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Endocrine Module Flashcards

1
Q

What are the layers of adrenal glands?

A

cortex
medulla

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2
Q

what are the layers of cortex?

A

Zona glomerulosa
Zona fasiculata
zona reticularis

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3
Q

What is the role of the zona glomerulosa

A

secretes mineralocorticoids

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4
Q

What is the role of the zona fasiculata

A

secretes glucocorticoids

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5
Q

What is the role of the zona reticularis

A

secretes sex hormones

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6
Q

What is the role of aldosterone

A

helps regulate BP and electrolytes
Sends signals to the kidneys to promote Na reabsorption and K excretion in the urine

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7
Q

what is the role of cortisol

A

widespread effects on the body
helps regulate the body response to stress
helps regulate fat, protein, and carbs metabolism
helps regulate the inflammatory response and immune system

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8
Q

what is the role of DHEA and DHEA-S

A

promotes protein anabolism and growth
main source of androgens in females
20% as potent as testosterone

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9
Q

Actions of the adrenal medulla

A

releases epinephrine and norepinephrine
helps control BP, HR, sweating for example

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10
Q

What is the role of epinephrine

A

increases blood flow to muscles and brain
increases conversion of glycogen to glucose
stimulation of metabolic rate

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11
Q

what is the role of norepinephrine

A

similar but less potent effect as epinephrine
main action - vasoconstriction to increase BP

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12
Q

What is the adrenal medulla regulation?

A

release stimulated by fight or flight response of sympathetic nervous system

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13
Q

What happens in states of low mineralocorticoid activity

A

lower amt aldosterone
manifests as hypotension

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14
Q

What happens in states of low glucocorticoid activity

A

fatigue
low BP

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15
Q

What happens in states of excess mineralocorticoid activity

A

manifest as hypertension

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16
Q

What happens in states of excess glucocorticoid activity

A

high BP

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17
Q

What is the adrenal cortex regulation?

A

Adrenocorticotropic hormone stimulates the adrenal cortex to release its hormones

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18
Q

What is the HPA axis

A

is the feedback interaction of the hypothalamus, pituitary and adrenal glands

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19
Q

What hormones comprise the endocrine system?

A

Steroids
amines
peptides
proteins

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20
Q

What factors determine circulating levels of hormones?

A

synthesis
secretion
transport

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21
Q

What does hormone transport depend on in the blood?

A

affinity of hormone for plasma protein carriers
hormone degradation
availability of receptors
receptor binding
hormone uptake

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22
Q

What are some functions of hormones binding to a proteins?

A

protects hormone from degradation or uptake
allows for fine control over circulation levels
prevents hormone from binding to unintended sites
allows transport of lipid soluble hormones

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23
Q

What regulates plasma proteins?

A

They regulate themselves

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24
Q

Describe hormone degradation

A

all hormones have half life and will eventually degrade (changing levels)

