First Aid - Endocrine

arold001's version from 2015-12-27 19:21

Section 1

Question Answer
whats the most common tumor of adrenal medulla in adults vs kids?adults: pheochromocytoma. kids: neuroblastoma
another name for vasopressinADH
what are the 3 cell types in endocrine pancreas and what do they secrete?alpha cells = secrete glucagon. beta cells = secrete insulin. delta cells = secrete somatostatin
describes how glucose causes insulin release from beta cells1) glucose enters pancreatic beta cells via GLUT2 2) glucose enters glycolysis and ATP is generated 3) ATP generated by glucose metabolism closes K+ channels and depolarizes beta cell membrane 4) opens voltage gated Ca+2 channels 5) Ca+2 influx stimulates exocytosis of insul
what are 3 main functions of insulin in terms of synthesisincreases glycogen synthesis/storage, increases TG synthesis/storage, increases protein synthesis (muscles)
what hormone is secreted in response to hypoglycemia?glucagon (by pancreatic alpha cells) = stimulates glycogenolysis, gluconeogenesis, lipolysis, ketone production
GLUT5frustose transporter
whats the 5 criteria for metabolic syndrome?1) abdominal obesity: waist >40 (men), waist >35 (women)
2) TG >150
3) HDL <40
4) BP>135/85
5) fasting serum glucose >100 or 2 hour post oral glucose >140
TRH stimulates release of what 2 hormonesTRH --> TSH, prolactin
CRH stimulates release of what 3 hormonesCRH --> ACTH, MSH, beta-endorphin
somatostatin inhibits which 2 pituitary hormonesinhibits GH and TSH
prolactin inhibit which hypothalamic hormone?prolactin inhibits GnRH
what secretes prolactinanterior pituitary
another name for somatotropinGH
what effect does GH have on insulinGH --> increases insulin resistance --> bad for diabetics!
whats the main problem seen in congenital bilateral adrenal hyperplasias?CAH: decreased cortisol production --> reflex increase ACTH --> hyperplasia of adrenal glands

Section 2

Question Answer
17-alpha hydroxylase deficiency: mineralcorticoids? cortisol? sex hormones?HIGH mineralcorticoids (aldosterone), no cortisol, no sex hormones
which deficiency: HTN and masculinization?11-beta hydroxylase deficiency
which deficiency: HTN and no sex hormones (ambiguous genitalia)17-alpha hydroxylase deficiency
which deficiency: HYPOtension, hyperkalemia, increased renin activity, masculinization21-hydroxylase deficiency
what are the 5 actions of cortisol? (BBIIG)1) maintains Blood pressure via upregulating alpha-1 receptors on arterioles 2) decreases Bone formation (osteoporosis 3) anti-Inflammatory/Immunosuppressant 4) increases Insulin resistance (worsens diabetes) 5) increases Gluconeogenesis, lipolysis, proteolysis
why is cortisol an immunosuppressant and anti-inflammatory?1) inhibits production of leukotriences and prostaglandins 2) inhibits leukocyte adhesion --> neutrophilia 3) blocks histamine release from mast cells 4) reduces eosinophils 5) blocks IL-2 production
what secretes cortisol?adrenal zona FASICULATA
what secretes PTH?chief cells of parathyroid
what are the 4 main functions of PTH?1) increases bone resorption of calcium and phosphate
2) increases kidney reabsorption of calcium in DCT
3) decreases reabsorption of phosphate in PCT
4) increases calcitriol production by stimulating kidney 1-alpha hydroxylase
how is PTH related to osteoblast?PTH increases production of M-CSF and RANK-L in osteoblasts which stimulates osteoclasts
vitamin D deficiency in adults vs kidsadults: osteomalacia. kids: ricketts
what secretes calcitonin?parafollicular C-cells of the THYROID
whats the function of calcitonin?decreases bone resorption
what are the 4 B's of T3?Bone maturation, Bone growth, Beta1-adrenergic effects, increased BMR
whats Wolff-Chaikoff effect in terms of thyroid hormone?excess IODINE temporarily inhibits thyroid peroxidase --> decreased iodine organification --> decreased T3/T4 production
what enzyme converts T4 --> T3?5'-deiodinase
whats the MOA of peroxidase?peroxidase = oxidation and organification of iodide, coupling of MIT and DIT
whats the MOA of PTU vs methimazole?PTU: inhibits both peroxidase and 5'-deiodinase.
Methimazole: inhibits perioxidase only

