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General Boards > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Which ketones are/are not detected by a urine dipstick?

A

Beta-hydroxybutyrate are not (most prevalent ketone in DKA), acetone and acetoacetate are

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2
Q

What receptor/messenger system does ACTH utilize?

A

G-protein linked receptor, stimulates adenyl cyclase, increases intracellular cAMP, activates protein kinase A

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3
Q

Which hormone inhibits glucagon secretion?

A

Somatostatin (also suppresses insulin, growth hormone)

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4
Q

Which factors regulate the secretion of aldosterone?

A

Potassium concentration in ECF (hyperkalemia increases aldosterone secretion), RAAS system (angiotensin II secretion increases aldosterone secretion), sodium concentration in ECF (hypernatremia weakly inhibits aldosterone secretion)

ACTH is necessary for secretion of aldosterone but has little role in regulating it

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5
Q

Which hormones are secreted by the anterior pituitary gland?

A

Prolactin, ACTH, TSH, FSH, LH, GH

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6
Q

What are some biochemical abnormalities of hypoadrenocorticism?

A

Hyponatremia, hyperkalemia, hypochloremia, hypercalcemia, mild acidosis, lack of stress leukogram (normal neutrophil count/lymphocyte count despite illness), azotemia (pre-renal or renal), mild hypoglycemia

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7
Q

What are the general goals/treatments for management of a patient with DKA?

A

Goals: 1) restore intravascular volume, 2) resolve dehydration, 3) attend to electrolyte disturbances, 4) correcting acid-base imbalances, 5) decrease BG, 6) rid body of detectable ketones, 7) identify/treat co-existing diseases

Treatments: 1) Fluid therapy (buffered solution with added KCl), insulin (short-acting/regular insulin, intermittent boluses or as CRI) w/ dextrose, continue insulin until ketones resolved, patient eating/drinking then switch to long acting insulin (NPH)

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8
Q

Reason for increased TSH and total T4 in dog

A

Early hypothyroidism? (auto-antibodies can cross-react with TT4 test and cause a falsely high value, elevated TSH due to decreased thyroid hormone negative feedback)

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9
Q

What is the most sensitive test for diagnosis of hyperthyroidism in cat

A

fT4 is the most sensitive (98%) BUT, less specific (more false positives) and more expensive assay. Not used as the first-line screening test

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10
Q

What is the main factor for vasopressin (ADH) release?

A

Increased osmolality; other factors include hypovolemia, hypotension, nausea, pain, stress, and drugs

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11
Q

What is the effect of insulin on glucose metabolism

A

Increases uptake and storage of glucose by muscles (as glyocogen), adipose tissue as glycerol, then triglycerides), and liver (as glycogen) and inhibits gluconeogenesis. Overall effect is anabolic

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12
Q

Which thyroid product is faster acting (tsh, thyroglobulin, t4, t3)?

A

T3

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13
Q

What results do you expect on a LDDS test in a normal patient, a patient with PDH, and a patient with FAT?

A

Normal patient: Pre (any), 4 hour (any), 8 hour (suppressed <40 nmol/L)
PDH: Pre (normal), 4 hour (<50% baseline or <40 nmol/L), 8 hour (>40 nmol/L)
FAT: Pre (normal), 4 hour (>50% basal or >40 nmol/L), 8 hour (>40 nmol/L but <50% basal)

Basically, if 8 hour is >40 nmol/L, you can diagnose HAC; the 4 hour mark may or may not prove diagnostic in differentiating between PDH and FAT

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14
Q

Which hormones are secreted by the posterior pituitary gland?

A

Antidiuretic hormone and oxytocin

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15
Q

What test results do you expect to see (PTH, PTHrP, iCa, tCa) in a primary hyperparathyroid patient?

A 
PTH - Normal or elevated 
PTHrP - Normal (none) 
iCa - elevated 
tCa - elevated 
P - low or low-normal
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16
Q

What test results do you expect to see (PTH, PTHrP, iCa, tCa, P) in a patient with hypercalcemia secondary to CKD?

A 
PTH - Elevated 
PTHrP - Normal (none) 
iCa - usually normal 
tCa - mildly elevated 
P - elevated
17
Q

What test results do you expect to see (PTH, PTHrP, iCa, tCa, P) in a patient with hypercalcemia secondary to malignancy?

A 
PTH - Normal or low 
PTHrP - Normal or elevated (not all malignancies associated with elevated PTHrP 
iCa - elevated
tCa - elevated
P - low
18
Q

What test results do you expect to see (PTH, PTHrP, iCa, tCa, P) in a patient with hypercalcemia secondary to vitamin D toxicosis?

