Endocrine Normal/Patho Flashcards
What hormones are synthesized in the ventral hypothalamus?
Releasing hormones
GHRH, TRH, CRH, gnRH, PRH
Where do hormones produced in the ventral hypothalamus go?
Anterior pituitary where they release or inhibit hormones
Where is prolactin produced?
Anterior pituitary
What does prolactin do?
Promotes lactation in the breast
Where is growth hormone produced?
Anterior pituitary
What hormones are produced in the anterior pituitary?
Prolactin Growth hormone (GH) Thyroid stimulating hormons (TSH) Adrenocorticotropic hormone (ACTH) Follicle stimulating hormone (FSH) Lutenizing hormone (LH)
What hormone is produced in the hypothalamic (paraventricular nucleus)?
Oxytocin
What two areas does oxytocin act on?
Uterus- stimulates contraction
Breast- stimulates milk ejection
What two hormones are produced in the hypothalamus?
Oxytocin
Antidiuretic hormone ADH
What hormone is produced in the supraoptic nucleus (hypothalamus)?
Antidiuretic hormone (ADH)
What does thyroid hormone act on?
All body cells except brain, spleen, testes and uterus
Which hormone is synthesized in follicle cells in the thyroid?
Thyroid hormone (TH)
What hormone is synthesized in the parafollicular cells within the thyroid gland.
Calcitonin
What hormone inhibits bone resorption, stimulates calcium incorporation into bone?
Calcitonin
Where is parathyroid hormone (parahormone) syntehsized?
Parathyroid gland
What hormone stimulates bone resorption and in the kidneys stimulates reabsorption of caclium and activation of Vit D as well as absorption of calcium in intestinal mucosa?
Parathormone
What are 2 glucocorticoids?
Cortisol, hydrocortisone
Where are glucocorticoids synthesized?
Adrenal cortex
Zona fasciculate mainly
What do glucocorticoids do in the liver?
Gluconeogenesis
Where are gonadocorticoids (androgens) synthesized?
Adrenal cortex
Zona reticularis mainly
What do gonadocorticoids play a role in?
Sexual development during puberty
Where are epi and norepi produced?
Adrenal medulla
Chromaffin cells
What are norepi and epi involved in?
Flight or fight response
Where is glucagon synthesized?
Pancreas- Islets of Langerhans
Alpha cells
What does glucagon do in the liver?
Glycogenolysis, gluconeogenesis, release of glucose into the blood
Where is insulin synthesized?
Pancreas- Islets of Langerhans
Beta cells
What does insulin do in body cells (muscle and fat)?
Stimulates glucose uptake, oxidation
Where are estrogen and progesterone syntehsized?
Ovaries
What 2 hormones play a role in female sexual development, oogenesis, menstrual cycle, pregnancy?
Estrogen
Progesterone
Where is testosterone synthesized?
Testes
What hormone is involved in male sexual development and spermatogenesis?
testosterone
What are hormones that stimulate the development and activity of endocrine glands?
Tropic hormones
What hormone increases protein synthesis, cell growth, and division?
Growth Hormone
What is it called when growth hormone causes an increased glycogen breakdown and leads to a rise in blood glucose.
Diabetogenic effect
What 2 hormones control the hypothalamic secretion o GH?
GHRH and GHIH
What allows TSH to be released?
TRH (thyroid release hormone)
What inhibits TSH?
GHIH (growth hormone inhibiting hormone)
What hormone stimulates the adrenal cortex to release steroid hormones?
ACTH
The hypothalamic secretion of ACTH is regulated by what?
CRH (corticotropic releasing hormone)
High blood glucocorticoid levels ______ CRH release?
Decrease
What triggers CRH release?
Stressor
WHat hormone stimulates production of gonadal hormones, follicle development in females with FSH, triggers ovulation?
LH (lutenizing hormone)
The release of what hormone from the hypothalamus control LH and FSH secretion?
GnRH (gonadotropic releasing hormone)
What type cells does prolactin act upon?
Lactotropic cells
What two hormones mediate prolactin?
PRH and PIH
What prolactin mediating hormone is dominant in males?
PIH
PRH is stimulated when ______ is high.
Estrogen
What action by a baby stimulates PRH release?
Suckling
The release of ADH is stimulated when blood solute concentration is too _____
High
The thyroid gland has spherical follicles which are colloid surrounded by _______ cells
Follicular
Parafollicular cells produce what?
