Term
| What is the difference between the anterior and posterior pituitary? |
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Definition
-Anterior secretes TSH, PRL, ACTH, GH, FSH, and LH
-Posterior stores ADH and oxytocin which are made in the hypothalamus |
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Term
| Hyperpituitarism is excessive secretion of ___________ hormones usually caused by ___________ of the anterior pituitary |
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Definition
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Term
| pituitary adenomas are usually composed of a ___________ cell type that produces a ___________ hormone |
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Definition
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Term
| Most pituitary adenomas occur in ___________ and 3% are associated with ___________ |
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Definition
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Term
| What is the most common functional pituitary adenoma? What are the signs and symptoms? |
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Definition
prolactinoma
amenorrhea, galactorrhea, loss of libido, infertility |
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Term
| What is the second most common functional pituitary adenoma? What does this hormone stimulate and what does this adenoma cause? |
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Definition
-growth hormone producing adenoma
-GH stimulates hepatic secretion of IGF 1
-Before epiphyses close: causes gigantism
-After: acromegaly |
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Term
| A corticotrophin cell adenoma is an ___________-producing adenoma. It causes ___________ disease and ___________ |
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Definition
ACTH
cushing dz
hyperigmentation |
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Term
| Hypopituitarism is a deficiency of ___________ pituitary hormones. Why is panhypopituitarism rare? What causes hypopituitarism? |
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Definition
-anterior
-bc the anterior pituitary has large reserve of hormones
-Loss of absence of >75% of the ant. pituitary (nonfunctioning pituitary adenomas, ischemic injury: sheehan syndrome- post partum necrosis of ant. pituitary, ablation, inflammatory runs: TB or sarcoidosis) |
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Term
| The symptoms of hypopituitarism depend on the hormones that are deficient, what happens if GH, Gonadotropins, TSH, ACTH, or PRL are deficient? |
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Definition
GH= dwarfism
Gonadotropins= women: amenorrhea, infertility; men: decreased libido, impotence, loss of pubic and axillary hair
TSH= hypothyroidism
ACTH= hypoadrenalism and hypopigmentation
PRL= failure of postpartum lactation |
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Term
| A pituitary adenoma that causes radiographic abnormalities of the sella turcica can cause what type of vision problems? What does it do to the pressure in the brain? |
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Definition
-bitemporal hemianopsia-- lateral visual field defect caused by compression of fibers of the optic chasm
-elevated intracranial pressure leading to HA, N, V |
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Term
| Pituitary adenomas that extend beyond the sella turcica into the base of the brain can cause what three problems? |
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Definition
seizure
obstructive hydrocephalus
CN palsy |
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Term
| Hypothalamic neurons produce ___________ and ___________ which are stored in axon terminals of the ___________ pituitary |
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Definition
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Term
| What are the symptoms of abnormal oxytocin? ADH? |
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Definition
-abnormal oxytocin is not associated with significant clinical symptoms
-ADH deficiency: diabetes insipidus
-ADH excess: SIADH |
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Term
| What is diabetes insipidus? |
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Definition
| polyuria caused by ADH deficiency and inability of kidney to properly reabsorb water from urine. causes excretion of large volumes of dilute urine and excessive thirst (polydipsia) |
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Term
| What is the difference between central and nephrogenic diabetes insipidus? |
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Definition
central: caused by damage to the hypothalamus (or pituitary) from head injury, tumors, infxns, surg
nephrogenic: caused by renal tubule unresponsiveness to ADH from certain drugs, hypercalcemia, kidney dz |
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Term
| what is SIADH? What is the most common cause? What does it cause? |
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Definition
excessive fluid accumulation caused by inappropriately elevated levels of ADH, most common cause is ectopic ADH secretion by small cell lung cancer.
