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pp clues endocrine Flashcards

1
Q
  1. Somatotrope
  2. Gonadotrope
A
  1. GH
  2. LH, FSH
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2
Q

Thyrotrope?

Corticotrope?

A

TSH

ACTH

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3
Q

Lactotrope?

suppressed by?

A

PRL

Dopamine

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4
Q

What receptors do protein hormones use?

A

Cell membrane receptors
G-coupled

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5
Q

What receptors do steroid hormones use?

A

Nuclear membrane receptors

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6
Q

mc 2nd msger

A

cAMP

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7
Q

What are the steroid hormones?

A

“PET CAD”
Note: thyroid hormone acts like a steroid
Progesterone
E2
Testosterone
Cortisol
Aldo
Vit D

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8
Q

What does Exocrine mean?

A

Secretion into non-blood

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9
Q

What is Autocrine?

A

Works on itself

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10
Q

What is Paracrine?

A

Works on its neighbor

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11
Q

What is Merocrine?

A

Cell is maintained => exocytosis

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12
Q

What is Apocrine?

A

Apex of the cell is secreted

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13
Q

What is Holocrine?

A

The whole cell is secreted

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14
Q

What organs do not require insulin?

A

“BRICKLE”
Brain
RBC
Intestine
Cardiac, Cornea
Kidney
Liver
Exercising muscle

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15
Q

What does GnRH do?

A

Stimulates LH, FSH

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16
Q

What does GRH do?

A

Stimulates GH

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17
Q

What does CRH do?

A

Stimulates ACTH

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18
Q

What does TRH do?

A

Stimulates TSH

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19
Q

What does PRH do?

A

Stimulates PRL

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20
Q

What does DA do?

A

Inhibits PRL

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21
Q

What does SS do?

A

Inhibits GH

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22
Q

What does ADH do?

A

Conserves water, vasoconstricts

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23
Q

What does oxytocin do?

A

Milk letdown, baby letdown

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24
Q

What does GH do?

A

IGF-1 release from liver

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25
Q

What does TSH do?

A

T3,T4 release from thyroid

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26
Q

What does LH do?

A

Testosterone release from the testis,
Estrogen and Progesterone release from the ovary

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27
Q

What does FSH do?

A

Sperm or egg growth

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28
Q

Milk production

A

PRL

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29
Q

Cortisol release from adrenal gland

A

ACTH

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30
Q

Skin pigmentation

A

MSH: melanocyte-stimulating hormone

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31
Q

What are the stress hormones?

A

Epi: Immediate
Glucagon: 20min
Insulin: 30min
ADH: 30min
Cortisol: 2-4hr
GH: 24hr

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32
Q

Concentrates urine

A

ADH

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33
Q

Too little ADH => urinate a lot

A

Diabetes Insipidus

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34
Q

Brain not making ADH

A

Central DI

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35
Q

What is Nephrogenic DI?

A

Blocks ADH receptor,
can be caused by Li and Demecocycline

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36
Q

DI: Water Deprivation failed?

A

Renal problem

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37
Q

What does giving DDAVP tell you?

A

DDAVP => Central DI concentrates >25%

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38
Q

What is SIADH?

A

Too much ADH => expand plasma vol => pee Na

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39
Q

What is the difference b/w DI and SIADH?

A

DI has dilute urine,
SIADH has concentrated urine

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40
Q

What is Psychogenic Polydipsia?

A

Pathologic water drinking => low plasma osmolarity

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41
Q

What does Aldosterone do?

A

Reabsorbs Na, secretes H+/ K+

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42
Q

What is a Neuroblastoma?

A

Adrenal medulla tumor in kids,
dancing eyes/feet, secretes epi and norepinephrine

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43
Q

What is a Pheochromocytoma?

A

Adrenal medulla tumor in adults, 5 P’s

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44
Q

What does the Zona Glomerulosa make?

A

Aldosterone “salt”

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45
Q

What is the primary regulatory control for the Zona Glumerulosa?

A

Renin-Angiotensin

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46
Q

What does the Zona Fasiculata make?

A

Cortisol “sugar”

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47
Q

What is the primary regulatory Control for the Zona Fasiculata?

A

ACTH, CRH

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48
Q

What does the Zona Reticularis make?

A

Androgens “sex”

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49
Q

What is the primary regulatory control for the Zona Reticularis?

