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Mech. 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Endocrine organs

A

Hypothalamus and pit.
Thyroid
Parathyroid =Phosphate and Ca2+ metabolism
Adrenal gland

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2
Q

Endocrine dis.

A 
Hypotha./pith. 
-DI
-SIADH
-Sheehan synd. 
Adrenal gland
-addison dis. 
-cushing synd. 
-pheochromocytoma 
Thyroid 
-Goiter
-Thyroiditis 
-graves dis. 
Parathyroid 
-osteomalacia 
-HyperCa2+emia
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3
Q

Ant. and Post. pituitary

A 
Neurohyophysis=post. pit. (N.)
-Diabetes insipid. 
-SIADH 
Adenohypophysis=ant. pit. (hormones)
-adenomas 
-sheehand synd.
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4
Q

Neurohypophysis-DI

A

HypoADH=INCRE. H2O secretion
-hyperNa+emia and incre. osmo.
Caused by head trauma, tumors, inflamm. of hypoth. pit.
2 types
-central DI=insuff. ADH
-Nephrogenic DI=ADH insensitivity (kid. not respond to norm. ADH level)

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5
Q

Neurohypophysis-central DI

A 
S/S 
-incre. urination and thrist (b/c incre. Na+)
-cause life threatening dehydration 
Tx
-mild=drink more H2O
-severe=exogenous ADH(vasopressin)
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6
Q

Neurohypophysis-synd. of inappropriate ADH secretion (SIADH)

A 
Caused by 
-ADH secreting tumor (small cell lung carcinoma) 
-drugs
-CNS dis. 
Incre. ADH 
-incre. H2O 
-Dilute blood=hypoNaemia 
Clinical 
-HypoNatrimia 
-ceberal edema 
-Neuro dysfunction (~ H2O intoxication) 
Tx
-inhib. drug 
-tx tumor 
-depend on CNS issue tx cuase
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7
Q

Adenohypophysis=sheehan synd.

A

Ant. pit. hypertrophy w/o angiogen.=minor anoxia–>ischemic necrosis of adenhypohysis
Incre. sensitivity of cells to low BP
-hypovolemic shock due to hem. from delivery
:during prego. ant. hypergrophic b/c incre. FSH and LH
-infarct in ant. pit.
-necrosis–>fibrosis

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8
Q

Adenohypophysis=sheehan synd. s/s

A 
Ischemic tissue replaced by fibrotic nodule=postpartum hypopituitarism -->decre. adenoph. function 
Lack of horm. 
-FSH/LH=amenorrhea/infertile 
-prolactin=no lactation 
-TSH=hypothyroid
-MAS/POMC=pale
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9
Q

during prego.=hypertrophic ant. pit. b/c of which horm.

A

Incr. FS, LH and PRL
Need incre. horm. to support prego.
-HCG + product of horm.
-Progesteron is produced by corpus luteum
-inhib. of additional follicle
LH and prolactiin
-Support copus luteum function
-PRL inhib. GnRH=decre. LH
:Prog. and estrogen inhib. it until parturtion
-PRL release stim. by estrogen but activated when estrogen decr.

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10
Q

why is adrenal gland sim. to hypoth/pit.

A

N. and glandular tissue(horm.)

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11
Q

Adrenal gland and horm.

A

Cortex=steroid hom.
-adrenocorticotropic/tropic horm. form adenohypot.
Medulla=catacholamines/peptide homr. (N. epi/epi)
-release by N. sig.

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12
Q

Adrenal gland dis.

