Ahangari Phsyio exam 5

Steroid hormone precursor

cholesterol

Amine hormone (thyroid hormones, epinephrine, norepinephrine) precursor

tyrosine

Thyrotropin- releasing hormone (TRH)

stimulates secretion of TSH and prolactin

Corticotropin- releasing hormone (CRH)

stimulates secretion of ACTH

Gonadotropin- releasing hormone (GnRH)

stimulates secretion of LH and FSH

Thyroid- stimulating hormone (TSH)

stimulates synthesis and secretion of thyroid hormone

Follicle- stimulating hormone (FSH)

stimulates growth of ovarian follicles and estrogen secretion; promotes sperm maturation

Luteinizing hormone (LH)

stimulates ovulation, formation of corpus luteum, and synthesis of estrogen and progesterone (in ovary); stimulates synthesis and secretion of testosterone (in testes)

Growth hormone (GH)

stimulates protein synthesis and overall growth

Prolactin (PL)

stimulates milk production and breast development

Adrenocorticotropic hormone (ACTH)

stimulates synthesis and secretion of adrenal cortical hormones (Aldosterone, Cortisol, Androgen)

Melanocyte- stimulating hormone (MSH)

stimulates melanin synthesis

Oxytocin

Milk ejection; uterine contraction

Antidiuretic hormone (ADH)

stimulates H20 reabsorption by renal collecting ducts and contraction of arterioles

T3, T4

fetal CNS, bone, and thyroid gland development; stimulates alpha 1 and beta 1 which increases sensitivity for norepinephrine; increases oxygen consumption; regulates body temperature; controls memory and learning in CNS, sleep and gluconeogenesis

Glucocorticoids (cortisol)

stimulates gluconeogenesis; anti-inflammatory; immunosuppressant; appetite; increase BP; inhibits insulin

Estradiol

Growth and development of female reproductive organs; follicular phase of menstrual cycle

Progesterone

Luteal phase of menstruation cycle; prepares endometrium for implantation of fertilized ovum into uterine wall. In pregnancy, maintains uterine lining by preventing menstruation

Testosterone

spermatogenesis; male secondary sex characters

Estrogen

development of sperm (Males); prepare endometrium for regeneration after menstruation; breast development (females)

Parathyroid hormone (PTH)

increases serum [Ca2+]; decreases serum [phosphate]; 1-25-dihydroxycholecalciferol acts on bones for Ca2+ reabsorption

Aldosterone

Increases renal Na+ reabsorption, renal K+ secretion, and renal H+ secretion; vasoconstiction; increase BP

Insulin

Decreases blood glucose, blood amino acid, blood fatty acid

Glucagon

Increase blood glucose

Human Chorionic Gonadotropin (HCG)

First hormone secreted from placenta; Increases estrogen and progesterone synthesis in corpus luteum of pregnancy; controls follicle cells during first trimester; HCG in blood or urine means your pregnant

Protein Hormones

Bind to a cell- surface receptor; precursors are amino acids; Travel freely in blood; Protein hormones acts faster than steroid hormones; hydrophilic

Protein Hormone Examples

GH, Prolactin, PTH, Insulin, ACTH, Glucagon, Somatostatin, Adrenaline

Steroid Hormones

Bind to a Nuclear receptor; precursor is cholesterol; lipophilic or hydrophobic; travel bound to a protein in blood

Steroid Hormone Examples

Vitamin D, T3/T4, sex hormones, Cortisol

G Protein Coupled Receptors (GPCRs)

activated by ligands to form 2nd messengers: Adenylate Cyclase, cAMP, IP3, Phospholipase C; GDP is inactive, GTP is active bound to alpha subunit

Cytokine Receptors

JAK2 (protein) + liganded GH receptor = tyrosine kinase activity.

