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endocrine physio

QuestionAnswer
What promotes secretion of insulin (nervous) ACh
What promotes secretion of insulin (hormones) Cortisol, GH, glucagon, GIP, Secretin and gastrin
What promotes secretion of insulin (food) AA (lys, arg, leu), fatty acids, sugar
What promotes secretion of insulin? (Drugs) sulfonylureas
What inhibits insulin? decreased blood glucose, somatostatin, NE, Epi (alpha adrenergic stimulation), phenytoin, vinblastine, colchine
What are the four overall effects of insulin on blood levels? decreased glucose, AA, fatty acids, ketoacid, hypokalemia
Insulin acts with ___ receptor, glucagon acts with ___ tyrosine kinase receptor, cAMP
In obesity receptors are ___ in starvation they are __- decreased, increased
Beta cells have what type of GLUT receptors? GLUT 2
Describe how insulin is realsed Glu --> glut 2 --> glycolysis --> increased ATP--> ATP closes K+ channel --> depol --> open voltage Ca channels --> insulin secretion
How does sulfonylurea increased insulin Blocks K+ ATPase channel --> Increased depol
How does Epi, NE, and Glucagon work to change insulin levels? throught cAMP --> increase Ca
Target organs of insulin? Target organs of glucagon Insulin =liver, adipose, muscle. Glucagon = liver, adipose
4 actions of insulin 1. Decrease glucose, 2. decrease AA, 3. decrease fatty acid, 3. decrease potassium
How does insulin decrease glucose? Increase glucose uptake (glut 2), increase glycogen formation (muscle/liver), decrease gluconeogenesis (increase f26BP --> increase PFK)
How does insulin decrease fatty acids? stimulates fat deposition, inhibits lipolysis (fat), inhibits ketoacid formation (less FFA degradation --> less acetyl coA)
How does insulin decrease blood AA? stimulates AA uptake, increases protein syntheis, inhibits protein degradation
How does insulin decrease K? insulin increases K uptake into cells,
What stimulates glucagon Decreased blood sugar, increased AA(arg), NE, E, CCK (alerts to protein meal), AcH, glucocorticoids
AA that stimulate insulin, those that stimulate glucagaon Insulin (arg, leu, lys), glucagon (arg)
What inhibits glucaogn secretion? Hyperglycemia, fatty acids, ketoacids, somatostatin, insulin
Insulin increases/decreases 2,6 bisphosphate? Insulin increases (Shunts it to PFK)
4 main actions of glucagon 1. increase glucose, 2. increase fatty acids, 3. increase ketoacids, 4. increase urea
3 main actions of somatostatin 1. decreased secretion of insulin/glucagon, 2. decreased gastric, duodenal, gallbladder motility, 3. decreased funtion of intestinal mucosa (decreased absorption and secretion)
Adrenal cortex ____, Medulla ____ Mesoderm, neural crest cells
Somatotropin release-inhibiting hormone comes from ___- and actions are ____ SRIF (somatostatin): hypothalamus, inhibits GH, TSH
FSH actions, LH actions Stmiulates growth of ovarian follicles, estrogen secretion, promotes sperm maturation, Stimulates ovulation, formation of CL, synthesis of estrogen and progesterone (ovary). Stimulates synthesis and secretion of testosterone.
T4, T3 actions Bone maturatoin, O2 consumption (Na/K ATPase), increased BMR (increased protein, fat, carboyhydrate use, maturation of nervous system
Estradiol Grwoth and development of reproductive organs, follicular phase of menstrual cycle
Aldosterone actions Increased Na reabsorption, increased renal K secretion, increased renal H secretion
hCG actions Increased estrogen and progesterone synthesis in CL of pregnancy
hPL Same actions as growth hormone and prolactin during pregnancy
Adrenal cortex ____, Medulla ____ Mesoderm, neural crest cells
Somatotropin release-inhibiting hormone comes from ___- and actions are ____ SRIF (somatostatin): hypothalamus, inhibits GH, TSH
FSH actions, LH actions Stmiulates growth of ovarian follicles, estrogen secretion, promotes sperm maturation, Stimulates ovulation, formation of CL, synthesis of estrogen and progesterone (ovary). Stimulates synthesis and secretion of testosterone.
