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Endocrine Flashcards

1
Q

Which adrenal gland goes to the renal vein before the IVC?

A

Left adrenal gland (same as gonadal vein)

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2
Q

Which anterior pituitary hormones are basophils?

A

B-FLAT

Basophils - FSH, LH, ACTH, TSH

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3
Q

What type of receptors are insulin receptors?

A

Tyrosine kinase receptors

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4
Q 
How does insulin affect the following?
Na+:
TGs:
K+:
Amino acids:
A

Sodium retention increased in the kidneys
Triglyceride synthesis increased
Cellular uptake of potassium and amino acids increased

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5
Q

Which GLUT receptor is in the brain?

A

GLUT-1: RBCs, brain, cornea

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6
Q

What aside from glucose increases insulin release?

A

β2-agonists and Growth Hormone (increases insulin resistance)

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7
Q

How does prolactin influence GnRH?

A

Decreases GnRH release

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8
Q

How does TRH affect prolactin?

A

TRH increases prolactin

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9
Q

What enzymes are used to produce aldosterone from cholesterol?

A
  1. Cholesterol desmolase
  2. 3β-hydroxysteroid dehydrogenase
  3. 21-hydroxylase
  4. 11β-hydroxylase
  5. Aldosterone synthase
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10
Q

What enzyme is necessary to produce cortisol and sex hormones? What happens when this enzyme is deficient (For XX and XY individuals)?

A

17α-hydroxylase
XX: lack secondary sexual development
XY: pseudohermaphroditism (ambiguous genitalia and undescended testes)

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11
Q

What are the functions of cortisol? (BIG FIB)

A

Blood pressure increase (upregulates α1 receptors on arterioles)
Insulin resistance (diabetogenic)
Gluconeogenesis, lipolysis and proteolysis are increased
Fibroblast activity is DECREASED
Inflammatory and immune responses are DECREASED
Bone formation (osteoblast activity) is DECREASED

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12
Q

RANK-L (production induced by PTH) binds RANK on _______ leading to _______ stimulation

A

RANK-L (production induced by PTH) binds RANK on OSTEOBLASTS leading to OSTEOCLAST stimulation

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13
Q

How does Magnesium affect PTH secretion?

A

Low serum magnesium causes increased PTH secretion

Very low serum magnesium causes decreased PTH secretion

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14
Q

Which endocrine hormones work via a cAMP pathway?

A

FLAT CHAMP

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH

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15
Q

Which endocrine hormones work via an IP3 pathway?

A

GOAT HAG

GnRH, Oxytocin, ADH (V1 receptor), TRH, Histamine, Angiotensin II, Gastrin

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16
Q

Which endocrine hormones use an intrinsic tyrosine kinase receptor? (MAP kinase pathway)

A

Insulin, IGF-1, FGF, PDGF, EGF

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17
Q

What are the functions of T3? (4 Bs)

A

Bone growth
Brain maturation
Beta adrenergic effects (increase CO, HR, SV, contractility)
Basal metabolic rate increase (via increased Na+/K+ ATPase)

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18
Q

What is the Wolff-Chaikoff effect?

A

Excess iodine temporarily inhibits thyroid peroxidase causing decreased iodine organification and decreased T3/T4 production

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19
Q

What enzyme converts T3 to T4 in the periphery?

A

5’-deiodinase

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20
Q

From what cells is a neuroblastoma/pheochromoblastoma derived?

A

Neuroblastoma: Neural crest cells
Pheochromocytoma: Chromaffin cells (derived from neural crest cells)

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21
Q

What gene is overexpressed in a neuroblastoma? What is seen in the urine? What is seen on histology?

A

N-myc oncogene is overexpressed
Homovanillic acid (a breakdown product of dopamine) is increased in urine
Homer-wright rosettes seen on histology

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22
Q

What is the rule of 10s for pheochromocytoma?

A 
10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids
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23
Q

What is seen in the urine in a pheochromocytoma?

A

VMA - Vanillymandelic acid (breakdown product of NE and Epi)

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24
Q

How does hyperthyroidism affect cholesterol and through what mechanism?

