Clinical Chemistry Exam 2
Terms in this set (436)
small amounts (tests must be sensitive)
amount of hormones that circulate
levels changing with time (higher in morning, drop at night)
it can take up to _____ % destruction of a gland for hormone levels to be reduced
cortisol, GH, epinephrine, glucagon and insulin
hormones that all affect glucose metabolism
can influence carbohydrate metabolism (raise glucose), inhibit amino acid uptake and protein synthesis and increases the central distribution of fat
parent hormone of all steroids
synthesized as needed, lipid soluble, not stored in large amounts, and circulate bound to a carrier
insulin, GH, PTH
chain of glycoproteins that are all identical
where does the specificity of glycoproteins come from?
synthesized as a pro hormone (ex: insulin is cleaved from proinsulin)
attached to insulin
increase in C-peptide, decrease in glucose
caused by too much insulin
synthesized and stored in cells, water soluble, not bound to carrier protein
half life of protein hormones
behave like steroid/protein hormones (epinephrine, norepinephrine, T4, T3)
T3 and T4
amine proteins that are bound to a carrier and behave like steroid hormones
norephinephrine and epinephrine
amine hormones that are similar to protein hormones
hormone receptors are _____
equilibrium system of hormone receptor complex
system where there is only a certain amount of receptors on cells, once all sites are filled, no more response can occur
degree of response by target tissue is proportional to the amount of what?
receptors have high _____ so that even though hormones circulate in small amounts, they are attracted to their receptors
protein hormones leave cells and travel through_____, then interact with the _____, which activates _____ on the inner cell membrane, converting _____ to _____, which acts as a second messenger causing the effect to occur
hormones that react through _____ cause rapid effects that cease rapidly when stimulus stops
protein hormones and catacholamines (epi and norepi)
hormones that react through C-AMP
steroid hormones pass in the blood and interact with an _____ receptor site, complex binds to _____ producing _____, which enters the cytoplasm and initiates synthesizes of _____ that carry out action
can be enzymes, proteins or secretory products
require synthesis of secondary protein, so response takes longer to occur and cease
T3 and T4
enter nucleus without binding to receptor
the mechanism of control of hormones is regulated by what?
hormones that travel
brings glucose levels down
brings glucose levels back up
negative feedback system
stimulus turns off when hormone rises to appropriate level
suspended and fits into sella turcica
communicates with posterior pituitary and anterior pituitary
through nerve fibers
how does the hypothalamus talk to the neurohypophysis/posterior pituitary?
through blood highway/releasing factors
how does the hypothalamus talk to the anterior pituitary?
the adenohypophysis/anterior pituitary is also known as the what?
TRH, GNRH, LHRH, CRH, GHRH, PRH
releasing hormones from the hypothalamus
ADH (vasopressin) and oxytocin
posterior pituitary hormones
problem with the target organ
problem in the anterior pituitary (tumor)
problem in the hypothalamus (brain injury)
increased T4, decreased TSH
decreased T4, increased TSH and TRH
increased T4 and TSH, decreased TRH
increased T4, TSH and TRH
decreased T4 and TSH, increased TRH
promotes growth and development; prior to puberty, stimulates growth of long bones and soft tissues; after adolescence, promotes tissue replacement and repair
excessive secretion of GH before puberty, resulting from adenoma of the pituitary
excessive secretion of growth hormone after puberty, caused by adenoma
another name for growth hormone
GHRH and GHIH
controls release of GH (from hypothalamus)
bone, liver, heart, brain
target organs of GH
IGF-1 (insulin growth factor 1)
produced by the liver after it is acted on by GH to promote development and growth in bones and tissues
when is most growth hormone secreted?
decreased secretion of growth hormone; can be acquired, congenital, idiopathic, and results from damage to the pituitary and/or hypothalamus
mentally bright, growth slows, teeth don't come in at normal age, sexually undeveloped
describe pituitary dwarf
dwarfism that is genetic
exercise, 60-90 mins of sleep, insulin injection or arginine infusion
how is growth hormone stimulated for lab diagnosis?
regulates the rate at which the body utilizes and produces energy, controls BMR
mental dullness and lethargy
caused by a nonfunctioning thyroid gland
controlled by AP, stimulates thyroid gland
tertiary: TRH, secondary: TSH, primary: T3 and T4
what are the tertiary, secondary and primary hormones secreted for thyroid function?
