Endocrinology II

Question 1

What does the outer cortex of the adrenal gland produce?

Inner medulla?

Answer 1

Cortex - steroid hormones

Medulla - Catecholamines

Question 2

What 3 classes of molecules are made in the Adrenal Cortex?

Answer 2

mineralocorticoids
glucocorticoids
androgens

Question 3

What are the 3 steroid hormones of the Adrenal Cortex?

Answer 3

Aldosterone - (mineralocorticoid)
Cortisol - (glucocorticoid)
Dehydroepiandrosterone - (androgen)

Question 4

What 2 hormones are made in the adrenal medulla?

Answer 4

Epinepherine
Norpepinepherine

*the catecholamines

Question 5

Why are cortisol, aldosterone, and adrenal androgens bound to transport proteins in the blood?

Answer 5

otherwise would be excreted because of size

Question 6

Describe the Cortisol feedback loop:

Answer 6

CRH > ACTH > Cortisol

Question 7

What increases CRH pulses?

Answer 7

Illness, surgery, injury, psychiatric stress

any stress

Question 8

How is ACTH released from the Ant. Pituitary?

Answer 8

Pulses
Rhythm (diurnal)
highest level 4-6 AM

Question 9

What is the main immediate effect of Cortisol?

Answer 9

Increase blood glc

GNG, insulin resistance, glycogen storage, appetite

Question 10

T/F

Cortisol suppresses inflammation, immune response, and wound healing.

Answer 10

Yes

Question 11

T/F

Aldosterone is stimulated by ACTH

Answer 11

Yes, some

but mostly controlled by the kidney renin-angiotensin system

Question 12

What are the effects of Aldosterone?

Answer 12

Holds Sodium
Pumps out Potassium

Maintains blood volume and pressure

Question 13

Will ACTH stimulate all of the hormones of the adrenal cortex?

Answer 13

Yes

Question 14

What is the function of DHEA?

Answer 14

masculinizing hormone
(pubic hair)

in excess causes hirsutism (male and female)

Question 15

T/F

ACTH, cortisol, aldosterone, DHEA can all be found in the plasma and saliva for testing purposes?

Answer 15

True

Question 16

What are some causes of primary adrenal insufficiency?

Answer 16

Autoimmune
Infection (TB, cytomegalovirus in HIV) 
Cancer
Hemorrhage
Surgical removal

Question 17

What would be low and what would be high in Primary Adrenal Insufficiency?

Answer 17

Glucocorticoid (Cortisol), Mineralocorticoid (Aldosterone), and Adrenal androgen (DHEA) lost/low

ACTH high

Question 18

What might cause the following:
fatigue
weight loss, nausea
abdominal pain
low glc
illness amplified

Answer 18

Low cortisol

Question 19

What might cause the following:
low Na, high K
low BP

Answer 19

Low aldosterone

Question 20

What causes hyperpigmentation?

Answer 20

high ACTH

*note - in patients see especially in mucous lining of the mouth

Question 21

What does ACTH do at high concentrations?

Answer 21

stimulates melanocytes

Question 22

What are the symptoms of acute adrenal crisis?

Answer 22

weakness
nausea
vomiting
dehydration
hypotension
hypoglycemia

Question 23

What cortical hormone of the kidney is functionally viable in secondary adrenal insufficiency?

Answer 23

Aldosterone

regulated mostly by kidneys

Question 24

What is the treatment for both primary and secondary adrenal insufficiencies?

Answer 24

Cortisol and Cortisol

Question 25

What syndrome is defined by an excess of Cortisol?

Answer 25

Cushing Syndrome

Question 26

What causes Cushing disease? *as opposed to Cushing Syndrome?

Answer 26

Pituitary tumor producing ACTH

Question 27

What causes Cushing Syndrome?

Answer 27

anything that increases ACTH adrenal tumor, prescribed glucocorticoids, etc.

Question 28

What is a classic sign of Cortisol excess? | Cushing Syndrome

Answer 28

Purple stretch marks | Moon face

Question 29

High glc production, insulin resistance, hyperglycemia, and diabetes can be caused by...

Answer 29

Cortisol Excess

Question 30

What does Dexamethasone do?

Answer 30

Synthetic glucocorticoid so it suppresses ACTH

Question 31

What 3 levels can you address too much ACTH secretion pharmacologically?

Answer 31

block ACTH secretion inhibit cortisol production block cortisol receptors

Question 32

What is more important, the Adrenal medulla or cortex?

Answer 32

cortex | can survive without epi/norepi

Question 33

What is the tumor of the Adrenal Medulla?

Answer 33

Pheochromocytoma

Question 34

High ACTH, low cortisol, hyperpigmentation:

Answer 34

Adrenal insufficiency either autoimmune or TB-related treat with Cortisol

Question 35

High ACTH, high cortisol, hirsutism, full face.

