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21 fall: Biochem > Test 3: 59-60 > Flashcards

Test 3: 59-60 Flashcards

1
Q

HPA axis

A

hypothalamic pituitary adrenal axis

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2
Q

how does CRH from hypothalamus work

A
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3
Q

dexamethasone low suppression test

A

normal: give dexamethasome= cortisol will decrease
cushings: give dex= cortisol increases or remains normal

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4
Q

dexamethasone high suppression test

A

give dexamethasone 8 mg → cortisol decreases = pituitary cushings

give dex 8→ cortisol increases and ACTH low= adrenal cushings

give dex 8→ cortisol increases and high ACTH = ectopic ACTH tumor

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5
Q

how to diagnose pituitary cushings

A

high dex = low cortisol

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6
Q

how to diagnose adrenal cushings

A

high dex = high cortisol = low ACTH

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7
Q

summary of dexamethasone suppression test

A
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8
Q

how to diagnose ectopic cushings

A

high dex → high cortisol and high ACTH

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9
Q

hyperadrenocorticism is another name for

A

cushing disease

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10
Q

cushings disease is usually caused by a ___ tumor but in rare cases (10%) can be caused by a ___ tumor

A

pituitary

adrenal gland

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11
Q

symptoms of cushing’s

A

pot belly

loss of fur

increased urination

increased drinking and appetite

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12
Q

Treatment for cushings

A

repeat surgery

meds: mifepristonem, pasireotide, ketoconazole

radiosurgery

bilateral adrenalectomy

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13
Q

adrenal gland

A

stress gland

humoral response (short term: nervous system: fight and flight) → increased blood sugar, blood pressure, breathing

hormonal response: long term stress response: mineralcorticoids and glucocorticoids → insulin resistance, osteoporosis, suppressed immune system, kidney function

hypothalamus releases CRH → ACTH release from pituitary acts on the adrenal gland

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14
Q

two regions of adrenal gland

A

cortex

medulla

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15
Q

what hormones are released by the cortex of the adrenal gland

A

glucocorticoids

androgen

estrogen

mineralocorticoids→ aldosterone

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16
Q

what hormones are released by the medulla of the adrenal gland

A

catecholmine:

epinephrine

nor-epinephrine

dopamine

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17
Q

The adrenal medulla produces ___

A

catecholamines: such as adrenaline, noradrenaline and small amounts of dopamine

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18
Q

fight or flight hormones are released by what

A

medulla of the adrenal gland

adrenaline, noradrenaline and small amounts of dopamine

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19
Q

Mineralocorticoids: the most important of which is ___

A

aldosterone.

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20
Q

___ hormone helps to maintain the body’s salt and water levels which, in turn, regulates blood pressure

A

aldosterone

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21
Q

Without aldosterone, the kidney loses excessive amounts of salt (sodium) and, consequently, water, leading to severe ___ and low blood pressure.

A

dehydration

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22
Q

Glucocorticoids: predominantly ___

A

cortisol.

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23
Q

Cortisol stimulates ___ production helping the body to free up the necessary ingredients from storage (fat and muscle) to make glucose.

A

glucose

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24
Q

Adrenal ___ :male sex hormones mainly dehydroepiandrosterone (DHEA) and testosterone

A

androgens:

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25
Q

adrenal androgens: All have weak effects, but play a role in ___ development of the male sex organs in childhood, and female body hair during puberty

A

early

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26
Q

common diseases associated with the adrenal gland

A

cushings and addison’s disease

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27
Q

symptoms of addison’s disease

A

bronze pigmented skin

body hair in weird places

hypoglycemia

postural hypotension

weight loss and weakness

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28
Q

adrenal crisis

A

addison’s disease

fatigue

dehydration

vascular collapse

renal shut down

decreased serum sodium

increased serum potassium

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29
Q

Addison’s disease is a condition in which the adrenal glands cannot secrete enough ___

A

corticosteroid.

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30
Q

what is the opposite of cushings disease

A

addison’s disease

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31
Q

in cushings the body makes ___ corticosteroids, in addisons the body make ___ corticosteroids

A

too much

not enough

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32
Q

addison’s usually happen __

A

at younger age in female and certain dog breeds

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33
Q

three causes of addison’s disease

A

primary

secondary

atypical

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34
Q

what is the most common form of addison’s disease in dogs

A

primary

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35
Q

primary addisons

A

most common form of Addison’s disease in dogs.

autoimmune disease in which the immune system attacks the adrenal glands. This causes damage to the glands, making them fail to product sufficient amount of the corticosteroid hormones.

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36
Q

secondary addison’s

A

lack of (ACTH), whose function is to stimulate the adrenal gland to produce corticosteroids.

ACTH is produced by the pituitary gland, which may fail to produce sufficient amount of ACTH due to injury, inflammation, or a pituitary tumor.

