Patho: Hormones, Cardio, Lymphatic Flashcards
2 adrenal cortex issues:
Excess androgens and excess aldosterone
What secretes the most important factor in calcium regulation?
Parathyroid gland: PTH is the most important regulator of Ca++. While there are two pairs of parathyroid glands normally present, there may be two to six. They are small and located behind the thyroid gland. Thyroid hormone is produced by the thyroid gland and is unaffected by the parathyroid gland.
ADH (aka ____) does what to blood pressure?
vasopressin, arginine vasopressin; increases peripheral resistance=increases vasoconstriction=increases BP
Mineralocorticoid hormones cause sodium___ and loss of __ and ___.
retention; K+ and hydrogen
What is needed for PTH (parathyroid hormone) function?
Vitamin D (cofactor)
A disease where ACTH, TSH, FSH, LH, and GH are deficient due to ischemia, tumor, etc:
Panhypopituitarism
The posterior portion of the pituitary is also known as ____ while the anterior is known as ____.
Neurohypophysis; Adenohypophysis
Are water-soluble hormones hydrophilic or hydrophobic?
Hydrophilic
ADH is realeased in response to __ level of sodium, __ level of water, or ___ blood pressure.
High sodium; low water; low BP
How does the anterior pituitary regulate the thyroid gland?
The anterior pituitary synthesizes and releases thyroid-stimulating hormone (TSH), which travels in the bloodstream to the thyroid gland. It binds to a membrane receptor on thyroid cells and stimulates increased production and release of thyroid hormone. If the level of thyroid hormone is low, TSH synthesis is increased; if it is high, TSH synthesis is decreased.
Where is the thyroid gland located?
The thyroid is a butterfly-shaped gland that sits low on the front of the neck on either side of the trachea. Your thyroid lies below your Adam’s apple, along the front of the windpipe. The thyroid has two side lobes, connected by a bridge (isthmus) in the middle.
Hormone that causes an increase in progesterone in women and affects sertoli cells in men:
LH (luteinizing hormone)
Affects growth and maturation of tissues, cell metabolism, heat production, and oxygen consumption.
Thyroid hormone
3 effects of glucocorticoids:
Metabolic, anti-inflammatory, growth suppression
What cells secrete glucagon?
Alpha cells in pancreas/islets of Langerhans
With ___ disease, antibodies activate and produce T3/T4, whereas with ___, they destroy them
Grave’s; Hashimoto’s
What are the parts of the adrenal glands?
Adrenal cortex–outer portion (has 3 layers) and Adrenal medulla–inner portion
The posterior pituitary gland secretes:
a. ADH
b. PRF
c. TRH
d. GnRH
a. ADH
How does Diabetes insipidus relate to ADH?
Insufficiency of ADH
______ occurs when high concentrations of a hormone decrease the number of receptors.
Downregulation
Complication of DM, usually in type 2’s, that leads to hyperosmolar state, hyperglycemia, can lead to CNS depression, and potential for coma
HHNKS (Hyperosmolar hyperglycemic nonketotic syndrome)
What are the islets of Langerhans? Where are they located?
The islets of Langerhans are cellular masses lying in the interstitial tissue of the pancreas. They are endocrine glands composed of several cell types: alpha, beta, delta, and F.
____-soluble hormones circulate in free, unbound forms and have a ___-acting response.
water-soluble; short
Parathyroid hormone (PTH) increases serum ___ and decreases serum ___
Calcium; Phosphate
A symptom of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is:
a. Hyponatremia (diluational)
b. Hypernatremia (concentration)
c. Hyperosmolality (serum)
d. Hypoosmolality (urine)
a. Hyponatremia (dilutional)
The cardinal features of SIADH are symptoms of water intoxication. These include hyponatremia (low serum sodium), serum hypoosmolality, and urine that is inappropriately concentrated (hyperosmolar) with respect to serum osmolality.
