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Endocrinology-First Aid 2017 > Physiology > Flashcards

Physiology Flashcards

1
Q

Where in the cell is preproinsulin made?

A

Rough ER

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2
Q

Where is proinsulin stored?

A

Secretory granules

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3
Q

What conditions increase insulin and C-peptide?

A

Insulinoma an sulfonylurea use

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4
Q

Insulin and C-peptide are secreted in what amounts in relation to each other?

A

Equally

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5
Q

Insulin receptors have what type of enzymatic activity?

A

Tyrosine kinase activity

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6
Q

What does binding of insulin induce?

A

Glucose uptake and gene transcription

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7
Q

What are the effects of insulin on skeletal muscle and adipose tissue?

A

Increased glucose transport into those tissues

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8
Q

What are the effects of insulin on glycogen?

A

Increased glycogen synthesis and storage

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9
Q

What are the effects of insulin on triglycerides?

A

Increased triglyceride synthesis

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10
Q

What are the effects of insulin on sodium?

A

Increased sodium retention in kidneys

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11
Q

What are the effects of insulin on protein?

A

Increased protein synthesis in muscle

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12
Q

What are the effects of insulin on potassium?

A

Increased cellular uptake of potassium

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13
Q

What are the effects of insulin on glucagon?

A

Decreased glucagon release

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14
Q

What are the effects of insulin on lipolysis?

A

Decreased lipolysis in adipose tissue

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15
Q

What are the effects of insulin on the fetus?

A

None, cannot cross the placenta

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16
Q

Which GLUT transporter is insulin dependent?

A

GLUT4

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17
Q

Where are GLUT4 transporters found in the body?

A

Skeletal and adipose tissue

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18
Q

What activity can increase expression of GLUT4 transporters?

A

Exercise

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19
Q

What GLUT transporters are insulin independent?

A

GLUT1, GLUT 2, GLUT3, GLUT5

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20
Q

Where are GLUT1 transporters found in the body?

A

RBCs, brain, cornea, placenta

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21
Q

Which GLUT transporter is bidirectional?

A

GLUT2

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22
Q

Where are GLUT2 transporters found in the body?

A

B islet cells, liver, kidney, and small intestine

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23
Q

Where are GLUT3 transporters found in the body?

A

Brain and placenta

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24
Q

Where are GLUT5 transporters found in the body?

A

Spermatocytes and GI tract

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25
Q

Which GLUT transporter uptakes fructose

A

GLUT5

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26
Q

What molecule does the brain utilize for energy during starvation?

A

Ketones

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27
Q

What molecule does the brain normally use for energy?

A

Glucose

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28
Q

Why are RBCs only able to utilize glucose for energy?

A

They lack mitochondria for aerobic metabolism

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29
Q

What tissues are insulin-independent for glucose uptake?

A

Brain, RBCs, Intestine, Cornea, Kidney, Liver (BRICK L)

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30
Q

What is the major regulator of insulin release?

A

Glucose

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31
Q

What cell signaling molecule does insulin use in insulin-dependent glucose uptake?

A

Tyrosine kinase

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32
Q

What regulatory molecules are released after oral ingestion of glucose that stimulate insulin release?

A

Glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic peptide (GIP)

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33
Q

What is the effect of GLP-1 and GIP on beta cells?

A

Increased beta cell sensitivity to glucose

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34
Q

Stimulation of which adrenergic receptors decreases insulin release?

A

Alpha-2

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35
Q

Stimulation of which adrenergic receptors increase insulin release

A

Beta-2

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36
Q

What is the effect of glucose entering a pancreatic beta cell?

A

Increased ATP from glucose metabolism

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37
Q

What is the affect of increased ATP in a pancreatic beta cell?

A

Increased ATP closes potassium channel

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38
Q

What is the affect of closing the potassium channel in a pancreatic beta cell?

A

Depolarization of the membrane

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39
Q

What is the affect of depolarization of the membrane in a pancreatic beta cell?

A

Opens voltage-gated calcium channels

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40
Q

What is the affect of increased calcium in a pancreatic beta cell?

A

Exocytosis of insulin granules

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41
Q

What cells of the pancreas make glucagon?

A

Alpha cells

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42
Q

What causes secretion of glucagon?

A

Hypoglycemia

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43
Q

What inhibits glucagon release?

A

Insulin, hyperglycemia and somatostatin

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44
Q

Gluconeogenesis and glycogenolysis are mediated by what hormone?

