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5 Pathology > L3 Endocrine Pathologies > Flashcards

L3 Endocrine Pathologies Flashcards

1
Q

GHRH Loop

A

GHRH –> Growth hormone –> IGF in liver, other organs

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2
Q

Somatostatin Loop

A

SS –> Growth hormone –> IGF in liver, other organs

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3
Q

Thryotropin releasing hormone loop

A

TRH –> TSH –> T3 and T4 in thyroid

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4
Q

Corticotrophin-releasing hormone Loop

A

CRH –> ACTH –> Cortisol in adrenal cortex

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5
Q

Thyroid gland

A

at the base of the neck, wraps around the neck
composed of spherical follicles

each follicle contains one layer of epithelial cells, creating a space that is filled with thyroglobulin

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6
Q

synthesis of Thyroid hormone

A

Iodine is absorbed by the GI tract as iodide

Iodide is converted back to iodine and coupled to tryosine to form thyroglobulin

TSH stimulation causes thyroid hormones to be split from thyroglobulin

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7
Q

T4

A

prehormone
Thyroid gland secretes primarily T4

> 99% of T4 in blood is attached to TBG (higher affinity for it then T3)

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8
Q

T3

A

hormone
Thyroid secretes only small amount of T3, most is unbound
most physiologically active form

plasma concentration of free T3 is 10x higher than free T4

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9
Q

T4 is converted to T3

A

by the target tissues

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10
Q

Prehormone

A

hormone that is inactive until it is modified by the target cell

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11
Q

Mechanism of thyroid hormone action

A

Only the free form of T4 and T3 can enter target cells

T4 is converted to T3 inside target cells

T3 enters nucleus and binds to a nuclear receptor

Hormone receptor complex binds to specific section of DNA to activate specific genes

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12
Q

Stimulation of thyroid hormone secretion

A

TSH, TRH, increased TBG levels in pregnancy, thyroid stimulating immunoglobins in grave’s disease

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13
Q

Inhibitory factors of thyroid hormone secretion

A

iodine deficiency

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14
Q

Actions of thyroid hormone

A

Thyroid hormone acts on virtually every organ system

BMR
Metabolism
Growth
CV/Respiratory
CNS

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15
Q

Thyroid hormone impact on BMR

A

increases O2 consumption
increases activity of Na/K ATPase

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16
Q

Thyroid hormone impact on Metabolism

A

Increases glucose absorption from GI tract
increases the power of catcheolamines, glucoagon, and GH on gluconeogenesis, lipolysis, proteolysis

overall effect is catabolic

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17
Q

Thyroid hormone impact on growth

A

acts synergistically with GH and somatomedians to promote bone maturation

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18
Q

Thyroid hormone impact on CV and respiratory

A

increases CO by inducing the synthesis of cardiac beta 1 adrenergic receptors
induces synthesis of cardiac myosin and SR CaATPase

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19
Q

Thyroid hormone impact on CNS

A

essential for normal maturation of CNS. Perinatal lack of TH results in severe intellectual disability/delay

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20
Q

Hypothyroidism

A

Can be caused by lack/decrease in TRH or TSH, or inability to produce thyroid hormone (hashimoto, gland removal, lack of iodine)

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21
Q

Hashimoto’s thyroiditis

A

most common cause of hypthyroidism in the USA

AI disease in which antibodies attack thyroid galnd, resulting in an inability to produce sufficient TH

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22
Q

Hypothyroidism Goiter

A

when the cause of hypothyroidism is a defect in TH production in the thyroid gland, a goiter develops from the unrelenting stimulation of thyroid gland

if plasma TH is low, there is a lack of negative feedback to the anterior pituitary, which causes increased release of TSH, whcih leads to hypertrophy of thyroid gland