T4, T3 actions Bone maturatoin, O2 consumption (Na/K ATPase), increased BMR (increased protein, fat, carboyhydrate use, maturation of nervous system
Estradiol Grwoth and development of reproductive organs, follicular phase of menstrual cycle
Aldosterone actions Increased Na reabsorption, increased renal K secretion, increased renal H secretion, increased BP
hCG actions Increased estrogen and progesterone synthesis in CL of pregnancy
hPL Same actions as growth hormone and prolactin during pregnancy
What controls prolactin synthesis TRH stimultaes, dopamine inhibits
What stimulates dopamine? what medical agent is similar to dopamine? Prolactin, bromocriptine
Prolactin action inhibit GnRH; breast development, prevent obulation, spermatogenesis
alpha subunit is common to what hormones? TSH, LH/FSH, hCG
Enzyme that converts cholesterol to pregnolone is stimulated by ___ and inhibited by ____ Stimulated by ACTH, inhibited by ketoconazole
Decreased sex hormones, decreased cortisol, increased mineralcorticoids: Hypertension/hypotension, Hyper/hypokalemia. XY:, XX 17 alpha hydroxylase. SX: hypertension, hypokalemia. XY: pseudohermaphrodite (phenotypic famle, no internal structures). XX: lacking femal sexual characteristics (infantiilism)
decreased cortisol, decreased mineral corticoids, increased sex hormones, increased ACTH. Hypo/Hypertension, Hypo/hyperkalemia, XY, XX 21 hydroxylase deficiency. Sx: hypotension, hyperkalemia, increased plasma renin, volume depletion. Salt wasting can lead to hypovolemic shock in new borns. XX: virilization, XY: precocious puberty
Decreased cortisol, decreased aldosterone and corticosterone, increased sex hormones. Sx: Hypo/hypertension, XX, XY 11B hydroxylase. Hypertension, masculinization. Virilization.
All congenital adrenal enzyme deficiencies have what feature? They all have increased ACTH, are autosomal recessive, and have bilateral enlargement of adrenal glands
Cortisol levels are highest ___, lowest ____ High 8AM, low 12 AM
Cortisol function Anti-inflammatory, increased gluconeogenesis, lipolysis, proteolysis, decrease immune, maintain blood pressure, decrease bone formation
CRH is released from what nucleus in HTHAl? paraventricular nucleus
ACTH is derived from ___ POMC
Dexamethosone cannot suppress __- but does suppress ___ Suppress normal cortisol secretion, ACTH secreting tumors; cannot suppress adrenal cortical tumors
What stimulates the RAA system? decreased blood volume, decreased renal perfusion, increased renin
Where does aldosterone act in the kidney increased NA reabsortpion/K secretion = distal collecting duct by principal cells; increased H secretion: intercalated cells of distal collecting ducts
Parathyroid has two types of cells: which one is pink, which one is purple Oxyphil, chief cell
60% of calcium is free/bound Bound
3 functions of parathyroid. What cells secrete PTH? What cells do PTH stimulate? Chief cells: Increased serum Ca, Decreased serum PO4, Increased Urine PO4 (cAMP); OB, OC
What increases PTH/inhibits PTH decreased Ca, Increased PTH secretion. Decrease: low Mg, increase Ca, decrease PO4
How does PTH work on the intestine Increases PO4 and Ca from intestine indirectly by stimulatint 1,25 D3
What stimulates vitamin D production Decreased Ca, increased 1,25 (OH)2 from liver, decrease PO4 production
PTH and Vitamin D: calcium, phosphate PTH: increases calcium reabsorption, decreases phosphate reabsortpion, Vitamin D: increases reabsorption of calcium and phosphate.
