Carlos Shared "17 Endocrine" - 105 Picmonics

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17 Endocrine

Thyroid Embryology
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.
abnormalities
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.
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Thyroid Gland
Characteristics
TSH Stimulates T3 and T4 Release
Metabolism Regulation
Blood Calcium Sensor
Calcitonin Release
Blood Calcium Decreases
Bone Building
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2 mins
Adrenal Gland (Basic)
Characteristics
Adrenal Cortex
RAAS Stimulates Aldosterone
CRF (CRH) acts on Anterior Pituitary Gland to Release ACTH
Cortisol Released
Androgens Released
Adrenal Medulla
Epinephrine & Norepinephrine
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2 mins
Adrenal Gland (Advanced)
Characteristics
Adrenal Cortex
Zona Glomerulosa
Aldosterone
Zona Fasciculata
Cortisol
Zona Reticularis
Androgens
Adrenal Medulla
Chromaffin Cells
Epinephrine & Norepinephrine
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2 mins
Anterior Pituitary
Characteristics
Hypothalamic Control
FLAT PeG Mnemonic
Tropic Hormones
Follicle-Stimulating Hormone (FSH)
Lutenizing Hormone (LH)
Adrenocorticotropic Hormone (ACTH)
Thyroid-Stimulating Hormone (TSH)
Direct Hormones
Prolactin (PRL)
Growth Hormone (GH)
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2 mins
Posterior Pituitary
Characteristics
Neuroendocrine Reflex Stimulation (By Hypothalamus)
Direct Hormones
Vasopressin
Increased Water Retention (In Kidneys)
Oxytocin
Increased Uterine Contraction
Mammary Glands Contraction
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2 mins
Hypothalamus
Characteristics
Anterior Pituitary Stimulated Through the Hypophyseal Portal
GHRH
GnRH
TRH
PIF
CRF Released During Stress
Posterior Pituitary Stimulated Through Neural Control
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3 mins
Pancreas
Characteristics
Acinar Cells Release Digestive Enzymes
Ductal Epithelial Cells Release Bicarbonate
Islets of Langerhans
Beta Cells Release Insulin
Alpha Cells Release Glucagon
Delta Cells Release Somatostatin
Somatostatin Inhibits Alpha and Beta Cells
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3 mins
Insulin General Overview
Anabolic effects of insulin:
Increased glucose transport in skeletal muscle and adipose tissue
Increased glycogen synthesis and storage
Increased triglyceride synthesis
Increased Na+ retention (kidneys)
Increased protein synthesis (muscles)
Increased cellular uptake of K+ and amino acids
Decreased glucagon release
Decreased lipolysis in adipose tissue
Unlike glucose, insulin does not cross placenta.
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Insulin Transporters 308
GLUT transporters are via facilitated diffusion
Insulin-dependent glucose transporters
GLUT-4: adipose tissue, striated muscle (exercise can also increase GLUT-4 expression)
Insulin-independent transporters
GLUT-1: RBCs, brain, cornea, placenta
GLUT-2 (bidirectional): β islet cells, liver, kidney, small intestine
GLUT-3: brain, placenta
GLUT-5 (fructose): spermatocytes, GI tract
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Insulin Synthesis and Release
INSULIN SYNTHESIS
Preproinsulin (synthesized in RER)
Cleavage of “presignal”
Proinsulin (stored in secretory granules)
Cleavage of proinsulin
Exocytosis of insulin and C-peptide equally
Insulin and C-peptide are increased in insulinoma and sulfonylurea use, whereas exogenous insulin lacks C-peptide
SOURCE
Released from pancreatic β cells.
RELEASE
Glucose is the major regulator of insulin release
Glucose enters β cells
Increased ATP generated from glucose metabolism
Closes K+ channels (target of sulfonylureas)
Depolarizes β cell membrane
Voltage-gated Ca2+ channels open leading to Ca2+ influx
Stimulation of insulin exocytosis
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Insulin-dependent glucose uptake
Binds insulin receptors (tyrosine kinase activity )
Inducing glucose uptake (carriermediated transport) into insulin-dependent tissue.
And gene transcription (via RAS/MAP kinase)
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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.
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Glucagon (GlucaGen)
Mechanism
Increases Glucose
Indications
Hypoglycemic Emergency
Side Effects
Nausea and Vomiting
Considerations
Reconstitute Powder
Consume Oral Carbohydrates
50% Dextrose IV (If No Effect)
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2 mins
Hypothalamic-pituitary hormones
CRH
Increases ACTH, MSH, β-endorphin
Decreased in chronic exogenous steroid use.
Dopamine
Decrease prolactin, TSH
Dopamine antagonists (eg, antipsychotics) can cause galactorrhea due to hyperprolactinemia
GHRH
Increase GH
Analog (tesamorelin) used to treat HIV-associated lipodystrophy.
GnRH
Increases FSH, LH
Suppressed by hyperprolactinemia.
Tonic GnRH suppresses HPG axis (Hypothalamic–pituitary–gonadal axis)
Pulsatile GnRH leads to puberty, fertility.
Prolactin
Decreases GnRH
Pituitary prolactinoma leads to amenorrhea, osteoporosis, hypogonadism, galactorrhea.
Somatostatin
Decreases GH, TSH
Analogs used to treat acromegaly.
TRH
Increase TSH, prolactin
Increased TRH (eg, in 1°/2° hypothyroidism) may increase prolactin secretion, leading to galactorrhea.
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Prolactin Regulation
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Growth hormone (somatotropin)
SOURCE
Secreted by anterior pituitary
FUNCTION
Stimulates linear growth and muscle mass through IGF-1 (Insulin-like Growth Factor/somatomedin C) secretion by liver.
Increased insulin resistance (diabetogenic).
REGULATION
Released in pulses in response to growth hormone–releasing hormone (GHRH).
Secretion increases during exercise, deep sleep, puberty, hypoglycemia. Arginine stimulates release.
Secretion inhibited by glucose and somatostatin release via negative feedback by somatomedin.
Excess secretion of GH (eg, pituitary adenoma) may cause acromegaly (adults) or gigantism (children).
Treat with somatostatin analogs (eg, octreotide) or surgery.
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Appetite regulation
Ghrelin
Stimulates hunger (orexigenic effect) and GH release (via GH secretagog receptor).
Produced by stomach.
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
Leptin
Satiety hormone.
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
Endocannabinoids
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.”
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17 Alpha Hydroxylase Deficiency
Decreased Cortisol
Decreased Sex Hormones
Increased Mineralocorticoids (DOC)
Hypertension
Hypokalemia
XY Externally Phenotypic Female
No Internal Reproductive Structures Due to Mullerian Inhibitory Factor
XX Externally Phenotypic Female
Sexual Infantilism
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2 mins
21 Hydroxylase Deficiency
Pathophysiology
Decreased Cortisol
Increased 17 Hydroxyprogesterone
Decreased Aldosterone
Signs and Symptoms
Hypotension
Increased Renin
Hyperkalemia
Female Pseudohermaphroditism
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2 mins

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