Endocrine I Flashcards

Terms Definitions
pancreat/o
pancreas
Prednisolone
Prelone

Corticosteroids
C-myc
Burkitt Lymphoma
Liotrix
Thyrolar

Hypothyroid Agent
Domperidone
Stimulates lactation
Increase prolactin which in turn increases milk production.
Dopamine (D2) receptor antagonist.
Increase TRH==>(+) stimulates Prolactin
Hypoparathyroidism
-Equals hypocalcemia
-Causes: accidental removal with thyroidectomy, Surgery or radiation of throat or head, Autoimmune destruction
-Dx: low calcium, high phosphorus
decreases platelet aggregation
prostacyclin
Thymosin
Gland- ThymusTarget organ-T cellsAction- T cell maturation
endocrinologist
medical specialist in endocrinology
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Underweight: less than 18.5
Normal weight: 18.5 to 24.9
Overweight: 25 to 29.9
Obesity: 30 or more
glucocorticoids, androngens and dianzalol, asparginase cause..leves of..thyroid binding hormones and t3/t4
low
decreased acth
increased cortisol
decreased dhea
cushing's syndrome
VLDL
55% triglyceride
low density, smaller
contains apo B-100
secreted by liver
precursor fo IDL and LDL
Metformin
A biguanide
MOA unknown
 
Use: oral hypoglycemic. Can be used in pts w/o islet function
 
Tox: most serious AE is lactic acidosis
Initial prandial insulin dose
0.05-0.1 U/kg/meal
True or False:
 
Elevated blood levels of gonadotropins usually reflect lack of steroid negative feedback. Removal of the gonads from either males or females, as is commonly done to animals, leads to persistent elevation in LH and FSH. In humans, excessi
True.
pseudohypoparathyroid
kidney unresponsive to PTHshort stature, short 4th/5th digits 
Location fo nuerohypophyseal bud?
posterior lobe
ketone effects of liver
fatty liver
t4 half life is
6-8 days
the adrenal medulla is emryonianically....ted to the adrenal cortex
unrelated
Glucocorticoids
-from the adrenal cortex
-regulate metabolism, influence blood pressure, anti-inflammatory effect
what drug can cause thyrotoxicosis?
amiodarone
chylomicron
mostly triglyceride
largest but least dense
contains apo B-48
synthesized in intestine, secreted into lymphatics, and transport exogenous cholesterol, fatty acids, fat soluble vitamins into circulatory system via thoracic duct
GH is stimulated in response to
hypoglycemia
Adrenal cortex - Glomerulosa
secretes mineralocorticoids, principally aldosterone, under the control of the renin-angiotensin mechanism along with serum potassium
PCOS tx
Spironolactone + prgestin OCP, metformin, clomiphine (for live births)
goiter
chronic enlargement of the thyroid gland
The following are signs of what?
 
Adrenergic                        Metabolic                    MiscellaneousAnxiety, nervousness        Heat intolerance                MyopathyTremor          
Hyperthyrodism.
TH's primary effect
increase metabolic ratecalorigenic effect
Pars intermedia
atrophies in fetal development-is gone ias a lobe in adults- but its cell migrate into the ant. pituitary and persist
cGMP
same as cAMP just different base
retina
when plasma bs level reaches...during therapy for DKA, dextrose should be added
250
...or calcium is ionized an unbound
60
causes of primary aldoseteranism/minel.c excess
Unilateral adenoma
Bilateral hyperplasia
Carcinoma of adrenal
Insulin
-from the pancreas
-target the liver, skeletal muscle, adipose tissue
-facilitates uptake of glucose by the cells and adipose tissue, and the creation of glycogen
What is hyperthyroidism?
(or "overactive thyroid gland") is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both. Major causes are: Graves' disease (the most common etiology with 70-80%,
Toxic thyroid adenoma and
Toxic multinodular goitre.
What controls the release of androgens?
ACTH
dexamethasone
strong synthetic glucocorticoid. used to test if negative feedback is working as it should suppress endogenous cortisol. used to test cushing's
What does the zona reticularis secrete?
Gonadocorticoids
Name the Nine Endocrine System Glands
Hypothalmus
Pineal (hypophysis)
Thyroid
Parathyroids
Thymus
Adrenals
Islets of Langerhans
Ovaries
Testes
Calcitriol’s Effects on Calcium
Calcitriol’s Net Effects: ↑↑[Ca++] & ↑↑[PO4=]. Reabsorption of both in the kidneys. Absorption of Ca in GI tract, + effect on PTH stimulating bone resorbtion.
ovaries
female gonads; two oval shaped glands that are located in the pelvic cavity
True or False
 