A

Glucagon

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45
Q

What effect does cortisol have on glucagon?

A

Permissive effect allowing glycogenolysis

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46
Q

Increased ketone production is caused by what hormone?

A

Glucagon

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47
Q

What hypothalamic hormone is decreased with chronic steroid use?

A

CRH

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48
Q

What pituitary hormones are increased by CRH?

A

ACTH, MSH, and B-endorphin

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49
Q

What hypothalamic hormone decreases release of prolactin?

A

Dopamine

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50
Q

What is the effect of some antipsychotics on dopamine release?

A

Decreased dopamine release causing hyperprolactinemia which leads to galactorrhea and amenorrhea, osteoporosis and hypogonadism

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51
Q

Regulates release of GH from anterior pituitary

A

GHRH

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52
Q

Regulates release of FSH and LH from anterior pituitary

A

Pulsatile GnRH

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53
Q

What is the effect of tonic release of GnRH?

A

Suppresses HPG axis, decreased LH and FSH release

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54
Q

What is the effect of pulsatile release of GnRH?

A

Leads to puberty and fertility, increased LH and FSH release

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55
Q

What suppresses release of GnRH?

A

Hyperprolactinemia

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56
Q

What is the function of prolactin?

A

Decrease GnRH release, promote milk production, decrease ovulation in women and spermatogenesis in men

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57
Q

What are the affects of a pituitary prolactinoma?

A

Amenorrhea, galactorrhea, osteoporosis, and hypogonadism

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58
Q

What is the affect of somatostatin on GH and TSH

A

Decreases release of GH and TSH

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59
Q

What is the analog of somatostatin used for?

A

Treat acromegaly

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60
Q

What is the somatostatin analog?

A

Ocreotide

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61
Q

Prolactin release is stimulated by what hypothalamic hormone?

A

TRH

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62
Q

What is the function of TRH?

A

Increase release of TSH and prolactin

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63
Q

What pathologic conditions increase TRH?

A

Primary and secondary hypothyroidism

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64
Q

What is the effect of increased TRH secretion as seen in primary and secondary hypothyroidism?

A

Increased prolactin secretion causing galactorrhea

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65
Q

Where is prolactin secreted from?

A

Mainly anterior pituitary

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66
Q

Prolactin is structurally homologous to what other hormone?

A

Growth Hormone (GH)

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67
Q

Libido is associated with excessive amounts of what anterior pituitary hormone?

A

Prolactin

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68
Q

What is the function of prolactin?

A

Milk production, inhibit ovulation and spermatogenesis

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69
Q

What hypothalamic hormone is inhibited by prolactin?

A

GnRH

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70
Q

What dopamine agonist can be used to treat prolactinoma and inhibit prolactin secretion?

A

Bromocriptine

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71
Q

What is the effect of antipsychotics and estrogens on prolactin secretion?

A

Stimulate production via dopamine antagonistic effects

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72
Q

How does prolactin inhibit its own secretion?

A

Increases dopamine release

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73
Q

How does dopamine inhibit prolactin secretion?

A

Tonic release of dopamine via tuberoinfundibular pathway of hypothalamus

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74
Q

What are the effects on TRH by increasing plasma T3/T4?

A

Decreased TRH

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75
Q

What are the effects of pregnancy on prolactin release?

A

Increases estrogen which stimulates prolactin release

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76
Q

What are the effects of spermatogenesis and ovulation on prolactin release?

A

Increase FSH and LH which inhibit prolactin release

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77
Q

What is the effect of progesterone on prolactin release?

A

Inhibits prolactin release

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78
Q

What is the effect of nipple stimulation on prolactin release?

A

Increases prolactin release

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79
Q

What is the effect of a crying baby or sight of a baby on prolactin release?

A

Inhibits higher cortical centers which inhibit hypothalamic release of dopamine and stimulate TRH release causing prolactin secretion

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80
Q

What is the effect of GH on insulin?

A

Increases insulin resistance

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81
Q

What hormone is released by liver vi GH stimulation?

A

IGF-1

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82
Q

What type of release is seen in GH?

A

Pulsatile release

83
Q

What is the effect of excess GH release?

A

Adults - Acromegaly

Children - Gigantism

84
Q

What is the main cause of excess GH release?

A

Pituitary adenoma

85
Q

What is the treatment for acromegaly or gigantism?

A

Ocreotide or surgery

86
Q

What inhibits release of GH?

