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Endocrine > Intro > Flashcards

Intro Flashcards

1
Q

Hormones released by the hypothalamus include:

A

Hormones released by the hypothalamus include:
* CRH- corticotropin-releasing hormone
* TRH- thyrotropin-releasing hormone
* Somatostatin
* Dopamine
* GHRH- growth hormone-releasing hormone
* GnRH- gonadotropin-releasing hormone

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2
Q

CRH stimulates the release of _ from the anterior pituitary

A

CRH stimulates the release of ACTH from the anterior pituitary
* ACTH acts on the adrenal glands to release cortisol

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3
Q

TRH stimulates the release of _ from the anterior pituitary

A

TRH stimulates the release of TSH from the anterior pituitary
* Note that TRH can also nonspecifically stimulate prolactin release

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4
Q

Somatostatin, released from the hypothalamus, functions to inhibit _

A

Somatostatin, released from the hypothalamus, functions to inhibit TSH, Prolactin, GH

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5
Q

Dopamine, released from the hypothalamus inhibits the secretion of _ from the anterior pituitary

A

Dopamine, released from the hypothalamus inhibits the secretion of prolactin from the anterior pituitary

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6
Q

GHRH stimulates the anterior pituitary to secrete _

A

GHRH stimulates the anterior pituitary to secrete GH

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7
Q

GnRH stimulates the anterior pituitary to secrete _

A

GnRH stimulates the anterior pituitary to secrete LH/FSH

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8
Q

ACTH acts on its target organ _ to secrete _

A

ACTH acts on its target organ adrenal gland to secrete cortisol and aldosterone

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9
Q

TSH acts on its target organ _ to secrete _

A

TSH acts on its target organ thyroid glands to secrete T4,T3

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10
Q

Prolactin acts on its target organ _ to stimulate _

A

Prolactin acts on its target organ, the breast to stimulate lactation

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11
Q

GH stimulates its target organ _ to secrete _

A

GH stimulates its target organ the liver to secrete IGF-1 (insulin-like growth factor)
* IGF-1 then acts on the bones to stimulate growth

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12
Q

IGF-1 is secreted from the _ and acts on the _

A

IGF-1 is secreted from the liver and acts on the bones to stimulate growth

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13
Q

LH/FSH act on the target organs the _ to secrete _

A

LH/FSH act on the target organs testes, ovaries to secrete testosterone/ estradiol, progesterone

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14
Q

Prolactin release can be stimulated directly via _ or indirectly via _

A

Prolactin release can be stimulated directly by nipple stimulation or indirectly via TRH

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15
Q

Somatostatin released from the hypothalamus inhibits _ , somatostatin released by delta cells in the stomach inhibits _

A

Somatostatin released from the hypothalamus inhibits GH, TSH, prolactin , somatostatin released by delta cells in the stomach inhibits gastric acidity

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16
Q

Cortisol, T3, T4, estradiol, progesterone, testosterone, inhibin feed back and suppress the secretion of hormones from the _ in a negative feedback mechanism

A

Cortisol, T3, T4, estradiol, progesterone, testosterone, inhibin feed back and suppress the secretion of hormones from the hypothalamus in a negative feedback mechanism

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17
Q

The posterior pituitary receives _ stimulation from the _

A

The posterior pituitary receives direct neural stimulation from the hypothalamus

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18
Q

The neurons in the posterior pituitary are an extension of the _ in the hypothalamus where the hormones are produced

A

The neurons in the posterior pituitary are an extension of the neuroendocrine cell nuclei in the hypothalamus where the hormones are produced

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19
Q

(True/False) the posterior pituitary produces hormones

A

False; the posterior pituitary does not make hormones but just stores and releases hormones

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20
Q

The two hormones stored and released from the posterior pituitary are _ and _

A

The two hormones stored and released from the posterior pituitary are oxytocin and ADH

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21
Q

Role of oxytocin

A

Oxytocin is released during labor to increase contractions in the uterus
* It also causes the milk ejection reflex that contracts the breast during lactation

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22
Q

Which hormones are released from the anterior pituitary?

