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First Aid: Endocrine

What are the three layers of the adrenal cortex and what do they produce? Zona glomerulosa (Aldosterone); Zona fasciculata (glucocorticoids); Zona reticulares (androgens)
What embryological layers do the adrenals derive from? Cortex is from mesoderm; medulla is from neural crest (consider chromaffin cells postganglionic sympathetic neurons, helps you remember ACh acts on nicotinic receptors here as well)
Tumor of the adrenal medulla, most common in adults. Pheochromocytoma
Tumor of the adrenal medulla, most common in children, doesn't always produce catecholamines. Neuroblastoma
What are the two hormones produced by the posterior pituitary? ADH (vasopressin) and oxytocin
What are the hormones secreted by the anterior pituitary and from what cells are they secreted? "FLAT PiG"; Basophils "B-FLAT", FSH, LH, ACTH, TSH; Acidophils Prolactin and GH
What are the cell types within the islets of Langerhans and what do they secrete? alpha (glucagon); beta (insulin); delta (somatostatin)
How is prolactin regulated? Prolactin release is stimulated by TRH and inhibited by dopamine. This is a negative feedback loop because prolactin increases dopamine synthesis and secretion from the hypothalamus.
What inhibits release of both growth hormone and TSH? Somatostatin
What enzyme in adrenal steroid synthesis is activated by ACTH? What drug inhibits this enzyme? Desmolase, it is inhibited by ketoconazole
What enzyme deficiency will result in decreased sex hormones, decreased glucocorticoids, and increased mineralocorticoids? 17alpha hydroxylase deficiency; results in phenotypic female w/out maturation, hypertension, and hypokalemia
What enzyme deficiency will result in increased sex hormones, decreased glucocorticoids, decreased mineralocorticoids and hypotension? 21beta hydroxylase deficiency; results in masculinization, pseudohermaphroditism, hyponatremia, increased plasma renin activity, and volume depletion.
What enzyme deficiency results in increased sex hormones, decreased glucocorticoids, decreased mineralocorticoids and hypertension? 11beta hydroxylase deficiency; results in masculinization and hypertensions because 11-deoxycorticosterone acts as a weak mineralocorticoid
What would lead to decreased sex hormone, decreased glucocorticoids, and decreased mineralocorticoids? Addisons disease (low ACTH) or ketoconazole toxicity
What cells secrete parathyroid hormone? Chief cells of parathyroid
What are the four primary functions of PTH? 1. Increase bone resorption (both osteoclasts and osteoblasts) 2. Activate kidney 1alpha hydroxylase 3. Increase kidney reabsorption of calcium 4. Decrease kidney reabsorption of phosphorus
What are the 3 primary actions of vitamin D? 1. Increased bone resorption 2. Increased absorption of dietary calcium 3. Increased absorption of dietary phosphorus
In Paget's disease of bone, what would you expect to be elevated, calcium, phosphorus, or alkaline phosphatase? Alkaline phosphatase
In hyperparathyroidism, what would you expect to be elevated, calcium, phosphorus, or alkaline phosphatase? Calcium and alkaline phosphatase, phosphorus should be decreased
In renal insufficiency, what would you expect to be elevated, calcium, phosphorus, or alkaline phosphatase? Phosphorus would be elevated, calcium would be decreased due to insufficient vitamin D activation
What cells secrete calcitonin and what is its function? Parafollicular C cells of thyroid; calcitonin functions to decrease bone resorption. It is activated by elevated serum calcium
What are the primary functions of T3 and T4? The 4 B's; Bone growth, Brain maturation, Beta adrenergic effects, increased BMR
Through what mechanism do T3 and T4 increase BMR? Increase activity of Na/K ATPase leading to increased Oxygen consumption, increased RR rate, and increased body temperature
What is the mechanism of thyroid hormone regulation? TSH stimulates thyroid hormone release and T3 inhibits TRH release from the hypothalamus
What is the function of cortisol? It is an anti-inflammatory, increases gluconeogenesis (secondary diabetes), lipolysis, proteolysis, decreases immune function, maintains blood pressure
How would you distinguish Cushing's disease from primary adrenal hyperplasia/neoplasia? Both would present as Cushing's syndrome (excess cortisol); Cushing's disease would have elevated ACTH whereas adrenal hyper/neoplasia would have low ACTH; Clinically only Cushing's disease would have hyperpigmentation
What is the treatment for Cushing's disease? Ketoconazole
How would you distinguish between Conn syndrome and secondary hyperaldosteronism? Conn syndrome would result in low plasma renin; secondary hyperaldosteronism would have elevated plasma renin
What are some causes of secondary hyperaldosteronism? renal artery stenosis, chronic renal failure, decreased renal perfusion (CHF), nephrotic syndrome, etc.
