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ENDO II Test I > Endo Review > Flashcards

Endo Review Flashcards

1
Q

what are the lipid soluble hormones

A

steroids

thyroid hormones

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2
Q

plasma IGF-I measured at any time during the day is usually a good index of what

A

overal GH secretion

this is b/c IGF-I circulates attached to protein and has a long half life (20 hrs)

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3
Q

what is the suppression test used to diagnose acromegaly

A

failure of glucose to suppress GH diagnostic for acromegaly

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4
Q

what is the suppression test used in hypercortisolism

A

failure of dexamethasone (low dose) to suppress cortisol is diagnostic

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5
Q

the hormones in the hypothalamic anterior pituitary axis are all what type?

A

water soluble

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6
Q

what does the pulsatile release of GnRH prevent?

A

downregulation of its receptors on the gonadotrophs of the anterior pituitary

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7
Q

what does a constant infusion of GnRH cause a decrease in>

A

LH and FSH

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8
Q

what are the hypothalamic hormones

A

TRH - thyrotropin releasing hormone

CRH - corticotropin releasing hormone

GHRH- growth hormone releasing hormone

Somatostatin

Prolactin-inhibting factor (PIF, aka dopamine)

Gonadotropin releasing hormone (GnRH) (synthesized in the pre-optic nucleus)

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9
Q

TRH causes secretion of what and effects what pituitary target

A

affects thyrotrophs (10%) and releases TSH

affects lactotrophs and causes the release of prolactin

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10
Q

CRH acts on what and causes secretion of what?

A

acts on corticotrophs causing release of ACTH

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11
Q

GnRH acts on what and causes release of what

A

acts on gonadotrophs

causes release of LH and FSH

LH is favored during high frequency pulses

FSH is favored during low frequency pulses

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12
Q

GHRH acts on what and causes secretion of what

A

acts on somatotrophs

release of GH

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13
Q

what does somatostatin inhibit ?

A

release of GH

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14
Q

what does dopamine do in the hypothalamic pituitary axis

A

works on lactotrophs to inhibit release of prolactin

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15
Q

what is the most common tumor affecting the hypothalamic pituitary system in children

A

Craniopharyngioma

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16
Q

insulin infusion stimulates what

A

GH and ACTH

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17
Q

what characterizes microadenomas

A

<1 cm diameter

hormonal excess

treatable

ACTH (Cushing disease)

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18
Q

what characterizes macroadenomas

what is the most common manifestation

A

> 1 cm diameter

mass effect

larger tumors with suprasellar extension

associated with panhypopituitarism and visual loss

most common manifestation is hypogonadism

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19
Q

what are the hormones of the anterior pituitary

A

FLAT PiG

FSH
LH
ACTH
TSH
Prolactin 
GH
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20
Q

what links the hypothalamus to the anterior pituitary

A

hypothalamic hypophysial portal system

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21
Q

ACTH and MSH , B-lipotropin, and B-endorphin are derived from what

A

POMC (pro-opiomelancocortin)

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22
Q

secretion of growth hormone is continuous or pulsatile ?

A

pulsatile

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23
Q

secretion of GH is increased by what?

