Endocrine Flashcards
What is the remnant of the thyroglossal duct?
Foramen Cecum
How does thyroglossal duct cyst present?
anterior midline neck mass that moves
What tracer can be used to identify a thyroglossal duct cyst?
technitium-99
What is the most common tumor of adrenal medulla in children?
Neuroblastoma
Does a neuroblastoma cause hypertension?
rarely
How do the left and right adrenal glands drain?
just like gonadal veins
What does neurophysin I carry?
Oxytocin
What does neurophysin two carry?
ADH
What does the posterior pituitary develop from?
Neuroectoderm
What are the two acidophilic anterior pituitary hormones?
GH and prolactin
What are the four basophilic anterior pituitary hormones?
FSH/LH/ACTH/TSH
What embryological layer is the anterior pituitary derived from? Also known as?
ectoderm
Rathke’s Pouch
Which four hormones share similar α subunits?
FSH/LH/TSH/βHCG
Where in the α-cells is glucagon stored?
peripherally
Where in the β-cells is insulin stored?
centrally
Where in the Δ-cells is somatostatin stored?
interspersed
What is the function of 11β-HSD?
cortisol into cortisone or vice-versa
Which isoform of 11β-HSD is found in aldosterone sensitive tissues?
11β-HSD2
What compound is found in licorice? Also known as?
Glycyrrhetic acid
enoxolone
What enzyme can glycyrrhetic acid/enoxolone inhibit? What does this lead to?
11β-HSD2
syndrome of apparent mineralocorticoid excess
In what ratio are insulin and C-peptide released together?
equally
What type of activity do insulin receptors possess?
tyrosine kinase
What does insulin do to sodium levels?
sodium retention
Does insulin cross the placenta?
no
Which GLUT receptor is present on β-cells?
GLUT2
In which three tissues are GLUT1 found?
RBCs/Brain/Cornea
Which six tissues take-up glucose independent of insulin?
Brain/RBCs/Intestine/Cornea/Kidneys/Liver
What does Growth Hormone due to insulin release?
increase
What do β2 Agonists do to insulin release?
increase
What would a prolactinoma do to bones?
Osteoporosis
What does hyperthyroidism do to warfarin levels?
increase warfarin levels
What does prolactin do to GnRH levels?
inhibit GnRH synthesis
Which hypothalamic hormone increases prolactin levels?
TRH
What type of drugs can be used to treat a prolactinoma?
dopamine agonists
What does prolactin do to dopamine synthesis?
increase
Which cytokine does GH mediate its effects through?
IGF1
Does GH increase or decrease insulin resistance?
increase insulin resistance
What does glucose do to GH release?
decrease
Which nuclei synthesizes ADH?
Supra-optic
Which ADH receptor isoform mediates fluid volume?
V2
Which ADH receptor isoform mediates blood pressure?
V1
What drug inhibits desmolase?
Ketoconazole
What can androstenedione be metabolized into? What enzyme?
Estrone
Aromatase
How can 21α-Hydroxylase Deficiency be differentiated from 17α-Hydroxylase Deficiency?
17α-Hydroxylase Deficiency would present with hypertension
Would 17α-Hydroxylase Deficiency present with low or high renin?
low
What hormone causes the hyperplasia during CAH?
ACTH
Which adrenergic receptor does cortisol increase the synthesis of?
α1
Why does excess cortisol cause abdominal striae?
cortisol decreases fibroblast activity
What does cortisol do to circulating neutrophil levels? Why?
neutrophilia
decrease adhesion
What does cortisol do to mast cells?
blocks histamine release
What does cortisol do to eosinophils?
induces apoptosis
Which interleukin does cortisol block?
IL2
Why does cortisol cause osteoporosis?
blocks osteoblast activity
Which ions does PTH increase the resorption of out of bone?
calcium and phosphate
Where in the kidney does PTH promote the reabsorption of calcium?
DCT
Where in the kidney does PTH promote the excretion of phosphate?
