Endocrine Flashcards
medullary chromaffin cells are modified ________ sympathetic neurons that release catecholamines into the bloodstream in response to _____ released by ________ sympathetic neurons
postganglionic
ACh
preganglionic
__________ refers to a group of _____ disorders that results from defects in the enzymes involved in cortisol biosynthesis. Deficiency of _____ is the most common cause. Patients have salt wasting (low____, high ____), decreased ________ and _______, and ________ overproduction. Females present at birth with _______
Congenital adrenal hyperplasia
Autosomal recessive
21-hydroxylase
Na, K
cortisol
aldosterone (also inc ACTH)
androgen (17 hydroxyprogesterone)
ambiguous genitalia
Thiazolidinediones such as _____ bind to _________, an ___________ receptor that acts as a transcriptional regulator of many genes involved in glucose and lipid metabolism.
pioglitazone
PPARy
intracellular nuclear
_________ is by far the most effective preventative intervention in almost all patients, especially in those with diabetes
smoking cessation
__________ is an autosomal recessive disorder caused by _________ defciency and patients present with HSM, hypotonia, neurodegeneration, and a cherry red macular spot. __________ population is especially at risk. The pathology is due to accumulation of __________.
Niemann Pick disease
sphingomyelinase
Ashkenazi Jewish
Lipid laden foam cells
________ enzyme deficiency (Cori disease) leads to accumulation of _______ with abnormally short outer chains due to the inability to degrade a-1,6 glycosidic branch points. Patients present with hypoglycemia, ketoacidosis, hepatomegaly, and muscle weakness/hypotonia
debranching
glycogen
an increase in _____ activity as seen in pregnancy or post menopausal estrogen replacement therapy increases levels of __________, which leads to an increase in total thyroid hormone levels, but normal levels of biologically active thyroid hormone
estrogen
thyroxine binding globulin
primary mineralcorticoid excess due to a unilateral ____________ (Conn syndrome/hyperaldosteronism) leads to increased ______ reabsorption, HTN, _______, and metabolic ________.
adrenal adenoma
sodium
hypokalemia
alkalosis, but normal sodium levels
calcium sensing receptors are ______ that regulate the secretion of parathyroid hormone in response to changes in circulating levels. Hypocalciuric hypercalcemia is a benign ______ disorder caused by defective calcium sensing receptors in the PT gland and kidneys
GCPR
AD
patient with severe hypertriglyceridemia, pancreatic lipases can cause toxic levels of FFA to be released within the pancreatic tissue, leading to ________. ________ are the most effect agents to treat this condition
acute pancreatitis
fibrates (fenofibrate)
neurophysins are carrier proteins for ____ and _____. deficiency would lead to
oxytocin and vasopressin
neurogenic DI
____________ is characteristic pathology feature of type II DM
HLAclass II gene, pancreatic islet infiltratioin with leukocytes, and antibodies against islet antigen are frequently seen in
pancreatic islet amyloid deposition
TIDM
parathyroid, pituitary, pacreatic (gastrinomas) =
medullary thyroid, pheo, parathyroid =
medullary thyroid, pheo, mucosal neuromas and mafanoid habitus =
MEN1
MEN2A
MEN2B
fatigue weight gain constipation and diffuse goiter in a women most likely =
pathologically shows
Hashimoto’s thyroiditis
intense lymphocytic infiltrate w/ germinal centers
early virilization in males with elevated 17hydroxyprogesterone =
due to (with or without salt wasting)
treat by
Adrenal cortical hyperplasia
21hydroxylase deficiency
suppressing ACTH w/ low dose corticosteroids
patient presents with dysphagia difficulty breathing and hoarseness at a young age could be a _______ due to failure of proper thyroid _______
lingual thyroid
migration
cortisol binds to an ________ receptor
glucagon binds to a _________
both contribute to maintaining blood glucose during periods of fasting
intracellular
GPCR
fluid retention, weight gain, and edema are common side effects of _____ therapy and can exacerbate CHF
Thiazolidinedione
high blood pressure, muscle weakness, normal heart rate =
overactivity in the
hyperaldosteronism
zona glomerulosa of the adrenals (GFR, salt sugar, sex)
anastrozole is an ________ that decrease the synthesis of estrogen from androgens and slows the progression of _________ tumors
aromatase inhibitor
ER +
___________ impaires the synthesis of androgens, estrogens, and cortisol but does not inhibit mineralcorticoid production. Boys appear ________ at birth. Patients present with hypogonadism, HTN, and hypokalemia
17 alpha hydroxylase deficiency
phenotypically female
gynecomastia is commonly seen in men receiving androgen deprivation therapy for ___________. SERMs such as _______ can prevent this
prostate cancer
Tamoxifen
sulfonylureas (______) and meglitinides improve blood glucose in patients with TIIDM by increasing the secretion of insulin and (_______) from the pancreatic B cells.
