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Endocrine II Flashcards

1
Q

what is the thyroid glands secretory functional unit?

A

follicle

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2
Q

what does the thyroid follicle include?

A

cuboidal cells (follicular cells)
colloid (lumen)
c-cells (parafollicular cells)

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3
Q

cuboidal cells function

A

TG synthesis

iodine

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4
Q

colloid cell function

A

TG storage

T4/T3 storage

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5
Q

c cells function

A

calcitonin

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6
Q

what are the 8 steps to synthesis of t3/t4

A

1 TG synthesis and transport to lumen
2 Na/I cotransport into membrane
3 oxidation of I by peroxidase
4 organification of I into MIT and DIT on tyrosine on TG by peroxidase
5 coupling of MIT and DIT into t3/t4 by peroxidase
6 endocytosis of TG
7 hydrolysis and entering circ of t3/t4 by proteases
8 deiodination of MIT and DIT, recycle I and tyrosine

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7
Q

what is hashimotos thyroiditis?

levels of T4, TSH, TRH, Goiter?

A 
chronic lymphocytic thyroiditis 
(primary HYPOthyroidism)
T4- decrease
TSH- increase
TRH- increase
Goiter? possible
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8
Q

what is pituitary hypothyroidism?

levels of T4, TSH, TRH, Goiter?

A 
secondary hypothyroidism
T4- decrease
TSH- decrease
TRH- increase
Goiter? no
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9
Q

what is graves disease? BUG EYES

levels of T4, TSH, TRH, Goiter?

A 
TSI autoimmune primary HYPERthyroidism
T4- increase
TSH- decrease
TRH- decrease
Goiter? possible
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10
Q

does the thyroid make more t4 or t3?

A

t4 90%

t3/rt3 10% (made mostly by other tissues deiodinizing)

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11
Q

if you have a t4 and you deiodinize the inner ring, is it active or inactive?

A

inactive

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12
Q

in the circulation are t3/t4 free or bound?

A

bound 70% to TBG

bound 29% to albumin

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13
Q

what are the half lives for t3/t4, why is t4 greater?

A

t4- 6 days, b/c higher affinity for TBG

t3- 1 day

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14
Q

does birth control increase or decrease TBG?

A

increase

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15
Q

does liver failure increase or decrease TBG?

A

decrease

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16
Q

to have a goiter what do you need?

A

activation of TSH receptor, by TSH or TSI

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17
Q

does t3 or t4 have greater affinity for the THR?

A

t3

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18
Q

what are the 4 B’s of normal T3 function?

A

basal metabolic rate
beta adrenergic effects
brain maturation
bone turnover– bone growth

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19
Q

when would you have an increased likelihood of fracture? hypo or hyper thyroidism?

A

BOTH

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20
Q

subclinical

A

no clinical symptoms of disease yet, but still has disease

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21
Q

what is a good starting point to test thyroid function?

A

TSH

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22
Q

Is Iodine deficiency hypo or hyper? TSH?

A

hypo, TSH increase

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23
Q

is HPA depression hypo or hyper? TSH?

A

hypo, TSH decrease

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24
Q

is pituitary adenoma hypo or hyper? TSH?