Section 3

Question Answer
pt presents with HTN, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia due to insulin resistance, stiae, osteoporosiscushings syndrome
whats the main cause of cushing disease?ACTH secretion from pituitary adenoma: increased ACTH --> increased cortisol
what are 2 ectopic sources of ACTH?small cell lung carcinoma and bronchial carcinoids
what is primary hyperaldosteronism?primary hyperaldosteronism = caused by adrenal hyperplasia or aldosterone-secreting adrenal adenoma
what is conns syndromealdosterone-secreting adrenal adenoma
whats the difference btw primary hyperaldosteronism vs. secondary hyperaldosteronism?primary: LOW plasma renin. secondary: HIGH plasma renin
what is secondary hyperaldosteronism?renal perception of LOW intravascular volume results in an OVERACTIVE RAA
what are 5 causes of secondary hyperaldosteronism (renal preception of low intravascular volume resulting in overactive RAA system)renal artery stenosis, chronic renal failure, CHF, cirrhosis, nephrotic syndrome
whats the tx of secondary hyperaldosteronism?spironolactone = K+ sparing diuretic that works by acting as aldosterone antagonist
what is addisons disease?CHRONIC primary adrenal insufficiency due to adrenal atrophy or destruction by disease (autoimmune, TB, or metastasis)
why do you get dark/hyperpigmented skin in addisons disease?since no production of cortisol --> reflex increase in CRH and increase ACTH --> increased MSH = DARK SKIN!
deficiency of aldosterone and cortisol --> causing hypotension, hyperkalemia, acidosis, skin hyperpigmentationaddisons disease!
whats the difference btw primary adrenal insufficiency vs. secondary adrenal insufficiency?primary adrenal insufficiency (addisons disease) = skin hyperpigmentation. secondary adrenal insufficiency (decreased pituitary ACTH production) = NO skin hyperpigmentation and NO hyperkalemia
what is primary adrenal insufficiency vs. secondary adrenal insufficiency vs. tertiary adrenal insufficiencyprimary adrenal insufficiency = decreased ADRENAL cortisol and aldosterone production. secondary adrenal insufficiency = decreased PITUITARY ACTH production. tertiary adrenal insufficiency = decreased HYPOTHALAMIC CRH production
whats waterhous friederichsens syndrome?ACUTE primary adrenal insufficiency due to adrenal hemorrhage a/w Neisseria meningitidis septicemia, DIC, endotoxic shock
tumor that causes EPISODIC hypertensionpheochromocytoma = tx with phenoxybenzamine (alpha-antagonist) given first, then beta-blockers
what 3 hormones does pheochromocytome secreteEpi, NE, DA
urine shows increased VMA and metaneprhines (breakdown product of Epi and NE)pheochromocytoma
in kid, urine shows increased homovanillic acid (breakdown of DA)neuroblastoma!
autoimmune destruction of adrenal glands --> adrenal atrophy, decreased aldosterone, decreased cortisoladdisons disease

