Intro Flashcards
(152 cards)
1
Q
Hormones released by the hypothalamus include:
A
Hormones released by the hypothalamus include:
* CRH- corticotropin-releasing hormone
* TRH- thyrotropin-releasing hormone
* Somatostatin
* Dopamine
* GHRH- growth hormone-releasing hormone
* GnRH- gonadotropin-releasing hormone
2
Q
CRH stimulates the release of _ from the anterior pituitary
A
CRH stimulates the release of ACTH from the anterior pituitary
* ACTH acts on the adrenal glands to release cortisol
3
Q
TRH stimulates the release of _ from the anterior pituitary
A
TRH stimulates the release of TSH from the anterior pituitary
* Note that TRH can also nonspecifically stimulate prolactin release
4
Q
Somatostatin, released from the hypothalamus, functions to inhibit _
A
Somatostatin, released from the hypothalamus, functions to inhibit TSH, Prolactin, GH
5
Q
Dopamine, released from the hypothalamus inhibits the secretion of _ from the anterior pituitary
A
Dopamine, released from the hypothalamus inhibits the secretion of prolactin from the anterior pituitary
6
Q
GHRH stimulates the anterior pituitary to secrete _
A
GHRH stimulates the anterior pituitary to secrete GH
7
Q
GnRH stimulates the anterior pituitary to secrete _
A
GnRH stimulates the anterior pituitary to secrete LH/FSH
8
Q
ACTH acts on its target organ _ to secrete _
A
ACTH acts on its target organ adrenal gland to secrete cortisol and aldosterone
9
Q
TSH acts on its target organ _ to secrete _
A
TSH acts on its target organ thyroid glands to secrete T4,T3
10
Q
Prolactin acts on its target organ _ to stimulate _
A
Prolactin acts on its target organ, the breast to stimulate lactation
11
Q
GH stimulates its target organ _ to secrete _
A
GH stimulates its target organ the liver to secrete IGF-1 (insulin-like growth factor)
* IGF-1 then acts on the bones to stimulate growth
12
Q
IGF-1 is secreted from the _ and acts on the _
A
IGF-1 is secreted from the liver and acts on the bones to stimulate growth
13
Q
LH/FSH act on the target organs the _ to secrete _
A
LH/FSH act on the target organs testes, ovaries to secrete testosterone/ estradiol, progesterone
14
Q
Prolactin release can be stimulated directly via _ or indirectly via _
A
Prolactin release can be stimulated directly by nipple stimulation or indirectly via TRH
15
Q
Somatostatin released from the hypothalamus inhibits _ , somatostatin released by delta cells in the stomach inhibits _
A
Somatostatin released from the hypothalamus inhibits GH, TSH, prolactin , somatostatin released by delta cells in the stomach inhibits gastric acidity
16
Q
Cortisol, T3, T4, estradiol, progesterone, testosterone, inhibin feed back and suppress the secretion of hormones from the _ in a negative feedback mechanism
A
Cortisol, T3, T4, estradiol, progesterone, testosterone, inhibin feed back and suppress the secretion of hormones from the hypothalamus in a negative feedback mechanism
17
Q
The posterior pituitary receives _ stimulation from the _
A
The posterior pituitary receives direct neural stimulation from the hypothalamus
18
Q
The neurons in the posterior pituitary are an extension of the _ in the hypothalamus where the hormones are produced
A
The neurons in the posterior pituitary are an extension of the neuroendocrine cell nuclei in the hypothalamus where the hormones are produced
19
Q
(True/False) the posterior pituitary produces hormones
A
False; the posterior pituitary does not make hormones but just stores and releases hormones
20
Q
The two hormones stored and released from the posterior pituitary are _ and _
A
The two hormones stored and released from the posterior pituitary are oxytocin and ADH
21
Q
Role of oxytocin
A
Oxytocin is released during labor to increase contractions in the uterus
* It also causes the milk ejection reflex that contracts the breast during lactation
22
Q
Which hormones are released from the anterior pituitary?