Calcitonin
What cells produce thyroid hormone?
Follicular cells
Put in order the steps in TH production
A. Follicle cells endocytose iodinated thyroglobulin
B. Lysosomal enzyme cleave TH from thryoglobulin
C. Follicle cells synthesize thyroblogulin secreted into follicular lumen- becomes part of colloid
D. Exocytosis to secrete TH
E. Tyrosine residues in thyroglobulin are iodinated
C E A B D
Is T4 (thyroxine) or T3 the major component of TH in humans?
T4
Where is T3 formed?
From T4 at target
Is T3 and T4 more active?
T3 is 10x more active than T4
What do thyroxine binding globulins (TBGs) do?
Bind to T3/T4 for transport in blood.
Need binding proteins so they get to target and don’t slip into other cells first
What are the three actions of TH?
- Increase basal metabolic rate- increase glucose catabolism
- Heat-calorigenic effect (produce heat)
- Promotes normal growth and body development
What hormone is an antagonist to paraythyroid hormone?
Calcitonin- stimulates calcium uptake from blood
What hormone increases blood calcium levels?
Parathyroid hormone (PTH)
What hormone stimulates the activation of vitamin D?
Parathyroid hormone
What part of the adrenal (suprarenal) glands is essential for life?
Cortex
Medulla is not
What are the three types of corticosteroids?
Mineralcorticoids
Glucocorticoids
Gonadocorticoids
What are the two type of adrenal medullary hormones?
Nor- & epinephrine
What type of corticosteroid is aldosterone?
Mineralcorticoid
What does aldosterone regulate?
Renin-angiotensin mechanisms
ACTH release
ANP release
What type cells are found in the adrenal medulla?
Chromaffin cells
What do the chromaffin cells do?
Release catecholamines in response to sympathetic nervous system stimulation
What is the endocrine portion of the pancreas?
Islets of Langerhans
What do the islets of Langerhans secrete?
Insulin and glucagon
What are the 3 targets of glucagon and insulin ?
Liver
Skeletal muscle
Adipose tissue
What does glucagon stimulate in the liver?
Glycogenolysis
Gluconeogensis
What does glucagon stimulate in adipose cells?
Conversion of fats into glycerol and fatty acids
What does glucagon do to skeletal muscle?
Stimulates protein breakdown
Low blood sugar promotes the release of what from the pancreas?
Glucagon
High blood sugar promotes the release of what from the pancreas?
Insulin
What cells is insulin produced in in the Islets?
Beta cells
What does insulin stimulate in adipose and skeletal muscle?
Glucose uptake
Cellular respiration
Glucose storage
What does insulin stimulate in adipose tissue and the liver?
Formation of fats
What does insulin stimulate in skeletal muscle?
AA uptake and protein synthesis
What are two meachnisms of hormonal alterations?
Receptor associated disorder
Intracellular disorder
What are the four types of receptor associated disorders?(water soluble hormones)
Decrease in receptor number
Impaired receptor function
Antibodies against receptors
Unusual receptor expression
What are the two types of intracellular disorders?
Inadequate second messenger synthesis
Abnormal second messenger response
Water intoxication, hyponatremia, hypoosmolarity, inappropriately concentrated urine are all associated with what?
Syndrome of inappropriate ADH Secretion
What is a disorder where insufficient ADH leads to polyuria and polydipsia?
Diabetes Insipidus
What are the two forms of diabets insipidus?
Neurogenic (central)- most common
Nephrogenic (renal)
What is neurogenic diabetes insipidus due to?
Insufficient ADH, tumors
WHat is the neprhogenic form of diabetes insipidus associated with?
End-organ failure
What is hyperpituitarism generally due to?
Adenoma
Hypopituitarism may be due to ______.
Infarction
In what condition are all hormones absent (panhypopituitarism)
Sheehan Syndrome
A deficit of _____ is possibly life threatening.
ACTH
What causes acromegaly?
Oversecretion of GH
What do individuals with acromegaly die of?
Cardiac hypertrophy
Hypertension
Atherosclerosis
T2DM
_____ tissue proliferates in acromegaly.
Connective
What causes prolactin hypersecretion?
Tumors that secrete prolactin
In women, what happens with a prolactinoma?
