EXAM 1 Neuro and Endocrine Pathophysiology Flashcards
(235 cards)
1
Q
Cell communications: What are gap junction?
A
Pores in the cells membrane allowing signaling to move from cell to cell
2
Q
What are neurotransmitters?
A
Release from neuron to travel across gap to a 2nd cell
3
Q
What are paracrine hormones?
A
Local hormones secreted into tissue fluids to affect nearby cells
4
Q
Strict definition of hormones
A
Chemical messengers that travel in the bloodstream and stimulate response in another tissue or organ
5
Q
What are target cells?
A
They have receptors for hormone
6
Q
Endocrine hormones
A
Produce hormones
7
Q
Endocrine system : endocrine organs are
A
Thyroid , pineal, etc
8
Q
Endocrine system: also produce
A
hormone producing cells organs (Brain, heart, and small intestine)
9
Q
***Endocrine control : normal homeostatic control of what? MEWGIH
A
Metabolism Electrolyte balance (Na, K, Ca2+) Water retention and BP control Glucose levels Inflammation Healing
10
Q
Normal vs disease states complicated usually by?
A
Elevated stress of illness/surgery
11
Q
***Hormone regulation: levels of hormone, what happens?
A
levels maintained within a certain range for normal physiologic function
12
Q
***Hormone regulation is mainly controlled by what feedback?
A
Negative feedback
13
Q
What are the environmental factors that can affect levels of hormones? (SSSND)
A
Stress (both physical and mental) Systemic illness Sleep patterns Nutritional changes Day-night cycle
14
Q
Hormone Regulation: Most pituitary hormones exhibit what?
A
Circadian rhythm
15
Q
During hormone regulation, it ensure
A
Peak hormone levels at times of greatest demand
16
Q
When does peak secretion of ACTH and cortisol?
A
Occur early in the morning
17
Q
What is stress caused by?
A
Any situation that upsets homeostasis via physical or emotional causes
18
Q
What is general adaptation syndrome?
A
The way the body reacts to stress
19
Q
What are the 3 stages of general adaptation syndrome?
A
Alarm REACTION
Stage of RESISTANCE
Stage of EXHAUSTION
20
Q
Alarm reaction is the _________
What happens?
A
Initial response
Increase Epinephrine and norepinephrine levels
HR and BP and blood glucose (NEHBB) (NaH2O
Sodium and water retention (aldosterone)
21
Q
Stage of Resistance what happens?
GACFatGDS
A
Glycogen reserves gone Increase ACTH and cortisol levels Fat and protein breakdown Gluconeogenesis Depresses immune function Susceptibility to infection and ulcers
22
Q
Stage of Exhaustion is defined as
A
stress that continues until fat reserves are gone
23
Q
What happens during stage of exhaustion? Protein
PL HE HA
A
Protein breakdown and muscle wasting
Loss of glucose homeostasis
Hypertension and electrolyte imbalances (loss of K+H+)
Hypokalemia and alkalosis (can lead to death)
24
Q
***Effects of stress : What is activated and what does it depend on?
A
Activation of the adaptive processes to stress depends on the severity and or duration of the stressor event
25
***Effects of stress when adaptive process activated , 3 different outcomes possible
1. Restoration of homeostasis
2. Inadequate response
3. Exaggerated response
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***Stress response : a modified endocrine response
Causing physical and mental changes
27
***Modified endocrine response: what physical changes occur?
There is redirection of blood flow
Decreased to GLK (gut, liver and kidney)
Increased to HBLS (Heart, brain, liver and skeletal muscle)
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***Modified endocrine response: what mental changes occur?