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37
Q

atypical addisons

A

Just like primary Addison’s, atypical Addison’s occurs when the adrenal glands fail to work properly.

adrenal glands fail to secrete sufficient amount of the glucocorticoid hormones only, whereas the electrolyte balances are usually normal.

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38
Q

how to test for addison’s

A

short synacthen test

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39
Q

short synacthen test

A

addison’s test

give artificial ACTH

increased cortisol = normal

no change in cortisol = primary Addison’s

low cortisol = primary adrenal insufficiency- Addison’s→ damaged adrenal

or secondary adrenal insufficiency- lack of adrenal stimulation from ACTH- need to test ACTH levels as well

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40
Q

how to test for secondary addisions

A

short synacthen test

low cortisol

and then ACTH test → lack of adrenal stimulation from ACTH

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41
Q

treatment for addisons

A

hormone replacement therapy

Daily glucocorticoids, such as Prednisolone, and/or mineralocorticoids, such as Fludrocortisone.

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42
Q

how does the thyroid gland activate

A

TRH from hypothalamus

TSH from pituitary

Thyroid gland

thyroglobulin and iodine → T4

T4 + deiodinases → T3 or reverse T3

also makes calcitonin C cells (neuroendocrine function)

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43
Q

T3 and T4 cells and calcitonin-C cells are made by the

A

thyroid gland

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44
Q

how to increase T3

A

iodine, vitamine A, B2, B12, B6

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45
Q

how to increase rT3

A

abnormal cortisol

T4 medications

Vit D deficiency

estrogen dominances

high TPO antibodies

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46
Q

the more ___ you make, the more hypothyroid you are

A

rT3

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47
Q

common thyroid glands

A

hashimoto’s thyroiditis

grave’s disease

hyperthyroidism

hyporthyroidism

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48
Q

hashimoto’s thyroiditis

A

autoimmune thyroid disorder

hypothyroidism

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49
Q

cause and symptoms of hypothyroidism

A

fatigue, weight gain, lethargy (belly fat and rough coat in animals)

hashimoto’s thyroiditis, iodine deficiency, lithium (treatment for hyperthyroid)

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50
Q

The most common signs of hypothyroidism in are skin ___, weight ___, inactivity and intolerance to ___ temperatures

A

disease (flacky)

gain

cold

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51
Q

grave’s disease

A

hyperthyroidism

more common in females

bulging eyes, goiter, enlarged thyroid

heart intolerance

irritability

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52
Q

treatment for grave’s

A

medications

RAI (radiated iodine)

surgery

53
Q

treatment for hypothyroidism

A

replacement hormone therapy

54
Q

In the US, there are two antithyroid medications available—propylthiouracil (PTU) and methimazole (also known as Tapazole). The medications are similar, as they both stop the thyroid from producing ___ hormones.

A

T3 and T4

55
Q

thyroid cancer happens more in ___

A

males

56
Q

symptoms of thyroid cancer

A

neck pain, lump in neck, difficulty swallowing

57
Q

cause thyroid cancer

A

history of exposure to high doses of radiation

family history

58
Q

treatment of thyroid cancer

A

surgery

radioactive iodine uptake therpay

59
Q

parathyroid hormone

A

regulate calcium levels

60
Q

what is the only element that has its own regulatory system

A

calcium- controlled by parathyroid hormone

61
Q

parathyroid hormone acts of the ___, ___ and ___ to control calcium levels

A

bones, kidneys, intestines

62
Q

PTH in bones will cause ___

A

release of calcium

63
Q

PTH in kidneys will cause___

A

reduce calcium clearance. Vit D activation, phosphate balance

64
Q

PTH in the intestine causes ___

A

activated vit D helps absorb calcium in the gut

65
Q

high calcium will trigger:

A

PTH to act on kidneys to activate vit D, this will cause intestine to absorb more calcium

66
Q

parathyroid hormone works using which 2nd messenger?

A

cAMP

67
Q

hyperparathyroidism

A
  • osteoporosis
  • kidney stones
  • heart disease
  • high blood pressure
68
Q

Hypoparathyroidism

A
  • Tingling or burning (paresthesia) in your fingertips, toes and lips.
  • Muscle aches or cramps in your legs, feet, abdomen or face.
  • Twitching or spasms of your muscles, particularly around your mouth, but also in your hands, arms and throat.
  • Fatigue or weakness.
69
Q

Treatment for hyperparathyroidism

A

Calcimimetics:A calcimimetic is a drug that mimics calcium circulating in the blood-inhibits PTH and Ca.

Hormone replacement therapy

Bisphosphonates-prevents bone loss

70
Q

treatment for hypoparathyroidism

A

Direct injection of parathyroid hormone is risky!

Alternate: Teriparatide (Forteo) – stimulates new bone growth. It is used to treat osteoporosis in people who are at high risk of fractures, most often postmenopausal women.