A

Glucose, somatostatin via negative feedback by somatomedin

87
Q

When is secretion of GH seen?

A

Exercise, deep sleep, puberty and hypoglycemia

88
Q

Sleep deprivation or starvation lead to a decrease of which appetite regulatory hormone?

A

Leptin

89
Q

Sleep deprivation and Prader-Willi syndrome lead to an increase of which appetite regulatory hormone?

A

Ghrelin

90
Q

Where is leptin made?

A

Adipose tissue

91
Q

Where is ghrelin made?

A

Stomach

92
Q

What area of the brain is affected by endocannabinoids?

A

Hypothalamus and nucleus accumbens

93
Q

What hormone regulates serum osmolarity and blood pressure?

A

ADH

94
Q

What ADH receptors regulate serum osmolarity?

A

V2 receptors

95
Q

What ADH receptors regulate blood pressure?

A

V1 receptors

96
Q

How is osmolarity via ADH regulated?

A

Insertion of aquaporin channels in in principal cells of renal collecting duct

97
Q

What ADH levels are seen in central diabetes insipidus?

A

Decreased ADH levels

98
Q

What ADH levels are seen in nephrogenic diabetes insipidus?

A

Normal or increased ADH levels

99
Q

What type of mutation can cause nephrogenic DI?

A

V2 receptor mutation

100
Q

What ADH analog is used to treat central DI and nocturnal enuresis?

A

Desmopressin acetate

101
Q

What are the primary regulators of ADH?

A

Osmoreceptors in hypothalamus

102
Q

What condition can cause release of ADH?

A

Hypovolemia

103
Q

Which antifungal will inhibit cholesterol desmolase?

A

Ketoconazole

104
Q

Ketoconazole will inhibit which cholesterol enzyme?

A

Cholesterol desmolase

105
Q

What is the rate-limiting step of cholesterol synthesis?

A

StAR

106
Q

What enzyme is responsible for the conversion of testosterone to DHT?

A

5-alpha-reductase

107
Q

Which drug inhibits 5-alpha-reductase?

A

Finasteride

108
Q

The hormonal breast cancer drug, exemestane, will inhibit which enzyme?

A

Aromatase

109
Q

Which hormonal breast cancer drugs are known to inhibit aromatase?

A

Exemestane and anastrozole

110
Q

What is the only steroid that is not protein bound and is water soluble since it is sulfated?

A

DHEA

111
Q

What enzyme, responsible for aldosterone, is acted on by angiotensin II?

A

Aldosterone synthase

112
Q

What enzyme in cholesterol synthesis is acted on by ACTH?

A

Cholesterol synthase

113
Q

What are common findings in all congenital adrenal enzyme deficiencies?

A

Increased ACTH, enlarged adrenal glands, decreased cortisol and skin hyperpigmentation

114
Q

Which enzyme deficiency leads to ambiguous genitalia and undescended testes in men and lack of 2ndary sexual development in girls?

A

17-a-hydroxylase

115
Q

What potassium levels are seen in patient with decreased androstenedione and lack of 2ndary sexual development?

A

Hypokalemia

116
Q

17-a-hydroxylase deficiency will result in what sex hormone levels?

A

Decreased

117
Q

What hormones are produced in excess in 17-a-hydroxylase deficiency?

A

Mineralocorticoids

118
Q

What is the most common congenital adrenal enzyme deficiency?

A

21-B-hydroxylase deficiency

119
Q

What potassium levels are seen in 21-B-hydroxylase deficiency?

A

Hyperkalemia

120
Q

21-B-hydroxylase deficiency results in what mineralocorticoid levels?

A

Decreased

121
Q

Precocious puberty and salt wasting seen in infancy with decreased BP is seen in which congenital adrenal enzyme deficiency?

A

21-B-hydroxylase deficiency

122
Q

What renin levels are seen in 21-B-hydroxylase deficiency?

A

Increased renin levels

123
Q

Hypokalemia, increased sex hormones, high blood pressure and virilization is seen in what congenital adrenal enzyme deficiency?

A

11-B-hydroxylase

124
Q

17-a-hydroxyprogesterone is increased in which congenital adrenal enzyme deficiency?

A

21-B-hydroxylase

125
Q

What is the effect of Cortisol on hyperglycemia?

A

Increases gluconeogenesis and insulin resistance

126
Q

What effects does cortisol have on wound healing?

A

Decreased inflammatory and immune response

127
Q

What effects does cortisol have on TB and candidiasis?

