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101 Cards in this Set
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- Back
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What is the order of the layers of adrenal cortex from capsule to medulla?
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[GFR]
Zona [G]lomerulosa Zona [F]asciculata Zona [R]eticularis |
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What secretory products are produced in the various layers of the adrenal gland?
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["The deeper you go, the sweeter it gets."]
Zona Glomerulosa = Aldosterone (Salt) Zona Fasciculata = Cortisol (Sugar) Zona Reticularis = Androgens (Sex) Medulla = Catecholamines (Epi, NE) |
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What is the primary regulatory control of the Zona Glomerulosa of the Adrenal gland?
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Renin-Angiotensis
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What is the primary regulatory control of the Zona Fasciculata of the Adrenal gland?
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ACTH
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What is the primary regulatory control of the Zona Reticularis of the Adrenal gland?
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Hypothalamic CRH
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What is the primary regulatory control of the Medulla of the Adrenal gland?
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Preganglionic sympathetic fibers
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Which adrenal vein drains directly into the IVC?
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Right adrenal vein -> IVC
(Left adrenal vein -> Left renal vein -> IVC) |
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What does the Anterior Pituitary produce?
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[FLAT PiG]
[F]SH [L]H [A]CTH [T]SH [P]rolact[i]n [G]H (also Melanotropin = MSH) |
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Where is Vasopressin & Oxytocin produced?
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Made in hypothalamus & shipped to pituitary
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Which products of the pituitary gland are acidophils?
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GH & prolactin
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What is the Posterior Pituitary derived from?
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Neuroectoderm
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What is the Anterior Pituitary derived from?
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Oral ectoderm
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What is common about TSH, LH, FSH & hCG?
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Alpha subunit
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What does the Beta subunit do in hormones?
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Determines specificity
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What cell types make up the Islets of Langerhans and what do they produce?
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alpha = glucagon
beta = insulin delta = somatostatin |
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What is the relationship between prolactin & dopamine?
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Prolactin increases dopamine synthesis and secretion from hypothalamus
Dopamine inhibits (negative inhibition) prolactin secretion |
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What substance would be expected to inhibit prolactin secretion?
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dopamine agonists (eg bromocriptine)
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What substance would be expected to stimulate prolactin secretion?
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dopamine antagonists (eg antipsychotics)
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What is the relationship between prolactin & GnRH?
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Prolactin inhibits GnRH synthesis & release -> inhibits ovulation (why you don't get pregnant while you're breastfeeding)
prolactinomas = Amenorrhea |
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What enzyme allows the conversion of Cholesterol to Pregnenolone in the Adrenal Glands?
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Desmolase (+ACTH, -Ketoconazole)
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What does 17Alpha hydroxylase do?
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Converts mineralocorticoid pathway to glucocorticoid pathway:
Pregnenolone -> 17-hydroxypregnenolone Progesterone -> 17alpha-hydroxyprogesterone |
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What does 21Beta hydroxylase do?
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Allows first progression of Mineralocorticoid & Glucocorticoid pathways:
Progesterone -> 11deoxycorticosterone 17alpha-hydroxyprogesterone -> 11deoxycortisol |
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What does 11Beta hydroxylase do?
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Allows second progression of Mineralocorticoid & Glucocorticoid pathways:
11-deoxycorticosterone -> Corticosterone 11-deoxycortisol -> Cortisol |
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What is the Mineralocorticoid pathway?
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Cholesterol -> Pregnenolone -> Progesterone -> 11-deoxycorticosterone -> Aldosterone (C21)
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What is the Glucocorticoid pathway?
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17-hydroxypregnenolone -> 17alpha-hydroxyprogesterone -> 11-deoxycortisol -> Cortisol (21C)
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What is the Androgen pathway?
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DHEA -> Androstenedione -> Testosterone -> DHT (C19)
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What are the three congenital adrenal hyperplasias?
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[] 17-alpha-hydroxylase deficiency
[] 21-beta-hydroxylase deficiency [] 11-beta-hydroxylase deficiency |
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What clinical findings are associated with 17alpha-hydroxylase deficiency?
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[-] sex hormones -> phenotypical female w/o maturation
[-] cortisol [+] mineralocorticoids -> Hypertension, hypokalemia |
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What clinical findings are associated with 21beta-hydroxylase deficiency?
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[-] Cortisol -> [+]ACTH
[-] Mineralocorticoids -> Hypotension, hyponatremia, hyperkalemia, [+]renin, hypovolemic shock [+] sex hormones -> Masculinization, female pseudohermaphroditism |
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What are the clinical findings associated with 11beta-hydroxylase deficiency?
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[-] Cortisol
[-] Aldosterone/Corticosterone BUT [+] 11-deoxycorticosterone so HYPERtension [+] sex hormones -> masculinization |
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Where is PTH produced and what does it do?