Amenorrhea
Non-puerperal milk production
hirsutism
Osteopenia
What will happen in men with a proclatinoma?
Hypogonadism ED impaired libido oligospermia Diminished ejaculate volume
What can cause a secondary form of thyroid dysfunction?
Pituitary or hypothalamic alteration
What is due to any increased levels of circulating TH?
Thyrotoxicosis
What is a secondary form of thyrotoxicosis caused by?
TSH secreting pituitary adenomas
What symptoms will you have with thyrotoxicosis?
Increased BMR and goiter
Graves Disease is an ____________ disease.
Autoimmune
What are symptoms of Graves Disease?
Hyperthryoidism
Goiter
Opthalmopathy
Dermopathy
In Graves Disease, the antibodies mimic _____ and leads to the thyroid pumping out more TH.
TSH
What occurs in nodular thyroid disease?
Thyroid increasing in size due to TSH
Number of follicles increaes
then TSH drop and thyroid shrinks
Some follicular cells may be permanently changed and cause hyperthyroidism
What is a hyperthyroid condition that may become deadly?
Thyrotoxic Crisis (thyroid storm)
Who does a thyroid storm usually happen to.
A person with hyperthyroidism under additional stress (CV disorders, infection)
What are some symptoms of a thyrotoxic crisis?
Hyperthermia, tachycardia, high-output heart failure, N/V/D, delirium
What is the most common thyroid disorder?
Hypothyroidism
In hypothyroidism TH ______ and TSH _____.
TH decreases TSH increases (goiter)
What causes the secondary form of hypothyroidism?
Disorders affecting the pituitary or hypothalamus
What causes primary hypothyroidism?
Defective synthesis
Loss of thyroid tissue
What are the four types of primary hypothyroidism?
Subacute
Autoimmune (hasimoto disease)
Painless
Postpartum
What type of hypothyroidism is due to a gradual autoimmune destruction of the thyroid?
Autoimmune (Hashimoto disease)
What type of hypothyroidism has a similar course to subactue, and similar pathology to autoimmune?
Painless
What type of primary hypothyroidism has a similar course to painless?
Postpartum
What type primary hypothyroidism is due to non-bacterial inflammation of the thyroid- fever, tenderness, enlarged thyroid
Subacute
What are to hypothyroid conditions?
Congenital hypothyroidism
Thyroid carcinoma
What is congential hypothyroidism due to?
Absent thyroid tissue or TH synthesis defects.
What is secondary hyperparathyroidism due to?
Chronic disease state
In primary hyperparathyroidism inappropriate secretion is due to what?
Feedback failure
What happens whith hyperparathyroidism
Excessive osteoclast activity Bone fracture Kyphosis Renal effects muscle spasms
What condition has depressed serum calcium and increased phosphate.
Hyperparathyroidism
What disease is associated with excessive cortisol? Symptoms include - weight gain, moon face, buffalo hump, changes in skin pigmentation
Cushing Disease
What condition is due to excessive aldosterone due to primary adrenal disorders or secondary extradrenal stimulus?
Hyperaldosteronism
What does aldosterone do?
Causes you to retain sodium
What are some signs/symptoms of hyperaldosteronism?
Hypertension
Hypokalemia, renal potassium wasting
Neuromuscular problems
Metabolic alkalosis
What is inadequate stimulation of adrenal glands or inability to produce and secrete cortisol?
Hypocortisolism
What disease leads to primary adrenal insufficiency?
Addison disease
With Addison’s disease you will have symptoms of what two conditions?
Hypocortisolism
Hypoaldosteronism
What happens to the adrenal glands in Addison’s Disease?
Adrenal hemorrhage
Is Addison’s disease autoimmune?
yes
Excess androgens cause what?
Virilization
What happens with hypofunction of the adrenal medulla?
No known physiological alterations
With hyperfunction of the adrenal medulla, there are continuous or episodic release of what?
Catecholamines
What is hyperfunction of the adrenal medulla usually caused by?
Tumors
What are some symptoms of hyperfunction of the adrenal medulla?
Hypertension
Tachy
Palpitations
Severe headache
What is the normal blood glucose range?
70-120 mg/dl
What are the three classic symptoms of diabetes?
Polyuria, polydipsia, polyphagia
What are the two distinct types of Type 1 DM?
Immune and non-immune
T1DM has the strongest associated with ______ alleles.
MHC II
What are three virus that have been implicated in the environmental cause of T1DM?