A

Reactivation via blockage of IL-2 production

128
Q

What effect does chronic stress have on cortisol?

A

Causes prolonged secretion

129
Q

How does cortisol increase BP?

A

Upregulation of alpha-1 receptors on arterioles, increases sensitivity to NE and Epi and can bind to aldosterone receptors at high concentrations

130
Q

What is the active form of calcium?

A

Ionized or free calcium

131
Q

How is calcium found in the body?

A

Ionized (45%), bound to albumin (40%), and bound to anions (15%)

132
Q

Cramps, pain, paresthesias, and carpopedal spasms are seen with what electrolyte imbalance?

A

Hypocalcemia

133
Q

What causes increased binding of calcium to albumin

A

Increases in pH

134
Q

What is the primary regulator of PTH

A

Ionized/free calcium

135
Q

What effect do pH changes have on PTH secretion?

A

Can effect PTH levels based on pH

136
Q

What effect do changes in albumin levels have on PTH secretion?

A

None

137
Q

How does acidosis affect calcium levels?

A

Increases free calcium which decreases PTH levels

138
Q

How does alkalosis affect calcium levels?

A

Decreases free calcium which increases PTH levels

139
Q

D2 is obtained from what sources?

A

Ingestion of plants

140
Q

D3 is obtained from what sources?

A

Sun exposure and ingestion of plants

141
Q

Where in the body does vitamin D2 or D3 get converted to 25-OH?

A

Liver

142
Q

Where in the body does vitamin 25-OH get converted to 1,25-(OH)2?

A

Kidneys

143
Q

What is the active form of vitamin D?

A

1,25-(OH)2

144
Q

What is the function of vitamin D?

A

Increase absorption of calcium and phosphate in gut and enhance bone mineralization

145
Q

What increases production of 1,25-(OH)2?

A

Increased PTH and decreased calcium and phosphate

146
Q

What does vitamin D deficiency cause in children?

A

Rickets

147
Q

What does vitamin D deficiency cause in adults?

A

Osteomalacia

148
Q

What is the inactive form of vitamin D?

A

24,25-(OH)2 D3

149
Q

What is the function of PTH?

A

Increase calcium reabsorption and decrease phosphate reabsorption in the kidneys

150
Q

What increases reabsorption of both calcium and phosphate from the gut?

A

1,25-(OH)2 D3

151
Q

Where is parathyroid hormone secreted from?

A

Chief cells of he parathyroid

152
Q

Where in the renal tubule is calcium reabsorbed?

A

Distal convoluted tubule

153
Q

Where in the renal tubule is phosphate reabsorption blocked?

A

Proximal convoluted tubule

154
Q

What is the function of PTH

A

Increase bone resorption of calcium and phosphate
Increase calcium reabsorption at DCT
Increase 1,25-(OH)2 D3 production
Decrease phosphate reabsorption at PCT

155
Q

What is calcitrol?

A

1,25-(OH)2 D3, the active form of vitamin D

156
Q

How does PTH effect serum calcium and phosphate levels?

A

Increases calcium and decreases phosphate

157
Q

How does PTH effect urine calcium and phosphate levels?

A

Decreases calcium and increases phosphate

158
Q

How does PTH effect urine cAMP levels?

A

Increases cAMP

159
Q

What PTH like hormone ins commonly increased in malignancies like squamous cell carcinoma of the lung or renal cell carcinoma?

A

PTHrP

160
Q

What is the effect of PTH on osteoblasts and osteocytes?

A

Stimulates RANK-L

161
Q

What is the effect of RANK-L on osteoclast activity?

A

Binds to RANK receptor on osteoclast and increases calcium via bone resorption

162
Q

What serum calcium, phosphate, and magnesium levels are seen with increased PTH

A

Decreased calcium, phosphate, and magnesium levels

163
Q

What is the effect of markedly decreased magnesium levels on PTH?

A

Decreases PTH

164
Q

What commonly causes decreases in magnesium levels?

A

Diarrhea, aminoglycosides, diuretics and alcohol abuse

165
Q

Where is calcitonin secreted from?

A

Parafollicular cells (C cells) of the thyroid

166
Q

What enzyme in the kidney is responsible for converting vitamin D into its active form?

A

1-alpha-hydroxylase

167
Q

What serum calcium, phosphate, and magnesium levels cause PTH to be secreted?

A

Decreased levels

168
Q

What effect does an increase in 1,25-(OH)2 D3 have on PTH?

