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Endo Phys (FA) Flashcards

1
Q

What are the steps of insulin synth?

A

Preproinsulin (RER) –> cleavage of presignal –> Proinsulin stored in sectretory granules –> cleavage of proinsulin –> exocytosis of insulin and C-peptide

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2
Q

What is the use of C-peptide count?

A

Only indigenous insulin production results in C-peptide production.

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3
Q

What type of cell signaling takes place due to insulin?

A

Cell surface receptor –> tyrosine kinase activity –> inducing glucose uptake and gene transcription

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4
Q

What are the anabolic effects of insulin and in what tissues does it act?

A

Incr. gluc transport into sk. muscle and adipose tissue

incr. glycogen synth and storage
incr. triglyceride synth
incr. Na retention in kidneys
incr. protein synth
incr. cellular uptake of K+ and a.a.
decr. glucagon release

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5
Q

Does insulin cross the placenta? Does glucose?

A

No, Yes

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6
Q

What is the primary insulin-dependent glucose transporter and on what tissues is it found?

A

GLUT-4: adipose, sk. muscle

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7
Q

What are the insulin-independent glucose transporters and on what tissues are they found?

A

GLUT-1: RBC, Brain, Cornea
GLUT-2: B-islet cells, liver, kidney, sm. intestine
GLUT-5: spermatocytes, GI tract

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8
Q

What is the source of metabolism of the brain during the fed and fasting states?

A

Glucose, keytone bodies

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9
Q

What cell type always uses glucose as its only source of energy and why?

A

RBCs, they lack mitochondria

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10
Q

What is the acronym for insulin-independent glucose uptake tissues?

A

BRICK-L

Brain, RBC, Intestine, Cornea, Kidney, Liver

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11
Q

What is the major regulator of insulin release?

A

Glucose

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12
Q

How do GH and B-2 agonists influence insulin levels?

A

Both increase it. GH –> increase insulin resistance –> incr. insulin release)

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13
Q

What is the pathway by which glucose increases insulin release from a cell?

A

Gluc enters B cell –> increase in ATP generation –> Close of K+ channels –> open Ca++ channels (Ca++ enters cell) –> insulin exocytosis

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14
Q

What cells produce glucagon?

A

a-cells in pancreas

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15
Q

What are the metabolic effects of glucagon?

A

Glycogenolysis, Gluconeogenesis, Lipolysis, Ketone Production

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16
Q

What are the + and - regulation of glucagon?

A

+ : Hypoglycemia

- : insulin, hyperglycemia, and somatostatin

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17
Q

What hormones are influenced by corticotropin releasing hormone?

A

Incr. ACTH, MSH, and B-endorphin

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18
Q

What is the effect chronic exogenous steroid use has on CRH?

A

Decreased

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19
Q

What is the primary inhibitor of prolactin?

A

Dopamine

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20
Q

What is the function of gonadotropin releasing hormone?

A

Incr. FSH and LH

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21
Q

What is the regulatory hormone of GnRH?

A

Prolactin and androgens

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22
Q

What is the primary hypothalamic hormone responsible for puberty and fertility?

A

GnRH

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23
Q

What is the primary inhibitory hormone of GnRH?

A

Prolactin

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24
Q

By what pathway does Prolactinoma cause amenorrhea and osteoporosis?