A 
Addison dis.=1mry chronic adrenocortical insufficiency 
Cushing synd.
-AKA hypercortisolims 
-Exogenous and endogenous causes  
Pheochromocytoma 
-Medullary tumor
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13
Q

Addison Dis. is caused by

A 
Autoimmune adrenalitis(MC) 
Infection=TB/fungal 
AIDS
metastatic cancer
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14
Q

Addison dis. -autoimmune adrenalitis

A

Auto-antBD to steriod synth. enzymes
-immune syst. distroys steriod producing cells in adrenal cortex
Assoc. w/ autoimmune polyendocrine synd. (APS)
-dis. destroying multiple endocrine tissue/organs
-MC=APS1
:AutoantBD to IL-17 and 22(produced by THC)
:Chromo 22 single gene mutation
*gene product= AIRE so the thymus prot. expression to remove autoreactive T cells to adrenal cortex antGN

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15
Q

Addison Dis.-gross appearance of gland

A

Varies
Autoimmune=shrunk
infection=inflam. rxn
Cancer=enlarged w/ tumor

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16
Q

Addison dis. Histo.

A

extensive mononuclear infiltrate nd lost most of cortical cell

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17
Q

Addison Dis. S/S

A 
Notice when 90% is lost
1st=prog. wk w/ easily fatigue 
GIT b/c decre. cortisol=inhib. brk dwn fat, carb, and prot. 
-anorexia, nausea, vomit and wt loss, diarrhea 
Skin hyperpig. (~sheehan)
-no cortisol=anti. pit. need ACTH 
-incre. POMC brkdwn to incre. ACTH 
-POMC=MSH frag. 
Decre. aldosterone (cortex)=decre. Na while incre. K+
-Decre. vol. and hypoTN 
Decre. glucocorticoids leads to hypoglycemia and lack of gluconeogenesis 
-Cortisol incre. gluconeogenesis 
-Stress=adrenal crisis 
  :No cortisol=no gluconeogenesis 
  :fatal
  :Cont' vomit
  :abdo. pain 
  :hypoTN 
  :vascular collapse 
  :coma
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18
Q

What can glucocorticoids produce

A

Hyperglycemia
Glucosuria
2ndry diabetes
decre. immune

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19
Q

Aldosterone usual responsible

A

incre. Na reab .

incre. K+ and H+ secretion

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20
Q

How can cortisol cause vasconstruction

A

catecholamines

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21
Q

Cushing synd.

A

Chronic exposure to high blood glucocorticoid levels
MC causes=incre. ACTH secretion by adenohypophysis
Types
-Iatrogenic
-Endogenous (non-iatrogenic)

22
Q

Cushing synd.-Iatrogenic

A

Medical admin. of glucocorticoids to tx non-endocrine disorder Immiune suppression for atutoimmune, transplant pt.

23
Q

Cushing synd.-endogenous type

A

ACTH depend

ACT. indip.

24
Q

Cushing synd.-endogenous ACTH DEP.

A

Cushing dis.=ACTH secreting pt. adenoma
-incre. ACTH=incre. cortisol (bilat. adrenal hyperplasia)
-monoclonal microadenomas
-incre. cortisol cuases
:decre. CRH (hypoth.)
:decre. ACTH (directly and b/c decr. CRH to pit.)
:inhib. GH, TSH gonadotropin release
:directly affect insulin prod. and gluconeogen in liver
Ectopic ACTH syn.
-spont.
-MC=paraneoplastic cushing synd.
:tumor outside adrenal cortex=small cell lung carcinoma/bronchial carcinoid tumor
-incre. ACTH=incre. cortisol (adrenal hyperplasia)

25
Q

Cushing synd.-endogenous ACTH INID.

A

Adrenal cortical tumor=ACTH or ACTH like peptide

-w/in adrenal cortex=cn be tumor or nodular hyperplasia

26
Q

Cushing synd. and adrenal gland changes

A 
Depend on cuases 
Iatrogenic=cortical atrophy 
-exogenous GC decre. ACTH 
-no sitm.=atrophy 
Cushing dis.=diffuse hyperplasia 
ACTH indi.=nodular hyperplasia 
Adenoma/carcinoma=causative
27
Q

Cushings synd. and pit. changes

A

Dnt depend on cuase

Corticotorpic basophils=paler, fill w/ keratin filaments (crooke hyaline change)

28
Q

Cushing synd.-his.