Glyburide
C peptide
sunlight exposure catalyzes conversion of 7 dehydrocholesterol to _________ (vitamin D3) in the skin)
cholecalciferol
mild to moderate hyperprolactinemia due to new pituitary tumor often is _________ except for bitemporal visual deficits
asymptomatic
ACTH is the major trophic hormone for _________ and _____, whereas the glomerulosa is primarily regulated by _______
Fasciculata and reticularis
angiotensin II
Suppression of _____, ______, and cortisol by ________ therapy is the most common cause of adrenal insufficiency
CRH, ATCH
glucocorticoid
females born with ambiguous genitalia, hypertension, and hypokalemia =
with hypotension and hyperkalemia =
11 Beta hydroxylase
21 hydroxylase
Activating mutations of ______ are strongly associated with medullary thyroid cancer (inc calcitonin). These cancer shows up as a _____ with spindle shaped cells in amorphous background
RAS mutations are common in
mutations of p53 are common in
RET
cold
follicular thyroid cancer or adenomas
anaplastic thyroid cancer
Klinefelter syndrome (47___) is characterized by primary ________ (elevated FSH and LH, low _____) long lower extremities, small firm testes, and ________
XXY
hypogonadism
testosterone
azoospermia
______ is under negative feedback by T3. Reverse T3 is an inactive form that is generated from peripheral conversion of ______, just like T3. T3 supplementation will result in a _______ in all of these parameters
TSH
T4
decrease
the external branch of the __________ is at risk of injury during a thyroidectomy due to its proximity to the _________ artery and vein. This innervates the _____ muscle.
superior laryngeal nerve
superior thryroid
cricothyroid muscle
hyperosmotic volume contraction is caused by a loss of free water, which can occur in patients with ______ or as a result of decreased fluid/ excessive sweating
Diabetes insipidus
intellectual disability, gait or posture abnormality, eczema, and musty body odor =
inheritance
PKU
AR
_________ decreases the effects of radioiodine therapy through competitive inhibition of iodine transportation
potassium perchlorate
_____ is responsible for the intracellular effects of the GPCR cAMP second messenger system. hormone receptors that use this system are ____, ____, ______
Protein Kinase A
TSH
glucagon
PTH
Damage to the posterior pituitary causes ____ DI, while damage to the ________ causes permanent DI
transient
hypothalamic nuclei
_________ is administered to pregnant women at risk of premature delivery to prevent neonatal respiratory distress syndrome
dexamethasone
LH stimulates the release of ______ from ____ cells of testis
FSH stimulates the release of ______ from the _____ cells in the seminiferous tubules.
