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HY Endo Anat&Physio

Day 9

MC tumor of the adrenal medulla in adults Pheochromocytoma
MC tumor of the adrenals in children (Adrenal) neuroblastoma
Compare the consequences of pheochromocytoma vs. neuroblastoma on blood pressure Pheo causes episodic HTN. Neuroblastoma does not.
What is the path of the L adrenal gland to the IVC? L adrenal-->L adrenal v--> L renal v--> IVC (same as L gonadal v)
What is the path of the R adrenal gland to the IVC? R adrenal-->R adrenal v-->IVC (same as R gonadal v); remember the R side goes Right to the IVC
Where are ADH and oxytocin made? Hypothalamus
What hormones (H) are stored in the neurohypophysis? ADH/vasopressin and oxytocin are stored in the posterior pituitary/neurohypophysis
From which embryonal cells is the posterior pituitary derived? Neuroectoderm
What H are made by the adenohypophysis? FSH, LH, ACTH, TSH, Prolactin, GH, melanotropin (MSH) are made in the adenohypophysis/anterior pituitary. Mnemonic= FLAT PiG
From which embryonal cells is the adenohypophysis derived? Oral ectoderm (surface ectoderm) aka Rathke's pouch
Which subunit is common to TSH, LH, FSH, and hCG? Alpha subunit
Which subunit determines H specificity? Beta subunit
ACTH is synthesized as part of which polypeptide? POMC
Which cells in the pancreas make glucagon? Where are they located? Alpha cells; peripheral
Which cells in the pancreas make insulin? Where are they located? Beta cells; centrally
Which cells in the pancreas make somatostatin? Where are they located? Delta cells; interspersed
What metabolic signal causes beta cells to synthesize insulin? ATP from glucose metabolism causes K channels to close--> depolarizes cell--> opens Ca channels--> increased intracellular Ca triggers exocytosis of insulin packaged in vesicles
Which cells don't need insulin for glucose uptake? Which GLUT transporter are they missing? Brain, RBCs, Intestine, Cornea, Kidney, Liver (BRICK L). No GLUT 4 receptor.
Which cells have GLUT-1 receptor? RBCs, brain. These tissues can take up glucose regardless of insulin levels. The brain relies on glucose for metabolism under normal circumstances and uses ketones in starvation. RBCs always depend on glucose.
Which cells have GLUT-2 receptor? Beta islet cells, liver, kidney, small intestine
Which cells have GLUT-4 (insulin responsive)? Adipose tissue, skeletal m (these tissues depend on insulin for glucose uptake).
How does insulin affect the alpha cells of the pancreas? Inhibits them from releasing glucagon.
How can you differentiate the blood levels of a patient over-injecting insulin from a patient with an insulinoma? Exogenous insulin has no C-peptide, so the patient who is injecting will have low C peptide levels in their blood while the person with the insulinoma that is secreting endogenous insulin will have sky high C-peptide in their blood.
How does insulin affect Na retention in the kidneys? Increases it
What effect does prolactin have on GnRH? Inhibitory
Which hypothalamic H stimulates release of prolactin from the adenohypophysis? TRH (also stimulates release of TSH)
How does prolactin inhibit its own secretion? Increases dopamine synthesis and secretion from the hypothalamus
Stimulates milk production in breast prolactin
Inhibits ovulation in females and spermatogenesis in males by inhibiting GnRH synthesis and release Prolactin (think of how breastfeeding is like a natural contraceptive)
What agent can be used to treat prolactinomas? Bromocriptine (DA agonists)
Via what pathway does DA inhibit prolactin production? DA comes from the arcuate nucleus to inhibit prolactin production at the anterior pituitary
Which pharmacologic agents stimulate prolactin secretion DA antagonists (most antipsychotics) and estrogens (OCPs, also pregnancy)
WHat blocks the last step of cortisol synthesis, resulting in an ACTH surge with a resultant increase in steroid half product excretion? Metyrapone
Hypertension, hypOkalemia, pseudohermaphroditism (ext phenotypic female with no internal reproductive structures) or externally phenotypic female with normal internal sex organs but lacking secondary sexual characteristics 17 alpha hydroxylase deficiency (1 in first digit= HTN)
Masculinization, female psuedohermaphroditism, hypOtension, hyperkalemia, increased plasma renin, and volume depletion; salt wasting may lead to hypovolemic shock in newborn 21 hydroxylase deficiency (1 in second digit= masculinization)
Masculinization, HYPERtension 11beta-hydroxylase deficiency (1 in first digit=HTN, 1 in second digit=masculinization)
What is the precursor to cholesterol? Acetate
What enzyme converts cholesterol to pregnenolone? What substance stimulates this enzyme? What drug inhibits it? Desmolase. ACTH stimulates desmolase and ketoconazole inhibits it.
What enzyme converts testosterone to estradiol? Aromatase
What enzyme converts testosterone to its more active form, DHT? 5-alpha reductase
