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patho-endocrinology exam 2

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when are hormones released?
In response to an alteration in the cellular environment, To maintain a regulated level of certain substances or other hormones
what regulates hormones? (3)
chemical, hormonal, or neural factors
what is Feedback that reduces the output of a system, such as the action of heat on a thermostat to limit the output of a furnace?
negative feedback
what is Feedback that results in amplification or growth of the output signal?
positive feedback
what are some possible causes of elevated or depressed hormone levels? (4)
Failure of feedback systems, Dysfunction of an endocrine gland, Increased hormone degradation or inactivation, Ectopic hormone release
Secretory cells are unable to produce, obtain, or convert hormone precursors, or synthesizes or releases excessive amounts of hormone is what?
dysfunction of the endocrine gland
Decrease in number of receptors, Impaired receptor function, Presence of antibodies against specific receptors, Antibodies that mimic hormone action, Unusual expression of receptor function can cause what?
receptor-associated disorders
what is A cell releases a substance that stimulates the original cell and other cells of the same type in the surrounding tissue. For example, interleukin-6 (IL-6) is released from macrophages and IL-6 in turn stimulates macrophages to become more aggressive?
autocrine interactions
what is A cell releases a substance that affects the activity of different types of cells in the same tissue. For example in the pituitary, IL-6 is produced by one type of cell (folliculo-stellate cell) and IL-6 stimulates the release of growth hormone from GH-secreting cells, prolactin from prolactin-secreting cells, ACTH from ACTH-secreting cells, etc.?
paracrine interactions
what is A gland releases a hormone into the blood. The hormone is carried by the blood to other tissues (target tissue or organ), interacts with specific receptors on the cells of that tissue, and exerts a specific effect on the tissue or organ?
classical endocrine interaction
does one specific tissue secrete a certain hormone or do several tissues secrete several hormones?
a specific tissue produces the hormone in large amounts (the gland), and other tissues secrete the hormone in much smaller quantities (In these secondary sites of synthesis, the hormone generally plays a paracrine or autocrine role in the regulation of the function of the tissue)
most hypothalamic and pituitary hormones are what?
polypeptides
pancreatic hormones are what?
polypeptides
GI hormones are what?
polypeptides
parathyroid hormones and calcitonin are what?
polypeptides
thyroid hormones are what?
modified amino acids
Norepinephrine, epinephrine, dopamine (catecholamines) are what?
modified amino acids
adrenal hormones (cortisol, aldosterone, DHEA) are what?
steroids
sex hormones (testosterone, estrogen, progesterone) are what?
steroids
vitamin D derivatives are what?
steroids
do water-soluble or lipid soluble hormones transfer through Signal transduction?
water-soluble
first messenger molecules and second messenger molecules like Calcium and Cyclic adenosine monophosphate (cAMP) are lipid-soluble or water-soluble?
water-soluble
Steroid hormones like Androgens, estrogens, progestins, glucocorticoids, mineralocorticoids, thyroid are lipid-soluble or water-soluble?
lipid-soluble
do water soluble or lipid soluble hormones Diffuse across the plasma membrane and Bind to cytoplasmic or nuclear receptors?
lipid soluble
what do lipid soluble hormones activate?
RNA polymerase, DNA transcription and translation
how do water soluble hormones generally circulate in the blood?
free hormones
how are lipid soluble (water insoluble) hormones generally circulate in the blood?
bound to plasma proteins (at low concentrations travel as free hormones)
For what type of hormones is an equilibrium reached between the protein bound hormone and the free hormone. The protein-bound hormone cannot bind to receptors and therefore serves as a circulating reserve for the hormones?
lipid soluble (water insoluble)
Changing the concentration of hormone binding proteins in the plasma which can be caused by Liver damage, Malnutrition, Hormones such as estrogen does what to the ratio between free and protein-bound hormones?
changes
Many drugs compete with what hormone for binding sites on the plasma proteins. Therefore, these drugs can increase the free amount of this hormone without modifying total amount of hormone?