testosterone
Leydig
Inhibin B
Sertoli
postoperative hypoparathyroidism is common after _____; results in decreased ____ and ____ resorption from the bone and decreased calcium ______ from the kidneys
thyroidectomy
calcium and phosphate
reabsorption
failure of lactation, central hypothyroidism, and adrenal insufficiency in the setting of recent delivery =
due to
panhypopituitarism (Sheehan syndrome)
ischemic necrosis
________ measured by waist circumference is an important predictor of insulin resistance
Visceral obesity
distorted body image, inadequate diet, dry skin, lanugo hair =
causes low levels of (3)
anorexia nervosa
LH, FSH, estrogen
______ reduces intestinal absorption of cholesterol at the brush border of the small intestine
Ezetimibe
hypoglycemia with elevated insulin =
with elevated insulin and C peptide =
exogenous insulin
insulin secretagogue (sulfonylurea) or insulin secreting tumor
______ from lactotrophs are the most common ______ adenomas and can cause galactorrhea and menstrual irregularities
prolactinomas
pituitary
thiazolidinediones exert glucose lowering effect by decreasing
insulin resistance
_______ is the most common complication of statin use
statin induced myopathy (myalgia and inc CK)
muscle cramps, perioral paresthesias, hypotension, and neuromuscular hyperexcitability due to
injury to
hypocalcemia
parathyroid injury
GTP is synthesized by _______ during the conversion of succinyl CoA to cuccinate in the citric acid cycle. GTP is used to synthesize phophoenolpyruvate from ______
succinyl-CoA synthetase
oxaloacetate
impaired beta oxidation of fatty acids causes hypoglycemia after prolonged fasting and inappropriately low levels of ketone bodies. _________ catalyzes the first step in Beta oxidation and is the most commonly deficient enzyme
Actyl-CoA dehydrogenase
large prolactin secreting pituitary tumors can compress the optic chiasm, causing _______. in addition, elevated prolactin levels suppress ________, leading to decreased LH and Testosterone
bitemporal hemianopsia
GnRH
________ adrenergic receptors inhibit insulin secretion, while __________ stimulate insulin secretion.
alpha 2
beta 2
_________ is the most common non nuclear DNA found in eukaryotic cells and resembles prokaryotic DNA and is maternally derived
mtDNA
___________ is a tumor arising from the chromaffin cells of the adrenal medulla and is characterized by excess catecholamines. Episodic HTN, diaphoresis, palpitations, with elevated plasma metanephrine levels are characteristic
pheochromcytoma
medications that alter _______ such as thiazolidoinediones can have a delay of several days to a few weeks for improvements to be seen
gene expression
acute adrenal insufficiency due to adrenal hemorrhage or infarction is exhibited by _________, nausea and vomiting, weakness, and fever. It must be treated immediately with __________ or __________
hypotension/shock
dexamethasone or hydrocortisone and high IV fluids
the most sensitive screening test for diagnosing primary hypothyroidism is
TSH
Grave’s disease, ______________ is a rare but serious complication of antithyroid drugs and is monitored with a white blood cell count
agranulocytosis
G6PD is the rate limiting step in the synthesis of NADPH, which is necessary for the biosynthesis of __________ (3)
cholesterol, fatty acids, steroids
essential fructosuria is a benign disorder of fructokinase deficiency. Some of the dietary fructose is converted by _______ to fructose 6 phosphate which can enter glycolysis
hexokinase
__________ such as repaglinide and nateglinide are short acting ______ lowering medications that act by binding to and closing _______ in the pancreating beta cell membrane, inducing depolarization and L type Ca channel opening, which stimulates insulin release
meglitinides
glucose
ATP dependent K+ channel
cleavage of proinsulin in the pancreatic beta cell ______ yields insulin and C peptide, which are __________ until they are secreted
