Flashcards in Endo Deck (61):
Most common tumor of ad med in kids?
- can it cause episodic HTN?
- No, but a pheo in adults can
- derived from?
- how to hormones get to it?
- via neurophysins (carrier pr's), from the hypo
Ant pit is derived from?
- a-subunit of hormone is same in?
- which hormones are acidophils?
- which are basophils?
- what are the hormones it secretes?
Oral ectoderm (Rathke's pouch)
- TSH, LH, FSH, hCG
- GH, PRL
- B-FLAT: Baso's-FSH, LH, ACTH, TSH
- FLAT PiG: FSH, LH, ACTH, TSH, GH, PRL
Islet of Langerhans in panc contain what 3 cells? which make what?
a-cells: glucagon (on periph)
b-cells: insulin (centrally located)
gamma-cells: somatostatin (interspersed)
How does Glc stim insulin release?
Glc metab'n -> ATP which closes K+ ch's and depol's b-cell mem -> opens V-gated Ca ch's -> Ca influx stim's exocytosis of insulin granules
Which body parts don't need insulin to take up Glc?
- GLUT-1, 2, 4 =
BRICK L: Brain, RBCs, Intestine, Cornea, Kidney, Liver
- 1=insulin indepen. (RBCs, brain)
- 2=bidirec (b-cells, liver, kidney, smI)
- 4=insulin dep (adipose, SkM)
How do these affect insulin release:
- high Glc
- incr insulin
- incr (bc incr's insulin resistance)
What 2 paths does insulin binding its R take?
1) TK phos'n -> PI3-kinase pthwy -> GLUT-4 to surface, also syn of glycogen, lipids and pr
2) RAS/MAP kinase pthwy -> cell growth, DNA syn
Somatostatin inhib's which 2 hormones?
TSH and GH release from ant pit
- stim'd by?
- inhib'd by?
- DA from hypo, PRL also stim's DA -> less PRL
- works thr?
- secretion stim'd by? inhib'd by?
- IGF-1/somatomedin secretion
- exercise and sleep; glc and somatostatin
17a-hydroxylase defic =
XY and XX effects?
Can only make mcc's -> HTN and hypoK
XY: decr'd DHT -> pseudohermaph.
XX: nl F but no 2* sex charac's
3 types of congenital bilat ad hyperplasia?
17a-hydroxylase defic (only mcc's)
21-hydroxylase defic (only androgens) (most common)
11b-hydroxylase defic (androgens + 11-deoxycorticosterone)
21-hydroxylase defic =
- in Females?
Can only make androgens -> hypotension, hyperK, incr'd RAAS, vol depletion
- masculinization -> pseudohermaph
11b-hydroxylase defic =
- in Females?
Can only make androgens, 1 step further than 21-hydrox though so do make 11-deoxycorticosterone
- HTN from 11-deoxycorticosterone (mcc) and masculinization
- get striae from?
BBIIG = BP (upreg's a1Rs so incr's sensitivity on vessels), decr's Bone formation, anti-Inflamm/Immsupp'ive, Insulin resistance (diabetogenic), Gluconeogenesis (also lipolysis and proteolysis)
- inhib's fibrobl's
- effect on Ca and phos
- effect on VitD
- how do Ca and Mg affect its release? what about phosphate?
- incr bone resorption of them, incr Ca reab'n in DCT, decr phos reab'n in PT (phos trashing hormone!)
- incr 1,25-(OH)2D (calcitriol) prod in kidney by stim'ing 1a-hydroxylase
- decr'd Ca/Mg incr's PTH, but very decr'd Mg decr's PTH; incr'd phos -> incr'd PTH, decr'd phos -> decr'd PTH
Get decr'd Mg from?
- effect on PTH?
D, aminoglycosides, diuretics, EtOH abuse
- incr'd PTH secretion, unless it's really low then it decr's PTH
- made where?
- stim'd by?
- low phosphate or Ca and high PTH upreg the NZ that makes it
- incr's ab'n of dietary Ca and PO4 in GI, incr's bone resorption of Ca and PO4
- stim'd by
decr bone resorption of Ca (opposes actions of PTH) [incr's bone mineralization]
- incr'd serum Ca (not imp in nl Ca homeostasis)
Which hormones act via cAMP?
Which act via cGMP?
- FLAT ChAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 R), MSH, PTH + calcitonin, GHRH, glucagon
- Vasodilators: ANP, NO (EDRF)
Which hormones act via IP3?
- GGOAT: GnRH, GHRH (minor role), Oxytocin, ADH (V1 R), TSH + hist (H1), ATII, gastrin
Which hormones act via a steroid R?
VETTT CAP: VitD, Estrogen, Testos, T3/T4, Cortisol, Aldosterone, Progesterone
Which hormones signal thr a intrinsic TK R?
Which hormones have a R-assoc'd TK?
- GFs and MAP kinase pthwy: insulin, IGF-1, FGF, PDGF, EGF
- PIG + JAK/STAT: PRL, Immunomodulators (cytokines IL-2,6,8, IFN), GH
Wolff-Chaikoff effect =
excess iodine temp'ly inhib's thyroid peroxidase -> decr'd iodine organification -> decr'd T3/T4 production
4 B's: Brain maturation, Bone growth, b-adrenergic effects (incr's b1Rs on heart -> works better and harder), Basal metab rate (incr's Na/K ATPase so incr'd O2 consump) (also incr's E by glycogenolysis, gluconeogenesis, lipolysis)
TBG incr's/decr's when?
- T4 -> T3 by?