T3 and T4 are secreted and inhibit TSH and TRH
describe the negative feedback system of the thyroid gland
affects the adrenal cortex
tertiary: ACTHRH/CRH, secondary: ACTH, primary organ: adrenal cortex
what are the tertiary, secondary and primary hormones that stimulate the adrenal cortex?
FSH and LH
in females, stimulates growth of ovarian follicles and an associated increase in estrogen, and in males, stimulates spermatogensis
causes release of ovum from ovarian follicles in females, and is responsible for production of testosterone in males
ovulation (luteal phase)
estrogen and LH
in ovulation, _____ stimulates rapid growth of ovarian follicles and increase in estrogen, the rising estrogen levels suppress stimulation of _____ but stimulate _____ release, resulting in a mid cycle surge, which triggers _____, when egg is released, _____ and _____ drop in concentration
extremely important in maintaining a good environment for fertilization
tertiary: GnRH, secondary: FSH and LH, primary: ovaries - estrogen and progesterone and testes - spermatazoa
what are the tertiary, secondary and primary hormones associated with the ovaries and testes?
initiation and maintenance of lactation
target organ of prolactin
tertiary: PRH, secondary: prolactin, primary tissue - breast
tertiary, secondary and primary hormones/tissues that affect breast development
prolactin, estrogens, progesterones, corticosteroids, and insulin
what hormones promote full development of breast tissue?
increased levels of estrogen
inhibits prolactin during pregnancy
drop in estrogen, prolactin is produced, suckling also stimulates production
what happens to the mother at birth to promote milk production?
pituitary tumor or infarct
what can cause hypoprolactemia?
postpartum failure to lactate, usually due to hemorrhage of pituitary gland or DIC
2 amino acids
ADH and oxytocin (aka pitocin) are posterior pituitary peptide hormones that differ by _____
secreted by the posterior pituitary, prevents excess loss of water through the kidneys
makes DCT and collecting ducts permeable to water so it can reabsorb back into blood from tubules
how does ADH prevent excess loss of water through the kidneys?
changes in plasma osmolality, alterations in BP
what major stimuli control ADH release?
sodium, glucose and BUN
major determinants of plasma osmolality
ADH is released to dilute the blood
what happens when serum osmolality increases?
nausea, pain, stress, various infections, vascular and neoplastic disorders
what are some things besides increased osmolality and increased blood pressure that can stimulate ADH to be released?
syndrome of inappropriate ADH
ADH is secreted despite low serum osmolality (doesn't shut off due to negative feedback as it should)
tumors producing ectopic ADH (lung cancer)
CNS trauma, bacterial meningitis (most common)
administration of certain drugs (opioids)
pulmonary diseases (tuberculosis)
causes of SIADH
ADH comes from tumor instead of posterior pituitary
meninges swell and can press on posterior pituitary gland, causing release of ADH
how does bacterial meningitis cause SIADH?
caused by SIADH
hyposecretion of ADH
what causes water to not be reabsorbed, resulting in polyuria and copious amounts of dilute urine?
caused by hyposecretion of ADH, polyuria, dilute urine, polydipsia
destruction of posterior pituitary or hypothalamus
what causes diabetes insipidus/hyposecretion of ADH?
arginine vasopressin injection or DDAVP nasal spray (vasopressin)
how is diabetes insipidus treated?
posterior pituitary hormone that is a potent stimulator for contraction of smooth muscle, uterine contractions, strengthens contractions during labor
what else does oxytocin help with?
what does oxytocin prevent following delivery?
used to induce labor
means passing through
mens without taste
T4 or thyroxine and T3 or triiodothyronine
thyroid hormones secreted by the follicular cells
thyroid hormone produced by the perifollicular cells
thyroid hormone involved in calcium regulation when calcium rises by stopping bone resorption and promoting bone formation
what does calcitonin stimulate in response to elevated calcium levels?