Increased alertness and arousal, cognition, analgesia
| inhibition of appetite (Improved CAAA IA)
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***Hemodynamic & Metabolic Changes in stress leads to redirection of blood flow
Increase HR, CO and Metabolism with hyperglycemia (HCML) Lypolysis
Decreased insulin
30
Neuroendocrine effectors of Stress response: What are the peripheral effectors? (GEN)
Glucocorticoids
Epinephrine
Norepinephrine
31
Neuroendocrine effectors of Stress response: What are the central effectors? (CV)
Corticotropin Releasing hormone (CRH): { (CRH -->Pituitary --> ACTH)}
Vasopressin (ADH) Increase BP
32
Hypothalamic-Pituitary-Adrenal Axis (HPA-axis) stress reaction (CAA)
CRH stimulate release of ACTH from hypothalamus
Acts with Vasopressin to control pituitary adrenal axis
ACTH leads to cortisol release
33
What is the most important regulator of ACTH release?
CRH
34
***What are other components affecting HPA ? What does it depends on ? (CIAL)
Depending on the magnitude of the stress, additional factors to enhance HPA response are:
Cytokines (TNF)
Interlukins (IL-6 & IL-1)
Angiotensin II
Lipid mediators of inflammation (Arachidonic acid -->Prostaglandins & Leukotrienes)
35
***Short term stress (CLR)
Cortisol regulates CRH, Vasopressin & ACTH via negative feedback
Limits exposure of tissues to cortisol
Reduces excessive metabolic, CV, and Immune
stress response
36
***Long Term Stress examples (CAMPA)
```
Chronic illness/depression
Anorexia nervosa
Malnutrition
Panic disorder
Alcohol withdrawal
```
37
***Long term stress Sequela:(GIPI)
Increased gluconeogenesis, insulin resistance, protein catabolism, immune depression (GIPI)
38
Exocrine Glands vs Endocrine glands: Exocrine glands
secrete their product through a duct and onto an open surface or organ cavity. Extracellular effects (food digestion)
39
Exocrine Glands vs Endocrine glands: Endocrine glands
Secrete their products directly into the bloodstream, no ducts. Intracellular effects (Alter target cell metabolism)
40
Nervous vs Endocrine Systems: Communication
Nervous : both chemical and electrical
| Endocrine: Only CHEMICAL
41
Nervous vs Endocrine Systems: Speed and persistence of response
Nervous: reacts quickly , stops quickly
Endocrine: react slowly . effect may continue for weeks
42
Nervous vs Endocrine Systems: Adaptation to long term stimuli
Nervous: response declines (adapt quickly)
Endocrine: response persists
43
Nervous vs Endocrine Systems: Area of effect
Nervous: Targeted and specific (one organ)
Endocrine: general, widespread effects (many organs)
44
What are chemical that function as both hormones and neurotransmitters? CANT Do
```
Cholecystokinin
ADH
NE
Thyrotropin releasing hormone (TRH)
Dopamine
```
45
Some hormones are secreted by neuroendocrine cells
Oxytocin and catecholamine
46
Both Nervous and endocrine systems have
overlapping effects on same target cells
47
Both cause glycogenolysis in the liver
NE and Glucagon
48
Both nervous and endocrine systems can regulate each other, How so?
Neurons trigger hormone secretion
| Hormones stimulate or inhibit neurons
49
Hypothalamus description
Flattened funnel, forms floor and wall of third ventricle
50
What is the function of the hypothalamus?
Regulates homeostasis mechanisms and some endocrine functions.
51
Where is the pituitary gland hypophysis
Suspended by hypothalamus by stalk (infundibulum)
52
Where is the pituitary gland located?
House in SELLA TURCICA of sphenoid bone
| 1.3 cm diameter
53
Where is the Anterior pituitary ?
The anterior pituitary (Adenohypophysis) arises from hypophyseal pouch (outgrowth of pharynx)
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Where is the Posterior pituitary ?
Also called neurohypophysis (arises from brain)
55
Oxytocin released by
Posterior pituitary gland
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Pituitary Hormones - Anterior Lobe : What types of hormones?
Tropic hormones target other endocrine hormones
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What are the Gonadotropins hormones?
Target gonads (FSH and LH)
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What are the Anterior lobes hormones?
```
FLAT PG
FSH
LH
ACTH
TSH
PRL
GH
```
59
Axis refer to
Way endocrine glands interact
60
What is the role of FSH?
