Endocrine High Yield Flashcards
(133 cards)
1
Q
What connects the thyroid to the tongue?
A
Thyroglossal duct
2
Q
What is the remnant of the thyroglossal duct?
A
Foramen cecum
3
Q
What makes up the pharyngeal arches (1, 2, 3, 4, 6)?
A
Mesoderm and NCC
4
Q
What makes up the pharyngeal pouches?
A
Endoderm
5
Q
What makes up the pharyngeal grooves or clefts?
A
Ectoderm
6
Q
most common tumor in adult adrenal medulla?
A
Pheochromocytoma
7
Q
Most common tumor in child adrenal medulla?
A
Neuroblastoma
8
Q
Name the cells of the adrenal medulla?
A
Chromaffin cells (NCC origin)
9
Q
What is the anterior pituitary derived form?
A
Oral ectoderm (Rathke’s ouch)
10
Q
Name the basophilic cell types in the Anterior Pituitary?
A
B- FLAT
Basophils: FSH, LH, ACTH, TSH
11
Q
Which anterior pituitary hormones have a common alpha subunit?
A
TSH
LH
FSH
(hCG too)
12
Q
What hypothamaic nuclei is vasopressin made in?
A
Supraoptic nuclei
13
Q
What hypothamaic nuclei is oxytocin made in?
A
paraventricular nuclei
14
Q
Where is preproinsulin synthesized?
A
RER of beta cells
15
Q
When is proinsulin cleaved?
A
Just prior to exocytosis while in the secretory granule
16
Q
What type of activity do insulin receptors have in insulin dependent cells?
A
Tyrosine kinase
17
Q
What pathways does insulin receptor activate in insulin dependent cells?
A
RAS/ MAPk pathway–> cell growth and DNA synthesis
PI3k pathway–> glycogen, lipid, protein synthesis and increased GLUT 4 transporters
18
Q
Does insulin increase or decrease intracellular K+?
A
Increase
19
Q
Direction of GLUT 2 transporters?
A
Bidirectional
20
Q
What causes the release of insulin from beta cells?
A
glucose enters–> ATP production–> closure of ATP dependent K+ channel–> cell depolarized–> activation of volt gated Ca2+ channel–> increased intracellular Ca leads to exocytosis
21
Q
When dopamine increases, what happens to the levels of prolactin?
A
Prolactin decreases
22
Q
What hormone regulates the release of GnRH from the hypothalamus?
A
Prolactin
23
Q
What hormone regulates the release of GnRH from the hypothalamus?
A
Prolactin
24
Q
What is the function of somatostain?
A
Decrease GH, decrease TSH and Decrease Glucagon
25
How does prolactin inhibit its own secretion?
It increases dopamine synthesis and secretion from the hypothalamus
26
Which hormone can lead to a increase in prolactin levels?
TRH (as seen in hypothyroidism)
27
What Tx is used for prolactinemia?
Bromocriptine (DA agonist)
28
How doe GH stimulate linear growth and muscle mass?
through IGF-1 secretion
29
Describe the release of GH? and GHRH?
Pulsatile!
Secretion is increased by exercise and sleep
30
What organ produces Ghrelin?
Stomach
It stimulates hunger
31
What tissue produces leptin?
Adipose tissue
Satiety hormone
32
Which hormone increases with sleep loss: leptin or ghrelin?
Ghrelin
33
Through which receptors does ADH regulate:
1- osmolarity
2- Blood pressure
Osmolarity--> V2 receptor
Blood pressure--> V1 receptor
34
Name a ADH analog?
Desmopressin
35
Order of enzymes in adrenals?
```
Cholesterol desmolase--> 12
3--> 17
21
11
Aldosterone synthase
```
36
What type of hormone is increased in 17 alpha hydroxylase deficeicny?
Mineralcorticods (Aldosterone)
37
How do 17 alpha hydroxylase patients present?
ambguous genitalia (XY)
lack of secondary development (XX)
Salt wasting
38
What hormones are increased in both 21 hydroxylase and 11beta hydroxylase deficiency?
Androgens!
39
Which has an increased BP...21 hydroxylase and 11beta hydroxylase deficiency? Why?
11beta hydroxylase...due to increased 11 deoxycorticosterone
40
"presents in infancy with salt wasting or childhood with precocious puberty"
21 hydroxyase deficiency
41
How does cortisol increase BP?
Upregulates alpha 1 receptors on arterioles--> increased insitivity to NE and Epi
42
Why do striae form in excess cortisol?
decreased fibroblast activity
43
4 ways that cortisol is an antiinflammatory?
1- inhibit production of leukotrienes and prostaglandings
2- Blocks histamine release from mast cells
3- reduces eos
4- blocks IL-2
44
How does increase in pH affect Ca binding to albumin?
Increases Ca affinity for albumin--> Hypocalcemia
45
3 forms of plasma Ca2+ form?