PCT
What cytokine does PTH up-regulate the synthesis of?
RANK-L
Does RANK-L bind to osteoblasts or osteoclasts?
osteoblasts
What does mildly decreased Magesium do to PTH levels?
increase PTH
What does markedly decreased Magesium do to PTH levels?
decrease PTH
Does an increase or decrease in pH increase the affinity of albumin for calcium?
increase pH = increase affinity
Which 2nd messenger is used by ANP?
cGMP
Which 2nd messenger is used by GnRH?
IP3
Which 2nd messenger is used by oxytocin?
IP3
Which 2nd messenger is used by hCG?
cAMP
Which 2nd messenger is used by ADH?
cAMP
Which 2nd messenger is used by MSH?
cAMP
Which 2nd messenger is used by PTH?
cAMP
Which 2nd messenger is used by TRH?
IP3
Which 2nd messenger is used by TSH?
cAMP
Which 2nd messenger is used by Gastrin?
IP3
Which 2nd messenger is used by CRH?
cAMP
Which three hormones use RTKs?
Prolactin/Cytokines/GH
Which 2nd messenger is used by glucagon?
cAMP
Which 2nd messenger is used by GHRH?
cAMP
Which 2nd messenger is used by calcitonin?
cAMP
Does SHBG bind free estrogen?
no
What do decreased levels of SHBG do in women?
hirsutism
What do increased levels of SHBG do in men?
gynecomastia
Which receptor can thyroid hormone upregulate?
β1
Why does excess TSH increase basal metabolic rate?
increased expression of Na/K ATPase
What does TSH do to fat levels?
increase lipolysis
By which two mechanisms does TSH increase glucose levels?
glycogenolysis
gluconeogenesis
When would thyroxine binding globulin levels decrease?
hepatic failure
What two situations would thyroxin binding globulin levels increase?
pregnancy or OCPs
What enzyme converts T4 into T3 in the periphery?
5’-Deiodonase
What is the Wolff-Chaikoff effect?
excess iodine interrupts thyroid peroxidase
What enzyme(s) are/is inhibited by propylthiouracil?
TPO and 5’-Deiodonase
What enzyme(s) are/is inhibited by methimazole?
TPO
‘Taper’ means what drug?
Prednisone
What two tumors can secrete ACTH?
small cell lung
bronchial carcinoid
What does lack of inhibition by dexamethasone mean?
ectopic ACTH production
What is another name for Primary Hyperaldosteronism?
Conn Syndrome
Would Conn Syndrome have low or high plasma renin?
low
What drug would be used in Conn Syndrome?
Spironolactone
What causes Secondary Hyperaldosteronism?
Renal perception of low intravascular volumes
Would Secondary Hyperaldosteronism present with high or low plasma renin?
high
What is the treatment for Secondary Hyperaldosteronism?
spironolactone
What is secondary adrenal insufficiency?
decreased response to ACTH
What cells does a neuroblastoma originate from?
neural crest
Which does not cross the midline, Wilms or Neuroblastoma?
Wilms = not cross midline
Neuroblastoma = can cross
What is an easy mechanism to diagnose Neuroblastoma?
homovanillic acid in urine
What gene is neuroblastoma associated with?
N-myc
What is the tumor marker for Bombesin?
Neuroblastoma
What is homovanillic acid a breakdown product of?
Dopamine
What cells does a pheochromocytoma originate from?
neural crest
Which three diseases can result in a pheochromocytoma?
VHL
MEN2A
MEN2B
What is found in the urine during a pheochromocytoma?
VMA
What is VMA a breakdown product of?
epinephrine and norepinephrine
Which is given first during a pheochromocytoma, α-blockers or β-blockers?
α-blockers
Why does hypothyroidism present with hypercholesterolemia?
thyroid hormone upregulates LDL receptor
Why does hyperthyroidism present with hypocholesterolemia?
increase LDL receptor expression
What are the two autoantibodies present during Hashimotos?
anti-thyroglobulin
anti-thyroid peroxidase
What is the HLA haplotype most often found during Hashimotos Thyroiditis?