T3
what is an example of a hormone that is protein bound?
thyroid hormone
Total T3 concentration is what?
1.8 nM
free t3 concentration is ?
5.0 nM
protein bound t3 concentration is?
1.8
what two things increase the T3 binding protein concentration in the blood. Therefore, the amount of total T3 increases, but the free T3 remains relatively constant. This can be misdiagnosed as having too much T3 (total T3) when in fact there is a normal (free T3).
Pregnancy and oral contraceptives
in pregnancy, the total T3 is ____, but the free T3 (the active hormone) is _____.
elevated, normal
When is cortisol at its highest?
in the morning
what 5 hormones does the hypothalamus secrete?
GnR, TRH, CRH, PIF, GHRH
what 6 hormones does the anterior pituitary release?
LH, FSH, TSH, ACTH, Prolactin, GH
what does PIF stand for? what is another name for it?
prolactin-inhibiting factor or dopamine
when PIF increases, what happens to prolactin levels?
decrease
when PIF decreases, what happens to prolactin levels?
increase
what hormones does the posterior pituitary release directly into the blood?
oxytocin, ADH (vasopressin)
which hormone Causes an increase in the permeability of the renal collecting duct to water and at high concentrations causes constriction of arterial smooth muscle?
ADH
what disease of the posterior pituitary has a hypersecretion of ADH. For diagnosis, normal adrenal and thyroid function must exist. Clinical manifestations are related to enhanced renal water retention, hyponatremia, and hypoosmolarity.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
what are some causes of the disease SIADH (hypersecretion of ADH)? (5)
Ectopic production of ADH by cancer cells, Surgery (Probably related to surgery related stress), Some psychological diseases, Some drugs (anesthetic agents, morphine and other opiates, and barbiturates), Cranial abnormalities (head trauma, brain tumor, etc.)
what are the clinical manifestations of hypersecretion of ADH or SIADH? (4)
Increase in total body water, Decrease is serum osmolarity, Increase in sodium loss due to an increase in blood volume (increased ANH and decreased angiotensin II and aldosterone), Highly concentrated urine
how do you treat SIADH? (3)
water restriction, remove the tumor, Blockers of ADH receptors
hyposecretion (insufficiency) of ADH causes what?
diabetes insipidus
Polyuria (peeing a lot) and polydipsia (drinking lots of water), very dilute urine are clinical manifestations of what disease?
diabetes insipidus
what two types of problems can cause diabetes insipidus?
neurogenic, nephrogenic
what type of problem which causes diabetes insipidus is Insufficient amounts of ADH being produced?
neurogenic
what type of problem which causes diabetes insipidus is Inadequate response to ADH?
nephrogenic
damage to the brain or posterior pituitary. Generally caused by trauma of the head, cranial surgery, cranial tumor, or idiopathic is what type of diabetes insipidus?
neurogenic
lack of ADH receptors in the kidney or the failure of the receptors to modify the permeability of the collecting duct. This is generally a genetic disease. However, temporary DI may result from some drugs, pregnancy, electrolyte imbalances, or kidney trauma. Kidney failure may also cause permanent DI is what type of diabetes insipidus?
nephrogenic
drinking too much water. Often results from an attempt to purge the body of toxins, demons, etc is what type of diabetes insipidus?
psychogenic
what do you do to test for the type of diabetes insipidus?
restrict water intake. if urine osmolarity increases problem is psychogenic. if urine osmolarity only slightly increases or doesn't at all the problem is either nephrogenic or neurogenic. Give patient ADH. if urine flow decreases and urine osmolarity increases problem is neurogenic. if urine flow or osmolarity change little to none, problem is nephrogenic (kidney doesn't respond)
how do you treat psychogenic diabetes insipidus?
water restriction
how do you treat nephrogenic diabetes insipidus?
drink large amounts of water and have a diet moderately rich in sodium chloride
how do you treat neurogenic diabetes insipidus?
