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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
Q

what is IGF-I

A

it is a somatomedin which is produced in the liver

somatomedins inhibit the secretion of GH

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26
Q

what are GH’s effects on Adipose tissue, muscle tissue, hepatocytes, visceral organs

A

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

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27
Q

what are the actions of prolactin?

what are its effect on ovulation ?

A

stimulates milk production, breast development

inhibits ovulation by decreasing GnRH

inhibits spermiogenesis

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28
Q

what hypothalamic substances control prolactin

A

dopamine- inhibits

TRH - increases

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29
Q

what occurs when you have prolactin excess

A

galactorrhea
decreased libido
failure to ovulate and amenorrhea

30
Q

what are the factors that increase ADH secretion

A

increase in serum osmolarity

volume contraction
pain
nausea
hypoglycemia
nicotine, opiates
31
Q

what are some factors that decrease ADH secretion

A

serum osmolarity

ethanol

alpha-agonists
ANP

32
Q

what are the actions of oxytocin

A

contraction of the myoepithelial cells in the breast

contraction of the uterus

33
Q

in what portions of the hypothalamus are oxytocin and ADH located

A

ADH- supraoptic nuclei

Oxytocin- paraventricular nuclei

34
Q

GFR (adrenal cortex)

A

zona glomerulosa- aldosterone (salt)

zona fasiculata - produces mostly glucocorticoids (cortisol- sugar)

Zona reticularis - androgens (sex)

35
Q

what are the 21 carbon steroids

A

progesterone, deoxycorticosterone (which has mineralcorticoid activity), aldosterone, cortisol

36
Q

adrenal medulla produces what

A

catecholamines

37
Q

what are the 19 carbon steroids

A

have androgenic activity and are precursors to estrogens

38
Q

what are ACTH’s affects on the anterior lobe of the pituitary

A

increases steroid hormone synthesis in all zones of the adrenal cortex by stimulating cholesterol desmolase (increasing conversion of cholesterol to pregnenolone)

39
Q

what is the dexamethasone test and what does it tell you

A

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
Q

what are the effects of aldosterone on K

A

aldosterone increases renal K secretion in hyperkalemia

41
Q

17 alpha hydroxylase deficiency

A

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
Q

21 hydroxylase deficiency

A

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
Q

11-Beta hydroxylase deficiency

A

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
Q

what are the functions of cortisol

BIG FIIB

A

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
Q

why does hyperpigmentation occur with adrenocortical insufficiency

A

low cortisol levels stimulate ACTH secretion

ACTH contains the MSH fragment

46
Q

hypoglycemia
anorexia, weight loss

n/v

weakness, hypotension, hyperkalemia

metabolic acidosis

decreased pubic and axillary hair in women

hyperpigmentation

A

Addison’s disease (primary adrenocortical insufficiency)

ACTH levels are increased (negative feedback effect of decreased cortisol)

47
Q

hyperglycemia
muscle wasting
central obesity
round face, supraclavicular fat, buffalo hump

osteoporosis

striae

virilization and menstrual disorders in women

HTN

A

Cushing’s SYNDROME (primary adrenal hyperplasia)

Decreased ACTH levels b/c of neg feedback effect of cortisol

48
Q

cushing’s disease is different from cushing’s syndrome how?

A

cushing’s disease has excess ACTH

most likely b/c of a ACTH secreting tumor

49
Q

HTN
hypokalemia
Metabolic alkalosis
decreased renin

A

Conn’s syndomre (aldosterone secreting tumor)

50
Q

what is an example of a hormone that doesn’t follow the negative feedback loop

A

action of estrogen on LH release during midcycle

51
Q

what are the stress hormones

A

GH
glucagon
cortisol
epinephrine

52
Q

what can you measure by urine analysis (what hormones)

A

restricted to the measurement of catecholamines and steroid hormones

53
Q

what are the levels of TRH, TSH, T3/T4 (increased or decreased) in tertiary hypothalamic failure?

A

TRH decreased
TSH decreased
T3/T4 decreased

54
Q

what are the levels of TRH, TSH, T3/T4 (increased or decreased) in secondary pituitary failure?

A

TRH increased

TSH and T3/T4 decreased

55
Q

what are the levels of TRH, TSH, T3/T4 in primary thyroid dysfunction thyroiditis?

A

TRH increased
TSH increased
T3/T4 decreased

Think of loss of function - Hashimoto’s

56
Q

what are the levels of TRH, TSH, T3/T4 in primary thyroid dysfunction Grave’s disease?

A

TRH and TSH decreased due to feedback inhibition

T3/T4 increased

Thyroid stimulating immunoglobulins that induce release of TSH (analog)

57
Q

what regulates ADH

A

plasma osmolarity
-osmoreceptors in the hypothalamus

-hypovolemia

58
Q

what are 2 main functions of ADH

A

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
Q

how do you confirm the diagnosis of diabetes insipidus

A

dehydration stimulus followed by the inability to concentrate urine

60
Q

what pathway does GH work on (molecular signalling pathway)

A

JAK/STAT

61
Q

what are the stimulatory factors for GH

A

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
Q

what are the inhibitory factors for GH release

A

increased glucose concentration

increased free FA concentration

Obesity, Senescence

Somatostatin

GH
B-adrenergic agonists

Pregnancy

63
Q

what are the two main controllers of prolactin release

A

TRH +

Dopamine -
-prolactin creates a negative feedback to promote dopamine release to inhibit release of more prolactin

64
Q

what are the functions of prolactin

A

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
Q

what are the zona fasciculata and reticularis controlled by

A

ACTH

66
Q

aldosterone is regulated by what?

A

ANG II and potassium levels

so….. aldosterone and pressure-volume regulation is typically normal in individuals who have hypopituitarism

67
Q

most common tumor of the adrenal medulla in adults

A

pheochromocytoma

episodic HTN

68
Q

most common tumor of the adrenal medulla in children

A

neuroblastoma

rarely causes HTN

69
Q

what happens with chronically elevated cortisol levels (eg Cushings) ?

insulin/glucagon ratio?
Glycogen?
Lipolysis?

A

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
Q

what is the number 1 cause of cushing’s

A

exogenous corticosteroids

71
Q

how do you distinguish between Cushing disease and ectopic ACTH secretion?

A

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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