A

pig. micronodules

Lipofuscin-containing cells=pig. nodules

29
Q

Cushing synd.-S/S

A

HTN
WT gain
-centralized (trunk/post neck)
Selective atrophy of fast-twitch fiber atrophy=proximal limb. wk
Glucocorticoid
-hyperglycemia, glucosuria and 2ndry diabetes
incre. gluconeogen and decre. gluc uptake/immune

30
Q

Cushing synd.-catabolism

A 
Inhib. fibroblast funciton w/ collagen
-Fragile skin w/ poor wound healing
-stria skin (esp. on abdo.,)
-central obesity 
-~ stretch marks 
Bone=osteoporosis
31
Q

Pheochromocytoma-basic

A

Benign tumor in chromaffin cells in adrenal medulla

-affect adrenorecp, for N. epi.

32
Q

Pheochromocytoma-S/S

A

Tachycardia=pound heart
-@ B1 recp.=incre. HR/contractaility
Cold hand/feet
-@a1 recp. w/ vasoconstriciton=decre. BF
Hot feeling b/c no dissipate heat
Throbbing headache
-sever HTN and incre. HR, contrast and vasoconstriction
Nausea/vomit b/c decre. BF and sm. muscle relax
Visual disrupt. @B recp.
-alpha1 Recp.=dialte pupile

33
Q

Thyroid dis,.

A

Goiter=enlarged thyroid gland
Thyroiditis=inflammation
Graves dis.=MC cause of persisitent hyperthyroidism
-MC in women

34
Q

Goiter

A 
Impaired synth. of thyroid horm. 
-MC iodine insuff. 
Decre. T3/4 
-induce TRH and TSH release 
-Incre TSH=thyroid hypertrophy
35
Q

Thyroid horm. pord.

A 
Thyroglobulin 
-produce in RER 
-glycosylated 
-exocytose into follicular lumen 
Iodide from blood 
-transported by symptorter
-in lumen=oxidation 
Throglobulin brk dwn=T3/4 w/ iodine
36
Q

2 types of goiter

A 
Simple=diffuse and not toxic 
-endemic
  :More than 10% of population 
  :Usually related to diet 
-sporadic 
  :MC in women @/after puberty 
  :not really explained 
Multinodular =repeated hypertorphy episode
37
Q

Goiter-dietary causes

A

Insuf. Iodine
-MC in mountain regeions b/c decre. seaH2O
-decre. supplementation
Goitrogenic food intake
-certain vegies
:cruciferous(cabbage, cauliflower, cassava root-pastacio)
-cassava root has thiocyanate that inhib. iodine transport

38
Q

Goiter consequences

A

Compressive synd.

  • airway obstruction b/c thyroid infront of neck
  • compression of large blood vs.
  • difficult y swallowing (dysphagia)
39
Q

Goiter-tx

A

surgery to remove excess tissue

40
Q

Thyroiditis-types

A

Hashimoto
Granulomatous
Subacute lymphocytic

41
Q

Hashimoto thyroiditis

A 
Autoimmune disorder/genectic omp. 
-antBD against thyroglobulin and thyroid peroxidase (prod. of iodinated thryoglobulin) 
Unknown exact cease 
-abnormal Tcell
-thyroid antGN exposure 
Histo. 
-monoculear infiltrate 
-atrophic follices 
-huerthle cells=DX for stressed follicular cells (eosin)
42
Q

is hashimoto thyroidits=hypoth.

