Unknown 2

USMLE Endocrine
Study online at https://quizlet.com/_33yr8j
1. thyroid development: floor of primitive pharynx

thyroid diverticulum arises from ___ and neck
descends into ___
2. the thyroid, in development, is connect- thyroglossal duct

ed to tongue by ___. what is the fate of normally disappears but may
this structure? persist as pyramidal lobe of thy-
roid
3. what is the normal remnant of the thy- foramen cecum

roglossal duct?
4. most common ectopic thyroid tissue tongue

site
5. thyroglossal duct cyst presents as anterior midline

neck mass that moves with swal-
lowing or protrusion of tongue
(vs. persistent cervical sinus
leading to branchial cleft cyst in
lateral neck)
6. adrenal cortex is derived from what mesoderm

germ layer?
7. adrenal medulla embryologic dericative neural crest
8. adrenal cortex: zona reticularis

layers from innermost to outer zona fasciculata
zona glomerulosa
9. zona glomerulosa: renin-angiotensin

primary regulatory control and secreto- aldosterone
ry products
10. zona reticularis: ACTH, CRH

primary regulatory control and secreto- sex hormones (e.g. androgens)
ry products
11.
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USMLE Endocrine
zona fasciculata: ACTH, CRH
primary regulatory control and secreto- cortisol, sex hormones
ry products
12. endocrine cells of adrenal medulla Chromaffin cells
13. Chromaffin cells: preganglionic sympathetic fibers

primary regulatory control and secreto- catecholamines (epi, NE)
ry products
14. adrenal cortex layers mnemonic "deeper you go, the sweeter it
gets"
GFR corresponds with Salt
(Na+), Sugar (glucocorticoids),
Sex (androgens)
15. pheochromocytoma most common tumor of adrenal

who, where, what (effects) medulla in adults
episodic hypertension
16. neuroblastoma most common tumor of adrenal

who, where, what (effects) medulla in children
rarely causes hypertension
17. anterior pituitary hormones mnemonic B-FLAT:

Basophils: FSH, LH, ACTH, TSH
and
FLAT PiG:
FSH, LH, ACTH, TSH, Prolactin,
GH
18. acidophils of anterior pituitary secrete GH

what hormones? prolactin
19. from where is melanotropin secreted? intermediate lobe of pituitary
20. anterior pituitary is derived from ___ oral ectoderm (Rathke pouch)
21. hormonal subunit common to TSH, LH, alpha

FSH, GH
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USMLE Endocrine
22. hormonal subunit that determines pitu- beta
itary hormone specificity
23. posterior pituitary hormones vasopressin (ADH)

oxytocin
24. site of vasopressin (ADH) synthesis supraoptic nuclei of hypothala-

mus
25. site of oxytocin synthesis paraventricular nuclei of hypo-

thalamus
26. hormones from the hypothalamus are neurophysins (carrier proteins)

transported to the posterior pituitary
via___
27. posterior pituitary is derived from___ neuroectoderm
28. pancreatic islets arise from ___ pancreatic buds
29. pancreatic islet cells: secretion and lo- glucagon

cation peripheral
alpha
30. pancreatic islet cells: secretion and lo- insulin

cation central
beta
31. pancreatic islet cells: secretion and lo- somatostatin

cation interspersed
delta
32. insulin synthesis preproinsulin synth. in

RER--->cleavage of presig-
nal-->proinsulin (stored in se-
cretory granules)--->proinsulin
cleavage--->exocytosis of in-
sulin and C-peptide equally
33.
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USMLE Endocrine
2 conditions in which insulin and C-pep- insulinoma
tide are both increased sulfonylurea use
34. exogenous insulin lacks ___ C-peptide
35. insulin anabolic functions inc glucose transport in skeletal

muscle, adipose tissue
inc glycogen synth, storage
inc triglyceride synth
inc Na+ retention (kidneys)
inc protein synth (muscles)
inc K+, AA uptake by cells
dec glucagon release
36. does insulin cross placenta? glucose? no

yes
37. insulin binding to receptors stimulates... tyrosine kinase activity--->glu-

cose uptake via carrier-mediat-
ed transport into insulin-depen-
dent tissue
and
--->gene transcription
38. insulin-dependent glucose transporters GLUT-4: adipose tissue, striated

muscle
39. insulin and ___ can increase GLUT-4 ex- exercise

pression
40. insulin-independent transporters GLUT-1: RBCs, brain, cornea

GLUT-2 (bidirectional): beta islet
cells, liver, kidney, SI
GLUT-3: brain
GLUT-5 (fructose): spermato-
cytes, GI tract
41. brain's energy source during starvation, ketone bodies

when glucose is not available
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USMLE Endocrine
42. why do RBCs always (only) utilize glu- lack mitochondria for aerobic
cose? metabolism
43. insulin-independent glucose uptake BRICK-L:

mnemonic brain
RBCs
intestine
cornea
kidney
liver
44. insulin regulation: increase insulin

GH, beta2-agonists
45. GH causes ___ resistance insulin
46. insulin regulation by glucose (pathway) glucose enters beta cells--->inc

ATP generated via glucose me-
tabolism--->K+ channels close
(sulfonylurea target)--->beta cell
membrane depolarizes--->volt-
age-gated Ca2+ channels
open--->Ca2+ influx--->stimula-
tion of insulin exocytosis
47. glucagon catabolic function glycogenolysis

gluconeogenesis
lipolysis
ketone production
48. glucagon release: stimulation and inhi- stimulation: hypoglycemia

bition inhibition: insulin, hyper-
glycemia, somatostatin
49. hypothalmic-pituitary hormones: func- inc ACTH, NSH, beta-endorphin

tion and clinical notes: dec in chronic exogenous
CRH steroid use
50. dec prolactin

dopamine antagonists (e.g. an-
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USMLE Endocrine
hypothalmic-pituitary hormones: func- tipsychotics) can cause galact-
tion and clinical notes: orrhea due to hyperprolactine-
dopamine mia
51. hypothalmic-pituitary hormones: func- inc GH

tion and clinical notes: analog (tesamorelin) used to
GHRH treat HIV-associated lipodystro-
phy
52. hypothalmic-pituitary hormones: func- inc LH, FSH

tion and clinical notes: regulated by prolactin
GnRH tonic GnRH suppressed HPA
axis
pulsatile GnRH--->puberty, fer-
tility
53. hypothalmic-pituitary hormones: func- dec GnRH

tion and clinical notes: pituitary prolactinoma--->amen-
prolactin orrhea, osteoporosis, hypogo-
nadism, galactorrhea
54. hypothalmic-pituitary hormones: func- dec GH, TSH

tion and clinical notes: analogs used to treat
somatostatin acromegaly
55. hypothalmic-pituitary hormones: func- inc TSH, prolactin

tion and clinical notes:
TRH
56. prolactin source mainly anterior pituitary
57. prolactin function stimulation of milk production

ovulation, spermatogenesis inhi-
bition
(GnRH synth/release inhibition)
58. excessive prolactin is associated with libido

dec ___
59.
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USMLE Endocrine
prolactin secretion from ant. pit. is toni- dopamine
cally inhibited by ___ from ____ hypothalamus
60. how does prolactin inhibit its own secre- inc dopamine synthesis and se-
tion? cretion from hypothalamus
61. effect of TRH on prolactin secretion increase

(e.g. in primary or secondary hy-
pothyroidism)
62. effect of dopamine agonists (e.g. inhibit

bromocriptine) on prolactin secretion can be used to treat prolactino-
ma
63. effect of dopamine antagonisms (e.g. stimulation

most antipsychotics) and estrogens
(e.g. OCPs, pregnancy) on prolactin se-
cretion
64. somatotropin is aka GH
65. GH source ant. pit.
66. GH function stimulates linear growth and

muscle mass via IGF-1 (so-
matomedin C)
inc. insulin resistance (diabeto-
genic)
67. GHRH stimulates ___ pulsatile release of GH from ant.