A
FLAT PiG
* FSH
* LH
* ACTH
* TSH
* Prolactin
* GH
23
Q
Explain why primary adrenal insufficiency and Addison’s disease can lead to hyperpigmentation
A
Adrenal insufficiency –>
Low cortisol levels –>
High ACTH and CRH –>
ACTH derives the POMC protein that gets cleaved into ACTH and MSH –>
Melanocyte-stimulating hormone increases melanin
Ultimately the adrenal insufficiency impairs negative feedback and results in high ACTH
24
Q
In addition to stimulating the anterior pituitary to secrete ACTH, CRH also stimulates _ and _
A
In addition to stimulating the anterior pituitary to secrete ACTH, CRH also stimulates beta-endorphins and melanocyte-stimulating hormone
25
The POMC gene produces the POMC protein which gets cleaved into _ and _
The POMC gene produces the POMC protein which gets cleaved into **MSH** and **ACTH**
26
The negative regulator of the female HPG axis is _ ; the positive regulator is _
The negative regulator of the female HPG axis is **progesterone** ; the positive regulator is **estrogen**
27
Primary hypercortisolism is a problem with the _
Primary hypercortisolism is a problem with the **adrenal cortex**
28
Secondary hypercortisolism is a problem with the _
Secondary hypercortisolism is a problem with the **anterior pituitary**
29
Tertiary hypercortisolism is a problem with the _
Tertiary hypercortisolism is a problem with the **hypothalamus**
30
GH has _ effect on adipose cells
GH **stimulates adipose cells to break down stored fat**
* We call this the glucose sparing effect
31
GH stimulates growth by increasing the uptake of _ from the blood and enhancing cellular proliferation while reducing _
GH stimulates growth by increasing the uptake of **amino acids** from the blood and enhancing cellular proliferation while reducing **apoptosis**
32
GH has four target cell types:
GH has four target cell types:
1. Bone cells
2. Muscle cells
3. Nervous system cells
4. Immune system cells
33
Explain the diabetogenic effect of GH
**Diabetogenic effect:** GH stimulates the liver to break down glycogen into glucose
34
GH stimulates two things in the liver _ and _
GH stimulates two things in the liver **glycogen breakdown** and **release of IGF-1**
35
T3 and T4 control metabolism and heart rate through stimulating _ throughout the body
T3 and T4 control metabolism and heart rate through stimulating **gene expression** throughout the body
36
Growth hormone has _ effect on insulin
GH **antagonizes** insulin
37
Prolactin has _ effect on LH and FSH
Prolactin **decreases** LH and FSH
38
FSH stimulates _ synthesis and the development of _
FSH stimulates **estrogen synthesis** and development of **germ cells**
39
LH stimulates _ and _ synthesis
LH stimulates **progesterone** and **testosterone** synthesis; also stimulates egg development in females
40
Three actions of ADH
1. Renal water retention
2. Vasoconstriction
3. Increases release of ACTH
41
(LH/FSH) is involved in egg development
**LH** is involved in egg development
42
(LH/FSH) is involved in the development of germ cells
**FSH** is involved in the development of germ cells
43
Central or secondary adrenal insufficiency is a deficiency of _
Central or secondary adrenal insufficiency is a deficiency of **ACTH**
44
Central/Secondary adrenal insufficiency leads to a deficiency in _
Central/Secondary adrenal insufficiency leads to a deficiency in **cortisol** but *not aldosterone or androgens*
45
Signs of adrenal insufficiency include:
Signs of AI:
* Weight loss
* Fatigue
* Hypotension
* Hypoglycemia
* Vascular collapse and death
46
Vasopressin deficiency results in _
Vasopressin deficiency results in **central diabetes insipidus**
* Excessive urination with dilute urine
* Dehydration can be life threatening
* Causes hypernatremia
47
The most common cause of hypopituitarism is _
The most common cause of hypopituitarism is **sellar mass effect** *resulting from a tumor*
* The second most common cause is surgery
48
Causes of hypopituitarism
Causes of hypopituitarism:
* Sellar mass causing mass effect
* Resection of sellar mass
* Head trauma
* Stroke
* Granulomatous disease
* Radiation
* Pituitary infarction (Sheehan or pituitary apoplexy)
* Empty sella
49
Macroadenoma
50
Empty sella
51
_ is a term used when there is any number of pituitary hormone deficiencies;
_ is the term used when there is more than 1 pituitary deficiency
_ is the term used when all hormones are deficient
**Hypopituitarism** is a term used when there is any number of pituitary hormone deficiencies;
**Multiple pituitary hormone deficiency** is the term used when there is more than 1 pituitary deficiency
**Panhypopituitarism** is the term used when all hormones are deficient
52
We diagnose a prolactin deficiency via _ lab finding
We diagnose a prolactin deficiency via **low prolactin**
53
We diagnose a GH deficiency via _ lab finding
We diagnose a GH deficiency via **low IGF-1** and **lack of stimulation** by provocative testing with *glucagon, arginine, insulin*
54
What testing should be done if an FSH, LH deficiency is suspected
Check FSH, LH, estradiol, testosterone
55
What testing should be done if TSH deficiency is suspected?
