immunologic/nervous side effects of corticosteroids☆neutrophilia (demargination of neutrophils previously attached to the vessel wall→ neutrophil recruitment to fight infection in tissues is decreased)
PictureFollicular thyroid carcinomas (FTCs) are characterized by ☆invasion of the tumor capsule and/or surrounding blood vessels. endocrinologypathologyUWorld Jun 13, 2020, 1:37 AM HirotoShishido
signs of hyperlipidemiaobstructive biliary lesions, ☆primary billary cholangitis result in hypercholestrolemia
treatment for the patient exposed to radioactive iodine-131nonradioactive iodide(eg ☆potassium iodide) can competitively inhibit radioactive iodine-131 ☆from entering thyroid follicular cells (+release of T4+T3)
(large increases in serum iodide levels also inhibit iodine oiganification(Wolff-Chaikoff effect) and reduce thyroid hormone release)
(iodide=anion of iodine)
PTU(propylthiouracil) inhibit iodine organification, but potassium iodide promotes this effect more rapidly and efficiently endocrinologyUWorld Jun 4, 2020, 10:22 AM HirotoShishido
mechanism of correction of metabolic acidosis by kidney・Increased HCO3- reabsorption
・Increased H+ secretion
・Increased acid buffer excretion: In order to facilitate excretion of much larger amounts of acid, the kidney utilizes acid buffers to trap H+ without markedly lowering urinary pH. The 2 most important acid buffers in urine are ☆hydrogen phosphate (HPO4 2-) and ammonia (NH3). renalendocrinologyUWorld May 31, 2020, 10:33 AM HirotoShishido
direct effects of PTH(parathyroid hormone)bone, kidney (×intestine)
↑bone resorption
↑calcium reabsorption, ☆↓phosphorus reabsortion
↑1,25-dihydroxyvitamin D
(1,25-dihydroxyvitamin D works on intestines and bone
intestine→ ↑absorption of calcium and ☆phosphorus
bone→ ↑calcium and phosphorus release) endocrinologyUWorld SIM1 May 29, 2020, 10:58 PM HirotoShishido
thiazolidinedione mechanism of action(Pioglitazone, rosiglitazone)
↑Fatty acid uptake
weight gain
↑Adiponectin production
a cytokine secreted by fat tissue that lowers TG levels by ☆inducing differentiation of preadipocytes into insulin-responsive adipocytes and stimulates fatty
acid oxidation
extra adrenal pheochromocytoma10% malignant
10% bilateral
10% extra-adrenal (eg, bladder wall, ☆organ of Zuckerkandl)
10% calcify
10% kids endocrinologyUWorld SIM1 May 28, 2020, 7:39 AM HirotoShishido
where is preproinsulin synthesized?/
where is it accumulated with the patients with deletion in signal sequences which can be recognized by signal recognition particles(SRPs)RER
metabolic derangements in diabetic ketoacidosis☆hyponatremia
due to osmotic activity of serum glucose and hyperglycemia induced osmotic diuresis
metabolic acidosis, hyperkalemia, hyperketonemia, hyperglycemia→ free water loss→ hyperosmolality endocrinologyUWorld SIM1 May 27, 2020, 10:48 PM HirotoShishido
what regular activity is the most important and recommended in the patient with diabetes mellitus☆daily foot inspection
→clinicians are advised to complete comprehensive foot examinations annually on all diabetic patients, who should in turn be instructed on prophylactic foot care for trauma or infection (eg. wash and closely examined daily, change fitting socks daily, trim nails to the shape of the toe) endocrinologyUWorld SIM1 May 25, 2020, 10:00 AM HirotoShishido
acute adrenal insufficiency
predisposing factor, manifestationoften occurs in patients witha preexisting history of autoimmune disease(eg. ☆hypothyroidism, type Ⅰ diabetes mellitus)
↓aldosterone→ hypovolemia, orthostasis, hyperkalemia
↓cortisol→ hypoglycemia, ☆normocytic anemia, ☆eosinophilia endocrinologyUWorld May 19, 2020, 8:24 AM HirotoShishido
cretinism
symptoms, management6P
Pot-bellied, Pale, Puffy-faced child, with Protruding umbilicus
→(★)umbilical hernia, ☆Protuberant tongue, and Poor brain development
+hypotonia, (★)sluggish movement, lethargy, ☆enlarged fontanelle, constipation→ bloating
mechanism of sorbitol accumulationThe first step in the polyol pathway is the conversion of glucose into sorbitol by aldose reductase. Sorbitol cannot readily cross cell membranes and is therefore trapped inside the cells where it forms.
The second enzyme in the pathway, sorbitol dehydrogenase, is able to convert sorbitol into ☆fructose at a sufficient rate to prevent accumulation when glucose levels are normal.
cause of hypophosphatemia・Internal redistribution
→ especially refeeding malnourished patients
Reintroduction of carbohydrates (ie, dextrose-containing intravenous fluids) increases insulin secretion, which stimulates the ☆redistribution of phosphate from the serum into muscle and hepatic cells for use during glycolysis (eg, formation of ATP, 2-3 diphosphoglycerate)
counseling on the patents with insulin-induced weight gainReview for changes in diet
☆Ask about hypoglycemic symptoms(may cause patients to attempt to suppress feelings of hypoglycemia)
→dietary modification and changes to the insulin regimen can mitigate insulin lnduced weight gain endocrinologypharmacology May 13, 2020, 10:27 PM HirotoShishido
what causes glycogenolysis in liver, muscle(glycogen in the liver→ maintain blood glucose levels during fasting state
glycogen in muscles→ provide energy for muscle contraction)
in muscle,
☆increased intracellular calcium(more powerful than cAMP pathyway) activate PK, causing phosphorylation of glycogen phosphorylase which cause glycogenolysis
in liver,
primarily through the binding of glucagon and epinephrin to Gs protein coupled receptors, increasing cAMP concentrations endocrinologyUWorld May 13, 2020, 1:16 AM HirotoShishido