71
Q

pineal gland

A

deep in cerebral cortex

3rd eye

secretes melatonin: regulates sleep

72
Q

how to form melatonin

A

tryptophan → serotonin→ melatonin

73
Q

melatonin governs the entire ___ cycle,

A

sleep/ wake

74
Q

___ is involved more specifically in wakefulness, in triggering sleep, and in REM sleep.

A

serotonin

75
Q

what will inhibit melatonin production?

A

caffeine

76
Q

___ is the key hormone that stabilizes our mood, feelings of well-being, and happiness.

A

Serotonin

77
Q

melatonin can be used for ___ and ___ in animals such as sheep

A

treat hair loss in dogs

control fertility in sheep

78
Q

___ is foundational for a healthy pregnancy. It acts as an important antioxidant to improve egg and sperm quality. It also regulates the hormones needed for ___ and then implantation.

A

Melatonin

ovulation

79
Q

Thymus gland

A

2 lobed organ, large in infants but shrinks with age

make T-lymphocytes (white blood cells)

hormone function: promote production and maturation of T lymphocytes

thymus producing thymosins

80
Q

common thymus disease

A

myasthenis gravis

81
Q

myasthenia gravis

A

depletion/blocking of acetylcholine receptors at the neuromuscular junction

issue with thymosins maintaining immune balance.

pure red cell aplasia and hypogammaglobulinemia

82
Q

treatment for myasthenia gravis

A

acetylcholinesterase inhibitor

corticosteroids

83
Q

pancrease

A

insulin and glucagon release

alpha cells: secrete glucagon

beta cells: secrete insulin

gamma cells: release somatostatin, a paracrine inhibitor of both insulin and glucagon secretion

F cells: rare: produce pancreatic polypeptide

84
Q

glucagon→ ___ glucose signal

A

low

85
Q

insulin → ___ glucose signal

A

high

86
Q

type 1 DM

A

insulin dependent

treatment give insulin

87
Q

type 2 DM

A

insulin resistant, body makes insulin but it can’t get into cells, receptors for glucose are messed up

88
Q

symptoms of issues with the pancreas

A

diabetes

increased hunger and thirst

weight loss

increased urination

blurry vision

extreme fatigue

sores that don’t heal

89
Q

treatment for DM/ issues with the pancreas

A

insulin injections

metformin (type 2 )

exercise

90
Q

what is used to make sex hormones?

A

cholesterol

sex hormones= steroid hormones

91
Q

The ___ are a group of hormones responsible for controlling puberty, reproduction, birth, and lactation.

A

sex hormones

92
Q

Sex hormone disorders, also referred to as ___ hormone disorders, are medical conditions that affect the different glands and organs of the body responsible for the production of the sex hormones.

A

reproductive

93
Q

The sex hormones, which include ____ are substances that essential in almost every body function, but more so in sexual functions and reproduction

A

testosterone (male) and estrogen (female)

94
Q

Both testosterone and estrogen are present in males and females, but the levels differ according to ___

A

gender

95
Q

some symptoms of sex hormone disorders

A

reduced sex drive (libido)

vaginal dryness

infertility

excessive body hair.

96
Q

In men, testosterone is primarily produced in the testicles, but other glands and organs in the endocrine system, such as ___ are also involved

A

the adrenal glands

97
Q

In women, the ovaries produce ___, but the adrenal glands also help in the production and/or regulation of the hormone.

A

estrogen

98
Q

some functions of estrogen

A

female sexual characteristic

lipogenic effect

prevention of bone loss (promote bone growth)

hypocholesterolemic effect (lowers cholesterol)

99
Q

how does aromatase inhibitors work for breast cancer?

A

cholesterol → androstendedione (aromatase) → estrone and estriol

cholesterol → androstendedione → testosterone (aromatase) → estradiol

anti aromatase = no estrogens

100
Q

steroidogenesis of dihydrotestosterone

A

cholesterol → pregenenolone (3 beta- HAS) → testosterone (5alpha reductase)(NADPH)→ dihydrotestosterone

cholesterol → testosterone happens in the leydigg cells of the testes and theca cells of the ovaries

5 alpha reductase happens in peripheral tissue such as skin, prostate and epididymis

101
Q

steroidogenesis of estrogen

A

cholesterol → pregnenolone (3beta HSD)→ progesterone → testosterone (aromatase)→ estrogen

102
Q

progesterone can turn into ___ and ___

A

progesterone → cortisol and aldosterone

progesterone → testosterone → estrogen

103
Q

when is NADPH needed in sex hormone formation

A

testosterone (5 alpha reductase)(NADPH) → dihydrotestosterone

104
Q

first step of cholesterol into sex hormone

A

cholesterol (mitrochondrial enzyme) → pregnenolone

105
Q

CYP12A1 is an enzyme also called ___ and changes ___ into ___

A

17 aplha hydroxylase, 17, 20 lyase

progesterones into testosterone

pregnenolone (17 aplhahydroxylase) → 17 alpha hydroxypregnenolone (17,20 lyase) → dehydroepiandrosterone