A

hyper, TSH increase

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25
what are the clinical manifestations of thyroid storm?
``` fever tachy nausea diarrhea vomit arrhythmias ```
26
what pts are most likely to have thyroid storm?
graves disease thyroid tumor high dose thyroid meds subclinical hyperthyroidism
27
what are the treatments for thyroid storm? 3
``` PTU (inhibit t4/t3) potassium iodide (wolff-chaikoff effect, too much iodine) beta blocker (also slow t4-t3 conversion) ```
28
once thyroid hormones are transported to tissue cells what happens?
bind to hormone receptors that bind DNA and alter gene transcription
29
what are the two functional glands of the adrenal cortex?
cortex (3 layers that surround the medulla) | medulla (functions as modified sym. ganglion)
30
what are the 3 layers of the cortex
glomerulosa fasciculata reticularis
31
which layer binds ANGII/K and what does it produce?
``` glomerulosa aldosterone (mineralcorticoids) ```
32
which layer binds ACTH and makes cortisol? (glucocorticoids)
fasciculata
33
which layer binds ACTH and makes androgens?
reticularis
34
what does the medulla bind? what does it produce?
Binds ACTH/cortisol/Ach | produces epo
35
17alpha-OH deficient, ACTH? BP? aldosterone? androgen?
ACTH- increase BP- increase Aldosterone- increase androgen- decrease
36
21beta-OH deficient, ACTH? BP? aldosterone? androgen?
ACTH- increase BP- decrease Aldosterone- decrease androgen- increase
37
11beta-OH deficient, ACTH? BP? aldosterone? androgen?
ACTH- increase BP- increase Aldosterone- increase androgen- increase
38
what in cortisol production causes skin pigment changes?
MSH
39
how much of cortisol is protein bound?
CBG 92% (less available) | albumin 8%(bioavailable)
40
when is cortisol highest in the day
morning
41
what are the critical effects of cortisol? BIG FIB
``` BIG increase in BP increase in Insulin resistance increase in Glucose FIB decrease in Fibroblasts (stretch marks) decrease in Inflammation and immunity decrease in Bone formation BONUS: impaired learning/mem ```
42
what things make cortisol anti inflammitory
``` stabilizes lysosomal membranes decrease capillary permi decrease WBC migration decrease lymphocyte prolif decrease in interleukin, histamine, prostaglandin ```
43
if you are fasting and have acute stress what are the results?
liberation of all forms of energy: increase EPI/NE liver- glycogen to glucose sm- protein breakdown, glycogen to glucose adipose- fat breakdown
44
if you are overfed and chronically stressed
muscle wasting/ IR/ weight gain: decrease EPI/NE CNS- increase appetite liver- increase glycogen synthesis sm- protein breakdown, decrease glucose uptake adipose- decrease fat breakdown, TG synthesis, decrease glucose uptake
45
what is cushings syndrome usually caused by
ACTH secreting tumor adrenocortical hyperplasia excess cortisol
46
what does cushings disease look like?
``` unusual obesity striae bone loss muscle wasting buffalo hump diabetes ```
47
what can increase aldosterone?
****mostly RAAS ANGII increases serum K increases ACTH
48
what does aldosterone do to Na and K?
increases Na reabsorption | increases K secretion
49
what is the half life of aldosterone?
20min
50
how do corticoid receptors fx?
hormone binds to receptor in cytosol and sends regulatory proteins that allow the hormone-receptor complex to bind to DNA and alter transcription
51
does aldosterone bind MR or GR?
MR
52
does cortisol bind MR or GR?
MR and GR
53
what is addisons disease caused by?
autoimmune attack on adrenal cortex | decreased cortisol and aldosterone
54
what are the symptoms of addisons disease?
hypoglycemia increased lymphocytes hyperK hypoNa increase ACTH (increase MSH, why JFK had tan) decrease vascular response to adrenergics
55
short term stress response
adrenal medulla releases EPI increase BP, HR, breakdown of glucose, metabolic rate changes in blood flow to vital organs dilate bronichioles
56
long term stress response
``` retention of Na and water increase in BP protein and fat into glucose increase blood sugar decreased immune system ```
57
what is the major storage site for calcium and phosphate?
bone as hydroxyapatite (HA)
58
free calcium vs protein bound calcium vs complexed calcium
free 50% PB 40% complex 10%
59
free phosphate vs protein bound phosphate vs complexed phosphate
free 80% PB 10% complex 10%
60
how does thyroid regulate Calcium?
c cells release calcitonin and lowers calcium
61
how does parathyroid regulate phosphate and calcium?
chief cells release parathyroid hormone and increase phosphate and calcium
62
how do the skin, liver and kidney regulate phosphate and calcium?
skin intakes Vit D liver converts to 25OHVitD3 kidney converts to active VitD3
63
how does the bone regulate phosphate?
osteocytes secrete FGF23 that regulate phosphate
64
what is the normal blood calcium level?
10mg/100mL
65
what is used theraputically to prevent bone loss? shows no clinical symptoms when deficient..
calcitonin
66
what increased PTH?
hypocalcemia | hyperphosptemia
67
what decreases PTH?
hypercalcemia | increases in Vit D and FGF23
68
mechanism of action for release of PTH
``` Calcium binds to receptor on chief cell second messanger IP3 releases intracell calcium this inhibits production of PTH DAG stimulates PKC to inhibit exocytosis this inhibits release of PTH ```
69
what stimulates the kidney to produce calcitriol?
PTH
70
what inhibits the kidney to produce calcitriol?
increased Calcium increased calcitriol increased FGF23
71
if you have negative Calcium balance what happens?
increase in PTH, increase in calcitriol | increase in bone breakdown, renal reabsorbtion
72
if you have positive calcium balance what happens?
increase calcitonin, increase in calcitriol | inhibit osteoclasts and bone breakdown, promotes intestinal and renal reabsorbtion
73
what does FGF23 do?
when PTH,Pi, and Vit D are elevated it lowers phosphate levels, inhibiting renal reabsorbtion, PTH and Vit D
74
what if you have uncontrolled hyperphosphatemia?
typical in CKD | increase PTH, bone loss, vascular calcification, death

Physiology II (10 decks)

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