ENDOCRINE Flashcards
(216 cards)
1
Q
Negative feedback mechanism within the pancreas for glucagon and insulin levels
A
2
Q
What is the pancreas?
A
A triangular gland located partially behind the stomach.
3
Q
What types of cells does the pancreas have?
A
The pancreas has both exocrine and endocrine cells.
4
Q
What do acinar cells produce?
A
Acinar cells (exocrine) produce enzyme-rich juice for digestion.
5
Q
What are pancreatic islets?
A
Pancreatic islets (islets of Langerhans) contain endocrine cells.
6
Q
What types of cells are in pancreatic islets?
A
Pancreatic islets have two different types of cells: Alpha (α) cells and Beta (β) cells.
7
Q
What do alpha (α) cells produce?
A
Alpha (α) cells produce glucagon (hyperglycemic hormone).
8
Q
What do beta (β) cells produce?
A
Beta (β) cells produce insulin (hypoglycemic hormone).
9
Q
What is glucagon?
A
An extremely potent hyperglycemic agent.
10
Q
What triggers glucagon release?
A
Triggered by decreased blood glucose levels, rising amino acid levels, or sympathetic nervous system.
11
Q
How does glucagon raise blood glucose levels?
A
By targeting the liver to break down glycogen into glucose (glycogenolysis), synthesize glucose from lactic acid and other noncarbohydrates (gluconeogenesis), and release glucose into the blood.
12
Q
When is insulin secreted?
A
Insulin is secreted when blood glucose levels increase.
13
Q
How is insulin synthesized?
A
Synthesized as proinsulin (inactive) that is then modified.
14
Q
Is insulin needed for glucose uptake in all tissues?
A
Not needed for glucose uptake in liver, kidney, or brain.
15
Q
What role does insulin play in the body?
A
Plays a role in neuronal development, learning, and memory.
16
Q
What does insulin binding to its receptor trigger?
A
Triggers the cell to increase glucose uptake for use or storage.
17
Q
How does insulin lower blood glucose levels?
A
By enhancing membrane transport of glucose into fat and muscle cells, inhibiting breakdown of glycogen to glucose, and inhibiting conversion of amino acids or fats to glucose.
18
Q
What is metformin?
A
A non-insulin medication that helps with glucose uptake in the liver, causing stomach upset and decreasing A1C levels.
19
Q
What happens when glucose is pushed down into the kidneys with non-insulin medications?
A
Causes UTI.
20
Q
What can insulin trigger cells to do?
A
Catalyze oxidation of glucose for ATP production, polymerize glucose to form glycogen, and convert glucose to fat (particularly in adipose tissue).
21
Q
What hormone dominates post-prandial?
A
Insulin.
22
Q
What causes polyuria?
A
Glucose builds up in the tubules caused by osmotic diuresis, leading to water following into the tubule due to influx of glucose.
23
Q
Why are diabetics always hungry?
A
Their body thinks they are starving due to increased breakdown of fat and proteins, which can result in ketoacidosis.
24
Q
Who is more commonly affected by ketoacidosis?
A
DMT1.
25
What do gonads produce?
Gonads produce the same steroid sex hormones as those of the adrenal cortex, just in lesser amounts.
26
What hormones do ovaries produce?
Ovaries produce estrogen and progesterone.
27
What are the functions of estrogen?
Maturation of reproductive organs and appearance of secondary sexual characteristics.
28
What does estrogen do with progesterone?
With progesterone, it causes breast development and cyclic changes in uterine mucosa.
29
Testis produce testosterone
Initiates maturation of male reproductive organs
Causes appearance of male secondary sexual characteristics and sex drive
Necessary for normal sperm production
Maintains reproductive organs in functional state
30
Osteoblasts in bone secrete
Osteocalcin.
Prods pancreas to secrete more insulin; restricts fat storage; improves glucose handling; reduces body fat
Activated by insulin. Low levels of osteocalcin are present in type 2 diabetes: perhaps increasing levels may be new treatment
31
What does skin produce?
Skin produces Cholecalciferol and Calcitriol.
32
What is Cholecalciferol?
Cholecalciferol is a precursor of vitamin D.
33
What is Calcitriol?
Calcitriol is the active form of vitamin D that helps absorb calcium from the intestine.
## Footnote
It also modulates immunity, decreases inflammation, and may act as an anticancer agent.
34
What happens to the thymus with age?
The thymus is large in infants and children but shrinks with age.
35
What hormones are involved in T lymphocyte development?
