Week 3: Endocrine Flashcards by Sarah W

What do the endocrine glands do?

Regulate physiologic processes

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Name the endocrine glands

pituitary gland
adrenal gland
thyroid gland
parathyroid gland
islet cells of the pancreas

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What do troPic hormones do?

stimulate the release of other hormones

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What do troPHic hormones do?

promote the growth, development, and maintenance of tissues and organs

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In which bone is the sella turcica found?

pituitary gland sits in the sella turcica

sphenoid

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What structure sits above the pituitary gland?

optic chiasm

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Which nerves are found in the cavernous sinus?

III, IV, V1, V2 and VI

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What visual symptoms can occur if the pituitary gland is enlarged?

visual impairment, diplopia, horner’s syndrome

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When tropic hormones are released from the hypothalamus, hormones are released from which gland?

anterior pituitary

These hormones act on the target gland via hormone receptors

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what are the two categories of pituitary hormones?

polypeptide and glycoprotein

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Which hormones are released by the posterior pituitary gland?

Antidiuretic hormone and oxytocin

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What are the polypeptide hormones?

Growth hormone, adrenocorticotropic hormone, prolactin, antidiuretic hormone, oxytocin

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Which hormones are the glycoprotein hormones?

thyroid stimulating hormone, luteinizing horone, follicle stimulating hormone, human chorionic gonadotropin

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Is the cortex the inner or outer layers of the adrenal gland?

outer

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What hormone regulates the adrenal cortex?

ACTH

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Match the cell type with its hormone:
a) DHEA
b) Cortisol
c) aldosterone
1) zona fasiculata
2) Zona reticularis
3) zona glomerulosa

a2, b1, c3

zona reticularis: DHEA(S); zona fasiculata: cortisol; zona glomerulosa: aldosterone

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What produces epinephrine and norepinephrine

adrenal medulla

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3 conditions that are associated with adrenal gland dysfunction

cushing disease
addison disease
pheochromocytoma

cushing: increased cortisol; addisons: decreased cortisol (and aldosterone); pheochromocytoma: von hippel-lindau disease, neurofibromatosis type 1

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two unique characteristics of the adrenal medulla

function and regulation

functiosn separately from the adrenal cortex; not under pituitary control

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What condition is associated with an increased risk of pheochromocytoma along with hemangioblastomas of the brain and spinal cord, renal cell cancer, pancreatic tumors and genital cystadenomas?

Von Hippel Lindau Disease

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What condition is associated with retinal capillary hemangiomas?

Von Hippel Lindau Disease

60% of patients with VHL show retinal capillary hemangiomas and nearly all patients with multiple retinal capillary hemangiomas have VHL

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What is an ancilary test that is recommended for patients with VHL?

neuroimaging

25% of patients with retinal findings d/t VHL also have hemangiomas of the CNS

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What subtype of neurofibromatosis is the most common?

NF1

But NF2 does not have a risk of pheochromocytoma like NF1

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What are the clinical ocular signs of neurofibromatosis?

* cutaneous neurofibromas (benign masses of nerve tissue) * cafe au lait macules (6 or more) * freckling in the regions of skin folds * bilateral (or unilateral) optic nerve gliomas * Lisch nodules of the iris: occur in 95% of pt with NF1

Which thyroid hormone is under hypothalamic control? Which is under pituitary control?

TRH: hypothalamus; TSH: pituitary

Which type of feedback does the thyroid gland provide in order to decrease stimulatory hormone release?

negative feedback

Which hormones are low in hypothyroid and hyperthyroid?

Hypothyroid: T3, T4 Hyperthyroid: TSH

Which hormones are elevated in hypothyroid? Hyperthyroid?

Hypothyroid: TSH Hyperthyroid: T3/ T4

Along with high T3 and T4, what are other signs of Graves Disease?

presence of a goiter, thyroid eye disease

How long does the active phase of thyroid eye disease last for nonsmokers vs smokers?

nonsmokers: 1 year; smokers 2-3 years

When can surgical correction of residual eyelid misalignment or strabismus be pursued?

after 6 months of stability (Quiescent phase)

What is the first FDA approved pharmacologic immunotherapy for adults with TED?

Teprotumumab

Since parathyroid hormone does not have a tropic hormone to trigger its release, what is the stimulates the release of parathyroid hormone?

low blood calcium levels

What are the 3 functions of parathyroid hormone?

1. increase calcium resorption from the bones 2. stimulate renal tubular calcium resorption by kidneys 3. stimulate renal hydroxylation of vitamin D: increase blood calcium levels

Ionized calcium is involved in what three physiologic processes?

muscle contraction (including the heart); neurological transmission, blood coagulation

What maintains calcium homeostasis?

PTH, calcitonin, Vitamin D

What are the functions of activated vitamin D?

increase calcium absorption from the intestines, regulate bone turnover; provide negative feedback tot the parathyroid glands to decrease PTH production

Which cells secrete calcitonin from the thyroid gland?

parafollicular cells

What are the 3 functions of calcitonin in the bones?

slows bone turnover, maintain calcium stores, slow bone loss

What ocular condition forms from calcium salt deposits across the interpalpebral cornea?