what does resorption mean?
increases respiration, stimulates heart activity, GI activity, influences rate of oxygen and heat production in all tissues, and is necessary for growth, development and sexual maturation
what does T4, along with T3 enhance?
body temperature and cellular metabolism
what two things does T4 increase?
thyroid hormone consisting of two diiodathionines (DITs)
thyroid hormone consisting of one DIT and one monoiodothionine (MIT)
(tyrosine + 2 DIT = T4)
(tyrosine + 1 DIT and 1 MIT = T3)
what is the amino acid base of T4 and T3?
T3: MIT is on top, DIT is on bottom
RT3: DIT is on top, MIT is on bottom
what is different about RT3 from T3?
storage protein that T3 and T4 attach to
bound to a protein
how do T3 and T4 circulate in plasma?
TGB, TBPA and TBA
proteins that thyroid hormones circulate bound to
ratio of T4 to T3
most biologically active thyroid hormone
monodeiodination of T4
what percent of T3 is glandular? where does the other come from?
not so tightly bound to proteins, can diffuse into cells more easily, receptor protein within the cell nucleus has higher affinity for T3
why is T3 more biologically active than T4?
percent of T4 that is bound? free?
percent of T3 that is bound? free?
what portion of T3 and T4 is normally the biologically active form?
disease, hormones, drugs, acidosis
what can cause decreased protein binding and increased amount of free T3 and T4?
pregnancy and estrogen therapy
can affect thyroid globulin protein
determines thyroid status
normal functioning thyroid? increased secretion of hormones? decreased secretion?
when are exogenous TSH injections not helpful? when would this correct the problem?
hypothalamus releases TRH, which stimulates anterior pituitary to release TSH, which stimulates thyroid to secrete T3 and T4
what happens when thyroid hormone levels circulating in the blood drop?
metabolic processes slow down, BMR decreases
occurs during hypothyroidism
females (4x more than males)
who does hypothyroidism affect more, females or males?
percent of births with hypothyroidism
acquired between 30-60 years old
is hypothyroidism normally congenital or acquired?
impairment of cognition, fatigue, lethargy, cold intolerance, weight gain, slowing of mental and physical performance, exertion dyspnea, hoarseness, constipation, easy bruising, decreased sweating, muscle cramps, paresthesia, dry skin
symptoms of hypothyroidism
increased cholesterol and other lipids (LDL, lipoprotein-a and apo-b)
what is hypothyroidism associated with?
coronary heart disease
what condition may be caused by hypothyroidism?
necessary for formation of LDL receptors and up regulation of LDL reception, resulting in intracellular LDL due to endocytosis
damage to endothelial cells
what can increased LDL cause?
severe hypothyroidism that is not congenital
swelling of skin particularly in face
what does myxedema refer to?
infiltration of mucopolysaccharides
what causes puffy face in myxedema?
very common in myxedema patients
radiation damage, thyroid surgery
causes of myxedema
can be any
is myxedema primary, secondary or tertiary?
congenital hypothyroidism, mostly resulting from defects in development or function of the thyroid gland itself
primary - thyroxine is not synthesized
is cretinism primary, secondary or tertiary?
what are all newborns screened for?
cord blood or capillary blood collected on filter paper and tested for T4 and TSH
how are newborns tested for hypothyroidism?
what inborn error of metabolism are newborns tested for?