106
Q

CYP19A1 also called ___ can change testosterone into ___

A

aromatase

estrogens (estrone and estradiol and estriol)

107
Q

where does the reaction of testosterone into dihydrotestosterone occur

A

5 alpha reductase happens in peripheral tissue such as skin, prostate and epididymis

108
Q

where does the reaction of androgens into estrogens occur

A

aromatase

happens in the granulosa cells of the ovary

testosterone into estrogens (estradiol)

109
Q

where does the reaction of cholesterol into testosterone occur

A

adrenal cortex, leydig cells of the testes and theca cells of the ovaries

110
Q

high dihydrotestosterone leads to

A

hair loss

111
Q

___ are a class of steroid hormones which control the development and maintenance of female sexual characteristics

A

Estrogens

112
Q

___ synthesis occurs in the granulosa and theca cells of the ovaries, as well as the corpus luteum

A

glandular estrogen

113
Q

glandular estrogen synthesis

A

The granulosa cells are stimulated by LH to produce pregnenolone

Pregnenolone diffuses out of these cells to adjacent theca cells

Theca cells express 17,20-lyase and 3β-HSD, which mediate the conversion of pregnenolone to androstenedione via DHEA

Most androstenedione returns to the granulosa cells and is converted to estrone by aromatase, which is then converted to estradiol by 17β-HSD

The expression of aromatase and 17β-HSD is controlled by FSH stimulation

114
Q

extraglandular synthesis of estrogen

A

Aromatase is expressed in non-gonadal sites and facilitates peripheral aromatization of androgens to estrone.

Fat cells: increases serum estrogens by converting androgen to estrone.

Bone: converts testosterone to local estrogen to help mature the epiphyses.

115
Q

___ is synthesized from pregnenolone by action of 3β-HSD in the corpus luteum, by the placenta during pregnancy; as well as by the adrenals, as a step in androgen and mineralocorticoid synthesis.

A

Progesterone

116
Q

The products of hormone synthesis vary with the menstrual cycle; ___ is the main product during follicular maturation, whereas ___ is the main product in the luteal phase following ovulation.

A

estradiol

progesterone

117
Q

polycystic ovarian syndrome

A

also called polycystic ovary syndrome, occurs when a woman experiences hormonal imbalance.

menstruation difficulties or problems in conceiving a child.

The condition can also result in unwanted changes in her appearance.

118
Q

____ is characterized by excessive male pattern hair growth caused by increased levels of the male hormone testosterone and other androgens.

A

hirsutism

119
Q

Hirsutism is characterized by ___ hair growth caused by increased levels of the male hormone testosterone and other androgens.

A

excessive male pattern

120
Q

___ also referred to as sex hormone deficiency, is a condition characterized by the under production of the sex hormones. Some of the most common symptoms are fatigue, muscle loss, low bone density, anemia, and reduced sex drive

A

Hypogonadism

121
Q

PCOS is caused by

A

insulin resistance → high insulin trigger ovaries to make testosterone

increased stress and increased body fat → testosterone production

leads to diabetes, fertility issues and hirsutism

122
Q

treatment for PCOS

A

metformin

try to increase insulin sensitivity in cells, so body decreases the overall amount of insulin it creates leading to decrease in testosterone

123
Q

how does estrogen signaling work?

A

lipid soluable hormone (gets into cell easily)

ligand dependent signaling (estrogen gets into nucleus or triggers another pathway in cell)

ligand independent signaling

ligand other then estrogen will use estrogen pathway to get into cell and cause trouble

124
Q

estrogen signaling can have a ___ and ___ response

A

genomic and nongenomic

(can go into cell and into nucleus or can go into cell and trigger stuff from the cytoplasm)

125
Q

hormone signaling in normal breast development

A

estrogen formation of terminal end buds and ductal network

progesterone: more ducts and branching

prolactin: lactatogenesis

126
Q

estrogen in HRT alone can increase risk for ___ cancer, breast cancer and endometrial cancer

A

ovarian

127
Q

estrogen receptor alpha is a ___ and estrogen receptor beta is a ___, what is an exception?

A

oncogene

tumor supressor

TNBC and IBC

128
Q

hormonal endocrine therapies for breast cancer

A

decrease ligand

block receptor

tamoxifen (selective estrogen receptor modulators) and fulverstrant (selective estrogen receptor down regulator)

129
Q

endocrine resistance in breast cancer

A

over time will develop resistance

Luminal A- high responsiveness to ET

Luminal B- Lower endocrine sensitivity

21 fall: Biochem (44 decks)

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