A

FLAT PiG
* FSH
* LH
* ACTH
* TSH
* Prolactin
* GH

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23
Q

Explain why primary adrenal insufficiency and Addison’s disease can lead to hyperpigmentation

A

Adrenal insufficiency –>
Low cortisol levels –>
High ACTH and CRH –>
ACTH derives the POMC protein that gets cleaved into ACTH and MSH –>
Melanocyte-stimulating hormone increases melanin

Ultimately the adrenal insufficiency impairs negative feedback and results in high ACTH

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24
Q

In addition to stimulating the anterior pituitary to secrete ACTH, CRH also stimulates _ and _

A

In addition to stimulating the anterior pituitary to secrete ACTH, CRH also stimulates beta-endorphins and melanocyte-stimulating hormone

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25
Q

The POMC gene produces the POMC protein which gets cleaved into _ and _

A

The POMC gene produces the POMC protein which gets cleaved into MSH and ACTH

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26
Q

The negative regulator of the female HPG axis is _ ; the positive regulator is _

A

The negative regulator of the female HPG axis is progesterone ; the positive regulator is estrogen

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27
Q

Primary hypercortisolism is a problem with the _

A

Primary hypercortisolism is a problem with the adrenal cortex

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28
Q

Secondary hypercortisolism is a problem with the _

A

Secondary hypercortisolism is a problem with the anterior pituitary

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29
Q

Tertiary hypercortisolism is a problem with the _

A

Tertiary hypercortisolism is a problem with the hypothalamus

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30
Q

GH has _ effect on adipose cells

A

GH stimulates adipose cells to break down stored fat
* We call this the glucose sparing effect

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31
Q

GH stimulates growth by increasing the uptake of _ from the blood and enhancing cellular proliferation while reducing _

A

GH stimulates growth by increasing the uptake of amino acids from the blood and enhancing cellular proliferation while reducing apoptosis

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32
Q

GH has four target cell types:

A

GH has four target cell types:
1. Bone cells
2. Muscle cells
3. Nervous system cells
4. Immune system cells

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33
Q

Explain the diabetogenic effect of GH

A

Diabetogenic effect: GH stimulates the liver to break down glycogen into glucose

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34
Q

GH stimulates two things in the liver _ and _

A

GH stimulates two things in the liver glycogen breakdown and release of IGF-1

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35
Q

T3 and T4 control metabolism and heart rate through stimulating _ throughout the body

A

T3 and T4 control metabolism and heart rate through stimulating gene expression throughout the body

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36
Q

Growth hormone has _ effect on insulin

A

GH antagonizes insulin

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37
Q

Prolactin has _ effect on LH and FSH

A

Prolactin decreases LH and FSH

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38
Q

FSH stimulates _ synthesis and the development of _

A

FSH stimulates estrogen synthesis and development of germ cells

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39
Q

LH stimulates _ and _ synthesis

A

LH stimulates progesterone and testosterone synthesis; also stimulates egg development in females

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40
Q

Three actions of ADH

A
  1. Renal water retention
  2. Vasoconstriction
  3. Increases release of ACTH
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41
Q

(LH/FSH) is involved in egg development

A

LH is involved in egg development

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42
Q

(LH/FSH) is involved in the development of germ cells

A

FSH is involved in the development of germ cells

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43
Q

Central or secondary adrenal insufficiency is a deficiency of _

A

Central or secondary adrenal insufficiency is a deficiency of ACTH

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44
Q

Central/Secondary adrenal insufficiency leads to a deficiency in _

A

Central/Secondary adrenal insufficiency leads to a deficiency in cortisol but not aldosterone or androgens

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45
Q

Signs of adrenal insufficiency include:

A

Signs of AI:
* Weight loss
* Fatigue
* Hypotension
* Hypoglycemia
* Vascular collapse and death

