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DEMS > Exam 4 Week 1 > Flashcards

Exam 4 Week 1 Flashcards

1
Q

Basic endocrine secretion

A

Basolateral side of cell
No ducts
Secretion into blood via fenestrated endothelium

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2
Q

Anterior pituitary blood/hormone flow

A

Superior hypophysial a
Trabecullar a
Hypothalamic capillary beds (pick up releasing hormones)
Portal system
Pituitary capillary beds (act on pituitary cell bodies to release hormones)
Hormones release into blood and go to target organs

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3
Q

Posterior pituitary hormones and origin

A

ADH/vasopressin (supraoptic nucleus - hypothalamus)

Oxytocin (paraventricular nucleus - hypothalamus)

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4
Q

Adrenal zones and hormones (superficial to deep)

A

Zona glomerulosa: aldosterone (RAAS)
Zona fasiculata: cortisol (ACTH, CRH)
Zona reticularis: sex hormones (ACTH, CRH)
Medulla: NE, epi, enkephalins

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5
Q

Thyroglobulin get iodinated in the _________

A

Colloid

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6
Q

Main difference between parathyroid and thyroid on path? Parathyroid cell types

A
  1. Adipocytes
  2. Oxyphil cells (rich in mitochondria)
  3. Chief cells (secrete PTH)
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7
Q

Actions of parathyroid hormone

A

Overall: increase serum Ca2+, decreased serum PO4

  1. Osteoclast activation (RANK)
  2. Increased enterocyte uptake of dietary Ca2+
  3. Increased Ca2+ reabsorption in DCT
  4. Decreased PO4 in PCT
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8
Q

Actions of calcitonin

A

Overall: decrease serum Ca2+

1. Decreased osteoclast activity

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9
Q

Pituitary origin tissues

A

Anterior pit: oral ectoderm (Rathke’s pouch)
Posterior pit: diencephalon (neuroectoderm)
Vessels: mesoderm

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10
Q

Adrendal origin tissues

A 
Medulla: chromaffin cells (from sympathogonia, neural crest)
Cortex: mesoderm
First wave: reicularis
Second wave: fasciularis
Inside out development
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11
Q

Thyroid origin

A

Derived from endoderm

Thyroid diverticulum between 1st and 2nd pharyngeal pouches

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12
Q

Parafollicular cell/parathyroid origin

A

Ex: C cells
Neural crest cells
Ultimobronchial body
Between 3/4 (superior) and below 4 (inferior) pharyngeal pouches

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13
Q

What percent of patients don’t report IHM medications?

A

72%

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14
Q

DSHEA Regulations

A

1994 regulations (previous were grandfathered)
Manufacturer responsible for safety and truthfullness
FDA acts only after on market and proved dangerous
Must be different shelf from OTCs

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15
Q

Higher quality supplements labeling

A

MUST have FDA disclaimer
OPTIONAL to have structure/function claim
May contain seal

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16
Q

Dyslipidemia supplements

A

Fish oil
Fiber
Niacin
Plant sterols/stanols

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17
Q 
Fish oil:
Safety in pregnancy
Indications
Mercury CI
TC, LDL, TG effects
DHA/EPA?
A 
Pregnancy limit of 12oz/wk
Avoid shark,swordfish,tilefish due to mercury
Option for CI/non-tolerance of niacin
No effect on total cholesterol or LDL
More DHA/EPA = better
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18
Q

Plant sterols/stanols:
Timeline
Side effects
DDIs

A

Equally effective
2/3wks to work
GI side effects
DDI w/ ezitimibe

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19
Q

Bitter orange

A

GRAS, but no evidence is safer than Ephedra

Often contains caffeine

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20
Q

Weight loss supplements

A

Ephedra
Bitter orange
Alli
Ca2+ (inferior to low fat dietary intake)

