s DA -> less PRL

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11
Q

GH

  • works thr?
  • secretion stim’d by? inhib’d by?
A
  • IGF-1/somatomedin secretion

- exercise and sleep; glc and somatostatin

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12
Q

17a-hydroxylase defic =

XY and XX effects?

A

Can only make mcc’s -> HTN and hypoK
XY: decr’d DHT -> pseudohermaph.
XX: nl F but no 2* sex charac’s

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13
Q

3 types of congenital bilat ad hyperplasia?

A

17a-hydroxylase defic (only mcc’s)
21-hydroxylase defic (only androgens) (most common)
11b-hydroxylase defic (androgens + 11-deoxycorticosterone)

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14
Q

21-hydroxylase defic =

- in Females?

A

Can only make androgens -> hypotension, hyperK, incr’d RAAS, vol depletion
- masculinization -> pseudohermaph

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15
Q

11b-hydroxylase defic =

- in Females?

A

Can only make androgens, 1 step further than 21-hydrox though so do make 11-deoxycorticosterone
- HTN from 11-deoxycorticosterone (mcc) and masculinization

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16
Q

Cortisol

  • functions?
  • get striae from?
A

BBIIG = BP (upreg’s a1Rs so incr’s sensitivity on vessels), decr’s Bone formation, anti-Inflamm/Immsupp’ive, Insulin resistance (diabetogenic), Gluconeogenesis (also lipolysis and proteolysis)
- inhib’s fibrobl’s

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17
Q

PTH

  • effect on Ca and phos
  • effect on VitD
  • how do Ca and Mg affect its release? what about phosphate?
A
  • incr bone resorption of them, incr Ca reab’n in DCT, decr phos reab’n in PT (phos trashing hormone!)
  • incr 1,25-(OH)2D (calcitriol) prod in kidney by stim’ing 1a-hydroxylase
  • decr’d Ca/Mg incr’s PTH, but very decr’d Mg decr’s PTH; incr’d phos -> incr’d PTH, decr’d phos -> decr’d PTH
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18
Q

Get decr’d Mg from?

- effect on PTH?

A

D, aminoglycosides, diuretics, EtOH abuse

- incr’d PTH secretion, unless it’s really low then it decr’s PTH

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19
Q

1,25-(OH)2 D3

  • made where?
  • stim’d by?
  • actions?
A
  • kidney
  • low phosphate or Ca and high PTH upreg the NZ that makes it
  • incr’s ab’n of dietary Ca and PO4 in GI, incr’s bone resorption of Ca and PO4
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20
Q

Calcitonin

  • func
  • stim’d by
A

decr bone resorption of Ca (opposes actions of PTH) [incr’s bone mineralization]
- incr’d serum Ca (not imp in nl Ca homeostasis)

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21
Q

Which hormones act via cAMP?

Which act via cGMP?

A
  • FLAT ChAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 R), MSH, PTH + calcitonin, GHRH, glucagon
  • Vasodilators: ANP, NO (EDRF)
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22
Q

Which hormones act via IP3?

A
  • GGOAT: GnRH, GHRH (minor role), Oxytocin, ADH (V1 R), TSH + hist (H1), ATII, gastrin
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23
Q

Which hormones act via a steroid R?

A

VETTT CAP: VitD, Estrogen, Testos, T3/T4, Cortisol, Aldosterone, Progesterone

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24
Q

Which hormones signal thr a intrinsic TK R?

Which hormones have a R-assoc’d TK?