pit.
68. secretion of GH ___ during exercise and inc

sleep
69. inhibitors of GH secretion glucose

somatostatin release
(via negative feedback by so-
matomedin)
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USMLE Endocrine
70. excess secretion of GH (e.g. pituitary acromegaly
adenoma) causes what in adults? in chil- gigantism
dren?
71. ghrelin function stimulates hunger (orexigenic

effect) and GH release (via GH
secretagog receptor
72. ghrelin production location stomach
73. 2 causes of increased ghrelin produc- sleep loss

tion Prader-Willi syndrome
74. leptin function satiety hormone

dec during starvation
75. where is leptin produced? adipose tissue
76. effect of sleep deprivation on leptin pro- decreased

duction
77. mutation of leptin gene is associated congenital obesity

with what?
78. andocanabinoids function stimulate cortical reward cen-

ters--->inc desire for high-fat
foods
79. ADH source synthesized in supraoptic nuclei

of hypothalamus
released by post. pit.
80. ADH function primary function: dec serum os-

molarity, inc urine osmolarity
(V2 receptors) via regulation of
aquiporin channel insertion in
principal cells of CD
secondary: regulation of BP (V1
receptors)
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USMLE Endocrine
81. ADH levels in central diabetes insipidus dec
(DI)? nephrogenic DI? inc
82. nephrogenic DI can be caused by a mu- V2

tation in what receptor?
83. desmopressin acetate is a ___ analog ADH

and is used to treat ___ central DI
84. adrenal steroids and congenital adrenal + ACTH

hyperplasia: - ketoconazole
+ and - regulator of cholesterol desmo-
lase
85. adrenal steroids and congenital adrenal cholesterol desmolase

hyperplasia: zona glomerulosa
enzyme and location:
cholesterol--->pregnenolone
86. products of zona glomerulosa mineralcorticoids
87. products of zona fasciculata glucocorticoids
88. products of zona reticularis androgens
89. adrenal steroids and congenital adrenal 3beta hydroxysteroid dehydro-

hyperplasia: genase
enzyme and location: zona gomerulosa
pregnenolone--->progesterone
90. adrenal steroids and congenital adrenal 21-hydroxylase

progesterone--->11-deoxycorticos-
terone
91. adrenal steroids and congenital adrenal 11-beta-hydroxylase

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USMLE Endocrine
11-deoxycorticosterone--->corticos-
terone
92. adrenal steroids and congenital adrenal aldosterone synthase

corticosterone--->aldosterone
93. + regulator of aldosterone synthase angiotensin II
94. adrenal steroids and congenital adrenal 17-alpha-hydroxylase

hyperplasia: glomerulosa--->fasciculata
pregnenolone--->17-hydroxypre-
nenolone
95. adrenal steroids and congenital adrenal 17-alpha-hydroxylase

hyperplasia: glomerulosa--->fasciculata
progesterone--->17-hydroxyproges-
terone
96. adrenal steroids and congenital adrenal 3beta-hyroxysteroid dehydroge-

hyperplasia: nase
enzyme and location: zona fasciculata
17-hydroxypregnenolone--->17-hydrox-
yprogesterone
97. adrenal steroids and congenital adrenal 21-hydroxylase

hyperplasia: zona fasciculata
17-hyroxyprogesterone--->11-deoxycor-
tisol
98. adrenal steroids and congenital adrenal 11beta-hydroxylase

hyperplasia: zona fasciculata
11-deoxycortisol--->cortisol
99. fasciculata--->reticularis
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USMLE Endocrine
adrenal steroids and congenital adrenal
hyperplasia:
12-hydroxypregnenolone--->dehy-
droepiandrosterone (DHEA)
100. adrenal steroids and congenital adrenal fasciculata--->reticularis

hyperplasia:
17-hydroxyprogesterone--->androstene-
dione
101. adrenal steroids and congenital adrenal 3beta-hydroxysteroid dehydro-

hyperplasia: genase
enzyme and location: zona reticularis
DHEA--->androstenedione
102. adrenal steroids and congenital adrenal zona reticularis

hyperplasia:
androstenedione--->testosterone
103. adrenal steroids and congenital adrenal aromatase

hyperplasia: zona reticularis--->peripheral
enzyme and location: tissues
androstenedione--->estrone
104. adrenal steroids and congenital adrenal aromatase

testosterone--->estradiol
105. adrenal steroids and congenital adrenal 5-alpha-reductase

testosterone--->dihydrotestosterone
(DHT)
106.
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USMLE Endocrine
all congenital adrenal enzyme deficien- both adrenal glands
cies are characterized by enlargement of inc ACTH stimulation (due to dec
___ due to ___ cortisol_
107. adrenal enzyme deficiencies: 17-al- inc

pha-hydroxylase:
mineralocorticoids
108. adrenal enzyme deficiencies: 17-al- dec

pha-hydroxylase
cortisol

pha-hydroxylase
sex hormones
110. adrenal enzyme deficiencies: 17-al- inc

pha-hydroxylase
BP

pha-hydroxylase
[K+]
112. adrenal enzyme deficiencies: 17-al- dec androstenedione

pha-hydroxylase
labs
113. adrenal enzyme deficiencies: 17-al- XY: pseudohermaphrodism (am-

pha-hydroxylase biguous genitalia, undescended
presentation testes)
XX: lack secondary sexual de-
velopment
114. adrenal enzyme deficiencies: 21-hydrox- dec

ylase
mineralocorticoids
115. dec
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USMLE Endocrine
adrenal enzyme deficiencies: 21-hydrox-
ylase
cortisol
116. adrenal enzyme deficiencies: 21-hydrox- inc

ylase
sex hormones
117. adrenal enzyme deficiencies: 21-hydrox- dec

ylase
BP
118. adrenal enzyme deficiencies: 21-hydrox- inc

ylase
[K+]
119. adrenal enzyme deficiencies: 21-hydrox- inc renin activity

ylase inc 17-hydroxyprogesterone
labs
120. adrenal enzyme deficiencies: 21-hydrox- most common adrenal enzyme

ylase deficiency
presentation presents in infancy (salt wasting)
or childhood (precocious puber-
ty)
XX: virilization
121. adrenal enzyme deficiencies: dec aldosterone

11-beta-hydroxylase inc 11-deoxycorticosterone (re-
mienralocorticoids sult: inc BP)
122. adrenal enzyme deficiencies: dec

11-beta-hydroxylase
cortisol
123. adrenal enzyme deficiencies: inc

11-beta-hydroxylase
sex hormones
124. inc
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USMLE Endocrine
adrenal enzyme deficiencies:
11-beta-hydroxylase
BP
125. adrenal enzyme deficiencies: dec

11-beta-hydroxylase
[K+]
126. adrenal enzyme deficiencies: dec renin activity

11-beta-hydroxylase
labs
127. adrenal enzyme deficiencies: XX: virilization

11-beta-hydroxylase
presentation
128. cortisol adrenal zona fasciculata

source bound to corticosteroid-binding
globulin
129. cortisol BIG FIB:

function inc BP
inc Insulin resistance (diabeto-
genic)
dec Glucogenesis, lipolysis, pro-
teolysis
dec Fibroblast activity (causing
striae)
dec Inflammatory, Immune re-
sponses
dec Bone formation (dec os-
teoblast activity)
130. how does cortisol inc BP? upregulates alpha1 receptors

on arterioles--->inc sensitivity to
NE, epi
at high conc. can bind to min-
eralocorticoid (aldosterone) re-
ceptors
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USMLE Endocrine
131. how does cortisol dec inflammatory and inhibits production of
immune responses? leukotrienes, prostaglandins
inhibits WBC adhesion--->neu-
trophilia
blocks histamine release from
mast cells
reduces eosinophils
blocks IL-2 production
132. exogenous corticosteroids can cause TB

reactivation of ___ and ___ by blocking candidiasis
IL-2 production
133. cortisol regulation: CRH (hypothalamus)--->ACTH

stimulation release (pit)--->cortisol produc-
tion in z. fasciculata
134. excess cortisol causes what to happen dec

to CRH? (= dec ACTH = dec cortisol se-
cretion)
135. chronic stress does what to cortisol se- induces prolonged secretion
cretion?
136. 3 forms of plasma calcium ionized (45%)

bound to albumin (40%)
bound to anions (15%)
137. affect of inc plasma pH on Ca2+ in plas- inc affinity of albumin

ma for Ca2+ (inc nega-
tive charge)--->hypocalcemia
(cramps, pain, parasthesias,
carpopedal spasm)
138. Vit D source D3 from sun exposure in skin

