Test 1 (Week 1) Flashcards
If someone presents with a tender thyroid, think ______.
subacute granulomatous (De Quervain) thyroiditis
What do cells of the zona reticularis (in adrenal cortex) produce?
precursors to androgen hormones (DHEA and DHEA sulfate)
What do cells of the zona fasciculata (in adrenal cortex) produce?
glucocorticoids (cortisol)
What is the rate limiting substrate in thyroid hormone biosynthesis?
iodide
What’s the mechanism of sampling the thyroid?
fine needle aspiration (FNA)
What’s the most common cause of primary hyperparathyroidism?
parathyroid adenoma
what do cells of the zona glomerulasa (in adrenal cortex) produce?
aldosterone
What tissues are insensitive to thyroid hormone?
brain, uterus, testes, lymph nodes, spleen BUTt-LeSs
What’s the mnemonic to remember the clinical features of symptomatic hypercalcemia?
painful bones, renal stones, abdominal groans, and psychic moans
What should be in an umbilical cord?
There should be 2 arteries and 1 vein in the umbilical cord.
Fusion of the _____ and _____ obliterates the uterine cavity.
Fusion of the decidua caspularis and decidua parietalis obliterates the uterine cavity
List the anterior pituitary hormones that are glycoproteins with alpha and beta subunits
FSH LH TSH
Prolactin release is inhibited by ____.
dopamine from hypothalamus
What do thyroid C cells (or parafollicular cells) do?
produce the peptide hormone calcitonin which inhibits calcium resorption from bones= lowers blood calcium
The differentiation of minimally invasive follicular carcinoma from adenoma is dependent exclusively on _______.
invasion of the capsule
Autoimmune destruction by which type of T cells is seen in Hashimoto’s thyroiditis?
CD8+ T cells
What is Levothryoxine?
synthetic thyroxine (T4)
_____ secretion appears to be normally under inhibitory control by the hypothalamus.
Prolactin secretion appears to be normally under inhibitory control by the hypothalamus.
For Pseudohypoparathyroidism where the maternal allele is mutated, you get Albright hereditary osteodystophy. Is it with or without multi hormone resistance?
with multi hormone resistance. therefore, you will also have hypocalcemia, hyperphosphatemia, and elevated PTH. IT’S CALLED Pseudohypoparathyroidism Type 1a
list the basophils in the adenohypophysis
corticotropes, gonadotropes, thyrotropes
What is Liotrix?
mixture of T4 and T3
premature separation of the placenta from the uterine wall before delivery. heavy bleeding occurs
placental abruption
What’s the BMI range for overweight?
25.0-29.9
Eclampsia=
grand mal convulsions (seizures)
Where are newly synthesized thyroid hormones stored?
colloid
Which HLA is Hashimoto thyroiditis associated with?
HLA-DR5
The _____ is an upgrowth from the roof of the mouth.
Adenohypophysis (forms Rathe’s pouch)
If someone presents with a ‘hard as wood’ thyroid that involves local structures, think _____.
Riedel Fibrosing thyroiditis
How do papillary thyroid carcinomas typically spread?
via lymphatics
What’s the mechanism of action of Pegvisomant?
it’s a pegylated analog of hGH (decreases its renal clearance) that Binds to GH receptors, blocks GH from activating receptors and thus decreases production of insulin-like growth factors (IGF-1)
growth hormone release is stimulated by _____.
growth hormone releasing hormone (GHRH) from hypothalamus
What’s the mechanism of action of thionamides?
interfere with the organification and coupling steps in the biosynthesis of thyroid hormone
What do corticotropes make?
adrenocorticotropin (ACTH) and beta-endorphin
Pars distalis is more ____.
cellular
Graves’ disease is an autoimmune disorder that accounts for roughly 60-80% of all cases of _______.
HYPERthyroidism Graves’ disease is more common in women than in men.
carpal spasm induced by inflating blood pressure cuff
Trousseau sign
What are the most common secretory pituitary tumors?
Prolactinomas are the most common secretory pituitary tumors.
What’s the BMI range for normal?
18.5-24.9
Which hormone stimulates synthesis and secretion of TSH?