- which NZ
TBG decr's in hep failure, also w/ anabolic steroids or nephrotic synd (lost in urine) -> more free T3 to work (decr'd total serum T4, but nl FT4 and nl TSH)
TBG incr's in preg and w/ OCP use (estrogen!) -> less free T3 (more T4 bound to more TBG, but FT4 is still the same even though more T4 overall -> nl TSH)
- 5'-deiodinase in periph
How does body keep euvol state in SIADH?
- If Na gets really low, what happens?
- What drug can cause SIADH?
Decr'd aldos -> decr'd water retention to maintain near-nl vol status
benign tumor from Rathke's pouch remnants
- most common cause of hypopit in kids
Empty sella synd
- usu occurs in who?
- what happens?
obese women w/ HTN
- subarachnoid space extends into sella and fills up with CSF -> compresses pit gl
5Ps: Pot-bellied, Pale, Puffy-faced child w/ Protruding umbilicus and Protuberant tongue
Fixed, hard (rock-like) and painless goiter?
- Hashimoto's thyroiditis
- Subacute thyroiditis (de Quervain's) (self-limited, post viral illness)
- Riedel's thyroiditis (replaced by fibrous tissue)
- Autoimm, usu post partum w/ no germinal follicles in gland
Jod-Basedow phenomenon =
thyrotoxicosis if a patient w/ severe iodine defic goiter is made iodine replete
Thyroid storm =
- may see incr'd ALP from?
stress-induced catecholamine surge -> death by arrhythmia, also high F, shock from V, coma (serious comp of Graves and other hyperthyroid d/o's)
- incr'd bone turnover
Papillary ca of thyroid
- on histo see?
- incr'd risk w/?
Follicular ca of thyroid, on histo see?
- empty-appearing nuc (Orphan Annie's eyes), psammoma bodies, and nuc grooves
- childhood radiation
- uniform follicles
Why does resp/metab alkalosis give you tetany?
Alkalosis incr's (-) on alb (H+ leave it) -> binds more Ca2+ -> same serum Ca level but less free Ca (and thus incr'd PTH) -> partial depol of n's and m's bc lower threshold potential
Effect of PTH on bicarb?
Incr'd PTH decr's bicarb reab'n -> nl anion gap metabolic acidosis (type II RTA)
How is VitD act'd?
In liver by 25-hydroxylase to 23-(OH)D
Then in kidney by 1a-hydroxylase to 1,25-(OH)2D
Why do you get hypoPT from hypoMg?
Need Mg as cofactor for cAMP, which need for PTH act'n
- Ca, phos, cAMP?
- incr'd Ca, decr'd phos, incr'd urinary cAMP
- stones (Ca renal stones), bones (osteitis fibrosa cystica: cysts filled w/ brown fibrous tissue), groans (constipation) and moans (psychosis, confusion, anxiety, coma)
- Ca, phos, alk phos?
- decr'd Ca, incr'd phos if CKD or decr'd if anything else (more PTH, less phos reab'd), incr'd ALP (more bone brkdwn)
Renal osteodystrophy =
bone lesions from 2/3* hyperPT due to renal dz (no VitD, so low Ca, so incr'd PTH)
3* HyperPT =
refractory (autonomous) hyperPT from CKD, incr'd PTH even though incr'd Ca
- hypoCa, tetany
- AD kidney unresponsiveness to PTH (mutation in Gs R)
- hypoCa, short 4/5th digits, short stature
Chvostek's sign =
- sign of?
tapping of facial n. -> contraction of facial m's
- tetany from hypoCa in hypoPT
Trousseau's sign =
- sign of?
occlusion of brachial a. w/ BP cuff -> carpal spasm
- tetany from hypoCa in hypoPT
HTN, hypoK, metab alkalosis, low pl renin =
1* hyperaldosteronism (Conn's synd)
HTN from incr'd Na, alk from incr'd H+ out, low pl renin bc neg fdbk from high aldos levels
HTN, hypoK, metab alkalosis, high pl renin =
2* hyperaldos from renal perception of low IV vol -> incr'd RAAS
Hypotension, hyperK, metab acidosis =
- also have?
Addison's dz (no aldos nor cortisol)
Low Na (hypotension, high K, high H+ from no aldos to run proton pump
- skin pigmentation
Waterhouse-Friderichsen synd =
acute 1* ad insuff from bilat ad hemorrhage, usu from N.meningitidis septicemia, DIC and endotoxic shock
What do you have to give to a pt before removing a pheo?
Irreversible a-blockers (phenoxybenzamine) -> so no HTN crisis
Then b-blockers to slow HR
5Ps: P (high BP), pain (HA and ileus), Perspiration, Palpitations (tachy), Pallor
Pheo rule of 10s:
10% malg, bilat, extra-ad, calcify, kids
- what is high in urine?
overexp'n of N-myc oncogene assoc'd w/ rapid tumor progression
- HVA (DA brkdwn product)
Histo of islet cells in DM type 1 vs. 2?
T1DM - islet leukocytic infiltrate
T2DM - islet amyloid (AIAPP) deposit
Kussmaul respirations =
- seen in?
Rapid and deep breathing
Sx of DKA?
Kussmal resp's, N/V, ab pain, psychosis/delirium, dehydration, fruity breath odor (due to exhaled acetone)
- IV fluids and IV insulin, K+ (to replete IC stores), glc if needed to prevent hypoGlc
Carcinoid synd, rule of 1/3 = ?
- most common location
1/3 met, 1/3 present w/ 2nd malig, 1/3 mult
MEN 1 (Wermer's synd) =
- presents w/?
PT, pit (PRL or GH) and panc endo tumors (ZES, insulinomas, VIPomas, glucagonomas)
- kidney stones and stomach ulcers (ZES)
MEN 2A (Sipple's synd) =
Medullary thyroid ca (calcitonin), pheo, PT tumor