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25
What are some factors that influence availability of receptors?
down regulation up regulation
26
What is the main goal of hormones
to maintain homeostasis
27
List the key hormones in the body
thyroid cortisol parathyroid vasopressin mineralocorticoids insulin
28
When a hormone binds to cell surface or cell nuceli, the cell may
synthesize new molecules change permeability of the membrane alter rate of reactions
29
What is permissive?
binding to a target cell allows a different hormone to have its full effect
30
what is synergistic
two hormones act together to achieve a greater effect
31
What is antagonistic
two hormones produce an opposite effect
32
what ways can hormones work with each other?
permissive synergistic antagonistic
33
Where is the pineal gland located?
in the epithalamus
34
What does the pineal gland produce?
Melatonin
35
What is the role of melatonin?
binds to melatonin receptors causing anti-excitatory effects regulates sleep patterns
36
When does melatonin peak?
at 1-2 years of age remain stable until puberty then declines
37
What is the role of the hypothalamus?
communicates with the pituitary gland to control homeostasis regulates almost all aspects of growth, development, metabolism and homesostasis
38
Is the hypothalamus mainly stimulatory or inhibitory?
Inhibitory
39
What is the role of pituitary gland (anterior)?
controlling hormones sent from hypothalamus cause secretion of various hormones
40
What is the role of human growth hormone?
promotes syntehsis of a protein IGFs
41
Where is the hGH released from?
Pituitary hormone
42
What is the regulation pathway for hGH?
low BS stimulates release (increases glycogen breakdown)
43
What is the consequence of excess hGH?
uncontrolled growth of bones joint pain --> too much in hands, feet and face
44
How would excess of hGH be treated?
By removing the tumor, then using pharm to sublimate
45
What would you treat hGH deficiency?
giving synthetic hGH
46
Growth hormone releasing hormone would stimulate
human growth hormone
47
Thyrotropin releasing hormone stimulates
thyroid stimulating hormone
48
gonadotropin releasing hormone stimulate
follicle stimulating and luteinzing hormone
49
corticotropin releasing hormones stimulate
adrenocorticotrophic hormones
50
dopamine inhibits
prolactin
51
somatostatin inhibits
hGH and thyroid stimulating hormone
52
What does the thyroid gland look like?
butterfly shaped endocrine gland in the front of the neck
53
What is thyroid gland responsible for?
Synthesis, storage and release of T3 and T4
54
What are the cells of the thyroid gland?
colloid follicular cells parafollicular cells
55
What is the regulation pathway for synthesis of T3/T4?
TSH this is controlled TRH
56
What are the ingredients needed for the creation of T3 and T4?
iodide, thyroglobulin and tyrosine
57
Process of creating T3 and T4
iodide binds with tyrosine attached to thyroglobulin (mono or di iodo) MIT + DIT = T3 DIT + DIT = T4 then secreted into circulation
58
Why would the thyroid produce two different thyroid hormones?
One has more affinity for binding then the other as a way to regulate and adjust the level of activity needed
59
Steps of T3/T4 synthesis
thyroglobulin synthesis iodide trapping oxidation of iodide iodination of tyrosine coupling of MIT and DIT secretion of hormones
60
What are the actions of T3 and T4 in the heart
chronotropic and inotropic
61
What are the actions of T3 and T4 in the adipose tissue
catabolic
62
What are the actions of T3 and T4 in the muscle
catabolic
63
What are the actions of T3 and T4 in the bone
developmental
64
What are the actions of T3 and T4 in the nervous system
development
65
What are the actions of T3 and T4 in the gut
metabolic
66
Where is parathyroid gland located?
on the posterior surfaces of the lateral lobes of the thyroid
67
what is the purpose of the parathryoid?
to produce parathyroid hormone (PTH)
68
what is the role of PTH
to regulate calcium and phosphate
69
How does PTH increase blood calcium?
Stimulating number and activity of osteoclasts increasing calcium and magnesium reabsorption from urine increasing synthesis of calcitriol, which increases calcium and magnesium absorption from GI
70
How does PTH decrease blood phosphate?
increasing excretion from kidneys
71
Do the actions of PHT oppose or help the calcitonin?
Oppose
72
How does the action of PTH oppose by calcitonin?
secreted by follicular cells in thyroid inhibits activity of osteoclasts decreases reabsorption of calcium from urine
73
Regulation of PTH and calcitonin works by
circulating calcium levels act on parathyroid gland to reduce PTH secretion
74
What are potential consequences of removing the parathyroid gland?
lowers Ca and magneisum in the body
75
What are potential consequences of losing calcitonin?
lower the Ca and Mg that is absorbed from GI
76
Where is the thymus located?
in front of the heart and behind the sterum
77
What is the purpose of the thymus?
critical part of immune system and T cell development
78
What hormones does the thymus release and what does this stimulate?
thymosin alpha 1 thymulin thymopoietin T cell development
79
What other hormones can stimulate T cell development?
Prolactin, T3 and T4 and LH
80
What is hyperthyroidism?
disease caused by excess synthesis and secretion of thyroid hormone
81
What is a definitive treatment of hyperthyroidism?
radioactive iodine or surgery
82
What are common causes of hyperthyroidism?
toxic diffuse goiter (graves disease) toxic multi-nodular goiter (plummers disease) acute phase of thyroiditis toxic adenoma
83
What is the age group for graves disease?
20-50 yr old (most common)
84
What is Graves disease?
Autoimmune disorder immune system creates antibodies against the TSH receptor can result in hyperplasia of thyroid gland leading to a goiter
85
What is the pathway of plummers disease?
iodine deficiency --> less T4 production --> thyroid cells grow larger --> TSH receptors mutate --> continually active
