pp clues endocrine Flashcards
- Somatotrope
- Gonadotrope
- GH
- LH, FSH
Thyrotrope?
Corticotrope?
TSH
ACTH
Lactotrope?
suppressed by?
PRL
Dopamine
What receptors do protein hormones use?
Cell membrane receptors
G-coupled
What receptors do steroid hormones use?
Nuclear membrane receptors
mc 2nd msger
cAMP
What are the steroid hormones?
“PET CAD”
Note: thyroid hormone acts like a steroid
Progesterone
E2
Testosterone
Cortisol
Aldo
Vit D
What does Exocrine mean?
Secretion into non-blood
What is Autocrine?
Works on itself
What is Paracrine?
Works on its neighbor
What is Merocrine?
Cell is maintained => exocytosis
What is Apocrine?
Apex of the cell is secreted
What is Holocrine?
The whole cell is secreted
What organs do not require insulin?
“BRICKLE”
Brain
RBC
Intestine
Cardiac, Cornea
Kidney
Liver
Exercising muscle
What does GnRH do?
Stimulates LH, FSH
What does GRH do?
Stimulates GH
What does CRH do?
Stimulates ACTH
What does TRH do?
Stimulates TSH
What does PRH do?
Stimulates PRL
What does DA do?
Inhibits PRL
What does SS do?
Inhibits GH
What does ADH do?
Conserves water, vasoconstricts
What does oxytocin do?
Milk letdown, baby letdown
What does GH do?
IGF-1 release from liver
What does TSH do?
T3,T4 release from thyroid
What does LH do?
Testosterone release from the testis,
Estrogen and Progesterone release from the ovary
What does FSH do?
Sperm or egg growth
Milk production
PRL
Cortisol release from adrenal gland
ACTH
Skin pigmentation
MSH: melanocyte-stimulating hormone
What are the stress hormones?
Epi: Immediate
Glucagon: 20min
Insulin: 30min
ADH: 30min
Cortisol: 2-4hr
GH: 24hr
Concentrates urine
ADH
Too little ADH => urinate a lot
Diabetes Insipidus
Brain not making ADH
Central DI
What is Nephrogenic DI?
Blocks ADH receptor,
can be caused by Li and Demecocycline
DI: Water Deprivation failed?
Renal problem
What does giving DDAVP tell you?
DDAVP => Central DI concentrates >25%
What is SIADH?
Too much ADH => expand plasma vol => pee Na
What is the difference b/w DI and SIADH?
DI has dilute urine,
SIADH has concentrated urine
What is Psychogenic Polydipsia?
Pathologic water drinking => low plasma osmolarity
What does Aldosterone do?
Reabsorbs Na, secretes H+/ K+
What is a Neuroblastoma?
Adrenal medulla tumor in kids,
dancing eyes/feet, secretes epi and norepinephrine
What is a Pheochromocytoma?
Adrenal medulla tumor in adults, 5 P’s
What does the Zona Glomerulosa make?
Aldosterone “salt”
What is the primary regulatory control for the Zona Glumerulosa?
Renin-Angiotensin
What does the Zona Fasiculata make?
Cortisol “sugar”
What is the primary regulatory Control for the Zona Fasiculata?
ACTH, CRH
What does the Zona Reticularis make?
Androgens “sex”
What is the primary regulatory control for the Zona Reticularis?
ACTH, CRH
What do chromaffin cells produce?
Catecholamines
What is the primary regulatory control for chromaffin cells?
Preganglionic sympathetic fibers
ACH
What is Conn’s syndrome?
High Aldo (tumor), Captopril test makes it worse
What does ANP do?
Inhibits Aldo, dilates renal artery (afferent arteriole)
What does Calcitonin do?
Inhibits osteoclasts => low serum Ca2+
What is MEN I?
“Wermer’s”: Pancreas, Pituitary, Parathyroid adenoma (high gastrin) “PPP”
multiple endocrine
What is MEN II?
“Sipple’s”: Pheo, Medullary thyroid cancer, PTH
multiple paraneoplastic syndrome
MEN IIb
“MEN IIb”: Pheo, Medullary thyroid cancer, Oral/GI neuromas
marfanoid
What does CCK do?