secretory granules
stored
mental status change, muscle weakness, constipation, polyuria, polydipsia, excess vitamin D intake =
activated macrophages in _______ express 1 alpha hydroxylase, leading to the production of excess______ and hypercalcemia
Vit D intox
sarcoidosis
1,25-dihydroxyvitamin D
both chromaffin cells of the adrenal medulla and ________ of the thyroid originate from embryonic neural crest tissue
parafollicular C cells
thyroid peroxidase is responsible for the ___________ and the __________
antibodies to thyroid peroxidase are present in more than 90% of patients with _________
oxidation of iodide to iodine
iodination of thyroglobulin
autoimmune (Hashimoto’s) thyroiditis
chronic hyperglycemia causes intracellular sorbitol build up which accelerates ______ development. Sorbitol is normally metabolized into______
cataracts
fructose
patient with dyspnea on exertion, large weight gain, darkening of the skin, muscle weakness, lung mass, elevated cortisol and ACTH =
confirmation study
Cushings
dexamethasone suppression test
amiodarone can cause ________ and ________ should be checked before adminstration long term
hyper/hypothyroidism
serum TSH
__________ for HIV is commonly associated with body fat redistribution (lipoatrophy of face and extremities and central fat accumulation in the trunk and viscera)
HAART
painful enlargement of the thyroid with mood swings and hand tremor following a viral illness =
diagnostic testing
pathology
subacute granulomatous thyroiditis
inc ESR, CRP, dec radioiodine uptake
mixed cellular infiltrate with multinucleated giant cells
poor exercise tolerance, muscle cramps, rhabdomyolysis after intense sessions, no rise in blood lactate levels after exercise =
due to =
normal glucose levels, severe cardiomegaly, glycogen accumulation in lysosomes =
due to =
hepatomegaly, ketotic hypoglycemia, hypotonia, weakness, abnormal glycogen with very short outer chains =
due to =
hepatomegaly and steatosis, fasting hypoglycemia, lactic acidosis, hyperuricemia and hyper lipidemia =
due to =
McArdle disease
myophsphorylase deficiency
Pompe disease
acid alpha glucosidase
Cori disease
debranching enzyme deficiency
von Gierke disease
glucose 6 phosphatase deficiency
ethanol inhibits ______ and can cause hypoglycemia once hepatic glycogen stores are depleted
gluconeogenesis
mild hypoglycemia in a conscious patient treat with
severe hypoglycemia with LOC treat with _______ in a nonmedical setting and ________ in a medical setting
oral glucose admin
IM glucagon
IV dextrose
exercise intolerance, forearm ischemic test and muscle biopsy reveal absent lactate dehydrogenase activity; strenuous exercise in this patient leads to inhibition of _______ in skeletal muscle due to intracellular depletion of _______
glycolysis
NAD+
An elevated CK is high suggestive of underlying _________ which can be caused by _____________
also caused by Cushings (weakness and atrophy without pain, normal CK), polymyalgia rhematica (pain and stiffness, worse in the morning, normal CK), Inflammatory myopathies, statin induced myopathy
myopathy
hypothyroidism
insulin ______ glucose uptake, _______ lipolysis and ketoacid formation, and _________ glucagon release
increases
inhibits
suppresses
patient with recurrent renal colic, PUD , increased 24 hour urinary calcium excretion =
change in bone structure =
also called
hyperparathyroidism
sub periosteal resorption with cystic degeneration, salt and pepper skull
osteitis fibrosa cystica
increased fatigability, trouble sleeping, heart palpitations, weight loss, heat intolerance, elevated free thyroxine and suppressed TSH, autoimmunity to TSH receptor =
also exhibits
Grave’s
pretibial myxedema, exophthalmos, periorbital edema
delayed puberty plus anosmia =
failure of ______ secreting neurons to migrate from their origin in the olfactory placode
caused by a mutation in
