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Physiology MRCEM part 1 > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

Alpha cells of the pancreas produce?

A

Glucagon

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2
Q

Beta cells of the pancreas produce?

A

Insulin

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3
Q

Delta cells of the pancreas produce?

A

Somatostatin

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4
Q

Epsilon cells of the pancreas produce?

A

Ghrelin

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5
Q

Gamma / F cells of the pancreas produce?

A

Pancreatic polypeptide

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6
Q

What does Ghrelin stimulate?

A

Appetite, increase food intake and promotes fat storage

Also stimulates release of growth hormone from the pituitary gland

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7
Q

Glucagon MOA

A

Acts on G-protein coupled receptor to stimulate cAMP production

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8
Q

Impact of glucagon on blood levels:

Glucose
Fatty acid
Ketoacid

A

ALL INCREASE

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9
Q

Glucagon major actions:

A

Decrease glycogenesis
Increase glycogenolysis
Increase gluconeogenesis
Decrease fatty acid synthesis
Increase lipolysis
Increase ketoacid production

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10
Q

Impact of insulin on blood levels:

Glucose
Fatty acid
Ketoacid
K+
Aminoacid

A

DECREASE

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11
Q

Insulin MOA

A

Acts on tyrosine kinase receptor to activate the intracellular pathway that results in translocation of GLUT-4 transporter to the plasma membrane

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12
Q

Insulin major actions

A

Increase glucose uptake into cells
Increase glycogenesis
Decrease gylcogenolysis
Decrease gluconeogenesis
Increase protein synthesis (decrease degradation)
Increase fat deposition (reduce lysis)
Reduce ketoacid production
Increase K+ uptake

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13
Q

What simulates insulin release?

A

During eating by the parasympathetic system

Gut hormone secretin

Rise in plasma glucose concentration after a meal (most)

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14
Q

Where is somatostatin secreted from?

A

D cells n pyloric antrum, duodenum and pancreatic islet

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15
Q

What stimulates somatostatin secretion?

Inhibits?

A

H+ in GI lumen

Vagal stimulation

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16
Q

Actions of somatostatin?

A

Inhibits gastric acid secretion (directly on parietal cells and via G-protein coupled receptors, indirectly via inhibition of gastrin and histamine secretion)

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17
Q

Which hormones does somatostatin inhibit?

and therefore mediates ….

A

Insulin
Glucagon
Cholecystokinin
Secretin
GIP

DECREASED gastric and intestinal mobility
Decreased gastric and intestinal secretions
Decreased pancreatic endocrine and exocrine function
Decreased bile production

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18
Q

Main action of pancreatic polypeptide

A

The primary role of PP is to modulate digestion of food by inhibition of gastric emptying as well as biliary secretion

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19
Q

Hormones secreted by the ANTERIOR pituitary gland ?

A

FSH
Prolactin
TSH
ACTH
LH
GH

Fresh pituitary tastes almost like guinness…

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20
Q

Hormones secreted by the POSTERIOR pituitary gland ?

A

Oxytocin
ADH

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21
Q

POSTERIOR pituitary is a direct extension of?

A

Hypothalamus

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22
Q

Control most pituitary hormones except oxytocin is by which type of feedback mechanism?

A

Negative

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23
Q

Action of ACTH

A

acts on the adrenal cortex to stimulate glutococoticoid and

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24
Q

What stimulates ACTH release?

