Endocrine Flashcards
(194 cards)
1
Q
Signaling pathway for GH?
A
receptor associated tyrosine kinase (PIG)
2
Q
Low magnesium concentration does what to PTH?
A
Increases PTH
3
Q
Thyroid storm pathophys? Explain! Don’t cheat!
A
Increased production of thyroid hormone due to stress leads to an increase in catecholamines which can lead to death by arrhythmias (may see increased alk phosp)
3
Q
Inc IGF1; failure to suppress serum GH when given oral glucose tolerance test?
A
Acromegaly
4
Q
FSH stimulates?
A
sertoli cells (in seminiferous tubules)– inhibin B
4
Q
Orpahn annie nuclei? (ground glass)
A
Papillary carcinoma– increased risk with childhood irradiation
4
Q
Psammomma bodies?
A
Papillary carcinoma
5
Q
Cortisol levels are highest?
A
in the morning
5
Q
Alpha subunit is common to ?
A
TSH, LH, FSH, and hCG — each have Beta specific units
5
Q
Cutaneous flushing, asthmatic wheezing, diarrhea and Right sided valvular disease? inc?
A
Carcinoid syndrome–> inc 5 HIAA in urine and niacine deficiency
6
Q
End organ resistance to PTH? Labs?
A
Alrbrights hereditary osteodystrophy– defective Gs protein in kidney and bone Hypocalcemia and hyperparathyroidism
6
Q
Why do RBC always depend on glucose ?
A
Because they do not have mitochondria for aerobic metabolism
6
Q
Associations of MEN2b?
A
Medullary thyroid cancer and Marfanoid habitus
6
Q
Where do you see decrease in GAGs?
A
Lysosomal storage diseases– Hurlers, Hunters
7
Q
Cardiac drug that can stimulate prolactin synthesis?
A
Hydralazine
8
Q
Signaling pathway for insulin involves?
A
Tyrosine kinase receptor
8
Q
Signaling pathway for ADH?
A
IP3 and cAMP
8
Q
Facial and periorbital myxedema?
A
Hypothyroidism
8
Q
MEN1?
A
Pituitary; parathyroids; pancreas (ZE; insulinomas, VIPomas, glucagonomas)
9
Q
Peroxidase enzyme?
A
Catalyzes I- to I2
10
Q
Don’t forget this detail about acromegaly?
A
Patients have impaired glucose tolerance (insulin resistance)
10
Q
Treatment of acromegaly?
A
Octreotide
11
Q
Jod Basedow phenomenon?
A
Pt. with hypothyroidism can get thyrotoxicosis if patient with iodine deficiency goiter is made iodine replete too quickly (only occurs in people with abnormal thyroid glands)
11
Q
Ketoacidosis
A
common in type 1
12
ZE tumors come from where?
Duodenum or pancreas
13
Which thyroid cancer spread hematogenously?
Follicular carcinoma
14
Secondary hyperaldosteronism causes?
CHF; Renal failure; renal artery stenosis-- renal perception of low intravascular volume!
15
Adrenal cortex derived from?
mesoderm
15
cGMP signaling pathway?
ANP; NO-- vasodilators
15
Treatment of SIADH 3
Conivaptan, tolvaptan, demeclocycline (vaptans treat siadh)
16
Decreased Ca; increased PTH; decreased phosphate?
Vit D deficiency
17
LH stimulates?
Leydig cells--\>testosterone
17
Angiotensin II acts on which enzyme?
Aldosterone synthase (Corticosterone to aldosterone)
19
Where are CRH neurons located?
Paraventricular nuclei of hypothalamus
20
Insulin increased production of what two enzymes?
2,6 bisphosphate and phophofructokinase
20
MEN2b?
Oral and pheos
21
What must we rule out in pt with excess prolactin?
Hypothyroidism--\>increased TRH--\>increased prolactin
22
Shortened 4th and 5th digit, hypocalcemia?
Pseudohypoparathyroidism (Albrights hereditary osteodystrophy)
22
Secondary causes of nephrogenic DI?
Lithium, hypercalcemia, demeclocycline (ADH antagonist)
23
Chronic elevation of TSH causes?
Hypertrophy of pituitary gland
25
Treatment for Cushings disease?
Ketoconazole
26
Does insulin cross placenta?
No
27
What blocks peroxidase?
Propylthiouracil
28
Pheos derive from where?
Chromaffin cells in neural crest
29
Antithyroglobulin antibodies and antimicrosomal antibodies associated with which HLA?
DR5-- hashimotos thyroiditis-- at increased risk for non hodgkins lymphoma
30
Thyroid issue that leads to increased risk of non hodgkins?
