Endocrinology Flashcards
What is Necrosis?
Non-programmed cell death. Nucleus destroyed first
What is Apoptosis?
Programmed cell death, no inflammation, and cell membrane dissolved first. Nucleus guides death & destroyed last
What is Pyknosis?
Nucleus turns into blobs. (shrinkage)
What is Karyorrhexis?
Nucleus fragments
What is Karyolysis?
Nucleus dissolves
What is a Somatotrope?
Growth hormone
What is a Gonadotrope?
LH and FSH
What is a Thyrotrope?
TSH
What is a Corticotrope?
ACTH
What is a Lactotrope?
PRL – Prolactin
What receptors do Protein Hormones use?
Cell membrane receptors
What receptors do Steroid Hormones use?
Nuclear membrane receptors (except cortisol cytoplasmic receptor)
What are the Steroid Hormones?
Progesterone, Estradiol (E2), Testosterone, Cortisol, and Aldosterone
What does Endocrine mean?
Secreted into bood
What does Exocrine mean?
Secreted into a duct
What is Autocrine?
Works on itself. (except T-cell activation)
What is Paracrine?
Works on its neighbor. (except sweat gland)
What is Merocrine?
Cell is maintained. (exocytosis)
What is Apocrine?
Apex of the cell is secreted
What is Holocrine?
The whole cell is secreted. (except sebaceous gland)
What organs do not require insulin to absorb glucose?
“BRICKLE”: Brain, RBC, Intestine, Cardiac / Cornea, Kidney, Liver and Exercising muscle
What is the function of GnRH?
Stimulates release of LH & FSH
What is the function of GRH?
Stimulates GH release
What is the function of CRH?
Stimulates ACTH release
What is the function of TRH?
Stimulates TSH release
What is the function of PRH?
Stimulates Prolactin (PRL) release
What does Dopamine (DA) do?
Inhibits Prolactin (PRL) release
What does Somatostatin (SS) do?
Inhibits growth hormone (GH) release
What does Antidiuretic hormone (ADH) do?
Conserves water (V2 aquaporin receptors) and vasoconstriction
What does Oxytocin do?
Milk letdown and uterine contractions
What does Growth Hormone (GH) do?
Stimulates Insulin Growth Factor-1 (IGF-1) release from the liver
What is the function of TSH (Thyroid stimulating hormone)?
Stimulates release of T3 and T4 from the thyroid.
T3= Triiodothyronine
T4= Thyroxine
What is the fucntion of LH (Luteinizing hormone)?
Stimulates Testosterone release from the testis, Androgens and Progesterone release from the ovary
What is the function of FSH
Male: sperm, MIF, inhibin B
Female: Stimulates Estradiol (E2)
What is the function of Prolactin (PRL)?
Milk production
What is the function of ACTH (Adrenocorticotropic hormone)?
Stimulates Cortisol and Androgen releases from the adrenal gland
What is the fucntion of MSH (melanocyte-stimulating hormones)?
Provides skin pigmentation
What are the Stress Hormones and when do they appear?
Immediately Epinephrine, Glucagon (20 minutes), Insulin & ADH (30 minutes), Cortisol (2-4 hours), and growth hormone (24 hours)
What is the Primary Diabetes Insipidus (DI)?
Too much water (urinates a lot)
What is Central (neurogenic) diabetes insipidus?
Brain not making or producing enough ADH
What is Nephrogenic diabetes insipidus?
ADH (V2 aquaporin) is blocked or broken. Lithium association and Demeclocycline
What does the Water Deprivation Test tell you?
If the patient fails to concentrate urine, they do not have Primary DI
What does giving DDAVP during the Water deprivation tests tell you?
> 50% increase (central complete DI),
10-50% increase (central partial DI),
<10% (psychogenic polydipsia),
no change (nephrogenic DI)
What is SIADH?
Too much ADH present causes plasma volume to expand Serum Na+ less than 120
What is the difference between DI and SIADH?
DI: diluted urine
SIADH: concentrated urine
What is the Psychogenic Polydipsia?
Pathologic water drinking will have low plasma osmolality
What does Aldosterone do?