can occur if cretinism is not caught early
most cases result from inadequate secretion of thyroid hormones from a damaged thyroid
acquired hypothyroidism may be _____
chronic thyroiditis, birth control pills, surgical or radioactive treatment
causes of acquired hypothyroidism
chronic autoimmune thyroiditis, most common cause of primary hypothyroidism
there is a peak incidence of Hashimoto's in the _____ decade of life
antimicrosomal antibody and antithyroglobulin antibody
detected in 90% of Hashimoto's patients
TPO antibody (thyroid peroxidase)
preferred biomarker for Hashimoto's
causes of secondary hypothyroidism resulting in a lack of TSH
tumors, vascular insufficiency, trauma
causes of tertiary hypothyroidism/hypothalmic failure
tremors, tachycardia, weight loss, heat intolerance, fatigue, sweating, irritability, oligomenorrhea/amenorrhea, possible goiter
symptoms of hyperthyroidism
syndrome caused by increased levels of thyroid hormones in circulation
life threatening complication experienced by 1% of thyrotoxicosis patients
primary hyperthyroidism, autoimmune disorder
symptoms of Grave's disease
thyroglobulin Abs and microsomal Abs
may be elevated in Grave's patients
thyroid stimulating immunoglobulin and TSH receptor antibody
antibodies found in Grave's patients
thyroid stimulating immunoglobulin
antibody in Grave's patients that mimicks TSH
thyroid to produce thyroid hormones
what do the antibodies in patients with Grave's disease stimulate?
hormone that is low in Grave's patients
bacteria, mycobacteria, fungi and parasites
causes of acute thyroiditis (inflammation of the thyroid)? subacute?
thyroid nodules and cancer, pituitary adenoma (secondary), too high of a dosage for exogenous thyroid medication
other causes of hyperthyroidism
hormones compete for binding with specific antibody
how do thyroid laboratory testing methods work?
thyroid binding ratio, free thyroxine index, thyroid scan
tests used to dx thyroid conditions
test methods for T4
what portion of T4 is tested in the radioimmunoassay? what portion is used to dx subclinical disorders?
thyroid hormone binding ratio
now used instead of T3 uptake
the number of available binding sites of thyroxine binding globulin (TBG)
what does the thyroid hormone binding ratio measure?
amount of labeled T3 taken up by _____ is _____ to the number of binding sites of TBG
does the thyroid hormone binding ratio measure the degree of saturation or unsaturation of TGB?
labeled T3 is added, binds to available binding sites on TBG (unsaturated sites/not bound in vivo), binding material is added, and leftover T3 binds to binding material
explain how the thyroid hormone binding ratio works
more T3 is bound in vivo, less TBG binding sites are available to the labeled T3, more labeled T3 is left over to bind to binding agent, THBR is increased
explain the THBR for a patient with hyperthyroidism
less circulating T3, less binds to TBG in vivo, more TBG binding sites available, more labeled T3 binds to TBG, less is available to bind to binding material, THBR is decreased
explain the THBR for a patient with hypothyroidism
free thyroxine index / FTI (used to be called T7)
an indirect measure of free hormone concentration, increased in hyper and decreased in hypo
T4 x T3
how do you get the FTI?
equilibrium dialysis or ultrafiltrate
how may FTI be measured directly?
extremely useful for confirmation of suspected primary hyperthyroidism or hypothyroidism
high sensitivity TSH, considered most clinically sensitive assay for detection of primary thyroid disorders
reference range for TSH
h-TSH is _____ in primary hypothyroidism and _____ in primary hyperthyroidism
indirectly or directly
how may TBG be measured?
how is thyroglobulin measured?
useful tumor marker
antibody directed against thyroglobulin
antibody directed agaisnt protein component of thyroid cell microsomes
thyroid peroxidase Ab
antibody directed against the enzyme that is the auto-antigenic component of the thyroid microsomes
4, located on posterior side of the thyroid
how many parathyroid glands are there? where are they located?
the parathyroid glands are extremely important in regulating the levels of what substance in the blood?
what does PTH do?
digestive tract, kidneys and
what does PTH act on to increase calcium levels?
increases amount of calcium absorbed out
releases calcium from bone by stimulating osteoclast activity
how does PTH act on the digestive tract? kidneys? bone?
