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Flashcards in Endocrine random facts Deck (58):
1

What can you use to treat HIV associated lipodystrophy?

Tesamorelin (a GHRH analog)

2

What are epinephrine's effects on the pancreas?

Stimulates both beta-2 and alpha-2, but alpha-2 inhibitory effect predominates so overall inhibitory effect. Pretreatment with an alpha-2 blocker would cause epinephrine's effect on beta-2 to be predominant and increase insulin secretion

3

How are prolactin and the thyroid hormones related?

TRH increases prolactin secretion (eg. in primary or secondary hypothyroidism)

4

What is the other name for IGF-1?

Somatomedin C

5

What is the effect of growth hormone on blood sugar?

GH increases insulin resistance (diabetogenic)

6

What do ghrelin and leptin do?

Ghrelin stimulates hunger and GH release and is produced by the stomach. Leptin is the satiety hormone produced by adipose tissue. Sleep deprivation leads to decreased leptin production

7

What regulates ADH?

Osmoreceptors in hypothalamus (primary), hypovolemia (secondary)

8

How does cortisol increase blood pressure?

1. Upregulates alpha-1 receptors on arterioles leading to increased sensitivity to norepinephrine and epinephrine, 2. At high concentrations, can bind to mineralocorticoid receptors

9

Why does excess cortisol give you striae?

Decreases fibroblast activity

10

Relationship between pH and calcium homeostasis

Increase in pH causes an increased affinity of albumin to bind to calcium which causes hypocalcemia (cramps, pain, paresthesias, carpopedal spasm)

11

What type of cells secrete PTH?

Chief cells of the parathyroid

12

Where in the kidney does PTH cause the excretion of Ca and PO4?

Ca in the DCT, PO4 in the PCT

13

Where is calcitonin from?

Parafollicular cells of the thyroid

14

Which hormones act through cAMP?

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2 receptor), MSH, PTH, calcitonin, GHRH, glucagon

FLAT ChAMP (plus a few more)

15

Which hormones act through cGMP?

ANP, BNP, NO (EDRF)
Think vasodilators

16

Which hormones act through IP3?

GnRH, Oxytocin, ADH (V1 receptor), TRH, Histamine (H1 receptor), Angiotenin II, Gastrin
GOAT HAG

17

Which hormones act through an intracellular receptor?

Vitamin D, Estrogen, Testosterone, T3/T4, Cortisol, Aldosterone, Progesterone
VETTT CAP

18

Which hormones act through an intrinsic tyrosine kinase?

Insulin, IGF-1, FGF, PDGF, EF
MAP kinase pathway

19

Which hormones act through a receptor-associated tyrosine kinase?

Prolactin, Immunomodulators (eg, cytokines IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoietin,
JAK/STAT pathway

20

What converts T4 to T3

5'-deiodinase

21

What is the enzyme responsible for oxidation and organification of iodide as well as coupling of monoiodotyrosine (MIT) and di-iodotyrosine (DIT)?

Peroxidase (propylthiouracil inhibits both peroxidase and 5'deiodinase. Methiazole inhibits peroxidase only)

22

What is the Wolff-Chiakoff effect?

Excess iodine temporarily inhibits thyroid peroxidase leading to decreased iodine organification and decreased T3/T4 production

23

What should you think of if you see Homer-Wright pseudo rosettes?

Neuroblastoma

24

Presentation of neuroblastoma?

Irregular mass crossing the midline OR opsoclonus-myoclonus syndrome ("dancing eyes-dancing feet"). HVA and VMA increased in the urine. Bombazine and neuron-specific annuals positive

25

What mutation is neuroblastoma associated with?

Overexpression of N-myc oncogene

26

Treatment for pheo?