D2 ingested from plants
139. vit D3 and D2 are both converted to ___ 25-OH (liver)

in liver and ___ in kindey 1,25-OH2 (active form; kidney)
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USMLE Endocrine
140. Vit D deficiency causes what in kids? rickets
adults? osteomlacia
(malabsorption, dec sunlight,
poor diet, chronic kidney failure)
141. Vit D function inc absorption of dietary Ca2+

and phosphate
inc bone reabsorption--->inc
Ca2+ and phosphate
142. Vit D regulation: inc PTH = dec [Ca2+], dec phos-

PTH effect phate--->inc 1,25OH2 produc-
tion
143. Vit D regulation: feedback inhibition on its own

effect of 1,25-OH2 production
144. 24,25-OH2 D3 inactive form of vit D
145. effect of PTH in kidney inc Ca2+ and dec phosphate re-
absorption
146. effect of 1,25-OH2 in gut inc Ca2+ and phosphate ab-

sorption
147. calcium and phosphate homeostasis

diagram
148. PTH source chief cells of parathyroid
149. PTH function inc bone reabsorption of Ca and

Ph
inc kidney reab. of Ca in DCT
dec kindey reab. of Ph on PCT
inc 1,25-OH2 D3 (calcitriol) pro-
duction (by stimulating kidney
1alpha-hydroxylase in PCT)
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USMLE Endocrine
inc macrophage CSF and
RANK-L
150. RANK-L receptor activator of NF-KB lig-

and)
151. RANK-L (ligand) is secreted by___ and osteoblasts

____ binds RANK (receptor) on ___ and octeocytes
their precursors to stimulate ___ and inc osteoclasts
Ca2+ osteoclasts
152. intermittent PTH release can stimulate bone formation

___
153. PTH-related peptide (PTHrP) function functions like PTH

and when increased increased in many malignancies
154. PTH regulation: inc PTH secretion

dec serium Ca2+ =

inc serum phosphate =

dec serum Mg2+ =
157. PTH regulation: dec PTH production

big dec serum Mg2+ =
158. common causes of Mg2+ decrease diarrhea

aminoglycosides
diuretics
alcohol abuse
159. calcitonin source parafollicular (C) cells of thyroid
160. calcitonin function dec bone reabsorption of Ca2+

opposes actions of PTH
not important in normal Ca2+
homeostasis
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USMLE Endocrine
161. calcitonin regulation: calcitonin secretion
inc serum Ca2+ =
162. signaling pathways of endocrine hor- FLAT ChAMP:

mones: FSH
cAMP LH
ACTH
TSH
CRH
hCG
ADH (V2 receptor)
MSH
PTH
calcitonin
GHRH
glucagon
163. signaling pathways of endocrine hor- (think vasodilators)

mones: ANP
cGMP BNP
NO
(EDRF)
164. signaling pathways of endocrine hor- GOAT HAG:

mones: GnRH
IP3 Oxytocin
ADH (V1 receptor)
TRH
Histamine (H1 receptor)
Angiotensin II
Gastrin
165. signaling pathways of endocrine hor- VETTT CAP:

mones: Vit D
intracellular receptor Estrogen
Testosterone
T3/T4
Cortisol
Aldosterone
Progesterone
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USMLE Endocrine
166. signaling pathways of endocrine hor- insulin

mones: IGF-1
intrinsic tyrosine kinase FGF
PDGF
EGF
(think growth factors; MAP ki-
nase pathway)
167. signaling pathways of endocrine hor- PIGGlET:

mones: Prolactin
receptor-associated tyrosine kinase Immunomodulators (e.g. cy-
tokines, IL-2, IL-6, IFN)
GH
G-CSF
Erythropoietin
Thrombopoietin
168. signaling pathway of steroid hormones

diagram
169. how to steroid hormones circulate? are lipophilic, so must be bound

to specific binding globulins to
inc their solubility
170. men: inc ____-binding globulin (SHBG) sex hormone

lowers free ___--->gynecomastia testosterone
171. in women: dec ____ raises free testos- SHBG

terone, resulting in ____ hirstutism
172. OCPs, pregnancy ____ SHBG levels; SHBG

free estrogen levels remain ____ unchanged
173. T3/T4 functions control body's metabolic rate
174. thyroid hormone source follicles of thyroid

most T3 formed in target tissues
175. T3 functions
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USMLE Endocrine
4 B's:
Brain (CNS) maturation
Bone growth
Beta-adrenergic effects
Basal metabolic rate inc
(inc glycogenolysis, gluconeo-
genesis, lipolysis)
176. the bone growth stimulation of thyroid GH

hormones is a result of synergy with
what other hormone?
177. thyroid hormone action on heart inc beta1 receptors in heart--->

inc CO
inc HR
inc SV
inc contractility
178. how does T3 increase basal metabolic inc NA+/K+ ATPase activi-
rate? ty--->inc O2 consumption, RR,
body temp
179. what binds most T3/T4 in blood and ren- thyroxine-binding globulin (TBG)
ders it inactive? only free hormone is active
180. what results in dec. TBG? hepatic failure

steroids
181. what results in inc. TBG? pergnancy

OCP use
(inc estrogen = inc TBG)
182. enzyme that converts T4 (the major thy- 5'-deiodinase

roid product) to T3 in peripheral tissue?
183. does nuclear receptor have greater affin- T3

ity for T3 or T4?
184. what enzyme is responsible for oxida- peroxidase

tion and organification of iodine, as well
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USMLE Endocrine
as coupling of monoiodotyrosine (MIT)
to di-iodotyrosine (DIT)?
185. what inhibits both peroxidase and propylthiouracil

5'-deiodinase?
186. methimazole inhibits peroxidase in what oxidation and organification of

pathway? iodine, as well as coupling
of monoiodotyrosine (MIT) to
di-iodotyrosine (DIT)
187. thyroid hormone regulation TRH (hypothalamus)-->TSH (pi-

(+) tuitary)-->stimulation of follicular
cells of thyroid
188. thyroid hormone regulation free T3/T4--->acts on ant pit to

