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EndoRepro > Endocrine Week 1 > Flashcards

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
Q

What do the parathyroid glands originate from?

A

Pharyngeal pouches 3 & 4

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25
Q

What does the initial wave of epithelial cells form? The second wave?

A

Fetal adrenal cortex

Definitive adrenal cortex

26
Q

Neural crest forms secreting cells in which glands?

A

Thyroid, adrenal

27
Q 
Name the tissue these glands are derived from:
Pituitary
Thyroid
Parathyroid
Adrenal
A

Ectoderm
Endoderm
Endoderm
Mesoderm

28
Q

What is the primary determinant of free water excretion in humans?

A

regulation of urinary water excretion by circulating levels of vasopressin

29
Q

What is the major factor controlling AVP release?

A

plasma osmolality

30
Q

The release of vasopressin is more sensitive to which:
changes in volume/pressure
osmoreceptor response

A

osmoreceptor response

31
Q

Primary site of AVP response

A

collecting duct

32
Q

Causes for SIADH

A

lung disease, drugs, cerebral

33
Q

First step after noting hyponatremia?

A

measure serum and urine osmolality

Hypotonic serum, >100 mOsm/L in urine may be SIADH

34
Q

What are conivaptan and talvaptan used for?

A

Vasopressin receptor antagonists for SIADH

35
Q

What other drugs can be used for SIADH (not antagonists)?

A

furosemide, bumetanide

36
Q

What must nephrogenic and central diabetes insipidus be distinguished from?

A

primary polydipsia

37
Q

What to test with hypernatremia?

A

Volume status and urinary sodium content

euvolemia and variable sodium may be diabetes insipidus or dipsia

38
Q

If you have polyuria, what test results indicate diabetes inspidus?

A

low urine osmolality (300)

39
Q

If the the serum osmolality and sodium do not rise above normal and you suspect polydipsia, what will happen to urine osmolality?

A

concentrates

40
Q

What is DDAVP?

A

synthetic ADH for central diabetes insipidus (desmopressin)

41
Q

Structures in the cavernous sinus that could be compromised by pituitary growth

A

internal carotid artery

cranial nerves III, IV, V1, V2, VI

42
Q

Two posterior pituitary nerves

A

ADH, oxytocin

43
Q

Drugs that cause hyperprolactinemia

A

metoclopramide, risperidone

dopamine antagonists

44
Q

Symptoms of hyperprolactinemia in patient

A

Typically women

menstrual irregularities, galactorrhea, infertility

45
Q

Treatment of hyperprolactinemia

A

Dopamine agonists

cabergoline (preferred), bromocriptine

46
Q

Methods to diagnose acromegaly

A

serum IGF-1

oral glucose tolerance test

47
Q

Drugs to treat acromegaly

A

octreotide, lanreotide
cabergoline (works in limited population)
pegvisomant (GH receptor antagonist)

48
Q

Drug treatment for GH deficiency in children

A

recombinant human growth hormone (rGH)

49
Q

What is a condition that would alter the metabolism of cortisol?

A

chronic liver disease

50
Q

What enzyme converts cortisol to the inactive cortisone?

A

11B-HSD2

51
Q

In what areas of the body can cortisone be converted back to cortisol?

A

liver, visceral fat (by 11B-HSD1)

52
Q

What substance is elevated in pts with 17-hydroxylase deficiency in order to compensate for lack of cortisol?

A

corticosterone

53
Q

Drug used to treat endogenous hypercortisolism`

A

mifepristone (glucocorticoid receptor antagonist)

54
Q

Organ deficient in:
A) primary adrenal insufficiency
B) secondary adrenal insufficiency
C) tertiary adrenal insufficiency

A

A) adrenal gland
B) pituitary gland
C) hypothalamus

55
Q

Notable lab abnormality in primary adrenal insufficiency

A

hyponatremia

56
Q

drugs that cause primary adrenal insufficiency

A

ketoconazole, etomidate, mitotane, mifepristone

57
Q

A cause of false negatives in cosyntropin test of adrenal insufficiency

A

oral contraceptives

58
Q

Drug that can cause isolated ACTH deficiency

A

ipilimumab

59
Q

Drug used for primary and secondary adrenal insufficiency

A

hydrocortisone

60
Q

Diagnoses that raise your suspicion for Cushing syndrome?

A

diabetes/hypertension/metabolic syndrome, osteoporosis, adrenal nodules

61
Q

Will ACTH levels be low or high in ACTH independent Cushing’s?

A

low

62
Q

Medical therapies for Cushing’s

A

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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