A

Incr. prolactin –> decr GnRH –> amenorrhea and osteoporosis

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25
How is acromegaly treated (class) and the MoA?
Somatostatin analogues --> decr. in GH and TSH
26
What are the effects of TRH?
incr. TSH and prolactin
27
What is the source of prolactin?
Anterior Pituitary
28
What is the function of prolactin?
Milk production, inhibit ovulation and spermatogenesis by inhibiting GnRH
29
How does hypoprolactinemia influence libido?
Decrease
30
What is the primary inhibitory substance of prolactin?
Dopamine
31
What stimulates prolactin release?
TRH
32
What is the primary pharmacologic used for inhibiting prolactin secretion?
Bromochriptine (dopamine agonist)
33
What classification of drugs stimulate dopamine secretion?
antipsychotics
34
How does estrogen influence prolactin release and in what context is it typically presented?
Increase, OCP and pregnancy
35
What is another name for GH?
Somatotropin
36
From what area is GH secreted?
Anterior pituitary
37
What is the mechanism by which GH stimulates growth?
IGF-1
38
How does GH influence insulin sensitivity?
Increase resistance
39
What are the regulatory factors of GH?
GHRH, increased during exercise and sleep. | Inhibited by glucose and somatostatin
40
What results from excessive GH secretion?
Acromegaly in adults | Gigantism in kids
41
Where, specifically, is ADH synthesized and released?
Supraoptic nuclei of the hypothalamus | Posterior Pituitary
42
What is the main action of ADH and the mechanism by which it acts?
Increase Ser. Osmolality via V2-R in the kidney, increasing aquaporin transcription in the principal cells of the collecting ducts and BP via V1-R in vessels.
43
What are the ADH levels in central DI, nephrogenic DI, and primary polydipsia?
Decreased, Increased, Varies
44
What is the most common cause of nephrogenic DI?
V2-R mutation
45
What is the DoC for central DI?
Desmopressin
46
Where are the physiologic regulators of ADH?
Osmoreceptors in the hypothalamus and hypovolemia in the carotids
47
What enzyme is responsible for the committed (and rate limiting) step in steroid hormone synthesis?
Cholesterol Desmolase
48
How are the kidneys grossly affected in congenital adrenal hyperplasia and what is the mechanism?
Bilateral renal enlargement due to increase ACTH (from decreased cortisol)
49
What lab values are present in 17a-hydroxylase deficiency?
Incr. mineralocorticoids, decreased cortisol, decreased sex hormones, Hypertension, Hypokalemia, decr. DHT
50
What is the underlying reason for XY pseudohermaphroditism and XX lack of secondary sexual development?
17a-hydroxylase def.
51
What lab values are present in 21-hydroxylase deficiency?
decr. mineralocorticoids, decr cortisol, increased sex hormones, hypotension, hyperkalemia, incr. renin activity, incr. 17-hydroxyprogesterone
52
What are the most common presentations in 21-hydroxylase deficiency?
infant salt washing, precocious puberty, virilization (deep voice)
53
What are the lab values in 11B-hydroxylase deficiency?
decr aldosterone, incr 11-deoxycorticosterone (inc. BP), decr cortisol, incr. sex hormones, hypertension (low renin)
54
What is the most common presentation with 11B-hydroxylase deficiency?
virilization
55
Where is cortisol synthesized?
Adrenal zona fasciculata
56
What is the effect of cortisol on BP and the mechanism?
Incr by up regulating a1 receptors on arterioles, resulting in increased sensitivity to Epi / NE
57
How is cortisol diabetogenic?
Increases insulin resistance
58
What is cortisol's effect on GNG, lipolysis, and proteolysis?
Increases all
59
How does cortisol cause striae?
Decrease in fibroblast activity
60
What is cortisol's effect on immunity?
Decreases both immunity and inflammation
61
What is cortisol's effect on bone formation and the mechanism?
Decrease via decreased osteoblast activity
62
How is cortisol regulated?
CRH from the hypothalamus stimulates ACTH release in the pituitary, stimulating cortisol synth in the fasciculata
63
What is the acronym for the effects of cortisol?
Big Fib Incr BP, insulin, and GNG Decr. Fibroblast, inflammation, and Bone
64
What is the source of PTH?