Ionized (45%)
Bound to albumin (40%)
Bound to anions (15%)
46
4 factors that increase active vit D production?
Increased PTH
Decreased Ca2+
Decreased PO4
47
What cells produce PTH?
Chief cells of parathyroid
48
Where does PTH act in the kidney?
Distall tubule to increase Ca reab
In the PCT to decrease PO4 reabsorption
49
What hormone leads to increased 1 alpha hydroxylase activity in the kidney?
PTH...it works in the PCT
50
How does PTH increase bone resporption?
increase production of RANK-L (which then bonds RANK on osteoclasts
51
Does increased or decreased serum Mg2+ lead to increased PTH secretion?
decreased Mg2+ levels
52
What leads to increased calcitonin levels?
increased serum Ca2+
it works to decrease bone reab
53
Which endocrine hormone signal through cAMP?
FLAT ChAMP
FSH
LH
ACTH
TSH
```
CRH
hCG
ADH (v2)
MSH
PTH
```
calcitonin
GHRH
Glucagon
54
Endocrone hormone that act through cGMp? (3)
ANO, BNP, NO
55
Endocrone hormones that work through IP3?
GOAT HAG
GnRH
Oxytocin
ADH (v1)
TRH
Histamine (H1)
Angiotensin II
Gastrin
56
When endocrine hormones have an intracellular receptor?
VETTT CAP
```
Vit D
Estrogen
Testosterone
T3
T4
```
Cortisol
Aldosterone
Progesterone
57
Hormones that have receptors with intrinsic tyrosine kinase activity?
```
Insulin
IGF-1
FGF
PDGF
EGF
```
58
Hormones with receptor associated tyrosine kinase?
PIGG(L)ET
```
Prolactin
Immunomodulators
GH
G-CSF
Erythropoietin
Thrombopoietin
```
59
Hormones with receptor associated tyrosine kinase?
PIGG(L)ET
```
Prolactin
Immunomodulators
GH
G-CSF
Erythropoietin
Thrombopoietin
```
60
How does T3/ T4 increase CO/ HR/ SV?
By increasing beta 1 receptors in the heart
61
What are the 4 functions of T3?
Brain maturation
Bone growth
Beta adrenergic effects
basal metaboic rate increase
62
Functions of thyroid peroxidase?
oxidation and organification of iodide
Coupling of MIT and DIT
63
Most common cause of cushing syndrome?
exogenous corticosteroids
64
"ACTH secreting pituitary adenoma"
Cushing DISEASE
65
Which will suppress high dose dexamethasone...Cushing disease or Ectopic ACTH?
Cushing disease
66
"weakness, fatigue, orthostatic hypotension, muscle aches, weight loss GI disturbances, sugar and or salt cravings"
Adrenal insifficiency
67
What is th metyrapone stimulation test used for?
Dx adrenal insufficiency
blocks last step in cortisol synthesis..so normal response is to decrease cortisol and increase ACTH
in adrenal insufficiency--> ACTH remains decreased
68
Most common cause of primary chronic adrenal insufficiency?
autoimmunity
69
How do you differentiate between primary and secondary adrenal insufficiency?
Hyperkalemia and Skin pigmentation in primary
70
Histological finding of neuroblastoma?
Homer- Write Rosettes
71
What is different in the presentation of neuroblastoma and Wilms tumor?
Neuroblastoma: firm, irregular mass that can cross the midline
Wilms tumor: smooth and unilateral
72
Oncogene associated with neuroblastoma?
N-myc
73
Rule of 10's in pheochromytoma?
```
10% malignant
10% bilateral
10% extra adrenal
10% calcify
10% kids
```
74
4 conditions that pheochromocytoma is associated with?
NF-1
von Hippel- Lindau Diseae
MEN 2A/ 2B
75
"increased HVA (DA product) and VMA (NE product) in urine"
Neuroblastoma
76
"increased catecholamines and metanephrines in urine and plasma"
pheochromocytoma
77
Myxedema types seen in hypothyroidism and hyperthyroidism?
Hypo--> facial and periorbital myxedema
Hyper--> predibial (Graves) and periorbital
78
is hypercholesterolemia seen in hypo or hyperthyroidism?
hypothyroidism
79
HLA type of Hashimoto thyroditis?
HLA- DR5
80
3 histologic features of hashimoto?
Hurthle cells
Lymphoid aggregate
germinal centers
81
What type of cancer is associated with hashimoto?
Marginal zone lymphoma
82
"pot bellied. pale. puffy faced, protruding umbilicus, protuberant tongue, poor brain development"
cretinism (congenital hypothyroidism)
83
"granulomatous inflammation of the thyroid, painful goiter"
Subacute thyroiditis (de Quervain)
84
"fibrous tissue that replaces thyroid tissue, painless goiter"
Riedel thyroiditis
85
"thyroid gland downregulation in reponse to increased iodide"
Wolf- Chaikoff effect
86
"thyroid gland downregulation in reponse to increased iodide"
Wolf- Chaikoff effect
87
Most common cause of hyperthyroidism?