Stimulates production pf egg or sperm cells
61
What is the role of LH? In female
Mainly stimulates hormone production
| Female: stimulates ovulation and secretion of estrogen and progesterone
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What is the role of LH in males?
Stimulates testes to secrete testosterone
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What is the role of TSH?
Stimulates growth of thyroid and secretion of thyroid hormones
64
What is the role of ACTH (adrenocorticotropic hormone)
Regulates response to stress, stimulates adrenal cortex
65
What does corticosteroids regulated?
Glucose, Fat, and protein metabolism
66
What is the role of Prolactin (Prolactin releasing factor) ?
stimulates anterior pituitary produce it
67
Prolactin in female
Milk synthesis after delivery
68
Prolactin in male
Increase LH sensitivity and increase Testosterone secretion
69
Growth hormones aka
somatotropin
70
Where is the GH secreted?
Anterior pituitary
71
Growth hormone promotes
Tissue growth
72
Growth hormones promote tissue growth 2 ways
Mitosis and cellular differentiation
| Stimulates liver to produce IGF-I and II
73
Growth hormone , liver protein synthesis
Increase DNA transcription for Increase mRNA production, proteins synthesized
Enhanced amino acid transport into cells, decrease protein catabolism
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Growth hormone , Lipid metabolism how?
GW stimulates FFA and glycerol release from adipocytes, protein sparing.
75
Growth hormone, CHO metabolism
Glucose sparring effect = less glucose used for energy
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Growth hormone, Electrolyte balance
Promotes Na+, K+, Cl- retention, Ca2+ absorption
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Growth Hormone and Aging: Childhood and adoslescence
Bone, cartilage, and muscle growth
| Stimulates growth at Epiphyseal plates
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Growth Hormone and Aging: Adulthood
Increase osteoblastic activity and appositional growth affecting bone thickening and remodeling.
79
Growth hormone and aging, what changes occur in concentration
Blood concentration decrease by age 75 to 1/4 of that of adolescent.
80
Levels of GH throughout the day _______
fluctuates
81
GH is higher during (SAV)
Sleep, after high protein meals, vigorous exercise
82
GH is lower
After High CHO meals
83
Posterior Pituitary Hormones produced by
Hypothalamus
84
Posterior Pituitary Hormones are
AGO
ADH
GnRN (Gonadotropin-releasing hormone)
Oxytocin
85
What is the role of ADH?
targets kidneys, Increase water retention, reduce urine
| Also a neurotransmitter
86
Acts as both Neurotransmitter and hormones?
ADH
87
Oxytocin role ? Causes
Causes uterine contractions and milk ejection (letdown)
88
Stimulates production of FSH and LH
GnRH
89
Pituitary is under control of
Hypothalamic and Cerebral control
90
Anterior lobe control
Releasing hormones and inhibiting hormones of hypothalamus
91
Posterior lobe control
Neuroendocrine reflexes
92
Posterior lobe control hormone release in response to NS signals
hormones release in response to nervous system signals
| Sucking infant --> stimulates nerve ending --> Hypothalamus --> posterior lobe -->oxytocin --> milk ejection
93
Hormone release in response to higher brain centers
Milk ejection reflex can be triggered by a baby's cry
94
What is negative feedback?
Increase target organ hormone levels inhibits release of tropic hormones
95
What is positive feedback?
Stretching of uterus increase Oxytocin release, causes more contraction/stretching uterus until delivery
96
Pineal gland peak secretion ages_____by ______, lower
1-5 by puberty 75% lower
97
What does pineal gland produces? day vs night?
Serotonin by day
| Melatonin at night
98
Melatonin increase in
SAD + PMS
99
Melatonin decrease in
Phototherapy
100
Melatonin increase in
Depression, sleepiness, irritability, and carbohydrate craving.