A

Negative feedback, inhibits PTH

169
Q

What effect does decreased phosphate have on 1-alpha-hydroxylase activity?

A

Increases activity to make 1,25-(OH)2 D3 which increases calcium and phosphate gut absorption and release from bone

170
Q

What hormone opposes actions of PTH?

A

Calcitonin

171
Q

What effect does calcitonin have on calcium?

A

Decreases bone resorption of calcium

172
Q

What effect does increased serum calcium have on calcitonin?

A

Increases calcitonin secretion

173
Q

Where is T3 formed mostly?

A

At target organs

174
Q

What anterior pituitary hormone functions synergistically with T3/T4?

A

GH

175
Q

What is the effect of T3 on the body?

A

Increased:

  1. Bone growth and CNS maturation
  2. B1-receptors in heart = increased CO, HR, SV, contractility
  3. BMR via increased Na/K/ATPase activity
  4. Glycogenolysis, gluconeogenesis and lipolysis
176
Q

How do increased T3/T4 levels effect TRH?

A

Anterior pituitary - decreased sensitivity to TRH

Hypothalamus - decreased TRH release

177
Q

How does TRH effect T3/T4?

A

TRH stimulates TSH release from pituitary which stimulates follicular cells in thyroid to release T3/T4

178
Q

Effect where excess iodine temporarily inhibits thyroid peroxidase causing decreased iodine organification and production of T3/T4

A

Wolff-Chaikoff effect

179
Q

What protein is responsible for binding most T3/T4 in blood?

A

Thyroxine-binging globulin (TBG)

180
Q

Which form of T3/T4 is active form?

A

Unbound form

181
Q

When are decreased TBG levels seen?

A

Liver disease and steroid use

182
Q

When are increased TBG levels seen?

A

Pregnancy and OCP use

183
Q

What sex hormone increases TBG?

A

Estrogen

184
Q

What enzyme is responsible for the peripheral conversion of T4 to T3?

A

5’-deiodinase

185
Q

What thyroid hormone is the major thyroid product?

A

T4

186
Q

Which thyroid hormone has a greater affinity for the nuclear receptor in target tissues?

A

T3

187
Q

Which enzyme is responsible for oxidation, organification of iodide and coupling of MIT and DIT?

A

Thyroid peroxidase

188
Q

T4 is composed of what two molecules?

A

2 DIT molecules

189
Q

T3 is composed of what two molecules

A

1 DIT + 1 MIT

190
Q

Which drug inhibits both thyroid peroxidase and 5’-deiodinase?

A

Propylthiouracil (PTU)

191
Q

Which drug inhibits only thyroid peroxidase?

A

Methimazole

192
Q

What effect do glucocorticoids have on thyroid hormone production?

A

Inhibit peripheral conversion of T4 to T3

193
Q

Which endocrine hormones are associated with cAMP?

A

FLAT ChAMP:
FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH
calcitonin, GHRH, glucagon, histamine

194
Q

Which cAMP associated endocrine hormones have V2 receptor binding?

A

FSH, LH, ACTH, TSH, CRH, hCG, ADH

195
Q

Which cAMP associated endocrine hormones have H2 receptor binding?

A

MSH, PTH, calcitonin, GHRH, glucagon, histamine

196
Q

Which endocrine hormones are associated with cGMP?

A 
BAD GraMPa (think vasodilators):
BNP, ANP, EDRF
197
Q

Which endocrine hormones are associated with intracellular receptors?

A

PET CAT on TV:
Progesterone, Estrogen, Testosterone
Cortisol, Aldosterone, T3/T4, Vitamin D

198
Q

Which endocrine hormones are associated with receptor tyrosine kinase?

A

MAP kinase pathway (think Growth Factors):

insulin, IGF-1, FGF-1, PDGF, EGF

199
Q

Which endocrine hormones are associated with non-receptor tyrosine kinase?

A

JAK/STAT pathway (PIGGLET) acidophils and cytokines:

Prolactin, Immunomodulators, GH, G-CSF, Erythropoietin, Thrombopoietin

200
Q

What binding hormone causes gynecomastia in men?

A

Increased sex-hormone binding globulin

201
Q

What binding hormone causes hirsutism in women?

A

Decreased sex-hormone binding globulin

202
Q

What hormone binds testosterone?

A

Sex-hormone binding globulin

203
Q

What condition in women increases sex-hormone binding globulin?

A

OCPs and pregnancy

Endocrinology-First Aid 2017 (4 decks)

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