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Flashcards in Endocrinology II Deck (70):
1

What does the outer cortex of the adrenal gland produce?
Inner medulla?

Cortex - steroid hormones

Medulla - Catecholamines

2

What 3 classes of molecules are made in the Adrenal Cortex?

mineralocorticoids
glucocorticoids
androgens

3

What are the 3 steroid hormones of the Adrenal Cortex?

Aldosterone - (mineralocorticoid)
Cortisol - (glucocorticoid)
Dehydroepiandrosterone - (androgen)

4

What 2 hormones are made in the adrenal medulla?

Epinepherine
Norpepinepherine

*the catecholamines

5

Why are cortisol, aldosterone, and adrenal androgens bound to transport proteins in the blood?

otherwise would be excreted because of size

6

Describe the Cortisol feedback loop:

CRH > ACTH > Cortisol

7

What increases CRH pulses?

Illness, surgery, injury, psychiatric stress

(any stress)

8

How is ACTH released from the Ant. Pituitary?

Pulses
Rhythm (diurnal)
highest level 4-6 AM

9

What is the main immediate effect of Cortisol?

Increase blood glc
(GNG, insulin resistance, glycogen storage, appetite)

10

T/F
Cortisol suppresses inflammation, immune response, and wound healing.

Yes

11

T/F
Aldosterone is stimulated by ACTH

Yes, some

but mostly controlled by the kidney renin-angiotensin system

12

What are the effects of Aldosterone?

Holds Sodium
Pumps out Potassium

Maintains blood volume and pressure

13

Will ACTH stimulate all of the hormones of the adrenal cortex?

Yes

14

What is the function of DHEA?

masculinizing hormone
(pubic hair)

in excess causes hirsutism (male and female)

15

T/F
ACTH, cortisol, aldosterone, DHEA can all be found in the plasma and saliva for testing purposes?

True

16

What are some causes of primary adrenal insufficiency?

Autoimmune
Infection (TB, cytomegalovirus in HIV)
Cancer
Hemorrhage
Surgical removal

17

What would be low and what would be high in Primary Adrenal Insufficiency?

Glucocorticoid (Cortisol), Mineralocorticoid (Aldosterone), and Adrenal androgen (DHEA) lost/low

ACTH high

18

What might cause the following:
fatigue
weight loss, nausea
abdominal pain
low glc
illness amplified

Low cortisol

19

What might cause the following:
low Na, high K
low BP

Low aldosterone

20

What causes hyperpigmentation?

high ACTH

*note - in patients see especially in mucous lining of the mouth

21

What does ACTH do at high concentrations?

stimulates melanocytes

22

What are the symptoms of acute adrenal crisis?

weakness
nausea
vomiting
dehydration
hypotension
hypoglycemia

23

What cortical hormone of the kidney is functionally viable in secondary adrenal insufficiency?

Aldosterone

(regulated mostly by kidneys)

24

What is the treatment for both primary and secondary adrenal insufficiencies?

Cortisol and Cortisol

25

What syndrome is defined by an excess of Cortisol?

Cushing Syndrome

26

What causes Cushing disease?

*as opposed to Cushing Syndrome?

Pituitary tumor producing ACTH

27

What causes Cushing Syndrome?

anything that increases ACTH

adrenal tumor, prescribed glucocorticoids, etc.

28

What is a classic sign of Cortisol excess?

(Cushing Syndrome)

Purple stretch marks
Moon face

29

High glc production, insulin resistance, hyperglycemia, and diabetes can be caused by...

Cortisol Excess

30

What does Dexamethasone do?

Synthetic glucocorticoid so it suppresses ACTH

31

What 3 levels can you address too much ACTH secretion pharmacologically?

block ACTH secretion
inhibit cortisol production
block cortisol receptors

32

What is more important, the Adrenal medulla or cortex?

cortex

(can survive without epi/norepi)

33

What is the tumor of the Adrenal Medulla?

Pheochromocytoma

34

High ACTH, low cortisol, hyperpigmentation:

Adrenal insufficiency

either autoimmune or TB-related

treat with Cortisol

35

High ACTH, high cortisol, hirsutism, full face.