Thymulin, thymopoietins, and thymosins may be involved in the normal development of T lymphocytes in the immune response.
36
How do most endocrine organs function with age?
Most endocrine organs operate well until old age.
37
What happens to GH levels with age?
GH levels decline with age, which accounts for muscle atrophy.
38
What happens to TH levels with age?
TH levels decline with age, contributing to lower basal metabolic rates.
39
What is the effect of age on PTH levels?
PTH levels remain fairly constant with age, but lack of estrogen in older women makes them more vulnerable to bone-demineralizing effects of PTH.
40
How does glucose tolerance change with age?
Glucose tolerance deteriorates with age.
41
What changes occur in the ovaries with age?
Ovaries undergo significant changes with age and become unresponsive to gonadotropins, leading to problems associated with estrogen deficiency.
42
What happens to testosterone levels with age?
Testosterone diminishes with age, but the effect is not usually seen until very old age.
43
How is TH release regulated?
TH release is regulated by negative feedback.
44
What stimulates the release of TSH?
Falling TH levels stimulate the release of thyroid-stimulating hormone (TSH).
45
What provides negative feedback on TSH?
Rising TH levels provide negative feedback inhibition on TSH.
46
What can inhibit TSH?
TSH can also be inhibited by SST, dopamine, and increased levels of cortisol.
47
Hypothalamic thyrotropin-releasing hormone (TRH)
can overcome negative feedback during pregnancy or exposure to cold, especially in infants
48
Hormone Secretion-Humoral
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Hormone Secretion- Neural (posterior pituitary)
50
Hormone Secretion-hormonal control
51
What is one function of the medulla related to glycogen?
Increased hepatic and muscle glycogenolysis (Provides a quick source of glucose)
52
How does the medulla affect adipose tissue?
Increased breakdown of adipose tissue triglyceride (Provides a supply of glycerol for gluconeogenesis and fatty acids for oxidation)
53
What effect does the medulla have on cardiac function?
Increase cardiac function for increased heart rate
54
How does the medulla manage blood flow?
Diversion of blood from viscera to skeletal muscles by means of vasoconstriction in the former beds and vasodilation in the latter
55
What role does the medulla play in ventilation?
Increased long ventilation by stimulating brain breathing centers and dilating airways
56
What condition is associated with hypersecretion of glucocorticoids?
Cushing’s syndrome/disease
57
What is a primary cause of Cushing's syndrome?
A cortisol-secreting tumor of the adrenal
58
What is a secondary cause of Cushing's syndrome?
ACTH secreting tumor of the anterior pituitary
59
Hyposecretion (adrenal insufficiency)
Primary adrenal insufficiency characterized by low glucocorticoids/mineralocorticoids
Addison’s disease
60
Hyperthyroidism
Grave’s disease
Goiter
61
What is hypothyroidism?
A condition often caused by surgical removal or Hashimoto’s disease.
62
What is the result of hypersecretion of GH in children?
Gigantism.
63
What is the result of hypersecretion of GH in adults?
Acromegaly.
64
What is the result of hyposecretion of GH in children?
Pituitary dwarfism.
65
What is the result of hyposecretion of GH in adults?
Usually causes no problems.
66
What is hypercalcemia?
An elevated level of calcium in the blood.
67
What are the causes of hypercalcemia?
Primary hyperparathyroidism, hypercalcemia of malignancy, and excessive ingestion of vitamin D.
68
What are the signs of hypercalcemia?
Painful bones, renal stones, abdominal groans, sitting on the throne (constipation, polyuria), and psychiatric overtones.
69
Hypocalcemia
Primary hypoparathyroidism
Pseudohypoparathyroidism
Secondary hyperparathyroidism
70
Endocrine System
acts with nervous system to coordinate and integrate activity of body cells
Influences almost everything in our body
Consists of pituitary, thyroid, parathyroid, adrenal, and pineal glands
71
Exocrine vs Endocrine glands
72
What is a neuroendocrine organ?
The hypothalamus, which serves as a big connection between the nervous system and endocrine system.
73
What are hormones?
Long distance chemical signals that are transported in blood.
74
What are endocrine glands?
Glands that secrete hormones directly into the bloodstream.
75
What are exocrine glands?
Glands that secrete a variety of products into ducts, such as sweat glands and sebaceous glands.
76
What are amino acid-based hormones?
Water soluble molecules that include amino acid derivatives, peptides, and proteins (e.g., epinephrine, norepinephrine, dopamine, T3, T4).
77
What are steroid hormones?