Gallbladder contraction, bile release
Gluconeogenesis by proteolysis => thin skin
Autoimmu
Cortisol
What is Addison’s disease?
Autoimmune destruction of adrenal cortex => hyperpigmentation, ↑ACTH
What is Waterhouse Friderichsen?
Adrenal hemorrhage
What is Cushing’s syndrome?
High cortisol (pituitary tumor or adrenal tumor or small cell lung CA)
What is Cushing’s disease?
High ACTH (pituitary tumor)
What is Nelson’s syndrome?
Hyperpigmentation after adrenalectomy
If the low-dose dexamethasone test suppresses, what does that tell you?
Normal, obese, or depressed
If the low-dose dexamethasone test does not suppress, what does that tell you?
Cushing’s => do high dose test
If the high-dose dexamethasone test suppresses, what does that tell you?
Pituitary tumor => ACTH (call brain surgeon)
If the high-dose dexamethasone test does not suppress, what does that tell you?
Adrenal adenoma => Cortisol (call general surgeon)
* Small cell lung cancer => ACTH (call thoracic surgeon)
What are the survival hormones?
Cortisol: permissive under stress
TSH: permissive under normal
What does Epinephrine do?
Gluconeogenesis, glycogenolysis
What does Erythropoietin do?
released from?
release dt?
Makes RBCs
Hypoxia
What does Gastrin do?
Stimulates parietal cells => IF, H+
What does Growth hormone do?
Growth, sends somatomedin to growth plates, gluconeogenesis by proteolysis
What is a Pygmie?
No somatomedin receptors
What is Achondroplasia = Laron Dwarf?
Abnormal FGF receptors in extremities
What is a Midget?
↓Somatomedin receptor sensitivity
What is Acromegaly?
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
What is Gigantism?
Childhood acromegaly
What does GIP do?
Enhances insulin action => post-
prandial hypoglycemia
What does Glucagon do?
Gluconeogenesis, glycogenolysis, lipolysis, ketogenesis
What does Insulin do?
Pushes glucose into cells
What is Type I DM?
anti-islet cell Ab, GAD Ab, Coxsackie B, low insulin, DKA, polyuria, polydipsia, polyphagia
What is Type II DM?
Insulin receptor insensitivity,
high insulin,
HONK coma,
acanthosis
How does DKA present?
Kussmal respirations, fruity
breath (acetone), altered mental
What is the Dawn phenomenon?
Morning hyperglycemia 2° to GH
What is the Somogyi Effect?
Morning hyperglycemia 2° to
evening hypoglycemia
What is Factitious Hypoglycemia?
Insulin injection (↑insulin, ↓C-peptide)
What is an Insulinoma?
Tumor (↑insulin, ↑C-peptide)
What is Erythrasma?
Rash in skin folds, coral-red Wood’s lamp
What is Syndrome X = Metabolic Syndrome?
“Pre-DM”=> HTN, dyslipidemia, hyperinsulinemia, acanthosis nigricans
What are foot ulcer risk factors?
DM/ Glycemic control
* Male smoker
* Bony abnormalities
* Previous ulcers
What conditions cause weight gain?
Obesity
* Hypothyroidism
* Depression
* Cushing’s
* Anasarca
What does Motilin do?
stimulates segmentation (1° peristalsis, MMC)
What does Oxytocin do?
Milk ejection, baby ejection
Kallmann syndrome?