Alpha blockers THEN beta blockers THEN surgical resection

27

Histologic findings in Hashimoto's

Hurthle cells, lymphoid aggregate with germinal centers

28

Empty-appearing nuclei with central clearing, nuclear grooves

Papillary thyroid carcinoma, increased risk with RET and BRAF mutations, childhood irradiation, excellent prognosis

29

Cancer invading the thyroid capsule

Follicular carcinoma, good prognosis

30

Sheets of cells in an amyloid stroma

Medullary carcinoma, associated with MEN 2A and 2B (RET mutations)

31

Hypocalcemia, shortened 4th/5th digits, short stature

Pseudohypoparathyroidism (Albright hereditary osteodystrophy)- unresponsiveness of kidney to PTH. Autosomal dominant

32

Familial hypocalciuric hypercalcemia

An AD dx caused by defective Ca sensing receptor on parathyroid cells. PTH cannot be suppressed by an increase in Ca level

33

What type of receptor are Calcium sensing receptors?

Transmembrane G-protein coupled receptors

34

What can primary hyperparathyroidism cause?

Stoans, bones, groans, and psychiatric overtones. Also osteitis fibrous cystica

35

Cystic bone spaces filled with brown fibrous tissue

Osteitis fibrosa cystica (Brown tumor consisting of deposited hemosiderin from hemorrhages, causes bone pain)

36

What is the most common cause of death in kids with gigantism?

Heart failure

37

What does acromegaly predispose you to?

Increased risk of colorectal polyps and cancer

38

Treatment for nephrogenic DI?

HCTZ, indomethacin, amiloride, and hydration

39

What can you use to treat SIADH?

Fluid restriction, IV hypertonic saline, conivaptan, tolvaptan, demeclocycline

40

Deficiency of what enzyme in certain organs leads to osmotic damage in diabetes?

Sorbitol dehydrogenase (causes cataracts)

41

Most common initial sensory impairment in pts with diabetes

A loss of vibrational sense because it affects the Pacinian corpuscles

42

Histology of type 1 and type 2 diabetes

Type 1- islet leukocytic infiltrate, Type 2- islet amyloid polypeptide (IAPP) deposits

43

Presentation of glucagonoma

Dermatisis (necrolysic migratory erythema), diabetes, DVT, and depression

44

Presentation of carcinoid syndrome

Recurrent diarrhea, cutaneous flushing, asthmatic wheezing, right-sided valvular disease

45

Tx for carcinoid syndrome

Surgical resection, somatostatin analog (octreotide)

46

How do you test for Z-E syndrome?

Secretin stimulation test: positive (in Z-E) if gastrin levels remain elevated after administration of secretin, which normally inhibits gastrin release

47

MOA of biguanides

(Metformin) Decreases gluconeogenesis, increases glycolysis, increases peripheral glucose uptake

48

SE of metformin

GI upset, lactic acidosis (thus contraindicated in renal insufficiency- check Creatinine!)

49

MOA of sulfonylureas

Close K+ channel in beta-cell membrane

50

What are the sulfonylureas?

First gen: chlorpropamide, tolbutamide; second gen: glimepiride, glipizide, glyburide

51

SE of thiazolidinediones

Weight gain, edema, hepatotoxicity, HF, increased risk of fractures

52

What are the GLP-1 analogs?

Exenatide, liraglutide

53

What are the DPP-4 inhibitors?

Linapgliptin, saxagliptin, sitagliptin

54

What is pramlintide

An amylin analog, decreases gastric emptying, decreases glucagon

55

What is canagliflozin?

An SLGT-2 inhibitor. Blocks reabsorption of glucose in the PCT. DE: glucosuria, UTIs, vaginal yeast infections. Monitor BUN/Cr

56

What is are the alpha-glucosidase inhibitors and how do they work?

Acarbose, miglitol. Inhibit intestinal brush-border alpha-glucosidases.

57

What hyperthyroid med do you use in pregnancy?

PTU

58

What is cinacalcet?

It sensitizes Ca-sensing receptor in parathyroid gland to circulating Ca causing decreased PTH. Used for hypercalcemia due to primary or secondary hyperparathyroidism.