Test 3: 59-60 Flashcards
HPA axis
hypothalamic pituitary adrenal axis
how does CRH from hypothalamus work
dexamethasone low suppression test
normal: give dexamethasome= cortisol will decrease
cushings: give dex= cortisol increases or remains normal
dexamethasone high suppression test
give dexamethasone 8 mg → cortisol decreases = pituitary cushings
give dex 8→ cortisol increases and ACTH low= adrenal cushings
give dex 8→ cortisol increases and high ACTH = ectopic ACTH tumor
how to diagnose pituitary cushings
high dex = low cortisol
how to diagnose adrenal cushings
high dex = high cortisol = low ACTH
summary of dexamethasone suppression test
how to diagnose ectopic cushings
high dex → high cortisol and high ACTH
hyperadrenocorticism is another name for
cushing disease
cushings disease is usually caused by a ___ tumor but in rare cases (10%) can be caused by a ___ tumor
pituitary
adrenal gland
symptoms of cushing’s
pot belly
loss of fur
increased urination
increased drinking and appetite
Treatment for cushings
repeat surgery
meds: mifepristonem, pasireotide, ketoconazole
radiosurgery
bilateral adrenalectomy
adrenal gland
stress gland
humoral response (short term: nervous system: fight and flight) → increased blood sugar, blood pressure, breathing
hormonal response: long term stress response: mineralcorticoids and glucocorticoids → insulin resistance, osteoporosis, suppressed immune system, kidney function
hypothalamus releases CRH → ACTH release from pituitary acts on the adrenal gland
two regions of adrenal gland
cortex
medulla
what hormones are released by the cortex of the adrenal gland
glucocorticoids
androgen
estrogen
mineralocorticoids→ aldosterone
what hormones are released by the medulla of the adrenal gland
catecholmine:
epinephrine
nor-epinephrine
dopamine
The adrenal medulla produces ___
catecholamines: such as adrenaline, noradrenaline and small amounts of dopamine
fight or flight hormones are released by what
medulla of the adrenal gland
adrenaline, noradrenaline and small amounts of dopamine
Mineralocorticoids: the most important of which is ___
aldosterone.
___ hormone helps to maintain the body’s salt and water levels which, in turn, regulates blood pressure
aldosterone
Without aldosterone, the kidney loses excessive amounts of salt (sodium) and, consequently, water, leading to severe ___ and low blood pressure.
dehydration
Glucocorticoids: predominantly ___
cortisol.
Cortisol stimulates ___ production helping the body to free up the necessary ingredients from storage (fat and muscle) to make glucose.
glucose
Adrenal ___ :male sex hormones mainly dehydroepiandrosterone (DHEA) and testosterone
androgens:
adrenal androgens: All have weak effects, but play a role in ___ development of the male sex organs in childhood, and female body hair during puberty
early
common diseases associated with the adrenal gland
cushings and addison’s disease
symptoms of addison’s disease
bronze pigmented skin
body hair in weird places
hypoglycemia
postural hypotension
weight loss and weakness
adrenal crisis
addison’s disease
fatigue
dehydration
vascular collapse
renal shut down
decreased serum sodium
increased serum potassium
Addison’s disease is a condition in which the adrenal glands cannot secrete enough ___
corticosteroid.
what is the opposite of cushings disease
addison’s disease
in cushings the body makes ___ corticosteroids, in addisons the body make ___ corticosteroids
too much
not enough
addison’s usually happen __
at younger age in female and certain dog breeds
three causes of addison’s disease
primary
secondary
atypical
what is the most common form of addison’s disease in dogs
primary
primary addisons
most common form of Addison’s disease in dogs.
autoimmune disease in which the immune system attacks the adrenal glands. This causes damage to the glands, making them fail to product sufficient amount of the corticosteroid hormones.
secondary addison’s
lack of (ACTH), whose function is to stimulate the adrenal gland to produce corticosteroids.