Hashimotos
32
What happens to thyroid levels in hepatic failure
TBG levels decrease leading to decrease in total thyroid hormone, BUT NORMAL LEVELS OF FREE HORMONE
32
What occurs in testes with regard to testosterone?
Androstenedione is converted to testosterone
33
Neonatal hypothyroidism?
Cretinism-- short stature and low IQ
35
Deficiency in 21Beta hydroxylase?
Cannot make aldosterone or cortisol
36
Causes of SIADH?
Ectopic ADH (small cell lung cancer) CNS disorers Pulmonary disease Cyclophosphamide
37
What does aldosterone do to K+ and H+?
Increases renal secretion of both
38
Signaling pathway for Aldosterone?
Steroid
38
Cortisol increased which two enzymes?
PEP carboxykinase and Glucose 6 phosphatase
39
Excess ingestion of iodide can lead to?
Decrease levels of t4 and t3 by temporarily inhibiting thyroid peroxidase--\>decreased iodine organification
AKA Wolff Chaikoff effect-- the wolff shuts everything down
39
Tolvaptan and conivaptan?
Used for treatment of SIADH
40
HLA association of type 1?
DR3 or DR4 (DR4 is also seen in RA)
42
Hypothyroidism in perinatal period--\>?
Mental retardation
42
right adrenal vein drains?
directly into IVC
42
MCC of addisons?
Autoimmune
43
What happens when thyroid cells are stimulated?
iodinated thryoglobulin is taken back into follicular cells by endocytosis. Lysosomal enzymes then digest thryoglobulin releasing t4 and t3
43
TRH stimulates?
TSH and Prolactin
44
Common causes of low magnesium?
diarrhea, aminoglycosides, diuretics, and alcohol abuse
45
Signaling pathway for T4?
Steroid (thyroid and steroid hormon have similar mechanism)
45
Catecholamines are cousins with?
Thyroid hormone
45
Most common cause of goiter?
Iodine deficiency
46
Mutation in which gene requires prophylactic thyroidectomy?
RET gene
47
Perchlorate blocks?
Oxidation step (prevents I- from entering cell)
48
Small cell lung cancer can cause what disease?
SIADH
49
Pt. presents with tender thyroid and jaw pain. Coughing and fever two weeks ago?
Subacute thyroiditis-- may be hyperthyroid early
50
Blocks 11 Beta hydroxylase?
Metyrapone
52
Vit D acts through what signaling pathway?
Steroid receptor
53
11 Beta hydroxylase deficiency?
Same as 21 hydroxylase deficiency except have increased 11 deoxycorticosterone SO pt has HYPERTENSION as opposed to hypotension
53
Lidlag-- stare?
Hyperthyroidism
54
Cystic bone spaces with brown fibrous tissue?
Primary hyperparathyroidism-- soft and PAINFUL bones
56
Beta and alpha agonists on insulin?
Beta agonist INC insulin secretion Alpha agonist DEC insulin secretion (Stop GO alpha beta)
58
Beta endorphin stimulated by?
CRH
60
Bone maturation is stimulated by?
Thyroid hormone
61
TBG in pregnancy?
Increased-- amount of free is normal
61
Iselt amyloid deposits?
dm2
63
Adrenal medulla derived from ?
Neural crest
64
Signaling pathway for progesterone?
Steroid
65
Signaling pathway of prolactin?
Receptor associated tyrosine kinase (PIG)
66
Shock, coagulopathy, and petechial rash, adrenals?
Waterhouse Friderichsen syndrome-- acute adrenal crisis-- Neisseria
66
Trousseaus sign?
Occlusion of brachial artery with BP cuff--\>carpal spasm
68
TBG levels in pregnancy?
Increase, leading to increase in total but NORMAL free horomone
69
Inc in GAG deposition may lead to?
Mitral valve prolapse-- inc in dermatan sulfatate
70
Most common tumor of appendix?
Carcinoid
70
Man with low T4 and normal TSH?
Anabolic steroids
71
Norepi to Epi only occurs in the medulla-- why?
Requires PNMT enzymes which is only expressed in medulla
72
CRH stimulates?
ACTH and Beta endorphin!
72
Sheets of cells in amyloid stroma; associated with MEN 2a?
Medullary carcinoma
74
17 hydroxylase deficiency?
Dec androgen and cortisol levels
75
Renal perception of low intravascular volume--\>
Secondary hyperaldosteronism-- treat with spironolactone
76
Side effect of demeclocyline?
DI-- cannot concentrate urine and have high mOSMs \>290
77
Where is calcium absorbed in kidney?
distal convoluted tubule
78
Hurthle cells?