Unlike Osteoperosis, the ratio of mineral to osteoid in rickets is ___ Decreased (more osteoid), not just bone loss, but dimneralization
Labs for rickets: Increased alkaline phosphate (increased collagen syntehsis)
What is derived from POMC Alpha MSH, Beta MSH, ACTH
How is growth hromone secreted? when is it increased? decreased? GH: pulsatile fashion; Increased: sleep, stress, puberty hormones, exercise, hypoglycemia, starvation. Decreased: somatostain, somatmedins, obesity, hyperglycemia, pregnancy
GHRH is inhibited by __- negative feedback
Somatomedins are made from ___, due to ___ whereas somatotstain is made from ____ Somatomedins = liver and created with high levels of growth horomone. somatostatin = HTHAL, delta cells
IGF is a ___ and has ___ activity IGF = somatomedin that has tyrosine kinase activity
Actions of growth hormone decreased glucose uptake (diabetogenic), increased lipolyis, increased protein syntehsis in muscle, increased lean body mass, increased production of IGF
Actions of growth hormone via IGF Increased protein synthesis in chondrocytes, increased linear growth, increased lean body mass, increased organ size
Octreotide = somatostatin analog which inhibits growth hormone
Factors that stimulate prolactin secretions Estrogen, breast-feeding, sleep, stress, TRH, dopamine antagonsists
ADH is made in the ___ nuclei. It's stimulated by supraoptic nuclei. osmolarity, pain, nausea, hypoglycemia, nicotine, opiates, antineoplastic agents
Factors that decrease ADH secretion include decreased serum osmolarity, ethanol, alpha agonists, ANP
Oxytocin is made in the ___ nuclei paraventricular nuclei
Function of oxytocin milk ejection,reduce postpartum bleeding, induce labor,
What increases oxytocin secretion suckling, oxytocin, dilation of cervix, orgasm
What is a medullary carcinoma abrnomal proliferation of parafollicular cells wtih amyloid stroma
Inhibits Na/I pump Thiocyanate, percholate
Inhibit organification (MIT, DIT formation). Too much iodide (Wolff Chaikoff effect)
Mimic I2 deficiency Deficiency of thyroid deiodinase
What is a goiter and what can cause it? enlargement of thyroid. Hashimoto, goitrogens, iodine deficiency, physiologic enlargment (not uncommon during puberty and pregnancy)
TBG is ___ during pregnancy which means that __ is increased and TBG is ____ during hepatic injury, which means ___ is decreased Increased = pregnancy which means that total serum T4 is increased (free remains the same) decreased = hepatic injury, total serum T4 is decreased (free T4 remains the same)
Precocious puberty in boys is usually caused by midline harmartoma
In order to cahnge total serum T4 you must have an Increase/decrease in FT4
Increased FT4, decreased FT4 Grave's, thyroiditis; Hypothyroidism
Increased iodine uptake maeans that there is an increased synthesis of T4(examples: Grave's disease, toxic nodular goiter
Decreased iodine uptake means that there is a decreased synthesis of T4 (inactivity, thyroiditis)
Cold nodule=, increased uptake decreased uptake = cyst, cancer, Increased uptake = toxic nodular goiter
Branchial cleft cyst vs. thyroglossal cyst branchial cleft anterolateral neck, thyroglossal = cystic midline mass
acute vs. granulomatous thyroiditis acute= fever, tender galnd with painful cervical adenopathy, initial increased T4, decreased I. Subacute = viral infection (coxsackie), women 40-50, granulomatous with multinucleated giant cells.