Chief cells of parathyroid
65
What are the effects of PTH?
Incr. bone resorption (Ca++ and PO4) Incr. kidney reabsorption of Ca++ in DT Decr. PO4 reabsorption in PT Incr. 1,25-(OH)2D3 (calcitriol) production in kidney via 1a-hydroxylase stimulation
66
How does PTH stimulate bone resorption?
Incr. RANK-L --> stimulate osteoblasts --> stimulate osteoclasts --> increase resorption
67
How do low Ca++, low Mg, and very low Mg influence PTH?
Stimulate, Stimulate, Inhibit
68
What are the three forms of serum Ca++ and there relative percentages?
Ionized (45%), Albumin (40%), Bound to anions (15%)
69
How does and increase in pH influence serum Ca++ levels?
Favors albumin binding, resulting in hypocalcemia effect.
70
What are some common manifestations of hypocalcemia?
cramps, pain, paresthesias, caporal spam (trosseau and chvostek signs)
71
What are the sources of Vitamin D?
D3 from sun, D2 from plants
72
What is the pathway for Vitamin D activation?
D2/D3 --> 25-OH in liver --> 1, 25-(OH)2 in kidney
73
What is the function of Vitamin D?
increase Ca++ and PO4 dietary absorption and increase bone resorption
74
What are the regulating factors of Vit D synth?
High PTH, low Ca++, Low PO4 increase | Negative feedback by 1,25-(OH)2
75
What are the disease states caused by Vit D deficiency?
Rickets in kids, osteomalacia in adults
76
How do PTH and Vit D differ in their physiological roles?
PTH: incr. Ca++ and decr. PO4 reabsorption in kidney | Vit D: Incr both Ca++ and PO4 absorption in gut
77
What is the source of calcitonin, its function and regulation?
Parafollicular cells (C cells) of the thyroid, decease bone resorption (Ca++), incr serum Ca++ --> incr. calcitonin
78
What is the acronym used to signify the hormones that use cAMP?
FLAT ChAMP FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2-R), MSH, PTH, calcitonin, GHRH, glucagon
79
What hormones use cGMP?
ANP, NO
80
What hormones use IP3?
GOAT HAG | GnRH, Oxytocin, ADH (V1-R), TRH, Histamine (H1-R), Angiotensin II, Gastrin
81
What hormones use steroid receptors?
VETTT CAP | Vit D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone
82
What hormones use intrinsic tyrosine kinase?
Growth factors | Insulin, IGF-1, FGF, PDGF, EGF
83
What hormones use receptor-associated tyrosine kinase?
PIG: Think acidophils and cytokine | Prolactin, Immunomodulators, GH
84
What is the generic pathway of steroid hormones?
Circulate bound to globulin --> enter cell (lipophilic) --> Bind to cytoplasmic or nuclear receptor --> transformation of receptor and expose DNA binding site --> increase transcription --> increase protein translation
85
How does the concept of transport protein mediation influence pathology related to steroid hormones in males and females?
Incr in transport protein --> decrease in free hormone and vice versa Increase in sex hormone binding globulin in male --> decrease in available testosterone --> gynecomastia In females decrease in SHBG --> increase in testosterone --> hirsutism
86
What is the main effect of T3/T4 on the body?
Basal Metabolic rate regulation
87
What is the source of T4 and T3?
T4: Follicles of the thyroid T3: peripheral tissues convert T4 --> T3
88
How does T4 affect Bone growth, the CNS, CV system, Basal metabolic rate, and glucose stores?
It increases all via synergistic effect with GH, increasing B1 receptors, Na/K ATPase activity, and inc. GNG (etc.)
89
How are T3/T4 levels regulated?
TRH (hypothalamus) --> incr. TSH (pituitary) --> stimulate follicular cells Negative feedback by free T3/T4, decr. sensitivity to TRH in the ant. pituitary
90
What is the Wolff-Chaikoff effect (excess iodine)?
Excess iodine temporarily inhibits thyroid peroxidase
91
Under what conditions are Thyroxine-binding globulin levels affected?
Decr in hepatic failure | Incr. in pregnancy and OCP use (estrogen incr. TBG)
92
What enzyme is responsible for T4 --> T3 in the periphery?
5'-deiodinase
93
What are the MoA of propylthiouracil and methimazole?
PTU inhibits both peroxidase and 5'-deiodinase | Methimazole inhibits peroxidase only

Endo / Repro (15 decks)

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