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Generals G.O.A.T > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyrotropin-releasing hormone
- Gland produced by?
- Major function?

A
  • Gland: Hypothalamus
  • Function: Stimulates secretion of thyroid-stimulating hormone and prolactin
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2
Q

Corticotropin-releasing hormone
- Gland produced by?
- Major function?

A
  • Gland: Hypothalamus
  • Function: Causes release of adrenocorticotropic hormone
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3
Q

Growth hormone-releasing hormone
- Gland produced by?
- Major function?

A
  • Gland: Hypothalamus
  • Function: Causes release of growth hormone
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4
Q

Growth hormone inhibitory hormone (somatostatin)
- Gland produced by?
- Major function?

A
  • Gland: Hypothalamus
  • Function: Inhibits release of growth hormone
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5
Q

Gonadotropin-releasing hormone
- Gland produced by?
- Major function?

A
  • Gland: Hypothalamus
  • Function: Causes release of luteinizing hormone and follicle-stimulating hormone
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6
Q

Dopamine or prolactin-inhibiting factor
- Gland produced by?
- Major function?

A
  • Gland: Hypothalamus
  • Function: Inhibits release of prolactin
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7
Q

Growth hormone
- Gland produced by?
- Major function?

A
  • Gland: Anterior Pituitary
  • Function: Stimulates protein synthesis and overall growth of most cells and tissues
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8
Q

Thyroid-stimulating hormone
- Gland produced by?
- Major function?

A
  • Gland: Anterior Pituitary
  • Function: Stimulates synthesis and secretion of thyroid hormones (thyroxine and triiodothyronine)
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9
Q

Adrenocorticotropic hormone
- Gland produced by?
- Major function?

A
  • Gland: Anterior Pituitary
  • Function: Stimulates synthesis and secretion of adrenocortical hormones (cortisol, androgens, and aldosterone)
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10
Q

Prolactin
- Gland produced by?
- Major function?

A
  • Gland: Anterior Pituitary
  • Function: Promotes development of the female breasts and secretion of milk
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11
Q

Follicle-stimulating hormone
- Gland produced by?
- Major function?

A
  • Gland: Anterior Pituitary
  • Function: Causes growth of follicles in the ovaries and sperm maturation in Sertoli cells of testes
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12
Q

Luteinizing hormone
- Gland produced by?
- Major function?

A
  • Gland: Anterior Pituitary
  • Function: Stimulates testosterone synthesis in Leydig cells of testes;
  • stimulates ovulation, formation of corpus luteum, and oestrogen and progesterone synthesis in ovaries
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13
Q

Antidiuretic hormone (vasopressin)
- Gland produced by?
- Major function?

A
  • Gland: Posterior Pituitary (produced in hypothalamus secreted by PP)
  • Function: Increases water reabsorption by the kidneys and causes vasoconstriction and increased blood pressure
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14
Q

Oxytocin
- Gland produced by?
- Major function?

A
  • Gland: Posterior Pituitary (produced in hypothalamus secreted by PP)
  • Function: Stimulates milk ejection from breasts and uterine contractions
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15
Q

Thyroxine (T4) and triiodothyronine (T3)
- Gland produced by?
- Major function?

A
  • Gland: Thyroid
  • Function: Increases the rates of chemical reactions in most cells, thus increasing body metabolic rate
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16
Q

Calcitonin
- Gland produced by?
- Major function?

A
  • Gland: Thyroid C cells
  • Function: Promotes deposition of calcium in the bones and decreases extracellular fluid calcium ion concentration
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17
Q

Cortisol
- Gland produced by?
- Major function?

A
  • Gland: Adrenal Cortex - zona fasiculata
  • Function: Has multiple metabolic functions for controlling metabolism of proteins, carbohydrates, and fats; also has anti-inflammatory effects
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18
Q

Aldosterone
- Gland produced by?
- Major function?

A
  • Gland: Adrenal Cortex - zona glomerulosa
  • Function: Increases renal sodium reabsorption, potassium secretion, and hydrogen ion secretion
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19
Q

Norepinephrine, epinephrine
- Gland produced by?
- Major function?

A
  • Gland: Adrenal Medulla
  • Function: Same effects as sympathetic stimulation
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20
Q

Insulin
- Gland produced by?
- Major function?

