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Endocrine: Module II Flashcards

1
Q

The pancreas has both ____ and ____ function

A

Endocrine

Exocrine

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2
Q

3 cell types of Islets of Langerhans

A

Alpha
Beta
Delta

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3
Q

Function of alpha cells

A

secrete glucagon

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4
Q

Function of beta cells

A

Secrete insulin

Co-secrete amylin

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5
Q

Function of delta cells

A

Secrete somatostatin and gastrin

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6
Q

What is the function of glucagon?

A

Prevents hypoglycemia by mobilizing “metabolic fuels”

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7
Q

Target tissue of glucagon: (3)

A

Liver –> stimulates glycogenolysis and glucogensis

Fat tissue –> stimulates lypolysis

Muscle –> proteolysis

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8
Q

The breakdown of glycogen is called…

A

Glycogenolysis

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9
Q

The formation of glucose is called….

A

Glucogenesis

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10
Q

The breakdown of amino acid is called….

A

Proteolysis

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11
Q

4 Factors that stimulate glucagon secretion from pancreas

A
  1. Hypoglycemia
  2. Exercise
  3. Stress
  4. Fasting
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12
Q

1 Factor that inhibits glucagon secretion from pancreas

A
  1. Hyperglycemia
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13
Q

Amylin: when is it secreted and what is its function?

A
  • Co-secreted with insulin during feeding

- Suppresses glucagon

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14
Q

Main function of insulin

A

Prevents hyperglycemia –> promotes “metabolic fuel” storage

  • Dec blood glucose levels
  • Dec blood levels of amino acids and FFA/ketones
  • Dec serum potassium levles
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15
Q

What is the target tissue of insulin?

A
  1. Liver
  2. Muscle
  3. Adipose tissue
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16
Q

What happens in the liver when insulin is increased and decreased?

A

Insulin increased: glucose uptake, formation of glycogen, lipid/protein synthesis

Insulin Decreased: ketogenesis, glycogenolysis

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17
Q

What happens in the muscles when insulin is increased and decreased?

A

Insulin increased: glucose uptake, formation of glycogen, amino acid uptake, protein synthesis

Insulin decreased: lypolysis

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18
Q

What happens in adipose tissue when insulin is increased and decreased?

A

Insulin increased: glucose uptake, glucose to form glycerol phosphate, fat storage

Insulin decreased: lypolysis

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19
Q

Factors that stimulate insulin secretion (4)

A
  1. Hyperglycemia
  2. Increased serum levels of FFA, amino acids
  3. GI/digestive hormones
  4. Parasympathetic stimulation of pancreatic beta cells
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20
Q

Factors that inhibit insulin secretion (4)

A
  1. Hypoglycemia
  2. Negative feedback loop: increased insulin levels
  3. Sympathetic stimulation of pancreatic beta cells
  4. Prostaglandins (PGE2)
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21
Q

Excessive insulin levels will _____ the number of insulin receptors.

A

Decrease

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22
Q

In obesity do we see up regulation or down regulation of insulin receptors?

A

Down regulation

Adipose tissue down regulate insulin receptors -> decreased insulin sensitivity

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23
Q

What is the response to decreased insulin sensitivity in response to feeding:

A
  1. Glucose levels remain elevated despite app. release of insulin
  2. Additional insulin is released in attempt to lower blood glucose
  3. Prolonged insulin exposure promotes additional “down-regulation” of receptors
  4. RESULT: insulin resistance progresses –> this is a cycle
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24
Q

What are the 3 “poly’s” of diabetes?