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21
Q

Alli:
Mech
BMI indications
SE

A

Inhibits gastric and pancreatic lipase (take with fatty meal)
FDA approved, BMI>27 seen improvements
Risk of liver injury

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22
Q

Diabetes supplements

A

Chromium

Vanadium

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23
Q

Chromium

A

Type III in food/supplements
Decreases oxidative stress
Loss of DDI, renal elimination

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24
Q

Vanadium

A

Increases insulin sensitivity -> T2DM
Adverse rxn: green tongue
DDI with G herbs (coag risk)

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25
HTN supplements
Garlic Co Q-10 (additive effect, not on own) Flavonoids (straw/blueberries, dark chock)
26
Garlic
Allicin is active ingredient (and stinky part) | DDI with G herbs
27
G herbs
Garlic Ginger Ginseng Ginkgo
28
Tyrosine derivative hormones
NE Epi Thyroid hormone Dopamine
29
Peptide hormones
``` Oxytocin ADH Angiotensin TRH GnRH ```
30
Protein hormones
``` Insulin Glucagon GH PRL ACTH TSH ```
31
Steroid hormones
Sex hormones Cortisol Aldosterone Vitamin D
32
Water soluble hormones characteristics Storage Half life Receptors
Stored in vesicles (Ca2+ release) Shorter half life in blood (unbound) Receptors membrane bound: GPCR, Cyto, EGFR
33
3 classes of water soluble hormone receptors and ligands
GPCR: hypothalamic hormones Cytokine: GH, PRL EGFR: Insulin, IGF-1
34
``` Steroid hormones characteristics Storage Half life Receptors Regulation ```
Bound in blood (95%) Longer half life Free is active and regulated Intracellular receptors (then bind HRE, affect transcription)
35
Measuring hormone levels
Bioassays: exogenous system measurement, longer, more complex Immunoassays: Ab binding, RIA/ELISA, need normal hormone, faster
36
3 methods of hormone control
1. Pulsatile hormone release 2. Circadian control 3. Receptor regulation
37
2 pituitary end hormones
Growth hormone | Prolactin
38
GPCR receptor types and ligands
Gs: CRH, GHRH, ADHV2 Gi: SST, Dopamine Gq: ADHV1, GnRH, TRH
39
Cytokine receptor ligands and mech
GH, PRL | JAK-STAT pathway
40
Milk feedback from PRL, E, Progesterone, Dopamine Mammogenesis Lactogenesis Galactopoiesis
Mammogenesis (+)= PRL, E, Progesterone (-)= D Lactogenesis (+)=PRL (-)= D, E, Progesterone Galactopoiesis (+)=PRL (-)= D, E, Progesterone
41
Prolactinoma s/s
Galactorrhea Amenorrhea Loss of libido (via GnRH)
42
Hypopituitarism
Nonfunctional pituitary adenoma Sheehan syndrome: postpartum infarct following complicated delivery (failure to lactate, cold intolerance) Empty sella syndrome (common in obese women) Pituitary apoplexy Trauma Radiation Tx: HRT
43
Growth hormone direct actions
``` Counter regulatory (diabetogeneic in excess) Increased gluconeogenesis Increase FA oxidation via HSL Increased AA uptake into muscle Increased water and salt retention ```
44
Growth hormone indirect actions (mediated by IGF)
Increased long bone growth | Increased muscle growth
45
Metabolic states regulating IGF
High glucose, AA, insulin, GH -> IGF release by liver | IGF activated by combo of GH and insulin
46
Growth hormone dysfxn: hyper
Diabetogeneic Gigantism Acromegaly (after plates have fused, puberty) Cardiac hypertrophy
47
Growth hormone dysfxn: hypo
Dwarfism (decreased GH) Laron's dwarfism (decreased GH receptor) African pygmies (decreased IGF response)
48
POMC products
MSH | ACTH
49
