Endocrine Flashcards

Terms Definitions
Pineal Gland is..
Secretory cells
Infundibulum
The stalk of the Pituitary Gland
Dopamine (DA)
Hypothalamic hormone that regulates secretion of prolactin from the anterior pituitary. Also functions as neurotransmitter.
Erythropoietin
Hormone that stimulates production of red blood cells.
Which glands stores its hormone extracellularly?
 
kidney
pituitary
thyroid
adrenal cortex
pancreas
3. thyroid
Where is the Thyroid gland located?
Sternocleidomastoid area
Testosterone
Male sex hormone produced by the testes; during puberty promotes development of the secondary sex characteristics, and is necessary for normal sperm production.
Corticotropin-releasing hormone (CRH)
Hypothalamic hormone that regulates secretion of ACTH from the anterior pituitary.
Progesterone
Steroid hormone secreted by the ovary and placenta. Regulates ovarian function, uterine lining, breast development, and is required for pregnancy.
Changes in the composition of extracellular  fluid are called
 endocrine reflexes
hormonal stimuli
neural stimuli
humoral stimuli
none of the above
4. humoral stimuli
Parathyroid hormone (PTH)
Hormone released by the parathyroid glands that regulates blood calcium level.
Which hormone stimulates egg development and the secretion of estrogens by ovarian cells?
thyroid stimulating hormone TSH
 oxytocin OT
luteinizing hormone LH
follicle stimulating hormone FSH
andtiduretic hormone ADH
4. follicle stimulating hormone FSH
Which of the following is (are) a mineralocorticoid?
 
androgens
cortisol
ADH
thyroxine
aldosterone
5. aldosterone
The ____ is firmly attached to the superior border of the kidney.
 
thyroid
pancreas
adrenal gland
stomach
all of the above
3. adrenal gland
What are the little spots in the pancreas?
Islets of Langerhans
The only hormone to target all cells to some degree is
 
insulin
luteinizing hormone LH
growth hormone GH
thyroid hormone
none of the above 
3. growth hormone GH
The adenohypophysis can be divided into 3 regions:
pars distalis, pars tuberalis, and pars intermedia
 supraoptic, supra chiasmatic, and paraventricular nuclei
neurohypophysis, infundibulum, and adenohypophysis
adenohypophysis hypophyseal portal, and
1. pars distalis, pars tuberalis, and pars intermedia
What takes place in the Thymus Gland?
Where T Cells of the Lymphatic system become immunocompetent.
calc/i
calcium
TESTES
Testosterone
-emia
blood condition
t3 is..%
9
The Large Gland
Thyroid
Pituitary- also called?
Hypophysis
volitiles cause..insulin secretion
inhibition
Glargine
Lantus

Long acting insulin
Prolactin effects...
suppressed FSH, GnRH
In the pancreas...
exocrine gland
PARATHYROID GLAND
PTH (Parathyroid Hormone)
Gonadocorticoids
-from the adrenal cortex
-androgens
-influence sex-related characteristics
MODY 6
neuroD1 defect
VERY RARE
Hormones of Thyroid
Thyroid hormone, Cacitonin
Pseudohypoparathyroidism
present with hypocalcemia and hyperphosphatemia, and elevated PTH levels from resistance to all the actions of PTH. Two types of pseudohypoparathyroidism have been described.
thyroiditis
inflammation of the thyroid gland
Tx for DI
central: intranasal desmopressinnephrogenic: HCTZ, indomethacin, amiloride 
ADRENAL GLAND
MEDULLA:Catecholamines (Epinephrine & Norepinephrine)CORTEX:Cortisol AldosteroneAndrogens
Addison's Crisis
-Sudden life-threatening exacerbation triggered by a stressor
-Low Na, low BG, high K, dehydration, extremely low BP, tachycardia
Treatment: IV cortisol, Aggressive IV NS fluid, glucose admin, B/P meds and Na retention
most common cause of DKA
infection
Estrogen
-from the ovaries
-development and maintenance of female sexual characteristics and regulation of the menstrual cycle
-promotes maturation of the ovum
What is photophobia?
Sensitivity to light.
amylinmimetics
retards gastric emptying, suppresses postprandial glucagon, and suppresses appetite causing reduction in prostprandial hyperglycemia
major side effect is nausea
Sx of prolactinoma?
milk, infertile, amen
(galactorrhea, infertility, amenorrhea, decreased libido)
L-myc
small cell carcinoma of the lung
Nelson's Syndrome
appearance of an ACTH-producing adenoma following bilateral adrenalectomy for Cushing’s disease.
aldosterone
one of the corticosteroids, hormones produced by the adrenal glands
True or False
 