PTH also causes renal excretion of _____
as calcium increases, phosphorus decreases
explain the reciprocal relationship between calcium and phosphorus that is modulated by PTH
tetany (sustained muscular contraction)
caused by hypoparathyroidism
calcium is needed for what?
hypoparathyroidism causes the nervous system to become _____
released by thyroid when calcium levels are high, inhibits parathyroid and causes decrease in calcium
on top of each kidney
where are the adrenal glands located?
outer cortex and inner medulla
what are the adrenal glands composed of?
what type of hormones do the adrenal glands secrete?
minerolocorticoid secreted from the zona glomerulosa of the adrenal glands
glucocorticoid secreted by the adrenal glands
what portion of the adrenal glands secretes cortisol?
what portion of the adrenal glands secretes sex hormones?
androgens and estrogens
what sex hormones are secreted by the adrenal glands?
because they are also secreted by the adrenal glands
why do women have testosterone and men have estrogen if they are secreted from the testes and ovaries?
synthesize hormones from cholesterol inside the organs
principle mineralocorticoid, electrolyte regulating hormone
controls levels of aldosterone
juxtaglomerular apparatus of the kidney
renin is a protein that is produced where?
decreased renal profusion and decreased sodium levels
what causes renin to be secreted?
deficiency of aldosterone
Addison's disease results in a decreased amount of ____ and increased _____
what does renin act on?
alpha 2 macroglobulin
angiotensinogen is a _____ produced by the _____
angiotensinogen produces _____ which is converted to _____ by _____
potent vasoconstrictor that also stimulates the secretion of aldosterone
increase retention of sodium (secondarily chloride and water and excretion of K and H) which increases blood volume
aldosterone acts on renal tubular epithelium to do what?
vasoconstriction and increasing plasma volume
how does aldosterone increase blood pressure?
renin secretion and aldosterone production are suppressed
what happens when renal perfusion increases?
uncommon, primary hyperaldosteronism characterized by sodium retention, hypernatremia, hypokalemia, hypertension, increased aldosterone and decreased renin
aldosterone secreting adrenal adenoma
most common cause of Conn's syndrome (primary hyperaldosteronism)
sodium, blood pressure, aldosterone
potassium and renin
what all is elevated in Conn's syndrome? decreased?
the renin-angiotensin system (excessive production of renin)
secondary hyperaldosteronism is caused by abnormalities in _____
renal artery stenosis, renin-secreting tumor
causes of excessive renin production
aldosterone and renin
increased in secondary hyperaldosteronism
destruction of adrenal gland
what is hypoaldosteronism often due to?
what is hypoaldosteronism associated with?
renin, potassium and cortisol
aldosterone and sodium
increased in Addison's disease? decreased?
caused by decreased cortisol, common in patients with Addison's disease
principle glucocorticoid with wide spread actions
effect of cortisol on carbohydrates, fat and protein metabolism
water and electrolyte balance, stabilization of lysosomal membranes, suppression of inflammatory and allergic reactions
what are some functions of cortisol besides its anti-insulin effect?
pain, fever, low glucose and fear
causes of increased cortisol
hypothalsmic CRH and pituitary ACTH
what two hormones are involved in cortisol regulation?
what do ACTH and cortisol both show?
in the morning
when are cortisol levels the highest?
failure of levels to drop throughout the day
what cortisol test results would be indicative of a problem?
helps with sleep pattern (circadian rhythm)
why do cortisol levels normally drop throughout the day?
90%, cortisol binding globulin
what percent of serum cortisol is bound to a carrier protein? what is that protein?
cortisol binding globulin is very saturated at _____ levels of plasma cortisol
increases rapidly with increase in cortisol production
because cortisol binding globulin is very saturated, and no more binding sites are available
why does free cortisol increase rapidly with an increased production of cortisol?
readily filtered and excreted by kidney
what happens to free cortisol?
metabolites of cortisol, bc the free cortisol is excreted in urine by the kidneys
what is seen in the urine of a patient with high levels of free cortisol? why?
what are increased free cortisol levels a sensitive indicator of?
cortisol metabolite found in urine
porter-silber method and zimmermann method
classic methods for measuring cortisol metabolites
cushing's syndrome and cushing's disease
what is hypercortisolism referred to as?
which form of cushing's is more common?
primary hypercortisolism, an excessive production of cortisol in the blood due to an adrenal adenoma
excessive production of ACTH by a pituitary adenoma
oat cell carcinoma of lung (ectopic cortisol)
what else can cause cushing's disease (increased ACTH causing increased cortisol) besides a pituitary adenoma?