A

sleep, stress, hormones related to puberty, starvation, exercise, hypoglycemia

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24
Q

secretion of GH is decreased by what>

A

somatostatin
obesity
hyperglycemia
pregnancy

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25
what is IGF-I
it is a somatomedin which is produced in the liver somatomedins inhibit the secretion of GH
26
what are GH's effects on Adipose tissue, muscle tissue, hepatocytes, visceral organs
Diabetogenic effect--> decrease glucose uptake, increase blood glucose levels, increase lipolysis, increase blood insulin levels muscle--> increase protein synthesis, lean body mass visceral organs--> increase production of IGF--> increase in linear growth
27
what are the actions of prolactin? what are its effect on ovulation ?
stimulates milk production, breast development inhibits ovulation by decreasing GnRH inhibits spermiogenesis
28
what hypothalamic substances control prolactin
dopamine- inhibits TRH - increases
29
what occurs when you have prolactin excess
galactorrhea decreased libido failure to ovulate and amenorrhea
30
what are the factors that increase ADH secretion
increase in serum osmolarity ``` volume contraction pain nausea hypoglycemia nicotine, opiates ```
31
what are some factors that decrease ADH secretion
serum osmolarity ethanol alpha-agonists ANP
32
what are the actions of oxytocin
contraction of the myoepithelial cells in the breast contraction of the uterus
33
in what portions of the hypothalamus are oxytocin and ADH located
ADH- supraoptic nuclei Oxytocin- paraventricular nuclei
34
GFR (adrenal cortex)
zona glomerulosa- aldosterone (salt) zona fasiculata - produces mostly glucocorticoids (cortisol- sugar) Zona reticularis - androgens (sex)
35
what are the 21 carbon steroids
progesterone, deoxycorticosterone (which has mineralcorticoid activity), aldosterone, cortisol
36
adrenal medulla produces what
catecholamines
37
what are the 19 carbon steroids
have androgenic activity and are precursors to estrogens
38
what are ACTH's affects on the anterior lobe of the pituitary
increases steroid hormone synthesis in all zones of the adrenal cortex by stimulating cholesterol desmolase (increasing conversion of cholesterol to pregnenolone)
39
what is the dexamethasone test and what does it tell you
based on the ability of dexamethasone to inhibit ACTH secretion Normal--> low does dex inhibits ACTH and subsequently suppresses cortisol secretion ACTH secreting tumor- low dose dex does NOT inhibit cortisol but high dose dex does Adrenal cortical tumors- neither low or high dose dex inhibits cortisol secretion
40
what are the effects of aldosterone on K
aldosterone increases renal K secretion in hyperkalemia
41
17 alpha hydroxylase deficiency
decrease in Cortisol and sex hormones increase in mineralcorticoids HTN, hypokalemia, decrease in DHT males--> pseudohermaphroditism (ambiguous genitalia, undescended testes) female--> lack secondary sexual development
42
21 hydroxylase deficiency
decrease in mineralcorticoids and cortisol increase in sex hormones hypotension, hyperkalemia increase in renin activity increase in 17-hydroxyprogesterone presents in infancy with salt wasting or childhood with precocious puberty virilizaiton in females
43
11-Beta hydroxylase deficiency
decrease in aldosterone but an increase in 11-deoxycorticosterone (results in increase in BP) decrease in cortisol increase in sex hormones hypertension (low renin) Female virilization
44
what are the functions of cortisol BIG FIIB
Increase Blood pressure -upregulate alpha receptors on arterioles - increased sensitivity to NE and Epi Increase Insulin resistance (diabetogenic) Increase Gluconeogenesis, lipolysis and proteolysis Decrease fibroblast activity (cause striae) decrease inflammatory and immune response - decresae production of leukotrienes and PG's - decrease esoinophils and decrease histamine release from mast cells - block IL-2 production Decrease Bone formation (decrease osteoblast activity)
45
why does hyperpigmentation occur with adrenocortical insufficiency
low cortisol levels stimulate ACTH secretion ACTH contains the MSH fragment
46
hypoglycemia anorexia, weight loss n/v weakness, hypotension, hyperkalemia metabolic acidosis decreased pubic and axillary hair in women hyperpigmentation
Addison's disease (primary adrenocortical insufficiency) ACTH levels are increased (negative feedback effect of decreased cortisol)
47
