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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
Q

Clinical presentation of Hypothyroidism

A

Cretinism in infant
Low BMR
Myxedema

how you treat it: synthetic T4/Synthroid

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26
Q

Cretinism

A

untreated congenital deficiency of TH
presents as gross dwarfing, severe intellectual disability, all development milestones are delayed

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27
Q

Low BMR clinical presentation

A

weight gain, lethargy, slurred speech, constipation, decreased metal acuity, decreased heat production

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28
Q

Myxedema clinical presentation

A

usually due to long hypothyroidism. Accumulation of proteins/fluid in subcutaneous tissues

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29
Q

causes of Hyperthyroidism

A

Grave’s disease
Increased TRH
altered levels of TSH
excessive administration of thyroid hormone

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30
Q

Grave’s disease

A

autoimmune disorder characterized by increased levels of thyroid stimulating immunoglobulins

the antibodies stimulate the thyroid gland, causing increased TH secretion and gland hypertrophy

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31
Q

Dx of hyperthroidism

A

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

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32
Q

Clinical presentation of hyperthyroidism

A

weight loss
increased food intake
excessive heat production and sweating
rapid HR
nervousness/weakness
goiter (sometimes)
exopthalmos (grave’s)

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33
Q

Treatment of hyperthyroidism

A

radioactive iodine ablation , surgical removal of thyroid gland

TH replacement after

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34
Q

Stimuli and Inhibitory of Growth HOrmone

A

GHRH acts on anterior pituitary to stimulate GH synthesis/secretion

Somatostatin inhibits GH secretion by blocking action of GHRH on anterior pituitary cells

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35
Q

How is growth hormone secreted?

A

GH is secreted in a pulsatile manner, about every two hours. Largest burst happens within 1 hour of falling asleep

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36
Q

GH is the ______ hormone for normal ____

A

single most important, growth

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37
Q

GH secretion throughout life

A

Not constant throughout life
increases steadily from birth to early childhood

Puberty has huge GH bursts
Declines after puberty
Lowest levels in old age

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38
Q

Stimulatory Factors for growth hormone secretion

A

Increase in GHRH secretion
Exercise
Stress
Fasting (decreases FFA/Glucose)
Puberty
Deep Sleep

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39
Q

Inhibitory Factors of growth hormone

A

increase in somatostatin release
increase in GH release
increased glucose or FFA concentration
REM sleep
Old Age

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40
Q

Actions of growth hormone

A

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

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41
Q

Effects of growth hormone

A

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
Q

Results of decreased glucose uptake by GH

A

causes increased blood glucose and insulin levels (diabetogenic effect)

43
Q

Growth Hormone Deficiency in Childhood

A

causes dwarfism
failure to grow
short stature
mild obesity
delayed puberty

treated with human GH replacement

44
Q

GH Deficiency in Adulthood

A

considered that no overt clinical symptoms are evident

some clinicians now recognize somatopause –> obesity, decreased muscle mass, BMD< dyslipidemia, decreased CO

45
Q

Growth Hormone Excess before puberty

A

GIGANTISM
long bones grow disproportionately
usually diabetic (GH brings glucose into blood)
Acromegalic features

TX: somatostatin analogues, which inhibit GH secretion

46
Q

GH hormone after puberty

A

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
Q

Adrenal Glands

A

each gland is compromised of 2 distinct endocrine glands

Adrenal medulla: secretes cathecholamines
Adrenal Cortex: secretes corticosteroids

48
Q

Corticosteroids

A

cortisol, aldosterone, adrenal androgens

49
Q

Cathecholamines

A

E, NE, Dopamine

50
Q

Stimulatory Factors of cortisol secretion

A

Decreased plasma cortisol
Physical stress
chronic anxiety and psychological stress
sleep-wake transition (peaks as you wake)
heavy exercise

51
Q

Inhibitory Factors of cortisol secretion

A

increased plasma (cortisol)

52
Q

Actions of cortisol

A

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
Q

How does cortisol maintain normal BP?

A

permissive effect on NE/E can increase bp. Stimulates synthesis of alpha 1 receptors

54
Q

Cortisol increases availability of _____ ______

A

energy sources
it is a catabolic hormone that is essential for fasting, breaks down proteins and fat.