TSH, T3, T4
56
How do we diagnose ADH deficiency?
1. Patient has polyuria and decreased urine osmolality
2. Water deprivation test does not improve it
3. Improvement when ADH is given (if central DI)
57
The treatment for TSH deficiency is _
The treatment for TSH deficiency is **levothyroxine** (T4 supplementation)
58
Panhypopituitarism results in _ deficiencies first
Panhypopituitarism results in **ACTH and coritsol** deficiencies first
* These develop quickly
59
(TSH/T4) has a short half life
**TSH** has a short half life; **T4** has a long half life
* Deficiencies will develop over a long period of time
60
When do we use dynamic testing for hypopituitarism?
1. Adrenal insufficiency
2. GH deficiency
61
Growth hormone is a _ type hormone and it binds to receptors _
Growth hormone is a **hydrophilic peptide hormone** that binds to **receptors on the cell surface**
62
Glucose (increases/decreases) release of GH
Glucose **decreases** release of GH
63
Ghrelin (increases/decreases) release of GH
Ghrelin **increases** release of GH
64
Somatostatin (increases/decreases) the release of GH
Somatostatin **decreases** the release of GH
65
Somatostatin comes from the _
Somatostatin comes from the **hypothalamus**
66
IGF-1 comes from the _
IGF-1 comes from the **liver (hepatocytes)**
67
Ghrelin comes from the _
Ghrelin comes from the **stomach**
68
GHrH comes from the _
GH comes from the _
GHrH comes from the **hypothalamus**
GH comes from the **anterior pituitary**
69
(GH/IGF-1) increases glucose and increases growth
**Both GH and IGF-1** increase glucose and growth
70
The single best lab for diagnosing GH abnormalities is _
The single best lab for diagnosing GH abnormalities is **IGF-1**
* Longer half life than GH
71
(True/False) Isolated GH deficiency in newborn population does not cause any specific sx
**True;** Isolated GH deficiency in newborn population does not cause any specific sx
72
GH deficiency in children may present as _
GH deficiency in children may present as **"falling off the growth curve"**
* Bone and muscle growth is inhibited
* Bone age is lower than expected
73
Adults with GH deficiency have vague sx such as _
Adults with GH deficiency have vague sx such as **decreased bone mineral density, decreased muscle mass, increased fat mass**
74
_ is an autosomal recessive mutation in the GH receptors that leads to GH insensitivity in newborns/children
**Laron syndrome** is an autosomal recessive mutation in the GH receptors that leads to *GH insensitivity* in newborns/children
75
_ is a chromosome 15 deletion that leads to GH deficiency and therefore short stature, increased body weight, and increased ghrelin levels
**Prader-Willi syndrome** is a chromosome 15 deletion that leads to GH deficiency and therefore short stature, increased body weight, and increased ghrelin levels
76
Prader willi syndrome is a deletion of chromosome _
Prader willi syndrome is a deletion of **chromosome 15**
77
GH deficiency in children and adults are often either from _ or they are idiopathic
GH deficiency in children and adults are often either from **sellar tumors causing mass effect** or they are idiopathic
78
Treatment for GH deficiency is _
Treatment for GH deficiency is **recombinant GH replacement** (for all ages)
79
Another lab value that can be evaluated besides IGF-1 for GH deficiency is _
Another lab value that can be evaluated besides IGF-1 for GH deficiency is **IGFBP-3**
80
If a patient has normal GH levels then the administration of insulin will cause (hyperglycemia/hypoglycemia) which will induce GH to (increase/decrease)
If a patient has normal GH levels then the administration of insulin will cause **hypoglycemia** which will induce GH to **increase** to restore glucose levels
* *A patient with GH deficiency will not have a rise in GH*
81
The most common cause of a GH excess is _
The most common cause of a GH excess is **pituitary adenoma**
82
Children with an excess of GH have _ ; adults have _
Children with an excess of GH have **gigantism** ; adults have **acromegaly**
83
Clinical features of acromegaly include:
Clinical features of acromegaly include:
* Enlarged hands/feet
* Hoarse voice
* Snoring
* Arthralgias
* Coarse facial features, enlarged jaw
84
Complications associated with agromegaly in adults include:
Complications associated with agromegaly in adults include:
* Diabetes
* Hypertension
* Obstructive sleep apnea
* Carpal tunnel
* Colon cancer
85
Macroadenoma
86
Insulin tolerance test is used to diagnose (GH excess/ GH deficiency)
Insulin tolerance test is used to diagnose **GH deficiency**
87
Oral glucose tolerance test is used to diagnose (GH excess/ GH deficiency)
Oral glucose tolerance test is used to diagnose **GH excess**
88
In a normal individual, a large glucose load will _ GH levels
In a normal individual, a large glucose load will **suppress** GH levels
* If GH does not suppress after the intake of oral glucose, GH excess is confirmed
89
List the three most important tests to diagnose GH excess:
List the three most important tests to diagnose GH excess:
1. IGF-1 or IGF1BP3
2. Oral glucose tolerance test
3. MRI for pituitary adenoma
90
Most pituitary adenomas will cause increased secretion of only one pituitary hormone; the exception is that some adenomas can secrete both _ and _
Most pituitary adenomas will cause increased secretion of only one pituitary hormone; the exception is that some adenomas can secrete both **GH** and **prolactin**
91
What is the preferred therapy for GH pitiutiary adenoma?
