Download ChemPPT Flashcards Unit 4

Chem PPT Flashcards, Unit 4
Diabetes Mellitus is a group of metabolic
disorders of ___ metabolism
Diabetes Mellitus can cause the following lifethreatening episodes:
Complications of DM includes:
Diabetes was first classified as Juvenile vs.
adult onset, then insulin dependent vs. noninsulin dependent and finally:
Two other types of DM include:
Type 1 DM accounts for __% - __%
Type 1 DM presents with:
In type 2 DM, insulin deficiency is caused by:
loss of pancreatic islet
β-cells
Type 2 DM accounts for __%:
Are patients with type 2 DM dependent on
insulin?
What is the mechanism for type 2 DM?
How is type 2 DM usually treated?
Usually occurs in people over:
Other causes of DM can include:
Gestational DM is defined as:
Incidence is between __% and __%
Impaired glucose tolerance is defined as:
Rare complications of IGT are:
There is an increased prevalence of :
Hormone that decreases blood glucose
Counter-regulatory hormones that increase
blood glucose concentrations
Insulin is produced by the _______ of the islets
of Langerhans of the _____.
Carbohydrate
Ketoacidosis and hyperosmolar coma
Retinopathy, nephropathy, neuropathy and
atherosclerosis
Type 1 and type 2
Gestational and other types
5 - 10
polyuria, polydipsia, and rapid weight loss
loss of pancreatic islet β-cells
90%
No.
Insulin resistance
dietary manipulation, oral hypoglycemic
agents, or insulin to control hyperglycemia
40
Genetic defects of β-cell function, Genetic
defects in insulin action Exocrine pancreas
disease, Endocrinopathies (Cushing
syndrome, acromegaly,
glucagonoma)Hormones or drugs that induce
β-cell dysfunction (dilantin, pentamidine) or
impair insulin action (glucocorticoids,
thiazides, β-adrenergics), Infection,
Uncommon forms of immune-mediated
diabetes, Other genetic conditions (Down
syndrome, Klinefelter syndrome, porphyria)
carbohydrate intolerance of variable severity
with onset or first recognition during
pregnancy
6-8
people with intermediate glucose levels (140
to 199 mg/dL or 7.8 to 11.1 mmol/L
Microvascular disease and renal and retinal
CVD
Insulin
Glucagon, epinephrine, cortisol, growth
hormone
B-cells, pancreas
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Chem PPT Flashcards, Unit 4
Insulin is an _______ hormone that stimulates
uptake of glucose into fat and muscle.
Insulin promotes the conversion of glucose to
glycogen or fat for storage.
Insulin inhibits glucose production by the liver.
Insulin stimulates protein synthesis and inhibits
protein breakdown.
______ is the major storage form of insulin and
has approximately 10% of insulin potency.
Glucose transport is modulated by what two
families of proteins?
_____ promotes the uptake of glucose and
galactose from the lumen of the small bowel
and their reabsorption from urine in the kidney.
_____ is located on the surface of all cells, and
are designated GLUT1 to GLUT14.
What does IGF stand for?
_____ were previously referred to as nonsuppressible insulin-like activity or
somatomedin.
IGF exhibit metabolic and growth-promoting
effects similar to those of insulin.
_____ was previously known as somatomedin
C, mediates growth hormone action, and
regulates cell growth and differentiation.
Synthesis of IGF-1 occurs primarily in the
______.
Exogenous administration of IGF-1 produces
_______.
Deficiency of IGF-1 causes ________.
The physiological role of IGF-2 is unknown.
Glucagon, epinephrine, and growth hormone
have actions ______ to those of insulin.
Where is glucagon secreted?
What is the major target organ for glucagon?
Glucagon stimulates the production of glucose
in the liver by _______ and ________ and
enhances ketogenesis in the liver.
The minor target organ for glucagon is
___________, where the hormone increases
lipolysis.
Increased secretion of glucagon is primarily
regulated by low concentrations of _____
______. High concentration is regulated by
decreased secretion.
______, ______, and ______induce glucagon
Anabolic
True
True
True
Proinsulin
Sodium dependent glucose transporter, and
facilitative glucose transporters
Sodium dependent glucose transport
Facilitative glucose transporters
Insulin-like growth factors
IGF
True
IGF-1
Liver
Hypoglycemia
Dwarfism
True
Opposite
Alpha cells of the pancreas
Liver
Glyconeogenesis and gluconeogenesis
Adipose tissue
Plasma glucose
Stress, exercise, and amino acids
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Chem PPT Flashcards, Unit 4
release.