A

ACTH, CRH

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50
Q

What do chromaffin cells produce?

A

Catecholamines

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51
Q

What is the primary regulatory control for chromaffin cells?

A

Preganglionic sympathetic fibers
ACH

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52
Q

What is Conn’s syndrome?

A

High Aldo (tumor), Captopril test makes it worse

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53
Q

What does ANP do?

A

Inhibits Aldo, dilates renal artery (afferent arteriole)

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54
Q

What does Calcitonin do?

A

Inhibits osteoclasts => low serum Ca2+

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55
Q

What is MEN I?

A

“Wermer’s”: Pancreas, Pituitary, Parathyroid adenoma (high gastrin) “PPP”

multiple endocrine

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56
Q

What is MEN II?

A

“Sipple’s”: Pheo, Medullary thyroid cancer, PTH

multiple paraneoplastic syndrome

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57
Q

MEN IIb

A

“MEN IIb”: Pheo, Medullary thyroid cancer, Oral/GI neuromas

marfanoid

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58
Q

What does CCK do?

A

Gallbladder contraction, bile release

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58
Q

Gluconeogenesis by proteolysis => thin skin
Autoimmu

A

Cortisol

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59
Q

What is Addison’s disease?

A

Autoimmune destruction of adrenal cortex => hyperpigmentation, ↑ACTH

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60
Q

What is Waterhouse Friderichsen?

A

Adrenal hemorrhage

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61
Q

What is Cushing’s syndrome?

A

High cortisol (pituitary tumor or adrenal tumor or small cell lung CA)

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62
Q

What is Cushing’s disease?

A

High ACTH (pituitary tumor)

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63
Q

What is Nelson’s syndrome?

A

Hyperpigmentation after adrenalectomy

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64
Q

If the low-dose dexamethasone test suppresses, what does that tell you?

A

Normal, obese, or depressed

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65
Q

If the low-dose dexamethasone test does not suppress, what does that tell you?

A

Cushing’s => do high dose test

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66
Q

If the high-dose dexamethasone test suppresses, what does that tell you?

A

Pituitary tumor => ACTH (call brain surgeon)

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67
Q

If the high-dose dexamethasone test does not suppress, what does that tell you?

A

Adrenal adenoma => Cortisol (call general surgeon)
* Small cell lung cancer => ACTH (call thoracic surgeon)

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68
Q

What are the survival hormones?

A

Cortisol: permissive under stress
TSH: permissive under normal

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69
Q

What does Epinephrine do?

A

Gluconeogenesis, glycogenolysis

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70
Q

What does Erythropoietin do?
released from?
release dt?

A

Makes RBCs
Hypoxia

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71
Q

What does Gastrin do?

A

Stimulates parietal cells => IF, H+

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72
Q

What does Growth hormone do?

A

Growth, sends somatomedin to growth plates, gluconeogenesis by proteolysis

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73
Q

What is a Pygmie?

A

No somatomedin receptors

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74
Q

What is Achondroplasia = Laron Dwarf?

A

Abnormal FGF receptors in extremities

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75
Q

What is a Midget?

A

↓Somatomedin receptor sensitivity

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76
Q

What is Acromegaly?

A

Adult bones stretch “my hat doesn’t fit”, coarse facial features, large furrowed tongue, deep husky voice, jaw protrusion,
↑IGF-1 b/c of GH tumor

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77
Q

What is Gigantism?

A

Childhood acromegaly

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78
Q

What does GIP do?

A

Enhances insulin action => post-
prandial hypoglycemia

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79
Q

What does Glucagon do?

A

Gluconeogenesis, glycogenolysis, lipolysis, ketogenesis

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80
Q

What does Insulin do?

A

Pushes glucose into cells

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81
Q

What is Type I DM?

A

anti-islet cell Ab, GAD Ab, Coxsackie B, low insulin, DKA, polyuria, polydipsia, polyphagia

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82
Q

What is Type II DM?

A

Insulin receptor insensitivity,
high insulin,
HONK coma,
acanthosis

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83
Q

How does DKA present?

A

Kussmal respirations, fruity
breath (acetone), altered mental

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84
Q

What is the Dawn phenomenon?

A

Morning hyperglycemia 2° to GH

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85
Q

What is the Somogyi Effect?