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23
Q

Causes of Hypothyroidism Goiter

A

defect in TH production
hashimoto’s hypothyrodism
iodine deficiency

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24
Q

Causes of Hyperthyroidism goiter

A

Grave’s disease
increased TRH or TSH

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25
Clinical presentation of Hypothyroidism
Cretinism in infant Low BMR Myxedema how you treat it: synthetic T4/Synthroid
26
Cretinism
untreated congenital deficiency of TH presents as gross dwarfing, severe intellectual disability, all development milestones are delayed
27
Low BMR clinical presentation
weight gain, lethargy, slurred speech, constipation, decreased metal acuity, decreased heat production
28
Myxedema clinical presentation
usually due to long hypothyroidism. Accumulation of proteins/fluid in subcutaneous tissues
29
causes of Hyperthyroidism
Grave's disease Increased TRH altered levels of TSH excessive administration of thyroid hormone
30
Grave's disease
autoimmune disorder characterized by increased levels of thyroid stimulating immunoglobulins the antibodies stimulate the thyroid gland, causing increased TH secretion and gland hypertrophy
31
Dx of hyperthroidism
S/S and increased plasma levels of T3 and T4 TSH levels can be increased or decreased, depending on the cause of hyperthyroidism If the cause is the gland--> tsh level will be decreased If the cause is disorder of hypothalamus --> TSH will be increased
32
Clinical presentation of hyperthyroidism
weight loss increased food intake excessive heat production and sweating rapid HR nervousness/weakness goiter (sometimes) exopthalmos (grave's)
33
Treatment of hyperthyroidism
radioactive iodine ablation , surgical removal of thyroid gland TH replacement after
34
Stimuli and Inhibitory of Growth HOrmone
GHRH acts on anterior pituitary to stimulate GH synthesis/secretion Somatostatin inhibits GH secretion by blocking action of GHRH on anterior pituitary cells
35
How is growth hormone secreted?
GH is secreted in a pulsatile manner, about every two hours. Largest burst happens within 1 hour of falling asleep
36
GH is the ______ hormone for normal ____
single most important, growth
37
GH secretion throughout life
Not constant throughout life increases steadily from birth to early childhood Puberty has huge GH bursts Declines after puberty Lowest levels in old age
38
Stimulatory Factors for growth hormone secretion
Increase in GHRH secretion Exercise Stress Fasting (decreases FFA/Glucose) Puberty Deep Sleep
39
Inhibitory Factors of growth hormone
increase in somatostatin release increase in GH release increased glucose or FFA concentration REM sleep Old Age
40
Actions of growth hormone
most actions of GH are indirectly mediated through the production of somatomedins (insulin-like growth factors) by the liver Some actions are due to the direct effects of GH on skeletal muscle, liver, adipose
41
Effects of growth hormone
REMEMBER--GH promotes growth in every organ/organ system by making fuel available 1. Increase protein synthesis and organ growth (uptake of AA and synthesis of DNA) 2. Increase Lipolysis 3. Decrease glucose uptake and utilization of glucose by muscle and adipose tissue 4. Increase linear growth 5. Alter every aspect of cartilage metabolism
42
Results of decreased glucose uptake by GH
causes increased blood glucose and insulin levels (diabetogenic effect)
43
Growth Hormone Deficiency in Childhood
causes dwarfism failure to grow short stature mild obesity delayed puberty treated with human GH replacement
44
GH Deficiency in Adulthood
considered that no overt clinical symptoms are evident some clinicians now recognize somatopause --> obesity, decreased muscle mass, BMD< dyslipidemia, decreased CO
45
Growth Hormone Excess before puberty
GIGANTISM long bones grow disproportionately usually diabetic (GH brings glucose into blood) Acromegalic features TX: somatostatin analogues, which inhibit GH secretion
46
GH hormone after puberty
Acromegaly short bone epiphyseal plates do not close hands, feet, skull, lower jaw continue to grow -coarsening of facial features -increased organ size -insulin resistance Tx: somatostatin analogues
47
Adrenal Glands
each gland is compromised of 2 distinct endocrine glands Adrenal medulla: secretes cathecholamines Adrenal Cortex: secretes corticosteroids
48
Corticosteroids
cortisol, aldosterone, adrenal androgens
49
Cathecholamines
E, NE, Dopamine
50
Stimulatory Factors of cortisol secretion
Decreased plasma cortisol Physical stress chronic anxiety and psychological stress sleep-wake transition (peaks as you wake) heavy exercise
51
Inhibitory Factors of cortisol secretion
increased plasma (cortisol)
52
Actions of cortisol
anti-inflammtory/immunosuppression stimulation of gluconeogenesis and lipolysis maintenance of normal BP inhibition of bone formation Decreases Type 1 collagen formation increases wake tine and decreases REM sleep
53
How does cortisol maintain normal BP?
permissive effect on NE/E can increase bp. Stimulates synthesis of alpha 1 receptors
54
Cortisol increases availability of _____ ______
energy sources it is a catabolic hormone that is essential for fasting, breaks down proteins and fat.
55
MOA for cortisol
Most of cortisols effects are due to changes in gene transcription 1. Decreases transcription of proinflammatory genes 2. Increases gene transcription of proteins that decrease inflammation Cortisol produces proteins that inhibit the production of phosphoplipase A, which decreases production of inflammatory mediators Timeframe: hrs to days
56
Cortisol produces...
lipocortins/annexins, which are a group of proteins the body makes in response to cortisol release Have same effect as predinisone
57
Cortisol deficiency is also known as
Addison's disease
58
Addison's disease