1. **Transsphenoidal resection**
2. **Radiation**
3. **Medication (octreotide, cabergoline, pegvisomant)**
92
Steps for GH excess diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. _ test
3. MRI of pituitary
Steps for GH excess diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. **Oral glucose tolerance test**
3. MRI of pituitary
93
Steps for GH deficiency diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. _ test
3. MRI of pituitary
Steps for GH deficiency diagnosis:
1. IGF-1 & IGFBP3 levels checked
2. **Insulin tolerance test**
3. MRI of pituitary
94
Hyperpituitarism is almost exclusively caused by _
Hyperpituitarism is almost exclusively caused by **pituitary adenomas**
* *Prolactinemia can also be caused by stalk compression or trauma of the head*
95
A pituitary adenoma < 1 cm is a _
A pituitary adenoma < 1 cm is a **microadenoma**
96
A pituitary adenoma > 1 cm is a _
A pituitary adenoma > 1 cm is a **macroadenoma**
97
Microadenoma
98
Macroadenoma
99
The most important mass effect caused by macroadenomas is _
The most important mass effect caused by macroadenomas is **bitemporal hemianopia**
100
The direct effect of hyperprolactinemia is _
The direct effect of hyperprolactinemia is **galactorrhea**
101
Indirect effects of hyperprolactinemia result from prolactin's (stimulation/suppression) of GnRH
Indirect effects of hyperprolactinemia result from prolactin's **supression of GnRH** --> hypogonadotropic hypogonadism
* Low libido
* Infertility
* Amenorrhea
102
A pituitary adenoma that secretes excess ACTH will present as _
A pituitary adenoma that secretes excess ACTH will present as **cushing's disease**
* Hyperglycemia
* HTN
* Weight gain
* Abdominal striae
* Moon face
* Truncal obesity
* Easy bruising
103
Signs of excessive TSH from an adenoma include:
Signs of excessive TSH from an adenoma (very rare) include:
* Weight loss
* Tremor
* Palpitations
* Anxiety
* Diarrhea
* Heat intolerance
104
Large pituitary adenomas can encroach on the optic nerve and result in _
Large pituitary adenomas can encroach on the optic nerve and result in **bitemporal hemainopia**
105
5 types of cells that are overactive in adenomas:
5 types of cells that are overactive in adenomas:
1. Lactotrophs
2. Somatotrophs
3. Corticotrophs
4. Gonadotrophs
5. Thyrothrophs
106
What is the workup for a patient with suspected pituitary adenoma?
Labs:
* Prolactin
* LH/FSH with estrogen/testosterone
* ACTH with cortisol
* TSH with T3/T4
* GH with IGF-1
Imaging: MRI with contrast
107
The expected labs in a prolactinoma would be high _ and low _
The expected labs in a prolactinoma would be **high prolactin** and **low LH/FSH, estrogen/testosterone**
108
For most adenomas, the first line treatment is _ , followed by _ and _
For most adenomas, the first line treatment is **surgery** , followed by **medication** and **radiation**
109
For prolactinoma the first line treatment is always _
For prolactinoma the first line treatment is always **medical**
110
Endocrine hormones enter the _
Endocrine hormones enter the **bloodstream** to travel to distant organs
111
Glands are just _
Glands are just **envaginations of epithelial cells**
112
Exocrine glands are glands that _
Exocrine glands are glands that **produce substances for secretion outside the body**
113
Steroid hormones are derived from _ ; they easily cross the cell membrane and therefore bind to (extracellular/intracellular) receptors
Steroid hormones are derived from **cholesterol** ; they easily cross the cell membrane and therefore bind to **intracellular receptors** (nuclear receptors)
114
Peptide hormones are hydrophilic, meaning they cannot easily cross the cell membrane and will bind _ receptors
Peptide hormones are hydrophilic, meaning they cannot easily cross the cell membrane and will bind **membrane bound receptors**
115
The pineal gland is located behind the _ and secretes _
The pineal gland is located behind the **third ventricle** and secretes **melatonin**
116
The pituitary gland is a pea sized gland that rests on the _ within the _ bone
The pituitary gland is a pea sized gland that rests on the **sella turcica** within the **sphenoid bone**
117
Adrenal glands are located _ and secrete _
Adrenal glands are located **above the kidneys** and secrete **steroid hormones** (cortisol, aldosterone, androgens)
118
Adipose cells contain an enzyme called _ that converts androgens to estrogen
Adipose cells contain an enzyme called **aromatase** that converts androgens to estrogen
119
The anterior pituitary is also called the _ ; the posterior pituitary is also called the _
The anterior pituitary is also called the **adenohypophysis** ; the posterior pituitary is also called the **neurohypophysis**
120
D- the anterior pituitary is an upward growth of the oral ectoderm
121
Where is the posterior pituitary?