A
  • GFs and MAP kinase pthwy: insulin, IGF-1, FGF, PDGF, EGF

- PIG + JAK/STAT: PRL, Immunomodulators (cytokines IL-2,6,8, IFN), GH

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25
Wolff-Chaikoff effect =
excess iodine temp'ly inhib's thyroid peroxidase -> decr'd iodine organification -> decr'd T3/T4 production
26
T3 functions?
4 B's: Brain maturation, Bone growth, b-adrenergic effects (incr's b1Rs on heart -> works better and harder), Basal metab rate (incr's Na/K ATPase so incr'd O2 consump) (also incr's E by glycogenolysis, gluconeogenesis, lipolysis)
27
TBG incr's/decr's when? - T4 -> T3 by? - which NZ
TBG decr's in hep failure, also w/ anabolic steroids or nephrotic synd (lost in urine) -> more free T3 to work (decr'd total serum T4, but nl FT4 and nl TSH) TBG incr's in preg and w/ OCP use (estrogen!) -> less free T3 (more T4 bound to more TBG, but FT4 is still the same even though more T4 overall -> nl TSH) - 5'-deiodinase in periph
28
How does body keep euvol state in SIADH? - If Na gets really low, what happens? - What drug can cause SIADH?
Decr'd aldos -> decr'd water retention to maintain near-nl vol status - seizures - cyclophosphamide
29
Craniopharyngioma = | - causes?
benign tumor from Rathke's pouch remnants | - most common cause of hypopit in kids
30
Empty sella synd - usu occurs in who? - what happens?
obese women w/ HTN | - subarachnoid space extends into sella and fills up with CSF -> compresses pit gl
31
Cretinism findings?
5Ps: Pot-bellied, Pale, Puffy-faced child w/ Protruding umbilicus and Protuberant tongue
32
Nontender hypothyroidism? Tender hypothyroid? Fixed, hard (rock-like) and painless goiter? Painless thyroiditis?
- Hashimoto's thyroiditis - Subacute thyroiditis (de Quervain's) (self-limited, post viral illness) - Riedel's thyroiditis (replaced by fibrous tissue) - Autoimm, usu post partum w/ no germinal follicles in gland
33
Jod-Basedow phenomenon =
thyrotoxicosis if a patient w/ severe iodine defic goiter is made iodine replete
34
Thyroid storm = | - may see incr'd ALP from?
stress-induced catecholamine surge -> death by arrhythmia, also high F, shock from V, coma (serious comp of Graves and other hyperthyroid d/o's) - incr'd bone turnover
35
Papillary ca of thyroid - on histo see? - incr'd risk w/? Follicular ca of thyroid, on histo see?
- empty-appearing nuc (Orphan Annie's eyes), psammoma bodies, and nuc grooves - childhood radiation - uniform follicles
36
Why does resp/metab alkalosis give you tetany?
Alkalosis incr's (-) on alb (H+ leave it) -> binds more Ca2+ -> same serum Ca level but less free Ca (and thus incr'd PTH) -> partial depol of n's and m's bc lower threshold potential
37
Effect of PTH on bicarb?
Incr'd PTH decr's bicarb reab'n -> nl anion gap metabolic acidosis (type II RTA)
38
How is VitD act'd?
In liver by 25-hydroxylase to 23-(OH)D | Then in kidney by 1a-hydroxylase to 1,25-(OH)2D
39
Why do you get hypoPT from hypoMg?
Need Mg as cofactor for cAMP, which need for PTH act'n
40
1* HyperPT - Ca, phos, cAMP? - sx?
- incr'd Ca, decr'd phos, incr'd urinary cAMP - stones (Ca renal stones), bones (osteitis fibrosa cystica: cysts filled w/ brown fibrous tissue), groans (constipation) and moans (psychosis, confusion, anxiety, coma)
41
2* HyperPT | - Ca, phos, alk phos?
- decr'd Ca, incr'd phos if CKD or decr'd if anything else (more PTH, less phos reab'd), incr'd ALP (more bone brkdwn)
42
Renal osteodystrophy =
bone lesions from 2/3* hyperPT due to renal dz (no VitD, so low Ca, so incr'd PTH)
43
3* HyperPT =
refractory (autonomous) hyperPT from CKD, incr'd PTH even though incr'd Ca
44
HypoPT sx? PseudohypoPT = - sx?
- hypoCa, tetany - AD kidney unresponsiveness to PTH (mutation in Gs R) - hypoCa, short 4/5th digits, short stature
45
Chvostek's sign = | - sign of?
tapping of facial n. -> contraction of facial m's | - tetany from hypoCa in hypoPT
46
Trousseau's sign = | - sign of?
occlusion of brachial a. w/ BP cuff -> carpal spasm | - tetany from hypoCa in hypoPT
47
HTN, hypoK, metab alkalosis, low pl renin =
1* hyperaldosteronism (Conn's synd) | HTN from incr'd Na, alk from incr'd H+ out, low pl renin bc neg fdbk from high aldos levels
48
HTN, hypoK, metab alkalosis, high pl renin =
2* hyperaldos from renal perception of low IV vol -> incr'd RAAS
49
Hypotension, hyperK, metab acidosis = | - also have?
``` Addison's dz (no aldos nor cortisol) Low Na (hypotension, high K, high H+ from no aldos to run proton pump - skin pigmentation ```
50
Waterhouse-Friderichsen synd =
acute 1* ad insuff from bilat ad hemorrhage, usu from N.meningitidis septicemia, DIC and endotoxic shock
51
What do you have to give to a pt before removing a pheo?
Irreversible a-blockers (phenoxybenzamine) -> so no HTN crisis Then b-blockers to slow HR
52
Pheo sx:
5Ps: P (high BP), pain (HA and ileus), Perspiration, Palpitations (tachy), Pallor
53
Pheo rule of 10s:
10% malg, bilat, extra-ad, calcify, kids
54
Neuroblastoma oncogene? | - what is high in urine?
overexp'n of N-myc oncogene assoc'd w/ rapid tumor progression - HVA (DA brkdwn product)
55
Histo of islet cells in DM type 1 vs. 2?
T1DM - islet leukocytic infiltrate | T2DM - islet amyloid (AIAPP) deposit
56
Kussmaul respirations = | - seen in?
Rapid and deep breathing | - DKA
57
Sx of DKA? | - trtmt?
Kussmal resp's, N/V, ab pain, psychosis/delirium, dehydration, fruity breath odor (due to exhaled acetone) - IV fluids and IV insulin, K+ (to replete IC stores), glc if needed to prevent hypoGlc
58
Carcinoid synd, rule of 1/3 = ? | - most common location
1/3 met, 1/3 present w/ 2nd malig, 1/3 mult | - appendix
59
``` MEN 1 (Wermer's synd) = - presents w/? ```
PT, pit (PRL or GH) and panc endo tumors (ZES, insulinomas, VIPomas, glucagonomas) - kidney stones and stomach ulcers (ZES)
60
MEN 2A (Sipple's synd) =
Medullary thyroid ca (calcitonin), pheo, PT tumor
61
MEN 2B =
Medullary thyroid ca, pheo and oral/GI ganglioneuromatosis (marfanoid habitus)

First Aid Diseases (16 decks)

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