A 
Yes 
Inflammation=enlarge thyroid 
-diffuse or nodular(cancer)
Destroy parenchyma=decre. T3/4 (~1ry hypothyroid) 
-@ 1st ~s/s as depression (vague)
  :fatigue
  :apathy
  :mental sluggish 
-slower metab.
-cold intol. 
-decre. symp. N. activity(constipation/decre. sweating)
-decre. BF=pale/cool skin
-decre. CO=SOB, decre. exercise capability 
-ECM accum. in skin (hylornic acid)
  :Non pitting edema
  :enlarg tongue 
  :deep voice 
Nonspecific s/s=serum dx 
-serum TSH INCRE. (import.)
-serm T4 DECER.
43
Q

Graves dis.=hyper thyroid

A

yes

44
Q

Graves dis.

A

Autoimmune
-genetic susceptibility linked to mutation in immune function
-antBD + thyroid
:dnt recog. thyroid as self antGN @ TSH Recp.
:MC antBD
*IgG agonist for TSH Recp.
#+follicular cell to incre. horm.
*thyroid growth +IgG
#follicular cell hyperplasia
*TSH-binding inhib. IgG
#decre. activity and no hyperthryo.
TRH–>TSH =thyorid stim. horm. (thyrotropin)
-TRH inhib. by T3/4

45
Q

Graves dis.-clinical

A

Thyroid hypertorphy=tx destroy excess tissue (diffused)
Extra-thyroidal (beta-adrenergic effects)
-generalized lympohid hyperplasia
-cardiac hypertrophy iscehmia
-exophthalmos-edema in tissue around eye
:also fibrosis, lympohcyte infiltrates
-dermal thickening –>lymphocyte infiltrate
Localized infiltrate demopathy (skin)

46
Q

Graves dis.-clinical

A

Thyroid hypertrophy=tx destryo excess tissue (diffused)
Extra thyroidal (beta Adrenergic effects)
-Generalized lymphoid hyperplasia
-cardiac hypertrophy/ischemia
-exophthalmos=edema in tissue around eye
:also fibrosis, lymphocyte infiltrates
-dermal thickening=lympohcyte infiltrate
localized infiltrate demopathy (skin)

47
Q

Parathyroid-release PTH

A 
PTH release by cheif cells 
-Ca2+ recep. located 
  :GPCR messages that enough Ca2+=no PTH
-low Ca2+=release PTH 
  :bind to + osteoclast to incre. Ca2+ and incre. Phosphat. in kid.
48
Q

Parathyroid dis. types

A

Osteomalacia=sk. dis. assoc. w/ vit. D def.
Hypercalcemia=clinically apparent is most often due to malignancy
-Asymp. is assoc. w/ hyperparathyroidism

49
Q

Parathyroid-osteomalacia

A 
Excess persistent osteoid
-osteoblast dnt have Vit. D  
NO mineralization 
-Vit. D def. 
  :no sun 
  :freq. prego w/ children followed by lactation (not enough of Ca2+)
-HypoCa2+emia 
  :Renal disorder
  :malabsorp Ca2+ def.
50
Q

Parathyroid-osteomalacia clinical

A

Soft bone=incre. brk
~osteoporosis
Children w/ rickets
Tx=Vit D supplement (ie milk)

51
Q

Parathyroid-Hypercalcemia

A 
1ry hyperparathyroidism 
-95%=solitary parathyroid adenoma 
-incre. PTH production incre. blood Ca2+ by promoting resorption from bone 
  :cnt crontral chem. of Ca2+ recpt. 
2ndry hyperparathyroidism 
-MC w/ chronic renal failure 
  :Vit D. conversion 
  :re-absorption 
-any hypocalcemia will cause 2ndry hyperparathyrodisim
52
Q

Parathyroid-hyperparathyroidism and morphologic changes

A 
Bone
-incre. osteoclast 
  :Erode Bone matrix=mobilize Ca2+salts 
-~ osteoporosis=thinner trabeculae) 
-Advanced dis. 
  :thin bone cortex 
  :marrow contains fibrosis and clumps of irregular cells that mimic neoplasms
Kidney 
-Formation of kidney stones 
-Calcification of instertitium and tubules

Mech. 2 (8 decks)

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