Thyrotropin releasing hormone (TRH)
What is Gonadorelin and what is it used for?
synthetic GnRH; administered in a pulsatile manner to treat hypogonadotropic hypogonadism
tapping facial nerve results in twitch of eyes, mouth or nose
Chvostek sign
What’s another name for somatostatin?
growth hormone inhibiting hormone
growth hormone release is inhibited by ____.
somatostatin from hypothalamus
What’s the gold standard to evaluate pituitary secretion of growth hormone?
Induction of hypoglycemia by administration of insulin; GH secretion is increased with hypoglycemia
What does the pars intermedia produce?
ACTH and melanocyte stimulating hormone (MSH); not really a big deal in humans b/c the adenohypophysis can do this too (and better)
From where do the parathyroid glands develop embryologically?
3rd and 4th pharyngeal pouches
Approximately 80% of plasma T3 (the thyroid hormone exhibiting the greatest activity) production occurs in the periphery following metabolism of T4 by __________.
two 5′ deiodinases, referred to as D1 and D2.
from outside in, what are the 3 zones of the adrenal cortex?
zona glomerulosa, zona fasciculata, zona reticularis
Melatonin is inhibitory to gonadotropins (LH and FSH), therefore children with destroyed pineal gland may go through _______.
precocious puberty
What are the two clinical signs you can test for if you suspect hypoparathyroidism ?
Trousseau and Chvostek sign
List the acidophils of the adenohypophysis
somatotropes and lactotropes
end organ resistance to the actions of PTH
pseudohypoparathyroidism
What’s the equation for respiratory quotient (RQ)?
CO2 produced/ O2 consumed
Which two organelles play a prominent role in steroid hormone production of the adrenal cortex?
mitochondria and smooth ER
What are the 3 cell types of the parathyroid gland?
adipose cells, chief cells, oxyphil cells
What is used to treat prolactinomas?
a dopamine agonist (such as bromocriptine)
used to induce labor
oxytocin
Primary lymphoma of the thyroid is strongly associated with:
Strongly associated with autoimmune thyroiditis (Hashimoto or lymphocytic) and external beam radiation
The posterior region of the pituitary gland is the ____.
neurohypophysis
Desmopressin (DDAVP) is a ____ analog.
ADH it’s a long lasting synthetic analog, used in nasal spray form; used to treat diabetes insipidus
characterized by a well defined well circumscribed capsule w/o invasion
follicular adenomas
What’s the MOA of Cabergoline?
–Decreases Dopamine turnover (i.e., increases hypothalamic DA) –Direct action on Dopamine-Receptor to inhibit prolactin release increase dopamine = inhibit prolactin
For Pseudohypoparathyroidism where the paternal allele is mutated, you get Albright hereditary osteodystophy. Is it with or without multi hormone resistance?
it is without multi hormone resistance, therefore, your calcium and PTH levels are normal
placenta attaches to the lower uterine cavity and covers (partially/completely) the internal cervical os
placenta previa
What are the side effects of iodide drugs?
Iodism: 1) Brassy taste 2) Increased salivation 3) Soreness of teeth and gums 4) Swelling of the eyelids 5) Symptoms resembling upper respiratory infection 6) Severe frontal headache
Why are natural hormones usually not good drugs?
Inactive Orally Rapidly Degraded
Why is the transition of cytotrophoblast cells from epithelial to endothelial and subsequent invasion of maternal spiral arteries so important?
it transforms those arteries from small diameter/high resistance, to large diameter/low resistance =blood flow
What do gonadotropes make?
luteinizing hormone (LH) and follicle stimulating hormone (FSH)
On what cells will FSH act and what will they stimulate these cells to do (male and female individually) ?
Male: Sertoli cells —> spermatogenesis Female: Follicles —-> estrogen
The _____ is a down growth from the floor of the diencephalon.
neurohypophysis
What are the adverse effects of thionamides?
-skin rash -headache, nausea -leukopenia -agranulocytosis (most dangerous)
Primary hypothyroidism is a problem with the ___.
thyroid itself (like in Hashimoto’s)
what immunohistochemical marker will be positive in Pituicytomas ?