ADH replacement (generally nasally)
A twenty-four-year-old female patient comes to your reproductive clinic with complaints of frequent urination. Test reveal that her urine osmolarity is very low. The woman is admitted to the hospital and she is restricted of water. After about 12 hours her urine flow remains high and her urine osmolarity remains low. The woman was then administered synthetic ADH through a nasal spray. Within 60 minutes her urine flow decreased and urine osmolarity increased. What is the diagnosis of this woman's condition?
neurogenic diabetes insipidus
what controls oxytocin release? (5)
stretch of cervix during birth, tactile stimulation (nursing), mother hearing baby cry, stress, mother thinking about baby
is there a pathophysiology of oxytocin?
no
anterior pituitary hormones are considered what?
peptides
how do you determine if an endocrine problem is at the hypothalamus or the pituitary?
take iv blood sample from patient, inject one or more hypothalamus releasing factors, draw new blood sample and measure various amounts of pituitary hormones before and after injection
what makes the pituitary very vulnerable to ischemia and infarction?
highly vascularized
blood loss from severe hemorrhage during delivery (can damage mother's pituitary) is known as what?
Sheehan syndrome
what three things can cause a pituitary infarction leading to hypopituitarism?
sheehan syndrome, hemorrhage, shock
what things can cause hypopituitarism? (4)
head trauma, infections, tumors, infarction
Nonspecific damage to the anterior pituitary will cause?
panhypopituitarism (ACTH, TSH, FSH and LH, GH deficiency)
what is Commonly due to a benign, slow-growing pituitary adenoma?
hyperpituitarism
Headache and fatigue, Visual changes, Hyposecretion of neighboring anterior pituitary hormones are manifestations of what?
hyperpituitarism
what is manifested by an inability to properly dilate or constrict the pupil in one or more eyes, Inability to properly follow objects with the eyes, or
Inability to open eyelid properly?
oculomotor palsies
what 4 things can signal a pituitary tumor?
headache, visual defect, tumor on anterior pituitary (CT scan or MRI), oculomotor palsies
as a pituitary tumor gets bigger, what happens to the blind spot in the visual field?
gets bigger
hypersecretion of GH in children and adolescents causes what?
gigantism
Hypersecretion of GH during adulthood causes what?
acromegaly
hypersecretion of GH is caused by what?
tumor
why does hypersecretion of GH cause acromegaly and not gigantism in adults?
epiphesial plate is sealed
what hormone Stimulates IGF production by liver and other tissues, this and IGF stimulate growth of long bones at the epiphyseal plate, this and IGF increase amino acid incorporation into proteins, this and IGF inhibit protein breakdown, this and IGF increases lipolysis, Inhibits hepatic glucose uptake / promotes gluconeogenesis, Stimulates the immune system?
GH
Elongation of the Head and Face and Increased Tongue Size occur with what disease?
acromegaly
Large tongue, lips, fingers, toes, jaw bone, ears, and skull bones, Marked increase in blood glucose (the resulting overproduction of insulin can destroy the endocrine pancreas), Headaches if the tumor is large, Visual disturbance if the tumor is large, Joint pain, Barrel chest, Cardiovascular diseases including hypertension, cardiac hypertrophy, etc. which cause early death., Malignancies may become more aggressive because GH and IGF are growth factors. These are clinical manifestations of what disease?
acromegaly
what are three treatments for growth hormone excess?
Somatostatin analog (octreotide), Surgery if drug therapy fails, Radiation if drug therapy and surgery fail to treat tumor
hyposecretion of GH causes what?
dwarfism (growth failure)
growth failure, Increased percentage of body composition that is fat and a decrease in the percentage of the body composition that is muscle, Poor strength and development of bones (bones are thin and fragile), Poor immune function are clinical manifestations of what?
hyposecretion of GH
Poor lactation, Poor immune system function, Low blood glucose, Depression, Decreased mass of bones in young adults shows onset of what?
