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Medical Physiology- Costanzo > Endocrine Physiology > Flashcards

Endocrine Physiology Flashcards

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USMLE® Step 1 flashcards
1
Q

In what chemical form is cholesterol typically transported in serum?

A

typically transported in serum as a cholesterol ester with a fatty acid at the third carbon of the cholesterol structure.

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2
Q

What is the primary physiological role of glucocorticoids?

A

The primary physiological role of glucocorticoids is the regulation of energy metabolism.

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3
Q

What is the primary physiological role of sex hormones?

A

regulation of sexual development and function

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4
Q

minearlocorticoid GR type 1

A

binds aldosterone and cortisol, but cortisol is enzymatically converted to an inactive form in aldosterone sensitive cells.

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5
Q

What are the major steroid hormone classes and their functions?

A
  • glucocorticoids, affect energy metabolism
  • mineralocorticoids, affect electrolyte balance
  • sex hormones- affect sexual development and function
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6
Q

What are the groups of the nuclear receptor superfamily?

A

group 1- classic steroids
group 2- thyroid/retinoid/vit D/PPAR
group 3- orphans

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7
Q

SERM

A

Selective Estroen-Receptor Modulators

Estradiol (agonist)
uterus-mitogenic
breast-mitogenic
bone-increases

Raloxifene
uterus-NA
breast-
bone-increases

Tamoxifen
uterus-mitogenic
breast-differtiates
bone-NA

Complete antagonist
uterus-NA
breast-diff
bone-NA

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8
Q

Syndrome of Apparent Mineralocorticoid Excess

A

dx: symptoms of excess aldosterone, hypertension
BUT normal [aldo]

cause: excessive licorice consumption
bc licorice blocks a 11B-HS so cortisol is not inactivated and binds to the receptor

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9
Q

Which hormone(s) are produced in the Zona Fasciculata of the Adrenal Cortex in a healthy adult?

A

cortisol
DHEA
DHEAS

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10
Q

Which hormone(s) are produced in the Zona Glomerulosa of the Adrenal Cortex in a healthy adult?

A

aldosterone

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11
Q

Which way does blood flow between the adult Adrenal Medulla and Adrenal Cortex flows?

A

Centripetal: From the Adrenal Cortex to the Adrenal Medulla

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12
Q

Which enzyme is responsible for the rate limiting committed step of steroid synthesis?

A

Which enzyme is responsible for the rate limiting committed step of steroid synthesis?

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13
Q

Why does the adult Zona Glomerulosa produce only aldosterone?

A

Because it lacks the enzyme P450-17alpha, which is required for cortisol and adrenal androgen synthesis.

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14
Q

Congenital adrenal hyperplasia (in most cases caused by enzyme deficiency of 21-hydroxylase, aka P450-21) is characterized by what?

A
  • decreased cortisol and aldosterone

- increased testosterone and estradiol

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15
Q

What causes hyper-pigmentation of the skin in Addison’s disease?

A

decreased cortisol -> increased ACTH -> increased pronetior, propriomelanocortin -> increased MSH and hyperpigmentation

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16
Q

In complete deficiency of 21-hydroxylase (P450-21), what are cortisol levels?

A

absent

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17
Q

Congenital adrenal hyperplasia

A

cause: deficiency in 21-hydroxylase(p450-21)
symptoms:
no cortisol or aldosterone production
high ACTH -> high adrenal androgens (androgenital syndrome for Fs, early puberty for Ms)

tx: glucocorticoids

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18
Q

Addison’s Disease

A

cause: atrophy or
dysgenesis of the adrenal, possibly autoimmune attack or TB or ACTH receptor abnormality

symptoms:
decreased cortisol (fatigue, weakness, weight loss, nausea, hypoglycemia)
increased ACTH (hyperpigmentation)
decreased aldosterone (decreased Na -> hypotension, increased K -> arrythmia)

tx:

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19
Q

Cushing’s Syndrome

A

cause: high cortisol
(exogenous glucocorticoids AKA latrogenic, adrenocortical tumor, ACTH or CRH tumor)
symptoms: weight gain
red skin, moon face
hyperglycemic
increased aldosterone (increased Na -> hypertension, decreased K -> inverted T-waves)

tx:

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20
Q

The neural input that regulates chromaffin cells primarily uses which neurotransmitter:

A

Ach

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21
Q

What is present in chromaffin granules?