Graves
88
What is the cause of exophthalmos in Graves?
retroorbital fibroblast targeting
89
What is the cause of pretibial myxedema in graves?
dermal fibroblast targeting
90
Are malignant thyroid nodules hot or cold?
Generally cold
91
"thyrotoxicosis that results if a patient with iodine deficiency is made iodine repeate"
Jod- Basedow phenomenon
92
What nerve can be damaged in thyroid surgery?
recurrent laryngeal nerve (6th pharyngeal arch)
93
Most common form of thyroid cancer?
papillary carcinoma
94
Histologic finding in paillary thyroid cancer?
"orphan annie" cells and psammoma bodies
95
Mutations associated with papillary carcinoma?
RET and BRAF gene mutations
96
Thyroid cancer associated with sheets of amyloid stroma?
medullary carcinoma
97
What type of thyroid cancer is seen in older patients?
undifferentiated/ anaplastic carcinoma
98
What is Chvostek sign?
tapping of facial nerve leads to contraction of facial nerve
seen in hypoparathyroidisim
99
What is trousseau sign?
Occlusion of brachial arteru with BP cuff leads to carpal spasm
100
"unresponsiveness of kidney to PTH, hypocalcemia, shortened 4th/5th digits and short stature that is AD inherited"
Pseudohypoparathyroidism
101
"defective Ca2+ sensing receptor on parathyroid cells"
Familial hypocalciuric hypercalcemia
102
Symptoms of hyperparathyroidism?
Stones, bones, groans, psychiatric overtones
103
Bone findings of primary hyperparathyroidism?
osteitis fibrosa cystica (cystic bone spaces filled with brown fibrous tissue--> brown tumor)
104
Most common cause of secondary hyperparathyroidism?
chronic renal disease
105
Vitamin D level in secondary hyperparathyroidism?
Decreased (because decreased action of 1 apha hydroxylase)
106
Vitamin D level in secondary hyperparathyroidism?
Decreased (because decreased action of 1 apha hydroxylase)
107
Tx for acromegaly and gigantism?
Octreotide (somatostatin analog)
pegvisomat (GH receptor antagonist)
108
Serum osmolarity seen in diabetes insipidus?
>290
109
"hypernatremia with high serum osmolarity"
diabetes inspidus
110
"euvolemic hyponatremic with coninued urinary Na+ exretion"
SIADH
111
Why does hyponatremia develop in SIADH?
because body responds to ADH driven water retention by decreasing aldosterone to maintain near normal volume status
112
What can occur if SIADH imbalances are corrected too quickly?
osmotic demyelination syndrome (AKA central pontine myelinolysis)
113
"sdeen hemorrhage of pituitary gland, often in the presence of an existing pituitary adenoma"
pituitary apoplexy
114
HLA type associated withT1DM?
HLA DR3/4
115
Is the genetic predisposition to develop diabetes stronger in type 1 or type 2?
T2DM
116
Describe insulin sensitivity in T1DM?
HIGH
117
Histology of pancreas in T1DM?
Islet leukocytic infiltrate
118
Histology of pancreas in T2DM?
Islet amyloid polypeptide deposits
119
What are ketone bodies made of?
Fat (from increased lipolysis)
120
"necrolytic megratory erythema, hyperglycemia, DVT, depression"
glucagonoma
121
"necrolytic megratory erythema, hyperglycemia, DVT, depression"
glucagonoma
122
When are symptoms of carcinoid syndrome seen?
if there are metastatic tumors... if it is limited to the GI tract then 5-HT undergoes 1st pass metabolism and does not exert effects
123
"recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular disease"
Carcinoid syndrome
124
Test used to diagnose zollinger- Ellison Syndrome?
secretin stimulation test--> gastrin levels remain elevated after administration of secretin (which normally inhibits gastrin release)
125
Elevated hormone in zollinger Ellison?
Gastrin
126
"achlorhydria, cholelithiasis with steatorrhea"
somatostatinoma--> inhibition of gastrin and CCK
127
"watery diarrhea, hypokalemia and achlorhydria"
VIPomas
128
"watery diarrhea, hypokalemia and achlorhydria"
VIPomas
129
MEN 1?
Parathyroid tumor
Pituitary tumor
Pancreatic endocrine tumors
130
Gene associated with MEN1?
MEN1 gene...Tumor suppressor gene
131
Gene associated with MEN 2A/ 2B?
RET
132
MEN 2A?
Parathyroid hyperplasia
Pheochromocytoma
Medullary thyroid carcinoma
Marfinoid habitus
133
MEN 2B?
Pheochromocytoma
Medullary thyroid carcinoma
Mucosal neuromas
Marfanoid habitus