A 
PTH - Low
PTHrP - Normal (none) 
iCa - elevated
tCa - elevated
P - elevated
19
Q

What is the main mechanism behind PU/PD in hyperadrenocorticism?

A

Cortisol inhibits the action of ADH on V2 receptors in the collecting ducts of the nephron > decreased water reabsorption > polyuria (secondary nephrogenic diabetes insipidus).

20
Q

What are the main functions of aldosterone in terms of electrolyte absorption/secretion?

A

Na+ absorption, K+ secretion, H+ secretion

21
Q

Where does PTH come from and what effect does it have on the kidney, bone and intestine?

A

PTH comes from the chief cells of the parathyroid glands.

Kidney:

  • Enhances Ca++ reabsorption and increases phosphorus excretion
  • Stimulates conversion of calcidiol to calcitriol (active form of vitamin D), which stimulates Ca++ and phosphorus absorption in the intestine

Bone:
-Enhances release of Ca++ and phosphorus into the bloodstream

Intestine:
-Enhances Ca++ and phosphorus absorption (mediated by vitamin D)

22
Q

What is the mechanism of action of Trilostane?

A

It is a competitive inhibitor of 3-beta hydroxysteroid dehydrogenase, which catalyzes the biosynthesis of steroids

23
Q

What is the mechanism of action of Mitotane?

A

It is an adrenocorticolytic; it causes selective necrosis of the zona fasciculata and reticularis

24
Q

What enzyme in the adrenal cortex does ACTH stimulate?

A

Cholesterol desmolase

25
Q

What hormones cause insulin release?

A

CCK, secretin, GIP, gastrin, glucagon

26
Q

What hormones are produced by the kidney?

A

EPO, renin, calcitriol (active form of vitamin D)

27
Q

What is the most common cause of insulin resistance in cats?

A

Acromegaly (hypersomatotropism)

Results in increased levels of GH, which has anti-insulin effects.

28
Q

What are the functions of thyroid peroxidase (TPO)?

A

1) Conversion of iodide to iodine
2) Incorporation of iodine into the tyrosine residues of thyroglobulin
3) Coupling of the iodine/thyroglobulin molecules together to form either T3 or T4

29
Q

What causes increased GFR in hyperthyroid patients?

A

Increased metabolism leads to increased by-production of vasodilators > decreased systemic vascular resistance > activation of the RAAS > increased GFR

30
Q

What is the mechanism of action of methimazole?

A

Inhibits TPO

31
Q

What drugs can potentially cause a decrease in thyroid levels?

A 
Phenobarbital
Steroids
Sulfonamides - this one can actually cause clinical hypothyroidism
NSAIDs
Tricyclic antidepressants (clomipramine)
32
Q

What is the mechanism behind hypoglycemia seen in Addison’s disease?

A

Decreased glucocorticoids leads to decreased hepatic gluconeogenesis and increased peripheral sensitivity to insulin.

33
Q

Where does calcitonin come from and what is it’s mechanism of action?

A

Calcitonin comes from the c cells (parafollicular cells) of the thyroid gland.

Calcitonin opposes the action of PTH mainly by inhibiting osteoclastic activity in bone. (Lesser effect is to inhibit renal tubular reabsorption of Ca++ and phosphate)

34
Q

What causes the myopathy in hypothyroid dogs?

A

Impaired Na+/K+ pump activity causing axonal degeneration.

Results in generalized weakness, laryngeal paralysis, megaesophagus, facial paralysis, peripheral vestibular signs.

35
Q

What is the most potent stimulator for aldosterone secretion?

A

K+

36
Q

How does insulin affect lipoprotein lipase (LPL)?

A

Increases/activates LPL

37
Q

What works directly in the brain to increase appetite?

A

Ghrelin

38
Q

What are the symptoms of untreated Cushing’s disease?

A

PU/PD, polyphagia, apparent weight gain, muscle weakness, panting, hair loss, hypertension, hypercoagulable, impaired wound healing and recurrent infections

39
Q

Where are the islets of Langerhans found and what is their function?

A 
Endocrine cells of the pancreas
Beta cells - secrete insulin and amylin
Alpha cells - secrete glucagon
Delta cells - secrete somatostatin
Epsilon cells - secrete ghrelin
Gamma (F or PP cells) - secrete pancreatic polypeptide

General Boards (19 decks)

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