3 hormones that are altered during Type 1 DM:
insulin, amylin, glucagon:
Lose insulin and amylin, but also lose regulation of glucagon b/c insulin and amylin both help to suppress glucagon normally; b/c they are both reduced, glucagon levels rise, which leads to hyperglycemia
__-soluble hormones don’t need surface receptors while ___-soluble ones do bind to surface receptors.
Lipid-soluble; water-soluble
What is Addison disease?
A disorder in which the adrenal glands do not produce enough of the hormones cortisol and aldosterone; caused by an autoimmune response
Manifestations of Type 2 DM:
fatigue, pruritus, recurrent infections, visual changes, symptoms of neuropathy, often overweight, dyslipidemia, HTN, and hyperinsulinemic
Disease with signature “moon face” and “buffalo hump”
Cushing disease
What cells secrete pancreatic polypeptide?
F cells in pancreas/islets of Langerhans
Hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth.
Sheehan Syndrome
Manifestations of hypoparathyroidism include ___calcemia, ___phosphatemia, and ___kalemia.
Hypocalcemia, Hyperphosphatemia, and Hypokalemia
Who is affected by Hyperaldosteronism?
people in their 30’s-50’s; females>males; african americans have a greater risk of fatality; rare in kids
What cells secrete calcitonin?
Parafollicular cells (C cells) of thyroid
What cells secrete insulin and amylin?
Beta cells in pancreas/islets of Langerhans
What does the Anterior Pituitary secrete:
ACTH MSH GH LH TSH FSH PRL
“All male giraffes like to feel pretty.”
What are hormones? By what mechanisms do they function?
Hormones are chemical substances synthesized and secreted by endocrine glands and carried to other parts of the body in the blood. They are messengers that alter the function of the target organs by binding to receptors on the cell membranes or in the nuclei of target cells. The hormone-receptor binding initiates a signal to intracellular effectors that changes the function of the target cell.
Insulin secretion is promoted by what?
Increased blood levels of glucose, amino acids, GI hormones
What is the action of antidiuretic hormone (ADH)?
The primary action of ADH is the regulation of plasma osmolality by increasing the permeability of the distal tubules and collecting ducts of the kidneys and thus promoting reabsorption of water and decrease in osmolality. High doses of ADH also cause vasoconstriction. Although ADH and oxytocin have very different actions, they differ in structure by only two amino acids. They are both synthesized by the hypothalamus and move down the nerve axons of the pituitary stalk in vesicles to the posterior pituitary gland, where they are stored until needed. The release of both hormones is mediated by cholinergic neurotransmitters.
A symptom of a prolactinoma includes:
a. Galactorrhea
b. Alopecia
c. Excessive menses
d. Pregnancy
a. Galactorrhea
Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Amenorrhea (absence of menses), hirsutism (excessive body hair), and osteopenia can all be caused by a prolactinoma. Pregnancy is a normal cause of galactorrhea.
Where are the receptors located for lipid-soluble hormones?
Steroid hormone receptors are located primarily in the cytosol and nucleus but can be in the plasma membrane.
Where are hormone receptors located?
in the plasma membrane or in the intracellular compartment of the target cell
Are lipid-soluble hormones hydrophobic or hydrophilic?
Hydrophobic
Major part of the pituitary gland where hormones are produced and secreted:
Pars distalis (in Anterior Pituitary)
What is the most potent naturally occurring glucocorticoid, and how is its secretion related to that of adrenocorticotropic hormone (ACTH)?
Cortisol is the most potent naturally occurring glucocorticoid. It is secreted by the adrenal cortex in response to ACTH, an anterior pituitary hormone. There is a negative feedback relationship between the two hormones. If the cortisol level is elevated, ACTH release is inhibited; if the cortisol level is low, the anterior pituitary increases secretion of ACTH.
What is metabolic syndrome?
A grouping of health conditions associated with increased risk for heart disease and type 2 diabetes. Conditions include HTN, a large waist, high triglyceride levels, low HDL (good cholesterol-“highly desired”), and above normal blood glucose levels
An autoimmune disorder that causes hyperthyroidism. With this disease, your immune system attacks the thyroid and causes it to make more thyroid hormone than your body needs.