most common cause of a group of symptoms known as cushing symptoms
it is inhibited
what happens to the feedback system of cortisol if there is a pituitary tumor?
it continues to work, but cortisol is produced anyway
what happens to the feedback system of cortisol if there is an adrenal cortex tumor?
enlarged adrenal cortex due to increased ACTH produced by lung cancer
inhibition of ACT secretion, no more cortisol produced from cortex
what does ingestion of cortisol cause?
truncal obesity with thin extremities, buffalo hump back, hyperglycemia, protein wasting, poor wound healing, striae of skin, high BP, cushingoid moon face, and decreased ability to limit infection
what are the symptoms of hypercortisolism, both primary and secondary?
can cause increased risk of osteoporosis
reference range for am and pm cortisol
reference range for stimulated and suppressed cortisol
loss of cortisol circadian rhythm is indicative of what?
ACTH in primary hypercortisolism
surgery, radiation, chemo
treatment for hypercortisolism due to adrenal tumor
autoimmune primary hypocortisolism
aldosterone and cortisol
what hormones are decreased in addison's disease?
what is addison's disease (adrenal insufficiency) most often do to?
tuberculosis, histoplasmosis, metastatic tumor, DIC with adrenal hemorrhage
what factors can trigger addison's disease?
cortisol, aldosterone, sodium, bicarbonate and glucose
what laboratory tests are low in a patient with addison's disease?
potassium, BUN and ACTH
what lab values are high in a patient with addison's disease?
hyper pigmentation of skin
what does increased ACTH in addison's disease cause?
ACTH injection is given, and a peak value of cortisol is reached within 30 mins
explain the ACTH stimulation test in a patient with normal adrenal function
an ACTH stimulation test with no significant response/increase in cortisol is indicative of what?
urine metabolites (17-OCHS)
how may the ACTH stimulation test be performed besides testing cortisol?
thin, cardiac insufficiency, muscle weakness, adrenal atrophy and personality changes
symptoms of addison's disease
where do androgens come from?
testosterone, androstenedione and DHEA
name 3 androgens
congenital adrenal hyperplasia
excessive production of androgens
what are 95% of congenital adrenal hyperplasia cases due to?
what does congenital adrenal hyperplasia cause?
hirsutism (body hair in male like fashion)
most common manifestation in females with congenital adrenal hyperplasia
most potent female sex hormone, small amounts secreted from adrenal glands
where are catecholamines produced?
cells of the sympathetic nervous system
where does the adrenal medulla originate in the developing fetus?
vasoconstriction, heart rate, blood pressure, pupillary dilation, erection of hairs
what does the adrenal medulla stimulate?
dopamine, norepinephrine and epinephrine
dopamine --> norepinephrine --> epinephrine
what precursor hormones does epinephrine come from?
where does norepinephrine come from?
constitutes 80% of the hormonal output of the adrenal medulla
epinephrine acts as a hormone even though it is a _____
metanephrines and VMA
metabolites of epi and norepi
stress, physical activity, low glucose
what stimulates the hypothalamus to send nerve impulses to the adrenal medulla to produce epinephrine?
24 hour urine
what specimen is used to test catecholamines in the urine?
chromatin cell tumor of adrenal medulla, causes unexplained hypertension
often fatal malignancy in children, cancer of the nervous system with an increase in norepinephrine
neuroblstoma and pheochromocytoma
what disorders are urinary catecholamines the best screening test for?
has endocrine and exocrine functions
insulin and glucagon
hormones secreted by the pancreas
peptide hormone from beta cells of islets of lagerhands, synthesized as large inactive precursor
what process does insulin decrease? increase?
insulin and C-peptide
proinsulin is cleaved to form what hormone and what inactive fragment?
muscle and fat
insulin lowers blood glucose by facilitating uptake by _____ and _____ cells, inducing glycogen storage in the _____, promoting _____ synthesis
changes permeability of cell membrane
how does insulin act as a key to letting glucose enter the cell?
abnormalities in insulin function reflect what?