(-) dec sensitivity to TRH
189. thyroid-stimulating Igs (e.g. TSH) stimu- Graves disease

late follicular cells in what diseases (an
example)?
190. Wolff-Chaikoff effect excess iodine temporarily in-

hibits thyroid peroxidase--->
dec iodine organification--->dec
T3/T4 production
191. anions that have a negative regulatory perchlorate

effect on iodine oxidation to I2 in the pertechnetate
thyroid thiocyanate
192. Cushing syndrome inc cortisol due to variety of

etiology causes:
1. exogenous corticosteroids
2. primary adrenal adenoma, hy-
perplasia, carcinoma
3. pseudohyperaldosteronism
4. ACTH-secreting pituitary ade-
noma (Cushing disease)
5. paraneoplastic ACTH secre-
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USMLE Endocrine
tion (e.g. small cell lung cancer,
bronchial carcinoids)
193. what is responsible for the majority Cushing disease (ACTH-secret-

of endogenous cases of Cushing syn- ing pituitary adenoma)
drome?
194. how do exogenous corticosteroids dec ACTH, bilateral adremal at-

cause Cushing syndrome? rophy
195. most common cause of Cushing syn- exogenous corticosteroids

drome
196. how do primary adrenal ademona, hy- dec ACTH-->atrophy of unin-

perplasia, carcinoma, and pseudohy- volved adrenal gland
peraldosteronism cause Cushing syn-
drome?
197. how do Cushing disease (ACTH-secret- inc ACTH--->bilateral adrenal

ing pituitary adenoma) and paraneo- hyperplasia
plastic ACTH secretion result in Cush-
ing syndrome?
198. Cushing syndrome findings hypertension

weight gain
moon facies
truncal obesity
buffalo hum
skin changes (thinning, striae)
osteoporosis
hyperglycemia (insulin resis-
tance)
amenorrhea
immunosuppression
199. Cushing syndrome diagnosis: inc free cortisol on 24-hr urinaly-

screening tests sis
inc midnight salivary cortisol
no suppression with overnight
low-dose dexamethasone test
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USMLE Endocrine
200. Cushing syndrome diagnosis: adrenal tumor

what to suspect if ACTH is dec
201. Cushing syndrome diagnosis: Cushing disease or ectopic

what to suspect if ACTH is inc ACTH secretion
202. tests used to distinguish Cushing dis- 1. high-dose (8mg) dexametha-

ease from ectopic ACTH secretion sone suppression test
2. CRH stimulation test
203. Cushing syndrome diagnosis: ectopic ACTH secretion

if ACTH is not decreased with high-dose (source is resistant to negative
(8mg) dexamethasone test___ feedback)
204. Cushing syndrome diagnosis: ectopic ACTH secretion

if ACTH is not increased with CRH stim- (pituitary ACTH is suppressed)
ulation test ___
205. adrenal insufficiency inability of adrenal glands to

generate enough mineralo- +/-
glucocorticoids
206. adrenal insufficiency symptoms weakness

fatigue
orthostatic hypotension
muscle aches
weight loss
GI disurbances
sugar and/or salt cravings
207. adrenal insufficiency diagnosis measurement of serum elec-

trolytes
morning/random serum cortisol
and ACTH
response to ACTH stimulation
test
208. metyrapone stimulation test for adrenal insufficiency diagno-

sis
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USMLE Endocrine
metyrapone blocks last step of
cortisol synthesis (11-deoxycor-
tisol-->cortisol)
normal: dec cortisol, compen-
satory inc ACTH
+: ACTH remains dec after test
209. primary adrenal insufficiency loss of gland function =

dec aldosterone and cor-
tisol--->hypotension (hypona-
tremic vol contraction), hy-
perkalemia, metabolic acido-
sis, skin/mucosal hyperpigmen-
tation
210. what causes hyperpigmentation of MSH, a byproduct of inc ACTH

skin/mucosa in primary adrenal insuffi- production from pro-opiome-
ciency? lanocortin
211. primary adrenal insufficiency sudden onset (e.g. due to mas-

acture sive hemorrhage)
may present with sock and acute
adrenal crisis
212. primary adrenal insufficiency autoimmunity

most common cause in Western worls esp. associated with autoim-
mune polyglandular syndromes
213. primary adrenal insufficiency aka - Addison disease

chronic
214. Addison disease chronic primary adrenal insuffi-

ciency
due to adrenal atrophy or de-
struction due to disease (e.g. au-
toimmune, TB, metastasis)
215. Waterhouse-Friderichsen syndrome acute primary adrenal insuffi-

ciency due to adrenal hem-
orrhage associated with sep-
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USMLE Endocrine
ticemia (usually N. meningitidis),
DIC, endotoxic shock
216. secondary adrenal insufficiency dec pituitary ACTH production

no skin/mucosal hyperpigmen-
tation
no hyperkalemia (aldosterone
synthesis preserved)
217. tertiary adrenal insufficiency in patients with chronic exoge-

nous steroid use, precipitated by
abrupt withdrawal
aldosterone synthesis unaffect-
ed
218. neuroblastoma most common adrenal tumor in

children <4yo
originates in neural crest cells
Homer-Wright rosettes charac-
teristic
occurs anywhere along sympa-
thetic chain
219. neuroblastoma presentation abdominal distension with firm,

irregular mass that can cross
midline (vs. Wilms tumor -
smooth and unilateral)
opsoclonus-myoclonus syn-
drome (dancing eyes-dancing
feet)
bombesin and neuron-specific
enolase +
220. there is an increased presence of what 1. homovanillic acid (HVA; prod-

in urine associated with a neuroblas- uct of dopamine breakdown)
toma? 2. vanillylmandelic acid (VMA);
NE breaskdown product)
221. neuroblastoma is associated with over- N-myc oncogene

expression of what gene?
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USMLE Endocrine
222. neuroblastoma is associated with de- hypertension

creased likelihood to develop what?
223. pheochromocytoma most common tumor of adrenal

etiology gland in adults
derived from chromaffin cells
(arise from neural crest)
rule of 10s
224. pheochromocytoma 10% malignant

etiology: rule of 10s 10% bilateral
10% extra-adrenal
10% calcify
10% kids
225. pheochromocytoma most tumors secrete epi, NE,

symptoms dopamine-->episodic hyperten-
sion
associated with neurofibromato-
sis type 1, von Hippel Lindau dis-
ease, MEN 2a,2B,
symptoms occur in spells
episodic hyperadrenergic symp-
toms
226. pheochromocytoma 5 Ps:

episodic hyperadrenergic symptoms Pressure (in BP)
Pain (headache)
Perspiration
Palpitations (tachycardia)
Pallor
227. pheochromocytoma inc catecholamines and

findings metanephrines in urine and
plasma
228. pheochromocytoma irreversible alpha-agonists (e.g.

treatment phenoxybenzamine) followed by
beta-blockers prior to tumor re-
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USMLE Endocrine
section
(must be alpha then beta to
avoid hypertensive crisis)
229. hypothyroidism cold intolerance (dec heat pro-

signs/symptoms duction)
weight gain, dec appetite
hypoactivity, lethargy, fatigue,
weakness
constipation
dec reflexes
myxedema (facial, periorbital)
dry, cool skin; coarse, brittle hair
bradycardia, dyspnea on exer-
tion
230. hypothyroidism inc TSH (sensitive test for prima-

lab findings ry hypothyroidism)
dec free T3, T4
hypercholesterolemia (dec LDL
receptor expression)
231. hyperthyroidism heat intolerance (inc heat pro-

signs/symptoms duction)
weight loss, inc appetite
hyperactivity
diarrhea
inc reflexes
pretibial myxedema (Graves dis-
ease); periorbital edema
warm, moist skin; fine hair
chest pain, palpitations, arrhyth-
mias
inc #/sensitivity of beta-adrener-
gic receptors
232. hyperthyroidism dec TSH (if primary)

lab findings inc free or total T3, T4
hypocholesterolemia (inc LDL
receptor expression)
27 / 52
USMLE Endocrine
233. hypothyroidism: Hashimoto thyroiditis most common cause of hypothy-

roidism in iodine-deficient re-
gions
autoimmune (anti-thyroid perox-
idase, antimicrosomal, antithy-
roglobulin Abs)
associated with HLA-DR5 and
inc risk non-Hodgkin lymphoma
may be hyperthyroid early due
to thyrotoxicosis during follicular
rupture
234. hypothyroidism: Hashimoto thyroiditis Hurthle cells

histologic findings lymphoid aggregate with germi-
nal centers
235. hypothyroidism: Hashimoto thyroiditis moderately enlarged, nontender

findings thyroid
236. hypothyroidism: congenital (cretinism) severe fetal hypothyroidism due

to maternal hyperthyroidism,
thyroid agenesis, thyroid dysge-
nesis (most common cause in
US), I deficiency, dyshormono-
genetic disorder
237. hypothyroidism: congenital (cretinism) 6 P's:

findings Pot-bellied
Pale
Puffy-faced child
Protruding umbilicus
Protuberant tongue
Poor brain development
238. hypothyroidism: subacute thyroiditis self-limiting