Kallman
GnRH
KAL-1 or FGFR1
hirsuitism, acne, androgenic alopecia, menstrual irregularity, =
treated with oral contraceptive pills by suppressing _____ and decreasing ovarian androgen production
Polycystic ovary syndrome
LH secretion
vasopressin and oxytocin are synthesized within neuronns found in the ________ and ________ nuclei of the the hypothalamus and are released into the circulation from anxon terminals in the __________
paraventricular
supraoptic
posterior pituitary
_____________ are solid, cystic, calcified, suprasellar, childhood tumors that arise from _________ in the anterior pituitary. They cause mass effect with visual deficits
craniopharyngiomas
Rathke’s pouch remnants
Postop hypoparathyroidism treated with
secondary hyperparathyroidsim is dialysis patients is treated with
oral calcium (calcitriol) and vitamin D
Cinacalcet
patients with DKA have an _________ serum potassium despite a total body potassium _______ due to ___________ in intracellular stores
increased
deficit
decrease
leuprolide is a ________ agonist that causes a transient _______ in pituitary LH secretion, which leads to a ________ in testosterone levels and DHT levels, followed by ________ of LH release and a _________ in T and DHT
GnRH hormone
increase
increase
suppression
decrease
reduced gallbladder contractility due to decreased _______ secretion is responsible for biliary stones in patients with somatostatinoma
cholecystokinin
PKU with elevated prolactin and progressive neurologic degeneration due to _____ deficiency
dihydrobiopterin reductase
_________ cant use ketone bodies for energy because of the lack of mitochondria
RBCs
_______ decreases hepatic synthesis of TGs and VLDL and reduces HDL clearance. It also decreases renal excretion of uric acid which can precipitate
Niacin
gout
glucagon has a significant effect on ______, while an insignificant effect on skeletal muscle, adipose tissue, and renal cortex, unlike epinephrine
the liver
_______ stimulates gluconeogenesis by increasing the activity of pyruvate carboxylase. Pyruvate will be shunted toward ________ production when ______ levels are low, preventing the cell from becoming depleted of energy
Acetyl CoA x 3
________ competitively inhibits thyroid uptake of radioactive iodine isotopes following nuclear accidents to protect the thyroid
potassium iodide
___________ deficiency causes hereditary fructose intolerance, which manifests after fruits and fruit juices are introduced into the diet. This presents with failure to thrive, jaundice, and hepatomegaly in an infant recently off of breast milk
Aldolase B
family history and genetic predisposition to gestational hyperglycemia = decreased activity in __________ which is the glucose sensor in pancreatic beta cells
also seen in maturity onset diabetes of the young
glucokinase
most common deficiency of the urea cycle characterized by discrete episodes of vomiting, tachypnea, confusion, hyperammonemia and elevated orotic acid in the urine
Ornithine transcarbamylase
acetyl CoA is converted to ________ by acetyl CoA carboxylase during fatty acid synthesis. This product inhibits mitochondrial carnitine acyltransferase and beta oxidation of newly formed fatty acids
Malonyl CoA
HSM, neuro regression, cherry red macular spot in infancy =
due to
Niemann Pick
sphingomyelinase deficiency
Maple Syrup Urine Disease is ________ disorder characterized by the defective breakdown of _______
some patients improve with
AR
BCAA - leucine, isoleucine, valine
thiamine supplmentation
_________ is found in adipose tissue, where it functions to breakdown TG into free fatty acids for substrates for hepatic gluconeogenesis and ketone body formation
Hormone sensitive lipase
_______ syndrome results from maldevelopment of the _________, which give rise to the inferior parathyroids/thymus and the superior parathyroids, resulting in thymic and parathyroid hypoplasia.