marked decrease in glucose (less than 40 mg/dl)
lack of glucose on the brain
what causes weakness, headache, blurred vision, convulsions and coma in hyperinsulinemia?
release of catecholamines
what causes sweating, pallor and palpitations in hyperinsulinemia?
attempting to raise glucose
why does hyperinsulinemia cause a release of catecholamines?
tumor of beta cells secreting insulin, causes low glucose
ingestion of commercial insulin
what is another cause of hyperinsulinemia?
increase in insulin and C-peptide
increase in insulin and decrease in C-peptide
what are the lab evaluations for hyperinsulinemia with increase in endogenous insulin? exogenous?
insulin:glucose ratio during insulinoma attack
<0.3 (insulin production is appropriate for decreased glucose)
insulin:glucose ratio in reactive hypoglycemia
hypoinsulinemia (diabetes mellitus)
fasting hyperglycemia, abnormalities of fat and protein metabolism
beta cells fail to secrete insulin, autoimmune insulin dependent diabetes mellitus
insulin insensitivity by tissues
genetics, environment, viral infection
factors that contributed to type 1 DM
weight loss, bed wetting, fruity odor of mouth
what is the typical picture of a child with an onset of DM 1?
does not work effectively in patients with DM 2
neuropathy, retinopathy and nephropathy, infection, gangrene, necrosis
complications of DM
gluconeogensis and glycogenolysis
what two processes are glucagon responsible for?
stimulates release of glucagon
circulates in liver and stimulates the release of glucose
how does the release of glucagon allow glucose to rise?
what week of gestation are the primitive germ cells present in epithelial tissue of the gonad? what is the gonad at this point?
presence or absence of Y chromosome
what does the differentiation of the gonad dependent on?
what does the gonad develop into if the Y chromosome is present?
leydig cells to secrete testosterone
what is stimulated by HCG in the gonads if the Y chromosome is present?
ovaries, internal and external female genitalia
develops from the gonads in the absence of testosterone
estrogens, progesterone and small amounts of androgens
what hormones are secreted by the ovaries?
estradiol, estrone and estriol
what secretes progesterone within the ovaries?
egg released, regresses within ovary
what forms the corpus luteum?
preparing for menstrual cycle
important function of progesterone
what is progesterone important in when the egg is not fertilized?
the corpus luteum maintains the _____for anticipated contraception
responsible for growth of the uterus, fallopian tubes and vagina, as well as termination of linear growth, promotion of breast development, maturation of external genitalia and deposition of body fat into female distribution
female estrogen levels? males? prepuberty?
what is the cropus luteum rich in?
development of placenta
after implantation, what is progesterone responsible for?
prepares the lobules of the breasts for lactation
progesterone reference ranges during luteal phase? prior to luteal phase?
LH causes release of ovum
what causes ovulation?
FSH and LH
what controls the development of follicle with the appropriate release of estrogen and progesterone?
stimulates anterior pituitary to produce FSH and LH
acts on primary follicles to produce developing follicle that secretes estrogen (axillary and pubic hair, pelvis broadens, female reproductive structures, etc)
stimulates ovulation (progesterone from corpus luteum prepares endometrium for implantation and mammary glands for lactation)
estrogen abnormality resulting from ovarian abnormalities
secondary abnormalities in estrogen are due to irregularities in _____
oligomenorrhea, infertility, delayed or accelerated onset of puberty
abnormalities in estrogen cause what?
caused by testicular atrophy, excessive production or administration of estrogen
hyperestrinism in males is most often due to _____
development of breasts in males
alcoholism, exogenous estrogens for prostate cancer
who is hyperestrinism in males commonly seen in?
corpus lutuem does not regress in the absence of fertilization and menstruation does not occur
causes variation in duration and amount of menstrual flow
polycystic ovary syndrome
chronic involution associated with hyperandrogenism
hirsuitism and precocious puberty
what does PCOS cause?
do you have to have cystic ovaries to be diagnosed with PCOS?
cystic ovaries on ultrasound
what demonstrates a classic picture of PCOS?