(de Quervain) follows flu-like illness
may be hyperthyroid early in
course
28 / 52
USMLE Endocrine
239. hypothyroidism: subacute thyroiditis granulomatous inflammation
(de Quervain)
histology
240. hypothyroidism: subacute thyroiditis inc ESR

(de Quervain) jaw pain
findings early inflammation
tender thyroid
241. hypothyroidism: Riedel thyroiditis thyroid replaced by fibrous tis-

sue (hypothyroid), which may ex-
tend to local structures (e.g. air-
way)
mimics anaplastic carcinoma
is a manifestation of
IgG4-related systemic disease
(e.g. autoimmune pancreatitis,
retroperitoneal fibrosis, nonin-
fectious aortitis)
242. hypothyroidism: Riedel thyroiditis fixed, hard (rock-like), painless

findings goiter
243. hypothyroidism: other causes iodine insufficiency

goitrogens
Wolff-Chaikoff effect (thyroid
gland downregulation due to inc
iodine)
244. hyperthyroidism: most common cause Graves disease
245. hypertyroidism: Graves disease IgG stimulates TSH receptors

on...
1. thyroid (hyperthyroidism and
diffuse goiter)
2. retro-orbital fibroblasts (ex-
ophthalmos proptosis, extraocu-
lar muscle swelling)
3. dermal fibroblasts 9pretibial
myxedema)
29 / 52
USMLE Endocrine
often presents during stress
(e.g. childbirth)
246. hyperthyroidism: toxic multinodular hoi- focal patches of hyperfunction-

ter ing follicular cells working in-
depenedently of TSH (mutated
TSH receptor)
inc T3, T4 release
hot nodules are rarely malignant
247. hyperthyroidism: thyroid storm stress-induced catecholamine

surge as serious complication
of thyrotoxicosis due to disease
and o/ hyperthyroid disorders
248. thyroid storm presentation agitation

delirium
fever
diarrhea
coma
tachyarrhythmia (cause of
death)
inc ALP due to inc bone turnover
249. thyroid storm treatment 3 P's:

beta-blockers (e.g. Propranolol)
Propylthiouracil
corticosteroids (e.g. Prenisone)
250. hyperthyroidism: Jod-Basedow phe- thyrotoxicosis if patient with io-

nomenon dine defiency goiter is made io-
dine replete
251. thyroidectomy is an option for___ thyroid cancer and hyperthy-

roidism
252. complications of thyroidectomy hoarseness (recurrent laryngeal

nerve damage)
hypocalcemia (parathyroid
gland removal)
30 / 52
USMLE Endocrine
transection of recurrent and su-
perior laryngeal nerves (during
ligation of inferior thyroid artery
and superior laryngeal artery, re-
spectively)
253. papillary carcinoma most common thyroid cancer;

excellent prognosis
empty-appearing nuclei with
central clearing (Orphan Annie
eyes)
psammoma bodies
nuclear grooves
lymphatic invasion common
inc risk w/ childhood radiation,
RET and BRAF mutations
254. follicular carcinoma thyroid cancer w/ excellent prog-

nosis
invades capsule (unlike follicular
adenoma)
uniform follicles
255. medullary carcinoma a thyroid cancer

from parafollicular "C"
cells--->produces calcitonin,
sheets of cells in an amyloid
stroma
hematogenous spread common
associated with MEN 2A and 2B
(RET mutations)
256. undifferentiated/aplastic carcinoma of older patients

thyroid local structures
very poor prognosis
257. lymphoma of thyroid associated with Hashimoto thy-

roiditis
258.
31 / 52
USMLE Endocrine
hypoparathyroidism
diagram
259. hypoparathyroidism causes accidental surgical excision

autoimmune destruction
DiGeorge syndrome
260. hypoparathyroidism findings hypocalcemia

tetany
Chvostek sign
Trousseau sign
261. Chvostek sign tapping facial nerve (tap Cheek)

-->facial muscle contraction
262. Trousseau sign occlusion of brachial artery with

BP cuff--->carpal spasm
263. pseudohypoparathyroidism aka - Albright hereditary os-

teodystrophy
unresponsiveness to kidney
PTH
hypocalcemia, shortened
4th/5th digits, short stature
AD
264. familial hypocalciuric hypercalcemia defective Ca2+-sensing recep-

tor on parathyroid cells
PTH cannot be suppressed
by inc [Ca2+]---->mild hypercal-
cemia with normal/inc PTH lev-
els
265. PTH and Ca2+ pathologies: hypoparathyroidism

low calcium, low PTH
266.
32 / 52
USMLE Endocrine
PTH and Ca2+ pathologies: secondary hyperparathyroidism
low calcium, high PTH (Vit D deficiency, chronic renal
failure)
267. PTH and Ca2+ pathologies: PTH-independent hypercal-

high calcium, low PTH cemia
(excess Ca2+ ingestion, cancer)
268. PTH and Ca2+ pathologies: primary hyperparathyroidism

high calcium, high PTH (hyperplasia, adenoma, carcino-
ma)
269. hyperparathyroidism: primary parathyroid adenoma or hyper-

causes plasia
270. hyperparathyroidism: primary hypercalcemia

presentation hypercalciuria (renal stones)
hypophosphatemia
inc PTH
inc ALP
inc cAMP in urine
weakness and constipation
abdominal/flank pain (kidney
stones, acute pancreatitis)
depression
271. osteoitis fibrosa cystica cystic bone spaces filled with fi-
brous brown tissue
("brown tumor of deposited he-
mosiderin from hemorrhages;
bone pain)
associated with primary hyper-
parathyroidism
272. hyperparathyroidism: secondary secondary hyperplasia due to

causes dec Ca2+ absorption or inc
phosphate
Add... most often chronic renal dis-
ease (causes hypovitaminosis
D-->dec Ca2+ absorption)
33 / 52
USMLE Endocrine
273. hyperparathyroidism: secondary hypocalcemia

presentation hyperphosphatemia in chronic
renal failure (hypophasphatemia
in most other causes)
inc ALP
inc PTH
274. renal osteodystrophy one lesions due to secondary

or tertiary hyperparathyroidism
(mainly due, in turn, to renal dis-
ease)
275. pituitary adenoma most commonly benign prolac-

toma
adenoma may be hormone-pro-
ducing (functional) or silent
(non-functional)
276. presentation of nonfunctional tumors mass effect (bitemporal

associated with pituitary adenoma hemianopia, hypopituitarism,
headache)
277. presentation of functional tumors asso- based on hormone produced,

ciated with pituitary adenoma e.g.:
1. prolactinoma: amenorrhea,
galactorrhea, low libido, infertility
2. somatotropic adenoma:
acromegaly
278. hyperparathyroidism: tertiary refractory (autonomous)

resulting from chronic renal dis-
ease
big inc PTH
inc Ca2+
279. acromegaly excess GH in adults
280. gigantism excess H in children

inc linear bone growth
34 / 52
USMLE Endocrine
281. most common cause of death associat- HF

ed with gigantism
282. acromegaly large tongue with deep furrows

findings deep voice
large hands, feet
coarse facial features
impaired glucose toelrance (in-
sulin resistance)
increased risk colorectal polyps,
cancer
283. acromegaly inc serum IGF-1

diagnosis failure to suppress serum GH
following oral glucose tolerance
test
pituitary mass on brain MRI
284. acromegaly resection of pituitary adenoma