Corneal band keratopathy

What systemic condition is associated with corneal band keratopathy?

sarcoidosis

What calcium related disorder is a cause of papilledema (especially chronic)

hypocalcemia ## Footnote responsive to calcium supplementation

Does the pancreas have exocrine or endocrine functions?

both

What do beta cells of the pancreas secrete?

insulin

What do alpha cells of the pancreas secrete?

glucagon

What do delta cells of the pancreas secrete?

somatostatin | decreases smooth muscle contraction

What do gamma cells in the pancrease secrete?

pancreatic polypeptide

Which pancreatic cells secrete ghrelin, the hormone that stimulates hunger?

epsilon cells

What does the destruction of beta cells in type 1 diabetes lead to?

absolute insulin deficiency

What is the diagnostic criteria for fasting blood glucose and HbA1c?

FBG: > 126 mg/dL HbA1c: >/=6.5%

What are the 3 mechanisms that cause damage to the retina in diabetic retinopathy?

microvascular injuries, inflammation and glutamate excitotoxicity ## Footnote this damage exacerbates neuronal dysfunction, retinal hypoxia and increases VEGF

How does VEGF lead to angiogenesis?

by stimulating endothelial cell proliferation, migration and tube formation

True or False: VEGF only released by the RPE

False ## Footnote Other retinal cell types that produce and secrete VEGF are: Muller cells; astrocytes, ganglion cells and vascular endothelium

Which types of cells produce the greatest amount of VEGF under hypoxic conditions?

muller cells and astrocytes

What triggers muller cell proliferation and thus the production of VEGF?

High glucose levels

What is the pathway involved in the development in diabetic cataracts?

Sorbitol pathway

What converts glucose into sorbitol?

Aldose reductase

How does the lens swell in diabetes?

Sorbitol accumulates in the lens, increasing the osmolarity of the lens and drawing more water in

How can the swelling of the lens be reduced?

lowering glucose levels

All management for NPDR is observation, what is the follow up schedule?

* mild: 12 months * moderate: 6 months * Severe: 4 months * Very severe: 2 months

All PRD management is specialty care by retina, when should patients be seen?

* early: 1 month: decide treatment vs observation * High-risk: 24-48 hours: prompt treatment * CSME (any stage): within 2 weeks: decide treatment vs observation

standard photo 2A is used to differentiate between which classifications of NPDR? ## Footnote photo 2A is used for hemorrhages and microaneurysms

Mild, Moderate and Severe NPDR ## Footnote Mild: < photo 2A Moderate: > photo 2A in 1-3 quadrants Severe: > photo 2A in all 4 quadrants

What is standard photo 6B used for?

Venous Beading ## Footnote severe: venous beading in 2+ quadrants

What is standard photo 8A used for?

IRMA ## Footnote the presence of IRMA in any quadrant is automatically severe NPDR

What is often found along with IRMA in severe NPDR

cotton wool spots

What is standard photo 10A used for?

neovascularization of the disk ## Footnote neo > 10A is high risk PDR

What is the most common cause of diabetic retinopathy related vision loss?

diabetic macular edema ## Footnote may be present with any level of retinopathy; can be focal or diffuse

What is the goal of panretinal photocoagulation?

lowering VEGF levels, vascular permeability, and angiogenesis ## Footnote best when patient is between severe NPDR and early PDR

what is a benefit of pattern scan laser vs PRP?

shorter treatment time with reduced pain and less collateral damage

what are two laser treatments used for dme?

focal/grid laser and subthreshold diode micropulse laser photocoagulation

Which laser treatment can be combined with anti-VEGF therapy in severe DME?

subthreshold diode micropulse laser photocoagulation

When would we want to use an intravitreal steroid in DME treatment? | traimcinolone acetonide

diffuse edema throughout the macula

Which pathway is affected in horner syndrome?

oculosympathetic pathway

# oculosympathetic pathway what is the path of the first-order (central) neuron?

posterior hypothalamus -> ciliospinal center of Budge

# oculosympathetic pathway What is the path of the second-order (preganglionic) neuron?

spinal cord -> stellate ganglion at pulmonary apex ->superior cervical ganglion (C3 to C4)

# oculosympathetic pathway What is the path of the 3rd order (postganglionic)?

superior cervical ganglion -> cavernous sinus -> superior orbital fissure

What is the relationship between axial length and the development of proliferative diabetic retinopathy? | Why is myopia believed to be protective against diabetic retinopathy?

increase axial length, decrease risk of diabetic retinopathy

Why is longer axial length associated with lower VEGF levels in the eye?

VEGF in the anterior chamber and in the vitreous cavity may be diluted due to the longer axial length leading to increased intraocular volume

Waht are 3 anatomical changes in myopia that are protective against diabetic retinopathy?

1. longer axial length 2. chorioretinal thinning 3. altered blood flow

How is the chorioretinal thinning that happens as a result of myopia associated with lower VEGF production?

Thinning reduces metabolic demand and facilitates oxygen diffusion throught the retina via increased choroidal perfusion; this leads to decreased risk of retinal hypoxia

Week 3: Endocrine Flashcards

(81 cards)