86
What is plummers disease?
second most common cause of hyperthyroidism iodine deficiency most common trigger for nodules to grow but can be many others develops slowly over several years
87
what is toxic adenoma?
benign tumors growing on thyroid gland become active and act just like thyroid cells secretting T3/4 but not responding to negative feedback
88
Acute Phase of Thyroiditis
causes inflammation and damage to the thyroid gland damage causes excess hormones to be released eventually leads to hypothyroidism once T3/T4 stores exhausted
89
List some non specific hyperthyroidism symptoms
tremor hands diarrhea heat intolerance unintentional weight loss weakness
90
Symptoms of toxic diffuse goiter specific
exophthalmos periorbital edema diplopia diffuse goiter pertibial myxedema
91
Treatments of hyperthyroidism
Pharmacotherapy Radioactive Iodine surgery
92
What are thioamides?
includes PTU and MMI not typically used life long main use is to reduce severity of hyperthyroidism to prepare a pt for curative therapy
93
Thioamides of MOA
inhibits production of thyroid hormone by preventing iodine from incorporating with tyrosine residue on thyroglobulin inhibits coupling reaction of MIT and DIT inhibits peripheral conversion of T4 --> T3
94
Which thioamide has different doses for the levels of hyperthyroidism?
propylthiouracil
95
What is the dosing for MMI for mild hyperthyroidism?
initial 10-15 mg OD then 5-15 mg OD to maintain
96
What is the dosing for MMI for moderate hyperthyroidism?
initial 20-30 mg OD then 5-15 mg OD to maintain
97
What is the dosing for MMI for severe hyperthyroidism?
initial 30-40 mg OD then 5-15 mg OD to maintain
98
What is the dose for PTU?
initial 300 mg BID-TID then 100-150 mg BID-TID
99
Common side effects for thioamides
GI upset Rash Arthralgia
100
What serious side effects of thioamides?
Agranulocytosis neutropenia hepatotoxicity and cholestatic jaundice vasculitis polyarthritis
101
What is agranulocytosis?
a condition with very low granules (WCB) count
102
what is neutropenia?
having too few neutrophils (WCB) count
103
What is cholestatic jaundice?
Too much cholestate that causes the block the bile
104
What is vasculitis?
The inflammation of the blood vessels
105
What is polyarthritis
having arthritis in multiple joints high degree of pain and swelling
106
Which thioamides should you use during pregnancy?
to balance the risk of teratogenicity and hepatotoxicity 1 st trimester --> PTU 2nd and 3rd trimester --> MMI
107
What factors are involved when deciding which thioamide to use during pregnancy?
PTU - low teratogenenicity but higher hepatoxicity MMI - some teratogenic concern in 1st but lower hepatotoxicity
108
MOA of beta blockers for hyperthyroidsim
reduces symptoms related to cardiac over stimulation
109
Surgery for hyperthyroidism
thyroidectomy leads to permanent hypothyroidism
110
Radioactive iodine
curative option taken up by the thyroid causing ablation
111
Explain what a thyroid storm
Rare, life-threatening condition Characterized by severe manifestations of hyperthyroidism Can occur in patients with untreated hyperthyroidism
112
What can trigger a thyroid storm?
Thyroid surgery or radioactive iodine Trauma Infection Giving birth
113
Define hypothyroidism
A condition of thyroid hormone deficiency caused by a defect anywhere on the hypothalamic-pituitary-thyroid axis
114
What is the most common cause of hypothyroidism?
chronic autoimmune thyroiditis hashimoto's disease
115
Tx options for hypothyroidism
involves replacement of thyroid hormones Desiccated thyroid Liothyronine Levothyroxine Combined T3/T4
116
Desiccated thyroid
first agent prepared from thyroid glands of animals contians t3 and t4 causes high peaks
117
Liothyronine
Contains T3, no effect on T4 Causes wide fluctuations in serum levels Costly
118
Levothyroxine
Analogue of T4 Standard 1st line therapy Half life of 7 days Conversion to T3 regulated by body
119
Levothyroxine dose
Average dose is 1.6mcg/kg/d Starting dose ranges from 12.5mcg/day to max wt based Often give 100mcg empirically (average replacement dose)
120
Risk factors for levothryoxine
Any CVD (eg. ischemic heart disease) Rhythm disturbances >50 years old Severe, long-standing hypothyroidism
121
Levothyroxine AE
Hyperthyroidism symptoms Cardiac risk increase Aggravate existing CVD BMD reduction
122
Levothyroxine DI
Antacids / H2 blockers / PPIs Iron Calcium / mineral supplements Cholestyramine Raloxifene Manage by taking levothyroxine 2 hours before, or 4 hours after these meds
123
Monitoring plans for levothyroxine
getting blood test to check levels
124
What does the HPA axis regulate?
Stress response Digestion Immune system Mood and emotions Energy storage and expenditure
125
Define cushing syndrome
a condition characterized by hypercortisolemia usually due to ACTH producing pituitary tumor
126
Tx for cushing Disease
surgery is the treatment of choice
127
Tx Rx for cushing disease
ketoconazole metyrapone mitotane pasireotide
128
MOA of ketoconazole
inhibits cortisol biosynthesis at the first step
129
MOA of metyrapone
inhibits cortisol biosynthesis at the final step
130
MOA of mitotane
inhibit cortisol biosynthesis at various steps
131
MOA of pasireotide
binds to somatostatin and inhibits ACTH secretion
132
Explain addison's disease
primary adrenal insufficiency caused by destruction of the adrenal glands - all 3 zones of the adrenal cortex
133
Tx of chronic insufficiency
Daily glucocorticoid and mineralocorticoid replacement E.g. HC 15-30mg/d (divided) and fludricortisone 0.1mg daily May require stress dosing Perhaps DHEA for women
134
Tx acute adrenal crisis
Emergency situation: IV corticosteroids and IV fluids
135
What does the adrenal glands release
cortex produces glucorticorticoids, mineralocorticoids and androgens
136
What does the pancreas release
produce insulin
137
What does the ovaries release
produce E, P, T
138
what does the testes release
produces T

PHARM 123 (4 decks)

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