Reabsorbs Na+ and three waters
What does Atrial Natriuretic Peptide do?
Inhibits aldosterone and dilates the afferent arteriole
What is a Neuroblastoma?
Adrenal medulla tumor in kids, dancing eyes and feet and secretes catecholamine’s
Whatis Pheochromocytoma?
Adrenal medulla tumor in adults, they will have five P’s: Palpitations, Perspiration, Pallor, Pressure (HTN), and Pain (headache)
What are the layers of the Adrenal Cortex and what do they produce?
Zona Glomerulosa (Aldosterone), Zona Fasciculate (Cortisol), Zona Reticularis (Androgens)
What is Conn’s Syndrome?
High Aldosterone (primary tumor), Cpatopril test makes it worse, and increase’s secretin hormone
What does Calcitonin do?
Inhibits Osteoclasts and binds to calcium
What is Multiple Endocrine Neoplasia I?
“Wermer’s” 3 P’s: Pancreas, Pituitary, Parathyroid adenoma
What is Multiple Endocrine Neoplasia II (2A)?
“Sipple’s” Pheochromocytoma, Medullary Carcinoma of the Thyroid, Parathyroid Adenoma. (tumor marker RET)
What is Multiple Endocrine Neoplasia III (2B)?
Pheochromocytoma, Medullary Carcinoma of the Thyroid, Mucosal Neuromas/ Marfanoid body habitus. (tumor marker RET)
What does CCK (Cholecystokinin) do?
Stimulates bile release and gallbladder contraction, inhibits gastric motility (closes sphincters), and made by I-cell of duodenum
What does cortisol do?
Gluconeogenesis by proteolysis and thins the skin, prevents and immune response, and decrease bone mass
What is Addison’s disease?
Autoimmune destruction of adrenal cortex, causes hyperpigmentation (looks tan), and increased ACTH
What is Waterhouse-Friderichsen syndrome (WSF) or Hemorrhagic Adrenalitis or Fulminant Meningococcemia?
Adrenal hemorrhage most commonly due to Meningococcus Neisseria Meningitides
What can cause Cushing’s syndrome?
High cortisol produced from an adrenal tumor
What is Cushing’s disease?
High ACTH due to pituitary tumor or Small cell carcinoma of the lungs
When performing a low does dexamethasone test, a depression in ACTH levels occur, what does that tell you?
Patient is either depressed, obese, or it’s a normal variant, if the low dose Dexamethasone test does not suppress…
When performing a high dose dex. Test, if positive…
Patient has a pituitary tumor
Negative high dose Dex. and High ACTH levels?
Ectopic ACTH- small cell CA of the lungs
Negative high dose Dex. and low ACTH levels?
Adrenal CA (high cortisol)
What are the Survival Hormones?
Cortisol: permissive under stress.
TSH: permissive under normal
What does epinephrine (Epi) do?
Drives gluconeogenesis and glycogenolysis
What does erythropoietin (EPO) do?
Makes RBC’s (prolong RBC life)
What does Gastrin do?
Stimulates parietal cells to release intrinsic factor (IF) and H+
What does Growth Hormone (GH) do?
Stimulates growth, sends Somatomedin to growth plates, Gluconeogenesis by proteolysis
What is achondroplasia (Laron Dwarf)?
Patient with abnormal FGF receptors in exremities. (abnormal FGF3)
What is the receptor problem with Midgets?
Patient with decreased Somatomedin receptor sensitivity
What is Acromegaly?
Growth hormone tumor producing increased IGF-1 causing: bone growth in adults, coarse facial features, large furrowed tongue, deep husky voice, jaw protrusion
What is Gigantism?
Childhood form of Acromegaly
What does Gastric Inhibitory Peptide (GIP) do?
Increases insulin action, responsible for post-prandial hypoglycemia
What does Glucagon do?
Active in Gluconeogenesis, Glucogenolysis, Lipolysis, and Ketogenesis
What does Insulin do?
Pushes glucose into cells and K+ follows
What is Type 1 Diabetes Mellitus?
Anti-islet cell antibody /GAD (Glutamic Acid Decarboxylase) antibody.
What is Type 2 Diabetes Mellitus and associations?