TTF-1 (will also have PAS+ granules)
What is the embryological origin of the adrenal medulla?
neural crest
List the common thionamides
propylthiouracil (PTU), methimazole, and carbimazole
What do lactotropes make ?
prolactin
Patients with Hashimoto thyroiditis are at an increased risk for what cancer?
b cell lymphoma
Medullary thyroid carcinoma is derived from ____.
C cells
Tertiary hypothyroidism is a problem at the ___.
hypothalamic level (like a hypothalamic tumor or trauma)
How do follicular thyroid carcinomas typically spread?
hematogenously (often to lungs)
What do the hormones produced by cardiovascular muscle endocrine cells do?
decrease blood volume and blood pressure
What’s the drug of choice for most hypothyroid conditions?
Levothyroxine
What will large doses of iodide do ?
-Inhibits TH release –Rapid decrease in TH levels -Inhibits organification –Decreases synthesis of TH -Decreases the vascularity, size and fragility of thyroid gland –Good prior to surgical removal
What’s the function of adrenal medulla cells?
produce norepinephrine and epinephrine
What’s the most obvious in vivo effect of the thyroid hormones?
increase O2 consumption
Oxyphil cells are filled with ____.
mitochondria
How does hyperthyroidism increase sympathetic nervous system activity?
increased expression of beta-1 adrenergic receptors
a type of brain tumor derived from pituitary gland embryonic tissue (remnants of Rathkes pouch)
craniopharyngioma
What are the two main thyroid hormone binding proteins in the plasma?
Thyroid binding globulin (TBG) and transthyretin (TTR) TBG binds a much greater percentage of T3 and T4 in the plasma than TTR
What’s another name for growth hormone?
somatotrophin
Secondary hypothyroidism is a problem at the ___.
pituitary level (like hypopituitarism)
What would you use GH antagonists for treating?
GH secreting pituitary adenomas–> treat acromegaly and gigantism
The anterior region of the pituitary gland is the _____.
adenohypophysis
How does hyperthyroidism increase the basal metabolic rate?
increased synthesis of Na-K ATPase
Secretion of vasopressin is inhibited by _____.
ethanol Ethanol is an “anti” anti-diuretic i.e., it has a diuretic effect.
placenta attaches to the myometrium
placenta accreta
A single umbilical artery occurs in 1/200 babies and these have a 20% chance of having _______ defects
cardiac and other vascular
Where do you get human chorionic gonadotropin from and what is the hormone it contains?
urine of pregnant women; LH only
Which cells of the parathyroid gland produce parathyroid hormone?
chief cells
nests of cells in the pars nervosa. involutes in humans
pars intermedia
Insufficient Migration of ______ Leads to Preeclampsia.
cytotrophoblast cells
placenta penetrates into the myometrium
placenta increta
What’s the blood supply to the pars nervosa (neurohypophysis) ?
inferior hypophyseal arteries (branch from internal carotids)
What’s the BMI range for thin?
less than 18.5
Describe the physical findings in Albright hereditary osteodystrophy (AHO). What causes it?
short stature, obesity, short metacarpal and metatarsal bones and variable mental deficits genetic imprinting
placenta perforates the myometrium and can attach to rectum or bladder
placenta percreta
What’s the second most common thyroid malignancy? What is it associated with?
follicular carcinoma iodine deficiency
What lab value do you look at if you suspect medullary carcinoma of the thyroid?
calcitonin
The histologic diagnosis of papillary thyroid carcinoma is solely defined by its ‘characteristic nuclear features’. What are some of these features?
-elongation -fine grooves -fine powdery chromatin (nucleus looks glassy) - chromatin clearing and margination -pseudoinclusions don’t occur uniformly in all papillary cancers. will only see 3-4 of these
Which thyroid hormone is not produced in the periphery?
T4
Which amino acid is the most potent stimulator of growth hormone secretion?
arginine
PTH increases serum calcium by acting at targets in the ____, _____, and ____.
bone, kidney, GI tract
What’s the blood supply to the pars distalis?
superior hypophyseal arteries (branch from internal carotids)
_____ and ____ are somatostatin analogs.
Octreotide and Lanreotide
What’s the mechanism of action of Mesasermin? What are its uses?