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[] Chief cells of parathyroid
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What lab values are affected in an increase of PTH?
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[+] Serum Ca
[-] Serum PO4 [+] Urine PO4 (PTH = Phosphate Trashing Hormone) |
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What is the function of PTH?
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[+] bone resorption of Ca/PO4
[+] kidney reabsorption of Ca in DCT [-] kidney reabsorption of PO4 [+] vitamin D production in kidney |
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What does 1alpha hydroxylase do?
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production of Vitamin D in kidney
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What regulates PTH?
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[-] serum Ca -> [+] PTH secretion
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What do you get if you are deficient if vitamin D?
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rickets in kids
osteomalacia in adults |
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What is the function of vitamin D?
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[+] absorption of dietary calcium
[+] absorption of dietary phosphate [+] bone resorption of Ca & PO4 |
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What are the Calcium / Phosphate & Alkaline Phophatase levels in Hyperparathyroidism?
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Ca [+]
Phos [-] AlPhos [+] |
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What are the Calcium / Phosphate & Alkaline Phophatase levels in Paget's disease of bone?
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Ca [0/+]
Phos [0] AlPhos [+++] |
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What are the Calcium / Phosphate & Alkaline Phophatase levels in Vitamin D intoxication?
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Ca [+]
Phos [+] AlPhos [0/+] |
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What are the Calcium / Phosphate & Alkaline Phophatase levels in Osteoporosis?
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Ca 0
Phos 0 AlPhos 0 ! |
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What are the Calcium / Phosphate & Alkaline Phophatase levels in Renal insufficiency?
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Ca [-]
Phos [+] AlPhos [0] |
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Where is Calcitonin produced?
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C cells of thyroid
|
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What opposes the actions of PTH?
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Calcitonin
|
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The need for gene transcription and protein synthesis delays the onset of action of what hormones.
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Steroid Hormones
[PET CAT] [P]rogesterone [E]strogen [T]estosterone [C]ortisol [A]ldosterone [T]hyroxine |
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What would increased levels of SHBG do to you?
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lower free testosterone which leads to gynecomastia
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What would decreased levels of SHBG do to you?
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raises free testosterone which leads to hirsuitism
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What are the functions of T3?
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[4 B's]
[B]rain maturation [B]one growth [B]eta-adrenergic effects (++CO/HR/SV) [B]MR increased Also: [+]glycogenolysis/gluconeogenesis/lipolysis |
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What affects the levels of TBG?
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[+] Pregnancy
[-] Anabolic steroids / liver failure |
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How do skeletal muscle & adipose tissue increase glucose updtake?
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insulin
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Does the brain & RBC rely on insulin for glucose uptake?
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No. They use GLUT-1!
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<Buffalo hump & moon facies>
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Cushing Syndrome
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How does the dexamethosone suppression test work?
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Healthy: [-] cortisol after low dose
ACTH-producing tumor: [+] cortisol after low dose Cortisone-producing tumor: [+] cortisol after low or high dose |
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What are the four different etiologies of Cushing's syndrome?
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[] Cushing disease (primary pituitary adenoma [+]ACTH
[] Primary adrenal hyperplasia/neoplasia [-]ACTH [] Ectopic ACTH production (SCLC) [+]ACTH [] Iatrogenic (chronic steroids) [-]ACTH |
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<purple stria>
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Cushing syndrome
|
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<hypertension, hypokalemia, metabolic alkalosis>
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Hyperaldosteronism
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What is the difference between primary and secondary hyperaldosteronism?
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Primary (Conn syndrome) caused by aldosterone secreting tumor -> LOW plasma renin
Secondary caused by kidney perception of low intravascular volume results in overactive R-A-A system therefore HIGH plasma renin |
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What is the treatment for Conn syndrome?
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Conn syndrome = primary hyperaldosteronism therefore use Spironolactone (K+ sparing diuretic) is aldosterone antagonist.
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<hypotension w/ skin hyperpigmentation>
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Addison's disease
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What is the difference between primary and secondary hypoaldosteronism?
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skin hyperpigmentation associated with primary hypoaldosteronism [+]ACTH
Secondary: [-]ACTH |
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What are the characteristics of Addison Disease?
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[A]drenal [A]trophy & [A]bsence of hormone production involving [A]ll 3 divisions of gland.
|
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What is the most common adrenal tumor in adults?
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Pheochromocytoma
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What is the most common adrenal tumor in children?
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Neuroblastoma
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What type of cells is pheochromocytoma derived from?
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chromaffin cells
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<intermittant hypertension>
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pheochromocytoma
|
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What is the Rule of 10s?
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Applies to pheochromocytoma:
10% malignant 10% bilateral 10% extra-adrenal 10% calcify 10% kids 10% familial |
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What does pheochromocytoma secrete?