Grave’s disease
Where are the adrenal glands located?
Close to the upper pole of each kidney
Manifestations resulting from excess cortisol:
Cushing syndrome
Which has greater potency, T3 or T4?
T3 has ten times greater potency
Are hormones released mostly with a negative or positive feedback system?
Negative
Hypocalcemia leads to ____ excitability of muscles/nerves
Increased
What is one of the first signs/symptoms of a pituitary tumor? Why?
Vision issues; not much room to grow and presses on the optic chiasma
Hormone secreted by parafollicular cells of the thyroid gland. It acts to reduce blood calcium, opposing the effects of parathyroid hormone
Calcitonin
Anabolic hormone made by the pancreas:
insulin: synthesis of proteins, lipids, and nucleic acids
What are some symptoms of Acromegaly?
Bones will become thicker/wider, especially the forehead, chin, larynx (voice changes), hands, and feet
Symptoms of this in females include amenorrhea, galactorrhea, hirsutism, and osteopenia:
Prolactinoma:
Prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia—too much prolactin in the blood—or by pressure of the tumor on surrounding tissues
What does oxytocin do?
Oxytocin is produced in the hypothalamus and is secreted into the bloodstream by the posterior pituitary gland. The two main actions of oxytocin in the body are contraction of the womb (uterus) during childbirth and lactation. Oxytocin stimulates the uterine muscles to contract and also increases production of prostaglandins, which increase the contractions further..
Class of corticosteroids produced in the adrenal cortex and influence salt and water balances.
Mineralocorticoids
Excessive secretion of ACTH, leading to excess cortisol is what disease?
Cushing disease
What is Conn disease?
Primary hyperaldosteronism
As calcium levels rise, ___ typically fall.
Phosphate levels
What does monoamine oxidase do?
Involved in removing the neurotransmitters norepinephrine, serotonin and dopamine from the brain
Signs/Symptoms of SIADH:
Related to enhanced renal water retention, hyponatremia (cerebral edema, decreased neuron and muscle excitability) and serum hypoosmolality; No peripheral edema but can see dyspnea upon exertion, weight gain and confusion, muscle twitching with decreasing levels of Na+ in plasma
Hormone produced by the Anterior Pituitary; affects neural cells and has analgesic effect (to reduce pain):
Beta-endorphins
If the outer two layers of the adrenal cortex are removed, the patient will experience:
a. Hypernatremia
b. Hyperkalemia
c. Hyperglycemia
d. Decreased Epinephrine
b. Hyperkalemia:
The outer two layers of the adrenal cortex produce aldosterone and glucocorticoids. Aldosterone deficiency would cause hyponatremia and hyperkalemia. A deficiency in glucocorticoids would result in hypoglycemia. Epinephrine would only decrease if the adrenal medulla was damaged or removed.
Hormone released from Anterior Pituitary that’s involved in milk production:
Prolactin
____ is secreted in response to TSH. 90%__ and 10% ___.
Thyroid hormone; T4; T3
What form of thyroid hormone is biologically active?
Most thyroid hormone is transported in the blood bound to proteins (bound form). It is only the unbound form (free form) of the hormone that can interact with target cell receptors and be biologically active. Of the two types of thyroid hormones, T3 and T4, T3 is more biologically active. Most T4 is converted to T3 in the tissues for an effective target cell response to thyroid hormone.
What is the thinnest layer of the adrenal cortex and produces androgens?