In the adrenal, blood flow directionally is from outer cortex to the medulla; basal flow is high and can increase substantially  during stress, a response mediated by pituitary secretion of adrenocorticotrophic hormone (ACTH) 
True
anti-microsomal Abs
result of thyroid destruction in hashimoto'santi-thyroglobulin too 
Isthmus
mass of tissue connecting lobes of thyroid gland
axons from the ventral tuberal region to the ant. pituitary make up the ____________ tract
tubero-hypophyseal
signs of pheocrhomocytoma
Sx: HTN, diaphoresis, headache, palpitations, weight loss (triad = diaphoresis, tachycardia, headache in the hypertensive patient)
Hypovolemia from sustaine hypertension and concentrated HCT
increased renin activity is associated with
secondary aldosternism
two tissue types: pancreas
acini, islet of langerhans
Diabetes Insipidus
-caused by insufficient production of ADH or failure of the kidneys to respond
-allows too much fluid to be excreted
-symptoms: polydipsia, polyuria
A negative finding of biopsy indicates what kind of mass?
benign
Somogyi effect
rebound hyperglycemia in the AM because of counterregulatory hormone release after hypoglycemia at night
Osteoporosis
- bone resorption > deposition
- osteoclasts mobilize Ca to plasma
3 AM glucose is low (40)
Somogyi effect
GH (in metabolism)
stimulated by hypoglycemia
acts on muscle
decreases glucose uptake via insulin resistance
promotes lipolysis and stimulates protein synthesis
HDL
40% protein and core of mostly cholesteryl ester
smallest, most dense
contains apo A-I
shuttles apolipoproteins E and CII to and from chylomicrons and VLDL
aids in atherosclerosis by removal of tissue cholesterol in the reverse cholesterol transport system. acquires redundant surface lipids from processed chylomicrons and VLDL

disk-like particles at secretion; after lecithin-cholesterol acyltransferase (LCAT) mediated cholesterol esterification, the cholesteryl esters enter the core of the particles, leading to spherical HDL particles

cholesterol is transferred to apo B containing lipoproteins by the action of lipid transfer proteins. it can then be delivered to peripheral tissues or to the liver for excretion
What are gonadocorticoids
male and female sex hormones
Stimulates the release of milk from a new mothers breast?
Oxytocin
Differential Diagnosis for hypercalcemia
a. Primary hyperparathyroidism - most common cause in outpatientsb. Carcinoma1. Secretion of a PTH-related protein (paraneoplastic syndrome, most often with squamous cell carcinoma of lung and renal cell carcinoma).2. Carcinoma of breast, lymphoma, and multiple myeloma cause osteolytic metastases with release of TNFą and IL-1 that stimulate osteoclasts.c. Rare causes of hypercalcemia include:- Vitamin D toxicity- Granulomatous diseases (tuberculosis, sarcoidosis)- Drugs (thiazide diuretics)- Prolonged immobilization
Cromocriptine, Pergolide, Cabergoline
(Dopamine Agonists)
What could be an indication for all these drugs?


Uses: Decrease GH secretion in acromegaly
10. Essential for growth and development of the thyroid gland. Stimulates production of thyroxine and triiodothyronine (both T-Cells), influences the body's metabolic process, and is located in the anterior lobe of the pituitary gland?
Thyroid stimulating hormone (TSH)
Thyroid hormones- function
regulate metabolism and activity of nervous system
Complications of Hyperglycemia
-Damaged blood vessels, nerves and decreased ability to fight infections
-Affects kidneys, eyes, skin, feet, heart
secretion of glucocorticoids is stimulated by
acth from anterior pituitary
Carcinoid tumor cells are derived from:
GI neuroendocrine cells
When does subacute lymphocytic thyroiditis usually occur?
During the postpartum period
What do symptoms of diabetes insipidus and diabetes mellitus have in common?
polyuria, polydipsia
what is SIADH
syndrome of inappropriate secretion of ADH - excess secretion of ADH from posterior pit
What disease does a deletion in chrom 22 go with?
DiGeorge
Adrenal adenoma
yellow tumors surrounded by thin or well developed capsules, and weight < 30 g.
- ACTH independent Cushing Syndrome
1,25-(OH)2-VitD interactions
carried by DBP
diffuses into cells and interacts with a single nuclear receptor (VDR)
acts on transcription factor for genes with Vitamin D Response Elements (VDRE).

Mutations within the VDR cause VDDR2 (rickets type 2)
type 1 is caused by mutation in 1alpha-hydroxylase (25 to 1,25)
Pineal body stoma consists of
1) capsule 2) trabeculae
Adrenal gland drainage
Same as left and righ gonadal veins.Left adrenal → left adrenal vein → left renal vein → IVC. Right adrenal → right adrenal vein → IVC.
Subacute granulomatous thyroiditis (De Quervain’s disease)
Probably viral origin, follows infection i.e. flu. Painful enlarged thyroid, destruction of follicles, granulomatous inflammation and giant cells. hyperthyroid, then hypothyroid, then normal.This is usually a self-limited disease with a course over weeks to months.
A large precursor protein named proopiomelanocortin (POMC) is synthesized and proteolytically cleaved into several fragments.  The hormones other than ACTH that are produced in this process are:

Beta-endorphin and Met-enkephalin: Opioid peptides with pain-alleviation and euphoric effects.