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46
Q

Vasopressin deficiency results in _

A

Vasopressin deficiency results in central diabetes insipidus
* Excessive urination with dilute urine
* Dehydration can be life threatening
* Causes hypernatremia

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47
Q

The most common cause of hypopituitarism is _

A

The most common cause of hypopituitarism is sellar mass effect resulting from a tumor
* The second most common cause is surgery

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48
Q

Causes of hypopituitarism

A

Causes of hypopituitarism:
* Sellar mass causing mass effect
* Resection of sellar mass
* Head trauma
* Stroke
* Granulomatous disease
* Radiation
* Pituitary infarction (Sheehan or pituitary apoplexy)
* Empty sella

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49
Q
A

Macroadenoma

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50
Q
A

Empty sella

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51
Q

_ is a term used when there is any number of pituitary hormone deficiencies;
_ is the term used when there is more than 1 pituitary deficiency
_ is the term used when all hormones are deficient

A

Hypopituitarism is a term used when there is any number of pituitary hormone deficiencies;
Multiple pituitary hormone deficiency is the term used when there is more than 1 pituitary deficiency
Panhypopituitarism is the term used when all hormones are deficient

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52
Q

We diagnose a prolactin deficiency via _ lab finding

A

We diagnose a prolactin deficiency via low prolactin

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53
Q

We diagnose a GH deficiency via _ lab finding

A

We diagnose a GH deficiency via low IGF-1 and lack of stimulation by provocative testing with glucagon, arginine, insulin

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54
Q

What testing should be done if an FSH, LH deficiency is suspected

A

Check FSH, LH, estradiol, testosterone

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55
Q

What testing should be done if TSH deficiency is suspected?

A

TSH, T3, T4

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56
Q

How do we diagnose ADH deficiency?

A
  1. Patient has polyuria and decreased urine osmolality
  2. Water deprivation test does not improve it
  3. Improvement when ADH is given (if central DI)
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57
Q

The treatment for TSH deficiency is _

A

The treatment for TSH deficiency is levothyroxine (T4 supplementation)

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58
Q

Panhypopituitarism results in _ deficiencies first

A

Panhypopituitarism results in ACTH and coritsol deficiencies first
* These develop quickly

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59
Q

(TSH/T4) has a short half life

A

TSH has a short half life; T4 has a long half life
* Deficiencies will develop over a long period of time

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60
Q

When do we use dynamic testing for hypopituitarism?

A
  1. Adrenal insufficiency
  2. GH deficiency
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61
Q

Growth hormone is a _ type hormone and it binds to receptors _

A

Growth hormone is a hydrophilic peptide hormone that binds to receptors on the cell surface

62
Q

Glucose (increases/decreases) release of GH

A

Glucose decreases release of GH

63
Q

Ghrelin (increases/decreases) release of GH

A

Ghrelin increases release of GH

64
Q

Somatostatin (increases/decreases) the release of GH

A

Somatostatin decreases the release of GH

65
Q

Somatostatin comes from the _

A

Somatostatin comes from the hypothalamus

66
Q

IGF-1 comes from the _

A

IGF-1 comes from the liver (hepatocytes)

67
Q

Ghrelin comes from the _

A

Ghrelin comes from the stomach

68
Q

GHrH comes from the _
GH comes from the _

A

GHrH comes from the hypothalamus
GH comes from the anterior pituitary

69
Q

(GH/IGF-1) increases glucose and increases growth

A

Both GH and IGF-1 increase glucose and growth

70
Q

The single best lab for diagnosing GH abnormalities is _

A

The single best lab for diagnosing GH abnormalities is IGF-1
* Longer half life than GH

71
Q

(True/False) Isolated GH deficiency in newborn population does not cause any specific sx

A

True; Isolated GH deficiency in newborn population does not cause any specific sx

72
Q

GH deficiency in children may present as _

A

GH deficiency in children may present as “falling off the growth curve”
* Bone and muscle growth is inhibited
* Bone age is lower than expected

73
Q

Adults with GH deficiency have vague sx such as _

A

Adults with GH deficiency have vague sx such as decreased bone mineral density, decreased muscle mass, increased fat mass