Cushings Disease

caused by tumor

36

What is the RDA for calcium 19-70?

1000 mg

37

What 2 things does Vitamin D increase absorption of from the gut?

Calcium and Phosphorous

38

What are the 2 sources of Vitamin D?

sunlight (cholecalciferol - D3)
plants (ergocalciferol - D2)

39

What type of Vitamin D is usually measured?

Storage form in Liver

40

Vitamin D is a ______ hormone that increases absorption of both ____ and ____.

Steroid

Calcium, Phosphorous

41

Name 4 Calcium regulating hormones.

PTH
PTHrP
Calcitonin
Vitamin D

42

T/F
PTH is a slow acting hormone

False
controls Calcium on timescale of around a minute

43

Why does PTH decrease Phosphorous?

Its actions in the kidney preserve Calcium and secrete phosphorous

44

What does PTH increase?

Calcium and Vitamin D

45

What is the difference between PTH and PTHrP?

PTHrP increases Calcium (like PTH) but does NOT activate Vitamin D.

net effect: increase Ca, decrease PO4, PTH

46

What can cause hypercalcemia?

Too much PTH, Vitamin D, or PTHrP

47

What can cause hypocalcemia?

Not enough PTH or Vitamin D

Resistance to PTH, Vitamin D

48

What are the major causes of hypercalcemia?

high PTH or PTHrP (tumor)
high Vitamin D

49

What are the symptoms of hypercalcemia?

high PTH or PTHrP (tumor)
high Vitamin D

50

What are the symptoms of Hypercalcemia?

Stones, groans, moans, overtones, bones

51

Primary Hyperparathyroidism:
Ca Phos 1,25D PTH

high, low, high, high

52

What are the causes of Hypocalcemia?

low PTH
low Vitamin D
low Calcium intake

53

What is the main symptom of Hypocalcemia?

neuromuscular irritability

54

What are low PTH effects on:
Ca Phos 1,25D

low, high, low

55

Low Ca, Phos, and high PTH
Unmineralized bone
diagnosis?

Rickets

Childhood Vitamin D deficiency

56

What does severe Vitamin D deficiency lead to in adults?

Osteomalacia

*diffuse bone pain
*everything low but PTH

57

What indicates Renal Failure?

low Ca, 1,25D
high Phos, PTH

58

What is the difference between Primary and Secondary Hyperparathyroidism?

Primary - failure at parathyroid (too much PTH causes high calcium)

Secondary - low vitamin D or kidney failure
*high PTH secondary to low calcium

59

RANK/RANKL are part of what system?

Immune

60

What is a major osteoclast inhibitory factor?

Osteoprotegerin

61

Is low weight a risk factor in bone fracture?

Yes - incidental to frailty
(somewhat counterintuituve)

62

Can Glucocorticoids cause fractures?

Yes

(could've been designed as evil for bones)

63

What are some preventions/treatments for osteoporosis?

Calcium and Vitamin D
Exercise
Osteoclast inhibition
Osteoblast stimulation

64

What are treatments that inhibit osteoclasts?

Denosumab (RANKL antibody)
Calcitonin
Bisphosphonates
Estrogen/SERMS

(also, Calcium supplements)

65

What does SERM stand for and what do they do?

Selective Estrogen Receptor Modulators

Act at Estrogen Receptors in bone but NOT in breast/uterus

*effective osteoclast suppressor

66

How do bisphosphonates work?

Bind Ca++ to bone
Increase osteocyte death
Long half life

67

What is a possible dental side effect of Bisphosphonates?
other side effects?

Jaw osteonecrosis
(probably due to high turnover)

Atypical femoral fractures
(uncommon)

68

What two treatments are associated with jaw osteonecrosis and atypical femur fractures?

Denosumab and Bisphosphonates

69

When can exercise increase bone density?

Only when very intense

- otherwise will stabilize bone density

70

What is a counter-intuitive treatment for bone loss?

hPTH (PTH analog)

*stimulates osteoclasts, but osteoblasts and osteocytes more.
*effective, expensive, and shown to cause horrible bone cancer when given in high doses to rats

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