treatment of not cured: octreotide (somato-
statin analog) or pegvisomant
(GH receptor antagonist)
285. diabetes insipidus characteristics intense thirst

polyuria
inability to concentrate urine
lack of ADH (central) or failure
to respond to circulating ADH
(nephrogenic)
286. central DI: pituitary tumor

etiology autoimmune
trauma
surgery
ischemic encephalopathy
idiopathic
287. central DI: dec ADH

findings urine SG < 1.006
35 / 52
USMLE Endocrine
serum osmolality: >290
mOsm/kg
hyperosmotic volume contrac-
tion
288. central DI: >50% inc in urine osmolality only

water deprivation test after ADH analog administration
289. central DI: intranasla desmopressin ac-

treatment etate
hydration
290. water deprivation test for diagnosis of DI

no water intake 2-3 hours fol-
lowed by hourly measurements
of uring vol/oslmolarity and plas-
ma Na+ conc. and osmolarity
if normal values are not clearly
reached: administer ADH analog
(desmopressin acetate)
291. nephrogenic DI: hereditary (ADH receptor muta-

etiology tion)
secondary to hypercalcemia,
lithium, demeclocycline (ADH
antagonist)
292. nephrogenic DI: normal ADH levels

findings urine SG< 1.006
serum osmolality > 290
mOsm/kg
hyperosmotic volume contrac-
tion
293. nephrogenic DI: minimal change in urine osmo-

water deprivation test lality, even after administration of
ADH analog
294. nephrogenic DI: HCTZ, indomethacin, amiloride

treatment hydration
36 / 52
USMLE Endocrine
295. SIADH syndrome of inappropriate ADH

secretion:
excessive water retention
euvolemic hyponatremia with
continued urinary Na+ excretion
urine osmolality > serum osmo-
lality
296. SIADH causes extopic ADH (e.g. small cell lung

cancer)
CNS disorders/head trauma
pulmonary disease
drugs (e.g. cyclophosphamide)
297. SIADH treatment fluid restriction

IV hypertonic saline
conivaptan
tolvaptan
demeclocycline
298. SIADH: dec aldosterone (hyponatremia)

body response to the abnormal ADH se- to maintain near-normal volume
cretion and consequences of response --->cerebral edema, seizures
299. SIADH slowly

correct slowly or quickly? why? need to prevent osmotic de-
myelination syndrome (aka cen-
tral pontine myelinosis)
300. hypopituitarism causes nonsecreting pituitary adenoma

craniopharyngioma
Sheehan syndrome
Empty Sella syndrome
Pituitry Apoplexy
brain injury
radiation
301. hypopituitarism treatment hormone replacement therapy:

corticosteroids
37 / 52
USMLE Endocrine
thyroxine
sex steroids
human GH
302. Sheehan syndome ischemic infarct of pituitary fol-

lowing postpartum bleeding
failure to lactate, absent men-
struation, cold intolerance
(cause of hypopituitarism)
303. empty sella syndrome atrophy or compression of pitu-

itary
often idiopathic
common in obese women
304. pituitary apoplexy sudden hemorrhage of pituitary,

often in presence of existing pi-
tuitary adenoma
305. acute manifestations of diabetes melli-

tus
diagram
306. maifestations of diabetes mellitus polydipsia

polyuria
polyphagia
weight loss
DKA (type I)
hyperosmolar coma (type 2)
rarely: unopposed GH and epi
secretion
307. what two conditions may cause unop- diabetes mellitus (rarely)
posed secretion of GH and epi? glucocorticoid therapy (steroid
diabetes)
308. 1. small vessel disease

--->retinopathy (hemorrhage,
38 / 52
USMLE Endocrine
chronic complications of diabetes melli- exudates, microaneurysms, ves-
tus: sel proliferation), glaucoma,
nonenzymatic glycation neuropathy, nephropathy
2. large vessel atheroscle-
rosis, CAD, peripheral vas-
cular occlusive disease, an-
grene--->limb loss, cerebrovas-
cular disease--->MI/death (most
commonly)
309. nephropathy due to diabetes mellitus nodular goleruloscerosis (Kim-

causes____ melsteil-Wilson nodules)--->pro-
gressive proteinuria and ather-
osclerosis--->hypertension and
chronic renal failure
310. diabetes mellitus diagnosis fasting serum glucose

oral glucose tolerance test
HbA1c (reflects average blood
glucose over prior 3 months)
311. Diabetes mellitus: type 1 vs. type 2: 1. autoimmune beta cell dstruc-
primary defect tion
2. increased insulin resistance;
progressive pancreatic beta cell
failure
312. Diabetes mellitus: type 1 vs. type 2: 1. always

insulin necessary for treatment? 2. sometimes
313. Diabetes mellitus: type 1 vs. type 2: 1. <30 yrs

age (exceptions common) 2. >40 yrs
314. Diabetes mellitus: type 1 vs. type 2: 1. no

obesity association? 2. yes
315. Diabetes mellitus: type 1 vs. type 2: 1. weak (50% concordance w/

genetic predisposition identical twins); polygenic
2. strong (90% " "), polygenic
39 / 52
USMLE Endocrine
316. Diabetes mellitus: type 1 vs. type 2: 1. yes (HLA-DR3, -DR4)
association w/ HLA system 2. no
317. Diabetes mellitus: type 1 vs. type 2: 1. severe

glucose intolerance 2. mild-moderate
318. Diabetes mellitus: type 1 vs. type 2: 1. high

insulin sensitivity 2. low
319. Diabetes mellitus: type 1 vs. type 2: 1. common

ketoacidosis 2. rare
320. Diabetes mellitus: type 1 vs. type 2: 1. dec

beta cell #s in islets 2. variable (with amyloid de-
posits)
321. Diabetes mellitus: type 1 vs. type 2: 1. dec

serum insulin level 2. variable
322. Diabetes mellitus: type 1 vs. type 2: 1. common

classic symptoms (polyuria, polydipsia, 2. sometimes
polyphagia, weight loss)
323. Diabetes mellitus: type 1 vs. type 2: 1. islet leukocytic infiltrate

histology 2. islet amyloid polypeptide
(IAPP) deposits
324. diabetic ketoacidosis inc insulin requirements from inc

causes stress (e.g. infection)
excess fat breakdown, ketogen-
esis from inc FAs--->ketone bod-
ies
usually type 1 diabetes (endoge-
nous insulin in type 2 prevents
lipolysis usually)
325. ketone bodies beta-hydroxybutyrate

acetoacetate
326.
40 / 52
USMLE Endocrine
diabetic ketoacidosis Kussmaul respirations (rapid,
signs/symptoms deep breathing)
nausea/vomiting
abdominal pain
psychosis/delirium
dehydration
fruity breath odor (due to ex-
haled acetone)
327. diabetic ketoacidosis hyperglycemia

labs inc H+
dec HCO3- (inc anion gap meta-
bolic acidosis)
inc blood ketone levels
leokocytosis
kyperkalemia (depleted intracel-
lular K+ due to shift from dec
insulin; so total body is actually
K+ depleted)
328. diabetic ketoacidosis life-threatening mucormycosis

complications (usually Thizopus infection)
cerebral edema
cardiac arrhythmias
HF
329. diabetic ketoacidosis IV fluids

treatment IV insulin
K+ (to replete intracellular
stores)
glucose if necessary to prevent
hypoglycemia
330. glucagonoma (cause and signs/symp- tumor of pancreatic alpha

toms) cells--->
glucagon overproduction
dermatitis (necrolytic migrato-
ry erythema), diabetes (hyper-
glycemia), DVT, depression
41 / 52
USMLE Endocrine
331. insulinoma tumor of pancreatic beta
cells-->insulin overproduc-
tion--->hypoglycemia
may see Whipple triad
dec. blood glucose, inc C-pep-
tide levels (vs. exogenous insulin
use)
332. Whipple triad 1. low blood glucose