Cortisol bound to cortisol binding globulin (CBG or transcortin) is biologically INACTIVE cortisol. 
True.
The hormone that causes strong contractions of the uterus during labor is:
oxytocin
Size of pituitary or hypophysis?
Pea sized
____ and ____ transform/excrete hormones
liver, kidney
↓ insulin causes fat utilization except by
brain
peptide hormones from the hypothalmus are
ACTH
TSH
GH
LH
FSH
Prolactin
growth hormone inhibitory hromone is called
somatostatn
Neurohypophysis
-Posterior lobe of the pituitary gland
-resevoir for chemicals created by the hypothalamus
-secretes oxytocin and ADH
Eosinophilic tumors that develop early in life result in what?
gigantism
Myxedema
- hypothyroid in adults
- facial tissues swell and look puffy
- slow HR, decreased body temp, sensitivity to cold, weight gain, mm weakness, lethargy
acidophil cell types
growth hormone and prolactin
linear growth
increased: +GH, +T3, androgen, estrogen
decrased: -GH, -T3, cortisol
thyroid embryology
formed from an epithelium outpouching which develops in the floor of the foregut at 3-4 weeks gestation.Thyroid migrates leaving thethyroglossal duct wchi closes leaving the foramen cecum as the adult remnant. The thyroid begins secreting hormone 18th week of dev.
toxic adenoma



•In most patients, the nodule produces too little thyroid hormone to cause hyperthyroidism


•Generally must be >2.5 cm to cause clinical hyperthyroidism (“toxic adenoma”)


• Constitutively activating mutations of the TSH receptor are causative in many cases





vThionamides will lower T4 and T3, but will not lead to cure.

v

vTherefore, preferred therapy is surgery or radioiodine.

v

vThe patient can be followed without therapy if she/he is euthyroid (normal TSH).





 
CONGENITAL HYPOPARATHYROIDISM
most common form of genetic hypoparathyroidism is autosomal dominant hypocalcemia. In it, hypocalcemia is mild to moderate, urinary calcium excretion is high and serum PTH is inappropriately low. Activating mutations in the calcium-receptor gene causes it
GH deficiency
Increased fat, decreased muscle and bone density, decreased strength, endurance and well being. Test is GH stimulation test.
Mecasermin


