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Endocrine I Flashcards

1
Q

What does the anterior pituitary derive from?

A

Rathke’s pouch (ectodermal diverticulum)

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2
Q

What does the posterior pituitary derive from?

A

Invagination of the hypothalamus (neuroectoderm)

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3
Q

What gets secreted from the supraoptic nuclei?

A

ADH (AKA vasopressin)

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4
Q

What increases ADH secretion?

A

Nicotine

Opiates

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5
Q

What decreases ADH secretion?

A

Alcohol
ANP
Decreased serum osmolarity

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6
Q

What does ADH do?

A

ADH binds to V2 → increased cAMP → increased aquaporin 2 to lumenal side

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7
Q

Which 4 hormones have the same alpha subunit?

A

LH, FSH, hCG, and TSH

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8
Q

ACTH and MSH (melanin stimulating hormone) are both originally part of what protein?

A

Proopiomelanocortin (POMC)

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9
Q

Sheehan syndrome happens when there is hypo perfusion to the pituitary after labor/delivery. What symptoms would be expected with this condition?

A

Agalactorrhea (no oxytocin)
Amenorrhea (no FSH/LH)
Secondary hypothyroidism (no TSH)

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10
Q

Why are the fetal adrenals so important?

A

Cortisol is needed for type II pneumocytes to produce surfactant

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11
Q

What are the symptoms of 21a-hydroxylase deficiency?

A

Increased ACTH (d/t inability to produce cortisol)
Hypotension and salt wasting ( d/t inability to produce mineralocorticoids)
Masculinization (d/t increased production of sex hormones)

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12
Q

What is seen with 17a-hydroxylase deficiency?

A

Phenotypic female who is unable to mature (d/t inability to produce sex hormones and cortisol)
HTN (d/t increased production of mineralocorticoids)

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13
Q

What is seen with 11b-hydroxylase deficiency?

A

HTN (d/t increased production of deoxycorticosterone)

Masculinization (d/t increased production of sex hormones)

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14
Q

How does deoxycorticosterone cause HTN?

A

Deoxycorticosterone is a weak mineralocorticoid

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15
Q

What is an easy way to remember the symptoms with steroid synthesis enzyme deficiencies?

A

1X → HTN

X1 → masculinization

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16
Q

When is cortisol (a glucocorticoid) released?

A 
In response to stress:
Up-regulates apha1 arteriole receptors
Increases gluconeogenesis (and similar)
Suppresses immune system and inflammation
Decreases bone formation
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17
Q

How does cortisol suppress the immune system/inflammation?

A

Inhibits COX and PLA2

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18
Q

What is the most common cause of Cushing syndrome?

A

Exogenous steroid use

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19
Q

Besides exogenous steroid use, what are some other causes of Cushing syndrome?

A

Cushing disease
Ectopic ACTH
Cortisol-producing adrenal adenoma

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20
Q

What is Cushing disease?

A

An ACTH producing pituitary adenoma

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21
Q

What kind of cancer produces ectopic ACTH?

A

Small cell lung cancer

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22
Q

What CAN’T you confuse small cell lung cancer’s production of ACTH with?

A

Squamous cell lung cancer’s production of PTH-like protein

23
Q

What should be seen in a normal person with low-dose and high-dose dexamethasone tests?

A

Cortisol normally decreases with dexamethasone administration

24
Q

Dexamethasone tests are done, and cortisol remains high after both tests. What is the cause of the Cushing syndrome?

A

Either ectopic ACTH or a cortisol-producing adrenal adenoma

No matter how much synthetic glucocorticoid is given, there will not be a negative-feedback inhibition

25
Q

Dexamethasone tests are done, and cortisol remains high after the low-dose but lowers after the high-dose. What is the cause of the Cushing syndrome?

A

Cushing disease

At a high enough dose there will be negative-feedback inhibition

26
Q

What is the mnemonic for the symptoms of Cushing syndrome?

A

“BAM, CUSHINGOID’’

27
Q

What symptoms does the ‘BAM’ in “BAM, CUSHINGOID” represent?

