Endocrinology Flashcards
What is a Somatotrope?
GH
What is a Gonadotrope?
LH, FSH
What is a Thyrotrope?
TSH
What is a Corticotrope?
ACTH
What is a Lactotrope?
PRL
What receptors do protein hormones use?
Cell membrane receptors
What receptors do steroid hormones used?
Nuclear membrane receptors
What are the steroid hormones?
PET CAD
- Progesterone
- E2 = estriol
- Testosterone
- Cortisol
- Aldosterone
- D vitamin
*Note: Thyroid hormone acts like a steroid
What does endocrine mean?
Secretion into blood
What does exocrine mean?
Secretion into non-blood
What is Autocrine?
Works on itself
What is Paracrine?
Works on its neighbor
What is Merocrine?
Cell is maintained => exocytosis
What is apocrine?
APEX of the cell is secreted
What is Holocrine?
The WHOLE cell is secreted
What organs do not require insulin?
BRICKLE
- brain
- RBC
- intestine
- cardiac, cornea
- kidney
- liver
- exercising muscle
What does GnRH do?
Stimulates LH, FSH production
What does GRH do?
Stimulates GH production
What does CRH do?
Stimulates ACTH production
What does TRH do?
Stimulates TSH production
What does PRH do?
Stimulates PRL production
What does DA (dopamine) do?
Inhibits PRL production
What does SS (somatostatin) do?
Inhibits GH production
What does ADH do?
Conserves water
Vasoconstricts
What does oxytocin do?
Milk letdown
Baby letdown
What does GH do?
IGF-1 release from liver
What does TSH do?
T3, T4 release from thyroid
What does LH do?
Testosterone release from testis
E2 and Progesterone release from ovary
What does FSH do?
Sperm or egg growth
What does PRL do?
Milk production
What does ACTH do?
Cortisol release from adrenal gland
What does MSH do?
Skin pigmentation
What are the stress hormones?
Epi - immediate
Glucagon - 20 min
Insulin - 30 min
ADH - 30 min
Cortisol - 2-4 hours
GH - 24 hours
What does ADH do?
Concentrates urine
What is diabetes insipidus?
Too little ADH => urinate a lot
What is Central DI?
Brain not making ADH
What is Nephrogenic DI?
Blocks ADH receptor
Can be caused by Lithium and Democycline
What does the water deprivation test tell you?
Water deprivation => DI fails to concentrate urine
High specific gravity
High osmolarity
What does giving DDAVP (desmopressin) tell you?
Central DI concentrates >25%
What is SIADH?
Too much ADH
=> expand plasma vol => pee Na
What is the difference b/w DI and SIADH?
DI has dilute urine
SIADH has concentrated urine
What is psychogenic polydipsia?
Pathologic water drinking
=> low plasma osmolarity
What does Aldosterone do?
Reabsorbs Na
Secretes H/K
What is a neuroblastoma?
Adrenal medulla tumor in kids
Dancing eyes/feet
Secretes catecholamines
What is a pheochromocytoma?
Adrenal medulla tumor in adults
5 Ps
- pressure (HTN)
- pain (HA)
- perspiration
- palpitations
- pallor
What does the zona glomerulosa make?
Aldosterone “salt”
What is the primary regulatory control for the zona glomerulosa?
Renin-angiotensin
What does the zona fasciculata make?
Cortisol “sugar”
What is the primary regulatory control for the zona fasciculata?
ACTH, CRH
What does the zona reticularis make?
Androgens “sex”
What do chromaffin cells produce?
Catecholamines
What is the primary regulatory control for the chromaffin cells?
Preganglionic sympathetic fibers
What is Conn’s syndrome?
High aldosterone (tumor)
Captopril test makes it worse
What does ANP do?
Inhibits Aldosterone
Dilates renal artery (afferent arteriole)
What does calcitonin do?
Inhibits osteoclasts
=> low serum Ca
What is MEN I?
Wermer’s
Pancreas
Pituitary
Parathyroid adenoma
High gastrin
What is MEN II?
Sipple’s
Pheochromocytoma
Medullary thyroid cancer
PTH
What is MEN III?
= MEN IIb
Pheochromocytoma
Medullary thyroid cancer
Oral/GI neuromas
What does CCK do?
Gallbladder contraction
Bile release
What does cortisol do?
Gluconeogenesis by proteolysis
=> thin skin
What is Addison’s disease?
Autoimmune destruction of adrenal cortex
=> hyperpigmentation
Elev ACTH
What is Waterhouse-Friderichsen?
Adrenal hemorrhage
What is Cushing’s Syndrome?
High cortisol
(Pituitary tumor or adrenal tumor or small cell lung carcinoma)
What is Cushing’s disease?
High ACTH
(Pituitary tumor)
What is Nelson’s syndrome?
Hyperpigmentation after adrenalectomy
If the low-dose Dexamethasone test suppresses, what does that tell you?
Normal
Obese
Depressed
If the low-dose Dexamethasone test does not suppress, what does that tell you?
Cushing’s
=> do high dose test
If the high-dose Dexamethasone test suppresses, what does that tell you?
Pituitary tumor
=> ACTH
(call brain surgeon)
If the high-dose Dexamethasone test does not suppress, what does that tell you?
Adrenal adenoma
=> Cortisol
(Call general surgeon)
Small cell lung cancer
=> ACTH
(Call thoracic surgeon)
What are the survival hormones?
Cortisol: permissive under stress
TSH: permissive under normal conditions
What does epinephrine do?
Gluconeogenesis
Glycogenolysis
What does erythropoietin do?
Makes RBCs
What does Gastrin do?