A

CRh

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25
ACTH Deficiency -> Excess ->
Secondary adrenal insufficiency Cushing's disease
26
ADH action
Acts on the KIDENYS to increase water permeability in the DISTAL NEPHRON Allowing greater water reabsorption and concentration of urine Also acts on vascular smooth muscle causing vasoconstriction
27
What mainly stimulates ADH release?
Raised plasma osmolality detected by osmoreceptors in the Ant. hypothalamus
28
What inhibits ADH release?
Low plasma osmolality Alcohol Caffeine Glutocorticoids ANP
29
ADH deficiency -> Excess ->
Central diabetes insipidus SIADH
30
Three zones of the adrenal cortex
Outer glomerulosa Middle zona fasciculata Inner zone reticularis
31
Outer glomerulosa releases what? + example
Mineralcorticoids e.g. aldosterone
32
Middle zona fasciculata releases what? + example
Glucocorticoids e.g cortisol
33
Inner zone reticularis release what?
Androgens and stress hormones
34
Mineralcorticoids e.g aldosterone regulate?
Salt and water homeostasis
35
Glucocorticoids e.g. cortisol regulate?
Carbohydrate metabolism and response to stress
36
What regulates cortisol release?
ACTH
37
What regulates aldosterone release?
RAS
38
what does the adrenal medulla release ?
Catecholamines
39
Which zones of the adrenal cortex are typically affected in primary adrenal insufficiency (addisions)
All three
40
Aldosterone release stimulated by (3)
Angiotensin II (secondary to fall in blood volume, BP or plasma sodium) High K+ ACTH (least important)
41
Where does aldosterone act in the kidney?
Distal convoluted tuble
42
Action of aldosterone at the DCT?
Sodium retention and potassium loss (increase synthesis of transport mechanisms)
43
Which part of the brain drives the stress response and what does it lead to?
amygdala stimulates CRH neurons -> ACTH stimulates sympathetic nervous system stimulates parasympathetic nerves that cause acid secretion in the stomach Fear
44
What stimulates tyrosine breakdown by specific enzymes to create catecholamines?
Cortisol
45
What receptors do catecholamines act on?
Alphas and beta G protein coupled receptors
46
Alpha 1 adrenergic receptors Main stimulator Actions
Noradrenaline > adrenaline Vasoconstriction Increase PVR Increased B Mydriasis Increased closed bladder sphincter
47
Alpha 2 adrenergic receptors Main stimulator Actions
Adrenaline > Noradrenaline Inhibits NA release Inhibits ACh release Inhibits insulin release
48
Beta 1 adrenergic receptors Main stimulator Actions
Adrenaline = Noradrenaline Increase HR Increased lipolysis Increase myocardial contractility Increases renin
49
Beta 2 adrenergic receptors Main stimulator Actions
Adrenaline >> Noradrenaline Vasodilation Decrease PVR Bronchodilation Glycogenolysis Glugacon release Relaxes uterine smooth muscle e
50
Common presenting sx of phaeochromocytoma?
Headache / sweating / pallor / palpitations
51
Phaeochromocytoma aetiology?
Catecholamine secreting tumour
52
diagnosis of Phaeochromocytoma
Biochemical confirmation of elevated catecholamines followed by radiological localisation of the tumour
53
Cushing's syndrome =
Clinical signs & symptoms related to chronic glucocorticoid excess
54
Cushing's disease =
Excess corticosteroids due to ACTH secreting pituitary adenoma
55
Causes of Cushing's syndrome (3)
Excess ACTH (pituitary or ectopic ACTH secreting tumour) Excess cortisol (adrenal tumur) Exogenous steroids
56
Where is Ca2+ mainly absorbed?
Duodenum and proximal jejunum (some in S. intestine)
57
How to activated Vit D act in the gut?
To increased Ca2+ gut absorption
58
How does pH act on Ca2+ levels?
Increase in pH (alkalosis) promotes increased protein binding, decreasing free Ca2+ levels (competes with H+ ions for binding sites on albumin etc)
59
What mainly drives Ca2+ reabsorption in the nephron?
Na2+ reabsorption
60
Where in the kidney is the main target for hormonal control of Ca2+?
Distal nephron
61
How does parathyroid hormone control Ca2+?
Acts on the kidney to increase calcium re-absorption in the distal tubule Activates Ca2+ entry channels in the apical membrane and Ca2+ ATPase pumps in the basolateral membranes Also stimulates osteoclasts to release Ca2+ from bone
62
How does activated Vit D control Ca2+?
Activates Ca2+ ATPase pumps in the basolateral membranes
63
PTH action on phosphate reabsorption?
Decrease phosphate reabsorption in the proximal tubule
64
Activated Vit D action on phosphate reabsorption?
Increase phosphate reabsoprtion
65
How does calcitonin control Ca2+?
Inhibits renal reabsorption of calcium Osteoclast activity inhibited
66
What synthesises PTH?
Chief cells of the parathyroid gland
67
PTH is released in response to...
Decrease plasma Ca2+ Increased blood phosphate level
68
Action of PTH on the kidneys
Increase Ca2+ reabsorption Increase phosphate excretion Inhibit bicarb re-absorption -> metabolic acidosis -> favour dissociation of calcium from plasma proteins Stimulate 1-alph-hydroxylase in the kidneys to produce MORE activated vit D
69
How does PTH act on the gut?
Increase calcium and phosphate absorption in the small intestine (via activated vit D)
70
How does PTH act on bone?
Increase calcium and phosphate resorption
71
Pre vit D3 -> activated Vit D
Pre Vit D -> cholecalciferol (D3) -> Calcitrol in the liver via enzyme -> Activated Vit D in the kidneys via enzyme
72
Action of activated Vit D on the gut?
Increase Ca2+ and phosphate absorption in the small intestine
73
Action of activated Vit D on the kidneys?
Increase calcium reabsorption Increase phosphate reabsorption Negative feedback on the enzyme in the kidney creating activated vit D
74
Enzyme in the kidney creating activated Vit D?
1-ALPHA-HYDROXYLASE
75
What secretes calcitonin?
C cells (parafollicular) cells of the thyroid gland
76
When is calcitonin secreted?
Rising levels of Ca2+
77
Actions of calcitonin?
Act on kidneys to inhibit renal absorption of calcium and phosphate & on bones to inhibit resorption by osteocytes
78
ADH binds to which receptors (2)
V2 on renal principle cells -> increase water reabsorption via aquaporins V1 receptor on vascular smooth muscle, causing vasoconstriction
79
What activates the baroreceptor reflex
A fall in blood pressure detected by a fall in CVP (atrial or other cardiopulmonary stretch receptors)
80
Sympathetic stimulation in baroreceptor reflex, actions:
Peripheral vasoconstriction, increased TPV Renal vasoconstriction to decrease eGFR Stimulate ADH to increase water reabsorption Stimulate release of renin
81
Where are renin producing granular cells found?
Juxtaglomerular apparatus
82
What stimulates renin production
Fall in extracellular fluid volume, CVP or arterial BP Decrease perfusion pressure in renal afferent arterioles Decreased tubular NaCl concentration (detected by macula densa cells) reduced eGFR
83
MOA of benzodiazepines
GABA receptor agonists, enhance inhibitory synaptic transmission throughout the CNS
84
Benzodiazepines duration of action: Midazolam Lorazepam / temazepam Diazepam / chlordiazepoxide
<6hrs 12-18hrs 24-48hrs
85
Why do patients taking antipyschotic drugs get extra pyramidal side effects?
Blockage of dopamine receptors in the basal ganglia
86
Examples of extra pyramidal side effects
Parkinsonian symptoms - tremor, bradykinesia and rigidity Dystonia Dyskinesa Akathsia - motor restlessness Tardive dyskinesia - rhythmic, involuntary movements of the tongue / face / jaw
87
Treatment for acute dystonia
Acute dystonia should be treated with IM/IV anticholinergics (e.g. procyclidine).
88

Physiology MRCEM part 1 (7 decks)

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