gene
patients present with hypocalcemia (Chvostek and Trousseau sign), T cell dysfunction (recurrent viral, fungal, protozoan infections)
DiGeorge
3rd and 4th pharyngeal/branchial pouches
22q11.2 microdeletion
phosphorylation of _____ and ______ residues of insulin receptor and insulin receptor substrate by ______ leads to insulin resistance. This can be induced by TNF-alpha, catecholamines, glucocorticoids, and gluagon
serine
threonine
serine kinase
_______ found around the kidneys and adrenal galnds of a newborn contributes to temperature regulation by producing heat
brown adipose tissue
intellectual disability, seizures, light pigmentation, musty odor of a child =
essential amino acid for child =
PKU
tyrosine
pituitary adenomas are most commonly
prolactinomas
___________ such as prednisone are used to control severe Grave’s ophthalmopathy by decreasing the severity of _______ and decreasing extraocular volume. Conventional antithyroid drugs do not improve ophthalmopathy
High dose corticosteroids
inflammation
____________ with progressive beta cell loss is the most common cause of T1DM. Has characteristic ___________
autoimmune insulitis
Islet leukocyte infiltration
long acting sulfonlureas (glyburide, glimepiride) have a high incidence of _________ in the elderly
recurrent hypoglycemia
meningitis septicemia can cause _______ commonly called
bilateral hemorrhagic infarction of adrenal glands
waterhouse Friderichsen syndrome
mealtime insulin analogs (lispro, aspart, glulisine) with amino acid substitution at the C terminal end of the B chain have a ________ onset and offset of action
rapid
__________ can relieve HTN, tachycardia, fatigue, tremor, heat intolerance, but not exophthalmos in Grave’s
Beta blockers
non selective B blockers ______ hypoglycemia and mask its adrenergic symptoms mediated by NE and epi. They could be used with caution in patients with ______
(Propanolol)
diabetics
bile acid binding resins such as ________ increase uptake of cholesterol from the circulation, and reduce LDL levels, however, they increase hepatic production of ________
cholestyramine
TGs
the enzymes responsible for glycolysis, fatty acid synthesis, and the _______ reside in the ________
beta oxidation of fatty acids, the TCA cycle, and carboxylation of pyruvate all occur in the
pentose phosphate pathway
cytosol
mitochondria
weight loss and strenuous exercise with abnormal eating habits can lead to suppression of __________ and amenorrhea
hypothalamic suppression
_________ carcinoma cells are large with overlapping nuclei containing finely dispersed chromatin with a ground glass appearance (orphan annie eye) with numerous intranuclear inclusions and grooves. Psammoma bodies are also seen in this tumor
Papillary thyroid
Xanthelasmas on the eyelids indicated
LDL receptor abnormality
primary adrenal insuffiency where __________ administration does not increase serum cortisol
present with _______, ________, _________, and non anion gap metabolic acidosis
ACTH
hyponatremia
hyperkalemia
hyperchloremia
hyperprolactinemia from pituitary adenoma causes suppression of GnRH, which leads to reduced ______ in women and risk for __________
estrogen
accelerated bone loss
oxidative metabolism of glucose in pancreatic beta cells generates ________, which induces closure of the ______ sensitive K+ channel leading to membrane depolarization and subsquent insulin release
ATP
ATP
T1DM typically presents subacutely with polyuria, polydipsia, and polyphagia accompanied by fatigue and weight loss. THe diagnosis can be confirmed with a __________ or HbA1c
fasting blood glucose
________ is the most common cause of death in patients with DM
coronary heart disease (MI)
hyperparathyroidism is not a feature of MEN___`
2B
______ is a well known complication of hyperprolactinemia that is associated with prolactin induce hypogonadism. ________ is a another very common manifestation of estrogen deficiency
Low bone density
vaginal dryness
in pyruvate dehydrogenase complex deficiency, metabolism of exclusively ketogenic amino acids _________ can provide energy in the form of acetyl CoA without increasing lactate production
lysine, leucine
________ disease is caused by impaired transport of neutral amino acids in the small intestine and proximal tubule of the kidney. Symptoms include pellagra-like skin eruptions, cerebellar ataxia, which occur as a result of ______ deficiency.