A
  • Gland: Pancreas (beta cells)
  • Function: Promotes glucose entry in many cells, and in this way controls carbohydrate metabolism
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21
Q

Glucagon
- Gland produced by?
- Major function?

A
  • Gland: Pancreas (α cells)
  • Function: Increases synthesis and release of glucose from the liver into the body fluids
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22
Q

Parathyroid hormone
- Gland produced by?
- Major function?

A
  • Gland: Parathyroid chief cells
  • Function: Controls serum calcium ion concentration by increasing calcium absorption by the gut and kidneys and releasing calcium from bones
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23
Q

Testosterone
- Gland produced by?
- Major function?

A
  • Gland: Testes
  • Function: Promotes development of male reproductive system and male secondary sexual characteristics
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24
Q

Estrogens
- Gland produced by?
- Major function?

A
  • Gland: Ovaries
  • Function: Promotes growth and development of female reproductive system, female breasts, and female secondary sexual characteristics
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25
Progesterone - Gland produced by? - Major function?
- Gland: Ovaries - Function: Stimulates secretion of 'uterine milk' by the uterine endometrial glands and promotes development of secretory apparatus of breasts
26
Renin - Gland produced by? - Major function?
- Gland: Kidney - Function: Catalyzes conversion of angiotensinogen to angiotensin I (acts as an enzyme)
27
1,25-Dihydroxycholecalciferol - Gland produced by? - Major function?
- Gland: Kidney - Function: Increases intestinal absorption of calcium and bone mineralization
28
Erythropoietin - Gland produced by? - Major function?
- Gland: Kidney - Function: Increases erythrocyte production
29
Atrial natriuretic peptide - Gland produced by? - Major function?
- Gland: Heart - Function: Increases sodium excretion by kidneys, reduces blood pressure
30
Gastrin - Gland produced by? - Major function?
- Gland: Stomach - Function: Stimulates hydrogen chloride secretion by parietal cells
31
Secretin - Gland produced by? - Major function?
- Gland: Small Intestine - Function: Stimulates pancreatic acinar cells to release bicarbonate and water
32
Cholecystokinin - Gland produced by? - Major function?
- Gland: Small Intestine - Function: Stimulates gallbladder contraction and release of pancreatic enzymes
33
Leptin - Gland produced by? - Major function?
- Gland: Adipocytes - Function: Inhibits appetite, stimulates thermogenesis
34
Which hormones are derived from tyrosine
- thyroid hormones - catecholamines
35
which hormones are transported predominantly by proteins
- steroid hormones - thyroid hormones
36
Which embryonic structure do the anterior pituitary and posterior originate from
- Anterior - ranthke's pouch (pharyngeal epithelium) posterior - neural tissue from hypothalamus
37
Which hormones are produced by the anterior pituitary gland
* GH, ACTH, TSH, Prolactin, FSH, LH
38
Which hormones are secreted by the posterior pituitary gland - by what mechanism
* ADH, Oxytocin synthesised by magnocellular neurons in hypothalamus and transported along nerve fibres to posterior pituitary
39
Which blood vessel system helps control the anterior pituitary
- hypothalamic-hypophysial portal vessels - flow from hypothalamus to anterior pituitary to allow hormone control
40
* Growth hormone has what main metabolic effects * What mediates the effect of growth hormone
- increase protein synthesis - increased fat mobilisation - decreased glucose utilisation (inslin resistance) - tissue growth mediated by Insulin like growth factors (IGF-1)
41
What proportion of thyroid hormone is T3 and T4
- 93% T4, 7% T3 - T4 converted to T3 in tissues
42
What is essential for thyroid hormone synthesis
Iodine
43
What transporter is used to transport iodine from blood into thyroid cells
- sodium iodide symporter - cotransports 1x iodide with 2x sodium
44
which glycoprotein is essential for thyroid formation and storage
Thyroglobulin
45
Outline the formation of T4 and T3