A
  1. Polyuria –> excessive urine production
  2. Polydipsia –> excessive thirst
  3. Polyphagia –> increased appetite
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25
Diabetes Mellitus Type I (insulin dependent)
Insulin insufficiency d/t result of pancreatic destruction of beta cells Antibodies attach beta cells Not associated w/ obesity
26
What happens in DM 1? (4 things)
1. Hyperglycemia (b/c cells unable to take up glucose) 2. Hyperlipidemia 3. Increased ketone bodies/ketoacidosis 4. Catabolic affect on muscle mass
27
Hyperlipidemia | --> in DM1
Increased lipoproteins in blood - Lack of insulin is inhibitory to fat storage - Promotes atherosclerotic changes in blood vessels
28
Describe the catabolic affects on muscle mass seen in DM 1
Body attempts to mobilie amino acids for "fuel" when insulin is low which results in muscle wasting, weight loss, and weakness/fatigue
29
What are 3 causes of insulin shock?
1. Excessive insulin administration 2. Increased physical activity 3. Poor glucose monitoring/missed meals
30
Hypoglycemia produces ____, ______, and _____. (physical symptoms)
Hunger Sweating Irritability
31
Prolonged hypoglycemia =
diabetic coma/decrease CNS metabolism Can lead to death
32
Treatment for insulin shock
Administer glucose to restore blood glucose levels
33
What is the major cause of DM Type 2?
Obesity
34
DM Type 2 is associated with _____ insulin ____.
Increased insulin resistance
35
Inefficient clearance of glucose from blood results in _____ insulin being secreted
MORE
36
How can one improve their diabetes type 2?
Diet changes and exercise
37
GTT stands for:
Glucose Tolerance Test
38
How do you perform a GTT? (steps)
1. Baseline glucose level is established 2. Administer glucose preparation 3. Blood drawn in intervals (30 minutes) making sure to draw blood for at least 120 minutes 4. Read values
39
Normal GTT values | fasting and 2 hours
Fasting: < 110 mg/dl | 2 hours: < 140 mg/dl
40
DM GTT values | fasting and 2 hours
Fasting: > 126 mg/dl | 2 hours: > 200 mg/dl
41
3 Hormones of the thyroid gland
1. T4 (thyroxine) 2. T3 (tri-iodothyronine) 3. Calcitonin
41
3 Hormones of the thyroid gland
1. T4 (thyroxine) 2. T3 (tri-iodothyronine) 3. Calcitonin
42
Where are thyroid hormones produced? What is this molecule that they produce?
thyroglobulin produced in follicle cell
42
Where are thyroid hormones produced? What is this molecule that they produce?
thyroglobulin produced in follicle cell
43
Describe how T3/T4 is released from the thyroid?
1. TRH hormone released from hypothalamus 2. Ant. pituitary releases TSH 3. TSH stimulates endocytosis 4. Enzymes separate T3/T4 and TGB 5. T3/T4 diffuse into bloodstream
44
Stimuli for thyroid hormone release
1. Metabolic demand determines rate 2. TSH directly controls amt of T3/T4 released 3. Pregnancy (growth) 4. Gonadal and adrenocortical steroids (growth) 5. Extreme cold temp (stress/energy production) 6. Catecholamines (epi/NE) *stress
45
Thyroid hormone effects in the heart
Increased HR and CO (inotrophic and chronotropic) Do this by increasing sensitivity to sympathetic system/epi
46
2 main forms of hyperthyroidism
1. Primary hyperthyroidism | 2. Secondary hyperthyroidism
47
Causes of a thyroid storm (7 causes)
1. Infections, especially lung 2. Thyroid surgery 3. Stopping medications for hyperthyroidism 4. Too high of thyroid dose (hypothyroidism) 5. Tx w/ radioactive iodine 6. Pregnancy 7. Heart attack or other heart emergencies
48
What is the distinguishing symptom of "thyroid storm"
Temperature of 105-106
49
Iatrogenic hyperthyroidism (cause)
Excessive use of synthetic thyroxine
50
``` Lab results of Grave's Dz TSI TSH T3/T4 TRH ```
``` TSI: elevated TSH: decreased (inc. T3/T4 inhibit ant. pituitary from releasing TSH) T3/T4: elevated --> T3: 3-4x more --> T4: 2x more TRH: decreased ```
51
3 Types of primary hyperthyroidism
1. Endogenous (Grave's Dz) 2. Iatrogenic 3. Thyroid Storm
52
Thyroid hormone effects in the pituitary gland
