Endocrine
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| Pituitary Acidophils & Basophils | FLAT PiG: Fsh, Lh, Acth, Tsh (Basophils) ProlactIn, Gh (Acidophils)
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| Alpha & Beta Subunits | - Alpha: Common to TSH, LH, FSH, hCG. Beta: Determines hormone specificity.
- ACTH & MSH (and beta-endorphin) derived from POMC
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| Endocrine Pancreas Cells | Alpha cells: Glucagon, peripheral.
Beta Cells: Insulin, central.
Delta Cells: Somatostatin, interspersed.
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| TRH | -> TSH, Prolactin.
Dopamine --| prolactin.
Somatostatin --|TSH.
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| CRH | -> ACTH
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| Somatostatin (Octreotide) (physiologic & Therapeutic functions) | --| GH, TSH
Octretoide treats gigantism, Acromegaly, Carcinoid, Gastrinoma, Glucagonoma (Necrolytic migratory erythema, stomatitis, chelosis)
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| POMC Derivatives | Produces Beta endorphin, ACTH, MSH
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| 17alpha-Hydroxylase Deficiency | CAH. Aldosterone only, no Cortisol or Androgens.
-> Hypertension & Hypokalemia. Phenotypic female w/o maturation.
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| 21-Hydroxylase Deficiency | #1 CAH. Androgens only. No cortisol or aldosterone.
-> Masculinization/female pseudohermaphrodite, Hypotension & hyperkalemia, elevated renin. Hypovolemic shock in newborn.
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| 11beta-Hydroxylase Deficiency | CAH. Androgens & aldosterone pre-cursor (11-Deoxycorticosterone). No cortisol.
-> Masculinization & HYPERtension.
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| PTH Function | - Activates Ca absorption (renal, GI) & inhibits PO4 absorption(renal).
- Active 1,25(OH)2D production.
- Osteoclast/blast stimulation.
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| Vit D Synthesis & Function | Sources: D2 (Plants) & D3(sun) –(liver)-> 25-(OH)D.
Low PO4/Ca, High PTH: 25-(OH)D –(kidney)-> 1,25-(OH)2D. -> -> Ca & PO4 GI reabsorption & bone release.
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| Etiology of AlkPhos Elevation | Pagets, Osteoblastic bone tumor, HyperPTH, Rickets/Osteomalacia.
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| Glut4 | Insulin-Dependent glucose uptake. Skeletal muscle & fat.
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| Glut1 | Insulin-Independent glucose uptake. Brain, RBCs
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| cAMP-Mediated Hormones | hCG, Calcitonin, CRH, Glucagon, Straight-up “hormones”
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| cGMP-Mediated Hormones | Vasodilators (ANP, NO/Endothelium Derived Relaxing Factor)
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| IP3-Mediated Hormones | Hypothalamus-Derived Hormones (GhRH, TRH, GHRH, ADH, Oxytocin)
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| Steroid Receptor-Mediated Hormones | Glucocorticoids, Vit D, T3/4
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| Tyrosine Kinase-Mediated Hormones | Insulin, Growth FACTORS (IGF-1, FGF)
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| Cushings Syndrome Etiology | - Cushing Disease (Pituitary adenoma, only responds to high Dex suppression, others don’t respond)
- Adrenal hyper/neoplasia
- Small Cell Lung Cancer
- Steroid use
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| Adrenal Insufficiency Sx, Etiology | - Primary Adrenal Insufficiency (Addison’s). HypoTN, skin hyperpigmentation (high ACTH). Tx: Glucocorticoids.
- Waterhouse-Freidrichsen Syndrome (n. meningitidis bacteremia-> infarct).
- Secondary: Pituitary insufficiency (low ACTH).
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| Pheochromocytomas Genetics & Characteristics | #1 adult adrenal tumor. VMA.
MEN II, III (ret), neurofibromatosis.
+/-Bilateral, malignant, ectopic, calcified, pediatric, inherited.
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| Neuroblastoma | #1 pediatric adrenal tumor. HVA. N-myc.
Local or sympathetic chain-ectopic.
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| Sheehan’s Syndrome Cause & Sx | Postpartum hemorrhage/hypotn-> pituitary infarct.
Poor lactation.
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| MEN I Cancers & Sx | Kidney stones & gastric ulcers.
- Pancreas (ZE, VIPoma, Insulinoma)
- Pituitary (Prolactinoma)
- Parathyroid
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| MEN II Cancers | ret
- Pheochromocytomas
- (Para)Thyroid.
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| MEN III Cancers | ret.
- Pheochromocytoma
- Medullary thyroid carcinoma (Amyloid)
- Oral/GI mucosal neuromas
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| Riedel’s Thyroiditis | Fibrosis of thyroid. HypoThyroid
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| Hashimoto’s Thyroiditis Sx, Dx | - Hypothyroid w/Thyrotoxicosis
- AI: Anti-Microsomal & Thyroglobulin Antibodies. Hurthle Cells.
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| Subacute/de Quervain’s Thyroiditis Presentation & variants | Post-flulike illness. Jaw pain.
- Granulomatous form is painful
- Lymphocytic form is painless.
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| Toxic Multinodular goiter | TSH-independent TH production. Not malignant
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| Jod-Basedow Phenomenon | Thyrotoxicosis when endemic-goiter patient moves to Iodine non-deficient area.
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| Papillary Thyroid Carcinoma | #1, good prognosis.