- iodide is oxidised by thyroid peroxidase - binds to tyrosine in thyroglobulin - forms mono and diiodotryosine - combine to form T4 and T3 - stored in thyroglobulin
46
Outline the release of thyroid hormones
- throid cells engulf colloid - lysosyme proteases digest thyroglobulin to release T4 and T3 - free hormones diffuse into capillaries
47
How are thyroid hormones transported
99% bound to Thyroxine binding globulin
48
How does methimazole work
prevents formation of thyroid hormones from tyrosine and iodide --> blocks peroxidase and coupling reactions
49
What does each layer of the adrenal secrete
* Glomerulosa - Aldosterone * Fasicularis - Cortisol * Reticularis - Andogens * Medulla - catecholamines
50
What are adrenocortical hormones derived from
cholesterol
51
What is the rate limiting step in steroid synthesis
conversion of cholesterol to pregnenolone by the enzyme cholesterol desmolase
52
What enzyme converts pregnenolone into 17-OH pregnenolone (for cortisol synthesis) and also progesterone into 17 OH progesterone (for cortisol synthesis)
17a Hydroxylase (CYP17A1)
53
What is the last enzyme in cortisol synthesis in dogs
11-beta-hydroxylase enzyme (CYP11B1)
54
Where are steroid hormones metabolised and into what substance
- Liver and conjugated into glucuronic acid - for renal or bile excretion
55
Which secreted glucocorticoid is responsible for most effect
- cortisol (95%) - additional effect from corticosterone
56
What are the major effects of glucocorticoids
- carbohydrate metabolism (gluconeogenesis, decrease tissue glucose utilisation) - protein metabolism (increased catabolism, increased plasma protein production, decreased cellular AA uptake) - Fat metabolism (increased fatty acid oxidation) - anti-inflammatory effects and immune supression
57
which enzyme modulates cortisol's effect in tissue
11β-hydroxysteroid dehydrogenase
58
What cells are in the pancreatic islets - in what proportion and what do they secrete
- Beta cells (60%) - insulin and maylin - Alpha cells (25%) - secrete glucagon - Delta cells (10%) - secrete somatostatin - PP cells - secrete pancreatic polypeptide
59
When pro-insulin is cleaved what are the substrates what is the plasma half life
Insulin and c peptide half life 6 minutes
60
What hormones are incretins and what is their effect
* GLP and GIP * anticipatory increase in insulin beofre the effect of glucose after eating
61
What is the effect of increased insulin levels
- carbohydrate utilisation - supressing fat use - Excess glucose storage as glycogen - Fat storage
62
what is the effect of reduced insulin secretion
- fat utilisation for energy - except in brain
63
what is the effect of glucagon
- increases blood glucose by stimulating gluconeogenesis and glycogenolysis
64
What is the effect of GH and cortisol during hypoglycemia
- released during hypoglycemia - inhibit glucose utilisation and promote fat utilisation
65
What is the effect of epinephrine on carbohydrate/lipid metabolism
- glycogenolysis and activation of HSL - increase both blood glucose and fatty acid levels
66
What is the effect of somatostatin
- secreted in response to metabolic products and GI hormones - inhibits insulin and glucagon - decreases GI motility and secretion/absorption - Extend nutrient assimilation time
67
What is type 1 diabetes
Insulin dependent - cause by a lack of insulin secretion
68
What is type 2 diabetes
non-insulin dependent Insulin resistance
69
What proportion of total body calcium is in: - ECF - ICF - Bone
- ECF - 0.1% - ICF 1% - Bone 99%
70
What are the three forms of plasma calcium
- ionised - 50% - active form - protein bound - 40% - albumin mostly - chelated - 10% - chelated with lactate, cirtate, bicarbonate
71
What is the effect of hypocalcemia
* Low calcium increases neuronal membrane permeability to sodium ions * causes nervous excitement, spontaneous nerve discharge and tetany
72
what is the effect of hypercalcemia
- depresses the CNS and reflex activities - decreases QT interval (increased risk of arrhythmia)
73
What is the function of osteoblasts
- bone deposition
74
what is the function of osteoclasts
- bone reabsorption - controlled by PTH
75
Vitamin D - outline conversion