1. Inhibits TSH 2. Stimulate release of GH 3. Stimulate synthesis of pituitary hormones
53
Thyroid hormone effects in the GI
Maintain secretions of GI tract
54
Thyroid hormone effects in the liver
Promote TG and cholesterol metabolism Regulate LDL homeostasis
55
Thyroid hormone effects in bone cells
Promote bone growth/devleopment synergistically with IGF-1/growth hormones --> stimulate osteoblast/osteoclast activity
56
Thyroid hormone effects in muscle cells
1. Promote muscle protein growth/development synergistically w/ other growth hormones 2. Excess levels will promote catabolic metabolism of muscle to provide fuel for inc. BMR
57
Thyroid hormone effects in the CNS
1. Stimulate myelin/axonal growth and development 2. Stimulate sympathetic activity * Overall systemic "overdrive"
58
Thyroid hormone effects in pulmonary system
Stimulates respiration centers in brain to increase ventilation
59
Thyroid hormone effects in vascular system
Decrease peripheral resistance of vascular system
60
Thyroid hormone effects overall
1. Glycogenolysis 2. Gluconeogenesis - -> amino acids from muscle break down - -> lipolyosis
61
What happens when one is deficient in thyroid function during the perinatal period?
Cognitive impairments (CNS doesn't mature properly)
62
Describe how thyroid hormones effect growth/development
Stimulate GH release, necessary for IGF-1 function CNS maturation is dependent on thyroid function ....
63
Describe how thyroid hormones effect basal metabolic rate
Increase basal metabolic rate and O2 consumption Also temp regulation (heat is produced d/t inc. BMR)
64
Inhibition of thyroid hormone release
1. Negative feedback (serum levels of T3/T4) 2. GHIH (somatostatin) 3. Dopamine
65
What is the eventual fate of rT3 and T3 when they are no longer utilized?
Converted to T2, a completely inactive form of thyroid hormone
66
Where is the primary site of T4 --> T3 conversion?
The liver
67
If T4 is able to enter cell then it follows which 2 pathways?
1. Binds to T4 receptor within cell nucleus | 2. Undergo conversion to T3 or rT3 in cell cytoplasm/membrane
68
__% of thyroid hormone released is in form of T4. Only 0.03% is "bioavailable" and free and remainder is protein bound and has "____ ____" which allows for more difficult disassociation from carrier and thus ____ active than T3
80-90% "Strong bind" less
69
____% of thyroid hormone is released in the form of T3. Only 0.03% is "bioavailable" and free to enter cells while the remainder is _____ _____ and unable to enter cell until it disassociates. (acts as a circulating storage pool)
10-20% | protein bound
70
"Biological activity" on target cell of ___ is much greater than ___.
T3 | T4
71
Free T3 and T4 are easily excreted by the _____.
Kidneys
72
Does T3/T4 usually circulate freely or bound to a carrier protein? Include percentages
99. 9% bind to carrier protein (TGB, albumin, transthyretin) | 0. 03% T4/T3 circulate freely and considered "active"
73
When iodine binds to the tyrosine/TGB molecule what is this process called?
Organification
74
How much of dietary iodine is "trapped" by the thyroid gland?
25%
75
Which tyrosine hormone is the active form and which is the inactive form?
T3 is active | T4 is inactive
75
Proper doses of calcium:
500 mg BID (so 1,000) total
75
What are the differences between calcium carbonate and calcium citrate?
Carbonate: cheaper, absorption best w/ food Citrate: more expensive, slight advantage in absorption (w/ or w/o food) - especially in pts w/ reduced stomach acid
75
What are the two functions of the kidneys in calcium homeostasis/balance?
1. Most calcium in glomerular filtrate is reabsorbed | 2. Site of "conversion" of inactive vitamin D to active vitamin D (calcitriol)
75
Medications that impair absorption will ____ calcium secretion.
Increase
75
What are the two functions of bones in relation to calcium?
1. Store calcium | 2. Stimuli to increase calcium resorption (for osteoclast activity)
75
What are the 3 primary regulatory hormones that regulate ECF calcium?