A

Causes hypocholesterolemia due to increased LDL receptor expression

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25
Which HLA is associated with Hashimoto's thyroiditis? | What disease are patients at increased risk for with Hashimoto's thyroiditis?
HLA-DR5; non-Hodgkin lymphoma
26
What are the "6 Ps" of congenital hypothyroidism (cretinism)?
``` Pot-bellied Pale Puffy-faced child Protruding umbilicus Protuberant tongue Poor brain development ```
27
What type of thyroiditis occurs when the thyroid is replaced by fibrous tissue (manifestation of IgG4-related systemic disease)?
Riedel thyroiditis
28
De Quervaine thyroiditis is (painful/painless) | Riedel thyroiditis is (painful/painless)
De Quervaine thyroiditis is PAINFUL | Riedel thyroiditis is PAINLESS
29
What is a toxic multinodular goiter? What is the Jod Basedow phenomenon for toxic multinodular goiters?
Hyperfunctioning follicular cells working independently of TSH due to mutation in TSH receptor JB: Thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
30
How is a thyroid storm treated (3 Ps)
Propranolol (β-blockers) , Propylthiouracil, Prednisolone (corticosteroids)
31
What artery is at risk of transection in a thyroidectomy?
Inferior thyroid artery
32
Which thyroid cancer is associated with psammoma bodies, orphan annie eye nuclei, and RET and BRAF mutations?
Papillary carcinoma (excellent prognosis)
33
Which thyroid cancer is associated with MEN2A and 2B mutations, produces calcitonin, and displays sheets of cells in an amyloid stroma?
Medullary carcinoma
34
What is osteitis fibrosa cystica caused by? What are the symptoms of this disease?
Primary hyperparathyroidism Stones (renal), Bones (bone pain), Groans (Weakness and constipation - acute pancreatitis), and psychiatric overtones (depression)
35
What are Chvostek sign and Trousseau sign in hypoparathyroidism?
Chvostek sign: Tapping of facial nerve causes contraction of facial muscles Trousseau sign: Occlusion of brachial artery with BP cuff causes carpal spasm
36
What is pseudohypoparathyroidism and what is a unique finding?
Autosomal dominant unresponsiveness of kidney to PTH | Shortened 4th and 5th digits
37
What is the most common cause of death in children with gigantism?
Cardiac failure
38
What 2 tests is used to diagnose acromegaly?
Failure to suppress serum GH following oral glucose tolerance test and Increased serum IGF-1 levels
39
How does the body maintain near normal volume status in SIADH?
Body responds to water retention with decreased aldosterone (leads to hyponatremia)
40
What is the purpose of the HbA1c test in diabetes mellitus?
Reflects average blood glucose over prior 3 months
41
Which type of diabetes has a stronger genetic predisposition?
Diabetes Type 2 (90% concordance in identical twins)
42
What happens to potassium during diabetic ketoacidosis?
Hyperkalemia, but depleted intracellular K+ due to transcellular shift from decreased insulin
43
What is the Whipple triad (associated with insulinoma CNS effects)?
Lethargy, syncope, diplopia
44
What diseases are associated with MEN1
Pituitary, Parathyroid, and Pancreatic tumors
45
What diseases are associated with MEN2A?
Parathyroids Pheochromocytoma Medullary Thyroid carcinoma
46
What diseases are associated with MEN2B?
Medullary thyroid carcinoma Pheochromocytoma Oral/Intestinal ganglioneuromatosis
47
What are the functions of amylin analogs (Pramlintide)?
Decreased gastric emptying | Decreased glucagon
48
What are the functions of GLP-1 analogs (Exenatide, Liraglutide)?
Increase insulin | Decrease glucagon release
49
What are the functions of DDP-4 Inhibitors (Linagliptin, Saxagliptin, Sitagliptan)?
Increase insulin Decrease glucagon release *Block the degradation of GLP-1 analogs
50
What is the adrenal cortex derived from? | What is the medulla derived from?
Cortex: Mesoderm Medulla: Neural crest
51
What drugs can cause nephrogenic diabetes insipidus? | What drug can cause SIADH?
NDI: Lithium and Demeclocycline (treatment for SIADH) SIADH: Cyclophosphamide
52
By what mechanism does hyperthyroidism increase basal metabolic rate? Sympathetic nervous system activity?
BMR: Increased synthesis of Na+/K+ ATPase | SNS activity: Increased expression of Beta1 adrenergic receptors
53
What transports oxytocin and vasopressin from the hypothalamus to the posterior pituitary?
neurophysins
54
Where are β cells located in the pancreas? α cells? What does each produce?
β cells (insulin producing) are central and α cells (glucagon) are peripheral
55
CRH increases what three hormones?
ACTH, MSH, and β-endorphins
56
What increases somatomedin? What does somatomedin cause?
Growth hormone (somatotropin) increases somatomedin which increases somatostatin which suppresses growth hormone release
57
How does cortisol affect IL-2 and histamine release?
Blocks IL-2 production (can lead to reactivation of candidiasis and TB) and blocks histamine release from mast cells
58
Which endogenous hormone increases production of macrophage colony-stimulating factor?
PTH
59
How does pH affect calcium levels?
Increase in pH → increased affinity of albumin (negative charge) to bind calcium → clinical manifestations of hypocalcemia (cramps, pain, paresthesias)
60
Which endocrine hormones use a receptor associated tyrosine kinase (JAK/STAT)? (PIG)
Prolactin, Immunomodulators (cytokines and interleukins), Growth hormone
61
Why are sodium levels normal in primary hyperaldosteronism (Conn syndrome or adrenal hyperplasia)?
Aldosterone escape: Secretion of ANP to prevent hypernatremia
62
How is primary adrenal insufficiency distinguished from secondary adrenal insufficiency?
secondary adrenal insufficiency has no skin/mucosal hyperpigmentation and no hyperkalemia
63
Where can a neuroblastoma occur and how is it differentiated from Wilms tumor?
Neuroblastomas can occur anywhere along the sympathetic chain Presents as a firm, irregular mass that can cross the midline vs. Wilms tumor which is smooth and unilateral
64
Increased cAMP in urine is most likely due to...
Primary hyper-parathyroidism (PTH works through Gs pathway)
65
What is pegvisomant?
Growth hormone receptor antagonist
66
How does T2DM lead to nephrotic syndrome? Blindness?
Nephrotic syndrome: NEG → hyaline arteriorsclerosis → preferential involvement of efferent arterials → glomerular hyperfiltration → microalbuminuria → nephrotic syndrome Blindness: Glucose freely enters schwann cells → aldose converts glucose to sorbitol → osmotic damage → neuropathy → blindness

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