2. symptoms of hypoglycemia
(e.g. lethargy, syncope, diplopia)
3. resolution of symptoms after
normalization of glucose levels
333. insulinoma treatment surgical resection
334. carcinoid syndrome caused by carcinoid tumors

causes (neuroendocrine cells), esp
metastatic bowel tumors, which
secrete hig levels of serotonin
(5-HT)
not seen if tumor is only in GI
tract (5-HT undergoes first-pass
metabolism in liver)
335. carcinoid syndrome recurrent disrrhea

presentation cutaneous flushing
asthmatic wheezing
right-sided valvular disease
inc 5-hydroxyindoleacetic acid
(5-HIAA) in urine
niacin deficiency (pellagra)
336. carcinoid syndrome treatment surgical resection

somatostatin analog (e.g. oc-
treotide)
337. most common malignancy of SI carcinoid syndrome
338.
42 / 52
USMLE Endocrine
carcinoid syndrome: 1/3 metastasize
rule of 1/3s 1/3 present with 2nd malignancy
1/3 are multiple
339. Zollinger-Ellison syndrome gastrin-secreting tumor (gastri-

noma) of pancreas or duodenum
acid hypersecretion--->recurrent
ulcers in duodenum, jejunum
abdominal pain (peptic ulcer dis-
ease, distal ulcers)
darrhea (malabsorption)
+ secretin stimulation test
may be associated with MEN-1
340. secretin stimulation test for Zollinger-Ellison syndomre

+ if gastrin levels remain ele-
vated after secretin administra-
tion (normally inhibits gastrin re-
lease)
341. multiple endocrine neoplasias (MEN) in- AD

heritance
342. MEN-1 3 P's:

characteristics Parathyroid tumors
Pituitary tumors (prolactin or
GH)
Pancreatic endocrine tu-
mors (Zollinger-Ellison syn-
drome, insulinomas, VIPomas,
glucagonomas (rare)
MEN1 gene mutation
343. MEN1 gene function menin (tumor suppressor) en-

coded
344. MEN2A 2P's:

characteristics Parathyroid hyperplasia
Pheochromocytoma
medullary thyroid carcinoma
43 / 52
USMLE Endocrine
(secretes calcitonin)
RET gene mutation (tyrosine ki-
nase receptor)
345. MEN2A and 2B are associated with ___ marfanoid habitus
346. MEN2B 1 P:
characteristics Pheochromocytoma
medullary thyroid carcinoma
(secretes calcitonin)
oral/intestinal ganglioneuro-
matosis (mucosal neuromas)
RET gene mutation (tyrosine ki-
nase receptor)
347. MEN 2A vs 2B (medullary thyroid cancer at

center of both shapes)
348. diabetes treatment: low-carb diet

type 1 insulin replacement
349. diabetes treatment: dietary modification and exer-

type 2 cise for weight loss
if lifestyle changes fail: insulin re-
placement
350. diabetes treatment: dietary modifications

gestational diabetes mellitus (GDM) exercise
insulin replacement if lifestyle
changes fail
351. insulin preparations: rapid acting

examples
44 / 52
USMLE Endocrine
aspart
glulisine
lispro
352. insulin preparations: rapid acting binds insulin receptor (tyrosine

action kinase activity)
Liver: inc glucose stored as
glycogen
Muscle: inc glycogen, protein
synthesis, K+ uptake
Fat: TG storage
353. insulin preparations: rapid acting type 1 DM

clinical use type 2 DM
DM (postprandial glucose con-
trol)
354. insulin preparations: rapid acting hypoglycemia

toxicities rare hypersensitivity rxn
355. insulin preparations: short acting (regu- type 1 DM

lar) type 2 DM
clinical use GDM
DKA (IV)
hyperkalemia (+glucose)
stress hyperglycemia
356. insulin preparations: intermediate act- type 1 DM

ing (NPH) type 2 DM
clinical use GDM
357. insulin preparations: long acting detemir

examples glargine
358. insulin preparations: long acting type 1 DM

clinical use type 2 DM
GDM (basal glucose control)
359. oral hypoglycemia drugs: biguanides metformin

examples
45 / 52
USMLE Endocrine
360. oral hypoglycemia drugs: biguanides exact mechanism unknown

acting dec gluconeogenesis
inc glycolysis
inc peripheral glucose uptake
(inc insulin sensitivity)
361. oral hypoglycemia drugs: biguanides oral

clinical use first-line therapy in type 2 DM
causes modest weight loss
can be used in pts without islet
function
362. oral hypoglycemia drugs: biguanides GI upset

toxicities lactic acidosis (contraindicated
in renal insufficiency; most seri-
ous side-effect)
363. oral hypoglycemia drugs: sulfonylureas First generation: chloro-

examples propamide, tolbutamide
Second generation: glimepiride,
glipizide, glyburide
364. oral hypoglycemia drugs: sulfonylureas close K+ channel in beta

action cell membrane--->depolariza-
tion--->insulin release via inc
Ca2+ influx
365. oral hypoglycemia drugs: sulfonylureas stimulate release of endoge-

clinical use nous insulin in type 2 DM
cannot be used for type 1 DM
because some islet cell function
is required
366. oral hypoglycemia drugs: sulfonylureas risk of hypoglycemia inc in renal

toxicities failure
1st generation: disulfiram-like ef-
fects
2nd generation: hypoglycemia
46 / 52
USMLE Endocrine
367. oral hypoglycemia drugs: glitazones/thi- piolitazone
azolidinediones: rosiglitazone
examples
368. oral hypoglycemia drugs: glitazones/thi- inc insulin sensitivity in peripher-

azolidinediones: al tissue
action binds PPAR-gamma nuclear
transcription regulator
369. oral hypoglycemia drugs: glitazones/thi- monotherapy for type 2 DM or

azolidinediones: combined with biguanides/sul-
clinical use fonylureas
370. oral hypoglycemia drugs: glitazones/thi- weight gain

azolidinediones: edema
toxicity hepatotoxicity
HF
inc fracture risk
371. PPAR-gamma genes encode transcrip- FA storage

tion factors that activate genes for ___ glucose metabolism
372. PPAR-gamma activation causes inc ___ insulin

sensitivity and inc levels of ___ adiponectin
373. oral hypoglycemia drugs: GLP-1 exenatide

analogs liraglutide
examples
374. oral hypoglycemia drugs: GLP-1 dec insulin relase

analogs inc glucagon release
action
375. oral hypoglycemia drugs: GLP-1 type 2 DM

analogs
clinical use
376. oral hypoglycemia drugs: GLP-1 nausea

analogs vomiting
toxicities pancreatitis
47 / 52
USMLE Endocrine
377. oral hypoglycemia drugs: DPP-4 in- linagliptin

hibitors sexagliptin
examples sitagliptin
378. oral hypoglycemia drugs: DPP-4 in- inc insulin release

hibitors dec glucagonrelease
action
379. oral hypoglycemia drugs: DPP-4 in- type 2 DM

hibitors
clinical use
380. oral hypoglycemia drugs: DPP-4 in- mild urinary or respiratory infec-
hibitors tions
toxicities
381. oral hypoglycemia drugs: amylin pramlinitide

analogs
example
382. oral hypoglycemia drugs: amylin dec gastric emptying

analogs dec glucagon
action
383. oral hypoglycemia drugs: amylin types 1 and 2 DM

analogs
clinical use
384. oral hypoglycemia drugs: amylin hypoglycemia

analogs nausea
toxicities diarrhea
385. oral hypoglycemia drugs: SGLT-2 in- canagliflozin

hibitors
example
386. oral hypoglycemia drugs: SGLT-2 in- block glucose reabsorption in

