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Endocrine Part II Key Points Flashcards

1
Q

What is the hypothalamic-pituitary-gonadal (HPG) axis?

A

Includes hypothalamic gonadotropin-releasing hormone (GnRH) which is secreted in a pulsatile fashion initially the night and with pubertal progression through the day

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2
Q

What does GnRH stimulates?

A

Stimulates pituitary secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

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3
Q

What does LH and FSH promotes?

A

Development and function of the gonad (ovaries in females and testicles in males) and associated reproductive system structures

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4
Q

What is the synthesis and secretion of gonadal steroids in females?

A

Synthesis and secretion of the gonadal steroids estrogen and progesterone in females of reproductive age are cyclic, moving through times of negative and positive feedback at the hypothalamus and pituitary to promote ovarian follicle development and ovulation.

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5
Q

When is the development of the reproductive system begins?

A

First trimester of prenatal development

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6
Q

What does it means when embryos destined to be female?

A

46,XXX have spontaneous regression of male primordial structures and development of ovaries, fallopian tubes, uterus, cervix, and vagina

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7
Q

What does sex determination in the embryos destined to become a male is like?

A

Chromosomal identification 46, XY depends on SRY protein coded for by DRY gene - name for sex-determining region of the Y chromosome.

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8
Q

What is SRY gene?

A

Sex-determining region of the Y chromosome.
By 8th wks gestation, this gene expressed and begins to direct primordial gonadal structures toward differentiation into tests and other male genetic structures

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9
Q

What is the pregnancy related alterations in mom?

A

Greatly altered organ system function
- blood volume and cardiac output rise
- vascular resistance increases

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10
Q

what is the pregnancy related alterations in renal, resp, and hematological?

A

Glomerular function rate increases, resp increases, blood becomes hypercoagulable, and placenta serves as additional endocrine organ.
- pregnancy disorders can result from maladaptations to system changes

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11
Q

What is menopause?

A

Cessation of menstrual periods and a time of decreased estrogen secretion

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12
Q

What is the physiological changes associated with menopause?

A

Accelerated loss of bone density and development of postmenopausal osteoporosis

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13
Q

What does lack of estrogen alters?

A

Alters normal balance of bone resorption and bone deposition, with relatively more resorption and less bone formation.

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14
Q

What does lack of estrogen tendency to exacerbate by?

A

Hyperparathyroidism which promotes osteoclast activity.
- Older age of both women and men increases osteoporosis and risk of Fx and disability

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15
Q

What etiology of hyperthyroidism increases in incidence in older adults?

A

Multinodular goiter and thyroid adenomas

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16
Q

Which cardiovascular effects are characteristic of hyperthyroidism?

A

Increased cardiac output, increased systolic pressure, and increased pulse pressure

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17
Q

What is not an expected finding in chronic Hashimoto thyroiditis?

A

Hyperreflexia

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18
Q

Which electrolyte change is able to inhibit iodine uptake by the sodium-iodide (NIS) transporter?

A

Increased extracellular iodide

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19
Q

Which type of antibodies are most likely to be found at high levels in Graves disease and not in Hashimoto thyroiditis?

A

Antibodies to TSH receptor

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19
Q

Why does pregnancy increase insulin requirements, contributing to gestational diabetes?

A

The placenta degrades insulin and produces anti-insulin hormones

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20
Q

Which of the following is not a target organ of hormones regulating metabolism?

A

GI tract

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21
Q

Life-span trajectories of hypothalamic-pituitary-gonadal function include which of the following?

A

Peak activity during embryonic and fetal sexual differentiation in the first 20 wks or prenatal, increased acitivity for 2 mo immediately after birth, and maximal levels during puberty

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22
Q

At which phase of the menstrual cycle does estradiol provide positive feedback to the hypothalamus and anterior pituitary to produce a peak of luteinizing hormone secretion?