Hypogonadotropic hypogonadism: defective migration of GnRH- releasing neurons
association of Kallmann syndrome
No puberty or incomplete puberty
can’t smell
can’t hear
can’t pee
origin and action of erythropoietin
renal parenchymal cells
erythropoiesis in bone marrow
stimulator and inhibitor of Erythropoietin
Hypoxia stimulates
high 02 inhibits
causes of polycythemia with normal erythropoietin
lose of plasma
stress polycythemia
Gaisbock’s syndrome
causes of polycythemia with high erythropoietin: hypoxia
acute hypoxia: tachypnea and dyspnea
Chronic hypoxia: clubbing, polycythemia
RLD, COPD, Renal cell carcinoma
causes of polycythemia with low erythropoietin
bone marrow cancer
polycythemia rubra vera
essential thrombocythemia
Adrenal cortex: Aldo stimulator and effector tissue
stimulator: high K, Low volume , low Na+
late DCT, early collecting duct and ascending colon
Aldo inhibitor and action
Hypervolumia
Increase production of Na-K pumps and K/H exchange
Aldo syndrome: too much
Conn’s syndrome
HTN, High Na, low K, alkalosis
Aldo syndrome: too little
Adrenal insufficiency
21 HO
17 HO
11 HO
This may be seen in adults abrupt withdrawal of steroid
Cortisol origin and stimulus
Zona fasciculata
stress, hypoglycemia
cortisol inhibitor and effector tissue
hyperglycemia
permissive and up-regulate all receptors during stress
cortisol physiologic action
proteolysis
gluconeogenesis
cortisol anti-inflammatory action(I- KISS
Inhibits
phospholipase A
* Kills T-lymphocytes
and eosinophils
* Inhibit macrophage
migration
* Stabilizes mast cells
* Stabilizes
endothelium
too little cortisol
adrenal insufficiency
21 HO
11 HO
too much cortisol
Cushing’s syndrome
the 3 Cushing’s Disease
Pituitary adenoma
Small cell carcinoma
Adrenal adenoma
dexamethasone suppression occurs
Obesity
depression
normal variant
dexamethasone suppression does NOT occurs with Hi ACTH
small cell carcinoma
dexamethasone suppression does NOT occurs with low ACTH
Adrenal adenoma
high does dexa will suppress
Pituitary adenoma
High does Dexa will not suppress
small cell carcinoma
in women Progesterone (B4 menses) =
testosterone in men
origin of Testosterone and stimulus
zona reticularis
male external genitalia
Action of testoterone
Aggression, increase appetite, violence, hi RBC, hi Libido
sources of DHEA-S
adrenal in males
Ovaries
DHT made by _______________(enzyme) in ______________(locattion)
5 a-reductase
testes
at birth and puberty
hi DHT
Androgenic balding
PCOS
5 a reductase blocker
Fenesteride/Dutasteride
FLutamide moa
blocks DHT receptors
Epinephrine origin and stimulus
adrenal medulla
Stress/hypoglycemia
EPi inhibitor and target
hyperglycemia
liver and adrenal cortex, Heart
EPI action
glycolysis
gluconeogenesis
glycogenolysis
Excess NE and Epi
Pheo and Neuroblastoma
symptoms of Excess NE and Epi
Intermittent HTN, palpitations, diaphoresis and headaches
seen in Neuroblastoma with hi EPi and NE
Opsoclonus
hypsarrhythmia
(EEG: https://www.researchgate.net/figure/EEG-findings-in-hypsarrhythmia-burst-suppression-variant-there-are-bursts-of-bilateral_fig2_256086128
treatment for hi EPI/ NE
phentolamine
phenoxybenzamine (zero order)
surgery for hi EPI/NE
give alpha blocker until surgery
Beta-blocker right b4 surgery to block catecholamine effect
MC abdominal mass in children
Neuroblastoma
Stress hormone released immediately
Receptors
EPI : B1/2 : GS, a1:Gq, a2: Gi
Stress hormone released 20min
Glucagon: Gs
Stress hormone released 2-4hr
cortisol permissive up regulation of all receptors
Stress hormone released 24hr
GH: Jak-stat
produces sugar
Released within 30 mins of Stress
Insulin:RTK-MAPK: pushes glucose in cells
ADH :V2:GS: normalizes Osmolarity cause by sugar
