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PAS 753 (Molecular Pathophysiology) > Endocrine > Flashcards

Endocrine Flashcards

1
Q

paracrine

A

chemical signalling to nearby cells

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2
Q

autocrine

A

chemical signaling of cells among the same type

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3
Q

major endocrine glands (10)

A
  1. pineal gland
  2. parathyroid
  3. thyroid
  4. hypothalamus
  5. pituitary
  6. thymus
  7. kidney
  8. adrenal
  9. pancreas
  10. ovary/testes
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4
Q

what type of feedback loop primarily regulates the endocrine system

how is regulation accomplished

A

negative

secretion of inhibiting or enhancing factors

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5
Q

short feed back loop

A

a feedback loop where a trophic hormone from the pituitary inhibits production of stimulating factors from the hypothalamus

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6
Q

long feedback look

A

a feedback loop where the end hormone produce by trophic stimulation will inhibit production at the hypothalamus and pituitary

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7
Q

which is more relevant, long or short feedback loops?

why?

A

long, because they work on the hypothalamus and the pitutiary

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8
Q

how are hormones sent through out the body

A

dissolved in blood or bound to carriers

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9
Q

what type of hormones will dissolve in blood

what type of hormones will need a carrier

A

water soluable

lipid soluble

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10
Q

target cell

A

the end-target of a hormone that produces a response within the cell

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11
Q

two ways that hormone-receptor complexes elicit effects in target cells

A

2nd messanger

DNA transcription leading to protein production

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12
Q

what links receptors of the same “family)

A

they have a similar structure

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13
Q

what can happen if a homone is present in high enough concentrations

A

the hormone can interact with receptors of the same family

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14
Q

four types of receptor hormone interactions

A

agonists (stimulate receptors)

antagonists (block receptors)

down regulation

change receptor affinity

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15
Q

why is it imporant to know the amount of a hormone that is bound vs free

A

a bound hormone can’t do anything

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16
Q

T/F horomes are secreted continuously

A

false they are usually in pulses

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17
Q

three amino acid hormones

A

dopamine

thyroxine

catecholamines

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18
Q

four small neurpeptide hormones

A

GnRH

TRH

vasopressin

somatostatin

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19
Q

5 protein/glycoprotein hormones

A

FSH

LH

TSH

HCG

Insulin

PTH

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20
Q

three types of steroid hormones

A

estrogens

androgens

progestins

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21
Q

two types of vitamin derived hormones

A

retinoids (vitamin A)

vitamin D

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22
Q

5 general categories of hormones

A

amino acid

neuropeptides

proteins/glycoproteins

Steroids

Vitamin deriviatives

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23
Q

why can FSH, LH, TSH, and HCG cross react with each other

A

they have receptors in the same family

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24
Q

three facts about peptide/protein/glycoprotein hormones

A

water soluble

interact with cell membrane

work through second messanger

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25
Q

three facts about steroid hormones

A

insoluble

requires transport molecules

causes DNA transcription and translation

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26
Q

explain why endocrine systems are homeostatic

A

they respond to outside challenges to maintain homeostasis

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27
Q

three environmental changes that can cause an endocrine response

A

nutritional

thermal

existential

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28
Q

what is the main task of the thyroid

A

to produce T3 ad T4

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29
Q

what is the full name of T3

T4

which is the main functional hormone of the thyroid

A

triodothyroinine

tetraiodothyroinine

T3

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30
Q

which thyroid hormone is most readily available

why is this effect in treatment

A

T4

because T4 is converted to T3 in tissues

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31
Q

where are T3 receptors found

A

in alll most all human tissue

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32
Q

5 locations in the body with especially high numbers of T3 receptors

A

brain

heart

muscle

kidneys

gonads

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33
Q

what will the response to T3 be

A

increased…

energy utilization

protein synthesis

sensitivity to other hormones

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34
Q

two regulators of thyroid function

A

thyrotropin-releasing hormone (TRH)

thyrotropin (TSH)

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35
Q

what is the function of TRH

A

stimulates the production of TSH and prolattin

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36
Q

what is the effect of thyrotropin (TSH)

A

increased T3 and T4

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37
Q

what wil happen if the thyroid gland is dysfunctional

what can also happen?

