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Thyroid diverticulum arises from floor of primitive pharynx and descends into neck. Connected to tongue by thyroglossal duct, which normally disappears but may persist as cysts or the pyramidal lobe of thyroid.
Thyroid tissue and parafollicular cells (aka, C cells, produce Calcitonin) of the thyroid are derived from endoderm.
Foramen cecum is normal remnant of thyroglossal duct.
The pyramidal lobe of thyroid.
Thyroglossal duct cyst presents as an anterior midline neck mass that moves with swallowing or protrusion of the tongue (vs persistent cervical sinus leading to branchial cleft cyst in lateral neck).
Most common ectopic thyroid tissue site is the tongue (lingual thyroid).
Removal may result in hypothyroidism if it is the only thyroid tissue present.
TSH Stimulates T3 and T4 Release
Blood Calcium Sensor
Blood Calcium Decreases
Adrenal Gland (Basic)
RAAS Stimulates Aldosterone
CRF (CRH) acts on Anterior Pituitary Gland to Release ACTH
Inducing glucose uptake (carriermediated transport) into insulin-dependent tissue.
And gene transcription (via RAS/MAP kinase)
Insulin Response - Oral Glucose vs IV Glucose
Increased insulin response with oral vs IV glucose because of incretins such as glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which are released after meals and increased β cell sensitivity to glucose.
Nausea and Vomiting
Consume Oral Carbohydrates
50% Dextrose IV (If No Effect)
Increases ACTH, MSH, β-endorphin
Decreased in chronic exogenous steroid use.
Decrease prolactin, TSH
Dopamine antagonists (eg, antipsychotics) can cause galactorrhea due to hyperprolactinemia
Analog (tesamorelin) used to treat HIV-associated lipodystrophy.
Sleep deprivation or Prader-Willi syndrome leads to increased ghrelin production
Decreases after gastric bypass surgery.
Lateral area of the hypothalamus is stimulated by ghrelin
Produced by adipose tissue.
Mutation of leptin gene leads to congenital obesity.
Sleep deprivation or starvation leads to decreased leptin production.
Ventromedial area of the hypothalamus is stimulated by Leptin
Act at cannabinoid receptors in hypothalamus and nucleus accumbens, two key brain areas for the homeostatic and hedonic control of food intake.
Causes increased appetite.
Exogenous cannabinoids cause “the munchies.”
17 Alpha Hydroxylase Deficiency
Decreased Sex Hormones
Increased Mineralocorticoids (DOC)
XY Externally Phenotypic Female
No Internal Reproductive Structures Due to Mullerian Inhibitory Factor
XX Externally Phenotypic Female
21 Hydroxylase Deficiency
Increased 17 Hydroxyprogesterone
Signs and Symptoms
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