Pancrease hormones
glucagon: from ALPHA cells
* Insulin: from BETA cells
* Somatostatin: from DELTA cells
* Pancreatic Polypeptide: from ‘F’ cells
Catabolic 2nd MSG
c-AMP
Jat stat: GH
cortisol
Glucagon target
adrenal cortex
liver
adipose tissue
glucagon stimulus and inhibitor
Sti: Hypoglycemia/stress
Inh: hyperglycemia
MOA of glucagon
gluconeogenesis
glycogenolysis
lypolysis
ketogenesis
Alpha cell tumor with necrolytic migratory erythema
hi glu
hi lipid
hi ketones
Insulin stimulus and inhibitor
hyperglycemia
hypoglycemia
what tissues do not require insulin
low Km hi affinity
Brain
RBC
Intestine
cardiac/cornea
kidney
liver
exercising muscle
insulinoma signs
hypogluc hi C-Peptide
CT scan–> surgery
Infants: Nessidioblastosis
same as insulinoma
subtotal pancreatectomy
Delta cells
somatostatin
sti: insulin and glucagon
inch: low insulin and glucagon
what is the analog of somatostatin
octreotide
slows gastric emptying/GI blood flow in
esophageal varicose bleeding
Stomach hormones
Gastrin
Ghrelin Vs Leptin
Duodenum hormone
Secretin
CCK
Motilin
GIP
VIP
Somatostatin
Secretin is stimulated by
low PH(acid) from stomach
action of secretin
(+) pancreas and GB =Bicarb
(- )Gastrin
slow gastric emptyingC
CCK stimulated by
Food( FAT)
for fat and protein digestion
CCK stimulate
Pancreas (digestive enzyme) and gallbladder(bile)
CCK second msg
IP3/DAG
Duodenum
GPI stimulus and inhibition
glucose
high pH
Target of GIP and MOA
Pancreatic islet cells
enhances insulin secretion
GIP syndromes
Dumping syndrome: Billroth II
causes insulin resistance (type 2 diabetes)
somatostatin
stimulus & inhibition
Duodenal hormones
High pH
purely inhibitory
Auerbach’s plexus
VIP
stimulus and Inhibition
duodenal hormones
High pH
inhibitory paracrine
VIPOMA
watery diarrhea
CAT scan
surgery
what are the causes of watery diarrhea
Vibrio
ETech
Giardia
Vipoma
stomach antrum
Gastrin
high pH
Low pH
Gastrin target & MOA
Parietal cell
HCL and intrinsic factor production
Ca++ 2nd msg
What is gastrinoma
pancreatic tumor
zollinger-Ellison syndrome
hi, unsuppressable gastrin
Gastrinoma may be associated with what syndrome
MEN-1
pancreatic tumor
Right Atrium and Ventricle
ANP
stimulus & inhibitor
high volume
Low volum
ANP target and MOA
Afferent renal artery dilateion
inhibits aldosterone
2nd msg: NO
ANP syndrome results in
polyuria, nocturia and hyponatremia
Calcium metabolism
Hormones
PTH
Vitamin D
Calcitonin
enbrionic origin
PTH
3rd/4th pharyngeal pouch
parathyroid gland
stimulus/inhibitor
PTH
low Ca++, Hi Phosphorus
Hi Ca++, low phosphorus
PTH target
osteoclasts of bone
kidney PCT
Kidney Late DCT
MOA of PTH
stimulate osteoclast
phosphorus secretion increase
activate 1-alpha hydroxylas–> make vit D
C-AMP
low PTH syndrome
PTH receptor defect is
x-linked dominant pseudo hypoparathy with short 3rd and 5th digit
mcc or 1st hypo PTH
Thyroidectomy
Normal Ca++ with Hypo PTH
Pseudopseudo PTH
Hi PTH
1st Hi PTH
parathyroid adeno
isolated hi ca++
inflammatory bone condition causing scaring
osteosclerosis
increase osteoclastic activity, Ca++ and alkaline Phosphatase
Osteitis Deformans
loss of bone mass, matrix and miniralization
osteopenia
thick bone, no marrow, low osteoclastic activity
osteopetrosis
soft bones
loss of mineralization
osteomalacia
hi osteoclastic activity, loss of matrix/osteoid, less osteoblastic acitivity…post menopause
osteoporosis
2nd hi PTH
Renal failure
Renal osteodystrophy
Vit D deficiency
osteomalacia
Rickets
Vit D production
Skin
Liver
Renal
Cholecalciferol
25-oH
1,25 D, OH
Vit D target tissue
Kidney
GI
Bone
MOA of vit D
Production of Ca-ATPase
Production CBP
stimulates
Osteoblast activity
Calcitonin production
Parafollicular cells of thyroid