HLA-DR5
Is Hashimotos a tender or nontender thyroid?
non-tender
What structure is present during Hashimotos Thyroiditis?
germinal centers
What type of inflammation is present during de Quervain thyroiditis?
granulomatous
Is de Quervain painful or painless?
painful
What is the course of thyroid hormone release during DeQuervains?
transient hyper
followed by hypo
Does Riedel Thyroiditis present with hypothyroidism or hyperthyroidism?
hypothyroidism
What disease can mimmick Anaplastic Carcinoma?
Riedel Thyroiditis
Is Riedel Thyroiditis painful or painless?
painless
Is Riedel Thyroiditis tender or nontender?
nontender
Which disease, Riedel or de Quervain, may present as hyperthyroidism early in the disease course?
de Quervain
What is the Jod-Basedow Phenomenon?
thyrotoxicosis if a person with an iodine deficiency goiter is made iodine sufficient
Would hyperthyroidism have increase or decreased bone turnover?
increased
What three drugs are used to treat thyroid storm?
Propylthiouracil
Propranalol
Prednisolone
Which two genes can lead to papillary cacinoma of the thyroid?
RET and BRAF
Biggest risk factor for Papillary Thyroid Cancer?
childhood irradiation
Difference between Follicular Carcinoma and Follicular Adenoma?
carcinoma invades capsule
Which thyroid cancer secretes calcitonin?
Medullary
What is the buzzword phase for Medullary Carcinoma of Thyroid?
malignant cells in amyloid stroma
Marker of excess PTH in urine?
cAMP
Will levels of ALP be increased or decreased during Primary Hyperparathyroidism?
increased
What causes Osteitis Fibrosis Cystica?
Hyperparathyroidism
Three buzz words for excess calcium?
stones
groans
psychiatric overtones
Will levels of ALP be increased or decreased during Secondary Hyperparathyroidism?
increased
What would happen to vitamin D levels during Secondary Hyperparathyroidism?
decreased vitamin D
What is Tertiary Hyperthyroidism?
autonomous PTH secretion
What is the mode of inheritance for Pseudohypoparathyroidism?
autosomal dominant
What would be observed on physical examination during Pseudohypoparathyroidism?
shortened 4th and 5th digits
What is the most common hormone secreted from a Pituitary Adenoma? Benign or malignant?
Prolactinoma
Benign
What two drugs are used to treat a prolactinoma?
Bromocriptine
Cabergoline
Two most common physical features during Acromegaly?
large tongue and deep voice
What is the most common cause of death during acromegaly?
Cardiac
What are the two mechanisms to Dx acromegaly?
increased IGF1
high GH after oral glucose
What is the growth hormone receptor antagonist?
Pegvisomant
What are two drugs that can cause Nephrogenic Diabetes Insipidus?
Lithium
Demecocycline
What three drugs are used to treat nephrogenic diabetes insipidus?
HCTZ/Amiloride/Indomethacin
Which anti-neoplastic can cause SIADH?
cyclophosphamide
What is Sheehan Syndrome?
ischemic infarction of pituitary after pregnancy
How does Sheehan Syndrome often present?
failure to lactate
In what population is Empty Sella Syndrome most common?
obese women
Is Hyperosmolar Coma Type 1 or Type 2 Diabetes?
Type two
What is the most common cause of death in Diabetes?
Myocardial Infarction
What molecule damages cells during Type 2 DM?
Sorbitol
What are three main tissues that express Aldose Reductase?
lens
Retina
Schwann Cell
What is the enzyme that when present can damage tissues during Type 2 DM?
Aldose Reductase
What is the enzyme that when absent can damage tissues during Type 2 DM?
Sorbitol Dehydrogenase
Which form of Diabetes has a stronger genetic predisposition?