ACTH is produced by the pituitary gland, which may fail to produce sufficient amount of ACTH due to injury, inflammation, or a pituitary tumor.
atypical addisons
Just like primary Addison’s, atypical Addison’s occurs when the adrenal glands fail to work properly.
adrenal glands fail to secrete sufficient amount of the glucocorticoid hormones only, whereas the electrolyte balances are usually normal.
how to test for addison’s
short synacthen test
short synacthen test
addison’s test
give artificial ACTH
increased cortisol = normal
no change in cortisol = primary Addison’s
low cortisol = primary adrenal insufficiency- Addison’s→ damaged adrenal
or secondary adrenal insufficiency- lack of adrenal stimulation from ACTH- need to test ACTH levels as well
how to test for secondary addisions
short synacthen test
low cortisol
and then ACTH test → lack of adrenal stimulation from ACTH
treatment for addisons
hormone replacement therapy
Daily glucocorticoids, such as Prednisolone, and/or mineralocorticoids, such as Fludrocortisone.
how does the thyroid gland activate
TRH from hypothalamus
TSH from pituitary
Thyroid gland
thyroglobulin and iodine → T4
T4 + deiodinases → T3 or reverse T3
also makes calcitonin C cells (neuroendocrine function)
T3 and T4 cells and calcitonin-C cells are made by the
thyroid gland
how to increase T3
iodine, vitamine A, B2, B12, B6
how to increase rT3
abnormal cortisol
T4 medications
Vit D deficiency
estrogen dominances
high TPO antibodies
the more ___ you make, the more hypothyroid you are
rT3
common thyroid glands
hashimoto’s thyroiditis
grave’s disease
hyperthyroidism
hyporthyroidism
hashimoto’s thyroiditis
autoimmune thyroid disorder
hypothyroidism
cause and symptoms of hypothyroidism
fatigue, weight gain, lethargy (belly fat and rough coat in animals)
hashimoto’s thyroiditis, iodine deficiency, lithium (treatment for hyperthyroid)
The most common signs of hypothyroidism in are skin ___, weight ___, inactivity and intolerance to ___ temperatures
disease (flacky)
gain
cold
grave’s disease
hyperthyroidism
more common in females
bulging eyes, goiter, enlarged thyroid
heart intolerance
irritability
treatment for grave’s
medications
RAI (radiated iodine)
surgery
treatment for hypothyroidism
replacement hormone therapy
In the US, there are two antithyroid medications available—propylthiouracil (PTU) and methimazole (also known as Tapazole). The medications are similar, as they both stop the thyroid from producing ___ hormones.
T3 and T4
thyroid cancer happens more in ___
males
symptoms of thyroid cancer
neck pain, lump in neck, difficulty swallowing
cause thyroid cancer
history of exposure to high doses of radiation
family history
treatment of thyroid cancer
surgery
radioactive iodine uptake therpay
parathyroid hormone
regulate calcium levels
what is the only element that has its own regulatory system
calcium- controlled by parathyroid hormone
parathyroid hormone acts of the ___, ___ and ___ to control calcium levels
bones, kidneys, intestines
PTH in bones will cause ___
release of calcium
PTH in kidneys will cause___
reduce calcium clearance. Vit D activation, phosphate balance
PTH in the intestine causes ___
activated vit D helps absorb calcium in the gut
high calcium will trigger:
PTH to act on kidneys to activate vit D, this will cause intestine to absorb more calcium
parathyroid hormone works using which 2nd messenger?
cAMP
hyperparathyroidism
- osteoporosis
- kidney stones
- heart disease
- high blood pressure
Hypoparathyroidism
- Tingling or burning (paresthesia) in your fingertips, toes and lips.
- Muscle aches or cramps in your legs, feet, abdomen or face.
- Twitching or spasms of your muscles, particularly around your mouth, but also in your hands, arms and throat.
- Fatigue or weakness.
Treatment for hyperparathyroidism
Calcimimetics:A calcimimetic is a drug that mimics calcium circulating in the blood-inhibits PTH and Ca.
Hormone replacement therapy
Bisphosphonates-prevents bone loss
treatment for hypoparathyroidism
Direct injection of parathyroid hormone is risky!