Elevated prolactin: 2 physiologic 3 pathologic 2 pharmacologic
Physio: pregnancy, lactation/suckling Path: prolactinoma, stalk compression, hypothyroidism Pharm: estrogen, antipsychotic meds
50
Chronology of anterior pituitary hormone deficiency
1. GH 2. FSH/LH (gonadotropins) 3. ACTH 4. TSH 5. PRL Good Felines Always Trash Pants
51
Prolactin lab values in excess
Normal <150 Stalk issues >150, <250 Macroadenoma >250
52
Treatment for pituitary adenoma
Prolactinoma: dopamine agonist (regardless of size), surgery if unresponsive Surgery: transnasal (trans sphenoidal) approach
53
DI findings and difference in central vs. nephrogeneic
``` Low urine specific gravity (<1.006) High serum osm Hyperosmotic volume contraction Central: Low ADH Nephro: Normal or high ADH ```
54
Water deprivation test central vs nephro DI
With hold water for 2-3 hours Administer ADH analog >50% increase in urine osm = central No change = nephrogenic
55
Treatment of DI
Central: ADH, hydration Nephro: Water restriction, HCTZ, amiloride, indomethacin
56
Acromegaly s/s
``` Acral and facial changes Teeth spacing Hyperhydrosis HA Oligo/amenorrhea CV complications - HTN, valve dz, hypertrophy ```
57
Acromegaly diagnostic tests
Clinical features Elevated IGF-1 (gender, age matched - decreases with age) OGTT, GH levels
58
GH Deficiency tests
Insulin induced hypoglycemia (<40 with GH > 3-5) | Arg, glucagon test performed now
59
ACTH dysfunction tests
1. 24 hour urine cortisol 2. 12am salivary cortisol 3. 1mg dex suppression w/ 8am serum cortisol (<1.8)
60
ACTH hyper vs. hypo
Hyperactivity: cushingings Hypoactivity: adrenal insufficiency
61
SIADH Labs
Low serum Na Low serum osm Inappropriately high urine osm
62
SIADH treatment
``` Water restriction V2 antagonist Hypertonic saline (CAREFUL: central pontine myelinolysis) ```
63
Pituitary image gold standard
MRI | CT if contraindication
64
MRI types and indications
T1: Anatomy T2: Pathology and anatomy
65
Relax rate with T1 and T2
T1: protons align with magnetic field T2: loss of magnitization
66
Pituitary masses: overview
Generally WHO type I (excision) Hyperfunctional, mass effect, visual disturbances Generally present middle aged adults
67
Rare types of pituitary tumor that present similar to adenoma
Pituicytoma (derived from posterior gland) Spindle cell onocytoma Rathke's cyst (common, only removed if HA) Hypophysitis
68
Consequences of mass effect
HA Visual disturbances Invasion of cavernous sinus (3,4,6): diplopia, ptosis DON'T invade blood vessels
69
Craniopharyngeoma
``` Bimodal age distribution Develops from Rathke's pouch epithelium Calcification is common Papillary = adult (BRAF) Adam = kids (WNT/ßcatenin) ```
70
Pituitary masses and transcription factors and IHC
SF-1: FSH/LH (gonadotrophs, nonfxnal) Pit-1: TSH, PRL, GH (somatotrophs, fxnal) acidophils T-pit: ACTH (corticotrophs) TTF-1: posterior gland Reticulin: nml anterior gland, disruption = pathologic
71
Familial pituitary tumor syndromes and 1 example
95% are sporadic, only 5% familial Multi tumor, FHx, and early onset provide clues DICER1: ACTH secreting tumor (pituitary blastoma)
72
Nonfunctional pit tumors
``` Present with mass effect Often gonadotrophs (SF-1 positive) ```
73
Functional pit tumors
GH secreting (dense vs. sparse keratin stain) Mixed GH/PRL (don't respond well to D2 agonist) Prolactinoma ACTH secreting
74
Mets to the pituitary
very rare, usually breast cancer (estrogen receptor positive)

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