Lipid-soluble hormones synthesized from cholesterol, including gonadal and adrenocortical hormones (e.g., cortisol, aldosterone, testosterone, estradiol).
78
How does structure impact hormone function?
It affects response time and half-life.
79
Where do lipid-soluble hormones come from?
They come from the adrenal cortex, gonads, and thyroid gland.
80
How are lipid-soluble hormones stored?
They are not stored in secretory vessels and are bound to plasma proteins.
81
What is the mechanism of action for lipid-soluble hormones?
They activate genes, causing synthesis of new proteins.
82
What are water-soluble hormones?
All amino acid-based hormones except thyroid hormone, which are stored in secretory vesicles and usually free in plasma.
83
What is the half-life of water-soluble hormones?
They have a short half-life and have receptors on the plasma membrane.
84
How do water-soluble hormones act?
Usually acts through second messenger systems across the phospholipid bilayer.
85
What is the role of lipid-soluble hormones in messaging?
They enter the cell and directly bind to impact synthesis in the nucleus for direct gene modification and cellular activation.
86
How are blood levels of hormones controlled?
By negative feedback systems.
87
What controls hormone release?
Endocrine gland stimuli: humoral, hormonal, and nervous system stimuli and modulation.
88
Humoral Stimulus
Calcium ions
Detection of change and making decisions to change and release hormones
Low calcium stimulates the release of PTH
89
Hormonal Stimulus
Hypothalamus will make a decision to release hormones like TSH, GnRH and then these hormones will go to the
Anterior pituitary gland and more hormone will be released and then these hormones will go to the thyroid and the thyroid will release more
90
Neural Stimulus
Sympathetic input is from the spinal cord
Adrenal glands where epi, norepi, and dopamine come from
91
Hormone circulate in the blood either free or bound
Matters especially with thyroid hormone like TSH.
Active vs inactive
Free vs bound
92
Hormonal target cells
DOWNREGULATION VS
UPREGULATION
How many receptors are available- premise for overdose, diabetes, etc.
Up-regulation vs down-regulation
93
Target cell activation depends on three factors
1. Blood levels of hormone
2. Relative number of receptors on/in target cell (modified by up and down regulation)
3. Affinity (strength) of binding between receptor and hormone
94
Hormones and Target cells
95
What are the three ways hormones can interact on the same target?
Permissiveness, Synergism, and Antagonism
96
What is permissiveness in hormone interaction?
One hormone cannot exert its effects without another hormone being present.
## Footnote
Need for a co-stimulatory hormone to stimulate effects.
97
What is synergism in hormone interaction?
More than one hormone produces the same effects on target cells, causing amplification.
98
What is antagonism in hormone interaction?
One or more hormones oppose(s) the action of another hormone.
99
Where does the pituitary gland sit?
In the sella turcica.
100
How is the hypothalamus connected to the pituitary gland?
Via the stalk called the infundibulum.
101
How does the hypothalamus release signals to the pituitary gland?
In a pulsatile manner.
102
How many major hormones does the pituitary secrete?
At least eight major hormones.
103
What are the two major lobes of the pituitary gland?
The posterior pituitary and the anterior pituitary.
104
What is the posterior pituitary composed of?
Neural tissue that secretes neurohormones.
105
What makes up the neurohypophysis?
The posterior lobe along with the infundibulum.
106
What is the anterior pituitary also known as?
Adenohypophysis.
107
What does the anterior pituitary consist of?
Glandular tissue.
108
Anatomy of the hypothalamus and the pituitary gland
109
Anterior vs posterior pituitary gland
110
111
Hormones produce in the hypothalamus and then stored in the posterior pituitary
112
Where are hormones made?
Hormones are made in the hypothalamus.
113
Where are hormones stored?
Hormones are stored in the posterior pituitary.
114
What two neurohormones does the posterior pituitary secrete?
The posterior pituitary secretes oxytocin and antidiuretic hormone (ADH, vasopressin).
115
How are hormones released from the posterior pituitary?
Hormones are stored in the axon terminals in the posterior pituitary and are released into blood when neurons fire.
116
What is ADH also known as?
ADH is also known as vasopressin.
117
What is the function of ADH?
ADH opens aquaporins at the collecting ducts of the kidneys and is responsible for some blood vessel constriction.
118
What is the function of oxytocin?
Oxytocin is a strong stimulant of uterine contractions released during childbirth and acts as a hormonal trigger for milk ejection during breastfeeding.
119
What is oxytocin commonly referred to as?
Oxytocin is commonly referred to as the love hormone for bonding.