A

Morning hyperglycemia 2° to
evening hypoglycemia

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86
Q

What is Factitious Hypoglycemia?

A

Insulin injection (↑insulin, ↓C-peptide)

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87
Q

What is an Insulinoma?

A

Tumor (↑insulin, ↑C-peptide)

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88
Q

What is Erythrasma?

A

Rash in skin folds, coral-red Wood’s lamp

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89
Q

What is Syndrome X = Metabolic Syndrome?

A

“Pre-DM”=> HTN, dyslipidemia, hyperinsulinemia, acanthosis nigricans

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90
Q

What are foot ulcer risk factors?

A

DM/ Glycemic control
* Male smoker
* Bony abnormalities
* Previous ulcers

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91
Q

What conditions cause weight gain?

A

Obesity
* Hypothyroidism
* Depression
* Cushing’s
* Anasarca

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92
Q

What does Motilin do?

A

stimulates segmentation (1° peristalsis, MMC)

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93
Q

What does Oxytocin do?

A

Milk ejection, baby ejection

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94
Q

Kallmann syndrome?

A

Hypogonadotropic hypogonadism: defective migration of GnRH- releasing neurons

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95
Q

association of Kallmann syndrome

A

No puberty or incomplete puberty
can’t smell
can’t hear
can’t pee

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96
Q

origin and action of erythropoietin

A

renal parenchymal cells
erythropoiesis in bone marrow

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97
Q

stimulator and inhibitor of Erythropoietin

A

Hypoxia stimulates
high 02 inhibits

98
Q

causes of polycythemia with normal erythropoietin

A

lose of plasma
stress polycythemia
Gaisbock’s syndrome

99
Q

causes of polycythemia with high erythropoietin: hypoxia

A

acute hypoxia: tachypnea and dyspnea
Chronic hypoxia: clubbing, polycythemia
RLD, COPD, Renal cell carcinoma

100
Q

causes of polycythemia with low erythropoietin

A

bone marrow cancer
polycythemia rubra vera
essential thrombocythemia

101
Q

Adrenal cortex: Aldo stimulator and effector tissue

A

stimulator: high K, Low volume , low Na+
late DCT, early collecting duct and ascending colon

102
Q

Aldo inhibitor and action

A

Hypervolumia
Increase production of Na-K pumps and K/H exchange

103
Q

Aldo syndrome: too much
Conn’s syndrome

A

HTN, High Na, low K, alkalosis

104
Q

Aldo syndrome: too little

A

Adrenal insufficiency
21 HO
17 HO
11 HO
This may be seen in adults abrupt withdrawal of steroid

105
Q

Cortisol origin and stimulus

A

Zona fasciculata
stress, hypoglycemia

106
Q

cortisol inhibitor and effector tissue

A

hyperglycemia
permissive and up-regulate all receptors during stress

107
Q

cortisol physiologic action

A

proteolysis
gluconeogenesis

108
Q

cortisol anti-inflammatory action(I- KISS

A

Inhibits
phospholipase A
* Kills T-lymphocytes
and eosinophils
* Inhibit macrophage
migration
* Stabilizes mast cells
* Stabilizes
endothelium

109
Q

too little cortisol

A

adrenal insufficiency
21 HO
11 HO

110
Q

too much cortisol

A

Cushing’s syndrome

111
Q

the 3 Cushing’s Disease

A

Pituitary adenoma
Small cell carcinoma
Adrenal adenoma

112
Q

dexamethasone suppression occurs

A

Obesity
depression
normal variant

113
Q

dexamethasone suppression does NOT occurs with Hi ACTH

A

small cell carcinoma

114
Q

dexamethasone suppression does NOT occurs with low ACTH

A

Adrenal adenoma

115
Q

high does dexa will suppress

A

Pituitary adenoma

116
Q

High does Dexa will not suppress

A

small cell carcinoma

117
Q

in women Progesterone (B4 menses) =

A

testosterone in men

118
Q

origin of Testosterone and stimulus

A

zona reticularis
male external genitalia

119
Q

Action of testoterone

A

Aggression, increase appetite, violence, hi RBC, hi Libido

120
Q

sources of DHEA-S

A

adrenal in males
Ovaries

121
Q

DHT made by _______________(enzyme) in ______________(locattion)