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[] Epinephrine
[] NE [] Dopamine |
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What lab values are associated wih pheochromocytoma?
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[+] Urinary VMA levels
[+] plasma catecholamines |
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What symptoms occur in spells in pheochromocytoma?
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hyperadrenergic symptoms (5 P's):
[P]ressure (BP) [P]ain (Headache) [P]ersperation (Tachycardia) [P]alpitations [P]allor |
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What is the treatment for pheochromocytoma?
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alpha-antagonists (ie phenoxybenzamine)
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<ZE + parathyroid & pituitary tumor>
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MEN I (Werner)
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<Medullary carcinoma of thyroid + pheochromocytoma + Parathyroid tumor>
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MEN IIa (Sipple)
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<Medullary carcinoma of thyroid + pheochromocytoma + mucosal neuroma>
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Men IIb
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What gene is associated with MEN IIa & MEN IIb
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ret
|
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What is MEN I?
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aka Wermer syndrome
[3 P organs] [P]ancreas (ZE, Insulinoma, VIPoma) [P]ituitary [P]arathyroid |
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What is MEN IIa?
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aka Sipple syndrome
[] Medullary carcinoma of Thyroid [] pheochromocytoma [] parathyroid |
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What is MEN IIb?
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[] Medullary carcinoma of Thyroid
[] pheochromocytoma [] mucosal neuroma |
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What are the clinical features of Hypothyroidism?
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"Weight gain w/ decreased appetite"
[] Cold intolerance [] hypoactivity [] weight gain [] fatigue [] lethargy [-] appetite [] constipation [] weakness [-] reflexes [] myxedema (periorbital) [] dry, cool skin [] coarse, brittle hair |
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<Weight gain w/ decreased appetite>
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hypothyroidism
|
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What are the clinical features of Hyperthyroidism?
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[] Heat intolerance
[] hyperactivity [] weight loss [] chest pain/palps [] arrhythmias [] diarrhea [+] reflexes [] warm, moist skin [] fine hair |
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<"Exophthalmos">
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Graves disease
|
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What type of Hypersensitivity reaction is associated with Graves disease?
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type II (antibody-receptor)
|
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What is Riedel's thyroiditis?
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hypothyroid state associated with thyroid replacement with fibrous tissue
|
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What is Hashimoto's thyroiditis?
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Autoimmune hypothyroidism disorder. Antibodies against receptor that DEACTIVATE it.
Slow course Antimicrosomal & Antithyroglobulin antibodies |
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What is de Quervain's thyroiditis?
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Self-limited hypothyroidism following flulike illness
|
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What are the findings in de Quervain's thyroiditis?
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[] Elevated ESR
[] Jaw pain [] very tender thyroid gland |
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What are the three types of thyroid cancer?
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[] Papillary carcinoma
[] Follicular carcinoma [] Medullary carcinoma |
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<"Orphan annie eye nuclei">
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Papillary Thyroid carcinoma
|
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Which thyroid cancer is associated with amyloid stroma?
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medullary carcinoma
|
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Which thyroid cancer is associated with psammoma bodies?
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papillary carcinoma
|
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What are the clinical findings associated with cretinism?
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Pot-bellied, pale, puffy-faced children with protuding umbilicus & protuberant tongue.
|
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What normal reasons can cause GH to increase?
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stress, exercise & hypoglycemia
|
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What is increased GH called?
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Acromegaly in adults
Gigantism in children |
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<"Stones, bones & groans">
|
Primary hyperparathyroidism
|
|
What are the clinical findings in hyperparathyroidism?
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[Stones, bones & groans]
renal stones = hypercalcemia/hypercalcuria bone pain = osteitis fibrosa cystica groans = weakness & constipation |
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What is secondary hyperparathyroidism?
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hyperplasia of parathyroid gland due to decreased serum Ca. Associated with chronic renal disease.
|
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<"nuckle, nuckle, dimple, dimple">
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pseudohypoparathyroidism
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<"Hypocalcemia + tetany">
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hypoparathyroidism
|
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What is Chvostek's sign?
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tap facial nerve -> constraction of facial muscles.
Indicates tetany due to hypoparathyroidism |
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What is Trousseau's sign?
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occlusion of brachial artery with BP cuff -> carpal spasm
Indicates tetany due to hypoparathyroidism |
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What are the causes of hypercalcemia? (Even a chimp would know this one!)
|
[CHIMPANZEES]
[C]alcium ingestion [H]yperparathyroid / [H]yperthyroid [I]atrogenic (thiazide) [M]ultiple myeloma [P]aget disease [A]ddison disease [N]eoplasms [Z]ollinger-Ellison [E]xcess vitamin D [E]xcess vitamin A [S]arcoidosis |
