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Endocrine Week 1 Flashcards

0
Q

Are group I hormones lipophilic or hydrophilic?
Do they have transport proteins?
What is their half life like?

A

Lipophilic
Yes
Long

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1
Q

What hormones are in Group I?

A

Steroids, iodothyronines (thyroid)

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2
Q

List the following in order of longest to shortest half life: Steroids, thyroids, peptides/proteins

A

Thyroid>Steroids>Peptides/proteins

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3
Q

What is the rate limiting step for all steroidogenic pathways?

A

StAR protein mediation of cholesterol uptake from cytosol to inner mitochondrial membrane

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4
Q

What determines the major steroid product of each gland?

A

enzyme expression

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5
Q

What determines which circulating secretagogue the gland will respond to?

A

G-coupled protein receptor

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6
Q 
Quick summary of the following types of signaling:
A) Endocrine
B) Paracrine
C) Autocrine
D) Neurotransmitter
E)Neuroendocrine
A 
A) cell to distant cell
B) cell to adjacent cell
C) cell to itself
D) neuron to adjacent neurons
E) neuroendocrine cell to distant organ
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7
Q

Where can thyroid hormone receptors be found?
Glucocorticoid receptors?
Peptides, etc?

A

Nuclear receptors
Cytoplasmic or Nuclear receptors
Cytoplasmic receptors

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8
Q

What differentiates polypeptide receptors from proteins?

A

Proteins have a tertiary structure

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9
Q

What enzyme is targeted in breast cancer? What are its actions?

A

Aromatase
Converts androstenedione to estrone (E1 which is then converted to E2/estradiol which promotes growth in estrogen related tumors)

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10
Q

Hypothalamus releases what hormone to the anterior pituitary? What hormone does the anterior pituitary release to the adrenal cortex? What does the adrenal cortex release that inhibits the previous two hormones?

A

CRH
ACTH
Cortisol

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11
Q

Example of positive feedback

A

Ovulation during menstrual cycle (estradiol leads to more hormone)
Childbirth (cervix stretch->post pit->uterine contraction->stretch)
Lactations (suckling->post pit->oxytocin->milk)

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12
Q

How do you recognize secondary hyperfunction?

Secondary hypofunction?

A

Cushing’s example: ACTH is inappropriately elevated when it should be suppressed by cortisol
Secondary adrenal insufficiency: ACTH is inappropriately unelevated in relation to the low levels of cortisol

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13
Q

Which portion of the pituitary is more cellular? Which is more fibrous and resembles nerve tissue?

A 
Anterior pituitary (distal, intermediate, tuberal lobe)
Posterior pituitary (neural lobe, pituitary stalk, median eminence)
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14
Q

What will damage to long portal vessels cause?

A

atrophy of anterior pituitary

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15
Q

Effects of pituitary adenoma?

A

Excess hormone secretion–endocrine syndromes

Can compress optic chiasm

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16
Q

Most thyroid tumors are derived from what type of cells?

A

follicle epithelial cells

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17
Q

Adipocytes are a constant feature of what gland?

A

Parathyroid

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18
Q

What disease do you think of when serum calcium levels are persistently low?

A

Primary hyperparathyroidism

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19
Q

What are the key characteristics of steroid secreting cells?

A

abundant smooth ER
tubulovesicular cristae in mitochondria
membrane bound lipid droplets

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20
Q

What germ layer are the endocrine and exocrine layers derived from?

A

epithelium

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21
Q

What is the pituitary gland derived from?

A

Oral ectoderm/hypophyseal diverticulum/Rathke’s Pouch
(forms anterior lobe, pars distalis & tuberalis & intermedia)
Neural ectoderm/Infundibulum
(forms stalk and posterior lobe)

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22
Q

Craniopharyngioma symptoms?

Originating tissue?

A

Optic chiasm impingement, hyrodephalus, pituitary dysfunction
Rathke’s pouch remnants-pharyngeal hypophysis

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23
Q

Aberrant thyroid tissue is found where most often?

What are midline structures that can rupture or form fistula?