-excessive ADH enhances the reabsorption of water by kidney tubules and the concentration of urine
-excess free water absorption causes hyponatremia, which may lead to cerebral edema and changes in mental status |
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Term
| The hypothalamus secretes ___________ which prompts the anterior pituitary to secrete ___________ which prompts the hypothalamus to secrete ___________ and ___________ |
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Definition
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Term
| Thyroid hormones bind to nuclear receptors, change gene expression, (increases/decreases) CHO and fat breakdown, (stimulates/suppresses) PRO synthesis, and results in (increased/decreased) metabolic rate |
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Definition
increases
stimulate
increased |
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Term
| What are two major causes of hyperthyroidism? |
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Definition
-thyroid gland hyperfunction (diffuse toxic hyperplasia: grave's dz, hyperfunctioning multinuodular goiter, hyperfunctioning adenoma)
-extra-thyroidal source of thyroid hormone |
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Term
| To determine if someone has hyperthyroidism, screen for (low/high) TSH levels relative to T4, and measure radioactive ___________ uptake in thyroid to distinguish between causes |
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Definition
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Term
| Graves dz is caused by ___________ to TSH receptor. What gender is more susceptible? What genes are involved sometimes? Three characterizations? |
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Definition
autoantibodies
females>males
HLA-B8, HLA-DR3
-Exopthalmos, Thyrotoxicosis (diffusely enlarged and hyperfunctional thyroid), pretibial myxedema |
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Term
| hyperthyroidism causes a (hyper/hypo)-metabolic state |
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Definition
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Term
| Hypothyroidism can be linked to ___________ deficiency |
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Definition
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Term
| to screen for hypothyroidism you screen for (high/low) TSH levels relative to T4 |
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Definition
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Term
| What is the term for hypothyroidism developing in infancy or early childhood? |
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Definition
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Term
| What are some signs and symptoms of cretinism? |
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Definition
| -impaired development of skeletal and nervous systems, short statue, severe mental retardation, coarse facial features, protruding tongue, umbilical hernia |
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Term
| What is myxedema? What are some clinical features? |
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Definition
-hypothyroidism
-often obese
-myxedema in skin and tissues results in broad, coarse facial features, enlargement of tongue, and deepening voice
-bradycardia
-muscle weakness, apathy, mental sluggishness
-dry, cool, pale, cold intolerant
-constipation |
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Term
| what is the most common cause of hypothyroidism in areas where iodine is sufficient? |
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Definition
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Term
| Hashimoto thyroiditis is an ___________ destruction of the thyroid gland |
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Definition
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Term
| people with hashimoto have (hypo/hyper)thyroidism, what do they have a risk of developing? |
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Definition
hypo
b-cell non-hodgkins lymphomas |
|
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Term
| what sex is more often affected in hashimoto? |
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Definition
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Term
| What are the genes involved in hashimoto thyroiditis? |
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Definition
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Term
| What is the probably etiology of de Quervain thyroiditis? What sex is more often affected? Most patients have recurrent ___________/___________/___________ infection prior |
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Definition
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Term
| Subacute lymphocytic thyroiditis often occurs following ___________. Is it (painful/painless)? What is the most likely etiology? What is the thyroid upon gross inspection? |
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Definition
pregnancy
painless
autoimmune
normal
rarely progresses to hypothyroidism |
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Term
| What is a goiter? What is it usually caused by (3)? What is the pathophys? |
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Definition
-enlargement of the thyroid gland
-caused by: mainly dietary iodine deficiency (endemic goiter). other mainly unknown (sporadic), risk increased in females >40 w. family hx
-impairment in production of T4,T3 leads to compensatory increase in TSH, which causes hypertrophy and hyperplasia of thyroid gland |
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Term
| What is the take home point with thyroid neoplasms? |
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Definition
| They aren't very clinically significant |
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Term
| Parathyroid hormones are composed mainly of ___________ cells that contain secretory granules of ___________ |
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Definition
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Term
| Activity of parathyroids is controlled by the level of what in the bloodstream? |
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Definition
| free (ionized) Ca in the bloodstream |
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Term
| Decreased levels of free Calcium stimulates ___________ and ___________ of PTH which cause what 5 things? |
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Definition
synthesis and secretion
-calcium and phosphorous mobilized from bone
-increased renal tubular reabsorption of Ca
-increased urinary phosphate excretion
-increased conversion of Vit D to active form
-increased GI absorption of Ca |
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Term
| What is hyperparathyroidism? What genes are involved (5% of the time)? What is the difference between primary and secondary? |
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Definition
-overproduction of PTH
-MEN-1 and MEN-2A
-primary is the most common cause of clinically silent hypercalcemia (adenoma, hyperplasia, carcinoma)
-secondary is due hyperplasia; a compensatory response to hypocalcemia caused by kidney disease |
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Term
| What is the saying to remember hyperparathyroidism? |
|
Definition
painful bones, renal stones, abdominal groans, and psychic moans
-osteoporosis
-renal stones
-GI constipation, peptic ulcer, pancreatitis, gallstones
-CNS lethargy depression
-Muscle weakness and hypotonia |
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Term
| Hypothyroidism is very rare, but what is the most common cause? What are some signs and symptoms? |