C: The posterior pituitary is the downward extension of the neuroectoderm- extension of the hypothalamus
122
These are **acidophils**
* The anterior pituitary contains both acidophils and basophils
123
Which anterior pituitary cells are acidophils?
**Somatotrophs** (making GH) and **Mammotrophs** (making prolactin)
124
Which anterior pituitary cells are basophils?
B-FLAT:
* Gonadotrophs (FSH, LH)
* Corticotrophs (ACTH)
* Thyrotrophs (TSH)
125
Storage structures in the posterior pituitary are called _
**Herring bodies** store ADH and oxytocin
* They are really just dilated terminal portions of the axons
126
What kind of capillaries are found in the anterior pituitary?
**Fenestrated capillaries**
* Can see the somatotrophs, gonadotrophs, thyrotrophs and their many secretory vesicles
127
What is contained in the X?
Colloid
128
Thyroxine (T4) is a _ type of hormone
Thyroxine (T4) is a **hydrophobic amine**
129
These cells are _ and they function to _
These cells are **parafollicular cells** and they function to **secrete calcitonin**, which decreases calcium levels
130
These are _ cells in the parathyroid
These are **chief cells** in the parathyroid --> *make PTH*
131
What does the yellow cell represent?
**Osteoblasts** --> when stimulated by PTH it reduces bone deposition and releases osteoclast stimulating factor
132
Which region secretes aldosterone?
The **zona glomerulosa** (A) secretes aldosterone
133
What stimulates these cells?
**ACTH** stimulates these cells in the **zona fasciculata** to make cortisol
134
What hormone is produced here?
**Zona reticularis** produces **sex hormones**
135
What do these cells secrete?
**Chromaffin cells** secrete epinephrine and norepinephrine
136
Epinephrine is derived from _
Epinephrine is derived from **tyrosine**
137
Tyrosine is the precursor for many important amine hormones including _
Tyrosine is the precursor for many important amine hormones including **thyroxine** and **dopamine** --> **NE** --> **E**
138
Where do these cells secrete their products?
These are **acinar glands** of the **exocrine pancreas** and they secrete their products (digestive enzymes) **into ducts**
139
What do these cells most likely secrete?
These are most likely **beta cells** which secrete **insulin**; these cells are the most numerous and centrally located in the islet of langerhan
140
141
In MEN1 syndrome patients have an insulinoma and high C-peptide; C-peptide is made in the _
In MEN1 syndrome patients have an insulinoma and high C-peptide; C-peptide is made in the **rough ER**
142
Alpha cells make _
Alpha cells make **glucagon**
142
Which is the mechanism by which insulin signals?
Insulin is a **polypeptide, hydrophilic** hormone that binds receptors on the outside of the cell
143
Beta cells make _
Beta cells make **insulin** and **amylin**
144
Delta cells make _
Delta cells make **somatostatin**
145
Epsilon cells make _
Epsilon cells make **ghrelin**
146
PP cells (gamma or F cells) make _
PP cells (gamma or F cells) make **pancreatic polypeptides**
147
Steroid secreting cells have extensive _ ER and lots of _
Steroid secreting cells have extensive **smooth ER** and lots of **fat droplets**
148
Identify the categories of hormones
149
Which hormones might be enhancing transcription here?
**Cortisol or thyroxine**
150
Which hormone might be binding to the receptor here?
**Catecholamines**
151
The endocrine organ that secretes melanin is _
The endocrine organ that secretes melanin is **pineal gland**