hibitors PCT
action
48 / 52
USMLE Endocrine
387. oral hypoglycemia drugs: SGLT-2 in- type 2 DM
hibitors
clinical use
388. oral hypoglycemia drugs: SGLT-2 in- glucosuria

hibitors UTIs
toxicities vaginal yeast infections
389. oral hypoglycemia drugs: alpha-glucosi- acarose

dase inhibitors miglitol
examples
390. oral hypoglycemia drugs: alpha-glucosi- inhibit brush border alpha-glu-

dase inhibitors cosidases
action delayed carb hydrolysis and glu-
cose absortion---> dec post-
prandial hyperglycemia
391. oral hypoglycemia drugs: alpha-glucosi- monotherapy for type 2 DM or

dase inhibitors combined with other oral hypo-
clinical use glycemic drugs
392. oral hypoglycemia drugs: alpha-glucosi- GI disturances

dase inhibitors
toxicities
393. propylthiouracil, methimazole: block thyroid peroxidase-->I ox-

mechanism idation/organification (coupling)
inhibited--->inhibition of thyroid
hormone synthesis
propylthiouracil also blocks
5'-deiodinase--->dec T4 to T3
conversion in peripheral tissues
394. propylthiouracil, methimazole: hyperthyroidism

clinical use propylthiouracil used in preg-
nancy
395. propylthiouracil, methimazole: skin rash

toxicities agranulocytosis (rare)
49 / 52
USMLE Endocrine
aplastic anemia
hepatotoxicity (propylthiouracil)
teratogen (methimazole; aplasia
cutis)
396. levothyroxine (T4), triiodothyronine (T3): thyroid hormone replacement

mechanism
397. levothyroxine (T4), triiodothyronine (T3): hypothyroidism

clinical use myxedema
used off-label as weight-loss
supplements
398. levothyroxine (T4), triiodothyronine (T3): tachycardia

toxcitity heat intolerance
tremors
arrhythmias
399. hypothalamic/pituitary drugs: ADH ago- conivaptan

nists tolvaptan
examples
400. hypothalamic/pituitary drugs: ADH ago- SIADH

nists block action of ADH at V2 recep-
clinical use tor
401. hypothalamic/pituitary drugs: desmo- central (not nephrogenic) DI

pressin acetate
clinical use
402. hypothalamic/pituitary drugs: GH GH deficiency

clinical use Turner syndrome
403. hypothalamic/pituitary drugs: oxytocin stimulates labor, uterine contrac-

clinical use tions, milk let-down
controls uterine hemorrhage
404. hypothalamic/pituitary drugs: somato- acromegaly

statin (octreotide) carcinoid syndrome
clinical use gastrinoma
50 / 52
USMLE Endocrine
glucagonoma
esophageal varices
405. demeclocycline: ADH antagonist (member of

mechanism tetracycline family)
406. demeclocycline: SIADH

clinical use
407. demeclocycline: nephrogenic DI

toxicity photosensitivity
bone/teeth abnormalities
408. glucocorticoids: beclomethasone

examples dexamethasone
fludrocortisone (also has miner-
alcorticoid activity)
hydrocortisone
methylprednisone
prednisone
triamcinolone
409. glucocorticoids: metabolic, catabolic, anti-inflam-

mechanism matory, immunosuppresive ef-
fects mediated by interactions
w/ glucocorticoid response ele-
ments
phospholipase A2 inhibition
inhibition of transcription factors
such as NK-kB
410. glucocorticoids: Addison disease

clinical use inflammation
immunosuppression
asthma
411. glucocorticoids: Iatrogenic Cushing syndrome

toxicity adrenalcortical atrophy
peptic ulcers
steroid diabetes
51 / 52
USMLE Endocrine
steroid psychosis
adrenal insufficiency (when drug
stopped abruptly after chronic
use)
412. presentation of Iatrogenic Cushing syn- hypertension

drome weight gain
moon facies
truncal obesity
buffalo hump
thinning of skin
striae
osteoporosis
hyperglycemia
amenorrhea
immunosuppression
413. cinacalcet: sensitizes Ca2+-sensing recep-

mechanism tor (CaSR) in parathyroid gland
to circulated Ca2+ ---> dec PTH
414. cinacalcet hypercalcemia due to primary or

clinical use secondary hyperparathyroidism
415. cinacalcet hypocalcemia

toxicity
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USMLE Endocrine

Study online at https://quizlet.com/_33yr8j

1. thyroid development: floor of primitive pharynx

2. the thyroid, in development, is connect- thyroglossal duct

3. what is the normal remnant of the thy- foramen cecum

4. most common ectopic thyroid tissue tongue

5. thyroglossal duct cyst presents as anterior midline

6. adrenal cortex is derived from what mesoderm

7. adrenal medulla embryologic dericative neural crest

8. adrenal cortex: zona reticularis

9. zona glomerulosa: renin-angiotensin

10. zona reticularis: ACTH, CRH

12. endocrine cells of adrenal medulla Chromaffin cells

13. Chromaffin cells: preganglionic sympathetic fibers

15. pheochromocytoma most common tumor of adrenal

16. neuroblastoma most common tumor of adrenal

17. anterior pituitary hormones mnemonic B-FLAT:

18. acidophils of anterior pituitary secrete GH

19. from where is melanotropin secreted? intermediate lobe of pituitary

21. hormonal subunit common to TSH, LH, alpha

23. posterior pituitary hormones vasopressin (ADH)

24. site of vasopressin (ADH) synthesis supraoptic nuclei of hypothala-

25. site of oxytocin synthesis paraventricular nuclei of hypo-

26. hormones from the hypothalamus are neurophysins (carrier proteins)

27. posterior pituitary is derived from___ neuroectoderm

28. pancreatic islets arise from ___ pancreatic buds

29. pancreatic islet cells: secretion and lo- glucagon

30. pancreatic islet cells: secretion and lo- insulin

31. pancreatic islet cells: secretion and lo- somatostatin

32. insulin synthesis preproinsulin synth. in

34. exogenous insulin lacks ___ C-peptide

35. insulin anabolic functions inc glucose transport in skeletal

36. does insulin cross placenta? glucose? no

37. insulin binding to receptors stimulates... tyrosine kinase activity--->glu-

38. insulin-dependent glucose transporters GLUT-4: adipose tissue, striated

39. insulin and ___ can increase GLUT-4 ex- exercise

40. insulin-independent transporters GLUT-1: RBCs, brain, cornea

41. brain's energy source during starvation, ketone bodies

43. insulin-independent glucose uptake BRICK-L:

44. insulin regulation: increase insulin

45. GH causes ___ resistance insulin

46. insulin regulation by glucose (pathway) glucose enters beta cells--->inc

47. glucagon catabolic function glycogenolysis

48. glucagon release: stimulation and inhi- stimulation: hypoglycemia

49. hypothalmic-pituitary hormones: func- inc ACTH, NSH, beta-endorphin

50. dec prolactin

51. hypothalmic-pituitary hormones: func- inc GH

52. hypothalmic-pituitary hormones: func- inc LH, FSH

53. hypothalmic-pituitary hormones: func- dec GnRH

54. hypothalmic-pituitary hormones: func- dec GH, TSH

55. hypothalmic-pituitary hormones: func- inc TSH, prolactin

56. prolactin source mainly anterior pituitary

57. prolactin function stimulation of milk production

58. excessive prolactin is associated with libido

61. effect of TRH on prolactin secretion increase

62. effect of dopamine agonists (e.g. inhibit

63. effect of dopamine antagonisms (e.g. stimulation

64. somatotropin is aka GH

65. GH source ant. pit.

66. GH function stimulates linear growth and

67. GHRH stimulates ___ pulsatile release of GH from ant.

68. secretion of GH ___ during exercise and inc

69. inhibitors of GH secretion glucose