1. Parathyroid hormone (PTH) 2. Calcitonin 3. Calcitriol (active form of Vitamin D)
75
Where are parathyroid hormones synthesized and secreted from?
Parathyroid glands
75
What is the function of PTH?
Increase plasma (ECF) calcium levels
75
What are PTH's two target tissues?
Bone and Kidney
75
What does an inc in PTH stimulate in the bone?
1. Calcium resorption (stimulates osteocalstic activity)
75
What does an inc. in PTH stimulate in the kidneys?
1. Stimulates conversion of inactive vitamin D to active (calcitriol) 2. Converts 1,25 dihydroxyvitamin D 3. Stimulates calcium resorption in tubules of kidneys 4. Stimulates phosphate excretion
75
Stimulus for PTH release
Small decreases in plasma calcium
75
Inhibition of PTH release
Elevated plasma calcium and elevated calcitriol | negative feedback
75
Scientific (chemical) name for calcitrol
1,25-dihydroxyvitamin
75
What environmental exposure is necessary for vitamin D formation? What is another place you can get vitamin D from (not as necessary)
SUNLIGHT EXPOSURE! Vitamin D2 is in eggs, dairy, fish oil, plants
75
Vitamin ___ or ___ are biologically inactive
D2 or D3
75
How are D2 and D3 converted to their active form, calcitriol?
Many steps in liver and kidney Final step in kidney by PTH
75
Function of calcitriol?
Increase plasma calcium levels | --> also elevates phosphate levels in blood
75
What are the 3 target tissues of calcitriol?
1. Intestine 2. Bone 3. Kidney
75
Calcitriol release is stimulated by:
Elevated PTH levels
75
Calcitriol is inhibited by?
Decreased PTH levels
75
Where is Calcitonin produced/secreted?
Parafollicular cells of thyroid gland
75
What is the function of calcitonin?
``` Decrease plasma (ECF) calcium levels **Minor role...if not working properly, it doesn't reflect a large change in plasma calcium levels ```
75
Target tissue of calcitonin and what it does at those tissues
Kidney - inhibits calcium resorption by inhibiting osteoclasts Bone - stimulates calcium and phosphate excretion
75
Calcitonin release stimulated by:
Large increases of plasma calcium
75
Calcitonin is inhibited by:
Decreased levels of plasma calcium
75
What is a common cause of hyperparathyroidism?
Neoplasms secreting PTH
75
What would you see on labs in a pt w/ hyperparathyroidism?
1. Hypercalcemia 2. Hypercalciuria (calcium in urine) 3. Hypophosphatemia (low levels of phosphate in blood) 4. Potentially metabolic acidosis
75
What is the common cause of hypoparathyroidism?
Surgical removal or damage
75
Where are T3 and T4 stored?
Stored in the colloid
75
Describe how T3/T4 is released from the thyroid?
1. TRH hormone released from hypothalamus 2. Ant. pituitary releases TSH 3. TSH stimulates endocytosis 4. Enzymes separate T3/T4 and TGB 5. T3/T4 diffuse into bloodstream
75
rT3
reverse T3 Inactive form of T3 and usually exits cell
75
Stimuli for thyroid hormone release
1. Metabolic demand determines rate 2. TSH directly controls amt of T3/T4 released 3. Pregnancy (growth) 4. Gonadal and adrenocortical steroids (growth) 5. Extreme cold temp (stress/energy production) 6. Catecholamines (epi/NE) *stress
75
2 Main functions/actions of thyroid hormones
1. Necessary for growth/development 2. Control rate of metabolism - -> therefore regulate/influence EVERY ORGAN OF THE BODY
75
Thyroid hormones act on all target tissue except for:
1. Brain 2. Spleen 3. Gonads
75
Thyroid hormone effects in the heart
Increased HR and CO (inotrophic and chronotropic) Do this by increasing sensitivity to sympathetic system/epi
75
Thyroid hormone effects in fat cells
Increase lipolysis - mobilize FFA for metabolic fuel
75
Symptoms of hyperthyroidism
+/- goiter Cardiac: palpations, tachycardia, inc. CO, inc. pulse pressure, HTN Pulmonary: inc. RR CNS: hyperactive, fine tremor, nervousness, inc. sympathetic activity Integumentary: warm, moist skin, excessive sweating, thin/fine hair Wt loss: loss of muscle mass, weakness, fat loss Eyes: exophthalmos GI: inc. motility (inc. BM)
75
2 main forms of hyperthyroidism