A

TRH and TSH will be produced in high amounts

prolactin can also be produced

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38
Q

two main types of hyperthyroidism

A

graves disease

toxic nodular goiter

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39
Q

what are the laboratory tests that will confirm hyperthyroid

A

very low or absent TSH

very high T4

sometimes autoimmune tests are positive

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40
Q

what nervous system are many of the symptoms of hyperthyroidism related to

A

sympathetic nervous system

  1. restlessness
  2. insomnia
  3. tremor
  4. weight loss
  5. heat intolerance
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41
Q

three disease that can be triggered by hyperthyroid

A

acute chest pain (MI)

CHF

Arrhythmia

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42
Q

why would you check for hyperthyroidism in new onset a fib

A

because hyperthyroid can trigger arrhytmias

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43
Q

what is the most common type of hyperthyroidism (60-80%)

A

graves disease

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44
Q

what causes graves disease

A

auto-antibodies that bind and active TSH receptors

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45
Q

what is the gender ratio of patients with graves disease

A

female 8:1

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46
Q

exophthalmos

cause

A

protrusion of the eyes found in 20-40% of Graves patients

caused by lymphcytic infilitration of the eyes

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47
Q

what is the cause of goiters

is there a gender bias

what may be a contributing factor

A

unknown

no, 1:1

low iodine may contribute

48
Q

in what hyperthyroid condition does exopthalmos not occur

A

goiter

49
Q

what is the treatment plan of hyperthyroid

A

control symptoms

prevent thyrid storm

plan long term control

50
Q

thyroid storm

A

acute high levels of T3 and T4 that can cause hypotension and fever

51
Q

two long term control options for hyperthyroid

A

thyroid excision or destruction

continued antithyroid drugs

52
Q

what do beta blockers do in treating hyperthyroid

four results of treatment

A

block sympathetic pathways

rapid reduction in anxiety, restlessness, tremor, palpitations

53
Q

what are two methods of lowering T3 and T4 in hyperthyroidism

A

prevent hormone release

stop T3 and T4 production

54
Q

what drug can stop the relase of T3 and T4

A

potassium iodine

55
Q

what drugs stop the production of T3 and T4

when are they most effective

A

thioamides

when combined with beta blockers and potassium iodine

56
Q

what is the preferred method of treatment to definatively cure hyperthyroid

what makes it good

A

ablation wth radioactive iodine

because it spares the parathyroid

57
Q

why can radioactive iodine be used to ablate the thyroid

A

because the thyroid is the only place where iodine is stored in the bdoy

58
Q

what lab tests confirm hypothyroid

A

Low T4

very high TSh

59
Q

five hypothyroid symptoms

A
  1. cold intolerance
  2. hair loss
  3. weight gain
  4. weakness
  5. dry skin
60
Q

primary hyperthyroid

A

the 99% of hypothyroidism that is caused by failure of the thyroid galdn

61
Q

secondary hyperthyroid

A

failure of the pituitary to release TSH

62
Q

four causes of hypothyroid

A

post thyroidectomy/ablation

hashimotos thyroiditis

Drug induced

dietary iodine deficiency

63
Q

what is the most common cause of hypothyroid

A

hashimotos thyroiditis

64
Q

what drug will cause hypothyroid

A

amiodirone

65
Q

how common is hashimotos

is there a gender bias

A

1-4/1000

females 1:4

66
Q

what happens in hashimotos

A

the thyroid is infiltrated with T and B cells

67
Q

what is the first line treatment for hypothyroid

A

daily thyroxine

68
Q

two parts of the adrenal gland

A

medulla

cortex

69
Q

what is the function of the adrenal medulla

A

secretes epi/norepinephrine

70
Q

what is the function of the adrenal cortex

A

secretes glucocorticoids, androgens, mineralocorticoids

71
Q

describe the negative feedback loop that regulates adrenal function

A

pituitary secretes ACTH

adrenal cortex secretes cortisol

cortsol inhibits ACTH secretion

72
Q

cushing syndrome

A

a cluster of symptoms caused by excess cortisol

73
Q

three causes of Cushings

A

iatrogenic

secondary adrenal hyperplasia

primary adrenal hyperplasia

74
Q

what is a common iatrogenic cause of cushings

A

prednisone

75
Q

what causes cushings disease

what is the distinction between this and secondary adrenal hyperplasia

A

an ACTH secreting tumor on the pituitary

there isn;t one

76
Q

where are other ACTH secreting cells located beside the pituitary

A

small cell lung cancers

77
Q

primary adrenal hyperplasia causes

A

idiopathic

neoplasm

congenital

78
Q

five effects of cortisol

A

increases glucose production

raises blood pressure

raises blood sugar

lowers lymphcyte and monocyte levesl

79
Q

what two effects of cortisol are considerd to improve resistance to stress

A

increased glucose availibility

increased blood pressure

80
Q

5 adverse effects of cortisol

A

weight gain

striae

moon facies

HTN

peptic ulcers

81
Q

T/F most chronic conditions are no effected by cortisol

A

false, many (such as DM and HTN) can be exacerbated by cortisol

82
Q

how does cortisol exacebate HTN?