A

Buffalo hump
Amenorrhea
Moon facies

28
Q

What symptoms does the ‘CUSH’ in “BAM, CUSHINGOID” represent?

A

Crazy
Ulcers
Skin changes
HTN

29
Q

What symptoms does the ‘ING’ in “BAM, CUSHINGOID” represent?

A

Infection
Necrosis of femoral head
Glaucoma (and cataracts)

30
Q

What symptoms does the ‘OID’ in “BAM, CUSHINGOID” represent?

A

Osteoporosis
Immunosuppression
Diabetes

31
Q

What is the effect of aldosterone (mineralocorticoid)?

A

Activates ENaC and ROMK

32
Q

What increases the secretion of aldosterone?

A

High K+ (ROMK secretes K+)
Low Na+ (ENaC reabsorbs Na+)
ATII (reabsorption of water)

33
Q

What decreases the secretion of aldosterone?

A

High Na+

34
Q

A patient comes in with HTN, hypokalemia, and metabolic alkalosis. What is the likely diagnosis?

A

Hyperaldosteronism

35
Q

What is it called when there is an aldosterone secreting tumor?

A

Conn Syndrome

36
Q

Why does metabolic alkalosis occur with hyperaldosteronism?

A

H+/K+ ATPase tries to correct the hypokalemia…which then decreases serum H+ (which is the same thing as saying increasing the pH)

37
Q

What is a secondary cause of hyperaldosteronism?

A

Excess renal renin production d/t perceived low volume…like with stenotic renal arteries

38
Q

A patient presents with hypotension, hyponatremia, hyperkalemia, and skin hyperpigmentation. What is the likely diagnosis?

A

Addison’s disease (primary adrenal insufficiency)

39
Q

What is the likely cause of Addison’s disease?

A

Addison’s is usually autoimmune

40
Q

What are some situations in which the there can be a hemorrhage in the adrenals?

A

Waterhouse-Friderichsen syndrome can be occur with severe meningococcal sepsis or DIC

41
Q

What is seen with secondary adrenal insufficiency?

A

Leg weakness

Weight loss

42
Q

What causes tertiary adrenal insufficiency?

A

Sudden withdrawal of corticosteroids

43
Q

A patient comes in concerned about periodic headaches, sweats, and rapid heart rate. What is the likely diagnosis? What else is likely seen during these episodes?

A

This patient likely has a pheochromocytoma

There would also be HTN during these episodes

44
Q

What is seen on UA with a pheochromocytoma?

A

Catecholamine breakdown products (metanephrine, normetanephrine, vanillylmandelic acid [VMA])

45
Q

What are the rules of 10 for pheochromocytoma?

A 
10% malignant
10% bilateral
10% extra adrenal
10% calcify
10% children
46
Q

What are some associations of pheochromocytoma?

A

MEN2A and MEN2B

NF1

47
Q

Besides catecholamines, what else can be secreted by a pheochromocytoma? What other cancers can secrete this?

A

A pheochromocytoma can secrete EPO

Renal cell carcinoma, Hemangioblastoma, and Hepatocellular carcinoma can also secrete EPO

48
Q

What drug is used to treat HTN with a pheochromocytoma?

A

Alpha-blocker

A beta-blocker would cause unopposed alpha-receptor activity…like with cocaine addicts

49
Q

What is a tumor of sympathetic ganglion cells typically seen in children?

A

Adrenal neuroblastoma

50
Q

What is the primary symptom of an adrenal neuroblastoma?

A

Mild HTN

51
Q

What are some associations of adrenal neuroblastoma?

A

N-myc oncogene
Bombesin tumor marker
Neurofilament stain
Homer-Wright pseudorosettes

52
Q

What is seen with MEN1? What is the mutation?

A

Diamond shape
Parathyroid adenoma
Pituitary adenoma
Pancreatic tumor

Menin has a loss-of-function

53
Q

What is seen with MEN2A? What is the mutation?

A

Square shape
Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid cancer

Ret has a gain-of-function

54
Q

What is seen with MEN2B? What is the mutation?

A

Triangle shape
Medullary thyroid cancer
Pheochromocytoma
Ganglioneuromatosis

Ret has a gain-of-function

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