Ligand- regulated (Guanylyl Cyclase) Receptor

opens a channel, ion influx acts 2nd messenger. Ion influx activates Nitric Oxide Synthase, elevates cGMP levels promoting vasorelaxation

Anterior Pituitary Hormones (FLAT PG)

FSH, LH, ACTH, TSH, Prolactin, GH

Posterior Pituitary Hormones

ADH, Oxytocin (stored)

Hypothalamic Hormones

TRH, Dopamine, GnRH, SOmatostatin, GHRH, Oxytocin and ADH (produced), CRH

MIT + DIT

T3 (more active)

DIT + DIT

T4

Zona glomerulosa

mineralcorticoids, i.e Aldosterone

Zona fasciculata

glucocorticoids, i.e Cortisol

Zona reticularis

sex hormones, i.e androgen, testosterone, estrogen

Hyperthyroidism Symptoms

weightloss, nervousness, headache, sleep disorder, hypertension, cardiovascular disorder, enlarged thyroid called "goiter", sweating, oily skin and hair, big puffy eyes, metabolic rate increases. Differential Diagnosis: No hypernatremia

Grave's Disease (Primary hyperthyroidism)

Antibodies bind to TSH receptors on follicle cells and stimulates follicle cell leading to over production of T3/T4 in blood and decrease in TSH and TRH

Secondary Hyperthyroidism

Increase levels of TRH, TSH, T3/T4

Hyperthyroidism Treatment

Propylthiouracil (inhibits thyroid hormone synthesis by blocking peroxidase)

Thyroidectomy

Propanylol

Anti-thyroid drugs

Primary Hypothyroidism

Occurs directly in thyroid gland; s/s: weight gain, hypotension, bradycardia, motor sensory disorder, sleep disorder, weakness, dry skin/hair. Increase TRH and TSH, decrease T3/T4

Secondary Hypothyroidism

occurs indirectly in hypothalamus or ant. pituitary gland. Decreased TSH, TRH, T3/T4

Treatment: l-thyroxine, throid hormone replacement

Hypothyroidism Causes

Thyroiditis, surgical removal of thyroid, deficiency of Iodide, Cretinism (congenital), decreased TRH or TSH

Addison's Disease (Primary)

Causes: problem to adrenal cortex, i.e irritation, destruction, tumor results in deficiency of Aldosterone, Cortisol, Androgen

s/s: hyponatremia, hyperkalemia, hypoglycemia, hypotension, hair loss (deficiency of androgen), HYPERPIGMENTATION

Addison's Disease (Secondary)

Causes: problem to hypothalamus or ant. pituitary

Differential Diagnosis: No Hyperpigmentation because there are decreased levels of CRH, POMC, ACTH, MSH

POMC

precursor for ACTH, MSH, and Endorphines

Cushing's Syndrome (Primary Hypercortisolism)

Over production of cortex hormones. increased Aldosterone, Cortisol, and Androgen

Cushing's Disease (Secondary Hypercortisolism)

Due to elevated CRH or ACTH. Leads to overproduction of cortisol, also androgen/aldosterone

s/s: Hypertension INFERTILITY, hypernatremia, hypokalemia, fatigue weight gain, hyperglycemia, facial hair on women.

Conn's Disease

HYPERALDOSTERONISM

s/s: hypernatremia, hypokalemia, hypertension

treatment: Spironolactone

chief cells

release PTH

Hyperparathyroidism

s/s: hypercalemia, abnormal extrasystole of myocardium, HR increases, irritated CNS, Osteoporosis

Causes: parathyroid adenoma (benign tumor on parathyroid gland)

Hypoparathyroidism

s/s: hypocalcemia, muscle weakness, vitamin D deficiency

causes: could be from a thyroidectomy, could be congenital

Active form of Vitamin D

1, 25- dihydroxycholecalciferol catalyzed by 1∂- hydroxylase

1∂-hydroxylase activity is increased when:

decrease serum [Ca2+and Phosphate], increase PTH

1, 25- dihydroxycholecalciferol

increases both Ca2+ and phosphate in ECF to mineralize new bone, Increase intestinal and renal Ca2+ and phosphate absorption, increases bone reabsorption

Calcitonin

inhibits bone resorption and can be used to treat hypercalcemia

Follicular Phase (days 0 to 14)

Estradiol levels increase and cause proliferation of the uterus. FSH and LH levels are suppressed. Progesterone levels are low

Ovulation (day 14)

LH levels spike. Ovulation occurs as a result of the estrogen-induced LH spike. Estrogen levels decrease just after ovulation. Cervical mucus increases and becomes more penetrable by sperm

Luteal Phase ( days 14 to 28)