Uses: For treatment of sever IGF-1 deficiency unresponsive to GH.
Mecasermin is a complex of recombinant human IGF-1 (rhIGF-1) and recombinant human insulin-like growth factor-binding protein-3 (rhIGFBP-3). The binding protein is important in order to maintain an adequate half-life of rhIGF-1.
Most Common side effect is hypoglycemia take a meal or snack w/i 20 minute window of dose to prevent this. 
13. Known as a lactogenic hormone (LTH). It is a gonadotrophic hormone that stimulates the development and growth of the mammary glands. It is located in the anterior lobe of the pituitary gland?
Prolactin (PRL)
ATCH target
adrenal cortex (stimulates release of > 20 different corticosteroids)
Anterior pituitary hormone feedback on hypothalamus stop secretion of hypothalamic-releasing hormone.
Ultrashort-loop feedback
Foot problems
-60-80% of amputations are DM patients
-Causes: infections, non-healing ulcers
-Increased risk due to: neuropathy, poor circulation, high BG levels impair WBC function
systolic bp goes up..mm hg with increased thyroid stim
10-15
insulin circulates mostly
Circulates mostly unbound to protein
Hormones released by the hypothalamus which are released into the vascular system and travel to the _________ pituitary. A name for this is_________________.
anterior, adenohypophysis
TSH levels lower than 0.4 indicate what?
Hyperthyroidism
What is myxedema?
Severe form of hypothyroidism characterized by an accumulation of mucopolysacchariedes in subcutaneous and other interstitial tissues, a mask like expression, puffy eyelids, hair loss in the eyebrows, thick lips, and a broad tongue.
What is Albright Hereditary Osteodystrophy?
psuedohypoparathyroidism
- short stature
- obese
- bradydactyly
- round face
- dermal ossifications
- mental retardation
What is the histological morphology of T2DM?
amyloidosis
hormonal factors in normal fetal growth
insulin/igf-1
thryoid
placental lactogen
FSH/LH, testosterone
GH
effects of insulin on liver
inhibits: glycogenolysis, gluconeogenesis, ketogenesis
stimulates: glycogen synthesis, fatty acid synthesis
Bile acids increase or decrease w/ liver failure?
increase
Drug that causes hyperthyroidism
Amiodarone (can also cause hypothyroidism)
Treatment Principles for DKA
• Hydration (normal saline initially) with monitoring• Insulin (parenteral): gradual correction (100mg/dl/hr), adding glucose when levelapproaches 200-250.• Electrolytes (particularly K+)• Search for precipitating event.
testes
male gonads; two oval organs that lie in the scrotum
This is the biologically active form of Thyronine.
Tri-Iodo-Thyronine (T3).
The hormone that increases the rate of cell division is:
growth horomone
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What are the parts of Anterior and Posterior pituitary?
which antibiotic has a side effect of DI
tetracyline
Blood glucose primarily controls the switch between
CHO & fat
functions of prostaglandins
(5)
1 platelet aggregation
2 bronchi diameter
3 CV system
4 female reproductive system
5 inflammatory response
What is the normal value for serum TSH?
0.4-6.15
glargine vs. NPH
glargine causes fewer episodes of hypoglycemia
What is the most common cause of hyperparathyroidism overall?
primary
What does licorice inhibit?
11beta-HSD2 (which converts cortisol to cortisone) is inhibited, so there is lots of cortisol and subsequent HTN follows
major causes of hypoglycemia
1) drug-induced (insulin or sulfonylurea) - dangerous because administered insulin cannot be regulated to account for exercise/fasting
2) ethanol ingestion - ehtanol rapidly oxidized in the liver causing conversion of NAD+ to NADH. inhibits gluconeogenesis. problem when alcoholics with poor diet
3) insulinomas or tumors
4) endocrine diseases - hypothyroidism, hypopituitarism, GH deficiency
In sheep, 80% of fetal growth occurs in the last ____ weeks of gestation
6
Dx of prolactinoma?
serum Prl, MRI,
(also r/o pregnancy, hyperthyroidism, drugs - tranquilizers, OCP, IV cimetidine, opiates)
RX of Hyperthyroidism due to Thyroiditis
Treatment is symptomatic• ß-Blockers• Analgesics• Occasionally Steroids
Cushing's Syndrome
a hormonal disorder caused by too much hydrocortisone
What are 3 consequences of severe hypokalemia?
Glucose intolerance
Nephrogenic Diabetis insipidus 
Weakness, paralysis. 
Endocrine Vs ExocrineThe Endocrine Glands are a ______ system. They release hormones into ________ _______. They have ______ capillary networks to distribute hormones. They also have _________ effects and can alter cell metabolism
Endocrine Vs ExocrineThe Endocrine Glands are a ductless system. They release hormones into tissue fluids. They have dense capillary networks to distributehormones. They also have intracellular effects and can alter cell metabolism
acquired or nephrogenic di occurs from
Chronic renal disease
Hyperkalemia & hypocalcemia
Sickle cell disease
hormone are secreted into the..and then the...
intersittial space and blood
Primary hyperparathyroid is usually due to:
adenoma > hyperplasia > carcinoma
Lobectomy
Removal of a lobe of an organ (Ex thyroid)
What foods should the pt. avoid?
tea, coffee, cola, stimulants
Causes of hypoglycemia in DM
1. glucose underproduction, 2. hyperinsulin, 3. excessive epinephrine --> sweating, tremor, tachy, anxiety, hunger, 4. CNS dysfxn --> dizziness, HA, cloudy vision, confusion, convulsions, LOC.
What is the critical measurement in the determination of Ca and Pi equilibrium?
- solubility product
impaired glucose tolerance
two hour blood glucose value between 140 and 200 mg/dL after ingestion of 75 grams of glucose
Dark chief cells physical appearance
small cells with granular cytoplasm
Components of thyroid parenchyma
1) thyroid follicles 2) blood capillaries
How do you treat hypercalcemia?
Hydrate (replace volume lost, increase water/sodium, calcium to DCT and LoH, furosemide)
Decrease resorption of bone: palmidronate, alendronate
Salmon calitonin
Glucocoriticoids
Oral phossphate
Dialysis
Inferior Petrosal Venous Sinus Sampling
MRI scans detect corticotroph adenomas in about 50 – 60% of the time. If the adenoma is invisible on sellar MRI, the next step in the detection of the site of over production is by inferior petrosal venous sinus sampling.
What are the 3 effects of glucocorticoids on carbohydrate metabolism?
Maintain hepatic glycogen stores.
Maintain hepatic gluconeogenesis;and the actions of epinephrine and glucagon on this process.   
Reduce peripheral glucose utilization (muscle, fat).
What is the function of the Nervous System?Name two organs located in that system.
Interprets sensory informationRegulates body movementbrain, nerves
Self-augmenting. 
Ex 1: Estrogen to Anterior pituitary to increase FSH & LH to ovaries to secrete estrogen. 
Ex 2: Dilation of cervix to increase oxytocin from posterior pit to uterine contraction to increase dilation of cervix.
Regulation of hormone receptors: Dose-response relationship
anes. gi implications of hypoth
decreased gi function and aps risk
3 functions of Vitamin D:
1) inc. gut absorption of calcium...
2) ... and phosphate
3) inc. bone resorption of calcium & phosphate when low serum phosphate
What is the major action of PTH, parathyroid hormone?
Regulates serum calcium
What should you monitor pts for who are receiving iodine medication?
Iodine toxicity iodism
In Adults with hypothyroidism, what symptoms do they exhibit?
Lethargy, slow mentation, generalized slowing of body functions
how to tx DKA?
1. insulin, 2. IVF, 3. replace electrolytes
What do phosphate binders do?
- decrease the absorption of phosphate
- taken with meals and snacks
- used in pts with CRF as they cannot get rid of phosphate in blood.
paget's disease of bone
rapid bone turnover in localized areas of the bone (most common are skull and pelvis). causes bone pain, skeletal deformities, deafness, and enough increased bone blood flow to cause heart failure. treated with medications that block bone resorption
Suprarenal gland stroma structures
1) Capsule 2) fine trabeculae 3) reticular fibers
How do Children born to women with endemic goiter present?