primary adrenocrtical insufficiency usually caused by autoimmune destruction of ALL zones of adrenal cortex Tx: cortisol and aldosterone replacement
59
S/S of Addison's disease
S/S from loss of cortisol: hypoglycemia, anorexia, weight loss, nausea & vomiting, weakness. Also S/S from loss of aldosterone (like hypotension)
60
Cortisol Excess
Cushings Syndrome Cushings Disease
61
Cushings SYNDROME
(Too much cortisol) 1. Overproduction of cortisol by adrenal cortex 2. Systemic pharmacological administration of glucocorticoids Tx if due to problem 1: drugs that block steroid hormone synthesis
62
Cushings DISEASE
(too much ACTH) Excess of ACTH due to a pituitary tumor Tx: surgical removal of ACTH secreting tumor
63
S/S of Cushing's Syndrome
1. Hyperglycemia 2. Muscle Wasting 3. Increased fat in face, trunk, between scapulae 4. Striae 5. Poor wound healing 6. Hypertension 7. Emotional changes 8. Osteoporosis 9. AVN of femoral head
64
Plasma Calcium Regulation
Requires 3 hormones and 3 organs Hormones--PTH, Vitamin D, calcitonin Organs--Large intestine, kidney, bone
65
PTH
secreted by parathyroid glands acts on bones, kidneys, intestine to regulate blood most important hormone in regulation of calcium level in blood
66
___% of calcium in the body is in the bones
99% Remaining 1% is found in extracellular fluid Ionized Ca is the only biologically active form
67
Normal Blood Ca level
10 mg/dl
68
Calcium homeostasis
1000 mg goes into the body 800 mg will go out into feces 200 mg will be excreted in the urine
69
Bone bank (calcium)
PTH causes more calcium to be withdrawn (reabsorbed) Calcitonin causes more calcium to be deposited into the bone
70
Function of PTH
regulate the concentration of Ca in ECF/plasma the amount of PTH secreted from the parathyroid gland depends on the amount of calcium in the blood Low levels of blood calcium triggers an increase in PTH PTH remains at a basal level with normal levels of calcium
71
What level of calcium triggers PTH release?
<7.5 mg/dl
72
Actions of PTH on Bone
Bone resorption (withdrawal). Delivers both Ca and phosphate to the blood
73
Actions of PTH on Kidney
inhibits phosphate reabsorption, which increases phosphate excretion into the urine, to allow for more ionized Ca Increases Ca reabsorption in the DCT
74
Actions of PTH on Small Intestine
No direct effect on Ca absorption (the small intestine) indirectly stimulates Ca absorption by activation of Vitamin D
75
Calcitonin
Synthesized and secreted by C cells in the thyroid gland Secreted when plasma Ca is high Inhibits osteoclast bone resorption to decrease Ca delivery to plasma (causes bone deposition) Calcitonin does NOT regulate Ca minute to minute
76
Vitamin D
Promotes mineralization of new bone Increases plasma concentrations of both Ca and phosphate precursor is located in liver, active form is in the kidney
77
Actions of Vitamin D on Intestine, Kidney, Bone
Intestine/Kidney: Increases/stimulates Ca and phosphate absorption Bone: stimulates osteoclast activity and bone resorption
78
Osteomalacia
softening of bones
79
Osteoporosis
weakening of bone
80
Rickets
soft bones
81
Dosage is _____
everything! hormonal effects are very dependent on concentration a deficit or excess of hormone produces pathological responses
82
Ergogenic aids
durgs or dietary supplements used to enhance performance
83
Doping
use of a drug or blood product to improve athletic performance
84
Most studies to assess the value of ergogenic aids
-include only conditioned athletes and young adults -do not include children, adolescents -are of poor quality
85
Survey of 21000 college athletes
almost half reported taking protein
86
Review of adolescent use of performance enhancing substances
Protein, creatine, and caffeine were most commonly used ingredients athletes use more substances than nonathletes
87
Persons with most influence to taking ergogenic aids
coaches (65%) dietitians doctors
88
_____ knowledge about supplements is associated with ____ use
Greater Less
89
Education regarding ergogenic aids
Refer to evidence based information regarding cost-benefit ratio It is not within our scope to recommend or sell supplements. Education and recognition of ADRs is
90
Erythropoietin
Epo: hormone that is primary regulator of RBC formation Clinical uses: chemo induced anemia, esrd induced anemia, HIV/AIDS
91
Reasons rHuEpo is abused
Improve aerobic power in endurance sports
92
ADRs of Epo abuse
peripheral vein varicosities HTN thrombotic events causing MI, CVA< PE
93
Anabolic Sterioids
most are versions of testosterone Used clinically with HIV/AIDS, delay of growth syndromes abused to increase strength
94
Results of anabolic steroid abuse
increase skeletal muscle surface area and strength increases lipid profile, systolic BP, liver damage, acne, hair growth, psychological changes, mortality, genital alteration
95
Growth Hormone Abuse
Clinical uses: deficiency of GH that results in growth delay Abused: to increase muscle mass, strength, and decrease fat mass has not been proven to be an effective ergogenic aid
96
ADRs of Growth Hormone abuse
gigantism large hands and feet carpal tunnel syndrome myopathic muscles HTN insulin resistance
97
Amphetamines/Stimulants
Related to NE/E/DA Clinical uses: ADHD, narcolepsy Commonly abused substances: caffeine, ephedrine, amphetamines, meth Abused to increase endurance, weight loss
98
Amphetamines effectiveness
no increase in VO2 max, increased time to exhaustion increased max torque, peak power, lung function
99
ADRs of Amphetamines
increased dysrhythmias, HTN, MI, CVA, GI disturbances, heat intolerance, anxiety, insomnia, dizziness, paranoia, hallucinations, death
100
Adrenal Medulla
secretes catecholamines in response to SNS stimulation increases HR, sweat, decreased motility of GI

5 Pathology (9 decks)

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