Corpus Luteum begins to develop, and it synthesizes estrogen and progesterone. Secretory activity of the endometrium increase to prepare for fertilized egg. Basal body temperature increases. IF fertilization does not occur, corpus lute regresses and estradiol and progesterone levels decrease abruptly

Secretory Phase

endometrium builds back up

Fertilization

if fertilization occurs, HCG stop corpus luteum from regressing.

corpus luteum

responsible for production of estradiol and progesterone during first trimester

Second and third trimester

progesterone and estradiol are produced by placenta; estradiol is the major placental estrogen

A 41 y/o woman has hypocalcemia, hyperphosphatemia, and decreased urinary phosphate excretion. Injection of PTH causes an increase in urinary cAMP. Diagnosis?

d) Hypoparathyroidism after thyroid surgery

Which of the following Hormones acts on its target tissue by a steroid hormone mechanism of action?

a) Thyroid Hormone

A 38 y/o man who has galactorrhea is found to have a prolactinoma. His physician treats him with bromocriptine, which eliminates the galactorrhea. The basis for the therapeutic action of bromocriptine is that it...?

c) Inhibits prolactin release from the anterior pituitary

Which of the following hormones originates in the anterior pituitary?

e) Thyroid- stimulating hormone (TSH)

Which of the following functions of the Sertoli cells mediates negative feedback control of follicle-stimulating hormone (FSH) secretion

a) Synthesis of inhibin

Which of the following substances is derived from proopiomelsnocortin (POMC)>

a) Adrenocortotropic Hormone (ACTH)

Which of the following inhibits the secretion of Growth Hormone by the Ant. Pituitary?

d) Somatomedins

Selective destruction of the zona glomerulosa of the adrenal cortex would produce a deficiency of which hormone?

a) Aldosterone

Which of the following explains the suppression of lactation during pregnancy?

d) Blood levels of estrogen and progesterone are high

Which step in steroid hormone biosynthesis, if inhibited, blocks the production of all androgenic compounds but does not block the production of glucocorticoids?

d) Testosterone--> estradiol

A 46 y/o woman has hirsutism, hyperglycemia, obesity, muscle wasting, and increased circulating levels of ACTH. The most likely cause of her symptoms is...?

c) Primary overproduction of ACTH (Cushing's disease)

Which of the following decreases the conversion of 25-hydroxycholecalciferol to 1,25-hydroxycholecalciferol?

e) Chronic renal failure

Increased adrenocorticotropic hormone (ACTH) secretion would be expected in patients...?

a) with chronic adrenocorticol insufficiency (Addison's disease)

Which of the following would be expected in a patient with Grave's Disease?

h) Increased triiodothyronine (T3) levels

Blood Levels of which of the following substance is decreased in Grave's disease?

d)TSH

Which of the following hormones acts by IP3-Ca2+ mechanism of action?

e) Gonadotropin- releasing hormone

Which step in steroid hormone biosynthesis is stimulate by ACTH?

a) cholesterol-->pregnenolone

The source of estrogen during the second and third trimester of pregnancy is the...?

g) fetal adrenal gland, fetal liver, and placenta

Which of the following causes increased aldosterone secretion?

a) decreased blood volume

Secretion of oxytocin is increased by...?

b) dilation of cervix

A 61 y/o woman with hyperthyroidism is treated with propylthiouracil. The drug reduces the synthesis of thyroid hormones because it inhibits oxidation of...?

e) Iodide

a 39 y/o man with untreated diabetes mellitus type I is brought to the emergency room. An injection of insulin would be expected to cause an increase in his...?

d) blood pH

Which of the following results from the action of parathyroid hormone (PTH) on the renal tubule?

b) stimulation of phosphate reabsorption in the proximal tubule

Which step in steroid hormone biosynthesis occurs in the accessory sex target tissue of the male and is catalyzed by 5∂-reductase?

e) Testosterone--->dihydrotestosterone

Which of the following pancreatic secretions has a receptor with four subunits, two of which have tyrosine kinase activity?

a) Insulin

A 16 y/o, seemingly normal female is diagnosed with androgen insensitivity disorder. She has never has a menstrual cycle and if found to have a blind- ending vagina; no uterus, cervix, or ovaries; a 46 XY genotype; and intra- abdominal testes. Which of the following characteristics is cause by lack of androgen receptors?

c) Elevated serum testosterone