stimulated by hi Ca++
Calcitonin function
Inhibit osteoclastic activity
c-AMP
what cancer and syndrome
Increase calcitonin, low osteoclastic activity, thick bone
osteopetrosis
Medullary carcinoma of thyroid
RET gene
MEN 2 a
pheocho, parathyroid adenoma
2nd line drug for osteoporosis
works like calcitonin
Bisphoshonate (dronate)
Very corrosive to GI
causes osteonecrosis
Dopamine agonist
L-Dopa/carbidopa
bromocriptin
selegiline
amatadine
Carbidopa moa
stops L-DOpa break down in liver and GI
Selegilin MOA
MOA-a inhibitor
Bromacriptin SE
fibrosis: cardiac plueral
retroperitoneal
Amantedine
NMDA antagonist
increase Dopamin release
decrease dopamin reuptake
inhibit viral uncoating
D2 blocker
Phenothiazine family
Anti emetic
strong anticholinergic effect
sedative
Phenothiazine
*Prochlorperazine
adult antiemetic
Phenothiazine
promethazine
children Antiemetic
Phenothiazine
Fluphenazine
Long acting (great for homeless and no insurance pt)
Dopamin blockers indication
Schizophrenia
Bipolar disorder
Acute psychosis
Delirium
Acute agitated states
Butyrophenones (D2 blocker)
Haloperidol
Droperidol
Severe combative psychosis
atypicals
D-4 receptor blocker are use for
negative symptoms
extrapyramidal SE
D4 blocker
Clozapine SE
agranulocytosis
MC pituitary tumors
nonfunctional adenomas
prolactinoma
MC functional pituitary tumor
what are all pituitary tumors associated with
hi prolactin
galactorrhea and amenorrhea
which pituitary hormone is both catabolic and anabolic
GH
anabo: released after1st REM
Catabolic: release after 24 hrs of stress
symmetrical Dwarf is a
somatomedin (GH) receptor sensitivity defecite
achondroplasia
asymmetrical dwarf
mcc short stature
genetic
GH defi
chronic disease
excess GH
hyperglycemia
rapid bone growth
coarse facial feature
hyperglycemia
hat, shoes don’t fit
acromegaly
organomegaly
what is the only protein hormone with Nuclear receptor
Thyroid Hormone
protein hormone that croses placenta
permissive
thyroid hormone
controls growth and development
TRH
hi TSH also stimulate
Prolactin
galactorrhea and amenorrhea
Pituitary
TSH (+) has the same alpha chain as
HCG, LH,FSH
foramen cecum
base of tongue where thyroid gland migrated
permissive hi thyroid
explain HTN, hi O2 demand and hi Hrt rate
upregulate B1
Low T3 downregulate B1:slow
Hypothyroidism
in Baby and mom
Cretinism
mom only hypothyroidism
how long will baby present normal
baby normal
hypothyroid
mc in American adult
Hashimoto’s disease
hypothyroidism dt viral illness
De Quervain’s dz
painful, diffuse, firm, jaw pain
lymphocytic thyroiditis is seen with
postpartum
immune reconstitutional
Riedel’s Struma
hard thyroid mass
painless
hyperthyroidism
Grave’s Dz
toxic multinodular goiter
thyroid storm, congestive Hrt failure
Hyperthyroidism : Grave’s Dz
treatment
Propranolol
propylthiouracil
Methimazole
I-131
Propylthiouracil: use in first trimester of pregnancy
ADH
supraoptic and paraventricular nuclei
stimulus and inhibition
Hi osmolarity
low osmolarity
ADH MOA
increase vascular resistance
increase absorption of water using urea
ADH target
endothelial cells (V-1)
collecting duct or nephrons (V-2)
DDAVP for hemophilia a and VW Dz
Diabetes insipidus
cause
lack ADH or receptor defect
brain/kidney
treat central DI with
DDAVP
Neprogenic DI
causes
Lithium(bipolar pt)
demclocycline
‘vaptan
treat Nephrgenic DI with
Hyrochlorothiazide
sensitizes receptor
SiADH
cause
Pian
hi ICP
hypoxic lung dz
drugs
cancer
SiADH urine is inappropriate
normal plama volume, low NA
hi NA
hi Osmo
nipple stimulaton and term pregnancy (uterine distention)
hormone
Oxytocin
IP3/DAG
oxytocin moa
milk ejection
uterin contractions
overlapse with ADH –H2O intoxication
vaginal orgasm
induce labor