A

Epi & Nore
ATP, ADP
ascorbate
some dopamine and DBH

22
Q

What is the rate limiting step for catecholamine biosynthesis?

A

tyrosine hydroxlase

23
Q

What class of drugs formerly widely used to treat depression can cause hypertension when there are high levels of tyramines in food?

A

Monomine oxidase inhibitors

MAO breaks down epi and norepi, too much tyramines may replace norepi in storage vesicles -> hypertensive crisis

24
Q

Which catecholamine is released at greater levels by the adrenal medulla?

A

Epi
This is due to 7-8 fold greater number of chromaffin cells that have phenylethanolamine-N-methyltransferase (“A-cells”) as the terminal catecholamine biosynthetic enzyme rather than dopamine-beta-hydroxylase as the terminal catecholamine biosynthetic enzyme (“N-cells”).

25
Q

What would an autoimmune attack of the thyroid gland lead to?

A

Either hypothyroid (Hashimoto’s) or hyperthyroid (Graves’) function

26
Q

What do de-iodination rxns do?

A

activate thyroid hormones (T4 -> T3)

deactivate thyroid hormones (T3-rT3)

27
Q

Congenital hypothyroidism

A

common -> neonatal screening

28
Q

Paget’s disease

A

more common in men

29
Q

What is the most commonly prescribed class of drugs for treating osteoporosis, and briefly in one sentence, how do they work?

A

Bisphophophonates. These drugs inhibit osteoclasts from further degrading bone.

30
Q

Which membrane ion channel is responsible for regulating insulin release from beta cells?

A

The K-ATP channel, which includes SUR subunits.

31
Q

Which hormones are released from the endocrine pancreas?

A

somatostatin, insulin, pancreatic polypeptide, glucagon

32
Q

True or false, insulin up-regulates the activity of glucose-6-phosphatase in the liver?

A

False. Insulin promotes anabolic processes, so it up-regulates the activity of glucokinase, which has opposing biochemical actions to glucose-6-phosphatase

33
Q

Which oral hypoglycemic drugs are prescribed for Type II DM?

A

Sulfonylureas and biguanides (including metformin) are two of the most commonly prescribed as oral hypoglycemic drugs to patients with Type II Diabetes Mellitus

34
Q

What is the primary metabolic fuel for the brain during prolonged starvation

A

ketone bodies

35
Q

What is the most useful clinical lab test commonly used to monitor long term blood glucose levels?

A

Hemoglobin A1c

36
Q

What are the four “counter regulatory” hormones that promote glucose mobilization?

A

cortisol, glucagone, growth hormone, epinephrine

37
Q

What hormone is the best measure of fetal well being?

A

estriol

38
Q

What are the complications that result from hyperglycemia over long time periods?

A

vascular disease, retinopathy, nephropathy, neuropathy, increased infection rates, poor wound healing

39
Q

Which hormones are secreted by fat cells to regulate energy metabolism?

A

leptin, resistin, adiponectin

40
Q

Laron dwarfs

A

defective receptors for GH -> low IGF-1

41
Q

proliferative phase

A

aka follicular phase

42
Q

secretory phase

A

aka luteal phase

43
Q

ovulation

A

day 14, peak in serum LH on day 13-14

44
Q 
What is the approximate probility of intercouse for:
day 6
day 11
day 14
day 16
A

day 6: 0%
day 11:14%
day 14: 33%
day 16: 0%

45
Q

When could hCG could be detected?

A

day20

46
Q

prolactin

A

PRL inhibiting hormone is dopamine while all other hypothalmic releasing inhibitory hormones are peptides
PRL release is primarily under negative control and other hormones are under positive control

47
Q

What is the major change in an endocrine regulatory sytem that causes the onset of puberty?

A

decreasing sensitiviy of gonadostat

48
Q

What percent drop in ejaculate volume would be expected following vasectomy?

A

5%

49
Q

What is the biomechanical mechanism of erection?

A

NO stimulates guanylcylcase -> increases cGMP causes relaxation of s muscles and increases blood flow through the arterioles. TypeV phosphodiesteroes hydrolyzes cGMP and reverses the relaxation. Viagra inhibits typeV PDE

50
Q

Type 1 DM

A

diagnosis: autoimmune assay for glutamic acid decarboxylase, insulin and IA 2 transmembrane tyrosine phosphatase

twin concordance

51
Q

Type 2 DM

A

diagnosis: >200mg/dL blood glucose after 75g glucose load

Medical Physiology- Costanzo (11 decks)

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