Stimulates parietal cells
=> IF and H+
What does growth hormone do?
Growth
Sends somatomedin to growth plates
Gluconeogenesis by proteolysis
What is a pygmie?
No somatomedin receptors
What is achondroplasia (= Laron dwarf)?
Abnormal FGF receptors in extremities
What is a Midget?
Decreased somatomedin receptor sensitivity
What is acromegaly?
Adult bones stretch = “my hat doesn’t fit”
Course facial features
Large furrowed tongue
Deep husky voice
Jaw protrusion
Elev IGF-1 b/c of GH tumor
What is gigantism?
Childhood acromegaly
What does GIP do?
Enhances insulin action
=> post-prandial, hypoglycemia
What does glucagon do?
Gluconeogenesis
Glycogenolysis
Lipolysis
Ketogenesis
What does insulin do?
Pushes glucose into cells
What is Type I DM?
Anti-islet cell Ab
Glutamic acid decarboxylase Ab
Coxsackie B
Low insulin
DKA
Polyuria
Polydipsia
Polyphagia
What is Type II DM?
Insulin receptor insensitivity
High insulin
HONK coma = Hyperglycemic Hyperosmolar NonKetotic
Acanthosis
How does DKA present?
Kussmaul respirations
Fruity breath (acetone)
Altered mental
What is the Dawn phenomenon?
Morning hyperglycemia, secondary to GH
What is the Somogyi Effect?
Morning hyperglycemia, secondary to evening hypoglycemia
What is factitious hypoglycemia?
Insulin injection
- elev insulin
- decr C-peptide
What is an insulinoma?
Tumor
- elev insulin
- elev C-peptide
What is Erythrasma?
Rash in skin folds
Coral-red Wood’s lamp
What is Syndrome X (= metabolic syndrome)?
Pre-DM =>
- HTN
- dyslipidemia
- hyperinsulinemia
- acanthosis nigricans
What are foot ulcer risk factors?
- DM/Glycemic control
- male smoker
- bony abnormalities
- previous ulcers
What conditions cause weight gain?
- obesity
- hypothyroidism
- depression
- Cushing’s
- Anasarca (= generalized swelling)
What does motilin do?
Stimulates segmentation
- Primary peristalsis
- MMC
What does oxytocin do?
Milk ejection
Baby ejection
What does PRL do?
Milk production
What does PTH do?
Chews up bone
“Phosphate trashing hormone”
What does Vit D do?
Builds bone
What do parathyroid chief cells secrete?
PTH
What do stomach chief cells secrete?
Pepsin
What is the difference between norepinephrine and epinephrine?
NE: neurotransmitter
Epi: hormone
What is primary hyperparathyroidism?
Parathyroid adenoma
What is secondary hyperparathyroidism?
Renal failure
What is familial hypocalciuria hypercalcemia?
Decr Ca excretion
What if both serum Ca and PO4 decrease?
Vitamin D deficiency
What if serum Ca and PO4 change in opposite directions?
PTH problem
- high Ca => hyperPTH
- low Ca => hypoPTH
What is the most common cause of primary hypoparathyroidism?
Thyroidectomy
What is pseudohypoparathyroidism?
Bad kidney PTH receptor
Decr urinary cAMP
What is pseudopseudohypoparathyroidism?
G-protein defect
No Ca problem
What is Hungry Bone syndrome?
Remove PTH -> bone sucks in Ca
What does secretin do?
Secretion of bicarb
Inhibit gastrin
Tighten pyloric sphincter
What does somatostatin do?
Inhibits secretin, motilin, CCK
What do T3 and T4 do?
Growth
Differentiation
What disease has exophthalmos?
Grave’s disease
What disease has enophthalmos?
Horner’s syndrome
What are the Hyperthyroid diseases?
Grave’s disease
DeQuervain’s
Silent thyroiditis
Plummer’s
Jod-Basedow
What are characteristics of Grave’s disease?
Exophthalmos
Pretibial myxedema
TSH-receptor Ab
What are characteristics of DeQuervain’s?
Post-viral
Painful jaw
What is a characteristic of silent thyroiditis?
Post-partum
What are characteristics of Plummer’s syndrome?
Benign adenoma
Old person
What is a characteristic of Jod-Basedow?
Transient hyperthyroidism due to elevated Iodine
What are the hypothyroid diseases?
Hashimoto’s
Reidel’s struma
Cretin
Euthyroid sick syndrome
Wolff-Chaikoff
What is seen in Hashimoto’s?
Antimicrosomal Ab = TPO Ab
What is a manifestation of Reidel’s struma?
Woody thyroid
What are manifestations of Cretin?
Freaky features
Hypothyroid mom and baby
What is a manifestation of Euthyroid sick syndrome?
Low T3 syndrome
What is a manifestation of Wolff-Chaikoff?
Transient hypothyroidism
What is Plummer’s syndrome?
Hyperthyroid adenoma
What is Plummer-Vinson syndrome?
Esophageal webs
What does Testosterone do?
Makes external male genitalia
What does Müllerian inhibiting factor?
Makes internal male genitalia
What do TPO and thymosin do?
Help T cells mature
What does VIP do?
Inhibits secretin, motilin, CCK
How does a VIPoma present?
Watery diarrhea
How does a SSoma (somatostatinoma) present?
Constipation
What are the hormones with disulfide bonds?
PIGI
- PRL
- Insulin
- GH
- Inhibin
Which hormones have the same alpha-subunits?
LH, FSH
TSH
ẞ-hCG
What hormones produce acidophils?
GaP
- GH
- PRL
What hormones produce basophils?
B-FLAT
- FSH
- LH
- ACTH
- TSH