74
Q

_ is an autosomal recessive mutation in the GH receptors that leads to GH insensitivity in newborns/children

A

Laron syndrome is an autosomal recessive mutation in the GH receptors that leads to GH insensitivity in newborns/children

75
Q

_ is a chromosome 15 deletion that leads to GH deficiency and therefore short stature, increased body weight, and increased ghrelin levels

A

Prader-Willi syndrome is a chromosome 15 deletion that leads to GH deficiency and therefore short stature, increased body weight, and increased ghrelin levels

76
Q

Prader willi syndrome is a deletion of chromosome _

A

Prader willi syndrome is a deletion of chromosome 15

77
Q

GH deficiency in children and adults are often either from _ or they are idiopathic

A

GH deficiency in children and adults are often either from sellar tumors causing mass effect or they are idiopathic

78
Q

Treatment for GH deficiency is _

A

Treatment for GH deficiency is recombinant GH replacement (for all ages)

79
Q

Another lab value that can be evaluated besides IGF-1 for GH deficiency is _

A

Another lab value that can be evaluated besides IGF-1 for GH deficiency is IGFBP-3

80
Q

If a patient has normal GH levels then the administration of insulin will cause (hyperglycemia/hypoglycemia) which will induce GH to (increase/decrease)

A

If a patient has normal GH levels then the administration of insulin will cause hypoglycemia which will induce GH to increase to restore glucose levels
* A patient with GH deficiency will not have a rise in GH

81
Q

The most common cause of a GH excess is _

A

The most common cause of a GH excess is pituitary adenoma

82
Q

Children with an excess of GH have _ ; adults have _

A

Children with an excess of GH have gigantism ; adults have acromegaly

83
Q

Clinical features of acromegaly include:

A

Clinical features of acromegaly include:
* Enlarged hands/feet
* Hoarse voice
* Snoring
* Arthralgias
* Coarse facial features, enlarged jaw

84
Q

Complications associated with agromegaly in adults include:

A

Complications associated with agromegaly in adults include:
* Diabetes
* Hypertension
* Obstructive sleep apnea
* Carpal tunnel
* Colon cancer

85
Q
A

Macroadenoma

86
Q

Insulin tolerance test is used to diagnose (GH excess/ GH deficiency)

A

Insulin tolerance test is used to diagnose GH deficiency

87
Q

Oral glucose tolerance test is used to diagnose (GH excess/ GH deficiency)

A

Oral glucose tolerance test is used to diagnose GH excess

88
Q

In a normal individual, a large glucose load will _ GH levels

A

In a normal individual, a large glucose load will suppress GH levels
* If GH does not suppress after the intake of oral glucose, GH excess is confirmed

89
Q

List the three most important tests to diagnose GH excess:

A

List the three most important tests to diagnose GH excess:
1. IGF-1 or IGF1BP3
2. Oral glucose tolerance test
3. MRI for pituitary adenoma

90
Q

Most pituitary adenomas will cause increased secretion of only one pituitary hormone; the exception is that some adenomas can secrete both _ and _

A

Most pituitary adenomas will cause increased secretion of only one pituitary hormone; the exception is that some adenomas can secrete both GH and prolactin

91
Q

What is the preferred therapy for GH pitiutiary adenoma?

A
  1. Transsphenoidal resection
  2. Radiation
  3. Medication (octreotide, cabergoline, pegvisomant)
92
Q

Steps for GH excess diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. _ test
3. MRI of pituitary

A

Steps for GH excess diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. Oral glucose tolerance test
3. MRI of pituitary

93
Q

Steps for GH deficiency diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. _ test
3. MRI of pituitary

A

Steps for GH deficiency diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. Insulin tolerance test
3. MRI of pituitary

94
Q

Hyperpituitarism is almost exclusively caused by _

A

Hyperpituitarism is almost exclusively caused by pituitary adenomas
* Prolactinemia can also be caused by stalk compression or trauma of the head