What is primary Addison's disease? primary deficiency of aldosterone and cortisol due to adrenal atrophy leading ot hypotension and skin hyperpigmentation (due to elevated ACTH).
What is secondary Addison's disease? Decreased cortisol due to decrease in pituitary ACTH production. No skin hyperpigmentation
What would be expected in the urine of a patient suffering from pheochromocytoma? Vanillyl mandelic acid (VMA), a metabolite of norepinephrine
What would be expected in the urine of a patient suffering from neuroblastoma? Homovanillic acid (HVA), a metabolite of norepinephrine
What is Sheehan's syndrome? Pituitary insufficiency caused by infarction following severe bleeding and hypoperfusion during delivery.
What is Wermer's syndrome? MEN type I; associated w/ 3 P's (pancreas, pituitary, and parathyroid)
What is Sipple's syndrome? MEN type II; associated with pheochromocytoma, medullary carcinoma of the thyroid, and parathyroid tumor
What is MEN type III? Similar to type II with medullary carcinoma of the thyroid and pheochromocytoma, but with oral and intestinal ganglioneuromatosis (mucosal neuromas) instead of parathyroid tumor
What are the symptoms of pheochromocytoma? 5 P's; pressure, pain (headache), palpitations, perspiration, and pallor
What is the treatment of pheochromocytoma? Phenoxybenzamine; a nonselective, irreversible, alpha blocker
Cold intolerance, weight gain, fatigue, lethargy, and decreased reflexes. Diagnosis? Hypothyroidism
Heat intolerance, weight loss, chest pain, arrhythmias. Diagnosis? Hyperthyroidism
Autoantibodies which stimulate the TSH receptor. Diagnosis? Grave's disease
Antimicrosomal and antithyroglobulin antibodies. Diagnosis? Hashimoto's thyroiditis
What are Hurthle cells? Enlarged epithelial with abundant eosinophilic granules in the cytoplasm. Associated with Hashimoto's and follicular thyroid cancer.
Hypothyroidism often following a flulike illness with elevated ESR, jaw pain, and inflamed, tender thyroid gland. Subacute thyroiditis (de Quervain's); hypothyroid may be preceded by hyperthyroid period.
Thyroid cancer associated with ground glass nuclei, psammoma bodies, and irradiation exposure. Papillary carcinoma; most common
Thyroid cancer of parafollicular C-cells which produce calcitonin and sheets of cells in amyloid stroma. Medullary carcinoma
Thyroid carcinoma with enlarged uniform follicles. Follicular carcinoma
Thyroid cancer with worst prognosis. Undifferentiated/anaplastic
What causes cretinism? a defect in T4 formation or failure in thyroid formation
Pot-bellied, puffy faced child with protruding umbilicus and protuberant tongue. Diagnosis? Cretinism
47 yro male diabetic w/ a large tongue with deep furrows, deep voice, large hands and feet and coarse facial features. Diagnosis? Acromegaly; Remember GH is diabetogenic
Where are the cell bodies of the nerve cells in the posterior pituitary? In the hypothalamic nuclei
Patient presents with renal stones, bone pain, constipation, memory problems and lethargy. Diagnosis? Classic "stones, bones, groans(constipation), and psychiatric overtones"; hyperparathyroidism
What is the mechanism of renal osteodystrophy? Renal disease leads to decreased production of activated vitamin D, decreased secretion of phosphorus, and decreased reabsorption of calcium. Leads to high PTH, low serum calcium, elevated serum phosphorus.
What is pseudohypoparathyroidism? Kidney unresponsive to PTH
What are the causes of hypercalcemia? My favorite pnemonic "CHIMPANZEES"; Calcium ingestion, Hyperparathyroidism/thyroidism, Iatrogenic(thiazides), Multiple myeloma, Paget's disease, Addison's disease, Neoplasms, Zollinger-Ellison syndrome, Excess vitamin D, Excess vitamin A, Sarcoidosis
What are the symptoms of the most common pituitary adenoma? Prolactinoma; ammenorrhea, galactorrhea, low libidio, infertility
What is the treatment for prolactinoma? Bromocriptine (dopamine agonist)
Patient presents with anion gap metabolic acidosis, rapid/deep breathing, vomiting, and altered mental state. Diagnosis? DKA
Patient with intense thirst and polyuria and dilute urine. Diagnosis? Diabetes insipidus
Patient presents with new onset seizures, found to be extremely hyponatremic but urine osmolarity is markedly elevated. Diagnosis? SIADH; low serum sodium can lead to seizures, hyponatremia from fluid retention
Patient presents with diarrhea, cutaneous flushing, and asthmatic wheezing. Right sided valvular disease is found. Diagnosis? Carcinoid syndrome; neuroendocrine cells secrete high levels of serotonin
What is the treatment for carcinoid syndrome? octreotide; somatostatin analog used primarily to treat diarrhea and flushing
Created by: rahjohnson



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