MOA: it’s a recombinant human IGF-1 which stimulates IGF-1 receptors Uses: in children with growth failure unresponsive to GH due to deficient IGF-1
What does the neurohypophysis (posterior pituitary) release?
oxytocin and vasopressin
What’s the most common cause of secondary hyperparathyroidism?
chronic renal failure
Defects in ______ structure may indicate that villous tissue has remained behind in the uterus/poor perfusion. This can lead to prolonged postpartum hemorrhage.
cotyledon
contains only FSH from urine of post menopausal women
urofollitropin; LH is removed
Where do urofollitropin and hMG (menotropins) come from?
urine of post menopausal women
On what cells will LH act and what will they stimulate these cells to do (male and female individually) ?
Male: Leydig cells —> testosterone Female: corpus luteum—> induces ovulation, secretion of estrogen and progesterone
What cell types are parathyroid glands composed of?
chief cells, oxyphil cells (oncocytes), fat
What does parathyroid hormone do?
a peptide hormone that raises serum calcium by stimulating bone breakdown
What histologic findings will be seen in Hashimoto thyroiditis cases?
chronic inflammation w/ germinal centers and Hurthle cells
What’s the BMI range for obese?
30.0-39.9
What do somatotropes make?
growth hormone (GH)
What’s the BMI range for morbid obesity?
>40
Thyroid hormones are iodinated derivatives of the amino acid _____.
tyrosine
What does the pineal gland produce?
melatonin from serotonin
contains FSH and LH from urine of post menopausal women
hMG (menotropins)
Pineal cells are sensitive to what wavelength of light?
indigo blue light (460nm)
Fusion of the _____ with the _____ obliterates the chorionic cavity.
Fusion of the amnion with the chorion obliterates the chorionic cavity
Which part of the pituitary gland uses a portal system for signaling?
adenohypophysis
What’s the most common thyroid malignancy?
papillary carcinoma
What’s another name for hyperthyroidism?
thyrotoxicosis
What are some iodide drugs?
-Lugol’s solution -saturated solution of potassium iodide (SSKI) -sodium ipodate
What is preeclampsia characterized by?
characterized by sudden onset of maternal hypertension and edema
What is bromocriptine and what is it used to treat?
it’s a dopamine agonist used to treat acromegaly; this is Paradoxical b/c DA agonists usually increase GH in normal individuals.
Prolactin release is stimulated by ____.
thyrotropin releasing hormone from hypothalamus
What do thyrotropes make?
thyroid stimulating hormone (TSH)
What is papillary carcinoma associated with?
radiation exposure (~6%)
What’s the function of vasopressin?
AKA anti-diuretic hormone; raises blood pressure by water and sodium conservation in the collecting ducts of the kidney
Amiodarone is an iodine containing antiarrhythmic that can produce _____.
Hypothyroidism AND hyperthyroidism
the term for the uterine lining (endometrium) during a pregnancy, which forms the maternal part of the placenta.
decidua
Describe Hurthle cell adenomas.
Composed of predominately or exclusively of oncocytic follicular cells with prominent nucleoli and densely granular eosinophilic cytoplasm.
What is somatropin?
recombinant human growth hormone
Why is radioactive iodine therapy of little or no value in treating hurthle cell variant follicular carcinoma?
Hurthle cells are metabolically inactive
Presents as a rapidly enlarging neck mass
anaplastic carcinoma (100% mortality at 1 year)
What are pituicytes?
specialized glial cells of the posterior pituitary
What causes the hyperthyroidism produced by Graves’ disease ?
autoantibodies stimulate TSH receptors on thyroid
List the anterior pituitary hormones that are composed of a single chains of amino acids.
ACTH GH Prolactin
Pars nervosa is ____.
fibrous
What’s the function of oxytocin?
contractions of uterus and mammary gland myoepithelial cells (lactation)
What is Liothyronine and what is its potential side effect?
synthetic triiodothyronine (T3); potentially cardiotoxic
What’s another stupid name for insulin like growth factor 1 (IGF1)?
Somatomedin C
