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three polypeptides released from anterior petuitary gland
Growth Hormone
Prolactin
Adrenocorticotropin
Three Glycoproteins released from the Anterior Petuitary
FSH
LH
TSH
Two factors that cause release of Growth Hormone
GHRH
Ghrelin
inhibitors of Growth Hormone
somatostatin
feedback of GH itself
IGF-1
Tests for Growth Hormone
Insulin Tolerance Test
GHRH-arginine
Primary inhibitor of Prolactin
Dopamine
feature of high prolactin
galactorrhea
amenorrhea
Positive regulators of Prolactin
TSH
Estrogens
lab measurement of HPA axis
Cortisol
mass effects of macroadenomas of hte pituitary
headache
hydrocephalus
visual field deficits
cranial nerve palsies
csf rhinorrhea
Type 1 steroid receptors bind:
Aldosterone
Glomerulosa cells produce:
aldosterone
Fasiculata Cells produce:
cortisol
Reticularis cells produce:
Androstenedione
DHEA
DHEA levels change as a function of:
age
Enzyme required to make aldosterone and cortisol
11β Hydroxylase
peripheral enzyme that converts androgens to estrogens
P450 aromatase
CRH is produced in:
Paraventricular Nucleus
Cortisol varies as a function of:
time of day
Short-term actions of ACTH on Adrenal gland
↑blood flow
↑Cholesterol → pregnenolone
↑cortisol
Glucocorticoid effects on carbohydrates:
maintain hepatic glycogen stores
maintain hepatic gluconeogenesis
reduce peripheral glucose utilization
Glucocorticoid effects on lipids:
activate lipolysis
release fatty acids, glycerol
central fat accumulation
Glucocorticoid effects on Protein:
protein loss from muscle
Glucocorticoid effects on Renal function:
Suppress vasopressin release
Na retention
K wasting
hypertension
aldosterone synthase is only found in what cells?
Glomerulosa
Enzyme that catalyzes:
cortisol → cortisone
11β-HSD2
Stimulators of Aldosterone release:
Angiotensin II (via a ↓blood volume)
↑[K]
Levels of renin in primary hyperaldosteronism
decreased
Levels of renin in secondary hyperaldosteronism
increased
clinical manifestations of aldosterone deficiency
hyperkalemia
hyperchloremic acidosis
variable negative Na balance
most common anti-adrenal antibody
21 hydroxylase
Causes of Primary Adrenal Failure
autoimmune adrenalitis
infectious adrenalitis (TB)
bilateral adrenal hemorrhage
Congenital Adrenal Hyperplasia
Drug-Induced
Adrenoleukodystrophy
Cause of Type I Polyglandular Autoimmune Syndrome
AIRE mutation
Features of Type II Polyglandular Autoimmune Syndrome
Autoimmune Adrenalitis
autoimmune thyroid disease (Graves or Hashimoto's)
DM-1
Most common cause of Congenital Adrenal Hyperplasia
absence of 21 Hydroxylase
Result of Congenital Adrenal Hyperplasia
↑DHEA and androstenedione
Most common cause of Secondary adrenal failure
withdrawal of chronic glucocorticoid adminstration
Lab findings in Addison's Disease
↑ACTH
↓Cortisol
only mineralocorticoid replacement drug
fludrocortisone
Presenting features of Cushing's Syndrome
increased weight
new onset hypertension
Diabetes
3 common causes of Cushing's
Pituitary Tumor
Adrenal Tumor
Ectopic ACTH or CRH producing tumor (small cell cancer)
Drugs that block synthesis of cortisol
ketoconazole
aminoglutethimide
action of the PNMT enzyme
convert NE to epinephrine
Syndrome involving pituitary, parathyroid, pancreas
MEN1
Sydrome involving medullary thyroid cancer, pheos, and hyperparathyroidism
Men 2A
Syndrome involving medullary thyroid cancer, pheos, marfanoid habitus, and mucosal neuromas
MEN 2B
causes of Hypercalcemia
Hyperparathyroidism
Malignancy
Sarcoidosis
Milk-alkali
causes of hypocalcemia
Hypoparathyroidism
Vit D Deficiency
Mg Deficiency
Pancreatitis
iodine uptake transporter
sodium-iodide symporter
cause of Osteitis Fibrosa Cystica
Chronic PTH increase
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