1. Primary hyperthyroidism | 2. Secondary hyperthyroidism
75
Cause of Grave's Dz (primary endogenous hyperthyroidism)
Excessive TSI (thyroid-stimulating immunoglobulins) bind to TSH receptors and stimulate release of T3/T4
76
What is the significant effect of hypoparathyroidism?
Hypocalcemia *and hyperphosphatemia
77
3 Hormones of the thyroid gland
1. T4 (thyroxine) 2. T3 (tri-iodothyronine) 3. Calcitonin
78
Where are thyroid hormones produced? What is this molecule that they produce?
thyroglobulin produced in follicle cell
79
Which tyrosine hormone is the active form and which is the inactive form?
T3 is active | T4 is inactive
80
How much of dietary iodine is "trapped" by the thyroid gland?
25%
81
When iodine binds to the tyrosine/TGB molecule what is this process called?
Organification
82
Where are T3 and T4 stored?
Stored in the colloid
83
Describe how T3/T4 is released from the thyroid?
1. TRH hormone released from hypothalamus 2. Ant. pituitary releases TSH 3. TSH stimulates endocytosis 4. Enzymes separate T3/T4 and TGB 5. T3/T4 diffuse into bloodstream
84
Does T3/T4 usually circulate freely or bound to a carrier protein? Include percentages
99. 9% bind to carrier protein (TGB, albumin, transthyretin) | 0. 03% T4/T3 circulate freely and considered "active"
85
Free T3 and T4 are easily excreted by the _____.
Kidneys
86
"Biological activity" on target cell of ___ is much greater than ___.
T3 | T4
87
____% of thyroid hormone is released in the form of T3. Only 0.03% is "bioavailable" and free to enter cells while the remainder is _____ _____ and unable to enter cell until it disassociates. (acts as a circulating storage pool)
10-20% | protein bound
88
__% of thyroid hormone released is in form of T4. Only 0.03% is "bioavailable" and free and remainder is protein bound and has "____ ____" which allows for more difficult disassociation from carrier and thus ____ active than T3
80-90% "Strong bind" less
89
If T4 is able to enter cell then it follows which 2 pathways?
1. Binds to T4 receptor within cell nucleus | 2. Undergo conversion to T3 or rT3 in cell cytoplasm/membrane
90
rT3
reverse T3 Inactive form of T3 and usually exits cell
91
Where is the primary site of T4 --> T3 conversion?
The liver
92
What is the eventual fate of rT3 and T3 when they are no longer utilized?
Converted to T2, a completely inactive form of thyroid hormone
93
Stimuli for thyroid hormone release
1. Metabolic demand determines rate 2. TSH directly controls amt of T3/T4 released 3. Pregnancy (growth) 4. Gonadal and adrenocortical steroids (growth) 5. Extreme cold temp (stress/energy production) 6. Catecholamines (epi/NE) *stress
94
Inhibition of thyroid hormone release
1. Negative feedback (serum levels of T3/T4) 2. GHIH (somatostatin) 3. Dopamine
95
2 Main functions/actions of thyroid hormones
1. Necessary for growth/development 2. Control rate of metabolism - -> therefore regulate/influence EVERY ORGAN OF THE BODY
96
Describe how thyroid hormones effect basal metabolic rate
Increase basal metabolic rate and O2 consumption Also temp regulation (heat is produced d/t inc. BMR)
97
Describe how thyroid hormones effect growth/development
Stimulate GH release, necessary for IGF-1 function CNS maturation is dependent on thyroid function ....
98
What happens when one is deficient in thyroid function during the perinatal period?
Cognitive impairments (CNS doesn't mature properly)
99
Thyroid hormones act on all target tissue except for:
1. Brain 2. Spleen 3. Gonads
100
Thyroid hormone effects overall
1. Glycogenolysis 2. Gluconeogenesis - -> amino acids from muscle break down - -> lipolyosis
101
Thyroid hormone effects in the heart
Increased HR and CO (inotrophic and chronotropic) Do this by increasing sensitivity to sympathetic system/epi
102
Thyroid hormone effects in vascular system
Decrease peripheral resistance of vascular system
103
Thyroid hormone effects in pulmonary system
Stimulates respiration centers in brain to increase ventilation
104
Thyroid hormone effects in the CNS