120
What type of feedback mechanisms do oxytocin and ADH use?
Both are positive feedback mechanisms.
121
How does oxytocin act in the brain?
Oxytocin acts as a neurotransmitter in the brain and uses a second messenger system.
122
What is the let down reflex?
The let down reflex is the milk ejection at a fast pace.
123
What do osmoreceptors in the hypothalamus monitor?
The hypothalamus contains osmoreceptors that monitor solute concentrations.
124
What happens if solute concentration is too high?
If concentration is too high, the posterior pituitary is triggered to secrete ADH.
125
What type of feedback does ADH secretion follow?
ADH secretion follows a negative feedback mechanism.
126
What is the anterior pituitary composed of?
The anterior pituitary is composed of glandular tissue that is vascularly connected to the hypothalamus via the hypophyseal portal system.
127
What does the hypothalamus secrete to regulate hormone secretion in the anterior pituitary?
The hypothalamus secretes releasing and inhibiting hormones to the anterior pituitary.
128
Hypothalamus and anterior pituitary
129
IGF= insulin growth factor
SST= somatostatin
DA= dopamine
CRH= corticotropin releasing hormone
GH= Growth hormone
ACTH= adrenocorticotropic hormone
FSH= follicle stimulating hormone
LH= Luteinizing hormone
PRL= Prolactin
130
Anti-insulin effects of growth hormone functions
Promotes fat breakdown and gluconeogenesis
Stimulates gluconeogenesis
Reduces the ability of insulin to stimulate glucose uptake by adipose and muscle cells, resulting in higher blood glucose concentrations.
131
What are the gonadotropin releasing hormones?
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
132
What does Follicle-stimulating hormone (FSH) do?
Stimulates production of gametes (egg or sperm)
133
What does luteinizing hormone (LH) promote?
Promotes production of gonadal hormones
134
What does LH do in males?
Promotes production of testosterone
135
What does LH do in females?
Helps mature follicles of egg, triggers ovulation and release of estrogen and progesterone
136
What are the functions of growth hormone?
Induces precursor cells in bone, liver, and other tissues to differentiate and secrete insulin-like growth factor 1 (IGF-1), which stimulates cell division and promotes growth
137
What else does growth hormone stimulate?
Stimulates muscle protein synthesis
138
What inhibits growth hormone?
Inhibited by somatostatin
139
What are the anti-insulin effects of growth hormone?
Particularly at high concentrations
140
What does somatostatin inhibit?
Growth
## Footnote
Inhibits growth hormone and other growth factors.
141
What is the major stimulus of postnatal growth?
Growth hormone
## Footnote
Induces precursor cells to differentiate and secrete insulin-like growth factor 1 (IGF-1), which stimulates cell division.
142
What does insulin stimulate?
Fetal growth and postnatal growth
## Footnote
Stimulates secretion of IGF-1 and protein synthesis.
143
What is the role of thyroid hormone (T3) in growth?
Permissive for growth hormone’s secretion and actions
## Footnote
Also permissive for development of the central nervous system.
144
What is the significance of 3 bound iodine?
It is associated with thyroid hormone (T3)
## Footnote
Essential for its function in growth regulation.
145
How does testosterone affect growth?
Stimulates growth at puberty
## Footnote
Stimulates secretion of growth hormone and causes eventual epiphyseal closure.
146
What role does estrogen play in growth?
Stimulates the secretion of growth hormone at puberty
## Footnote
Causes eventual epiphyseal closure.
147
What effect does cortisol have on growth?
Inhibits growth
## Footnote
Stimulates protein catabolism.
148
What triggers adrenocorticotropic hormone (ACTH) release?
Hypothalamic corticotropin-releasing hormone (CRH)
## Footnote
Often in response to stress, stimulating cortisol release from the adrenal cortex.
149
Functions of cortisol (a glucocorticoid)
Permits action of epi and norepi on smooth muscles to control BP
Helps prevent low blood glucose
Decrease events of inflammatory response (high levels can cause poor wound healing)
Allows for proper fetal development- produced by the fetus
150
What is the role of prolactin in females?
Stimulates milk production in females.
151
What is the role of prolactin in males?
The role in males is not well understood.
152
How is prolactin regulation primarily controlled?
Regulation is primarily controlled by dopamine (DA).
153
What effect does dopamine have on prolactin release?
DA prevents release of PRL until needed; decreased levels lead to lactation.
154
What stimulates prolactin release during the menstrual cycle?
Increased estrogen levels stimulate PRL, causing breast swelling and tenderness.