A

Base of tongue

Thryoglossal Duct cysts

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24
What do the parathyroid glands originate from?
Pharyngeal pouches 3 & 4
25
What does the initial wave of epithelial cells form? The second wave?
Fetal adrenal cortex | Definitive adrenal cortex
26
Neural crest forms secreting cells in which glands?
Thyroid, adrenal
27
``` Name the tissue these glands are derived from: Pituitary Thyroid Parathyroid Adrenal ```
Ectoderm Endoderm Endoderm Mesoderm
28
What is the primary determinant of free water excretion in humans?
regulation of urinary water excretion by circulating levels of vasopressin
29
What is the major factor controlling AVP release?
plasma osmolality
30
The release of vasopressin is more sensitive to which: changes in volume/pressure osmoreceptor response
osmoreceptor response
31
Primary site of AVP response
collecting duct
32
Causes for SIADH
lung disease, drugs, cerebral
33
First step after noting hyponatremia?
measure serum and urine osmolality | Hypotonic serum, >100 mOsm/L in urine may be SIADH
34
What are conivaptan and talvaptan used for?
Vasopressin receptor antagonists for SIADH
35
What other drugs can be used for SIADH (not antagonists)?
furosemide, bumetanide
36
What must nephrogenic and central diabetes insipidus be distinguished from?
primary polydipsia
37
What to test with hypernatremia?
Volume status and urinary sodium content | euvolemia and variable sodium may be diabetes insipidus or dipsia
38
If you have polyuria, what test results indicate diabetes inspidus?
low urine osmolality (300)
39
If the the serum osmolality and sodium do not rise above normal and you suspect polydipsia, what will happen to urine osmolality?
concentrates
40
What is DDAVP?
synthetic ADH for central diabetes insipidus (desmopressin)
41
Structures in the cavernous sinus that could be compromised by pituitary growth
internal carotid artery | cranial nerves III, IV, V1, V2, VI
42
Two posterior pituitary nerves
ADH, oxytocin
43
Drugs that cause hyperprolactinemia
metoclopramide, risperidone | dopamine antagonists
44
Symptoms of hyperprolactinemia in patient
Typically women | menstrual irregularities, galactorrhea, infertility
45
Treatment of hyperprolactinemia
Dopamine agonists | cabergoline (preferred), bromocriptine
46
Methods to diagnose acromegaly
serum IGF-1 | oral glucose tolerance test
47
Drugs to treat acromegaly
octreotide, lanreotide cabergoline (works in limited population) pegvisomant (GH receptor antagonist)
48
Drug treatment for GH deficiency in children
recombinant human growth hormone (rGH)
49
What is a condition that would alter the metabolism of cortisol?
chronic liver disease
50
What enzyme converts cortisol to the inactive cortisone?
11B-HSD2
51
In what areas of the body can cortisone be converted back to cortisol?
liver, visceral fat (by 11B-HSD1)
52
What substance is elevated in pts with 17-hydroxylase deficiency in order to compensate for lack of cortisol?
corticosterone
53
Drug used to treat endogenous hypercortisolism`
mifepristone (glucocorticoid receptor antagonist)
54
Organ deficient in: A) primary adrenal insufficiency B) secondary adrenal insufficiency C) tertiary adrenal insufficiency
A) adrenal gland B) pituitary gland C) hypothalamus
55
Notable lab abnormality in primary adrenal insufficiency
hyponatremia
56
drugs that cause primary adrenal insufficiency
ketoconazole, etomidate, mitotane, mifepristone
57
A cause of false negatives in cosyntropin test of adrenal insufficiency
oral contraceptives
58
Drug that can cause isolated ACTH deficiency
ipilimumab
59
Drug used for primary and secondary adrenal insufficiency
hydrocortisone
60
Diagnoses that raise your suspicion for Cushing syndrome?
diabetes/hypertension/metabolic syndrome, osteoporosis, adrenal nodules
61
Will ACTH levels be low or high in ACTH independent Cushing's?
low
62
Medical therapies for Cushing's
Pasireotide (somatostatin receptor agonist)--pituitary directed Metyrapone - 11-B hydroxylase inhibitor (adrenal steroid inhibitor) Mifepristone: glucocorticoid and progesterone receptor inhibitor

EndoRepro (4 decks)

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