Hartnup
niacin
_______ accounts for the difference of serum insulin level/time curves seen in IV vs oral glucose
Glucagon-like peptide 1
Zinc finger motifs are present in receptors for
steroids, thyroid hormone, and fat soluble vitamins
Fructose 2,6 bisphosphate activates phosphofructokinase-1 and inhibits fructose 1,6 bisphosphatase. Increased levels of F2,6BP inhibit _________ leading to decreased conversion of ________ to glucose
gluconeogenesis
alanine
orotic aciduria is a rare ______ disorder of de novo pyrimidine synthesis that occurs due to a defect in ______. Children typically present with physical and mental retardation, megaloblastic anemia, and large amounts of urinary orotic acid
treat with
UMP-synthase
uridine supplementation
thionamides (________) decrease the formation of thyroid hormones via ________ and coupling of iodotyrosines. _______ also decreases the peripheral conversion of T4 to T3
methimazole and propylthiouracil
inhibition of thyroid peroxidase
propylthiouracil
integral membrane proteins contain transmembrane domains composed of _________ with hydrophobic amino acid residues (alanine, valine, leucine, isoleucine), which help anchor the protein to the phospholipid bilayer
alpha helices
_______ deficiency impairs fatty acid transport, which also leads to deficient synthesis in
Carnitine
Acetoacetate
primary (______) polydipsia is a disorder characterized by increased intake of free water leading to hyponatermia and production oa large volume of dilute urine
psychogenic
________ in septic shock results from tissue hypoxia, which ___________ causing of shunting of pyruvate to lactate following glycolysis
lactic acidosis
impairs OxPhos
elderly patients with dementia or hemiparesis may have ____ which is a risk factor for aspiration pneumonia
dysphagia
muscle cells and adipocytes are insulin ________ via ______
brain, intestine, RBCs, kidneys, and liver are insuline ________ via ________
dependent GLUT4
Independent GLUT1,2,3,5
male neonates with _______ are born with feminized external genitalia that typically masculinize at puberty. A small phallus and hypospadias are common
5a reductase deficiency
SGLT2 inhibitors such as _______ are oral antidiabetic agents that work by decreased proximal tubular reabsorption of glucose, thereby promoting urinary glucose loss. It is recommended to monitor serum ______ before and after initiating therapy with SGLT2 inhibitors
canagliflozin, dapagliflozin
creatinine
_________ may lead to erythrocytosis, testicular atrophy, acne, and virilization in women
androgenic steroid abuse
metyrapone stimulation test will cause a reactive increase in
ACTH
long term glucocorticoid use due to SLE results in _______(adrenals)
bilateral cortical atrophy
beta blockers also decrease the rate of
T4 to T3 conversion
severe headache, ophthalmoplegia, panhypopituitarism, prolactinoma, severely hypotensive then LOC and death =
on autopsy
pituitary apoplexy
intrapituitary hemorrhage
CKD, coversion of ________ to 1,25dihydroxyvitamin D in the kidneys is impaired
leads to compensatory rise in
25hydroxyvitamin D
PTH
humoral hypercalcemia of malignancy is caused by secretion of _____
parathyroid related protein
sex hormones promote growth and epiphyseal plate _____
closure
transport of glucose into the cells of most tissues occurs by means of _________________ facilitated diffuse
carrier mediated
______________ contribute to insulin resistance by impairing insulin dependent glucose uptake and increasing hepatic gluconeogenesis
chronically elevated free fatty acids
tall boy, sweats a lot =
caused by
growth mediated
gigantism
hypersecretion of GH
IGF1 release from the liver (JAK/STAT)
young boy, routine blood draw shows milky plasma that forms creamy supernatant on standing, liporotein lipase activity measured after IV heparin administration is substantially lower than normal =
most likely risk of
elevated LDL or VDL =
RIsk of ?