A

Midcycle/late follicular phase

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23
Q

What hormone is directly responsible for the development of secondary sexual characteristic during female puberty?

A

Estrogen

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24
What are the male genitourinary system anatomically combines?
Structures needed for urine elimination (bladder, urethra) with structures needed for procreation (seminiferous tubule, epididymis, vas deferens, accessory glands for semen production, ejaculatory ducts, and urethra)
25
What is the HPG axis activity in postpubertal males?
Relatively constant with pulsatile secretion of GnRH, LH stimulating Leydig cell testosterone production, and FSH stimulating Sertoli cell inhibin production.
26
What does LH stimulate in male?
Leydig cell testosterone production
27
What does FSH stimulate in male?
Sertoli cell inhibin production
28
What are the function of testosterone and inhibin to pituitary?
Testosterone provides negative feedback to pituitary LH secretion whereas inhibin provides negative feedback to pituitary FSH secretion.
29
How is testosterone converted?
By 5a-reductase enzyme to dihydrotestosterone (DHT), a more potent androgen, and by aromatase to estradiol.
30
What are the two androgens plus estradiol responsible for?
Contribute to various aspects of development, growth, and maintenance of male productive structures, a well secondary sexual characteristics.
31
What is true about hypogonadism in men?
Can be primary or secondary. Careful eval is needed to determine best course of tx with respect to correcting dysfunction while preserving or restoring fertility/.
32
What is erectile dysfunction?
An erection cannot occur or cannot be sustained, as often happen with older age and chronic diseases such as HTN and diabetes. Can be a drug adverse effect
33
What are the prostate disorders in men?
Benign prostatic hyperplasia (BPH) and prostate cancer
34
What does the benign prostatic hyperplasia and prostate cancer have in common?
Both in part to androgen stimulation of the prostate and androgen antagonism is one approved tx. If prostate enlarges (either excessive benign or malignant growth), blood level of prostate-specific antigen (PSA) rise, making PSA measurements one component of surveillance in middle-aged and older men
35
What population is a PSA measurement a component of surveillance?
Middle aged and older men
36
What is insulin?
Primary anabolic hormone responsible for duel storage in the fed state, as well as promoting growth and maintenance of tissues.
37
Is insulin a protein?
It is a protein consisting of two polypeptide chains connected by disulfide bonds.
38
What happen during insulin synthesis?
Connecting peptide (C peptide) is cleaved from proinsulin once the A and B chains have bonded together. C peptide assays used as an index of body insulin production.
39
What are the insulin receptors?
Tyrosine kinases that activate several intracellular signaling cascades including phosphoinositol 3 (PI3) and mitogen-activated protein(MAP) kinase pathways
40
What are the mechanism of action of insulin effects on target cells?
Stimulating liver glycogen and triglyceride synthesis and inhibiting glycogen breakdown, gluconeogenesis, and ketogenesis - Stimulating muscle glucose and amino acid transport, and synthesis of glycogen and protein - Stimulating fat glucose and fatty acid uptake and triglyceride synthesis, and inhibiting triglyceride breakdown
41
What is the key rapid effect of insulin?
Promote glucose uptake into muscle and fat cells by initiating translocation of the glucose transporter 4(GLUT4) from intracellular vesicles to plasma membrane
42
What is the slower onset of insulin?
Growth-promoting and cell proliferation effects
43
What are the three major targets insulin acts on to promote fuel uptake and storage?
Insulin acts on brain as a satiety signal and may contribute to maintenance of normal brain structure and function, reducing risk of neurodegenerative disorders
44
What is diabetes mellitus?
Group of diseases with different pathogenic mechanisms and genetic associations, but common finding of increased blood glucose and altered levels or signal of insulin
45
What are the two major types of DM?
T2DM and T2DM with many other forms and syndromes reported
46
What are the lab tests to diagnose diabetes?
