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Endocrine Flashcards

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1
Q

insulin receptor

A

tyrosine kinase receptor that induces glucose uptake into insulin-dependent tissues via GLUT-4 receptors and affects gene transcription.

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2
Q

Regulation of insulin release

A

Glucose enters beta cell and is metabolized, increasing ATP. ATP closes K+ channels leading to depolarization. VG Ca++ channels open leading to Ca++ influx and exocytosis of insulin.

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3
Q

Effects of somatostatin

A

Decreases growth hormone and TSH release from the pitutiary. Analogues can thus be used to treat acromegaly.

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4
Q

Effects of TRH

A

increases TSH and prolactin

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5
Q

Two functions of growth hormone

A

Stimulates growth through IGF-1

Increases insulin resistance (diabetogenic)

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6
Q

Regulation of growth hormone

A

Released in pulses in response to GHRG. Secretion higher during exercise and sleep. Secretion inhibited by glucose and somatostatin.

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7
Q

Ghrelin

A

Stimulates hunger and GH release. Produced by stomach

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8
Q

Leptin

A

Satiety hormone produced by adipose tissue

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9
Q

Regulation of ADH

A

Osmoreceptors in hypothalamus

Hypovolemia

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10
Q

17-alpha-hydroxylase deficiency

A

High mineralocorticoids; low cortisol and sex steroids. High BP, low K+, low androstenedione, non-virilizing. Males have ambiguous genitalia at birth, females lack secondary sex development.

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11
Q

21-hydroxylase deficiency

A

Most common cause of CAH. high sex hormones; low mineralocorticoids and cortisol. Low BP and high K+. High 17-OH-progesterone and high renin activity.

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12
Q

11beta-hydroxylase deficiency

A

Low aldosterone and cortisol but high 11-beta-deoxycorticosterone results in increased BP. High sex hormones. Virilization and salt wasting.

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13
Q

Cortisol functions

A

BIG FIB:

  • increases BP
  • increases insulin resistance
  • increases gluconeogenesis
  • decreases fibroblast activity which is what causes striae in cushings
  • decreases inflammatory/immune response: inhibits leukotriene and PG production, inhibits WBC adhesion resulting in neutrophilia, blocks histamine release, reduces eosinophils, blocks IL-2 production
  • decreases bone formation
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14
Q

functions of vitamin D

A
  • increaes absorption of Ca++ and phosphorus in gut

- increases bone resorption, increasing Ca++ and phosphorus

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15
Q

regulation of vitamin D

A

Active levels increased by high PTH and low Ca++ and phosphorus

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16
Q

Functions of PTH

A
  • increases bone resorption of Ca++ and phosphorus by increasing production of RANK-L which binds RANK receptor on osteoclasts to stimulate them
  • increases kidney reabsorption of Ca++ in distal tubule
  • decreases reabsorption of phosphorus in distal tubule
  • increases active vitamin D production in kidney
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17
Q

Regulation of PTH

A

increased by low Ca++, high phos, low Mg++. Decreased by very low Mg++.

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18
Q

Hormones that signal through cAMP

A

FLAT ChAMP: FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH, calcitonin, GHRH

Pituitary hormones: FSH, LH, TSH, ADH (V2 receptor), ACTH, MSH (all but prolactin and oxytocin)
Hypothalamic hormones: CRH, GHRH
Others: hCG, PTH, calcitonin, glucagon

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19
Q

Hormones that signal through cGMP

A

ANP, BNP, NO

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20
Q

Hormones that signal through IP3

A

GOAT HAG: GnRH, oxytocin, ADH (V1 receptor), TRH, histamine (H1 receptor), angiotensin II, gastrin

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21
Q

Hormones that signal through intracellular receptor

A

Steroid hormones, thyroid hormone, vitamin D

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22
Q

Hormones that signal through intrinsic tyrosine kinase

A

Insulin, IGF-1, other growth factors

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23
Q

Hormones that signal through receptor-associated tyrosine kinase (JAK/STAT)

A

PIGG(L)ET: prolactin, immunomodulators, GH, G-CSF, EPO, thrombopoietin

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24
Q

Functions of T3

A

4Bs:

  • brain maturation
  • bone growth
  • beta-adrenergic effects
  • increased basal metabolic rate
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25
Symptoms of adrenal insufficiency
Weakness, fatigue, orthostatic hypotension, muscle aches, weight loss, GI disturbance, sugar/salt cravings
26
Primary vs secondary vs tertiary adrenal insufficiency
Primary: Def of aldo and cortisol. Hypotension, hyperkalemia, and metabolic acidosis. ACTH high resulting in hyperpigmentation. Can be acute due to massive hemorrhage or chronic due to Addison disease Secondary: Decreased ACTH production. No hyperpigmentation or hyperkalemia Tertiary: Abrupt withdrawal of chronic exogenous steroid use
27
Neuroblastoma of adrenal medulla
Most common tumor of adrenal medulla in kids. Usually seen in those less than 4. Neural crest derivative with overexpression of N-myc. Pathology includes Homer-Wright rosettes. Presents with abdominal distension and firm, irregular mass (vs smooth Wilms tumor). May see dancing eyes-dancing feet. Labs: elevated HVA, VMA in urine due to breakdown or dopamine and NE. Bombesin and neuron-specific enolase pos.
28
Genetic syndromes associated with pheo
NF1, VHL, MEN2A, MEN2B
29
treatment of pheo
1) irreversible alpha antag (before beta blocker to prevent hypertensive crisis) 2) beta blocker 3) surgery
30
Reflexes in hypoand hyperthyroidism
decreased in hypo, increased in hyper
31
Autoantibodies and HLA type in hashimoto thyroiditis
anti-thyroid peroxidase, antimicrosomal, antithyroglobulin | HLA-DR5 associated
32
Tender vs non-tender thyroid in hypothyroidism
Nontender: hashimoto, Riedel thyroiditis Tender: subacute thyroiditis
33
Congenital hypothyroidism presentation
``` pot-belly pale puffy face protruding umbilicus protuberant tongue poor brain development ```
34
subacute thyroiditis
self-limited hyperthyroid progressing to hypothyroid granulomatous inflammation very tender thyroid
35
Riedel thyroiditis
thryoid replaced by fibrous tissue IgG4-related systemic disease fixed, hard, painless goiter
36
Presentation of Graves disease
hyperthyroidism, exophtalmos, pretibial myxedema
37
toxic multinodular goiter
focal patches of hyperfunctioning follicular cells due to TSH receptor mutation. Hot nodules rarely malignant
38
Thyroid storm
Stress induced catecholamine surge due to thyrotoxicosis. Agitation, delirium, fever, diarrhea, coma, tachyarrhythmia. Treatment: beta blocker, propylthiouracil, corticosteroids
39
Thyroid cancers: papillary, follicular, medullary, anaplastic, lymphoma
Papillary carcinoma: Most common and excellent prognosis. Empty-appearing nuclei with central clearing. Psammoma bodies with nuclear grooves. Follicular carcinoma: Good prognosis. Distinguished from follicular adenoma by invasion of the capsule. Medullary carcinoma: C-cell drived. Produces calcitonin. Associated with MEN2A and 2B Anaplastic carcinoma: seen in older patients. Very poor prognosis Lymphoma: associated with hashimoto
40
Symptoms of hypoparathyroidism
Hypocalcemia and tetany. Chvostek sign: tap facial nerve and see contraction of facial muscles Trousseau sign: occlude brachial artery with BP cuff and see carpal spasm
41
Pseudohypoparathyroidism
AD condition in which kidney unresponsive to PTH. Causes hypocalcemia, shortened 4th/5th digits, short stature
42
Familial hypocalciuric hypercalcemia
Defective Ca++ receptor on parathyroid cells so PTH not suppressed. High calcium with normal to high PTH.
43
Presentation of acromegaly
``` Large tongue with deep furrows Deep voice Large hands and feet Coarse facial features Insulin resistance Risk of colorectal polyps and cancer ```
44
Sheehan syndrome
Ischemic infarct of pituitary following postpartum bleeding leading to hypopituitarism. Presents with failure to lactate, absent menstruation, cold intolerance.
45
Empty sella syndrome
Atrophy or compression of pituitary leading to hypopit. Common in obese women
46
Pituiary apoplexy
Sudden hemorrhage of pituitary leading to hypopit
47
Diabetic complications of osmotic damage
Sorbitol accumulates in organs with aldolase reductase is what causes the damage. Neuropathy and cataracts.
48
Diabetic complications due to small vessel disease