Hashimotos-- may be hyperthyroid early in course (thyrotoxicosis during follicular rupture)
78
increase in estrogen does what to TBG?
Increases TBG
79
D2 comes from?
Plants
80
I- minus (iodine) transport into follicular cells is inhibited by?
Thiocyanate an perchlorate anions
81
Drug used to treat Pheo initially?
Phenoxybenzamine-- nonselective alpha antagonist-- avoid hypertensive crisis and then B blockers are given to slow heart rate
82
binding protein for iron?
Transferretin
84
Neither low nor high dose dexamehtasone inhibits cortisol secretion in?
Adrenal cortical tumors
85
TH on ANS?
Increases B-1 receptors in heart-- give propranolol
87
Propylthiouracil inhibits?
Peroxidase enzyme (which cataylyzes I minutes to I2
88
Pretibial myxedema?
Graves
89
Treatment for prolactinoma?
Cabergoline and bromocriptine (dopamine agonists)
90
AA that stimulate growth hormone?
Arginine and histidine-- basic amino acids
92
Cortisol up regulated which receptors?
Alpha 1 receptors on arterioles--\>inc arterial pressure
93
Peroxidase is inhibited by?
Propylthiouracil
94
Testosterone to Estradiol?
Aromatase (or if 5 alpha reductase acts on it, testosterone goes to DHT)
95
Converts cholesterol to pregnenolone?
Cholesterol desmolase (secreted by ACTH0
95
Anterior pituitary derived from?
Oral ectoderm (Rathke's pouch)
97
Insulin on SHBG?
Insulin suppresses production of sex hormone binding globulin
97
Hyperparathyroidism usually caused by?
Adenoma
98
Cyst in anterolateral portion of neck?
Branchial cleft cyst
100
Receptor associated tyrosine kinase?
Prolactin, Immunomodulators, and GH (PIG)
101
Hypercalcemia may lead to?
Polyurea
103
Posterior pituitary derived from?
Neuroectoderm-- extension of hypothalamus-- true neural structure-- blood brain barrier is absent here
103
GH involved in?
Gluconeogenesis and AA uptake
104
Test to perform in suspected DI?
Water deprivation test-- urine osmolality doesn't increase; response to desmopressin distinguished btw central and nephrogenic
105
C peptide of insulin is cleaved where?
Within storage granules-- the peptide is packaged and secreted along with the insulin
106
Pt. presents with hypocalcemia with sheets of malignant cells in stroma?
Medullary Ca-- associated with MEN 2a and 2b
108
Increase in SHBG in men leads to?
lower free testosterone
109
Mechanism of insulin release from beta cells?
ATP generation via glucose metabolism closes K+ channels--\>depolarizes Beta cell membrane--\> opening of Ca2+ channels. Ca2+ influx stimulates insulin secretion
110
21 Hydroxylase deficiency results in?
decreased cortisol and aldosterone production; see an increase in 17 hydroxyprogesterone; virilization in women
112
High levels of what inhibit organification?
I minus (organification is the phase in which tyrosine residues of thryoglobulin react with I2 to form mono or di iodotryosine)
114
Second messenger for PTH?
cAMP
114
Growth hormone does what to insulin?
Increases insulin resistance
116
Pt. presents with hard, non tender thyroid gland-- pathophys?
Thyroid is replaced by fibrous tissue due to IgG related systemic disease-- Reidels thyroiditis
117
Difference between neuroblastoma and Wilm's tumor?
Wilm's is unilateral and does not cross midline
118
EXtremely low magnesium concentration does what to PTH?
Decreases PTH
119
Infection in diabetic ketoacidosis?
Rhizopus
121
Renal osteodystrophy?
Renal failure-- kidney unable to make 1,25 dihydroxycholecalciferol-- decreased Ca leads to secondary hyperparathyroidism
123
Medulla secretes?
Catacholamines
124
4 Bs of thyroid?
Bone maturation; bone growth; beta adrenergic; BMR
125
Graves due to ???immuno?
IgG antibody against receptor (type 2-- also see type 2 in MG)
126
Glut1
Insulin independent (RBC, Brain)
127
Osmotic damage of DM can lead to?
Neuropathy and cataracts
128
Exopthalmos path?
GAG deposited in orbital fat and pushing the eye out
129
Potassium in diabetic ketoacidosis?
Hyperkalemia even though low potassium in body (K+ leaves intracellular space and swaps with H+)
130
Petechial lesions meningitis?
Neisseria
132
VMA?
Breakdown of norepi and epi
133
Steroid receptor pathway?
VETTT CAP; Vitamin D; Estrogen; Testosterone, T4/T3, Cortisol, aldosterone, progesterone
134
17 hydroxylase def in XY?
pseudohermaphdroditism due to decrease in DHT
135
T4--\>T3 via?