55
Q

MOA for cortisol

A

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
Q

Cortisol produces…

A

lipocortins/annexins, which are a group of proteins the body makes in response to cortisol release

Have same effect as predinisone

57
Q

Cortisol deficiency is also known as

A

Addison’s disease

58
Q

Addison’s disease

A

primary adrenocrtical insufficiency
usually caused by autoimmune destruction of ALL zones of adrenal cortex

Tx: cortisol and aldosterone replacement

59
Q

S/S of Addison’s disease

A

S/S from loss of cortisol:
hypoglycemia, anorexia, weight loss, nausea & vomiting, weakness.
Also S/S from loss of aldosterone (like hypotension)

60
Q

Cortisol Excess

A

Cushings Syndrome
Cushings Disease

61
Q

Cushings SYNDROME

A

(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
Q

Cushings DISEASE

A

(too much ACTH)
Excess of ACTH due to a pituitary tumor

Tx: surgical removal of ACTH secreting tumor

63
Q

S/S of Cushing’s Syndrome

A
  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
Q

Plasma Calcium Regulation

A

Requires 3 hormones and 3 organs

Hormones–PTH, Vitamin D, calcitonin
Organs–Large intestine, kidney, bone

65
Q

PTH

A

secreted by parathyroid glands
acts on bones, kidneys, intestine to regulate blood

most important hormone in regulation of calcium level in blood

66
Q

___% of calcium in the body is in the bones

A

99%
Remaining 1% is found in extracellular fluid

Ionized Ca is the only biologically active form

67
Q

Normal Blood Ca level

A

10 mg/dl

68
Q

Calcium homeostasis

A

1000 mg goes into the body
800 mg will go out into feces
200 mg will be excreted in the urine

69
Q

Bone bank (calcium)

A

PTH causes more calcium to be withdrawn (reabsorbed)

Calcitonin causes more calcium to be deposited into the bone

70
Q

Function of PTH

A

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
Q

What level of calcium triggers PTH release?

A

<7.5 mg/dl

72
Q

Actions of PTH on Bone

A

Bone resorption (withdrawal). Delivers both Ca and phosphate to the blood

73
Q

Actions of PTH on Kidney

A

inhibits phosphate reabsorption, which increases phosphate excretion into the urine, to allow for more ionized Ca

Increases Ca reabsorption in the DCT

74
Q

Actions of PTH on Small Intestine

A

No direct effect on Ca absorption (the small intestine)
indirectly stimulates Ca absorption by activation of Vitamin D

75
Q

Calcitonin

A

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
Q

Vitamin D

A

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
Q

Actions of Vitamin D on Intestine, Kidney, Bone

A

Intestine/Kidney: Increases/stimulates Ca and phosphate absorption

Bone: stimulates osteoclast activity and bone resorption

78
Q

Osteomalacia

A

softening of bones

79
Q

Osteoporosis

A

weakening of bone

80
Q

Rickets

A

soft bones

81
Q

Dosage is _____

A

everything!
hormonal effects are very dependent on concentration

a deficit or excess of hormone produces pathological responses

82
Q

Ergogenic aids

A

durgs or dietary supplements used to enhance performance

83
Q

Doping

A

use of a drug or blood product to improve athletic performance

84
Q

Most studies to assess the value of ergogenic aids

A

-include only conditioned athletes and young adults
-do not include children, adolescents
-are of poor quality

85
Q

Survey of 21000 college athletes

A

almost half reported taking protein

86
Q

Review of adolescent use of performance enhancing substances

A

Protein, creatine, and caffeine were most commonly used ingredients

athletes use more substances than nonathletes

87
Q

Persons with most influence to taking ergogenic aids

A

coaches (65%)
dietitians
doctors

88
Q

_____ knowledge about supplements is associated with ____ use

A

Greater
Less

89
Q

Education regarding ergogenic aids

A

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
Q

Erythropoietin

A

Epo: hormone that is primary regulator of RBC formation

Clinical uses: chemo induced anemia, esrd induced anemia, HIV/AIDS

91
Q

Reasons rHuEpo is abused

A

Improve aerobic power in endurance sports

92
Q

ADRs of Epo abuse

A

peripheral vein varicosities
HTN
thrombotic events causing MI, CVA< PE

93
Q

Anabolic Sterioids

A

most are versions of testosterone
Used clinically with HIV/AIDS, delay of growth syndromes

abused to increase strength

94
Q

Results of anabolic steroid abuse

A

increase skeletal muscle surface area and strength

increases lipid profile, systolic BP, liver damage, acne, hair growth, psychological changes, mortality, genital alteration

95
Q

Growth Hormone Abuse

A

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
Q

ADRs of Growth Hormone abuse

A

gigantism
large hands and feet
carpal tunnel syndrome
myopathic muscles
HTN
insulin resistance

97
Q

Amphetamines/Stimulants

A

Related to NE/E/DA
Clinical uses: ADHD, narcolepsy

Commonly abused substances: caffeine, ephedrine, amphetamines, meth

Abused to increase endurance, weight loss

98
Q

Amphetamines effectiveness

A

no increase in VO2 max, increased time to exhaustion

increased max torque, peak power, lung function

99
Q

ADRs of Amphetamines

A

increased dysrhythmias, HTN, MI, CVA, GI disturbances, heat intolerance, anxiety, insomnia, dizziness, paranoia, hallucinations, death

100
Q

Adrenal Medulla

A

secretes catecholamines in response to SNS stimulation

increases HR, sweat, decreased motility of GI

5 Pathology (9 decks)

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