101
*** Thymus is located
In mediastinum superior to heart
102
***Involution of thymus happens
after puberty
103
***The thymus secretes hormones that regulate development and
later activation of T-lymphocytes
| T- cells become immunocompetent
104
Largest endocrine gland
Thyroid; high rate of blood flow
105
Anterior and lateral sides of trachea 2 larges lobes
| connected by___
connected by isthmus
106
2 thyroid hormones
T3 (triiodothyronine)
T4 (Tetraiodothyronine)
Calcitonin
107
T4 is produced by
thyroid follicles filled with colloid and lined with simple cuboidal epitheliar "follicular cells"
108
Effect of T4 physiologic
| metabolic rate, O2 consumption, heat production, HR, contraction strength, RR, what happens to appetite
Increase metabolic rate, O2 consumption, increase heat production, increase HR, contraction strength, RR
stimulates appetite, and breakdown CHO lipid and proteins
109
What is calcitonin produced by___
Parafollicular "c" cells
110
Calcitonin and Ca2+
decrease blood calcium levels, promote Ca2+ deposition , antagonistic PTH
111
Parathyroid glands (PIS)
Parathyroid glands
Increase Blood Ca2+ Levels
Stimulates osteoclast maturation and mobilization of calcium from bone
112
What promote synthesis of calcitriol ?
3 roles
Parathyroid glands
Increase absorption of Ca2+
Decrease urinary excr3etion
Increase bone resorption
113
**Adrenal Gland: Adrenal cortex (GFR)
```
Zona Glomerulosa (outer)
Zona Fasciculata (middle)
Zona Reticularis (inner)
```
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***Adrenal Cortex: Zona Glomerulosis produces_____What do they do?
mineralcorticoids
| Control electrolyte balance, aldosterone promotes Na+ retention, water reabsorption and K+ excretion
115
***Adrenal Cortex: Zona Fasciculata produces ______What do they do?
Glucocorticoids
Cortisol, stimulates fat and protein catabolism, gluconeogenesis (from amino acids and FA) and lipogenesis (release of fatty acids and glucose into blood)
116
***What happens with long term use of Glucocorticoids?
Anti-inflammatory effect becomes immune suppression with long term use
117
***Zona Reticularis produces ________ what do they do?
Sex hormones
| Androgens (including DHEA with other tissues convert to testosterone) and estrogen (important after menopause)
118
*Adrenal medulla sympathetic ganglion innervated by
Innervated directly by sympathetic preganglionic fibers
119
Adrenal medulla consists of
Modified neurons called CHROMAFFIN CELLS
120
Stimulation causes release of
Catecholamines (epinephrine and NE)
121
Hormones effects of Adrenal medulla
| What about insulin?
Increase alertness, anxiety, fear, HR, airflow ,raises metabolic rate.
Insulin secretion inhibited
stimulates GLUCONEOGENESIS and GLYCOGENOLYSIS
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What causes medullary cells to stimulate cortex
Stress
123
***Adrenal Medulla Tumor
Pheochromocytomas
| Causes by tumors derived from the chromaffin cells of the adrenal medulla
124
***What secretes catecholamines
Pheochromocytomas
125
***What are the Clinical manifestations of Pheochromocytomas?
```
HTN
Diaphoresis
Tachycardia
Palpitations
Severe headaches
```
126
Is both exocrine and endocrine
Pancreas
127
***Endocrine tissue of Pancreas
Clusters of endocrine cells called Islets of Langerhands
128
***The islets include 4 types of cells that secrete different hormones:
Alpha cells
Beta cells
Delta cells
F cells
129
*** Alpha cells secrete
Glucagon
130
***Beta cells secrete
Insulin
131
***Delta cells secrete
Somatostatin
132
*** F cells
Pancreatic polypeptide
133
Pancreatic hormones
1-2 millions islets produce hormones
134
Insulin from Beta cells
Secreted after meals with carbohydrates raises blood glucose levels
135
Insulin on glucose and AA
stimulate glucose and amino acid uptake
136
Nutrient storage and pancreatic hormones
Nutrient storage effect (promotes glycogenesis and lipogenesis)
Antagonizes glucagon
137
Pancreatic hormones glucagon secreted when
Blood glucose is low, acts on liver cells to release glycogen, increases blood sugar.
