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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
Cushing synd.-endogenous ACTH INID.
Adrenal cortical tumor=ACTH or ACTH like peptide | -w/in adrenal cortex=cn be tumor or nodular hyperplasia
26
Cushing synd. and adrenal gland changes
``` 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
Cushings synd. and pit. changes
Dnt depend on cuase | Corticotorpic basophils=paler, fill w/ keratin filaments (crooke hyaline change)
28
Cushing synd.-his.
pig. micronodules | Lipofuscin-containing cells=pig. nodules
29
Cushing synd.-S/S
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
Cushing synd.-catabolism
``` Inhib. fibroblast funciton w/ collagen -Fragile skin w/ poor wound healing -stria skin (esp. on abdo.,) -central obesity -~ stretch marks Bone=osteoporosis ```
31
Pheochromocytoma-basic
Benign tumor in chromaffin cells in adrenal medulla | -affect adrenorecp, for N. epi.
32
Pheochromocytoma-S/S
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
Thyroid dis,.
Goiter=enlarged thyroid gland Thyroiditis=inflammation Graves dis.=MC cause of persisitent hyperthyroidism -MC in women
34
Goiter
``` Impaired synth. of thyroid horm. -MC iodine insuff. Decre. T3/4 -induce TRH and TSH release -Incre TSH=thyroid hypertrophy ```
35
Thyroid horm. pord.
``` 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
2 types of goiter
``` 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
Goiter-dietary causes
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
Goiter consequences
Compressive synd. - airway obstruction b/c thyroid infront of neck - compression of large blood vs. - difficult y swallowing (dysphagia)
39
Goiter-tx
surgery to remove excess tissue
40
Thyroiditis-types
Hashimoto Granulomatous Subacute lymphocytic
41
Hashimoto thyroiditis
``` 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
is hashimoto thyroidits=hypoth.
``` 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
Graves dis.=hyper thyroid
yes
44
Graves dis.
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
Graves dis.-clinical
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
Graves dis.-clinical
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
Parathyroid-release PTH
``` 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
Parathyroid dis. types
Osteomalacia=sk. dis. assoc. w/ vit. D def. Hypercalcemia=clinically apparent is most often due to malignancy -Asymp. is assoc. w/ hyperparathyroidism
49
Parathyroid-osteomalacia
``` 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
Parathyroid-osteomalacia clinical
Soft bone=incre. brk ~osteoporosis Children w/ rickets Tx=Vit D supplement (ie milk)
51
Parathyroid-Hypercalcemia
``` 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
Parathyroid-hyperparathyroidism and morphologic changes
``` 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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