Mental retardation, abnormalities of hearing, gait and posture, short stature
Which pouches are the thyroid and parathyroid glands formed from?
Thyroid: 2ndParathyroid: Between 3rd and 4th
What is the mechanism by which glucocorticoids mediate their effects on the cardiovascular system?
Not fully understood; increases sensitivity of the vessels to catecholamines and other pressors; increases receptor numbers for vasopressors; increases smooth muscle cell Ca2+ uptake; suppress vasodilator (PGs and NO) synthesis
Why is the high does dexamethasone test able to differentiate a pituitary adenoma hypersecreting ACTH from the other two common etiologies (ectopic & adrenal)?
Most pituitary ACTH hypersecreting tumors are semiautonomous, meaning that they respond to feedback inhibition by rising cortisol levels; wherease the other two tumor types are completely autonomous and are not regulated.
with oat cell carcinoma of lung has grand mal seizure. 
Serum sodium is low, osmolarity is low.
Urine osmolarity is high: hyperosmotic. 

Posterior pituitary AND ADH
t3 is ...protein bound and ..potent than t4
less protein bound more potent
What are the four actions of Hormones?
1. Maintain internal environment homeostasis
2. Help regulate energy production and usage
3. Exert and effect on reproduction
4. Impact growth and development
Total destruction o fth epituitary gland by trauma, tumor, or vascular lesion removes all stimuli that are normally recieved by the thyroid, the gonads, and the adrenal glands, what occurs as a result of the destruction?
Extreme wt. loss, emaciation, atrophy of all endocrine glands and organs, hair loss, impotence, amenorrhea, hypometabolism, hypoglycemia, coma and death
treatment for thyroid storm
1. IVF, steroids, cooling of fever, 2. PTU/methim to lower T3/T4, 3. iodine to inhibit hormone release, 4. B blockers, 5. dexamethasone to inhibit hormone release, impair T3/T4 production, renal support
vitamin d metbolism
skin uses UVB to make vit D from cholesterol.
fatty fish and fish oils also source

precursors D2 and D3 are converted to 25-OH-VitD (D2 shorter half life) in liver
vit D is fat soluble

25-OH-VitD undergoes second hydroxylation in kidney by 1alpha-hydroxylase. the activity of this renal enzyme is precisely regulated. pth and low phosphate increase activity of the enzyme while 1,25-(OH)2-vit D and high phosphate decrease activity.