A

5 a-reductase
testes
at birth and puberty

122
Q

hi DHT

A

Androgenic balding
PCOS

123
Q

5 a reductase blocker

A

Fenesteride/Dutasteride

124
Q

FLutamide moa

A

blocks DHT receptors

125
Q

Epinephrine origin and stimulus

A

adrenal medulla
Stress/hypoglycemia

126
Q

EPi inhibitor and target

A

hyperglycemia
liver and adrenal cortex, Heart

127
Q

EPI action

A

glycolysis
gluconeogenesis
glycogenolysis

128
Q

Excess NE and Epi

A

Pheo and Neuroblastoma

129
Q

symptoms of Excess NE and Epi

A

Intermittent HTN, palpitations, diaphoresis and headaches

130
Q

seen in Neuroblastoma with hi EPi and NE

A

Opsoclonus
hypsarrhythmia

(EEG: https://www.researchgate.net/figure/EEG-findings-in-hypsarrhythmia-burst-suppression-variant-there-are-bursts-of-bilateral_fig2_256086128

131
Q

treatment for hi EPI/ NE

A

phentolamine
phenoxybenzamine (zero order)

132
Q

surgery for hi EPI/NE

A

give alpha blocker until surgery
Beta-blocker right b4 surgery to block catecholamine effect

133
Q

MC abdominal mass in children

A

Neuroblastoma

134
Q

Stress hormone released immediately
Receptors

A

EPI : B1/2 : GS, a1:Gq, a2: Gi

135
Q

Stress hormone released 20min

A

Glucagon: Gs

136
Q

Stress hormone released 2-4hr

A

cortisol permissive up regulation of all receptors

137
Q

Stress hormone released 24hr

A

GH: Jak-stat
produces sugar

138
Q

Released within 30 mins of Stress

A

Insulin:RTK-MAPK: pushes glucose in cells
ADH :V2:GS: normalizes Osmolarity cause by sugar

139
Q

Pancrease hormones

A

glucagon: from ALPHA cells
* Insulin: from BETA cells
* Somatostatin: from DELTA cells
* Pancreatic Polypeptide: from ‘F’ cells

140
Q

Catabolic 2nd MSG

A

c-AMP
Jat stat: GH
cortisol

141
Q

Glucagon target

A

adrenal cortex
liver
adipose tissue

142
Q

glucagon stimulus and inhibitor

A

Sti: Hypoglycemia/stress
Inh: hyperglycemia

143
Q

MOA of glucagon

A

gluconeogenesis
glycogenolysis
lypolysis
ketogenesis

144
Q

Alpha cell tumor with necrolytic migratory erythema

A

hi glu
hi lipid
hi ketones

145
Q

Insulin stimulus and inhibitor

A

hyperglycemia
hypoglycemia

146
Q

what tissues do not require insulin

A

low Km hi affinity
Brain
RBC
Intestine
cardiac/cornea
kidney
liver
exercising muscle

147
Q

insulinoma signs

A

hypogluc hi C-Peptide
CT scan–> surgery

148
Q

Infants: Nessidioblastosis

A

same as insulinoma
subtotal pancreatectomy

149
Q

Delta cells

A

somatostatin
sti: insulin and glucagon
inch: low insulin and glucagon

150
Q

what is the analog of somatostatin

A

octreotide
slows gastric emptying/GI blood flow in
esophageal varicose bleeding

151
Q

Stomach hormones

A

Gastrin
Ghrelin Vs Leptin

152
Q

Duodenum hormone

A

Secretin
CCK
Motilin
GIP
VIP
Somatostatin

153
Q

Secretin is stimulated by

A

low PH(acid) from stomach

154
Q

action of secretin

A

(+) pancreas and GB =Bicarb
(- )Gastrin
slow gastric emptyingC

155
Q

CCK stimulated by

A

Food( FAT)
for fat and protein digestion

156
Q

CCK stimulate

A

Pancreas (digestive enzyme) and gallbladder(bile)

157
Q

CCK second msg

A

IP3/DAG

158
Q

Duodenum

GPI stimulus and inhibition

A

glucose
high pH

159
Q

Target of GIP and MOA

A

Pancreatic islet cells
enhances insulin secretion

160
Q

GIP syndromes

A

Dumping syndrome: Billroth II
causes insulin resistance (type 2 diabetes)