95
Q

A pituitary adenoma < 1 cm is a _

A

A pituitary adenoma < 1 cm is a microadenoma

96
Q

A pituitary adenoma > 1 cm is a _

A

A pituitary adenoma > 1 cm is a macroadenoma

97
Q
A

Microadenoma

98
Q
A

Macroadenoma

99
Q

The most important mass effect caused by macroadenomas is _

A

The most important mass effect caused by macroadenomas is bitemporal hemianopia

100
Q

The direct effect of hyperprolactinemia is _

A

The direct effect of hyperprolactinemia is galactorrhea

101
Q

Indirect effects of hyperprolactinemia result from prolactin’s (stimulation/suppression) of GnRH

A

Indirect effects of hyperprolactinemia result from prolactin’s supression of GnRH –> hypogonadotropic hypogonadism
* Low libido
* Infertility
* Amenorrhea

102
Q

A pituitary adenoma that secretes excess ACTH will present as _

A

A pituitary adenoma that secretes excess ACTH will present as cushing’s disease
* Hyperglycemia
* HTN
* Weight gain
* Abdominal striae
* Moon face
* Truncal obesity
* Easy bruising

103
Q

Signs of excessive TSH from an adenoma include:

A

Signs of excessive TSH from an adenoma (very rare) include:
* Weight loss
* Tremor
* Palpitations
* Anxiety
* Diarrhea
* Heat intolerance

104
Q

Large pituitary adenomas can encroach on the optic nerve and result in _

A

Large pituitary adenomas can encroach on the optic nerve and result in bitemporal hemainopia

105
Q

5 types of cells that are overactive in adenomas:

A

5 types of cells that are overactive in adenomas:
1. Lactotrophs
2. Somatotrophs
3. Corticotrophs
4. Gonadotrophs
5. Thyrothrophs

106
Q

What is the workup for a patient with suspected pituitary adenoma?

A

Labs:
* Prolactin
* LH/FSH with estrogen/testosterone
* ACTH with cortisol
* TSH with T3/T4
* GH with IGF-1

Imaging: MRI with contrast

107
Q

The expected labs in a prolactinoma would be high _ and low _

A

The expected labs in a prolactinoma would be high prolactin and low LH/FSH, estrogen/testosterone

108
Q

For most adenomas, the first line treatment is _ , followed by _ and _

A

For most adenomas, the first line treatment is surgery , followed by medication and radiation

109
Q

For prolactinoma the first line treatment is always _

A

For prolactinoma the first line treatment is always medical

110
Q

Endocrine hormones enter the _

A

Endocrine hormones enter the bloodstream to travel to distant organs

111
Q

Glands are just _

A

Glands are just envaginations of epithelial cells

112
Q

Exocrine glands are glands that _

A

Exocrine glands are glands that produce substances for secretion outside the body

113
Q

Steroid hormones are derived from _ ; they easily cross the cell membrane and therefore bind to (extracellular/intracellular) receptors

A

Steroid hormones are derived from cholesterol ; they easily cross the cell membrane and therefore bind to intracellular receptors (nuclear receptors)

114
Q

Peptide hormones are hydrophilic, meaning they cannot easily cross the cell membrane and will bind _ receptors

A

Peptide hormones are hydrophilic, meaning they cannot easily cross the cell membrane and will bind membrane bound receptors

115
Q

The pineal gland is located behind the _ and secretes _

A

The pineal gland is located behind the third ventricle and secretes melatonin

116
Q

The pituitary gland is a pea sized gland that rests on the _ within the _ bone

A

The pituitary gland is a pea sized gland that rests on the sella turcica within the sphenoid bone

117
Q

Adrenal glands are located _ and secrete _

A

Adrenal glands are located above the kidneys and secrete steroid hormones (cortisol, aldosterone, androgens)

118
Q

Adipose cells contain an enzyme called _ that converts androgens to estrogen

A

Adipose cells contain an enzyme called aromatase that converts androgens to estrogen

119
Q

The anterior pituitary is also called the _ ; the posterior pituitary is also called the _

A

The anterior pituitary is also called the adenohypophysis ; the posterior pituitary is also called the neurohypophysis

120
Q
A

D- the anterior pituitary is an upward growth of the oral ectoderm

121
Q

Where is the posterior pituitary?