hyposecretion of GH
Proliferation of glandular tissue of the mammary glands (requires estrogen and progesterone and other hormones including insulin and GH), Synthesis of milk proteins by the mammary glands, Increased calcium mobilization from bone and secretion of calcium into milk, Inhibits the release of LH and FSH from pituitary and blocks the effects of LH and FSH on the gonads, Stimulates the immune system are the actions of what hormone?
prolactin
what negatively regulates prolactin? (in the hypothalamus)
PIF=dopamine
In females, increased levels of what hormone causes amenorrhea, galactorrhea (milk production), hirsutism, and osteopenia (pre-osteoporosis)?
prolactin
In males, increased levels of what hormone causes hypogonadism, impaired libido, galactorrhea (rarely), and infertility?
prolactin
what is the hypersecretion of prolactin called?
prolactinomas
what is used for treatment of prolactinomas? (4)
dopamine agonists, somatostatin analogs, surgery, destroy pituitary with radiation if all else fails
Poor milk production and Poor function of immune system are the manifestations of what?
hyposecretion of prolactin
how do you diagnose (test for) hyposecretion of prolactin?
check blood levels of prolactin, inject TRH to see if problem is at pituitary (low prolactin after injection) or hypothalamus (normal levels after injection)
A female patient has a prolactin-secreting tumor of the pituitary gland. What can you expect dopamine levels to be like?
increased secretion
what is the normal regulatory pathway for any hormone?
hypothalamus, releasing hormone, pituitary, stimulating hormone, tissue/gland, hormone
SRIH, dopamine and stress inhibit what hormone?
TSH
cold and TRH increase what hormone?
TSH
TSH increases the release of what hormones from the thyroid gland?
T3 and T4
T3 and T4 (after being converted to T3 in the gland) inhibit the secretion of what hormone directly at the pituitary and inhibit the same hormone secretion indirectly by decreasing TRH and increasing SRIH release from the hypothalamus?
TSH
what produces over 2/3 of T3
tissues of body
what hormone Regulates the basal activity of most cells?
T3
the function of most cells requires what hormone?
thyroid hormones
what cause decreased cell growth, poor protein synthesis, poor conduction of nerve impulses?
hyposecretion of thyroid hormones
a large thyroid gland is called?
goiter
at what thyroid hormone levels does a goiter occur?
any level (The presence of a goiter provides evidence that there is some problem with the thyroid axis. However, the presence of a goiter provides no information of where this problem may occur)
what disease is caused by hyperthyroidism?
graves disease
what is another name for hyperthyroidism?
Thyrotoxicosis
what is an Autoimmune disease in which antibodies (thyroid-stimulating immunoglobulin or TSI) are produced that activates the TSH receptor, a diffuse goiter that takes up large amounts of radioactive iodine is produced, results in high thyroid hormones and low TSH?
graves disease
what is a Benign growth of the thyroid gland that produces thyroid hormones, Therefore, radioactive iodine is taken up in high quantities by the areas of the thyroid that have the growth, This results in high thyroid hormones and low TSH.
Toxic Adenoma or Toxic Nodular Goiter
what is another cause of hyperthyroidism that is similar to toxic adenoma except the thyroid has many benign nodules. Thyroid scan reveals many modules with normal thyroid tissue between nodules?
Toxic multinodular goiter
what is another cause of hyperthyroidism in which during the acute phase, thyroid hormones are released from injured or dead thyroid cells?
thyroiditis (acute phase)
what disease is caused by ingestion of excess thyroid hormones either through Taking excess thyroid hormone for weight loss, more energy, or psychological disease or Hamburger (or hotdog) thyrotoxicosis: too much thyroid in prepared meats. This also causes hyperthyroidism?
Thyrotoxicosis factitia
what are some treatments for hyperthroidism? (3)
Drugs that inhibits the thyroid from utilizing iodine, Radioactive iodine, Surgery (rarely necessary because of effectiveness of drug and radioactive treatments)
what is a bacterial infection of the thyroid?
Acute infectious thyroiditis
what is is generally a viral infection of the thyroid?