Insulin inhibits glucagon release from the
pancreas and decreases glucagon gene
expression, thereby attenuating its biosynthesis.
Increased glucagon concentrations are believed
to contribute to the hyperglycemia and ketosis
of diabetes.
Epinephrine is a ______ secreted by the adrenal
medulla.
Epinephrine stimulates glucose production via
gluconeogenesis and glycogenolysis, and
_______ glucose use, thereby _______ blood
glucose concentrations.
Epinephrine also ______ glucagon secretion
and ______insulin secretion by the pancreas.
_________ has a key role in glucose counterregulation when glucagon secretion is impaired
Phyisical or emotion stress _______
epinephrine production, releasing glucose for
energy.
What are tumors of the adrenal medulla also
known as?
What is a polypeptide hormone secreted by the
anterior pitutiary gland?
What is the anterior pituitary also known as?
What is the most abundant hormone produced
by the adenohypophysis?
During daytime hours, plasma concentrations
are ____.
In the evening hours, adults and children show a
marked _____ 90 minutes after the onset of
sleep.
Growth hormone stimulate _______, enhances
_____, and antagonizes insulin-stimulated
glucose uptake.
What is the major glucocorticoid synthesized
from cholesterol in the zona fasciculata and
reticularis of the adrenal cortex?
Cortisol is secreted in response to _____.
Cortisol stimulates _______and ________ the
breakdown of protein and fat.
Patients with Cushing Syndrome have _______
level or cortisol due to tumor or hyperplasia of
the adrenal cortex and may become
_____glycemic.
What hormone is secreted by the thyroid gland
True
True
Catecholamine
Decreases, increasing
Stimulates, inhibits
epinephrine
increases
pheochromocytomas
Growth hormone
Adenohypophysis
Growth hormone
Low
Rise
Gluconeogenesis, lipolysis
Cortisol
ACTH
Gluconeogenesis, increases
Increases, hyper
Thyroxine
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Chem PPT Flashcards, Unit 4
and is not directly involved in glucose
homeostasis?
Thyroxine stimulates _______ and increases the
rates of gastric emptying and intestinal glucose
absorption.
Patients usually have a normal fasting plasma
glucose concentration despite factors that may
produce glucose intolerance in thyrotoxic
individuals.
What is also known as growth hormone
inhibiting hormone?
Where is somatostatin found?
Glyconeogenesis
True
Somatostatin
Gastrointestinal tract, hypothalamus, and
Delta cells of the pancreatic islets
Somatostatin inhibits secretion of ________ and Glucagon, insulin
_______ by the pancreas, thus modulating the
reciprocal relationship between the two
hormones.
What are the primary clinical applications for
Immunoassays, isotope dilution mass
insulin for the evaluation of patients with
spectrometry assay, immunoreactive insulin
fasting hypoglycemia?
assays
What does IDMS stand for?
Isotope Dilution Mass Spectrometry
What is usually in patients with benign or
Proinsulin
malignant b-cell tumors of the pancreas?
What is primarily used to evaluate fasting
C-peptide
hypoglycemia and monitor patients response to
pancreatic surgery?
Measurement of urine C-peptide is useful when B-cell
continuous assessment of ______ is desired.
Very high concentrations of glucagon are seen
Glucagonomas
in patients with α-cell tumors of the pancreas
called
What is low glucagon associated with?
Chronic Pancreatitis
What are the names of type1 Diabetes Mellitus? Type 1A (Immune medicated diabetes)
Type 1B (Idiopathic diabetes)
Autoimmune process where there is 80% to
Type 1A
90% reduction in the volume of β-cells to
induce symptomatic type I diabetes
β-cells destruction is due to chromosomal
Type 1B
abnormality or an unknown cause rather than
any autoimmune process
What are the most practical markers of beta cell Islet Cell Antibodies (ICA)
autoimmunity our circulating antibodies which
Insulin Autoantibodies (IAA)
have been detected in the serum years before
Antibodies to the 65 kDa isoform of glutamic
the onset of hyperglycemia:
acid decarboxylase
Insulinoma-associated antigens (IA-2A and
IA-2βA)
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Chem PPT Flashcards, Unit 4
Zinc Transporter (ZnT8)
The human leukocyte antigen (HLA)-DQ and
–DR genetics factors
Insulin Resistance
What are the most important determinants for
risk of type I diabetes?