138
Glucagon stimulates
Glycogenolysis , fat catabolism (release of FFA) and promote absorption of amino acids for gluconeogenesis
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Somatostatin secreted when
secreted with rise in blood glucose and amino acids after a meal, inhibits GH
140
Somatostatin paracrine secretion
Inhibits secretion of insulin, glucagon by alpha and beta cells
141
Hyperglycemic hormones
Raise blood glucose (GH, EPi, NE, Corticol, Corticosterone)
142
Hypoglycemic hormones
Lower blood glucose (insulin)
143
Endocrine Functions of Other organs: Heart
ANP released with an increase in BP
| Decrease BV and BP by Increase Na and H2O loss by kidneys
144
Endocrine Functions of Other organs: SKIN
Helps produce D3
145
Endocrine Functions of Other organs: LIVER
15% of erythropoietin (stimulates bone marrow)
| Angiotensinogen (prohormone, precursor of angiotensin II)
146
Liver converts
Vitamin D3 to calcitriol
147
Promotes intestinal absorption of iron
Hepcidin
148
Produces 85% of erythropoietin
Kidneys
149
Stimulates bones marrow to produce RBCs what hormones
Erythropoietin
150
Convert angiotensinogen to angiotensin I
Kidneys (renin)
151
Kidneys and calcitriol
converts calcidiol to calcitriol (ACTIVE FORM OF VitD)
| By increasing absorption by intestine and inhbits loss in the urine; More Ca2+ available for bone deposition
152
Stomach and small intestines and endocrine
10 enteric hormones
| Coordinate digestive motility and secretion
153
Placenta and endocrine
secretes estrogen, progesterone, and others
| regulates pregnancy, stimulates development of fetus and mammary glands
154
Fat Soluble vs Water soluble : Steroids
Derived from cholesterol
| Sex steroids, corticosteroids
155
Fat Soluble vs Water soluble : Peptides and Glycoproteins
Oxytocin and ADH: all releasing and inhibiting hormones of hypothalamus: most of anterior pituitary hormones
156
Fat Soluble vs Water soluble :Monoamines (biogenic amines)
Derived from amino acids
| Catecholamines (Ne, Epi, Dopa and thyroid hormones)
157
Hormones synthesis: Steroid hormones synthesized from
Cholesterol : differs in functional groups attached to 4- rings steroid backbone
158
Hormones synthesis : Peptides -> Cellular steps
Rough ER removes segment, forms prohormones
Golgi complex further modifies it into hormones
(e.g. insulin formation preproinsulin converted to proinsulin in RER) proinsulin split into insulin and C peptide in Golgi complex).
159
Hormone synthesis: Monoamines: All are synthesized from
Tyrosine
160
What is the only monoamines not synthesized from tyrosine?
Melatonin (synthesized from tryptophan)
161
Thyroid hormones is unusual why?
Composed of 2 tyrosine molecules
| Requires a mineral, iodine
162
Thyroid Hormone Synthesis
1. Iodide absorption and oxidation
2. Thyroglobulin synthesis and secretion
3. Iodine added to tyrosines and thyroglobulin
4. Thyroglobulin uptake and hydrolysis
5. Release of T3 and T4 into the blood
163
T3 and T4 synthesis
Follicular cells
Absorb iodine from blood and store in lumen as Iodine
Synthesize thyroglobulin and store in lumen (contains tyrosine)
Tyrosine and iodine form T3 and T4
164
TSH
Stimulates follicular cells to remove T3 and T4 from Thyroglobulin for release into plasma
165
Hormones transport: Monoamines and peptides are (hydrophobic or hydrophilic)
Hydrophillic
166
How are protein hormones transported?
Transported in the bloodstream, transported free unbound as water soluble form
167
Steroids and thyroid hormones are
| (hydrophobic or hydrophilic) what must they do?
Hydrophobic
| They must bind to transport protein for transport
168
When bound hormone by to protein what happens?
Bound hormones attached to transport protein, prolongs half life to weeks and protect from enzymes and kidney filtration
169
What happens to unbound hormones?
