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Physiology Endocrine > Clinical > Flashcards

Clinical Flashcards

1
Q

Cushings disease

A

pulsatile pattern of pituitary hormone (anterior) release is altered

poor circadian pattern of corticotropin release

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2
Q

acromegaly

A

GH concentration remains detectable throughout the day

since pulsatile pattern of GH release is altered….sustained hypersecretion of GH

from a slow growing somatotroph tumor

symptoms:

  • thickening and oiliness of skin, particularly of the face
  • thickening and folding of scalp that are visible on skull Xray

gradual progression of symptoms and signs as a result of diagnosis are often delayed 15-20 years

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3
Q

syndrome of inappropriate ADH secretion (SIADH)

A

abnormal release of ADH causes water retention, hyponatremia

most common cause is cancer

therapy = must limit water intake to increase serum sodium

block V2 receptors (conivaptan, and tolvaptan)

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4
Q

Diabetes insipidus

A

deficiency of ADH

characterized by polyuria

caused by destruction of hypothalamic nuclei or defect in the kidney’s to respond to ADH

therapy = desmopressin

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5
Q

oxytocin

A

causes myoepithelial contractions to force milk from alveoli into ducts

and stimulation of SmM in the uterus

used to stimulate labor contractions and stopping immediate postpartum bleeding

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6
Q

estrogen and catecholamine effects on oxytocin

A

estrogen augments effects

catecholamines block them

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7
Q

OTC circulation

A

unbound in plasma and activates a 7 transmembrane domain receptor

causes elevation of Ca2+ and IP3 in target cells

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8
Q

stimuli for OTC release

A

suckling

uterine and genital stimulation

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9
Q

opoids on OTC

A

inhibit release

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10
Q

GH deficiency

A

either cannot secrete enough or cannot respond to its stimuli

short in stature and modestly obese

diagnosis = loss of nocturnal peaks on a diminution of total daily integrated secretion can be used as evidence for a more subtle GH deficiency and for GH replacement therapy

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11
Q

effects of giving GH to patients who are deficient

A

enhances positive nitrogen balance

decreases urea production

redistributes fats and reduces carbohydrat utilization

does NOT increase incidence of diabetes

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12
Q

giving IGFs to GH deficient people

A

decreases plasma amino acids due to increased use of amino acids into protein synthesis

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13
Q

GH on insulin function

A

it stimulates the expression of the insulin gene but

it induces resistance to insulin action

(why can be called a diabetogenic hormone)

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14
Q

disruption of pituitary connections to hypothalamus on prolactin

A

would leave to increase secretion

whereas, other homrones in the pituitary would decrease to a great extent

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15
Q

excess prolactin –>

A

inhibits GnRH release

can lead to lack of ovulation and infertility in women and low sperm in men

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16
Q

thiouracils

A

drugs that block enzyme peroxidases

treat thyroid hyperfunction

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17
Q

iodide treatment for hyper or hypo thryoidism ?

A

hyper

until more definitive therapy is undertaken

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18
Q

negative feedback by T3 and T4

A

inhibit synthesis of both TSH and TRH

T3 blocks the effect of TRH and also suppresses its release

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19
Q

actions of TSH on the thyroid cell

A

(+)cAMP –> (+) Ca2+, phosphoinositol, and growth factors

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20
Q

how TSH stimulates thyroid growth

A

increased DNA, RNA, protein, and phospholipids

increased cell size, number, and follicle formation

21
Q

how TSH stimulates TH secretion

A

increased

  • I trap
  • iodination
  • endocytosis of colloid
  • proteolysis of thyroglobulin
  • glucose oxidation
  • NADPH generation
22
Q

TRH

A

from hypothalamus

stimulates release of TSH by increasing ca2+ and IP3

down regulates and/or desensitizes its receptor thereby diminishes its effectiveness

23
Q

TSH structure

A

2 peptide subunits that come from separate genes

24
Q

what keeps T3 and T4 levels relatively constant

A

negative feedback loop

10-30% changes in TH can change TSH levels in opposite directions

25
Q

T3 suppresses release of what

A

TSH –> represses TSH gene and down regulates the receptor

26
Q

what inhibits TSH secretion

A 
T3
dopamine
somatostatin
cortisol
GH
27
Q

goiter

A

TSH hypersecretion is cause

28
Q

TH deficiency shows what plasma levels of TSH

A

high TSH

and enlarged pituitary gland containing increased numbers of thyrotrophs

29
Q

excess TH causes what

A

low plasma TSH and atrophy of thyrotroph cells

30
Q

what can cause lower TBG levels

A

acute liver disease, pregnancies, and estrogen therapy or kidney disease

31
Q

replacement TH therapy uses T4 or T3

A

T4

32
Q

Hyperthyroidism

A
  1. increase in metabolic rate –> weight loss and an increased intake of food
  2. excessive generation of heat causes discomfort in warm environments, sweating, thirst, and increased ventilation
  3. muscle weakness, atrophy, and osteoporesis
  4. high cardiac output, increased heart rate, and increased emotional liability

treatment = beta-adrenergic blockers can be used to ameliorate the clinical manifestation

33
Q

causes of hyperthyroidism

A

Graves’ disease –> autoimmune disease which an antibody binds to TSH receptors and mimics the effects of TSH

benign neoplasm of thyroid unregulated TSH

inflammation of thyroid, excess TSH, ingestion of excess T3 and T4 and high Iodide intake

34
Q

treatment of hyperthyroidism

A

short term iodine excess

treatment with thiouracil for 18mo which blocks synthesis of TH, or ablation of thyroid tissues by radioactive iodine or surgery (most commonly used procedure)

35
Q

hypothyroidism

A

mental retardation and delayed body development

lethargy, growth retardation, and poor performance

in both children and adults….the decreased metabolic rate causes intolerance of cold, decreased sweating, dry skin, a low CO, and weight gain

36
Q

what is hypersecretion of insulin usually caused by?

A

tumor of beta cells

leads to hypoglycemia

37
Q

what is a consequence of hypoglycemia (which can be caused by too much insulin)

A

need to ingest large amounts of carbs

this plus high insulin –> weight gain

38
Q

effect of sepsis, major fractures, surgery, or hypoglycemia on cortisol production

A

increases it

39
Q

negative nitrogen balance from prolonged cortisol exposure

A

in case of Cushing’s

skin becomes very thin and the loss of CT and capillaries that can rupture spontaneously

causes bruises

40
Q

long term treatment of pharma doses of glucocorticoids makes patients susceptible to

A

infection, diabetes, and osteoporesis

41
Q

cortisol replacement therapy can be used to treat

A

Addison’s diseaes

42
Q

cortisol deficiency can lead to (Addison’s)

A

weight loss, fatigue, poor tolerance to stress, fever, and or low glucose

43
Q

ANP and BNP effect on aldosterone release

A

potently inhibit

44
Q

what are best markers for fetal well being and placental adequacy

A

rising serum or urine estriol levels

16-OH-DHEA-S –> estriol

45
Q

Androgenital Syndrome can be caused by…

A

androgen producing tumors or by the lack of negative feedback on ACTH

46
Q

androgen deficiencies usually arise from

A

autoimmune deficiencies of adrenal glands or from congenital enzyme defects

or deficiency in ACTH

47
Q

Addison’s

A

progresses slowly with loss of androgens –> anemia and loss of boddy hairs

reduced cortisol –> fatigue, poor stress tolerance

low aldosterone –> low bp etc

low weight

48
Q

Cushing’s

A

too much cortisol –> obestity and muscle weakness due to adrenal or pituitary dysfucntions

Physiology Endocrine (7 decks)

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