endocrine Flashcards
what runs THROUGH the cavernous sinus
CN6 and ICA
Where is pancreas transplanted and why
Iliac vessels good blood supply
Eye symptoms of pituitary tumour
Progressive ophthalmoplegia
Loss of vision
Pituitary gland hangs down from
Hypothalamus
Posterior lobe of pituitary gland secreted
Adh oxytocin
Superior hypophyseal artery goes to and do what
Efferent hypophyseal veins to anterior pituitary to take hormones to secrete other hormones
Cavernous sinus contents
Three four v2,3 six inside, ica
ACTH produces what
Cortisol
Cushings is
Too much ACTH
Posterior pituitary way of working
Neuronal - neurosecretory
Anterior pituitary way of working
Blood
Two bits of adrenal glands
Cortex and medulla
Androgens secreted where
Reticularis of adrenal cortex
Glucocorticoid (cortisol) secreted where
Fasciculata of adrenal cortex
Aldosterone secreted where
Glomerulosa of adrenal cortex
Right suprarenal vein drains into
Left drains into
Ivc
left renal vein
Where does thyroid develop
Posterior of tongue
Thyroid bits, how many?
4
Right and left lobes
Isthmus
Pyramidal lobe
Superior thyroid artery comes from
External carotid
What is behind the thyroid glands
Parathyroid hormone
Danger surgery thyroid
Recurrent laryngeal (runs behind thyroid),
Parathyroid
Thyroid ima artery
Transverse pancreatic comes from
Splenic artery
Inferior pancreaticoduodenal comes off
Sma
Accessory pancreatic duct drains
Ulcinate process
what runs through the wall of the cavernous sinus
CN3,4,V1,V2
NOT CN2 or V3
which CN is most likely to be affected first by a cavernous ICA aneurysm?
- it’s the nearest one to it
this is the sella turcica
what bone and what are the four little corners called and what attaches to thwm
sphenoid
clinoid processes
dura
tghis is the back of the sphenoid. what is this part called and where does it slope towards
Clivus
towards foramen magnum
bitemporal hemianopia suggests…because…
pituitary gland tumour… optic chiasm is directily superior to the pituitary gland
what is pituitary gland called in doctor
hypophysis
anterior pituitary secretes
ACTH, FH, GH, LH, TSH and prolactin
A particularly good looking front testicle
intermediate lobe pituitary secretes
melanocyte stimulating hormone
what is in charge of the pituitary
hypothalamus
A pineal gland
B interthalamic adhesion
C hypothalamus
D infundibulum
E sphenoid bone
how to access pituitary gland in surgery
drill through sphenoid
A sternothyroid
Bthyrohyoid
C digastric
D sternohyoid
E sup belly of omohyoid
F inf belly of omohyoid
what is this and what is it a branch of
sup thyroid artery, branch of ECA
adrenals exocrine or endocrine
endocrine
shape of right and left adrenal glands
pyramid and crescent (same shape as spleen)
right sided HF -> liver problems
“nutmeg liver” speckled because of congestive hepatopathy
dilated IVC - suggestive of congested hepatopathy
ant and post pituitary lobes doctor name
adeno and neuro-hypophysis
cell bodies in which nucleus ADH manufacture
supraoptic
cell bodies in which nuclei oxytocin
paraventricular
link which hormone to Cushing’s
ACTH+++ causes too much cortisol
where are adrenalin and noradrenalin secreted
adrenal medulla
cortisol is released in response to (2)
stress and low blood sugar
what does cortisol do? (3)
increase blood sugar - gluconeogenesis
suppress immune system
decrease bone formation
thyroid spinal level
C5-T1
what is this, how many ppl have it
thyroid ima artery 10%
pancreas what exocrine what endocrine
ex - digestive enzymes
end - insulin and glucagon
inferior pancreaticoduodenal comes off
SMA
where are Central Pattern Generators and what do they do? Where are they
CPGs are neuronal circuits that when activated, produce rhythmic motor patterns (e.g. walking, breathing, swimming) in absence of inputs that carry timing information
in ventrolateral reticular formation
what is the major controller of vomiting
nucleus of the solitary tract
3 basic things are directed by the NTS for induction of vomiting. which nuclei control them and what are they
larynx closing
respiratory changes
digestive tract changes
nucleus ambiguus
Ventral Respiratory Group
dorsal motor nucleaus of vagus
hypo or hypercalcaemia worse for you
hypocalcaemia
what is serum calcium bound to? how much
40% albumin, 10% globulin
what is the connection between serum H+ and serum Ca?
bind to the same sites on albumin
if alkalosis, H+ will be freed so more Ca will bind leading to hypocalcaemia
what can low calcium lead to
too much neural conduction
tetany
tachyarrhythmias
pth effects on ca vs phosphate in bone gut kidney
liberates both from bone
increases absorption of both at gut
increases resorption of Ca BUT ni creases excretion of Po4 at kidney
what sort of hormone is pth
peptide 84 AAs
what stimulates pth…how?
low serum Ca via reduced CaSR stimulation
what happens to pth in very high serum calcium
it is not fully suppressed
what is the funny thing about Mg and CaSR
slightly low Mg decreases CaSR stimulation so more pth is produces but severely low Mg leads to pth block -> hypocalcemia
Familial hypocalciuric hypercalcemia?
loss of function CaSR mutation
CaSR in brain doesn’t feel hypercalcemia so more Ca is liberated
CaSR in kidney doesn’t feel hypercalcemia so Ca is not excreted (is reabsorbed)
what is cinacalcet
pretend calcium, used to lower pth levels in hyperparathyroidism
loop vs thiazide diuretics effect on Ca
loop loses calcium at thick ascending limb
thiazide increases reabsorption in the distal tubules
which enzyme activates vitamin D
1-alpha hydroxylase
what is the formula for calcitriol
1,25(OH)D3
when does vit D negative feedback go wrong
In the macrophage fighting off a tuberculosis
bacillus, however, there is positive feedback. Production of very high levels of vitamin D
from activated macrophages in granulomatous diseases (TB, sarcoid) can lead to serum
hypercalcemia.
what does vit d deficiency cause in bone
what does parathyroid ++ cause in bone
osteomalacia/ricketts
osteoporosis
medullary thyroid cancer blood marker
raised calcitonin
hyperalcemia of malignancy modulator
PTHrP (parathyroid related peptide) which is basiclaly pretend parathyroid hormone
kidney consequences of hypercalcemia
kidney stones
nephrogenic diabetes insipidus
two main causes of hypercalcaemia
++pth or malignancy
why hypercalcemia in cancer if not pth secreting tumour
bone mets
primary hyperparathyroid
single tumour
secondary hyperparathyroid
normal response to low calcium eg renal failure
3ary hyperparathyroid
mets, parathyroid hyperplasia
what happens in the adrenal medulla when cortisol flows through
PNMT enzyme is upregulated -> noradrenaline is converted to adrenaline
3 stressors dealt with by the adrenals
starvation
sepsis
blood loss
ZG cells respond to
angiotensin II and K+
ZG produces
aldosterone
which enzyme converts cortisol to cortisone
11bHSD-2
which enzyme is inactivated by liquorice and what can happen
11bHSD-2, apparent mineralocorticoid (cortisol) excess
where are pheochromocytomas
chromaffin cells
what are chromaffin tumours not in the adrenals called
Paragangliomas
Drug for acromegaly gh receptor blocker
Pegvisomant - gh receptor blocker
Ocreotide - somastatin analogue
Bromocriptine - dopamine analogue
link between lithium and DI
lithium is nephrotoxic and can cause nephrogenic DI