Type 2
What is the most common ketone during DKA?
β-hydroxybutyrate
Would DKA present with hyperkalemia or hypokalemia?
Hyperkalemia
What fungal infection can devastate T1DM patients?
Rhizopus
What is Whipples Triad regarding an Insulinoma?
Lethargy
Syncope
Diplopia
What type of cells give rise to Carcinoid Tumors?
Neuroendocrine
What vitamin can be depleted by a carcinoid tumor?
Niacin
Which MEN would Zollinger-Ellison Syndrome present with?
MEN1
Which three tumors are present during MEN1?
pituitary
parathyroid
pancreas
What is the mode of inheritance for all MEN Sydromes?
Autosomal Dominant
What is another name for MEN1?
Wermer Syndrome
What is another name for MEN2A?
Sipple Syndrome
What three tumors are present during MEN2A?
Medullary Thyroid
parathyroid
pheochromocytoma
RET gene is associated with what MEN Syndromes?
MEN2A and MEN2B
What three tumors are present during MEN2B?
oral/intestinal ganglioneuromas
Medullary thyroid
pheochromocytoma
What MEN Syndrome is associated with Marfinoid Habitus?
MEN2B
What are the three rapid acting insulins?
Lispro
Aspart
Glulisine
What are the two long-acting insulins?
Glargine
Detemir
What is the toxicity of Metformin?
lactic acidosis
What type of patients cannot receive metformin?
renal failure
What are the two first generation sulfonylureas?
Tolbutamide
Chlorpropamide
What are the toxicities of first generation sulfonylureas?
Disulfarim like reaction
hypoglycemia in pt’s with renal failure
What are the three second generations sulfonylureas? Main toxicity?
Glipizide/Glyburide/Glimeperide
hypogycemia
What is the MOA of -litazones?
increase PPAR txn to increase insulin receptor density
What are the four toxicities of the litazones?
edema
weight gain
hepatotoxicity
HF
What are the two α-glucosidase Inhibitors?
Miglitol
Acarbose
What are the two functions of Amylin?
decreases gastric emptying
inhibit glucagon release
What drug is the Amylin analogue? Main toxicity?
Pramlintide
hypoglycemia
What are the two MOAs of GLP1?
increase insulin
decrease glucagon
What are the GLP1 analogues?
Liraglutide
Exenatide
What are the two MOAs of DPP-4 Inhibitors?
increase insulin
decrease glucagon
What is the common suffix for DPP-4 Inhibitors?
-gliptin
What drug is used to treat hyperthyroidism during pregnancy?
Propylthiouracil
Which anti-thyroid can hepatotoxicity?
Propylthiouracil
What drug can be used during Turner Syndrome?
GH
What drug control uterine hemorrhage?
Oxytocin
What is the MOA of demeclocycline?
ADH antagonist
Treat Iatrogenic Cushings Osteoporosis with what drug?
bisphosphonates
Is fludricortisone a more powerful glucocorticoid or mineralocorticoid?
mineralocorticoid
The Meglitinides have a similar MOA to what diabetic drug?
sulfonylureas
Which metabolite can build up during metformin therapy causing lactic acidosis? Why?
lactate
cant be shunted to GNG
What are the two toxicities of DPP4 Inhibitors?
urinary and respiratory infections
What are the three toxicities of GLP1 analogues?
nausea
vomiting
pancreatitis
What gene is effected during MDOY?
glucokinase
What are the four D’s of a Glucoganoma?
Dermatitis
Diabetes
DVT
Depression
In what cells is Leptin produced?
adipocytes
What neurotransmitter does Leptin suppress the secretion of?
Neuropeptide Y
What are the two characteristics of a Lipid Panel of a Diabetic?
High triglycerides
low HDL
There is an insensitivity to what hormone during Laron Syndrome?
GH
What is the first line Tx for gestational diabetes? Second?