What drug inhibits 5 alpha reductase? What is its clinical application? Finasteride; can be used to treat male pattern baldness and BPH
Decreased sex hormones, decreased cortisol, increased mineralcorticoids 17-alpha hydroxylase deficiency
Decreased cortisol (increased ACTH), decreased mineralcorticoids, increased sex hormones 21-hydroxylase deficiency
Decreased cortisol, decreased aldosterone and corticosterone, increased sex hormones 11beta-hydroxylase deficiency
Why does 11beta hydroxylase deficiency present with hypertension if aldosterone levels are decreased? B/c normally the enzyme converts 11-deoxycorticosterone--> corticosterone. Without the enzyme, 11-deoxycorticosterone (a mineralcorticoid itself) builds up and causes HTN.
What are the 5 actions of cortisol? 1. Maintains BP 2. Decreases bone formation (this is why we prophylax with bisphosphonates) 3. Anti-inflammatory 4. Immunosuppressant 5. Increased gluconeogenesis, lipolysis, and proteolysis
Why is cortisol said to have a permissive effect with epinephrine? B/c it upregulates alpha 1 receptors on arterioles to maintain BP.
Why are you more likely to get diabetes with long-term cortisol use? Causes increased gluconeogenesis, lipolysis, and proteolysis
Where does PTH come from (which cells)? Chief cells of parathyroid
What does PTH increase production of in osteoblasts? What does this do to osteoclasts? M-CSF (macrophage colony stimulating factor) and RANK-L. Results in osteoclast stimulation
What does a decrease in free Mg do to PTH secretion? What conditions commonly cause Mg to decrease? Decreases PTH secretion. Decreased Mg can be caused by diarreha, aminoglycosides, diuretics, and alcohol abuse.
How does PTH increase 1,25-(OH2) vit D (calcitriol) production? By stimulating kidney 1-alpha hydroxylase.
What does PTH do to urinary cAMP? Increases it
How does PTH affect bone resporption of Ca and Phosphate? Increases both
How does 1,25-(OH2) vitamin D affect calcium and phosphate absorption in the gut? Increases both
Which vitamin D comes from sun exposure? Which vitamin D comes from plant ingestion? D3= sun; D2= plants
What is 24,25-(OH2)? The inactive form of vitD
From which embryonal cells do the calcitonin secreting cells arise? What is the name of these cells? Parafollicular cells (C cells) of the thyroid derive from the neural crest
What causes the secretion of calcitonin? Increased serum calcium levels. CalciTONin TONes down calcium levels.
True or false: Calcitonin is a key hormone in calcium homeostasis. False. Calcitonin is NOT important in calcium homeostasis.
For the most part, all anterior pituitary H use which signaling pathway? cAMP (FSH, LH, ACTH, TSH, CRH, hCG, ADH- V2 receptor, MSH, PTH, calcitonin, HGRH, glucagon) FLAT CHAMP=mnemonic
Vasodilators tend to use which signaling pathway? cGMP (makes sense); ANP and NO (EDRF)
Releasing H tend to use which signaling pathway? IP3 (GnRH, Oxytocin, ADH-V1 receptor, TRH); GOAT= mnemonic
Which H have a cytosolic steroid receptor? Vitamin D, Estrogen, Testosterone, Cortisol, Aldosterone, Progesterone (VET CAP); VERY important to know these!
Which H have a nuclear steroid receptor? T3/T4; VERY important to know this!
Which H receptors have an intrinsic tyrosine kinase (MAP kinase) pathway? Insulin, IGF-1, FGF, PDGF (remember FGF mutation is assoc'd with achondroplasia/dwarfism); think of growth factors for this one
Which H receptors have a receptor associated tyrosine kinase (JAK/STAT pathway)? GH and prolactin; also cytokine IL-2. Think of the Growth Hormone giant from JAK and the Bean Stalk.
In men, what changes in sex hormone binding globulin (SHBG) levels can lead to gynecomastia? Increased levels of SHBG (lower free testosterone--> gynecomastia)
In women, what changes in sex hormone binding globulin (SHBG) levels can lead to hirsuitism? Decreased levels of SHBG (higher free testosterone--> hirsuitism)
What delays the onset of steroid H? The need for gene transcription and protein synthesis.
What is the only purpose of iodine in the body? To make TH.
How does T3/T4 affect the heart? Upregulates B1 receptors in the heart--> increased CO, HR, SV, and contractility; this is why beta blockers like propanolol are the drug of choice in treating thyroid storm
What are the 4 B's of T3 function? Brain maturation (deficiency is assoc'd w/cretinism), Bone growth (cretins are short), Beta-adrenergic effects, and increased BMR (basal metabolic rate)
What happens to thyroxine-binding globulin levels in liver failure? Decrease
What happens to thyroxine-binding globulin levels in pregnancy? Increase
What is the enzyme responsible for oxidation and organification of iodide as well as coupling of MIT and DIT (to make T3 and T4)? Peroxidase
What converts T4 to T3? Peripheral tissues; most T3 is formed in the blood
Created by: sarah3148



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