Melanocyte-stimulating hormone (MSH): Controls melanin pigmentation in the skin of most vertebrates.
 Ant pit acidophils make
GH, prolactin"Throw acid in GP's face" 
Increae birth weight
GH deficiency causes? What are the symptoms? what is it caused by?
euthyroid pts may receive the dose of medication morning of surgery
full dose
Blast from the past: which mood stabilizer can cause hypothyroidism?
LITHIUM!! recall: LMNOP
What is the source of insuliln, glucagen?
Pancreatic islet cells
During surgery, glucose levels will rise, because there is an increased secretion of:
A. cortisol
B. epinephrine
C. glucagon
D. all of the above
During surgery, glucose levels will rise, because there is an increased secretion of:
D.
mononeuropathy in DM
affects single nerve or nerve trunk; vascular origin; foot drop, wrist drop or defect in EOM (CN 3, 4, 6)
What is Liddle's Syndrome?
severe HTN with low renin activity
hypoaldosteronism
hypokalemia
vit d and calcium homeostasis
intestine: vitd increases the efficiency of absorption of calcium and phosphorus. glucocorticoids can interere with this.

parathyroid: vitamin d potently decreases the PTH when calcium levels are normal or high. low ca stimulate production of calreticulin that binds PTH promoter such that VDR cannot access VDRE and thereroe PTH is not inhibited.

vit d increases proliferation of osteoclast precurors, increases number of active bone resorbing osteoclasts. increases ca and phophate released into circulation. vit also necessary for normal bone growth and mineralization.
kidney: vit d decreases activity of the 1alpha hydroxylase while increasing the activity of 24-hydroxylase (negative feedback)
pars distalis components
1) chromophil cells 50 percent 2) chromophobe or c cells 50 percents
What does calcitonin do?
Suppresses bone resorption leading to lower calcium levels in the blood
Composition of parathyroid gland
a. Chief cells- Predominant cell type- Secretes PTH- Granular pink to clearb. Oxyphil cells - Abundant cytoplasm loaded with mitochondria- Contain no secretory granulesc. Fat cells- Increase with age, up to 30% of gland.
What feeds back on the secretion of TRH &TSH?
T4 & T3.
Hormones that act on the cells that release them?
Autocrine*Example - insulin
resp tx of low ca levels
Avoid hyperventilation as alkalosis will further ↓ calcium levels as it causes ↑ binding to protein & ↓ in free, ionized calcium
Which bone cells does PTH act on?
BOTH osteoblasts & osteoclasts!!
What is the most common thyroid hormone used to "put the thyroid at rest?"
Levothyroxine sodium , (Synnthroid),
order of intervention for prolactinoma
dopamine agonist first, then surgery esp if compression of other structures or neuro sx's, last radiation
What drugs increase the hepatic metabolism of T4 and T3?
anything inducing CYP450s like rifampin, carbamezepine, imatinib, protease inhibitors, etc
How do you detect ketosis?
Ketonuria (Ketostix), fruity smell to breath, nonspecific signs: decreased milk production, loss of appetite, mild depression
Zona reticularis physical description
between zona fasciulata and medulla,. They are polyhedral cells, some darker some lighter
What can cause myxedema coma? What lab values would you use to distinguish it from sick euthyroid syndrome?
Prolonged hypothyroidism, precipitated by cold exposure, sepsis or other stressful conditions. Characterized by low T4, T3, T3R, and high cholesterol and TSH.
 