Answer 35

Cushings Disease caused by tumor

Question 36

What is the RDA for calcium 19-70?

Answer 36

1000 mg

Question 37

What 2 things does Vitamin D increase absorption of from the gut?

Answer 37

Calcium and Phosphorous

Question 38

What are the 2 sources of Vitamin D?

Answer 38

sunlight (cholecalciferol - D3) | plants (ergocalciferol - D2)

Question 39

What type of Vitamin D is usually measured?

Answer 39

Storage form in Liver

Question 40

Vitamin D is a ______ hormone that increases absorption of both ____ and ____.

Answer 40

Steroid Calcium, Phosphorous

Question 41

Name 4 Calcium regulating hormones.

Answer 41

PTH PTHrP Calcitonin Vitamin D

Question 42

T/F | PTH is a slow acting hormone

Answer 42

False | controls Calcium on timescale of around a minute

Question 43

Why does PTH decrease Phosphorous?

Answer 43

Its actions in the kidney preserve Calcium and secrete phosphorous

Question 44

What does PTH increase?

Answer 44

Calcium and Vitamin D

Question 45

What is the difference between PTH and PTHrP?

Answer 45

PTHrP increases Calcium (like PTH) but does NOT activate Vitamin D. net effect: increase Ca, decrease PO4, PTH

Question 46

What can cause hypercalcemia?

Answer 46

Too much PTH, Vitamin D, or PTHrP

Question 47

What can cause hypocalcemia?

Answer 47

Not enough PTH or Vitamin D Resistance to PTH, Vitamin D

Question 48

What are the major causes of hypercalcemia?

Answer 48

high PTH or PTHrP (tumor) | high Vitamin D

Question 49

What are the symptoms of hypercalcemia?

Answer 49

high PTH or PTHrP (tumor) | high Vitamin D

Question 50

What are the symptoms of Hypercalcemia?

Answer 50

Stones, groans, moans, overtones, bones

Question 51

Primary Hyperparathyroidism: | Ca Phos 1,25D PTH

Answer 51

high, low, high, high

Question 52

What are the causes of Hypocalcemia?

Answer 52

low PTH low Vitamin D low Calcium intake

Question 53

What is the main symptom of Hypocalcemia?

Answer 53

neuromuscular irritability

Question 54

What are low PTH effects on: | Ca Phos 1,25D

Answer 54

low, high, low

Question 55

Low Ca, Phos, and high PTH Unmineralized bone diagnosis?

Answer 55

Rickets Childhood Vitamin D deficiency

Question 56

What does severe Vitamin D deficiency lead to in adults?

Answer 56

Osteomalacia * diffuse bone pain * everything low but PTH

Question 57

What indicates Renal Failure?

Answer 57

low Ca, 1,25D | high Phos, PTH

Question 58

What is the difference between Primary and Secondary Hyperparathyroidism?

Answer 58

Primary - failure at parathyroid (too much PTH causes high calcium) Secondary - low vitamin D or kidney failure *high PTH secondary to low calcium

Question 59

RANK/RANKL are part of what system?

Answer 59

Immune

Question 60

What is a major osteoclast inhibitory factor?

Answer 60

Osteoprotegerin

Question 61

Is low weight a risk factor in bone fracture?

Answer 61

Yes - incidental to frailty | (somewhat counterintuituve)

Question 62

Can Glucocorticoids cause fractures?

Answer 62

Yes | could've been designed as evil for bones

Question 63

What are some preventions/treatments for osteoporosis?

Answer 63

Calcium and Vitamin D Exercise Osteoclast inhibition Osteoblast stimulation

Question 64

What are treatments that inhibit osteoclasts?

Answer 64

Denosumab (RANKL antibody) Calcitonin Bisphosphonates Estrogen/SERMS (also, Calcium supplements)

Question 65

What does SERM stand for and what do they do?

Answer 65

Selective Estrogen Receptor Modulators Act at Estrogen Receptors in bone but NOT in breast/uterus *effective osteoclast suppressor

Question 66

How do bisphosphonates work?

Answer 66

Bind Ca++ to bone Increase osteocyte death Long half life

Question 67

What is a possible dental side effect of Bisphosphonates? | other side effects?

Answer 67

Jaw osteonecrosis (probably due to high turnover) Atypical femoral fractures (uncommon)

Question 68

What two treatments are associated with jaw osteonecrosis and atypical femur fractures?

Answer 68

Denosumab and Bisphosphonates

Question 69

When can exercise increase bone density?

Answer 69

Only when very intense - otherwise will stabilize bone density

Question 70

What is a counter-intuitive treatment for bone loss?

Answer 70

hPTH (PTH analog) * stimulates osteoclasts, but osteoblasts and osteocytes more. * effective, expensive, and shown to cause horrible bone cancer when given in high doses to rats