Insulin
Glyburide
What three drugs, other than lithium, can cause Nephrogenic Diabetes Insipidus?
Conivaptan
Tolvaptan
Demeclycycline
What is the most common cause of death in acromegaly?
heart failure
Familial Hypocalciuric Hypercalcemia features a defective receptor for what?
Calcium sensor
Which diuretic can block lithium uptake?
Amiloride
What is the cause of Familial Primary Hypoparathyroidism?
constant activating of calcium receptor
What is the pathogenesis of Pseudohypoparathyroidism?
unresponsiveness of kidney to PTH
How do calcimimmetics function? What is the Calcimimmetic?
increase responsiveness of Calcium sensor
Cincalacet
What two symptoms can calcitonin produce during Medullary Carcinoma of Thyroid?
flusing and diarrhea
Do neoplastic thyroid cells produce hormone?
no
What are two causes of low ALP?
Hypothyroidism
Pernicious anemia
Which two drugs compete with Na/I for uptake?
perchlorate
pertechtenate
What is the mechanism by why beta-blockers can treat hyperthyroidism?
decreases peripheral conversion of T4 to T3
Other than thyroid hormone, which two hormones may increase during Thyroid Storm?
ALP and Catecholamines
What causes the increased ALP during Thyroid Storm?
bone turnover
What are the Four IgG4 Related Diseases?
Riedel Thyroiditis
Autoimmune pancreatitis
Retroperitoneal fibrosis
non-infectious Arthritis
What is the name of Hypothyroid Myopathy? What lab will be seen?
Hoffman Syndrome
increased creatine kinase
Hurthle Cells are associated with what disease?
Hashimoto
What are Cretinism kids short?
thyroid hormone is required for GH release
GH works synergistically with what other hormone?
TSH
Is sodium increased or normal during Conn Syndrome? Why?
normal
aldosterone escape = increased ANP
What enzyme is inhibited by Tetyrapone?
11-beta-Hydroxylase
Would Cushings Disease result in adrenal cortical hyperplasia or hypertrophy?
hyperplasia
Which two types of hormones use Intrinsic Tyrosine Kinase?
Insulin and Growth Factors
What is the 2nd messenger of Intrinsic Tyrosine Kinase?
MAP Kinase
Which three hormones use Receptor Associated Tyrosine Kinases?
Prolactin
Growth Hormone
Cytokines
What is the 2nd messenger of Receptor Associated Tyrosine Kinases?
JAK/STAT
Which two drugs can deplete magnesium?
aminoglycosides and diuretics
Which social factor can deplete calcium?
alcohol
Which precursor does the sun work on in the synthesis of vitamin D?
7-dehydrocholesterol
Which precursor does the sun work on in the synthesis of vitamin D?
7-dehydrocholesterol
What two reactions does Anastrozole inhibit?
Androstenedione into Estrone
Testosterone into Estradiol
Which two hormones function at the level of the principal cells in the kidney?
ADH and Aldosterone
What ion is not handled effectively during Hypothyroid Myopathy? Which organelle?
Calcium
SR
Does estrogen increase or decrease prolactin secretion?
increase
Does estrogen increase or decrease prolactin secretion?
increase
What is the GHRH Analogue? Used to treat?
Tesamorelin
fet redistribution of HIV
What is the GHRH Analogue?
Tesamorelin
Which two hormones does Somatostatin inhibit?
GH and TSH
Other than somatostatin, which hormone can down-regulate insulin signaling?
TNF
Which two sugars does SGLT reabsorb?
glucose and galactose
Which ion does insulin promote the retention of?
sodium
Where are the two locations of GLUT4?
skeletal tissue and adipose
What compound in licorice can interfere with water and sodium handling? What enzyme does this interfere with?
Glycyrrhetic acid
11-beta-HSD2
What compound in licorice can interfere with water and sodium handling?
Glycyrrhetic acid
Which drug can produce a similar effect to Glycyrrhetic acid ?
Enoloxone