Diffuse thickening of BM. Retinopathy, glaucoma, neuropathy, nephropathy.
49
Type I diabetes: HLA association
HLA-DR3 and HLA-DR4
50
Zollinger-Ellison syndrome
Gastrin-secreting tumor in pancreas or duodenum. Acid hypersecreting reulting in ulcers. presentation: abdominal pain and diarrhea Diagnosis: Pos secretin stim tes (gastrin stays high after giving secretin which should suppress it Associated with MEN 1
51
MEN1
Parathyroid tumors, pituitary tumors, pancreatic endocrine tumors (zollinger-ellison syndrome, insulinomas, VIPomas, glucagonomas)
52
MEN2A
Parathyroid hyperplasia, pheochromocytoma, medullary carcinoma, marfanoid habitus, RET mutation
53
MEN2B
Pheochromocytoma, Medullar thyroid carcinoma, oral/intestinal ganglioneuromatosis, marfanoid habitus, RET mutation
54
Names of insulins
Rapid acting: aspart, glulisine, lispro Short acting: regular insulin Intermediate acting: NPO Long acting: glargine, detemir
55
Metformin
MOA: unkown, decreases gluconeogenesis, increases glycolysis, increases peripheral glucose uptake (insulin sensitizer) Use: Oral for type 2 DM. Modest weight loss. ADRs: lactic acidosis (contraindicated in renal insufficiency)
56
Sulfonylureas
Names: chlorpropramide and tolutamide (first gen); glimepiride, glipizide, glyburide (second gen) MOA; Close K+ channel in beta cell membane resulting in depolarization and insulin release Use: Type 2 DM only ADRs: risk of hypoglycemia; disulfiram-like effects for first gen only DDIs: non-specific beta blockers can mask symptoms of hypoglycemia
57
Thiazolidinediones
Names: pioglitazone, rosiglitazone MOA: increase insulin sensitivity by binding PPAR-gamma Use: Type 2 DM ADRs: weight gain, hepatotoxicity, risk of fracture
58
GLP-1 agonists
Names: exenatide, liraglutide MOA: increase insulin, decrease glucagon release Use: Type 2 DM ADRS: pancreatitis, N/V
59
DPP-4 inhibitors
Names: linagliptin, saxagliptin, sitagliptin MOA: increase insulin, decrease glucagon release Use: Type 2 DM ADRs: urinary or resp infections
60
Amylin analogs (pramlintide)
MOA: decreases gastric emptying and decreases glucagon Use: Type 1 and type 2 DM ADRs: hypoglycemia
61
SGLT-2 inhibitors (canagliflozin)
MOA: blocks reabsorption of glucose in prox collecting tubule Use: Type 2 DM ADRs: UTIs and yeast infections due to glucosuria
62
alpha-glucosidase inhibitors
Names: acarbose, miglitol MOA: inhibits intesinal brush border alpha glucosidases, delaying glucose absorption and decreasing postprandial hyperglycemia Use: type 2 DM
63
Propylthiouracil and methimazole
MOA: block thyroid peroxidase, inhibiting oxidation and organification of iodine and thus inhibiting thryoid hormone synthesis. PTU also blocks peripheral conversion of T4 to T3 Use: Hyperthyroidism. PTU used in pregnancy because methimazole is possible teratogen ADRs: agranulocytosis, aplasatic anemia
64
ADH antagonists
Names: Conivaptan, tolvaptan, demeclocycline MOA: block ADH receptor Use: SIADH ADR: demeclocycline is of tetracycline family and so can cause bone and teeth abnormalities
65
Octreotide
MOA: somatostatin analogue Use: acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices
66
Cinacalcet
MOA: sensitizes parathyroid gland to calcium, decreasing PTH Use: primary or secondary hyperparathyroidism
67
Bromocriptine
MOA: dopamine agonist Use: hyperprolactinemia
68
Central DI: damage to pituitary vs hypothalamus
Damage to pituitary or infundibulum causes only transient DI because hypothalamic axons regenerate and hypertrophy. Damage to hypothalamic neurons results in permanent DI
69
Acetyl coA carboxylase
Fatty acid metabolism enzyme: converts acetyl coA to malonyl coA
70
Glycerol kinase
Part of gluconeogenesis from triglycerides
71
Parathyroid Ca++ sensing receptors
Transmembrane G protein coupled receptors
72
Neurophysins
Carrier proteins for oxytocin and vasopressin
73
glucagon receptor activates
Acts through Gs coupled receptor. Binds to receptor, alpha subunit releases GDP and binds GTP so can dissociate. Gs activates adenylate cyclase, which converts ATP to cAMP. cAMP activates PKA which phosphorylates serine/threonine residues in enzymes to activate or deactivate the,

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