Subacute thyroiditis
what is an autoimmune disease in which the Thyroid is progressively destroyed?
Hashimoto disease (Autoimmune thyroiditis)
thyroiditis, Genetic, Iodine deficiency (causes a large diffuse goiter), Pituitary failure, Hypothalamic failure, Chronic stress or chronic disease can all cause what?
hypothyroidism
what 3 types of thyroiditis cause hypothyroidism?
acute infectious thyroiditis, subacute thyroiditis, hashimoto disease (autoimmune thyroiditis)
what is the treatment for hypothyroidism?
give thyroid hormones
Decreased body temperature, Decreased heart rate, blood pressure, Poor wound healing, Muscle weakness, Weight gain, Fatigue, Excessive sleep, Poor mental function (slow problem solving), Coarsening and loss of scalp hair, Sudden loss of pigment in scalp and other body hair, Myxedema may develop (nonpiting edema caused by excess mucopolysaccharide in the tissue-- Often present around the eyes and in the hands and feet), Myxedema of voice box and tongue causes slurred speech and hoarseness, Poor synthesis of protein, All body functions decreased, Poor myelination of nerves are clinical manifestations of what disease?
hypothyroidism
The tendon reflex is slow in what disease because of the decreased myelination of the nerves and decreased speed of the muscle contraction?
hypothyroidism
in pregnancy, a low amount of what hormone in the mother causes various problems in the fetus. These problems include: Lower birth weight, Poorer development of the CNS, Permanent decrease in the predicted IQ by 10 to 20 points. Now every woman considering pregnancy must be screened for this hormone?
thyroid hormone
hyposecretion of thyroid hormones following birth causes what?
cretinism
Short stature, disproportional growth, and high body fat, Poor development of the nervous system due to decreased nerve myelination, poor reflexes, poor coordination of muscle movement, and a very low IQ are clinical manifestations for what disease?
cretinism
what are the small glands located behind the upper and lower poles of the thyroid gland?
parathyroid
what does the parathyroid gland produce?
parathyroid hormones (antagonist to calcitonin, increases blood calcium levels)
what stimulates PTH secretion?
low blood calcium levels
what stops PTH secretion?
increase in blood calcium levels
Excess secretion of PTH from one or more parathyroid glands is called what?
Primary hyperparathyroidism
Increase in PTH secondary to a chronic disease that causes hypocalcemia (i.e., renal failure) is called what?
secondary hyperparathyroidism
Abnormally low PTH levels, Usually caused by parathyroid damage in thyroid surgery is called?
hypoparathyroidism
What would be the most likely side-effect of hypoparathyroidism?
muscle spasms
the adrenal medulla produces what 2 hormones?
Epinephrine, Norepinephrine
what produces Mineralcorticoids: Aldosterone, and Glucocorticoids: Cortisol
adrenal cortex
what 2 sex hormones does the adrenal gland produce?
Androgens and Estrogens
Excessive anterior pituitary secretion of ACTH results in what disease?
cushing disease
Excessive level of cortisol, regardless of cause results in what disease?
cushing syndrome
hypersecretion of aldosterone usually from an adenoma is called?
Primary hyperaldosteronism (Conn disease)
hypersecretion of aldosterone usually from overactive RAAS pathway is called?
Secondary hyperaldosteronism
Hypersecretion of adrenal androgens causes what?
virilization
hypersecretion of adrenal estrogens cause what?
feminization
what is Caused by tumors derived from the chromaffin cells of the adrenal medulla (Pheochromocytomas) and Secrete catecholamines on a continuous or episodic basis?
Adrenal medulla hyperfunction
what type of addisons is Destruction of the adrenal gland?
primary
Adrenal Insufficiency or Hypocortisolism causes what disease?
addison's disease
what type of addison's is Lack of ACTH due to destruction of the pituitary?
secondary
what type of addisons is Decreased CRH due to hypothalamic damage (head injury) or exposure to high concentrations of glucocorticoids?
tertiary