Endocrine Flashcards
hormones that signal through cAMP
FLAT ChAMP
FSH, LH, ACTH, TSH
CRH, hCG, ADH, MSH, PTH
ant. pit. hormones
hormones that signal through IP3
GGOAT
GnRH, GHRH, Oxytocin, ADH, TRH
post. pit. hormones
steroid receptor hormones
VETTT CAP
vit D, estrogen, testosterone, T3/T4
Cortisol, Aldosterone, Progesterone
receptor tyrosine kinase hormones
PIG
prolactin, immunomodulators (cytokines), GH
stimulates bone and muscle growth
GH
stimulates milk production and secretion
prolactin
stimulates milk secretion during lactation
oxytocin
stimulates metabolic activity
thyroid hormone
increases blood glucose level and decreases protein synthesis
glucocorticoids
stimulates adrenal cortex to synthesize and secrete cortisol
ACTH
increases plasma calcium, increases bone resoprtion
PTH
decreases plasma calcium, increases bone formation
calcitonin
glucocorticoids
zona fasciculata of adrenal cortex
oxytocin
paraventricular n. of hypothalamus
atrial natriuretic hormone (ANH)
atria of heart
glucagon
a cells pancreas
vasopression (ADH)
supraoptic n of hypothalamus
calcitonin
parafollicular cells (c-cells)
epi and norepi
chromaffin cells of adrenal medulla
estradiol, estriol, estrone
ovaries, placenta, adipose
somatostatin
d-cells of pancreas
mineralocorticoids (aldosterone)
zona glomerulosa of adrenal cortex
clinical findings in man with high sex hormone binding globulin
gynecomastia (low testosterone)
clinical findings in woman with low sex hormone binding globulin
hirsutism (high testosterone)
which ant. pituitary hormones share the a subunit
TSH, LH, FSH, hCG
most likely clinical presentation of empty sella
asymptomatic
might have pit deficiency
most common presentation of hyperprolactinemia in female
premenopause: hypogonadism-infertility, oligo/amenorrhea
postmenopause: usually asymptomatic
might have galactorrhea in both
clinical features of acromegaly
increased size hands, feet, head,
coarse facial features
impaired glucose tolerance
inability to breastfeed, amenorrhea, cold intolerance
Sheehan syndrome
infertility, galactorrhea, and bitemporal hemianopsia
prolactinoma
adrenal gland from what tissue types
cortex: mesoderm
medulla: neural crest
adrenal secretory products
GFR
glomerulosa: aldosterone (mineralocorticoids)
fasciculata: cortisol, sex hormones (glucocorticoids)
reticularis: sex hormones (androgens)
medulla: chromaffin cells secrete catecholamines
adrenal steroid metabolism enzyme deficiency shortcut
if enzyme begins with #1: HTN
if second number in enzyme is 1: masculinization
ex: 11 hydroxylase def: HTN and masculinization
cortisol function
BBIIG maintains Blood pressure decreases Bone formation Immunosuppression/anti-Inflammatory increases Insulin resistance increases Gluconeogenesis
side effects of glucocorticoid use
BAM CUSHINGOID
buffalo hump, amenorrhea, moon facies, crazy, ulcers, skin changes, HTN, infection, necrosis of femoral head, glaucoma, osteoporosis, immunosuppression, diabetes
most common causes of Cushing syndrome
exogenous steroid use
ectopic ACTH secretion (small cell lung)
ACTH pit adenoma (Cushing Disease)
cortisol secreting adrenal tumor
treatment for nephrogenic DI
HCTZ, amiloride, indomethacin
HTN, hypokalemia, and metabolic alkalosis
hyperaldosteronism
hyperaldosteronism
Primary: adrenal hyperplasia or aldo adrenal adenoma (Conn’s)
Tx: surgery and/or spironolactone
Secondary: renal perceives low blood volume
Tx: spironolactone
hypotension, hyperkalemia, metabolic acidosis
adrenal insufficiency
Waterhouse-Friderichsen syndrome
acute primary adrenal insufficiency due to hemorrhage of adrenal cortex due to N. meningitidis
Addison’s disease
chronic primary adrenal insufficiency due to adrenal atrophy or destruction by disease
pheochromocytoma associated with what other diseases
neurofibromatosis type I
MEN 2A and 2B
tumors that secrete erythropoeitin and cause polycythemia
pheochromocytoma
renal cell carcinoma
heamngioblastoma
hepatocellular carcinoma
neuroblastoma
child adrenal tumor that does not increase BP c-myc oncogene bombesin tumor marker neurofilament stain Homer-Wright pseudorossettes
tumor locations for the multiple endocrine neoplasia syndromes
MEN 1: pituitary, parathyroid, pancreas
MEN 2A: parathyroid, pheochromocytoma, medullary thyroid carcinoma
MEN 2B: pheochromocytoma, medullary thyroid, mucosal neuroma
most common tumor of the adrenal
benign, non-functioning adrenal adenoma
most common tumor of the adrenal medulla (in adults)
pheochromocytoma