DM

A

HTN: increase salt intake

DM: increase blood sugar

83
Q

tests and exams to confirm cushings

A

elevated cortisol

cortisol suppression test

Low ACTH levels

imaging

84
Q

what pattern is lost with cushing syndrome

A

the diurnal pattern which causes higher cortisol in the morning and lower at night

85
Q

three possible treatment plans for cushings

A

stop glucocorticoids

surgery

antiglucocorticoid medication

86
Q

what diagnoses for cushings have a good prognosis?

poor?

A

good: cushings disease and iatrogenic cushings
bad: adrenal carcinoma and small cell lung cancer

87
Q

define diabete mellitus

A

a disorder characterized by chronic hyperglycemia due to relative or absolute deficiency of insulin, or resistance to insulin

88
Q

what cells in the pancreatic islets that secrete insulin

glucagon

A

beta cells

alpha cells

89
Q

which are more prominent, alpha or beta cells?

A

alpha (75% to 20%)

90
Q

what is insulin

what compound is it derived from

how does this happen

A

a small protein

conversion of proinsulin into insulin

removal of connecting C peptide

91
Q

what is the fucntion of C peptide after it is removed from proinsulin

what would high levels of c peptide indicate?

low?

A

nothing

high levels = type 2 DM

low = type 1 DM

92
Q

two actions of insulin

A

inhibit catabolism

promotes anabolism

93
Q

how does insulin promote anabolism

A

increase glycogen production and storage

promotes triglyceride synthesis in fat cells

incrases protein synthesis in muscle

94
Q

how does insulin inhibit catabolism

A

inhibits glycogen break down

inhibits amino acid and fatty acid break down

95
Q

describe tie etiology of Type I DM

A

an autoimmune disorder that causes rapid loss of beta cells

96
Q

what triggers beta cell loss in type I DM

A

can be a virus or toxin such as mumps or coxsackie, as well as a genetic predispostion

97
Q

describe the etiology of type II DM

A

a very slow loss of beta cells causd by genetic or obestity

98
Q

three Ps of diabetes

A

polyuria

polydipsia

polyphagia

99
Q

two other symptoms of diabetes that aren’t the 3 Ps

A

weight loss despite increased appetite

fatigue

100
Q

fatal complication of diabetes

A

diabetic ketoacidosis

101
Q

what typpe of diabetics are most likely to have DKA

A

type one

102
Q

five chronic complications of DM

A

CAD

PVD

nephropathy

neuropathy

retinopathy

103
Q

what causes DKA

A

hyperglycemia >300mg/dl causes keto acids to accumulate

104
Q

five symptoms of DKA

A

tachycardia

dehydration

SOB

lethargy

coma

105
Q

four conditions that are most commonly caused by DM

A

chronic renal failure

neuropathic pain

blindness

gangrene caused limb amputation

106
Q

what was the mean survival of a diabetic patient before 1922

after

what changed?

A

5 year <5%

increaed to 30-40 years

insulin was discovered

107
Q

when will most diabetic have complications

A

after 20 years

108
Q

what is the treatment for type I DM

type II

A

type I = insulin

type II = insulin plus other stuff

109
Q

five non-insulin treatments of DM

A

reduce insulin resistance

stimulate secretion fo endogeneous insulin

reduce glucagoon

reduce glucose absorption

enhance urinary secretion

110
Q

T/F complete control of glucose is bad

A

true, it decreases longevity

111
Q

what does tight management of DM entail

A

diet

frequent blood assays

medication 3-4 times daily

flexible dosing

112
Q

what is the hallmark of type II DM

A

insulin resistance

113
Q

two stratgies to reduce insulin resistance

A

weight loss

medication (biguanides and thiaxolidinediones)

114
Q

what is the most common medication for type II DM

A

metformin (glucophage)

115
Q

medication used to decrease glucagon secretion

A

glucagon like peptide 1

116
Q

where does glucagon like peptide naturally come from

what does it do

A

L cells in the intestine

opposes insulin

PAS 753 (Molecular Pathophysiology) (17 decks)

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