CMV
mumps
EB
______ may trigger autoantibodies in T1DM.
BSA (bovine serum albumin)
What are two causes of the non-immune form of T1DM?
Pancreatitis
Chronic inflammation of the pancreas
_____ are found in 85-95% of patients with T1DM.
ICAs (islet cell antibodies)
______ % of beta cell function must be lost before hyperglycemia occurs.
80-90%
T1DM patients have a lack of ______ and an excess of ______
Lack of insulin
Excess of glucagon
In T1DM both _____ and ______ cells function abnormally.
Alpha and Beta
Insulin normally stimulates _____ and inhibits ______
Stimulates lipogenesis
INhibits lipolysis
When there is an insulin deficit _____ is enhanced and there is an increase in ______ to the liver.
Lypolysis is enhanced
Increase in free fatty acids to the liver
T1DM clinically affects the metabolism of what three things?
Fat
Protein
Carbs
What is ketoacidosis due to?
Increase ketone levels in absence of anti-lipolytic effect of insulin
What is a suboptimal response of insulin-sensitive tissues to insulin?
Insulin resistance
Before clinical symptoms of T2DM, compensatory _________ occurs.
Hyperinsulinemia
In T2DM, the ratio of alpha to beta cells may be ______. Person may have levels of insulin that are not decreased.
Normal
What is the most powerful risk factor for T2DM?
Obesity
What are some theories why with obesity insulin is less able to facilitate glucose entry into cells?
Reduced insulin receptor numbers Post receptor events altered Hyperinsulinemia Release of free fatty acids Overeating leads to hyperinsulinemia Intracellular satiety factors reduce tissue responsiveness to insulin
What are 2 acute complications with DM?
Hypoglycemia
Diabetic ketoacidosis
Hypoglycemia is levels below ____ in newborns and _____ in adults.
Below 35 in newborn
Below 45-60 in adults
In which type of diabetes in hypoglycemia most common?
Type 1 patients on insulin
What causes the symptoms of insulin shock or insulin reaction?
SNS activation or abrupt cessation of glucose to the brain
What develops when there is an absolute or relative deficiency of insulin and an increase in insulin counter-regulatory hormones?
Diabetic Ketoacidosis
In diabetic ketoacidosis hepatic _____ production increases and peripheral glucose use ______ and ketogensis is _______.
Hepatic glucose production
Peripheral glucose use drops
Stimulated
What 4 things are often deficient in DKA?
Potassium
Sodium
Phosphorus
Magnesium
What are some S/S of DKA?
Hyperventilation Postural dizziness CNS depression Ketonuria Anorexia Naseau thirst
What causes microvascular disease in diabetic patients?
Thickening of capillary basement membrane
Endothelial hyperplasia
Thrombosis
Pericyte degeneration
What conditions can microvascular disease in diabetic patients lead to?
Blindness
End-stage renal disease
various neuropathies
What stage is proliferative diabetic retinopathy?
Stage 3
What stage is non-proliferative retinopathy?
Stage 1
What stage is pre-proliferative retinopathy?
Stage 2
What 2 major problems can retinopathy lead to?
Retinal detachment
Hemorrhage into vitreous humor
What causes glomeruli injury in diabetic nephropathy?
HIgh glucose levels and adverse effects of intraglomerular hypertension
What is the first manifestation of diabetic nephropathy?
Leakage of albumin
What are some later symptoms of diabetic nephropathy?
Hypoproteinemia
Reduction in plasma oncotic pressure
Anasarca (widespread edema)
Hypertension
Presence of CAD increases with the ______ of diabetes.
Duration (not severity)
Stroke is _____ times more common in diabetics?
2
Which type stroke is more common in diabetics?
Ischemic
What are 2 risk factors for stroke in diabetics?
Hypertension
Dyslipidemia
What does peripheral artery disease lead to in diabetics?
Gangrene and amputations
What are the two stages of diabetic neuropathies?
Clinical and subclinical
What is the difference b/w subclinical and clinical diabetic neuropathies?
Clinical- symptoms of clinically detectable neurologic deficits
Subclinical- Evidence of peripheral nerve dysfunction w/o clinical signs
What are some reasons diabetics are at higher risk for infections?
Impaired vision/ touch
Decrease O2 to tissues
WBC impairment
Pathogens multiply rapidly