Section 4

Question Answer
whats the most common cause of hypothyroidism?hashimotos thyroiditis
hypothyroidism a/w PAINLESS goiterhashimotos thyroiditis
HLA-DR5 hashimotos thyroiditis
hashimotos thyroiditis has increased risk of developing which cancer?non-hodgkins lymphoma
positive anti-thyroglobulin antibody and anti-thyroid peroxidase antibodyhashimotos thyroiditis
histology of thyroid: hurthle cells, lymphocytic infiltrate with germinal centershashimotos thyroiditis
self-limited hypothyroidism following flu-like illnesssubacute granulomatous de quervains thyroiditis
thyroid histology: granulomatous inflammationsubacute granulomatous de quervains thyroiditis
PAINFUL thyroid, increased ESR, jaw painsubacute granulomatous de quervains thyroiditis
hard, rock-like PAINLESS goiter in YOUNG patientriedels thyroiditis
whats a thyroid strom?complication of graves disease = massive release of thyroid hormone induced by stress causes catecholamine surge that leads to arrhythmias
orphan annie eyes, psammoma bodies, nuclear groovespapillary carcinoma of the thyroid
whats a HY risk factor for papillary carcinoma of thyroid?childhood radiation
what are 2 complication of thyroidectomy?removal of parathyroid and recurrent laryngeal nerve damage (hoarseness)
thyroid cancer from parafollicular C cells (produces calcitonin)medullary carcinoma = produces calcitonin
thyroid cancer shows sheets of cells in amyloid stromamedullary carcinoma of thyroid
whats a cause of secondary hyperparathyroidism?chronic renal failure = decreased calcium and increased phosphate in CKD leads to increased PTH response
what are 3 causes of primary hyperparathyroidism?parathyroid adenoma, hyperplasia, carcinoma = increased PTH --> increased Ca+2

Section 5

Question Answer
whats the MOA of demeclocycline?ADH antagonist = cause of nephrogenic DI
whats desmopressin?synthetic ADH
whats the tx of central DI?intranasal desmopressin (ADH analog)
whats the tx of nephrogenic DI?hydrochlorothiazie, indomethicin (NSAID), amiloride
what cancer can cause SIADH?small cell lung carcinoma
whats the tx of SIADH?fluid restriction, IV saline, conivaptan, tolvaptan, demeclocyline (ADH antagonist)
kidney histology shows kimmelstiel-wilson nodulesdiabetic nephropathy!
what causes DM1?autoimmune destruction of pancreatic beta-cells
what causes DM2?increased resistance to insulin, progressive pancreatic beta-cell failure
what are 2 ketone bodies?beta-hydroxybutyrate and acetoacetate
what syndrome: recurrent diarrhea, flushing, asthmatic wheezing, right sided valvular diseasecarcinoid syndrome
how do you diagnosis carcinoid syndrome?increased urinary 5-HIAA (breakdown of serotonin)
whats the tx of carciniod syndrome (small bowel tumor that secretes high level of serotonin)somatostatin analog = octreotide
whats the most common tumor of the appendix?carcinoid syndrome
what 2 places does carcinoid syndrome like to occur?small bowel or appendix
gastrin secreting tumor of the pancreas or duodenumzollinger-ellison syndrome
ulcers in distal small bowelgastrinoma = ZE syndrome
stomach shows rugal thickening with acid hypersecretionZE syndrome
MEN11) pituitary tumors (prolactinoma or GH) 2) parathyroid tumor 3) pancreatic tumor (ZE symdome, insulinoma, VIPomas, glucagonoma)
MEN2A medullary carcinoma of thyroid, pheochromocytoma, PARATHYROID TUMOR
MEN2Bmedullary carcinoma of thyroid, pheochromocytoma, oral neuoromas
what mutation is a/w MEN 2A and MEN 2BRET gene mutation

Section 6

Question Answer
Whats the tx for acromegaly?somatostatin = GHIH
whats the tx for carcinoid, gastrinoma, glucagonoma, esophageal varicessomatostain (octreotide) = GHIH
whats the tx of central diabetes insipidusdesmopressin = ADH analog
whats the MOA of demeclocycline?ADH antagonist
whats the tx of SIADH?demeclocycline = ADH antagonist
whats the MOA of glucocorticoids (hydrocortisone, prednisone, triamcinolone)decreased production of leukotrienes and prostaglandins by inhibiting phospholipase A2 and expression of COX-2

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