Alternate: Teriparatide (Forteo) – stimulates new bone growth. It is used to treat osteoporosis in people who are at high risk of fractures, most often postmenopausal women.
pineal gland
deep in cerebral cortex
3rd eye
secretes melatonin: regulates sleep
how to form melatonin
tryptophan → serotonin→ melatonin
melatonin governs the entire ___ cycle,
sleep/ wake
___ is involved more specifically in wakefulness, in triggering sleep, and in REM sleep.
serotonin
what will inhibit melatonin production?
caffeine
___ is the key hormone that stabilizes our mood, feelings of well-being, and happiness.
Serotonin
melatonin can be used for ___ and ___ in animals such as sheep
treat hair loss in dogs
control fertility in sheep
___ is foundational for a healthy pregnancy. It acts as an important antioxidant to improve egg and sperm quality. It also regulates the hormones needed for ___ and then implantation.
Melatonin
ovulation
Thymus gland
2 lobed organ, large in infants but shrinks with age
make T-lymphocytes (white blood cells)
hormone function: promote production and maturation of T lymphocytes
thymus producing thymosins
common thymus disease
myasthenis gravis
myasthenia gravis
depletion/blocking of acetylcholine receptors at the neuromuscular junction
issue with thymosins maintaining immune balance.
pure red cell aplasia and hypogammaglobulinemia
treatment for myasthenia gravis
acetylcholinesterase inhibitor
corticosteroids
pancrease
insulin and glucagon release
alpha cells: secrete glucagon
beta cells: secrete insulin
gamma cells: release somatostatin, a paracrine inhibitor of both insulin and glucagon secretion
F cells: rare: produce pancreatic polypeptide
glucagon→ ___ glucose signal
low
insulin → ___ glucose signal
high
type 1 DM
insulin dependent
treatment give insulin
type 2 DM
insulin resistant, body makes insulin but it can’t get into cells, receptors for glucose are messed up
symptoms of issues with the pancreas
diabetes
increased hunger and thirst
weight loss
increased urination
blurry vision
extreme fatigue
sores that don’t heal
treatment for DM/ issues with the pancreas
insulin injections
metformin (type 2 )
exercise
what is used to make sex hormones?
cholesterol
sex hormones= steroid hormones
The ___ are a group of hormones responsible for controlling puberty, reproduction, birth, and lactation.
sex hormones
Sex hormone disorders, also referred to as ___ hormone disorders, are medical conditions that affect the different glands and organs of the body responsible for the production of the sex hormones.
reproductive
The sex hormones, which include ____ are substances that essential in almost every body function, but more so in sexual functions and reproduction
testosterone (male) and estrogen (female)
Both testosterone and estrogen are present in males and females, but the levels differ according to ___
gender
some symptoms of sex hormone disorders
reduced sex drive (libido)
vaginal dryness
infertility
excessive body hair.
In men, testosterone is primarily produced in the testicles, but other glands and organs in the endocrine system, such as ___ are also involved
the adrenal glands
In women, the ovaries produce ___, but the adrenal glands also help in the production and/or regulation of the hormone.
estrogen
some functions of estrogen
female sexual characteristic
lipogenic effect
prevention of bone loss (promote bone growth)
hypocholesterolemic effect (lowers cholesterol)
how does aromatase inhibitors work for breast cancer?