SES will have low T4 and T3, but with high T3R and low TSH.
What are criteria for parathyroid carcinoma
Parathyroid carcinoma is rare (14 mg/dL), and the patients often die from uncontrollable hypercalcemia
Estrogen increases CBG and total cortisol levels.  Nephrotic syndrome lowers total plasma cortisol due to loss of large quantities of CBG through urine.  In both conditions, why do patients not have manifestations of cortisol deficiency?
In both conditions, what changes really is CBG, while unbound cortisol remains unchanged.  Unbound, free, cortisol is the biologically active form and is thus unaffected.
what two types of receptors respond to chemical signals
membrane bound and intracellular
in the brain, glucose
Glucose is the only substrate used for energy
tx for central and nephrogenic DI
Central : ADH as DDAVP
Nephrogenic: fluid replacement & Rx underlying cause
Your pt. has hyperthyroidism, and asthma, what medication would best fit this pt.?
Metoprolol (Lopressor), because it is cardioselective and will not have effects on the respiratory tract
What are canditates for subtotal thyroidectomy?
Pts with obstructive symptoms, for pregnant women in the second trimester, and for pts. with a need for rapid normalization of thyroid function
What are Suppression Tests?
Used when hormone levels are high or in the upper range of normal. Failure of hormone production to be suppressed during standarized testing indicates hyperfunction.
Osteitis fibrosa cystica
- brown tumors
- surplus of PTH, stim osteoclasts to increase serum Ca and decrease bone mass. the bones weaken and are replaced with fibrous tissue and then bleeding occurs --> hemosiderosis and brown tumors.
What treatment would you consider for a horse with EMS that is threatened by further episodes of laminitis?
Levothyroxine--trtmt to accelerate wt loss.
what do pituitary herring's bodies do?
represent dilated bulbuous endings of the fibers of the hypothalamic tract. They are funnel and storage of the hormones from the hypothalmus and others
A 57-year-old male is found comatose with a blood glucose of 780 mg/dl. Urinalysis reveals no ketosis or proteinuria, though there is 4+ glucosuria. He is most likely to have: A An islet cell tumor secreting glucagon B Type I diabetes mellitus C Cushin
CORRECT. Hyperosmolar coma is most typical for type II diabetes mellitus, seen in overweight persons.
what are the different parts of the neurohypophysis?
The posterior lobe (neurohypophysis) is composed of the axons of hypothalamic neurons that extend downward as a large bundle behind the anterior pituitary. The neurohypophysis is also divided into the main pars nervosa and the infundibulum. The pituitary stalk or infundibulum connects the pituitary gland with the hypothalamus.
After determination of PA/PRA ratio and administering an aldosterone suppression test, PHA is determined. What other procedures can be used in further distinguishing the etiology of the PRA.
CT scan, MRI, or adrenal venous sampling.
From pro-opiomelanocortin (POMC) prohormones.
Includes: ACTH, gamma & Beta lipotropin, beta-endorphin, & melanocyte stimulating hormone (MSH)
What is MSH involved in, found in and increased in?
how does gh effect bone length
GH causes ↑ bone length at epiphyseal cartilages
What would you monitor after a hypophysectomy?
visual changes, altered LOC, strength of extremities, leakage of CSF, fluid balance, prevent constipation, bleeding
An iodine intake less than 40 fg/day causes what?
They thyroid gland to hypertrophy
what are the physiologic defects of NIDDM?
1. abnormal insulin secretion, 2. insulin resistance in target tissues
What is nutritional secondary hyperparathyroidism?
Low Ca/P ratio. High grain/low forage diet, increases PTH levels, increases calcium mobilization from bone --> osteopenia --> fibrous osteodystrophy. Thinnest bones affected first. aka "Big Head"
Parathyroid parenchyma consists of what 2 cells?
1) principal or cheif cells 2) Oxyphil cells
What are 4 rules to management of hypothyrodism?
replacing target gland products is easier than replacing pituitary peptide hormones;
if multiple deficits exist, start replacing cortisol first, followed by thyroxine (allows a normal environment for ADH and sex steroids, thyroid accelerates the catabolism of cortisol); and
avoid over replacement, which can contribute to morbidity and excess mortality.
Mineralocorticoids need no supplementation.
Why do patients with Primary Hyperaldosteronism not experience edema, despite the sodium retaining action of aldosterone?
The magnitude of the expansion of the extracellular fluid volume in these patients is limited by compensatory renal tubular responses known as "mineralocorticoid escape", which limit the magnitude of sodium retention.  Increased secretion of natriuretic peptides of cardiac origin constitutes part of this compensatory response. 
glucose is the only nutrient normally used by (3)
Glucose is the only nutrient normally used by the brain, the retina, and the germinal epithelium of the gonads.
What is the major action of Thyroid stimulating hormone TSH?
Stimulates synthesis and secretion of thyroid hormone
Who is more likely to have Sheehan's syndrome?
Women with severe blood loss, hypovelemia, hypotension at the time of delivery.
pt with really high urine osmolarity, no signs of edema/HTN/dehydration, Na<120, and irritability, confusion, sz
cerebral edema from excess ADH --> hyponatremia 2/2 increased water retention and Na excretion
List the 6 hormones secreted by the anterior pituitary gland (adenohypophysis)
ACTH, TSH, LH, FSH, GH, prolactin
A 40 year old female has enlargement of the anterior neck region. Fine needle aspiration of the thyroid yields cells that are consistent with a neoplasm. A chest radiograph is normal. She is euthyroid, but her serum ionized calcium is elevated, and she ha
She has MEN IIa, with medullary thyroid carcinomas (often multiple when familial), parathyroid hyperplasia, and pheochromocytoma. b
Central Diabetes insipidus is caused by
failure of post pit to secrete ADH so decrease cirulating level of ADH so collecting duct impermeable to H20 &amp; urine can't be concentrated. Produce large volumes of dilute urine &amp; body fluids become concentrated. Rx: ADH/vasopressin analogue, dDAVP (desmopressin)
Would you also suspect that her serum osmolality would be high or low?
Her serum osmolality should be high because she is losing water and is becoming dehydrated
PTH effect on Ca Phos and Vit D
increases Ca and Vit D, decreases Phos
what do neuroglia cells do?
Not sure but we think it may be with melatonin and serotonin. may have influence over gonadal development.
You are reading a T3 resin uptake test, it states at the bottom that &quot;The number of available sites is high.&quot; What would you suspect the T3 uptake level to be, what does this indicate?
The level would be less than 25%, which indicates hypothyroidism
What should you teach the pt. about BP?
Teach the pt. and family to monitor BP and notify the Dr. if there are changes in BP
Cloprostenol
Prostaglandin
thyroid/o
thyroid gland
ADH
Antidiuretic Hormone
Oxytocin
Gland-Posterior PituitaryTarget Organ-Uterus and breastAction-Uterine contraction and lactation
Gonadotropins
LH and FSH
normal tsh
0.4-5 mul/l
adenohypophysis origin
pharyngeal epithelium
causes of hypocalcemia
pseudohypoparathyroidism-renal resistance to PTH
surgery
pseudopseudohypoparathyroidism
Hypoalbuminemia
hypomagnesemia
acute pancreatitis
Men I
(Wermer's) Parathyroid tumor, Pancreatic tumor, Pituitary tumor
Endemic Goiters
-Non-toxic
-Iodine deficiency
-Defect in thyroid hormone synthesis of T3 &amp; T4
-Increases TSH which causes hyperplasia of gland
-Firm or soft, enlarged
-May have difficulty swallowing
-Can progress to toxic goiter
-Tx: may shrink with Thyroid hormone replacement therapy
95% of corticosteroids are
cortisol
most common thyroid CA
papillary
MCC of Conn's syndrome?
adrenal adenoma
Anterior Lobe Pituitary ACTH=
Adrenal Gland
glucagon
hormone secreted by the pancreas
True or False
 