1. Stimulate myelin/axonal growth and development 2. Stimulate sympathetic activity * Overall systemic "overdrive"
105
Thyroid hormone effects in fat cells
Increase lipolysis - mobilize FFA for metabolic fuel
106
Thyroid hormone effects in muscle cells
1. Promote muscle protein growth/development synergistically w/ other growth hormones 2. Excess levels will promote catabolic metabolism of muscle to provide fuel for inc. BMR
107
Thyroid hormone effects in bone cells
Promote bone growth/devleopment synergistically with IGF-1/growth hormones --> stimulate osteoblast/osteoclast activity
108
Thyroid hormone effects in the liver
Promote TG and cholesterol metabolism Regulate LDL homeostasis
109
Thyroid hormone effects in the GI
Maintain secretions of GI tract
110
Thyroid hormone effects in the pituitary gland
1. Inhibits TSH 2. Stimulate release of GH 3. Stimulate synthesis of pituitary hormones
111
Symptoms of hyperthyroidism
+/- goiter Cardiac: palpations, tachycardia, inc. CO, inc. pulse pressure, HTN Pulmonary: inc. RR CNS: hyperactive, fine tremor, nervousness, inc. sympathetic activity Integumentary: warm, moist skin, excessive sweating, thin/fine hair Wt loss: loss of muscle mass, weakness, fat loss Eyes: exophthalmos GI: inc. motility (inc. BM)
112
2 main forms of hyperthyroidism
1. Primary hyperthyroidism | 2. Secondary hyperthyroidism
113
3 Types of primary hyperthyroidism
1. Endogenous (Grave's Dz) 2. Iatrogenic 3. Thyroid Storm
114
Cause of Grave's Dz (primary endogenous hyperthyroidism)
Excessive TSI (thyroid-stimulating immunoglobulins) bind to TSH receptors and stimulate release of T3/T4
115
``` Lab results of Grave's Dz TSI TSH T3/T4 TRH ```
``` TSI: elevated TSH: decreased (inc. T3/T4 inhibit ant. pituitary from releasing TSH) T3/T4: elevated --> T3: 3-4x more --> T4: 2x more TRH: decreased ```
116
Iatrogenic hyperthyroidism (cause)
Excessive use of synthetic thyroxine
117
What is the distinguishing symptom of "thyroid storm"
Temperature of 105-106
118
Causes of a thyroid storm (7 causes)
1. Infections, especially lung 2. Thyroid surgery 3. Stopping medications for hyperthyroidism 4. Too high of thyroid dose (hypothyroidism) 5. Tx w/ radioactive iodine 6. Pregnancy 7. Heart attack or other heart emergencies
119
What is a cause of secondary hyperthyroidism?
TSH secreting adenomas (rare)
120
``` What does lab work look like with secondary hyperthyroidism? TSI TSH T3/T4 TRH ```
TSI: normal TSH: elevated T3/T4: elevated TRH: decreased
121
What are the differences between primary and secondary hyperthyroidism in terms of labs
In primary: TSI is elevated TSH is decreased In secondary TSI is normal TSH is increased *Differences seen because in secondary, the ant. pituitary is effected while in primary, the thyroid is effected
122
Hypothyroidism can be ____ ____ or ______.
Adult-onset | Congenital
123
Symptoms of adult onset hypothyroidism
Cardiac: bradycardia, dec. CO, hypotension, inc. peripheral resistance Pulm: dec. RR CNS: hypoactive (lethargic, confused, slow speech), decreased DTRs Integumentary: cool dry skin, slow wound healing, dry brittle hair, myxedema Wt. gain GI: dec. motility --> protruding abdomen Muscle: stiffness, cramps, drooping eyelids Bone: anemia +/- goiter
124
What is myxedema
Puffy appearance of face, hands, feet Enlarged tongue d/t deposits in oral cavity
125
What causes puffy appearance in hypothyroidism?
Muccopolysaccharides attract water in skin/connective tissue
126
What are the different symptoms of congenital hypothyroidism?
Same as adult-onset but usually include in addition to those: 1. Cognitive impairment 2. Gross dwarfism
127
What is congenital hypothyroidism also called?
Cretinism
128
What are some early detection signs that would cause a provider to screen for hypothyroidism?
High birth weight Hypothermia Jaundice
129
Hashimoto's Thyroiditis (autoimmune)
Primary adult onset Gradual destruction of functional thyroid tissue
130
What do the labs look like in Hashimoto's Thyroiditis