- Vitamin D3 - cholecalciferol absorbed in diet - converted to 25 hydroxycholecalciferol in liver - converted to 1,25 dihydroxycholecalciferol in kidney by 1 alpha hydroxylase (requires PTH)
76
What are the actions of vitamin D
- intestinal calcium absorption - Phosphate absorption - renal calcium reabsorption - mobilises calcium from bone
77
What is the effect of PTH
* Mobilizing calcium from bone * Enhancing calcium reabsorption in distal tubules * Increasing urinary phosphate excretion * increasing renal activation of vitamin D3 for increased calcium absorption from GIT
78
Calcitonin effect
decreases calcium by reducing boine resorption
79
PTHrp effect
* mimics PTH activity * marker of malignancy associated hypercalcemia
80
Which vitamin D markers are available and what is their significance
* 25(OH)D calcidiol: Best assessment of overall vitamin D status * 1,25(OH)₂D calcitriol: Biologically active form, can be measured * Free 25(OH)D: Most biologically available fraction, can be measured
81
What changes in biochem and hormones are expected with malignancy associated hyeprcalcemia
- increased tCa and iCa - low or normal phosphate - Increased PTHrp - low PTH
82
What changes in biochem and hormones are expected with Primary hyperparathyroidism
- Increased tCa and iCa - Low/N phosphate - normal or increased urea/creat - increased PTH - normal or increased 1,25 OH2 D - normal or decreased 25 OH D
83
What changes in biochem and hormones are expected with Hypoadrenocorticism
- normal or increased iCa and tCa - normal or increased phos - normal or increased urea/creat - Normal PTH, PTHrp 1,25-OH2D, 25-OHD
84
What changes in biochem and hormones are expected with hypervitaminosis D
- Increased tCa and iCa - increased or normal phosphate - increased or normal urea/creat - decreased PTH - increased 1,25 OH2 D - normal or increased 25 OH D
85
What changes in biochem and hormones are expected with CKD
- any tCa - normal or decreased iCa - increased phosphate - increased urea/creat - increased PTH - normal or decreased 1,25 OH2 D - normal or decreased 25 OH D
86
Differentials for hypocalcemia
- Hypoalbuminemia (only total not iCa) - impaired PTH secretion - Calcium loss (eclampsia) - Vitamin D deficiency - Calcium chelation (ethylene glycol, AKI, pancreatitis, tumor lysis)
87
What can marked hypophosphatemia cause
haemolysis
88
What is the most common cause of hypercalcemia of malignancy in dogs
- T cell lymphoma - other causes AGASACA, carcinomas, MM
89
Management of hypercalcemia
- 0.9% NaCl (sodium enhances renal calcium excretion) - Furosemide after rehytdration - Glucocorticoids (effective for neoplasia, addisons, vit D and granulomatous) - bisphosphonates (reduce osteoclast activity) - Calcitonin for Vit D toxicity - EDTA chelation
90
Which breed are genetically predisposed to primary hyperparathyroidism
Keeshond
91
The risk of hypocalcemia is higher in dogs with what level of pre-treatment calcium
total calcium >3.5 mmol/L (14 mg/dL) or ionized calcium >1.80 mmol/L
92
Acute management of hypocalcemia
- bolus of calcium gluconate (monitor for bradycardia, PVC or QT interval shortening) - CRI calcium gluconate - oral calcium when able
93
What proportion of hyperadrenocorticism is ACTH dependent
- 80-85% - mostly pituitary dependent (PDH) - caused by anterior or pars intermedia tumor
94
What proportion of hyperadrenocorticism is ACTH independent
-15-20% - cortisol secreting adrenal tumors - most are carcinomas
95
What are the common clinicopathological findings in cushings
- eosinopenia - thrombocytosis - lymphopenia - 'stress leucogram' - increased ALP - increased ALT - Hypercholesterolemia - decreased BUN - mild hyperglycemia - USG<1.020 + proteinuria
96
LDDST - result in HC - sensitivity/specificity
- best 'overall' screening test - sensitivity 85-100%, specificity 45-75% - in healthy dogs 4 and 8hr cortisol supressed - in HC dogs either partial supression (PDH), escape pattern (PDH) or no supression (AT or large PDH)
97
ACTHstim - result in HC - sensitivity/specificity
- Exaggerated cortisol response - specificity 59-93%, sensitivity 80-83% - good screening test, false positives rare - no differentiation capacity
98
eACTH - utility
* PDH - normal to excessive ACTH * AT low or indetectable eACTH