Presentation with Cushings is classic for impaired glucose tolerance in 75%, DM 10-15%, HTN 75%, increased lipids, increased mortality 2ndary to ASHD, infections, and thromboembolism. 
True
GH target
bone, skeletal muscle, liver
ADH
post pituitary - SON&#13;&#10;water conservation
...adrenergic stimulation causes increased insulin secretion
b adrenergic
body makes grams of ca
1,100
Homeostasis
Maintenance of the internal environment within tolerable limits
postnantal growth and dev.
increases gluconeogenesis in liver
increases use of fat for energy
GH
reticularis cells
reticular organization, smaller, secrete ACTH (steroid)
IDL
VLDL remnants formed after triglyceride in VLDL is hydrolyzed by LPL
50% triglyceride, 50% cholesteryl ester
LDL measuments include IDL
Orlistat
MOA: alters fat metabolism bu inhibiting pancreatic lipases
 
Use: long-term obesity mgmnt (with modified diet)
 
AEs: steatorrhea, GI discomfort, reduced absortopn of fat-soluble vitamins, headache
Neuroblastoma
(a tumor of sympathetic ganglion cells)a. mostly seen in children b. they can secrete catecholamines, VMA, and homovanillic acid (HVA), usually in small amounts, so hypertension and other symptoms of catecholamine excess are uncommonc. often presents as abdominal enlargement with a mass and is metastatic at the time of diagnosis in 90% of patients
prolactin
secretion of the anterior pituitary gland
Atosiban


An Oxytocin Antagonist of the receptor which is used to treat pre-term labor.
a-glucosidase inhibitors
Acarbose, MiglitolInhibit brush border sugar hydrolysis 
T cell
Type of white blood cell
- &amp; + feedback mechanism
+ Feedback
Addison's Disease Treatment
-Lifelong cortisol replacement therapy
-Dose needs to be increased for physical and emotional stessors
-High Na intake
ketone body structure
acetoacetate and b-hydroxybuteric acid
...% of adrenal medulla is epi
80
stimulates ovulation and forms corpus luteum

stimulates testosterone production
LH
Hyperpituitarism
- excess secretion of tropic hormones
- adenomas, hyperplasia and carcinomas
ADENOMA IS MOST COMMON CAUSE
- hyperprolactinemia common
T1DM
absolute deficiency of insulin caused by autoimmune destruction of beta cells
- usually &lt;20yo
hyperthyroidism
due to either overstimulation of thyroid as part of autoimmune process, autonomous function, or destruction of the thyroid gland with release of preformed hormone.
notular goiters, subacute thyroiditis
patients feel hot, sweating, cutaneous vasoldilation, weight loss despite increased appetite. retroorbital inflitation, rapid heart rate, incrased tone of sympathetically-innervated Muller muscles,
high FT4 and low TSH

treated with thionamide to block thyroid hormone synthesis. betablockers for hyperadrenergic state
diabetic neuropathy
mixture of neuropathic features dominated by one or another subtype
most common: sensory or sensorimotor distal polyneuropathy

leads to insensate foot, vulnerable to trauma, skin breakdown, and eventually ulceration and infection

motor component will lead to focal or generalized weakness. autonomic neuropathy leads to bladder dysfunction, orthostatic hypotension, gastroparesis, sexual dysfunction, and diarrhea or constipation due to bowel dysfunction
Tx of Addison's disease?
cortis, dex, glucocort, mineralo
(Acute:
IV hydrocortisone or dexamethasone
Chronic:
glucococorticoid -hydrocortisone,
mineralocorticoid- fludrocortisone)
Apolipoprotein C2
responsible for the activation of lipoprotein lipase (LPL) in capillaries[1] and thus begins the catabolism of the chylomicrons and VLDL. It is also found in HDL. Deficits of this apoprotein C2 present with grave hypertriglyceridemia and hyperchylomicronemia during fasting
Vast majority of Hyperaldosteronism is due to
SECONDARY CAUSES!!!!!
Excessive production of 1,25-OH Vitamin D is usually seen in what type of cancer
B cell Lymphoma
adrenalectomy
surgical removal of one or both adrenal glands
True or False
 