155
When do blood levels of prolactin rise?
Blood levels rise toward the end of pregnancy.
156
What stimulates prolactin release during breastfeeding?
Suckling stimulates PRL release and promotes continued milk production.
157
What triggers the release of thyroid-stimulating hormone (TSH)?
Release is triggered by thyrotropin-releasing hormone from the hypothalamus.
158
How is TSH inhibited?
Inhibited by rising blood levels of thyroid hormones that act on both pituitary and hypothalamus.
159
T3 functions
Stimulates carbohydrate absorption from the small intestine and increases fatty acid release from adipocytes
Stimulates ATP consumption at a high rate to cause heat production and body temperature homeostasis
Upregulates beta-adrenergic receptors in tissues of the heart and nervous system
Needed for normal production of growth hormone in the anterior pituitary
Exerts many effects on the central nervous system during development, including the formation of axon terminals and the production of synapses, the growth of dendrites and dendritic extensions (called “spines”), and the formation of myelin.
160
Thyroid hormone is found in two forms
T4 (thyroxine): major form that consists of four bound iodine atoms
T3 (triiodothyronine): form that has three bound iodine atoms
161
T4 and T3 transported by
thyroxine-binding globulins (TBGs)
Both bind to target receptors
Peripheral tissues have enzyme needed to convert T4 to T3 [i.e., iodine molecule removal]
T3 is used and T4 is converted to be used
T3 is active and T4 is the stored form
162
What is the thymus?
A butterfly-shaped gland in the anterior neck on the trachea, just inferior to the larynx, that consists of isthmus, follicles, colloid, and parafollicular cells.
163
What is the isthmus?
A median mass connecting two lateral (left and right) lobes.
164
What are follicles?
Hollow spheres of epithelial follicular cells that produce glycoprotein thyroglobulin, a precursor to thyroid hormone, which combines with iodine.
165
What is colloid?
Within follicular cells, The fluid of the follicle in the lumen containing thyroglobulin plus iodine, and is a precursor to thyroid hormone.
Common way to see iodine deficiency
166
What are parafollicular cells?
Cells that produce the hormone calcitonin, which tones down calcium levels in the blood.
167
What is calcitonin?
A hormone produced by parafollicular (C) cells in response to high Ca2+ levels, and is an antagonist to parathyroid hormone (PTH).
168
What is the physiological role of calcitonin at normal levels?
Calcitonin has no known physiological role in humans at normal physiological levels.
169
What are the effects of calcitonin at higher-than-normal doses?
Inhibits osteoclast activity and prevents the release of Ca2+ from the bone matrix, and stimulates Ca2+ uptake and incorporation into the bone matrix.
170
PTH
Four to eight tiny yellow-brown glands embedded in posterior aspect of thyroid that secrete parathyroid hormone (PTH), or parathormone
171
The parathyroid glands function to
Stimulate osteoclasts to digest bone matrix and release Ca2+ to blood
Enhances reabsorption of Ca2+
Promotes activation of vitamin D by kidneys, which leads to increased absorption of Ca2+ by intestinal mucosa
172
Plasma Ca
173
example of permissiveness
binding of epi and norepinephrine two hormones binding
174
How does Vit D function in the body?
The function of vitamin D in the body to promote absorption of calcium from the GI tract to maintain calcium homeostasis
175
Vit D
176
Structurally and functionally, the adrenal glands are two glands in one
Adrenal cortex: three layers of glandular tissue that synthesize and secrete several different hormones
Adrenal medulla: nervous tissue that is part of sympathetic nervous system
177
What hormones favor bone formation and increased bone mass?
Insulin, growth hormone, insulin-like growth factor, estrogen, testosterone, calcitonin
178
What hormones favor increased bone resorption and decreased bone mass?
PTH, cortisol, and Thyroid hormone T3
179
What are the adrenal glands also referred to as?
Suprarenal glands
180
What hormones are produced by the adrenal cortex?
Aldosterone, cortisol, and androgens
181
What hormones are produced by the adrenal medulla?
Epinephrine (Epi) and norepinephrine (norepi)
182
What area of the adrenal gland produces corticosteroids?
Adrenal cortex
183
Are steroid hormones stored in cells?
No, steroid hormones are not stored in cells.
184
What determines the rate of release of steroid hormones?
The rate of release depends on the rate of synthesis.
185
What are the three layers of adrenal cortical cells?
