Endocrine Flashcards
Stimulates bone and muscle growth
GH
stimulates milk production
Prolactin
Stimulates milk secretion
Oxytocin
Stimulates metabolic activity
thyroid hormone
Increases blood glucose and decreases protein synthesis
Cortisol (glucocorticoids)
Preps endometrium for implantation/maintenance of pregnancy
Progesterone
Stimulates adrenals to make and secrete cortisol
ACTH
Stimulates follicle maturation in females and spermatogenesis in males
FSH
Increases plasma calcium, bone resorption
PTH
Decreases plasma calcium, increase bone formation
Calcitonin
Stimulates ovulation in females and testosterone synthesis in males
LH
Stimulates thyroid to produce TH and uptake iodine
TSH
Secretes growth hormone
anterior pituitary
secretes glucocorticoids
adrenals
secretes progesterone
ovaries
secretes prolactin
anterior pituitary
secretes oxytocin
hypothalamus paraventricular nucleus (stored in posterior pituitary)
secretes atrial natriuretic peptide
atria of heart
secretes glucagon
pancreas alpha cells
secretes testosterone
testes, ovaries
secretes FSH
anterior pituitary
secretes ADH (vasopressin)
hypothalamus (stored in posterior pituitary)
secretes calcitonin
C-cells of parathyroids
secretes TSH
anterior pituitary
secretes epi and NE
adrenal cortex
secretes insulin
beta cells of pancreas
secretes estradiol
ovaries
secretes estriol
placenta
secretes estrone
fat
secretes estrogen in males
testes
secretes somatostatin
delta cells of pancreas
secretes LH
anterior pituitary
secretes mineralocorticoids (aldosterone)
adrenals
secretes ACTH
anterior pituitary
inability to breastfeed, amenorrhea, cold intolerance
Sheehan syndrome - ischemic infarct of pituitary after delivery
hormones that share a common alpha subunit
TSH, LH, FSH, hCG
infertility, galactorrhea, bitemporal hemianopsia
prolactinoma
Mnemonic for remembering the symptoms of the congenital adrenal hyperplasia syndrome
1 first number = hypertension
1 second number = masculinization
Phenotypic female unable to mature, hypertension, salt and water retention
17alpha-hydroxylase deficiency
Virilization of genetic female, hypotension, salt wasting, high K+, elevated ACTH
in genetic males, it will present with precocious puberty
21alpha-hydroxylase deficiency (most common CAH syndrome)
Excessive sodium excretion in urine, early death, unable to produce glucocorticoids, mineralocorticoids, androgens, and estrogens
3beta-hydroxysteroid dehydrogenase deficiency
What drug blocks desmolase ability to form pregnenolone from cholesterol?
ketoconazole
Virilization of genetic female, hypertension, salt and water retention
11beta-hydroxylase deficiency
Causes of Cushing syndrome
exogenous corticosteroids (most common)
ACTH secreting small cell lung cancer
Cushing disease (pituitary tumor making ACTH)
Adrenal tumor making cortisol
Side effects of cortisol use of Cushing syndrome
BAM, CUSHINGOID
Buffalo hump, Amenorrhea/acne, Moon facies, Crazy, Ulcers, Skin changes (striae, bruising, thin skin), HTN, Infections, Necrosis of femoral head, Glaucoma/cataracts, Osteoporosis, Immunosuppression, Diabetes
What is the only tumor that will be suppressed by the high-dose dexamethasone test?