TSH tumors are rare of all pituitary tumors.
Present w/goiter, hyperthyroidism, NL, up TSH, elevated T4 & T3 
Females > males 3-6 decade.
6 yrs average delay in diagnosis due to mistaken hyperthyroidisim 
Typically agressive 3/4 invasiv
True.
What is the medical term for nearsightedness?
myopia
Location of Pituitary or hypophysis
hypophyseal fossa (pouch)
Thyroid
-T3 &amp; T4 secretion is controlled by TSH from the ant pit.
-T3 and T4 regulate the metabolism rate
deepest layer of the adrenal cortex
zona reticularis
insulin effects on muscle
promotes protein synthesis
increases amino acid transport
stimulates ribosomal protein synthesis
promotes glycogen synthesis
increases glucose transport
enhances activity of glycogen synthetase
inhibits activity of glycogen phosphorylase
___ --&gt; stimulates zona glomerulosa --&gt; releases ___
renin-angiotensin; aldosterone
stimulates release of t3 and t4
increases iodine uptake
increases growth of thyroid
TSH
dry skin, constipation, st. gain, cold intolerance , lowblood pressure, bradycardia are all symptoms of what?
hypothyroidism
how to diagnose hyperPTH?
neck exploration; no imaging
What pharyngeal pouch do the the inferior PT glands arise from?
3rd
posterior pituitary axon origins
paraventricular (oxytocin) and supraoptic (ADH) nuclei
hyperparathyroidism
most commonly caused by excess PTH from single parathyroid adenoma. usually found after disovery of hypercalcemia. usually treated by surgical removal if seen in nuclear medicine scan (Sesta-MIBI)

four-gland hyperplasia can also cause primary hyperparathyroidism. resection of 3.5 glands sometimes

chronic renal failure and chronic vitamin d def -&gt; hyperplastic parathyroid -&gt; high PTH

long-standing secondary HPT -&gt; autonomous PT called tertiary
Calcium Pyrophosphate Disease (CPPD) lab Dx?
pos, birefringe (Positively Birefringent crystals under polarizing light, from joint aspiration)
Name the short acting insulion drugs
Lispro, Aspart, glulisine
GLP-1
Exenatide - GLP-1 analogue. a. GLP-1 is released from intestinal endocrine cells after a meal, andcontributes to stimulating the postprandial increase in secretion of insulin (“incretin” effect).b. GLP-1 also suppresses postprandial secretion of glucagon (resulting indecreased hepatic glucose production), slows gastric emptying and inhibits food intakec. In type 2 diabetes, release of GLP-1 is reduced, and glucagon is notsuppressed; along with decreased insulin secretion, these deficits contribute to postprandial hyperglycemia.d. there is also evidence that GLP-1 may help preserve beta cell mass.**nausea/vomiting and diarrhea in ~ 50%; hypoglycemia in combo with sulfonylureab. recent concerns over development of pancreatitis
Thyroglobulin levels are elevated in
hyprtthyroid and destructive thyroiditis
what is a peptide produced by several tissues in the body including the hypothalamus, inhibits growth hormone release in response to GHRH and to other stimulatory factors such as low blood glucose concentration?
Somatostatin
Alpha subunit
common to TSH, LH, FSH, hCGB-unit differentiates them 
Hypophyseal fossa
a depression on superior surface of sphenoid bone that houses pituitary glands
causes of secondary aldosteranism
Stimulation of aldosterone secretion by affecting renin-angiotensin system
diagnosis of hypothyroidism is done by
low free T4
Plasma protein bound such that less than 10% of hormone is free in solution; reservoir 2
steroid thyroid
In women, prolactin inhibits ___ synthesis &amp; release, which inhibits ___. So that's why ___ is commonly seen in prolactinomas.
GnRH, ovulation; amenorrhea
Treatment for hyperparathyroidism?
The only definitive treatment is surgery. Surgical techniques for hyperparathyroidism now are much less invasive and much more effective than in the past. The procedure is called parathyroidectomy. Usually, the surgery will only involve one of the glands, and a successful surgery will allow the remaining parathyroids to correctly regulate blood calcium levels.

If hypercalcemia is severe, bisphosphonates may be required to maintain bone. Hyperparathyroidism can be treated medically with cinacalcet (a calcium receptor blocker), which is very expensive.
most common cause of hypoPTH
removal of the gland
Complications of thyroidectomy
- recurrent laryngeal and superior laryngeal nerve injury.
- hypoparathyroidism
- hypothyroidism
- extensive blood loss and infection (RARE)
liddle's syndrome
defective renal transport of ions that mimicks mineralcorticoids
symptoms of hyperaldosteronism:
hypokalemia
hypertension
muscle weakness
alkalosis
pars distalis desciption
aka pars anterior separated by residual lumen from pars intermedia
What condition is an endocrine emergency?
 
describe it
 
signs?
myxedema coma
20% mortality
severe hypothyroidism that has been prolonged and untreated precipitated by cold, sepsis, thyroidectomy, trauma and drug interactions (lithium, amiodarone, sedatives, narcotics)
 
signs:


slowness (speech, movement), coma, hypothermic, obviously myxedematous, bradycardic, unresponsive and frequent development of  respiratory failure, fluid overload, pericardial effusion
TRH causes the release of what hormones from the anterior pituitary
TSH and Prolactin
GH adenoma treatment
Octreotide and lanreotide work in 60% of patients but only modestly reduce tumors.
Low plasma cortisol and high plasma ACTH signals what kind of condition?
Primary adrenal failure
Insulin - what type of hormone
Name a hypoglycemic hormone
Hyposecretion of Vasopressin
-Diabetes Insipidus
-Lack of ADH
-Increased urine output (polyuria)
-Increased thirst
-Dilute urine
-Urine Specific Gravity &lt; 1.005
-Tx: nasal spray: desmopresin
ionized ca levels above will result in coma
15 mg/dl
Pentagastrin-stimulated rise in calcitonin is highly suggestive of:
medullary CA of thyroid (recall: thyroid C cells make calcitonin)
What are S&amp;S of hypoglycemia?
Tachycardia, pallor, tremors, changes in mental status
MEN-1 (wermer syndrome)
- dominant trait
- 3Ps:
1. pituitary (5%)
2. parathyroid (80%)
3. pancreatic islet (60%)