LH and androgens
what is elevated in PCOS?
ratio that is abnormal in PCOS
DHEA, testosterone, estrogen, LH, FSH
tests used to dx PCOS
problem caused by PCOS that is hard to reverse
may increase with LH in PCOS to produce androgens
increased androgens, inhibition of normal follicular development and lack of ovulation
what leads to cystic ovulation?
estrogen, sporinolactone, metforman
treatment for PCOS
HCG and HPL
hormones secreted by the placenta
placenta and implanted ovum
what secretes HCG?
what does HCG help to maintain?
HCG stimulates the development of _____ and synthesis of _____
1-2 days after fertilization
when can HCG be detected in serum and urine during pregnancy?
quantitative HCG (levels should rise)
what test is used to test for spontaneous abortion in women who are threatening to miscarriage?
what is a miscarriage also referred to as? (pos pre test but bleeding quickly after)
multiple fetuses, placental neoplasm, hiditiform moles, teratomas
can cause increase in HCG
tumors of placental tissues that can have hair or teeth
amniotic fluid, maternal urine and maternal serum
what specimens can HPL be measured in?
estrogen and progesterone synthesis by corpus luteum
HCG and HPL appear in concert with one another to stimulate what?
HPL stimulates the development of _____
ones with decrease in functioning placental tissue (such as hypertension)
what type of conditions is HPL used to monitor?
intrauterine growth retardation
what is HPL used to diagnose?
stimulates production of testosterone
high levels of testosterone
what suppresses FSH and LH?
causes growth and development of the male reproductive system, prostate and external genitalia
development of pubic, axillary and facial hair
growth of genitalia
hypertrophy of larynx
development of sex drive
what things does increased levels of testosterone cause at puberty?
infectious diseases, usually mumps, also radiation
what can cause primary testicular failure?
delayed puberty and hypogonadism
what does decreased testosterone cause?
effects 1/400 men, caused by the presence of an extra chromosome (47 XXY)
breast cancer, lupus, osteoporosis
what diseases are males with Kleinfelters more affected by?
a peptide produced by G cells of the antrum of the stomach
contact with food
what causes a release of gastrin?
what does gastrin cause the parietal cells of the stomach to secrete?
gastrin secretion is inhibited and acid production slows down
what happens as the pH of the gastric contents in the antrum decreases?
loss of negative feedback, elevated serum gastrin levels seen in patients who's stomach wall has inability to manufacture HCl
inability of the stomach wall to manufacture HCl
hypergastrinemia due to hyperplasia of the gastrin producing cells or because of ectopic production of gastrin by an islet cell carcinoma of the pancreas
what do Zollinger-Ellison syndrome patients suffer from?
an amine hormone derived from hydroxylation and decarboxylation of tryptophan
5 OH tryptamine
what is serotonin referred to as?
synthesize serotonin, located in the GI tract, bronchial mucosa, biliary tract and gonads
an important vasoconstrictor important in neural mechanisms important in sleep and sensory perception
what are alterations in serotonergic neural function in the CNS associated with?
block serotonin reuptake
how do TCAs work?
platelets, released during coagulation
when serotonin is secreted into the blood, what does it bind to? when is it released?
5-hydroxyindole acetic acid (5HIAA), in the urine
what is serotonin metabolized to in the liver when it is released from platelets? where is this secreted?
tumors arising from the enterchromaffin cells, occur manly in the appendix and ileum
serotonin, histamine and prostaglandins
what do carcinoid tumors produce?
diarrhea, flushing, tachycardia, hypotension
what symptoms do substances produced by carcinoid tumors produce? (carcinoid syndrome)
bananas, pineapple, walnuts, avocados
foods high in serotonin that cause false positives
class of hematopoietic proliferation factors produced by a variety of cells, such as monocytes and lymphocytes
cytokins affect the survival and proliferation of various populations of _____
interleukins, CSF, tumor necrosis factor
proteins in the cytokine group
hematological tumors, inflammatory process, and pathological processes of the immune system
what are cytokins involved in?
effect produced by cytokines that change the cells that produce them
altering other cells close to them
affect cells systemically
autocrine, paracrine and endocrine
what three effects do cytokines cause?