most common tumor of the adrenal medulla (children)
neuroblastoma
most common cause of primary hyperaldosteronism
adrenal adenoma
medical treatment for hyperaldosteronism
spironolactone or eplerenone
medical treatment for pheochromocytoma
non-selective a-blocker (phentolamine or phenoxybenzamine)
pheochromocytoma, medullary thyroid cancer, and hyperparathyroidism
MEN 2A
pheochromocytoma, medullary thyroid cancer, and mucosal neuromas
MEN 2B
Adrenal disease associated with skin hyperpigmentation
Addison disease
HTN, hypokalemia, metabolic alkalosis
hyperaldosteronism (Conn syndrome)
function of thyroid hormones
bone growth
CNS maturation
increase B1 receptors in heart
increase basal metabolic rate
hyperthyroidism symptoms and extremely tender thyroid gland
subacute (de Quervain) thyroiditis
hyperthyroidism symptoms and pretibial myxedema
Graves
hyperthyroidism symptoms and pride in recent weight loss, medical professional
thyroid hormone abuse
hyperthyroidism symptoms and palpation of single thyroid nodule
toxic thyroid adenoma
hyperthyroidism symptoms and palpation of multiple thyroid nodules
toxic multinodular goiter
hyperthyroidism symptoms and recent study using IV contrast (iodine)
Jod-Basedow phenomenon
hyperthyroidism symptoms and eye changes: proptosis, edema, injection
Graves
hyperthyroidism symptoms and history of thyroidectomy or radioablation of thyroid
too much exogenous thyroid hormone
treatment of hyperthyroidism
Propylthiouracil (PTU): inhibits peroxidase and 5’-deiodinase is peripheral tissue
methimazole: inhibits peroxidase
most common type of thyroid cancer
papillary
second most common type of thyroid cancer
follicular
activation of receptor tyrosine kinases in thyroid cancer
papillary and medullary
hashimoto thyroiditis is a risk factor
b cell lymphoma
cancer arising from parafollicular C cells
medullary
associated with RAS or PAX8-PPAR gamma 1 rearrangement
follicular
associated with RET or NTRKI or BRAF mutation
papillary
enlarged thyroid cells with ground-glass nuclei
papillary carcinoma of thyroid
lactic acidosis is rare but worrisome side effect
metformin
most common side effect is hypoglycemia
sulfonylureas
recommended first-line treatment for most DB II patients
metformin
not safe in settings of hepatic dysfunction or CHF
TZDs
should not be used in patients with elevated serum creatinine
metformin
should not be used in patients with cirrhosis or inflammatory bowel disease
a-glucosidase inhibitors
not associated with weight gain
metformin, DDP-4 inhibitors, GLP-1 analogs
metabolized by liver; excellent choice in patients with renal disease
TZDs
MOA: closes K channel on B cells -> depolarization -> Ca influx -> insulin release
sulfonylureas
MOA: inhibits a-glucosidase at intestinal brush border
a-glucosidase inhibitors
MOA: agonist at PPARy receptors -> improved target cell response to insulin
TZDs
MOA: decreases hepatic gluconeogenesis
metformin
good for weight loss
GLP-1 agonists
avoid in hypoglycemia
sulfonylureas
best treatment for anyone with organ failure (renal, liver, heart)
insulin
standard treatment for DKA
IV fluids, IV insulin, K replacement
standard treatment for type I DM
insulin
standard treatment for type II DM
low carb diet and weight loss, oral hypoglycemic, insulin
five categories for diagnosis of metabolic syndrome
abdominal obesity (waist circumference) increased triglycerides decreased HDL BP >130/85 increased fasting glucose
liver disease associated with obesity
nonalcoholic steatohepatitis (NASH)
3 functions of vit D
increase bone resorption of Ca and PO4
increase Ca and PO4 absorption in intestines
cell produces PTH and calcitonin
PTH: chief cells of parathyroid
calcitonin: parafollicular C cells of thyroid
signs of hypocalcemia
Chvostek’s
Trousseau’s
primary hyperparathyroidism
solitary parathyroid adenoma
parathyroid hyperplasia
most common cause of hypercalcemia
primary hyperparathyroidism
most common cause of primary hyperparathyroidism
parathyroid adenoma
most common cause of secondary hyperparathyroidism
chronic renal failure
most common cause of hypoparathyroidism
accidental parathyroidectomy
facial muscle spasm when tapping on the cheek
Chvostek’s sign
parathyroid, pancreatic, and pituitary tumors
MEN 1
hyperparathyroidism
stones, bones, groans and psychiatric overtones
differences in serum markers for primary and secondary hyperparathyroidism
primary: increased Ca, PTH, alk phop decreased PO4
secondary: decreased CA, increased PTH, alk phos and PO4