HPRT2
Type I hyperlipidemia
- eruptive xanthomas on the knees, elbows and buttocks
- decreased LPL
- alteres ApoCII
Graves' disease
aberrant immune response leads to igG (TSI) which can activate TSH receptor.
little colloid stored, lymphocytic presence among follicles, generalized lymphoid hyperplasia throughout body
presence of highly vascular goiter
presence of ocular pathology and dermopathy
pretibal myxedema - shiny trythematous nodules overlying tibial or ankle regions
Which ketone is commonly measured?
Beta-hydroxybutyrate in blood, Acetoacetate in urine w/ ketostix
Rate limiting step for fatty acid synthesis, regulation and disease association.
Acetyl-CoA carboxylase, requires biotin. Increased by insulin and citrate, inhibited glucagon and palmitoyl-CoA. Associated with myopathic CAT-2/CPT-2 deficiency which manifest by muscle weakness/aches and myoglobinuria provoked by prolonged exercise. Increase in muscle triacylglycerols.
THERAPEUTIC USES OF ANDROGENS
• HRT in primary or secondary hypogonadism• Induction of puberty in delayedmaturation• Rx of osteoporosis in males
Unlike the rest of the hormones, what is the one hormone released by the pituitary that is under tonic inhibition?
What is the predominant Prolactin inhibitory factor produced by the hypothalamus?
Prolactin, of course.
Dopamine. 
Describe sequence of events that ultimately lead to release of aldosterone, beginning w/change of state of renal perfusion.
Reduction in renal perfusion, secondary to reduction in circulating blood volume/pressure.
renal juxtaglomerular cells release renin
Renin hydrolyzes angiotensinogen produced by the liver and angiontensin I (Ang I) is produced
AngI is converted to AngII via Angiontensin converting enzyme (ACE) present in vascula endothelial cells, especially in the lung.
AngII is the stimulus for aldosterone secretion by the adrenal. 
Prolactin deficiency caused by &amp; causes?
d/t destruction of anterior pit.&#13;&#10;Failure to lactate.
acromegaly leads to vocal cord involvement because
of stretching of other structures
What does the parathyroid hormone (PTH) do?
regulates Ca and phosphate metabolism
If acute hypoparathyroidism and tetany occur how is it treated?
parenteral parathormon
(high allergic reactions)
What are the psychosocial aspects of hyperthyroidism?
Lability (mood instability), irritability, decreased attention span, and manic behaviors.
central vs. nephrogenic DI
central is a problem with ADH production in hypothalamus or with ADH secretion from posterior pit. nephrogenic is faulty kidney response to ADH.
- middle aged - elderly- elevated glucagon- DM- rash- necrolytic migratory erythema- anemia
Glucagonoma (alpha cell tumor)
What is the name of the hormone in the cortisol pathway that is secreted by the hypothalamus and stimulates the pituitary?
CRH
Components of Thyroid stroma
1) capsule 2) fine trabeculae 3) reticular fiber
A 45-year-old previously healthy female has a solitary palpable non-tender right anterior neck mass. Laboratory findings include a serum free thyroxine index of 1.3 ng/dl, TSH of 2.8 microU/ml, sodium 141 mmol/L, potassium 4.2 mmol/L, chloride 106 mmol/L,
About 10 to 20% of papillary carcinomas of thyroid first present as a lymph node metastasis. Papillary carcinomas comprise 60 to 70% of thyroid carcinomas. a
what are direct effects of GH?
stimulates adipocytes to break down triglyceride and suppresses their ability to take up and accumulate circulating lipids.
What are some reversible and common causes of hyperprolactinemia?
Common causes of mild hyperprolactinemia (<100) are primary hypothyroidism, perhaps because of increased TRH production, or neuroleptics which block dopamine receptors.  Hypothyroidism can cause hyperplasia of lactotrophs and result in a pituitary mass which will resolve with thyroid hormone replacement.  Pregnancy and neuroleptics can also be associated with reversible enlargement of the pituitary secondary to lactotroph hyperplasia.
Used to reduce sensitivity of target tissue when hormone level are high for extended period of time. &#13;&#10;Down-regulation occurs, response to hormone declines even though hormone levels are high.
Give an example of down-regulation.
sulfanaryeas and metformin should be...before surgery because
dc because of the long half lives
A type 2 diabetic presents:
older &gt; 40 yrs, obese, genetic predisposition, rarely ketoacidotic, not necessarily have polyuria/polydipsia
If the plasma and urine tests of catecholamines are inconclusive, what may be done?
a clonidine suppression test
tx for follicular thyroid CA
near total thyroidectomy + post op radioiodine ablation
Diagnosis of Cushing's syndrome
- 24 hr urine collection of free cortisol
- dexamethasone suppression test (morning cortisol should be &lt;1.8, positive test = high cortisol levels)
- inferior petrosal venous sampling: more sensitive than MRIs, inject CRH and sample ACTH before and after injection
T3 & T4: which one is mainly synthesized by thyroid?
which one is metabolically more active?
which one has a higher conc in blood?
which one is altered by changes in TBG levels?
how much more potent is T3 over T4?
 