1. Zona glomerulosa: Mineralcorticoids
2. Zona fasciculata: Glucocorticoids
3. Zona reticularis: Gonadocorticoids
186
The medulla is a part of what portion of the nervous system?
sympathetic
187
What do mineralocorticoids regulate?
Electrolyte concentrations (primarily Na+ and K+) in ECF
188
What is the primary mineralocorticoid?
Aldosterone
189
What is the importance of Na+?
Affects ECF volume, blood volume, blood pressure, and levels of other ions (K+, H+, HCO3- and Cl-)
190
What is the importance of K+?
Sets resting membrane potential of cells.
191
What do glucocorticoids influence?
Metabolism of most cells and help resist stressors.
192
What do glucocorticoids help maintain?
Blood glucose levels relatively constant and blood pressure by increasing action of vasoconstrictors.
193
What are the glucocorticoid hormones?
Cortisol (hydrocortisone), cortisone, corticosterone
## Footnote
Cortisol is the only glucocorticoid in significant amounts in humans.
194
Primary regulators
195
What condition is caused by hypersecretion of glucocorticoids?
Cushing’s syndrome/disease
196
What are the effects of glucocorticoids on the body?
Depresses cartilage/bone formation and immune system; inhibits inflammation; disrupts neural, cardiovascular, and gastrointestinal function.
197
What visual disruption may occur due to a tumor on the pituitary gland?
Disruption of vision because a tumor on the pituitary gland sits in the sella turcica and optic chiasm.
198
What are the causes of Cushing’s syndrome?
Tumor on pituitary, lungs, pancreas, kidney, or adrenal cortex; overuse of corticosteroids.
199
What are the Cushingoid signs?
“Moon” face and “buffalo hump.”
200
What are gonadocorticoids?
Adrenal sex hormones, weak androgens (male sex hormones) converted to testosterone in tissue cells, some to estrogens.
201
What are examples of gonadocorticoids?
Androstenedione and dehydroepiandrosterone (DHEA).
202
What do medullary chromaffin cells synthesize?
Catecholamines epinephrine (80%) and norepinephrine (20%).
203
How are medullary chromaffin cells innervated?
Sympathetically innervated by the spinal cord.
204
What are the effects of catecholamines?
Vasoconstriction, increased heart rate, increased blood glucose levels, blood diverted to brain, heart, and skeletal muscle.
205
What is the role of adrenal glands in long term stress?
Hypothalamic stimulation and activation with long term stress.
206
What is the pineal gland?
A small gland hanging from the roof of the **third ventricle.**
207
What do pinealocytes secrete?
Melatonin, derived from serotonin. Pulsatile release
208
What effects may melatonin have?
Timing of sexual maturation and puberty, day/night cycles, physiological processes that show rhythmic variations (body temperature, sleep, appetite), production of antioxidant and detoxification molecules in cells.
209
Treatment of Cushings
removal of tumor, discontinuation of drugs
210
What may gonadocorticoids contribute to?
Onset of puberty and appearance of secondary sex characteristics
Sex drive in women
Source of estrogens in postmenopausal women
211
pathophysiology for type 2 diabetes
Insulin resistance from:
Prolonged elevated blood glucose levels → Down regulation of insulin receptors → prevents glucose uptake → hyperglycemia → islet cells secrete more insulin to combat hyperglycemia → this causes hyperplasia and hypertrophy of islet cells → amyloid deposits in pancreas → hypertrophy of islet cells → dysfunction of islet cells → dysregulation of insulin secretion
212
further workup for type 2 diabetes
HbA1c
Autoantibodies/C peptide
Lipid Panel
Fundoscopic exam
Foot exam
Peripheral vascular exam
Lifestyle modifications
Diet
Exercise
Smoking cessation
Decrease alcohol consumption
213
patient education for type 2 diabetes
Glucose control- daily monitoring +/- glucose diary
Screening (A1c every 3 mo.)
ASCVD risk assessment
CV diseases (CHF, MI, CVA, etc)
Vaccinations
Podiatry for foot exams and foot care
Ophthalmology for yearly retinal exams
Cautions for nephrotoxic medications
214
type 2 diabetes medication that is reno protective but nephrotoxic
lisinopril
215
Pathophysiology for graves
b cells produce antibodies against thyroid proteins. autoimmune antibodies (like TSI or TSH receptor Ab) then bind to and stimulate the TSH receptor on follicular cells. this stimulation produces a hyperproduction of thyroid hormones.
216
Pathophysiology for plummers
hyperplasia of follicular cells --> 1+ autonomous, hyperfunctioning thyroid nodules, excess T3/T4 is produced independently of TSH levels