161
Q

somatostatin

stimulus & inhibition

A

Duodenal hormones
High pH
purely inhibitory

162
Q

Auerbach’s plexus

VIP

stimulus and Inhibition

A

duodenal hormones
High pH
inhibitory paracrine

163
Q

VIPOMA

A

watery diarrhea
CAT scan
surgery

164
Q

what are the causes of watery diarrhea

A

Vibrio
ETech
Giardia
Vipoma

165
Q

stomach antrum

Gastrin

A

high pH
Low pH

166
Q

Gastrin target & MOA

A

Parietal cell
HCL and intrinsic factor production

Ca++ 2nd msg

167
Q

What is gastrinoma

A

pancreatic tumor
zollinger-Ellison syndrome
hi, unsuppressable gastrin

167
Q

Gastrinoma may be associated with what syndrome

A

MEN-1

pancreatic tumor

168
Q

Right Atrium and Ventricle

ANP

stimulus & inhibitor

A

high volume

Low volum

169
Q

ANP target and MOA

A

Afferent renal artery dilateion
inhibits aldosterone

2nd msg: NO

170
Q

ANP syndrome results in

A

polyuria, nocturia and hyponatremia

171
Q

Calcium metabolism

Hormones

A

PTH
Vitamin D
Calcitonin

172
Q

enbrionic origin

PTH

A

3rd/4th pharyngeal pouch
parathyroid gland

173
Q

stimulus/inhibitor

PTH

A

low Ca++, Hi Phosphorus
Hi Ca++, low phosphorus

174
Q

PTH target

A

osteoclasts of bone
kidney PCT
Kidney Late DCT

175
Q

MOA of PTH

A

stimulate osteoclast
phosphorus secretion increase
activate 1-alpha hydroxylas–> make vit D

C-AMP

176
Q

low PTH syndrome

PTH receptor defect is

A

x-linked dominant pseudo hypoparathy with short 3rd and 5th digit

177
Q

mcc or 1st hypo PTH

A

Thyroidectomy

178
Q

Normal Ca++ with Hypo PTH

A

Pseudopseudo PTH

179
Q

Hi PTH

1st Hi PTH

A

parathyroid adeno
isolated hi ca++

180
Q

inflammatory bone condition causing scaring

A

osteosclerosis

181
Q

increase osteoclastic activity, Ca++ and alkaline Phosphatase

A

Osteitis Deformans

182
Q

loss of bone mass, matrix and miniralization

A

osteopenia

183
Q

thick bone, no marrow, low osteoclastic activity

A

osteopetrosis

184
Q

soft bones
loss of mineralization

A

osteomalacia

185
Q

hi osteoclastic activity, loss of matrix/osteoid, less osteoblastic acitivity…post menopause

A

osteoporosis

186
Q

2nd hi PTH

A

Renal failure
Renal osteodystrophy

187
Q

Vit D deficiency

A

osteomalacia
Rickets

188
Q

Vit D production

Skin
Liver
Renal

A

Cholecalciferol
25-oH
1,25 D, OH

189
Q

Vit D target tissue

A

Kidney
GI
Bone

190
Q

MOA of vit D

A

Production of Ca-ATPase
Production CBP
stimulates
Osteoblast activity

191
Q

Calcitonin production

A

Parafollicular cells of thyroid

stimulated by hi Ca++

192
Q

Calcitonin function

A

Inhibit osteoclastic activity

c-AMP

193
Q

what cancer and syndrome

Increase calcitonin, low osteoclastic activity, thick bone

osteopetrosis

A

Medullary carcinoma of thyroid
RET gene
MEN 2 a

pheocho, parathyroid adenoma

194
Q

2nd line drug for osteoporosis

works like calcitonin

A

Bisphoshonate (dronate)
Very corrosive to GI
causes osteonecrosis

195
Q

Dopamine agonist

A

L-Dopa/carbidopa
bromocriptin
selegiline
amatadine

196
Q

Carbidopa moa

A

stops L-DOpa break down in liver and GI

197
Q

Selegilin MOA

A

MOA-a inhibitor

198
Q

Bromacriptin SE

A

fibrosis: cardiac plueral
retroperitoneal

199
Q

Amantedine

A

NMDA antagonist
increase Dopamin release
decrease dopamin reuptake
inhibit viral uncoating