24-hydroxylase - first enzyme inactivation and degradation of vit d

Define unorganized endocrine tissue
cells forming parts of some of an organ
What are some of the main effects of thyroid hormone?
Increase catecholamine effect (lipolysis, glycogenolysis, gluconeogenesis)
Increae mitochondrial action, respiratory enzymes, Na-K ATPase
Increase oxygen consumption, basal metabolic rate
When to biopsy a thyroid nodule
> 1 cm, risk factors, US characteristics. Must biopsy > 3cm multiple times to reduce sample error.
What is the function of an antagonistic muscle? Give and example.
Muscles that have opposing functions to extend and flex. Bicep and Tricep
thyroid hormones form in the..and are stored in the...
thyroid globulin, stored in the collioid of the follicle
What would you monitor after a hypophysectomy?
visual changes, altered LOC, strength of extremities, leakage of CSF, fluid balance, prevent constipation, bleeding
How is the ACTH stimulation test done?
•ACTH Stimulation Test
baseline serumcortisol drawn
ACTH given IM/IV
serum cortisol drawn at 30 min. and 60 min.
- ACTH should stimulate increased cortisol level- little response suggests adrenocortical insufficiency
(problem=adrenal cortex)
What is the function of the pancreas?
-Exocrine function of the pancreas involves the secretion of digestive enzymes through ducts that empty into the duodenum.
-Endocrine function is primarily to regulate blood glucose (sugar).
What does PTH do to bone?
- binds to osteoblasts and stimulates the differentiation of osteoclasts for bone resorption to release Ca and Pi into the blood.
- increases collagen synthesis
- increases alkaline phosphatase activity
- increases local growth factors
List the five unorganized endocrine tissue
1) Islets of langerhans 2) intersitial cells of testis 3) Corpus luteum of ovary 4) endocrine cells of GIT 5) endocrine cells of placenta
Feedback hormones for FSH, LH and GH
FSH: inhibinLH: Sex steroidsGH: IGF-1
How does uptake of iodide ion take place?
Via sodium-iodide symporter on the basolateral side of thyrocytes.
How does the thymus function in immunity?
Has lymphocytes, one type of white cell, which in turn is either a T cell or B cell depending on its role in immunity
After a hypophysectomy, what would you tell your patient not to do?
Not to cough, sneeze, bare down post-op as to not risk leakage of CSF. Also no brushing teeth. Deep breathing ok.
What are the signs and symptoms of Cushing's syndrome?
Truncal obesity, moon face, acne, abdominal striae, and hypertension
What are the treatments for hypoglycemia?
- glucose
- glucagon (esp when pt is unconscious)
How can Graves be distinguished from multinodular goiter? How can follicular adenoma be distinguished from multinodular?
Grossly, Graves is more likely to be diffuse. Microscopically, goiters lack the papillations found in Graves.
 
Follicular adenomas are encapsulated.
Which statement is NOT true of hormone effects on bones?
GH decreases the rate of mitosis in growing bones.
What test are most commonly used for detection of thyroid dysfunction?
Serum immunoassay for TSH and free T4.
How would you treat a cow with postparturient hemoglobinuria?
*Short-term tx:* IV fluids containing phosphates (not phosphite solns--not converted), Fleet (R) sodium phosphate enemas are used IV. *Long-term tx:* adjust phosphorous content of ration, add trace minerals to diet.
What is the most common tumor of the appendix?
Carcinoid - secrete lots of serotonin, recurrent diarrhea, flushing, wheezing, right sided valve disease, elevated 5-HIAA in urine!
Your pt. who is post op thyroidectomy has visitors in the room, the family is asking the pt. lots of questions, what should you do?
Advise the family that the pt. should talk as little as possible to reduce edema to the vocal cords
What kinds of roles does the endocrine system play when adapting to our internal environment?
It helps us to adapt to shock, F&E imbalances, and osmolarity changes.
Are the cells of the PD and PI under negative feedback control?
PD is under neg. feedback control by cortisol. PI is not under neg feedback control (norm. prod. alpha-MSH)
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