TSH: elevated (d/t low circulating T3/T4) T3/T4: low
131
What do labs look like in secondary hypothyroidism?
*ALL ARE LOW* TSH: low (d/t ant. pituitary damage) T3/T4: low *Disfunctional feedback response
132
How do goiters usually come about?
D/t elevated TSH levels trying to stimulate the thyroid gland
133
In which instances is TSH elevated and you might see a goiter? (2)
1. Puberty | 2. Pregnancy
134
Do goiters predict whether thyroid function is normal, elevated, or diminished?
NO!!
135
What is the cause of a goiter in Grave's Dz?
D/t TSI stimulating thyroid gland to produce T3/T4
136
What is the cause of a goiter in Hashimoto's?
D/t elevated TSH trying to stimulate thyroid gland to produce T3/T4
137
What is the cause of a goiter in Iodine deficiency?
D/t elevated TSH trying to stimulate thyroid to produce T3/T4
138
Functions of calcium (HINT: 8)
1. Mineralization of bone matrix 2. Formation of bone and teeth 3. Maintain membrane permeability 4. Maintain excitability of nerve and muscle 5. Release neurotransmitters 6. Muscle contractions 7. Coagulation of blood 8. Milk production
139
Where is the majority of calcium stored?
98-99% in bone - -> 99% of that is in mineralized form - -> 1% in a pool ready to go into blood stream
140
Percentage of calcium in "free" form, bound to protein, and bound to phosphate in the extracellular fluid
50% in free form 45% bound to protein 5% bound to phosphate/citrate
141
The very small amount of intracellular calcium is responsible for: (3 things)
1. Intracellular signaling 2. Enzyme secretion 3. Muscle contraction
142
What are normal serum calcium values?
8-10 mg/dl
143
What are hypercalcemia leves? (mild, mod, severe)
Hypercalcemia: >10.5 mg/dl Mild: 10.5-11.9 mg/dl Moderate: 12- 13.9 mg/dl Severe "crisis": 14-16 mg/dl
144
Contrast calcium homeostasis with calcium balance?
Calcium homeostasis is short-term equilibrium while calcium balance is a long term maintenance of bone density.
145
The ECF is maintained through calcium exchange between three organs:
GI tract Kidneys Bone
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What are the 2 forms of calcium supplementation?
1. Calcium carbonate | 2. Calcium citrate
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% of calcium absorption in ____ related to the amount of calcium injested at one time
Inversly
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Proper doses of calcium:
500 mg BID (so 1,000) total
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What are the differences between calcium carbonate and calcium citrate?
Carbonate: cheaper, absorption best w/ food Citrate: more expensive, slight advantage in absorption (w/ or w/o food) - especially in pts w/ reduced stomach acid
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What are the two functions of the kidneys in calcium homeostasis/balance?
1. Most calcium in glomerular filtrate is reabsorbed | 2. Site of "conversion" of inactive vitamin D to active vitamin D (calcitriol)
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Medications that impair absorption will ____ calcium secretion.
Increase
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What are the two functions of bones in relation to calcium?
1. Store calcium | 2. Stimuli to increase calcium resorption (for osteoclast activity)
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What are the 3 primary regulatory hormones that regulate ECF calcium?
1. Parathyroid hormone (PTH) 2. Calcitonin 3. Calcitriol (active form of Vitamin D)
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What are the 3 secondary regulatory hormones that regulate ECF calcium?
1. GH 2. Thyroid hormones 3. Adrenal/gonadal steroid hormones
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Where are parathyroid hormones synthesized and secreted from?
Parathyroid glands
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What is the function of PTH?
Increase plasma (ECF) calcium levels