99
what pituitary to brain height ratio indicated pituitary enlargement
>0.31mm/mm2
100
What structural ultrasonographic adrenal features raise concern for malignancy
* heterogenous appearance * vascular invasion * >2cm
101
what is the action of trilostaine
Inhibits 3-beta-hydroxysteroid dehydrogenase (required for all steroid synthesis)
102
what is the action of mitotane
adrenocorticolytic agent and also inhibits steroidogenic enzymes
103
What are the typical biochemical changes with hypoadrenocorticism
- Hyperkalemia - Hyponatremia - hypercalcemia - Azotemia - Hypoglycemia - Increased liver enzymes - Hypoalbuminemia and hupocholesterolemia - relatively dilute urine - Lack of stress leucogram, lymphocytosis
104
What diseases can cause 'pseudo-Addisons' disease
Trichuriasis, salmonellosis Chylothorax
105
What is pheochromocytoma
- neuroendocrine tumor arising from chromaffin cells in adrenal medulla - produce catecholamines
106
What is the most reliable marker for pheochromocytoma diagnosis
Urine nor-metanephrines 2-3x normal
107
How can pheochromocytoma be medically managed
* Alpha blockers - phenoxybenzamine * can add in beta blockers and calcoum channel blockers if hypertension and tachycardia not controlled
108
Primary hyperaldosteronisim is characterised by what biochmical changes, clinical signs and diagnosis
- Hypokalemia - Hypertenison - PUPD, neck ventroflexion, ataxia, hypertensive target organ damage - elevated plasma aldosterone and supressed plasma renin activity
109
Endothelial V2 activation by ADH causes release of what substances
- vWF and tPA
110
ADH V1a receptor activation causes: ADH V1b receptor activation causes:
- V1a - smooth muscle contraction, PLT activation - V1b - ACTH release, insulin and glucagon secretion
111
ADH binding to renal V2 receptors causes what effect
- acquaporin 2 mediater water reabsorption
112
What are the responses of CDI, NDI and PP to a modified water deprivation test (water restriction, withdrawal and DDAVP)
* PP: USG increases to >1.025 during water restriction * CDI: Failure to concentrate urine during restriction but response to desmopressin * NDI: Failure to concentrate urine and no response to desmopressin
113
What are the clinicopathologic changes associated with hypothyroidism
- mild anaemia - thrombocytopenia - Hypercholesterolemia - Hypertriglyceridemia - increased CK - mild liver enzyme elevation
114
What are the clinicopathologic changes associated with hyperthyroidism
- mild eythrocytosis - leucocytosis, neutrophilia, lymphopenia - Increased ALT and ALP - Hyperphosphatemia - Hypercalcemia - Isosthenuria
115
what are the adverse effects of methimazole
- GI - mild haematologic changes - facial excoriation - hepatopathy - agranulocytosis and thrombocytopenia
116
radioactive iodine therapy - what radiation kills the cells - what is the half life
- beta radiation - 8 days
117
Which diuretic can be used as a treatment for NDI
thiazide diuretics
118
What is the effect of hyperthyroidism on GFR and creatinine
- increases GFR and decreases serum creatinine
119
what is the mechanism of hyperosmolar hyperglycemic state
- similar to DKA but minimal ketosis - relative insulin deficients - small amount of insulin remainin inhibits lipolysis - high plasma osmolaliry created from increased glucose - often have extreme hyperglycemia
120
what are the criteria for diagnosis of DKA
* diagnosis of DM * ketonemia: increased BHB concentrations, ketonuria, and/or detectable AcAc * metabolic acidosis defined as a venous/arterial blood pH <7.35 and decreased bicarbonate.
121
what are the criteria for hyperosmolarhyperglycemic state (HHS)
* Severe hyperglycaemia (BG >34 mmol/L) * Serum osmolality >325-330 mOsm/kg in dogs and >330-350 mOsm/kg in cats * Dehydration * Absence of significant ketoacidosis
122
How is serum osmolality calculated
osmolality - 2Na + BUN/2.8 + Gluc/18 - no conversion needed if in SI units
123
Which dog breeds are at increased risk of diabetes mellitus
- schnauzer, australian terrier, bichon frise
124
In which breed of cat has a genetic inheritance of diabetes been identified
Burmese

Generals G.O.A.T (13 decks)

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