A

C: The posterior pituitary is the downward extension of the neuroectoderm- extension of the hypothalamus

122
Q
A

These are acidophils
* The anterior pituitary contains both acidophils and basophils

123
Q

Which anterior pituitary cells are acidophils?

A

Somatotrophs (making GH) and Mammotrophs (making prolactin)

124
Q

Which anterior pituitary cells are basophils?

A

B-FLAT:
* Gonadotrophs (FSH, LH)
* Corticotrophs (ACTH)
* Thyrotrophs (TSH)

125
Q

Storage structures in the posterior pituitary are called _

A

Herring bodies store ADH and oxytocin
* They are really just dilated terminal portions of the axons

126
Q

What kind of capillaries are found in the anterior pituitary?

A

Fenestrated capillaries
* Can see the somatotrophs, gonadotrophs, thyrotrophs and their many secretory vesicles

127
Q

What is contained in the X?

A

Colloid

128
Q

Thyroxine (T4) is a _ type of hormone

A

Thyroxine (T4) is a hydrophobic amine

129
Q

These cells are _ and they function to _

A

These cells are parafollicular cells and they function to secrete calcitonin, which decreases calcium levels

130
Q

These are _ cells in the parathyroid

A

These are chief cells in the parathyroid –> make PTH

131
Q

What does the yellow cell represent?

A

Osteoblasts –> when stimulated by PTH it reduces bone deposition and releases osteoclast stimulating factor

132
Q

Which region secretes aldosterone?

A

The zona glomerulosa (A) secretes aldosterone

133
Q

What stimulates these cells?

A

ACTH stimulates these cells in the zona fasciculata to make cortisol

134
Q

What hormone is produced here?

A

Zona reticularis produces sex hormones

135
Q

What do these cells secrete?

A

Chromaffin cells secrete epinephrine and norepinephrine

136
Q

Epinephrine is derived from _

A

Epinephrine is derived from tyrosine

137
Q

Tyrosine is the precursor for many important amine hormones including _

A

Tyrosine is the precursor for many important amine hormones including thyroxine and dopamine –> NE –> E

138
Q

Where do these cells secrete their products?

A

These are acinar glands of the exocrine pancreas and they secrete their products (digestive enzymes) into ducts

139
Q

What do these cells most likely secrete?

A

These are most likely beta cells which secrete insulin; these cells are the most numerous and centrally located in the islet of langerhan

140
Q
A
141
Q

In MEN1 syndrome patients have an insulinoma and high C-peptide; C-peptide is made in the _

A

In MEN1 syndrome patients have an insulinoma and high C-peptide; C-peptide is made in the rough ER

142
Q

Alpha cells make _

A

Alpha cells make glucagon

142
Q

Which is the mechanism by which insulin signals?

A

Insulin is a polypeptide, hydrophilic hormone that binds receptors on the outside of the cell

143
Q

Beta cells make _

A

Beta cells make insulin and amylin

144
Q

Delta cells make _

A

Delta cells make somatostatin

145
Q

Epsilon cells make _

A

Epsilon cells make ghrelin

146
Q

PP cells (gamma or F cells) make _

A

PP cells (gamma or F cells) make pancreatic polypeptides

147
Q

Steroid secreting cells have extensive _ ER and lots of _

A

Steroid secreting cells have extensive smooth ER and lots of fat droplets

148
Q

Identify the categories of hormones

A
149
Q

Which hormones might be enhancing transcription here?

A

Cortisol or thyroxine

150
Q

Which hormone might be binding to the receptor here?

A

Catecholamines

151
Q

The endocrine organ that secretes melanin is _

A

The endocrine organ that secretes melanin is pineal gland

Endocrine (8 decks)

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