Zona reticularis
Two siblings are diagnosed with a thyroid disorder due to destruction of thyroid tissue by lymphocytes and circulating thyroid autoantibodies. This pathology is likely the result of:
a. Subacute thyroiditis
b. Hashimoto disease
c. Painless thyroiditis
d. Postpartum thyroiditis
B. Hashimoto:
Hashimoto disease is also called autoimmune thyroiditis. It results in the gradual destruction of thyroid tissue by infiltration or lymphocytes and circulating thyroid autoantibodies. This disorder is linked with several genetic risk factors. Painless thyroiditis has a similar course to subacute thyroiditis, but is pathologically identical to Hashimoto disease. Subacute thyroiditis is a nonbacterial inflammation of thyroid often preceded by a viral infection. Postpartum thyroiditis generally occurs within 6 months of delivery and occurs in up to 7% of all women.
Disorder of the adrenal medulla caused by tumors derived from the chromaffin cells of the adrenal medulla and cause excess catecholamines:
Pheochromocytomas
Part of anterior pituitary that plays a large role in infancy but is less important as adults:
Pars intermedia
A patient is diagnosed with type 1 diabetes and is unable to produce insulin. The pancreatic cells that are most likely damaged are the:
a. Beta
b. Alpha
c. C-peptide
d. Delta
A. Beta
T4 is ___ bound to 4 ____; same with T3
Thyroglobulin bound to 4 iodine; T3 is thyroglobulin bound to 3 iodine
Severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate
Myxedema coma
Steroid hormones are examples of ___-soluble hormones.
Lipid
How does aldosterone influence fluid and electrolyte balance?
Aldosterone causes reabsorption of sodium and water in the distal tubule of the kidneys. In exchange, potassium and hydrogen ions are excreted. An increase in aldosterone secretion, then, acts to increase blood volume.
Symptoms of Grave’s disease:
Whole body: excess sweating, fatigue, heat intolerance, or high blood pressure
Heart: fast heart rate, irregular heart rate, or palpitations
Mood: anxiety or nervousness
Eyes: abnormal protrusion of eyes (exophthalmos) or puffy eyes
Also common: absence of menstruation, diarrhea, enlarged thyroid, hair loss, hand tremor, insomnia, irritability, muscle weakness, puffy skin changes on the shin, weight loss, Pretibial myxedema (edema in shin area)
DKA usually occurs in Type __ diabetics and HHNKS usually occurs in Type __ diabetics
type 1; type 2
An acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs)
Thyrotoxic crisis (thyroid storm)
Risk factors for Type 2 DM:
Age, obesity, hypertension, physical activity, and family history
What are 4 types of cells in the islets of pancreas?
Alpha, Beta, Delta, F cells
Manifestations of Hyperparathyroid include __calcemia, ___phosphatemia, kidney stones, and pathologic fractures.
Hypercalcemia; Hypophosphatemia
Autoimmune disease from macrophages and CD8 cytotoxic T cells attacking the pancreas’ beta cells:
Type 1 DM
Which term describes “obvious changes in cell function that result from stimulation by a particular hormone”?
a. Upregulation
b. Downregulation
c. Direct effects
d. Permissive effects
c. Direct Effects:
Direct effects are obvious changes in cell function that specifically result from stimulation by a particular hormone. Permissive effects are less obvious and facilitate the maximal response or functioning of a cell. Upregulation is when low concentrations of a hormone increase the number of receptors per cell. Downregulation occurs when high concentrations of a hormone decrease the number of receptors.
Hypersecretion of GH (growth hormone) during adulthood=
Acromegaly
What is amylin?
Amylin is a peptide hormone that is cosecreted with insulin from the pancreatic β-cell and is thus deficient in diabetic people. It suppresses glucagon secretion, delays gastric emptying into duodenum, delays nutrient uptake, and acts as a satiety agent.
What are two different types of somatostatin?
Somatostatin from the hypothalamus inhibits the pituitary gland’s secretion of growth hormone and thyroid stimulating hormone. In addition, somatostatin is produced in the pancreas and inhibits the secretion of other pancreatic hormones such as insulin and glucagon
Rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.
Pheochromocytoma
Name three parts of the Posterior Pituitary:
Median eminence, Stalk, Pars nervosa
What cells secrete somatostatin and gastrin?
