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Flashcards in Endocrine High Yield Deck (133):
1

What connects the thyroid to the tongue?

Thyroglossal duct

2

What is the remnant of the thyroglossal duct?

Foramen cecum

3

What makes up the pharyngeal arches (1, 2, 3, 4, 6)?

Mesoderm and NCC

4

What makes up the pharyngeal pouches?

Endoderm

5

What makes up the pharyngeal grooves or clefts?

Ectoderm

6

most common tumor in adult adrenal medulla?

Pheochromocytoma

7

Most common tumor in child adrenal medulla?

Neuroblastoma

8

Name the cells of the adrenal medulla?

Chromaffin cells (NCC origin)

9

What is the anterior pituitary derived form?

Oral ectoderm (Rathke's ouch)

10

Name the basophilic cell types in the Anterior Pituitary?

B- FLAT

Basophils: FSH, LH, ACTH, TSH

11

Which anterior pituitary hormones have a common alpha subunit?

TSH

LH

FSH

(hCG too)

12

What hypothamaic nuclei is vasopressin made in?

Supraoptic nuclei

13

What hypothamaic nuclei is oxytocin made in?

paraventricular nuclei

14

Where is preproinsulin synthesized?

RER of beta cells

15

When is proinsulin cleaved?

Just prior to exocytosis while in the secretory granule

16

What type of activity do insulin receptors have in insulin dependent cells?

Tyrosine kinase

17

What pathways does insulin receptor activate in insulin dependent cells?

RAS/ MAPk pathway--> cell growth and DNA synthesis

PI3k pathway--> glycogen, lipid, protein synthesis and increased GLUT 4 transporters

18

Does insulin increase or decrease intracellular K+?

Increase

19

Direction of GLUT 2 transporters?

Bidirectional

20

What causes the release of insulin from beta cells?

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

When dopamine increases, what happens to the levels of prolactin?

Prolactin decreases

22

What hormone regulates the release of GnRH from the hypothalamus?

Prolactin

23

What hormone regulates the release of GnRH from the hypothalamus?

Prolactin

24

What is the function of somatostain?

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

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