Hashimoto is associated with what HLA types; what is it, antibodies? DR3, DR5; toxicosis --> hypothyroidism; antimicrosomal, thyroglobulin (result of gland injury)
Types of Cushing syndrome? Pituitary (adenoma), Adrenal, ectopic, drug related
Which type of Cushing syndrome can be suppressed by dexamethasone? Pituitary
In the presence of increased cortisol, what does a normal -increased, decreased, very high ACTH mean? Pituitary, Adrenal, Ectopic
Primary aldosteronism is also known as ___. Secondary aldosteronism is due to ___-, ___, ___,____. Which is associated with high Renin? low renin? Conn's syndrome. Caused by an aldosterone secreting (low renin. Renal artery stenosis, chronic renal failure, CHF, cirrhosis, nephrotic syndrome (caused by kidney perception of low intravascular volume in an overactive renin-angiotensin system. High renin
Hyperaldosteronism produces what lab? hypertension, hypokalemia, metabolic alkalosis
Causes of acute adrenocortical insuffiency abrupt withdrawl of corticosteroids, waterhouse friderichsen syndrome, anticoagulation therapy
Waterhouse Friderichsen synrome is caused by __- Septicemia from Neisseria meningitidis. patients develop endotoxic shock (release thromboplastin --> DIC). Bilateral adrenal hemorrhage (fibrin clots in vessels causing hemorrhagic infarction)
Causes of chronic adrenocortical insufficiency Addison's: TB, autoimmune, adrenogenital syndrome, metastasis (lung)
symptoms for addison due to deficiency of aldosterone and coritosl (adrenal atrophy): hypotension, skin hyperpigmentation.
What causes Sheehan's syndrome? Postpartum hypopituitarism. increased lactotrophs during pregnancy withouth blood supplye --> infarction of pituitary gland and bleeding/hypoperfusion during delivery. Sx: fatigue, anorexia, loss of pubic/axillary hair.
Pheochromocytoma secretes ____. secretes NE, EPi, DA in episodic waves. Causes hypertension and sever hyperglycemia.
What products are urine of a patient with pheochromocytoma HVA (dopamine), Norepinephrin (VMA), Epinephrine (metanephrine) metabolites.
What diseases are associated with pheochromocytoma? MEN 2A/B, neurofibromatosis, vHL disease
Treatment for pheochromocytoma alpha antagonists, phenoxybenzamine (nonselective irreversible alpha blocker)
What are the 5 Ps of pheochromocytoma? Pressure, pain (headache), perspiration, palpitations (tachycardia), pallor
Neuroblastoma most commonly found in what age group. where do they occur? How are they diagnosed. how are they different than pheochromocytomas in adults. What gene are tehy associated with? What do they usually look like? Most common tumor in adrenal medulla of children. Can occur anywhere along sympathetic chain. HVA (DA breakdown) in urine. Less likely to develop htn. N-myc oncogene amplifications. Presents with abdominal mass
What are the neuroblastoma gene products recognized? double minute chromosomes; related to aggressiveness of tumor
MEN 1 ___, Men 2A ___ MEN1 = Wermer's syndrome, MEN 2A = Sipple's syndrome
What are the Ps for MEN 1, 2A, 2B? Pancreas, Pituitary, Parathyroid; Pheochromocytoma, parathyroid; pheochromocytoma,
What are the pituitary tumors associated with MEN1? Pancreatic tumors? Pituitary: GH, prolactin; Pancreatic: Zollinger-Ellison, insulinomas, VIPomas, glucagonomas;
MEn syndrome taht presents with kidney stones and stomach ulcers MEN 1
What tumor secretes calcitonin? medullary thyroid carcinoma
Which MEN is associated with marfinoid habitus? Why does this happen? MEN2b; Oral/intestinal ganglioneuromatosis
what gene is associated with MEn? Ret: MEN 2A 2B
Which men is associated with medullary thyroid carcinoma? MEN 2A/B
Most common cause of hypopituitarism in children? Craniopharyngioma (pituitary tumor of Rathke's pouch); located above sella turcicca
What is associated with a craniopharyngioma? cystic tumor with hemorrhage and calcfication, bilateral hemioanopsia,
Created by: ddecampo