Insulin receptor insensitivity, HONK coma, Acanthosis Nigricans
How does DKA present?
Kussmaul respirations, fruity breath (acetone), and altered mental status
What is the Dawn Phenomenon?
Morning hyperglycemia secondary to Growth Hormone
What is the Somogyi Effect?
Morning hyperglycemia secondary to evening hypoglycemia
What is factitious hypoglycemia?
Exogenous insulin use, labs show elevated insulin and decreased C-peptide
What is an Insulinoma?
Insulin secreting tumor, labs show increased insulin and C-peptide
What is Erythrasma?
Rash in the skin folds, coral-red under Wood’s Lamp
What is Metabolic Syndrome X?
“Pre-DM” due to HTN, Dyslipidemia, Hyperinsulinemia, and Acanthosis Nigricans
What are the Foot Ulcer Risk Factors?
Poor glycemic control (HbA1C >7), smoking, bony abnormalities, previous ulcers
What conditions cause weight gain?
Obesity, Hypothyroidism, Depression, Cushing’s, Anasarca
What does motilin do?
Stimulates segmentation, primary peristalsis, and migrating motor complexes (MMC)
What does PTH do?
Stimulates osteoblast to activate osteoclasts, stimulates the reabsorption of Ca+ and the excretion of phosphate in the kidneys, and activation of vitamin D
What does Vitamin D do?
Helps in calcium absorption from the GI tract
What does the parathyroid cells secrete?
PTH
What do stomach chief cells secrete?
Pepsin
What is the difference between norepinephrine and epinephrine?
NE: Neurotransmitter
EPI: Hormone
What diagnosis has primary hyperparathyroidism?
Parathyroid Adenoma
What diagnosis has secondary hyperparathyroidism?
Renal failure
What is familial Hypocalciuria Hypercalcemia?
Patients with decreased calcium excretion
What disease process is present when both Serum Ca2+ and Serum Phosphate (PO4-) are decreased?
Vitamin D deficiency
What type of problem is there if serum Ca2+ and Serum PO4- change in same directions?
This is a secondary problem
What is the most common cause of primary hypoparathyroidism?
Thyroidectomy
What is pseudo-hypoparathyroidism?
Bad kidney, PTH receptor, decreased urinary, cAMP
What is pseudo-pseudo-hypoparathyroidsm?
G-Protein defect, and there is no calcium problem
What is Hungry Bone Syndrome?
Removal of PTH and the bone sucks in calcium
What does secretin do?
Secretion of bicarbonate, inhibit gastrin, tighten Pyloric Sphincter, and secreted by S-cell Duodenum
What does somatostatin do?
Inhibits secretin, motilin, and CCK
What is the function of T3 and T4?
Growth and differentiation
What disease has exophthalmos?
Grave’s disease
What other diseases can have exophthalmos?
Horner’s and Marfan’s
What are the hyperthyroid diseases?
Grave's DeQuervain's Silent Thyroiditis Plummer's Jod-Basedow
What do you see in Grave’s Disease?
Exophthalmos, Pretibial myxedema, anti-TSH receptor antibodies
What do you see in DeQuervain’s disease?
Viral origin, painful jaw, hypothyroid
When do you see silent thyroiditis?
Post-partum patients
When will you see Plummer’s Disease?
Patients with benign adenoma and or patients over 50 yrs. old. In an iodine scan, it looks like a nodular patter
What is Jod-Basedow Disease?
Transient hyperthyroidism due to increased iodine
What are the hypothyroid diseases?
Hashimoto’s, Riedel’s, Cretinism, Euthyroid SIck syndrome, Wolff-Chaikoff
What is Riedel’s Struma?
“Woody” connective tissue in neck, death due to suffocation and must rule out CA
What is Cretinism?
Mom and baby are hypothyroid
What is Euthyroid Sick Syndrome?
LOW T3 Syndrome and decreased conversion of T4 to T3 (increased T3r)
What is Wolff-CHaikoff?
Transient hypothyroidism
What is Plummer’s Syndrome?
Hyperthyroid adenoma
What is Plummer-Vinson Syndrome?
Esophageal webs, Iron-deficiency anemia, dysphagia