hyperglycemia muscle wasting central obesity round face, supraclavicular fat, buffalo hump osteoporosis striae virilization and menstrual disorders in women HTN
Cushing's SYNDROME (primary adrenal hyperplasia) Decreased ACTH levels b/c of neg feedback effect of cortisol
48
cushing's disease is different from cushing's syndrome how?
cushing's disease has excess ACTH most likely b/c of a ACTH secreting tumor
49
HTN hypokalemia Metabolic alkalosis decreased renin
Conn's syndomre (aldosterone secreting tumor)
50
what is an example of a hormone that doesn't follow the negative feedback loop
action of estrogen on LH release during midcycle
51
what are the stress hormones
GH glucagon cortisol epinephrine
52
what can you measure by urine analysis (what hormones)
restricted to the measurement of catecholamines and steroid hormones
53
what are the levels of TRH, TSH, T3/T4 (increased or decreased) in tertiary hypothalamic failure?
TRH decreased TSH decreased T3/T4 decreased
54
what are the levels of TRH, TSH, T3/T4 (increased or decreased) in secondary pituitary failure?
TRH increased | TSH and T3/T4 decreased
55
what are the levels of TRH, TSH, T3/T4 in primary thyroid dysfunction thyroiditis?
TRH increased TSH increased T3/T4 decreased Think of loss of function - Hashimoto's
56
what are the levels of TRH, TSH, T3/T4 in primary thyroid dysfunction Grave's disease?
TRH and TSH decreased due to feedback inhibition T3/T4 increased Thyroid stimulating immunoglobulins that induce release of TSH (analog)
57
what regulates ADH
plasma osmolarity -osmoreceptors in the hypothalamus -hypovolemia
58
what are 2 main functions of ADH
works on the principal cells of the distal tubule to increased water resorption - acts on V2 receptors on the basolateral membrane and increases expression of aquaporin 2 on the luminal side of principal cells - increases urine osmolarity induces contraction of vascular smooth muscle (V1 receptors) to protect against severe volume depletion
59
how do you confirm the diagnosis of diabetes insipidus
dehydration stimulus followed by the inability to concentrate urine
60
what pathway does GH work on (molecular signalling pathway)
JAK/STAT
61
what are the stimulatory factors for GH
Decreased glucose concentration decreased free fatty acid concentration arginine fasting or starvation hormones of puberty (estrogen, testosterone) Exercise Stress Stage III or IV sleep alpha-adrenergic agonists
62
what are the inhibitory factors for GH release
increased glucose concentration increased free FA concentration Obesity, Senescence Somatostatin GH B-adrenergic agonists Pregnancy
63
what are the two main controllers of prolactin release
TRH + Dopamine - -prolactin creates a negative feedback to promote dopamine release to inhibit release of more prolactin
64
what are the functions of prolactin
stimulates milk production in breast inhibits ovulation in females and spermatogenesis in males by inhibiting GnRH synthesis and release excessive amounts of prolactin are associated with decreased libido
65
what are the zona fasciculata and reticularis controlled by
ACTH
66
aldosterone is regulated by what?
ANG II and potassium levels so..... aldosterone and pressure-volume regulation is typically normal in individuals who have hypopituitarism
67
most common tumor of the adrenal medulla in adults
pheochromocytoma episodic HTN
68
most common tumor of the adrenal medulla in children
neuroblastoma rarely causes HTN
69
what happens with chronically elevated cortisol levels (eg Cushings) ? insulin/glucagon ratio? Glycogen? Lipolysis?
increased insulin to glucagon ratio high levels of cortisol antagonize insulins effect on GLUT4 mediated glucose uptake, so glucose intolerance frequently occurs Increase in hepatic glycogen synthesis increase in proteolysis decrease in GLUT-4 mediated glucose uptake Decrease in lipolysis Increase in triglyceride synthesis muscle wasting and weakness central obesity
70
what is the number 1 cause of cushing's
exogenous corticosteroids
71
how do you distinguish between Cushing disease and ectopic ACTH secretion?
ACTH will be increased so give a high-dose (8 mg) dexamethasone suppression test and CRH stimulation test. Ectopic secretion will not decrease with dexamethasone because the source is resistant to negative feedback; ectopic secretion will not increase with CRH because pituitary ACTH is suppressed.

ENDO II Test I (4 decks)

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