|
Definition
-inadvertent surgical ablation. also due to congenital absence and autoimmune issues
-hypocalcemia: tingling, muscle spasm tetany, cardiac arrhythmias, occasionally increased cranial pressure and seizure |
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Term
| The islets of langerhans make up the endocrine pancreas. They are comprised of beta, alpha, delta, and pancreatic polypeptide cells. What does each cell type secrete? |
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Definition
beta- insulin
alpha- glucagon
delta- somatostatin
pancreatic polypeptide- vasoactive intestinal peptide |
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Term
| Diabetes mellitus is a group of common metabolic disorders sharing the common underlying feature of ____________ |
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Definition
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Term
| Diagnosis of diabetes mellitus is based on elevation of blood glucose using any one of what three tests? |
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Definition
-random blood glucose
-fasting blood glucose
-oral glucose tolerance test |
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Term
| DM type 1 is an ____________ deficiency of insulin secretion. there is autoimmune ____________ of Beta cells. Starts in ____________. Depends on ____________ insulin for survival |
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Definition
absolute
destruction
childhood
exogenous |
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Term
| DM type 2 is a ____________ deficiency of insulin secretion, there is peripheral ____________ to insulin action. Inadequate compensatory response of insulin secretion by beta cells. |
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Definition
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Term
| insulin has an anabolic effect with increased synthesis and decreased degradation of what three things? |
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Definition
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Term
| DM type 1 results from a ____________ susceptibility and subsequent ____________ insult |
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Definition
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Term
| polymorphisms in the ____________ locus account for as much as 30-60% of the genetic susceptibility in DM type 1 |
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Definition
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Term
| What are two proposed environmental triggers for DM type 1? |
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Definition
| viral infections and early exposure to bovine albumin |
|
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Term
| what is the earliest sign of abnormality in a type 1 DM pt? |
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Definition
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Term
| Children of an affected father with IDDM have an increased risk compared to those with an affected mother, why? |
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Definition
| the paternity related increased risk appears to be limited to fathers with an HLA DQB1*0301 allele |
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Term
| What group of native americans has a prevalence of NIDDM of 50% by the age of 35-40 years |
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Definition
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Term
| 5-10% of patients with NIDDM have maturity-onset diabetes of the young (MODY), what does this mean? |
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Definition
| its an autosomal dominant mutation in one of 11 different genes (MODY 1-11); primary insulin secretion defects |
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Term
| persistent ____________ and ____________ develop before NIDDM |
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Definition
hyperglycemia
hyperinsulinemia |
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Term
| Typical NIDDM results from a combination of genetic susceptibility and environmental factors, a polymorphism in ____________ gene is significantly associated with NIDDM in several populations. What does this gene encode for? |
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Definition
| TCF7L2 encodes a transcription factor involved in the expression of the hormone glucagon, which raises the blood glucose concentration and opposes the action of insulin, meaning if you have this polymorphism you do not suppress glucagon as well as you should |
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Term
| A polymorphism in the nuclear hormone receptor, ____________, is significantly associated with NIDDM in Finnish and Mexican American populations. What is the function of this? |
|
Definition
-PPARG
-adipocyte function and differentiation, and reduces insulin resistance |
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Term
|
Definition
| the percentage of hgb that has become modified by glycosylation that can be used to monitor chronic hyperglycemia |
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Term
| What is a good way to remember the hormones released by the adrenal cortex? What are they? |
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Definition
-salt, sugar, sex
-salt= aldosterone: mineral corticoid that tells the kidney's distal tubules and collecting ducts to retain salt which means you will retain water too and increase BP
-sugar= cortisol: glucocorticoid involved in increasing blood sugar through gluconeogenesis, liver converts stored glucose into glucose, aids in fat and PRO and CHO metabolism
-sex= precursors to sex hormones that then get converted to sex hormones |
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Term
| What does the adrenal medulla produce? |
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Definition
| catecholamines (epinephrine) |
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Term
| Cushing syndrome is caused by (excessive/deficient) glucocorticoid levels |
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Definition
|
|
Term
| what are 4 causes of cushing syndrome? |
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Definition
ingested steroids *(MOST COMMON)
adrenal adenoma
pituitary adenoma
paraneoplastic syndrome |
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Term
| In cushings syndrome: hyper or hypo glycemia? weight gain or loss? increased or decreased muscle mass? hyper or hypo tension? increased or decreased risk of infection? |
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Definition
hyperglycemia
weight gain (truncal obesity, buffalo hump)
decreased muscle mass
hypertension
increased risk of infection |
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Term
| Addison dz is due to chronic adrenocortical ____________ |
|
Definition
insufficiency
cortisol and often aldosterone too |
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Term
| What are 3 causes of addison dz? |
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Definition
usually autoimmune adrenalitis (70%)
TB or other infections
Tumors metastatic to adrenal glands (rare) |
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Term
| Are Addison pts weak and fatigued or hyper? What are some GI symptoms? Hyper/hypo pigmented? what does low cortisol cause? low aldosterone? What is the tx? |
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Definition
weak and fatigued
anorexia, vomiting, weight loss
hyperpigmentation
hypoglycemia
hyponatremia, hypotension
steroids |
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