cholesterol → androstendedione (aromatase) → estrone and estriol
cholesterol → androstendedione → testosterone (aromatase) → estradiol
anti aromatase = no estrogens
steroidogenesis of dihydrotestosterone
cholesterol → pregenenolone (3 beta- HAS) → testosterone (5alpha reductase)(NADPH)→ dihydrotestosterone
cholesterol → testosterone happens in the leydigg cells of the testes and theca cells of the ovaries
5 alpha reductase happens in peripheral tissue such as skin, prostate and epididymis
steroidogenesis of estrogen
cholesterol → pregnenolone (3beta HSD)→ progesterone → testosterone (aromatase)→ estrogen
progesterone can turn into ___ and ___
progesterone → cortisol and aldosterone
progesterone → testosterone → estrogen
when is NADPH needed in sex hormone formation
testosterone (5 alpha reductase)(NADPH) → dihydrotestosterone
first step of cholesterol into sex hormone
cholesterol (mitrochondrial enzyme) → pregnenolone
CYP12A1 is an enzyme also called ___ and changes ___ into ___
17 aplha hydroxylase, 17, 20 lyase
progesterones into testosterone
pregnenolone (17 aplhahydroxylase) → 17 alpha hydroxypregnenolone (17,20 lyase) → dehydroepiandrosterone
CYP19A1 also called ___ can change testosterone into ___
aromatase
estrogens (estrone and estradiol and estriol)
where does the reaction of testosterone into dihydrotestosterone occur
5 alpha reductase happens in peripheral tissue such as skin, prostate and epididymis
where does the reaction of androgens into estrogens occur
aromatase
happens in the granulosa cells of the ovary
testosterone into estrogens (estradiol)
where does the reaction of cholesterol into testosterone occur
adrenal cortex, leydig cells of the testes and theca cells of the ovaries
high dihydrotestosterone leads to
hair loss
___ are a class of steroid hormones which control the development and maintenance of female sexual characteristics
Estrogens
___ synthesis occurs in the granulosa and theca cells of the ovaries, as well as the corpus luteum
glandular estrogen
glandular estrogen synthesis
The granulosa cells are stimulated by LH to produce pregnenolone
Pregnenolone diffuses out of these cells to adjacent theca cells
Theca cells express 17,20-lyase and 3β-HSD, which mediate the conversion of pregnenolone to androstenedione via DHEA
Most androstenedione returns to the granulosa cells and is converted to estrone by aromatase, which is then converted to estradiol by 17β-HSD
The expression of aromatase and 17β-HSD is controlled by FSH stimulation
extraglandular synthesis of estrogen
Aromatase is expressed in non-gonadal sites and facilitates peripheral aromatization of androgens to estrone.
Fat cells: increases serum estrogens by converting androgen to estrone.
Bone: converts testosterone to local estrogen to help mature the epiphyses.
___ is synthesized from pregnenolone by action of 3β-HSD in the corpus luteum, by the placenta during pregnancy; as well as by the adrenals, as a step in androgen and mineralocorticoid synthesis.
Progesterone
The products of hormone synthesis vary with the menstrual cycle; ___ is the main product during follicular maturation, whereas ___ is the main product in the luteal phase following ovulation.
estradiol
progesterone
polycystic ovarian syndrome
also called polycystic ovary syndrome, occurs when a woman experiences hormonal imbalance.
menstruation difficulties or problems in conceiving a child.
The condition can also result in unwanted changes in her appearance.
____ is characterized by excessive male pattern hair growth caused by increased levels of the male hormone testosterone and other androgens.
hirsutism
Hirsutism is characterized by ___ hair growth caused by increased levels of the male hormone testosterone and other androgens.
excessive male pattern
___ also referred to as sex hormone deficiency, is a condition characterized by the under production of the sex hormones. Some of the most common symptoms are fatigue, muscle loss, low bone density, anemia, and reduced sex drive
Hypogonadism
PCOS is caused by
insulin resistance → high insulin trigger ovaries to make testosterone
increased stress and increased body fat → testosterone production
leads to diabetes, fertility issues and hirsutism
treatment for PCOS
metformin
try to increase insulin sensitivity in cells, so body decreases the overall amount of insulin it creates leading to decrease in testosterone
how does estrogen signaling work?
lipid soluable hormone (gets into cell easily)
ligand dependent signaling (estrogen gets into nucleus or triggers another pathway in cell)
ligand independent signaling
ligand other then estrogen will use estrogen pathway to get into cell and cause trouble
estrogen signaling can have a ___ and ___ response
genomic and nongenomic
(can go into cell and into nucleus or can go into cell and trigger stuff from the cytoplasm)
hormone signaling in normal breast development
estrogen formation of terminal end buds and ductal network
progesterone: more ducts and branching
prolactin: lactatogenesis
estrogen in HRT alone can increase risk for ___ cancer, breast cancer and endometrial cancer
ovarian
estrogen receptor alpha is a ___ and estrogen receptor beta is a ___, what is an exception?
oncogene
tumor supressor
TNBC and IBC
hormonal endocrine therapies for breast cancer
decrease ligand
block receptor
tamoxifen (selective estrogen receptor modulators) and fulverstrant (selective estrogen receptor down regulator)
endocrine resistance in breast cancer
over time will develop resistance
Luminal A- high responsiveness to ET
Luminal B- Lower endocrine sensitivity