Receptors that T3 and T4 bind to
T4
T3, which originates primarily from peripheral conversion of T4
50x concentration
T4 b/c it's 50x more in blood
5x greater; free T4 is metabolically active
 
nuclear chromatin receptors
membrane and mitochondrial binding sites --> extranuclear binding sites implicated in thyroid-hormone-mediated aa transport when protein synthesis is blocked
Effects of Vit D in the gut
Vitamin D mediates GI calcium &phosphate absorption
pituitary ACTH, adrenal cortisol or aldosterone secretion reach adult levels at a certain age and remain constant throughout life in healthy adults. what is that age bracket?
by 1 to 3 yrs of age.
When would a physician entertain a high index of suspicion of Cushing's syndrome in a patient?
When diabetes and hypertension are present.
how does the thyroid increase minute ventilation
by increasing oxygen consumption and co2 production through an increase in the metabolic rate
What are 5 episodic manifestations of pheochromocytoma?
- pressure (HTN)
- pain (headache)
- perspiration (tachycardia)
- palpitations
- pallor
What is the major action of Epinephrine and Norepinephrine?
Serve as neurotransmitters for the sympathetic nervous system.
What are the symptoms of acute thyroiditis?
anterior neck pain and swelling, fever, dysphagia, dysphonia, pharyngitis or pharyngeal pain
1% reduction in HbA1C --> how does this affect risk of MI?
decreases MI risk by 14%
Explain the concept behind DCAD diets.
Fed during transition period (3-6 wks prepartum) added anionic salts induce a mild metabolic acidosis, blood pH unchanged, urine pH decreases, renal excretion of H+ and calcium. Calcium reabsorption from bone increases. PTH increases; therefore already upregulated when lactation begins. Urine calcium excretion ceases when milk begins. *Key: the calcium exiting the body in the urine is an available pool when demands increase.*
what is the ideal iodide intake for diet?
 
At what diet intake does gland function become impaired?
 
iodine deficiency is common where and leading cause of what (2)?

>200 µg/d



Less than 50 µg/d impairs thyroid gland function and T4 secretion, resulting in elevation of TSH and goiter





 


Iodine deficiency
–virtually non-existent in the US.
–Leading cause of goiter and hypothyroidism, world-wide
What are the 2 renal effects of glucocorticoids?
Maintain of normal free  water clearance.
Sodium retention, potassium wasting and hypertension. 
all hormones are down except prolactin is increased?
Hypothalmus lesion or pit stalk is severed
panhypopituitarism can result from gh excess because
tumor will cont to grow untill it explodes
What increases a persons risk of developing thyroid carcinoma?
External radiation of the head, neck, or chest in infancy and childhood
3 drugs to test for ACTH deficiency
1. insulin (stimulates ACTH so should see increase in cortisol if nl), 2. metyrapone (blocks cortisol --> dec neg FB on ACTH --> should see increase in ACTH if nl), 3. cosyntropin (ACTH analog) --> if low cortisol, then adrenal atrophy from pit insuff
How would you treat a horse that is having an acute episode of HYPP?
1. Gentle exercise stimulates epinephrine, which stim 3Na-2K ATPase. Moves resting potential further away. Oral glucose eg Karo syrup. 2. IV glucose. Insulin-mediated co-transport of K+. 3. Calcium gluconate raises the threshold potential. 4. Tracheostomy if severe resp. distress.
what does diminished secretion of LH and FSH cause?
Diminished secretion of LH or FSH can result in failure of gonadal function (hypogonadism). This condition is typically manifest in males as failure in production of normal numbers of sperm. In females, cessation of reproductive cycles is commonly observed.
Define autocrine and give an example of this type of communication.
Hormones have an effect on the cell they are released from. i.e. growth hormone.
What can be given to lower the pts. bp?
•Medication to lower blood pressure (Nipride), or regitine, procardia, Inderal
How do you diagnose a pheochromocytoma?
- 24 hr collection of urine to look for metanephrines and/or vanillylmandelic acid (VMA)
Name major muscles of the body and tell where they are located.
Trapezius - down the middle of the backDeltoid - shoulderLatissimus dorsi - across the backTriceps brachii - inside of upper armBrachioradialis - inside of lower armGluteus medius - between hip and buttocksGluteus maximus - buttocksBiceps femoris - back of thighGastrocnemius - calf of leg
How should the pt. support the neck after surgery?
raise the elbows and place the hands behind the neck to provide support and reduced the strain and tension on the neck muscles and the surgical incision
What is a good prognosis for a papillary carcinoma?
- &lt;40 yo
- female
- contained
- no mets
- &lt;2 cm
- well differentiated
over a period of hours to days during hypoglycemia..
Over a period of hours to days, GH &amp; cortisol are secreted due to hypoglycemia &amp; this decreases the rate of glucose utilization by most cells of the body shifting to fat utilization
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