- Orphan annie nuclei, Psamomma bodies.
- Increased risk w/childhood radiation
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| Follicular Thyroid Carcinoma | Good prognosis
- uniform follicles.
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| Medullary Thyroid Carcinoma | Parafollicular C cells->calcitonin.
- MEN II, III
- Amyloid forming
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| Undifferentiated/Anaplastic Thyroid Cancer | Older patients, very poor prognosis
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| Thyroid Lymphoma | Hashimoto’s-associated
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| Acromegaly/Gigantism Dx, Tx | Dx’d w/ Poor glucose tolerance test. Octreotide tx Gigantism.
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| Primary HyperPTH Etiology, associations, labs. | - PTH Adenoma: elevated urine cAMP, calcuria, constipation, Alk Phos
- Assoc. w/Osteitis Fibrosa Cystica (Bone cysts w/ brown fibrous tissue)
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| HypoPTH Etiology, PE | - DiGeorge
- AI
- Surgical
- Chvostek + (facial nerve), Trousseau + (BP cuff-> carpal spasm)
- PseudoHypoPTH: Kidney insensitivity to PTH. Short & small digits 4 & 5.
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| HyperCalcemia Etiology | CHIMPANZEES:
- Calcium intake
- HyperPTH, HyperThyroid
- Iatrogenic (thiazides)
- Multiple myeloma
- Paget’s
- Addison’s
- Neoplasms
- Z-E
- Excess vit D, A
- Sarcoid
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| DM1 | Insulin dependent (profound hypoinsulinism). DKA common. Viral-triggered AI attack on beta cells. Weak gene association (hla-DR3,4)
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| DM2 | Insulin Independent. Strong genetic association
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| DKA (Sx, Tx) | - Kussmaul respiration, N/V, abdominal pain
- Anion gap metabolic acidosis. Intercellular hypoK (Arrhythmias), Mucormycosis, Rhizopus Infx, heart failure.
- Rx: Fluid, insulin, K.
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| Diabetes Insipidus (Etiology, Dx) | - Pituitary tumor
- trauma/surgery
- Histiocytosis X
- Secondary HyperCa [renal]
- Lithium, Demeclocycloine
- Dx: Water deprivation. Desmopressin (ADH analog) distinguishes central & nephrogenic.
- Urine <1.006, blood >290 mOsm/L.
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| Diabetes Insipidus Tx | Central: Desmopressin.
Nephrogenic: HCTZ, Amiloride, Indomethacin.
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| SIADH Etiology, Labs, Tx | - Small cell Lung Ca & Pulm Dz
- CNS trauma
- Cyclophosphamide
- Labs: HypoNa, Urine > Serum osmolarity.
- Tx: slowly w/ demeclocycline, Lithium (SE’s), H20 Restriction.
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| Carcinoid Syndrome Labs, Sx, Morphology, Tx | Elevated urine 5-HIAA.
- GI enterochromaffin cell tumor (serotonin) outside GI.
Sx: Flushing, Diarrhea, wheezing, peripheral edema.
#1 appendix tumor, R Endocardial Fibrosis. MULTIPLE (metastatic, addt’l malignancy, multiple).
- Tx: Octreotide
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| Insulin | Time: Lispro & Aspart < NPH < Lente < Ultralente. Tx DM1, HyperK
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| 1st Gen Sulfonylureas | Tolbutamide, Chlorpropramide.
SE: Disulfram-like effects.
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| 2nd Gen Sulfonylureas | Glyburide, Gilmepiride, Glipizide.
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| Sulfonylurea mech | Close Beta cell K channel -> depolarization -> Ca influx -> Insulin release.
Only DM2
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| Biguanides | Metformin
Mech: Reduce gluconeogenesis, increase glycolysis, lowers serum glucose
SE: Lactic Acidosis. CI:Renal, Liver Failure/Alcoholics, CHF, Sepsis
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| Glitazones | Pio/Rosi-glitazone
Mech: Increase sensitivity to insulin via PPAR gamma.
SE: Wt gain, edema, hepato & cardio toxic
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| Alpha Glucosidase Inhibitors | Acarbose & Miglitol
Mech: inhibits brush border glucosidase -> slows glucose absorption
SE: GI disturbances
DM2 only
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| Methimazole, Propylthiouracil | Inhibits TH synthesis via -|thyroid peroxidase
PTU also inhibits T4->T3.
SE: Rash, Agranulocytosis & Aplastic Anemia
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| GH Therapy | GH Deficiency, Turner’s Syndrome
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| Desmopressin Therapy | Central DI
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| Glucocorticoid Use | Addison’s.
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| Secondary HyperPTH Labs, Associations | Renal failure: Low Ca, high PO4 & Alk Phs
Assoc w/Renal osteodystrophy (bone lesions b/c high PTH)
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| Cortisol Physiology | Stimulates Gluconeogenesis, Glycolysis, Epinephrine synthesis, Proteolysis, Lipolysis, Neutrophil Demargination. Suppresses Insulin, non-neutrophil lymphocyte counts.
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| Neurophysin | Transports ADH & Oxytocin from Hypothalamus to Neurohypophysis
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| Acute Hyperthyroid Tx | Beta blockers
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| Kallmans Syndrome | GnRH migration failure-> primary hypoandrogenism. + Anosmia
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| Conn's Syndrome | Primary Aldosteronism: Adrenal Hyperplasia/Adenoma
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