200
Q

D2 blocker

Phenothiazine family

A

Anti emetic
strong anticholinergic effect

sedative

201
Q

Phenothiazine
*Prochlorperazine

A

adult antiemetic

202
Q

Phenothiazine

promethazine

A

children Antiemetic

203
Q

Phenothiazine

Fluphenazine

A

Long acting (great for homeless and no insurance pt)

204
Q

Dopamin blockers indication

A

Schizophrenia
Bipolar disorder
Acute psychosis
Delirium
Acute agitated states

205
Q

Butyrophenones (D2 blocker)

Haloperidol
Droperidol

A

Severe combative psychosis

206
Q

atypicals

D-4 receptor blocker are use for

A

negative symptoms
extrapyramidal SE

207
Q

D4 blocker

Clozapine SE

A

agranulocytosis

208
Q

MC pituitary tumors

A

nonfunctional adenomas

209
Q

prolactinoma

A

MC functional pituitary tumor

210
Q

what are all pituitary tumors associated with

A

hi prolactin

galactorrhea and amenorrhea

211
Q

which pituitary hormone is both catabolic and anabolic

A

GH

anabo: released after1st REM
Catabolic: release after 24 hrs of stress

212
Q

symmetrical Dwarf is a

A

somatomedin (GH) receptor sensitivity defecite

213
Q

achondroplasia

A

asymmetrical dwarf

214
Q

mcc short stature

A

genetic
GH defi
chronic disease

215
Q

excess GH

A

hyperglycemia
rapid bone growth

216
Q

coarse facial feature
hyperglycemia
hat, shoes don’t fit

A

acromegaly

organomegaly

217
Q

what is the only protein hormone with Nuclear receptor

A

Thyroid Hormone

218
Q

protein hormone that croses placenta

permissive

A

thyroid hormone

controls growth and development

219
Q

TRH

hi TSH also stimulate

A

Prolactin

galactorrhea and amenorrhea

220
Q

Pituitary

TSH (+) has the same alpha chain as

A

HCG, LH,FSH

221
Q

foramen cecum

A

base of tongue where thyroid gland migrated

222
Q

permissive hi thyroid

explain HTN, hi O2 demand and hi Hrt rate

A

upregulate B1

Low T3 downregulate B1:slow

223
Q

Hypothyroidism

in Baby and mom

A

Cretinism

224
Q

mom only hypothyroidism

how long will baby present normal

A

baby normal

225
Q

hypothyroid

mc in American adult

A

Hashimoto’s disease

226
Q

hypothyroidism dt viral illness

A

De Quervain’s dz

painful, diffuse, firm, jaw pain

227
Q

lymphocytic thyroiditis is seen with

A

postpartum
immune reconstitutional

228
Q

Riedel’s Struma

A

hard thyroid mass
painless

229
Q

hyperthyroidism

Grave’s Dz

A

toxic multinodular goiter

thyroid storm, congestive Hrt failure

230
Q

Hyperthyroidism : Grave’s Dz
treatment

A

Propranolol
propylthiouracil
Methimazole
I-131

Propylthiouracil: use in first trimester of pregnancy

231
Q

ADH

supraoptic and paraventricular nuclei

stimulus and inhibition

A

Hi osmolarity
low osmolarity

232
Q

ADH MOA

A

increase vascular resistance
increase absorption of water using urea

233
Q

ADH target

A

endothelial cells (V-1)
collecting duct or nephrons (V-2)

DDAVP for hemophilia a and VW Dz

234
Q

Diabetes insipidus

cause

A

lack ADH or receptor defect

brain/kidney

235
Q

treat central DI with

A

DDAVP

236
Q

Neprogenic DI

causes

A

Lithium(bipolar pt)
demclocycline
‘vaptan

237
Q

treat Nephrgenic DI with

A

Hyrochlorothiazide

sensitizes receptor

238
Q

SiADH

cause

A

Pian
hi ICP
hypoxic lung dz
drugs
cancer

239
Q

SiADH urine is inappropriate

normal plama volume, low NA

A

hi NA
hi Osmo

240
Q

nipple stimulaton and term pregnancy (uterine distention)

hormone

A

Oxytocin

IP3/DAG

241
Q

oxytocin moa

A

milk ejection
uterin contractions

overlapse with ADH –H2O intoxication
vaginal orgasm
induce labor

Step 1 Clues (27 decks)

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