familial chylomicronemia syndrome (elevated chylomicrons)
acute pancreatitis
family hypercholesterolemia or dysbetalipoporteinemia
premature coronary artery disease
primary hypothyroidism is characterized by ______ T4, ___________TSH, and _____________T3 (if early)
decreased
increased
normal
the insulin receptor is a transmembrane protein with intrinsic _______ activity
activates cell growth and DNA synthesis via
activates glycogen, lipid, and protein synthesis via
tyrosine kinase
RAS/MAP pathway
PI3K - protein phosphatase pathway
finasteride is a _________ inhibitor that suppresses peripheral conversion of testosterone to dihydrotestosterone. It it used to treat BPH and androgenic alopecia
5a reductase inhibitor
following pituitary resection, ACTH secretion and cortisol production would be _____. This would result in ______________ activty and reduced conversion of norepinephrine to epinephrine
decreased PNMT (phenylethanolamine-N-methyltransferase)
lispro, aspart, glulisine are ________ insulins
NPH is ______ insulin used ____ daily
Glargine, detemir are ______ insulins used ________ daily
Regular insulin is used best in _________ for DKA
short acting, postprandial
long acting, twice
long acting, once
IV
MEN2 consists of pheochomocytoma, ______, and either parathyroid hyper plasia (MEN2__) or marfanoid habitus and mucosal neuromas (MEN2__)
pathology
medullary thyroid cancer
A, B
RET; parafollicular calcitonin secreting C cells, nests or sheets of polygonal or spindle shaped, amyloid deposits that stain with Congo red
gestational diabetes, baby has macrosomia, HCM, hypoglycemia after delivery
hypoglycemia due to
beta cell hyperplasia and hyperinsulinism
cushings with low ACTH =
cushings with elevated ACTH suppressed by high dose dexamethasone but not low dose =
cushings with elevated ACTH not suppressed by high dose dexamethasone =
adrenal adenoma/carcinoma
pituitary adenoma
ectopic ACTH
severe DKA can cause pulmonary edema, respiratory fatigue, decreased mental status, hypoventilation and subsequent hypercarbic ________
respiratory failure
hyperglycemic developing cataracts due to conversion of glucose to
sorbitol
after 12-18 hours of fasting, ______ becomes the principal source of blood glucose. The initial steps involve conversion of pyruvate to _______ and then to __________
gluconeogenesis
oxaloacetate
phosphoenolpyruvate
SIADH presents with euvolemic
hyponatremia
all steroid producing cells contain a well developed
smooth ER
the diarrhea caused by celica disease can lead to ______ through malabsorption. patients with this deficiency have ________ serum phosphorus, _________ serum PTH, and ________ serum calcium
Vitamin D deficiency
decreased
increased
decreased
unlike aldose B deficiency and classic galactosemia, essential furctosuria (_________ deficiency) is a benign diosrder. Patients will have a positive copper reduction test but negative urine dipstick test
fructokinase
the acute effects of corticosteroids on the WBC include an ________ neutrophil count and a ______ lymphocyte, monocyte, basophil, and eosinophil count
increased
decreased
eruptive palmar xanthomas, premature atherosclerosis, defective ApoE3 and 4 =
decreased clearance of
familial dysbetalipoproteinemia: AR
chylomicrons and VLDL remnants
pyruvate dehydrogenase and alpha keto glutarate require ______ as a cofactor. Adminisstration of glucose to deficient patients (alcoholics) can result in Wernicke encephalopathy
thiamine
______ is essential in the conversion of pyruvate to oxaloacetate and fatty acid metabolism. Ingestion of avidin found in ________ has been associated with a deficiency in this. This condition presents with mental status changes, myalgias, anorexia, macular dermatitis, and lactic acidosis
biotin
egg whites
long term _________ use is associated primarily with catabolic effects (muscle weakness, skin thinning, impaired wound healing) except for in the ______
glucocorticoid
liver
_______ produced by the degradation of TGs in adipose tissue can be used by _________ in the liver and kidney to synthesize glucose during gluconeogenesis (DKA)
glycerol
glycerol kinase
_________ inhibits hepatic gluconeogenesis and increases peripheral glucose utilization. Lactic acidosis is a rare complication, but its risk is increased in patients with underlying renal insufficiency, which should assessed by serum ________
metformin
creatinine measurement
GH works through the ______ intracellular pathway
JAK-STAT
diabetes mellitus/hyperglycemia, diarrhea, necrolytic migratory erythema =
diagnosis
glucagonoma
elevated glucagon levels