ACTH producing pituitary tumor (Cushing disease)
Triad of hypertension, metabolic alkalosis, hypokalemia
hyperaldosteronism
Most common cause of primary hyperaldosteronism
Adrenal adenoma (Conn syndrome)
Medical treatment for hyperaldoesteronism
Spirinolactone, Eplerenone
Adrenal insufficiency with skin pigmentation
Addison’s disease (AI destruction of adrenals)
Hypotension, hyponatremia, hyperkalemia, hypoglycemia, fatigue, weight loss, anorexia
Primary adrenal insufficiency
Tx of primary adrenal insufficiency
glucocorticoids, fludracortisone (mineralocorticoid)
Causes of secondary hyperaldosteronism (high renin and aldosterone)
renal artery stenosis, JG cell tumor, CHF, cirrhosis, nephrotic syndrome (detect hypoperfusion/low BP)
Pituitary tumors, Pancreatic endocrine tumors (Z-E syndrome, VIPoma, insulinoma), Parathyroid adenomas
MEN 1 (PPP)
Mutation in MEN 1
MEN 1 - tumor suppressor
Mutation in MEN2A and 2B
RET - receptor tyrosine receptor
Parathyroid hyperplasia, medullary thyroid cancer, pheocromocytoma
MEN 2A (PPM)
Pheocromocytoma, medullary thyroid cancer, mucosal neruomas
MEN 2B (PMM)
Most common tumor of adrenal medulla in kids
Neuroblastoma
Features of neuroblastoma
Homer-Wright rossettes
Neurofibrillary stain
N-myc oncogene overexpression
Bombesin tumor marker
Symptoms of pheocromocytoma
Paroxysms of palpitations (tachycardia), perspiration, pain (HA), pallor, pressure (HTN)
Treatment of pheocromocytoma
Alpha blocker - phenoxybenzamine, pentolamine
can follow with beta blocker
surgical resection
beta blocker alone will cause hypertensive crisis due to vasoconstriction of alpha agonism
Diagnosis of pheocromocytoma
VMA in urine, metanephrine and normetanephrine in plasma
Remnant of the thyroglossal duct
foramen cecum
Enlarged, non-tender thyroid with lymphoid aggregates on bx, Hurthle cells, associated with autoantibodies and hypothyroidism
Hashimoto’s thyroiditis
Fixed, rock hard painless goiter, hypothyroidism, fibrous tissue with eosinophils and macs on bx, may extend into local structures
Riedel thyroiditis
Hypothyroidism with very tender thyroid + granulomatous inflammation following URI
Subacute granulomatous thyroiditis
Effects of congenital hypothyroidism (cretinism)
intellectual disability, impaired growth, protuberant abdomen, protuberant tongue
Hyperthyroidism, pretibial myxedema, proptosis and exopthalmos, goiter, increased uptake of radioactive iodine, thyroid stimulating Abs
Grave’s disease
Thyrotoxicosis in a pt who is repleted with iodine after being deficient
Jod-Basedow phenomenon
Complications of thyroidectomy
hoarseness - damage to recurrent laryngeal nerve
hypocalcemia - removal of parathyroid glands
Empty-appearing nuclei with central clearing, nuclei can look like ground glass, psammoma bodies, nuclear grooves, most common thyroid cancer
Papillary carcinoma
Papillary carcinoma gene mutations
RET and BRAF - both receptor tyrosine kinases
Follicular carcinoma gene mutation
RAS
Unique spread via hematogenous spread, uniform cuboidal cells, invasion thru thyroid capsule
Follicular carcinoma
Originates from parafollicular C cells, associated with high calcitonin, polygonal stroma, amyloid stoma, MEN 2A and 2B
Medullary carcinoma
-screen all pts for pheocromocytoma due to MEN association
Older pt with rock hard thyroid, poor prognosis
Anaplastic carcinoma
What is lymphoma in the thyroid associated with?
Hashimoto’s thyroiditis
Location of GLUT-1 transporters
RBCs, brain, cornea, placenta (insulin independent)
Location of GLUT-4 transporters
skeletal muscle, adipose tissue (insulin dependent)
Location of GLUT-2 transporters
Beta cells of pancreas, kidneys, liver, small intestine (insulin independent)
What type of receptor is insulin?
tyrosine kinase
Mechanism of insulin release from beta cells
glucose metabolized –> increase ATP –> close K+ channels –> hyperpolarize cell –> open VG Ca2+ channels –> Ca2+ influx –> insulin released from vesicles
What complications of diabetes are associated with nonenzymatic glycosylation?
small vessel dz - retinopathy, nephropathy
large vessel dz - atherosclerosis, CAD, peripheral vascular dz, gangrene (limb loss)
What complications of diabetes are associated with osmotic damage?
neuropathy, cataracts
How are tissues damaged in diabetes due to osmotic damage?
Schwann cells, retina, kidneys, lens lack sorbitol dehydrogenase, so they can’t convert sorbitol to fructose
-do have aldose reductase to form sorbitol from glucose
What are two life threatening complications of DKA?
arrhythmias - due to hyperkalemia
Mucormycosis caused by rhizopus infection - lethal brain fungus infection