Unbound hormones leave capillary to reach target cell (half life a few minutes)
170
Transport proteins in plasma
Albumin and TGB (thyroxine binding globulin)bind to thyroid hormones
171
Steroid hormones bind to
Globulins
172
Aldosterone and transport protein
NO transport protein , 20 min half life
173
Hormones receptors are located on
plasma membrane, mitochondria, other organelles or in nucleus
174
Hormone binding turns
metabolic pathway on or off
| Exhibit specificity and saturation
175
How does hydrophobic hormones exert their actions
They penetrate plasma membrane and bind to intracellular receptors such as estrogen, T3 and aldosterone.
176
How does hydrophilic hormones exert their actions?
Must bind to cell surface receptors (such AS epinephrine)
177
Thyroid hormone effects : TH binds to receptors on mitochondria and
Increase rate of aerobic respiration
178
Thyroid hormone effects : TH binds to receptors on ribosomes and chromatin and
Increase protein synthesis
179
Thyroid hormones effects Na Na ATPase produced
Generates heat.
180
Hydrophillic hormones : Mode of Action
cAMP as second messenger i.e epinephrine
181
Hydrophillic hormones steps (HAPPAM)
1. Hormone binding activates G protein
2. Activate adenylate cyclase
3. Produces cAMP
4. Activates Kinases
5. Activates enzymes
6. Metabolic reactions: Synthesis, secretion, change membrane potentials.
182
Hormones may use
Different second messengers in different tissues
183
Hormones clearance signals must be
turned off
184
Hormone clearance take UP AND degraded by
Liver and kidney
185
Hormones excreted in
bile or urine
186
Metabolic clearance rate
Half time required to clear 50% of hormone
187
***Modulation of target cell sensitivity : Upregulation (LIS)
Low receptor density Weak response
Increase receptor density : Increase sensitivity
Stronger response
188
***Modulation of target cell sensitivity : Downregulation (HRD)
High receptor density Strong response
Reduced receptor density : Reduced sensitivity
Diminished response
189
Long term use of high pharmacological doses
Bind to receptor sites of related hormones
| Target cell may convert to different hormone
190
Hormones interactions 3 (SPA)
Synergistic effects
Permissive effects
Antagonistic effects
191
What is permissive effects
One hormone enhances response to a second hormone
192
Chemical messengers that diffuse short distances and stimulates nearby cells
Paracrine
193
Unlike neurotransmitters, paracrine secretions are
not produces in neurons
| not transported in blood
194
Examples of paracrine and their functions
| Histamine
Histamine (from mast cells of Connective tissue)
| causes relaxation of blood vessel smooth muscle
195
Examples of paracrine and their functions: Nitric oxide
From endothelium or blood vessels, causes vasodilation
196
Examples of paracrine and their functions: Somatostatin
From gamma cells, inhibits secretions of alpha and beta cells
197
Examples of paracrine and their functions: Catecholamines
Diffuse from adrenal medulla to cortex
198
Paracrine secretion :
Eicosanoids
199
Paracrine secretion: Eicosanoids: Leukotrienes
Converted from arachidonic acid (by lipoxygenase) mediates allergic and inflammatory reactions)
200
Paracrine secretion: Eicosanoids: Prostacyclin
By cyclooxygenase, inhibits blood clotting and vasoconstriction
201
Paracrine secretion: Eicosanoids: Thromboxane
by cyclooxygenase: Produces by blood platelets after injury; override prostacyclin, stimulates vasoconstriction and clotting
202
Paracrine secretion: Eicosanoids: Prostaglandins PGE
by cyclooxygenase:
| PGE: Relaxes smooth muscles in bladder, intestines, bronchioles, uterus and stimulates contraction of blood vessels.