Delta cells in pancreas/islets of Langerhans
____ and ___ are produced in neuronal cell bodies of the supraoptic and paraventricular nuclei in the hypothalamus. They are then transported along the axons of the hypothalamo-hypophyseal tract to the posterior pituitary, where they are stored.
ADH and oxytocin
Compare and contrast the actions of alpha, beta, delta, and F cells of the pancreas.
The alpha cells, located on the periphery of the islets of Langerhans, secrete glucagon, which increases blood glucose levels. The beta cells, in the middle of the islets, secrete insulin, which decreases blood glucose levels and promotes glucose uptake and use by target cells. The delta cells secrete gastrin (somatostatin), which regulates alpha- and beta-cell function. Finally, the F cells secrete pancreatic polypeptide, which inhibits gallbladder contraction and exocrine pancreas secretion of enzymes. All the pancreatic hormones participate in the regulation of carbohydrate, fat, and protein metabolism.
Most potent naturally occurring glucocorticoid =
Cortisol
A system of blood vessels in the microcirculation at the base of the brain, connecting the hypothalamus with the anterior pituitary. Its main function is to quickly transport and exchange hormones between the hypothalamus arcuate nucleus and anterior pituitary gland.
Hypothalamic hypophyseal portal system
Type of diabetes in adolescence/early adulthood with major genetic factor:
Maturity onset diabetes of youth (MODY)
Symptoms of Hyperthyroid:
Thin hair Exopthalamos Enlarged thyroid (warm on palpation, nodular, or solitary "toxic" nodule Heart failure Tachycardia Weight loss Diarrhea Warm skin, sweaty palms Hyperreflexia Pretibial edema (in shins) Heat intolerance
5 examples of Second messengers:
Calcium, cAMP, cGMP, Tyrosine kinase system, IP3
__-soluble hormones can pass through a membrane and bind to a receptor inside the cell while __-soluble cannot cross the membrane.
Lipid-soluble; water-soluble
What are catecholamines?
Catecholamines are the hormones epinephrine and norepinephrine, which are synthesized and secreted by the adrenal medulla. They have adrenergic actions similar to those of the sympathetic nervous system.
Hormone involved in increasing estrogen production in the ovaries and increased testosterone production in men:
FSH (follicle-stimulating hormone)
Name hormones secreted by the Posterior Pituitary:
ADH and Oxytocin
Symptoms of hypothyroid:
Loss of hair Coarse, brittle hair Periorbital edema Puffy face Normal or small thyroid Heart failure Bradycardia Constipation Cold intolerance Muscle weakness Edema of extremities
What is Adrenal/Addisonian crisis?
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol/glucocorticoid/mineralocorticoid
What is the substance called that’s inside follicles?
Colloid
Glucagon secretion is promoted by ___ blood glucose.
Decreased
Where are the islets of Langerhans located? What do they do?
Pancreas; Secretion of insulin and glucagon
Name the three parts of the Anterior pituitary:
1) Pars distalis (the major part)
2) Pars tuberalis
3) Pars intermedia
What is the relationship between the hypothalamus and the pituitary?
The hypothalamus is located at the base of the brain. It is connected to the pituitary gland by the pituitary stalk. The hypothalamus is connected to the anterior pituitary by way of the hypophysial portal blood vessels and to the posterior pituitary by way of a nerve tract referred to as the hypothalamohypophysial tract. Neurosecretory cells in the hypothalamus synthesize and secrete the hypothalamic-releasing hormones that regulate the release of hormones from the anterior pituitary and synthesize the hormones antidiuretic hormone and oxytocin that are released from the posterior pituitary gland.
The ____ is part of the epithalamus and secretes melatonin.
Pineal Gland
Symptoms of this in men include hypogonadism and erectile dysfunction:
Prolactinoma:
A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia—too much prolactin in the blood—or by pressure of the tumor on surrounding tissues
A disease where you lose water at an excess rate. Manifestations are related to enhanced water excretion, hypernatremia, and serum hyperosmolality; polyuria and polydipsia
Diabetes insipidus