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What are PTH's two target tissues?
Bone and Kidney
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What does an inc in PTH stimulate in the bone?
1. Calcium resorption (stimulates osteocalstic activity)
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What does an inc. in PTH stimulate in the kidneys?
1. Stimulates conversion of inactive vitamin D to active (calcitriol) 2. Converts 1,25 dihydroxyvitamin D 3. Stimulates calcium resorption in tubules of kidneys 4. Stimulates phosphate excretion
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Stimulus for PTH release
Small decreases in plasma calcium
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Inhibition of PTH release
Elevated plasma calcium and elevated calcitriol | negative feedback
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Scientific (chemical) name for calcitrol
1,25-dihydroxyvitamin
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What environmental exposure is necessary for vitamin D formation? What is another place you can get vitamin D from (not as necessary)
SUNLIGHT EXPOSURE! Vitamin D2 is in eggs, dairy, fish oil, plants
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Vitamin ___ or ___ are biologically inactive
D2 or D3
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How are D2 and D3 converted to their active form, calcitriol?
Many steps in liver and kidney Final step in kidney by PTH
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Function of calcitriol?
Increase plasma calcium levels | --> also elevates phosphate levels in blood
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What are the 3 target tissues of calcitriol?
1. Intestine 2. Bone 3. Kidney
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Calcitriol release is stimulated by:
Elevated PTH levels
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Calcitriol is inhibited by?
Decreased PTH levels
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Where is Calcitonin produced/secreted?
Parafollicular cells of thyroid gland
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What is the function of calcitonin?
``` Decrease plasma (ECF) calcium levels **Minor role...if not working properly, it doesn't reflect a large change in plasma calcium levels ```
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Target tissue of calcitonin and what it does at those tissues
Kidney - inhibits calcium resorption by inhibiting osteoclasts Bone - stimulates calcium and phosphate excretion
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Calcitonin release stimulated by:
Large increases of plasma calcium
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Calcitonin is inhibited by:
Decreased levels of plasma calcium
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What is a common cause of hyperparathyroidism?
Neoplasms secreting PTH
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What are some symptoms of hyperparathyroidism?
Precipitation/deposits of calcium/phosphate in tissues --> results in tissue dammage/organ dysfunction - Kidney Stones - Muscle weakness - Polyuria, nocturia, polydispia - Confusion, drowsy, coma - Nausea, vomitting, constipation - Potential dec. bone density
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What would you see on labs in a pt w/ hyperparathyroidism?
1. Hypercalcemia 2. Hypercalciuria (calcium in urine) 3. Hypophosphatemia (low levels of phosphate in blood) 4. Potentially metabolic acidosis
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What is the common cause of hypoparathyroidism?
Surgical removal or damage
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What is the significant effect of hypoparathyroidism?
Hypocalcemia *and hyperphosphatemia
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Symptoms of hypoparathyroidism
1. Neuromuscular excitability 2. Muscle spasms, tetany 3. Cardiac dysfunction

Pathophysiology (12 decks)

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