203
Paracrine secretion: Eicosanoids: Prostaglandins PGF
Opposite effects
204
Endocrine disorders characterized by
too much or too little
205
Hyposecretion
Inadequate hormone release
Tumor or lesion destroys glands For example head trauma affects pituitary gland ability to secrete ADH
DI = chronic poyluria
206
Hypersecretion
```
Excessive hormone release
Tumors or autoimmune disorder
Toxic goiter (Graves disease) antibodies mimic effect of TSH on the thyroid
```
207
Hypersecretion of growth hormones: Gigantism
| Dwarfism
If oversecretion Gigantism
| if Undersecretion Dwarfism
208
Hypersecretion of GH
Acromegaly
| Thickening of the bones and soft tisses
209
Congenital Hypothyroidism (Decreased TH) cretinism
infant suffers abnormal bone development , thickened facial features, low temperature, lethargy and brain damage
210
Myxedema (adult hypothyroidism) decrease TH
Low metabolic rate slugglishnes, sleepiness, weight gain, bradycardia, constipation, dry ksin
211
Endemic goiter
Dietary iodine deficiency , no TH ,no feedback, increased TSH
212
Toxic goiter
Graves disease
| Antibodies mimic TSH, increase TH, exophthalmos
213
Hyperthyroidism aka ________ is a condition that results from any cause of
Thyrotoxicosis
| increase levels of thyroid hormones. Excess amount of thyroid hormones are secreted from the thyroid gland
214
Clinical manifestation of Hyperthyroidism
Increase metabolic rate with heat intolerance and increased tissue sensitivity to stimulation by the SNS : Enlargement of the thyroid gland
215
Treatment of hyperthyroidsim
Methimazole or Propylthiouracil
Radiactive iodine therapy
Surgery
216
Parathyroid disorders: Hypoparathyroid
Surgical excision during thyroid surgery
| Fatal tetany 3-4 days
217
Parathyroid disorders: Hyperparathyroid
Excess PTH secretion
tumor in gland
Increase Ca2+ --> Renal Calculi
218
Cushing syndrome
Excess cortical secretion
219
S/S of Cushing syndrome
Hyperglycemia, HTN, Weakness, edema
Muscle and bone loss
Buffalo hump and MOON FACE (fat deposition between shoulders)
220
Adrenogenital syndrome
Adrenal androgen hypersecretion: Accompanies cushing
Enlargement of external sexual organs in children and early onset of puberty
Masculinizing effects of women (deeper voice and beard growth)
221
Diabetes Mellitus S/S
Hyposecretion of insulin
Polyuria, polydipsia and polyphagia
Hyperglycemia, glycosuria, ketonuria
osmotic diuresis
222
What is osmotic diuresis
Blood glucose levels rise above transport maximum of kidney tubules, glucose remains in urine (ketones also present) Increased osmolarity draws water into urine
223
Type I DM
IDDM
10%
Autoimmune destruction of B cells diagnosed about age 12
224
Type I Treated with
Diet, exercise, monitoring of blood glucose and periodic injections of insulin
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Type II
NIDDM
90%
Insulin resistance: Failure of target cell to respond to insulin
226
What are the 3 major risk factors for NIDDM
Heredity, age and Obesity
227
NIDDM treated with
Weight loss program diet and exercise
| Oral medication improve insulin secretion or target cell sensitivity
228
Acute pathology of Diabetes
Cells cannot absorb glucose, rely on fat and proteins (weight loss, weakness)
229
Fat catabolism and diabetes
FAT catabolism increase FFA in blood and ketone bodies
230
Ketonuria and diabetes
Ketoacidosis occurs as ketones decrease blood pH
| If continued causes dyspnea and eventually diabetic coma
231
Chronic pathology of Diabetes
Chronic hyperglycemia lead to neuropathy and CV damage from atherosclerosis
Retina and kidneys damage common in type I
Atherosclerosis leads to heart failure common in type II and GANGRENE
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Hyperinsulinism
From excess insulin injection or pancreatic islet tumor
233
Hyperinsulinism causes
| SIA
hypoglycemia, weakness and hunger
| Triggers secretion of epinephrine, GH and glucagon (SE: anxiety, sweating and increase HR)
234
Insulin shock (DUC)
Uncorrected hyperinsulinism with Disorientation
Unconsciousness
Convulsion
235
Tropic Hormones TAPGG
```
TSH
ACTH
PRL
Gonagotropins (FSH, LH)
GH
```