5' iodinase
137
Decreases in SHBG in women leads to?
Higher free testosterone--\>hirsutism SHBG levels INCREASE during pregnancy
138
Path of DM small vessel?
Nonezymatic glycosylation of basement membrane leading to hyaline arteriolesclerosis--\>eventually progresses to nephrotic syndrome characterized by sclerosis of the mesangium forming kimmelstiel wilson nodules
139
Acidic amino acids?
Glutamate and aspartate (COOH groups)
141
Glut 2
bidirectional: beta islet cells, liver, kidney, small intestine
142
Virilization of women, hypertension, Striae, osteoporosis, hyperglycemia?
Cushing's syndrome (disease if at level of pituitary)
142
Islet leukocytic infiltrate?
DM1
143
MEN2a?
Parathyroids and pheos
144
Prolactin is stimulated by?
TRH
146
D3 comes from?
sun exposure
148
Most common tumor of adrenal medulla?
Neuroblastoma
150
Patient presents with abdominal distention and firm irregular mass-- condition associated with over expression of N-myc oncogene?
Neuroblastoma-- see increased Homovanillic acid-- breakdown of dopamine
151
Sigs and sx of VIPoma?
WDHA; Watery diarrhea; hypokalemia; and achlorhydria
153
Mom presents with failure to lactate after giving birth?
Sheehans syndrome-- ischemic infarct of pituitary following postpartum bleeding
155
High urine Homovanillic acid?-- gene associated with this condition?
Neuroblastoma-- associated with N-myc; unusual growth in abdomen; pseudorossettes; occurs anywhere along sympathetic chain
156
Moderately enlarged non tender thyroid; HLA DR5?
Hashimotos
157
Mechanism by which cortisol produces striae?
Inhibits fibroblasts
158
I minus --\>I2 catalyzed by?
Peroxidase enzyme in follicular cell membrane
158
ADH and oxytocin are shipped to poster pituitary via?
Neurophysins
159
Negative Ca2+ balance is seen in women during?
Pregnancy and lactation
160
What kind of immune reaction is hashimotos?
Type 4
162
3yo presents with beer belly, pale and puffy eyes with a protubertant tongue?
Cretinism
163
Malignant proliferation of follicles surrounded by a capsule
Follicular carcinoma
164
Left adrenal vein drains?
Into left renal vein
165
MC cause of death in acromegaly?
cardiomyopathy
166
17 hydroxylase def in XX
Externally phenotypic female with normal internal sex organs; lacks secondary sex characteristics
167
Focal patches of hyperfunctioning follicular cells?
Toxic multinodular goiter-- mutation in thyroid receptor
168
Graves is what type of immune disease?
Type 2 hypersensitivity-- can see clubbing of fingers
170
Increased TSI?
Grave's disease
171
Must get what test with patient with atrial fib?
TSH-- for Grave's disease
173
Cortisol maintains BP how?
upregulates alpha 1 receptors on arterioles--\> increased sensitivity to NE
174
IP3 signaling pathway?
GGOAT GnRH GHRH Oxytocin ADH TRH histamine; AII, gastrin
175
Nonezymatic glyosylation
Inappropriate addition of glucose onto proteins
177
Treatment of DKA?
Bolus of K+, IV insulin, IV fluids, gluocose to prevent hypoglycemia (administration of insulin without K+ might cause hypokalemia)
178
Glut 4
Insulin DEPENDENT: Adipose tissue and skeletal muscle!
179
Treatment of nephrogenic DI?
HCTZ (gets rid of water and sodium in distal regions of nephron--\>making body respond by increasing uptake of water), indomethacin, amiloride
181
Blocks 5 alpha reductase in BPH?
Finasteride
182
Somatomedin?
IGF-1
183
Stain Medullary carcinoma with?
congo red-- apple green birefringence= amyloid A (which come from calcitonin)
185
Thyroid peroxidase?
Oxidation of iodine and Adding iodine onto tyrosine residues of TG and coupling of MIT and DIT
186
Metabolic acidosis, hyperkalemia, hypotension?
Addisons (or CAH i.e. 21hydroxylase)
187
Associatoins of MEN2?
Medullary thyroid cancer
188
High T4 with normal TSH woman?
Estrogen
189
Only two tissues that are insulin sensitive?
Skeletal muscle and adipose tissue
190
Deficiency in 17 hydroxylase?
Can only make Aldosterone
191
Androstenedione to estrone?
Aromatase
192
Blocks desmolase?
Ketoconazole (antifungal)
193
PNMT is under the control of? What does it do?
Under control of cortisol-- converts NE to epi
194