Fasting glucose, hemoglobin A1C, oral glucose tolerance test, or combination of random glucose with symptoms. Tests should be repeated to confirm the diagnosis
47
What is a type 1 diabetes?
autoimmune disorder that presents with complete destruction of b cells and plasma antibodies to characteristic antigens. - Result in complete reliance on exogenous insulin replacement
47
What are the acute complications of T1DM and insulin tx?
Hypoglycemia and diabetic ketoacidosis (DKA)
48
What is T2DM?
Disorder with variable presentation depending on genetics, ancestral descent, and individual differences
49
What is the pathogenesis of T2DM?
Combination of tissue insulin resistance that requires high levels of secreted insulin to normalize blood glucose levels, with B-cell vulnerable that leads to eventual failure and lead to dependence on exogenous insulin
50
What is onset of T2DM preceded by?
Period (variable length) of impaired glucose tolerance and prediabetes. Intensive lifestyle intervention in this period restore insulin sensitivity and prevent development of T2DM.
51
How is T2DM manage prior to insulin dependance?
Lifestyle modification and oral medications
52
What are the acute complications of T2DM?
Hypoglycemia and hyperosmolar hyperglycemia syndrome (HHS)
53
What are the common manifestations and chronic complications of T1DM and T2DM?
Excess glucagon secretion and liver glucose production as well as elevated fatty acid levels.
54
What is dyslipidemia?
Dyslipidemia with elevated cholesterol is common as is comorbid hypertension
55
What are the macrovascular diabetes complications?
Accelerated atherosclerosis development and high rates of events; MI, stroke, and peripheral arterial disease. - Requires tx by managing glucose, lipids, and BP
56
What are the microvascular complications of diabetes?
Retinopathy, nephropathy, and neuropathy (both somatic and autonomic). - Glycemic control to maintain A1C <7% is recommended to reduce micro complications - Tx individualized
57
What is pancreatic B-cell insulin secretion increased by?
Glucose and amino acids that increase during meal absortion
58
What is insulin secretion promoted by?
Acetylcholine and incretins glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1)
59
What is insulin secretion inhibited by?
Hypoglycemia, sympathetic nervous stimulation, epinephrine, and somatostatin
60
What is glucagon promote?
2nd major regulatory hormone of metabolic homeostasis -Promotes catabolic enzyme activity in liver, increasing glycogenolysis and gluconeogenesis to increase liver glucose release during fasting
61
What does glucagon promote in the absence of insulin?
Promote liver ketone formation particularly in absence of insulin
62
What does insulin normally inhibit?
Glucagon by a paracrine action in the fed state
63
What is glucagon secretion stimulated by?
Hypoglycemia and sympathetic nervous system stimulation
64
What is gestational diabetes?
dx in 2nd trimester. - Result from increased insulin resistance due to pregnancy-related hormones such as chorionic somatomammotropin and to the fact that insulin degraded by placenta - resolve after delivery but increase risk for development of T2DM
65
What is a latent autoimmune diabetes of adults?
Dx in adults older than 30 y/o at time of diabetes dx. - Slow progressive but typically one type of diabetes-related antibody found on testing
66
What is true about diabetes in children?
Children likely present with T1DM than T2DM before puberty. Management present challenges that vary depending on developmental stage from very young through young adulthood
67
What is true about T2DM in adolescents?
Increasing # of diabetes in adolescents particularly not of European ancestral descent. - More aggressive than occurring later in life
68
Why does older adults have higher incidence of T2DM?
Higher although trajectory may not be as severed. - Greater insulin resistance due to greater adipose declining muscle mass, and less physical activity
69
What is older adults at a higher risk for when treated with insulin or secretagogues?
Hypoglycemia than younger adults due to decreased autonomic responsiveness, comorbidities, and polypharmacy - glycemic targets can be relaxed if recurrent hypoglycemia is a problem
70
How many people in US have T2DM?
10%
71
The concept of insulin resistance is central to understanding what conditions?
T2DM, metabolic syndrome, and polycystic ovarian syndrome

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