What decreased ability of insulin to act on
peripheral tissue and also known as syndrome X
or the metabolic syndrome?
Inability of the pancreas to produce sufficient
B-cell dysfunction
insulin to compensate for the insulin resistance
Chronic complications in diabetes mellitus
Diabetes-specific microvascular pathology
includes:
in the retina, renal glomeruli, and
peripheral nerves produces retinopathy,
nephropathy, and neuropathy
Diabetes is the most frequent cause of?
Blindness
What disease is the leading cause of diabetes?
End stage renal disease
What is the major cause of mortality in
Myocardial Infarction
diabetes?
Portable meters for measurement of blood
1. In acute and chronic care facilities (at the
glucose concentrations are used in three major
patient's bedside and in clinics or
settings:
hospitals)
2. In physician’s offices
3. By patients at home, work, and school
(selfmonitoring of blood glucose - SMBG)
What is blood glucose monitoring called based
on enzymes, electrodes, or fluorescence
implanted subcutaneously?
Applies low-level electric current to the skin
Spectroscopic measurement of light absorption
from subcutaneous tissue
The primary substrates for ketone body
formation are?
What are the 3 kinds of ketone bodies?
What is Ketonemia
What is Ketonuria
Ketonemia and Ketonuria are seen in what two
instances?
What might cause a decrease in glucose
availability?
What might cause a decrease in carbohydrate
use?
Implanted sensors
Minimally invasive monitoring
Noninvasive monitoring
free fatty acids from adipose stores.
Acetone
β-hydroxybutyrate
Acetoacetate
Increased concentration of ketones in the
blood
Increased excretion of ketones in the urine
Decreased glucose availability
Decreased carbohydrate use
Starvation or severe vomiting
Diabetes mellitus
Glycogen storage disease (von Gierke
disease)
Alkalosis
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Chem PPT Flashcards, Unit 4
What are two specimens used to measure
ketones?
Why are ketones routinely measured in patients
with DM?
Which ketone body does Gerhardt’s ferric
chloride test test for?
True or false
Acetest is a tablet that turns purple when certain
ketones react to it.
Acetest tablets contain a mixture of glycine,
sodium nitroprusside, disodium phosphate and
lactose. Which of these causes the important
chemical reaction when in contact with certain
ketone bodies?
In an acetest tablet, what role does lactose play?
In an acetest tablet, what role does disodium
phosphate play?
Of the three ketones, Acetone, βhydroxybutyrate and Acetoacetate, which does
the acetest tablet test for?
Why doesn't the acetest test for βhydroxybutyrate?
Blood
Urine
To monitor diabetic ketoacidosis
What types of specimen can be used with the
acetest?
What is the test called that is a modification of
the nitroprusside test, in which a reagent strip is
used instead of a tablet?
Ketostix give a positive result in how many
seconds with specimens containing how much
acetoacetate in the sample?
What test tests for β-hydroxybutyrate?
Blood and urine
What is the first step in the DiaScreen 1K test?
β-hydroxybutyrate in the presence of NAD is
converted by β-hydroxybutyrate
dehydrogenase to acetoacetate, producing
reduced NADH.
Diaphorase catalyzes the reduction of
nitroblue tetrazolium (NBT) by NADH to
produce a purple compound, and its
absorbance is read in a special meter that
provides a digital readout.
the condensation of glucose with the Nterminal valine residue of each β-chain of
HbA to form an unstable Schiff base that may
dissociate to form a stable ketoamine.
The second step in the DiaScreen 1K test once
NADH is produced is?
How is HbA1c formed?
Acetoacetate
True
Nitroprusside
Enhances the color
Provides optimum pH for the reaction.
Acetoacetate and Acetone (to a lesser extent)
β-hydroxybutyrate does not react with
nitroprusside
Ketostix
15s , 50mg/L
DiaScreen 1K
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Chem PPT Flashcards, Unit 4
True or false
True
The rate of HbA1c formation is directly
proportional to the concentration of glucose in
the body.
How far in the past does the HbA1c assay detect HbA1c concentration represents integrated
glucose values?
values for glucose over the preceding 8-12
weeks.
An HbA1c value of ≥ 6.5% is considered to be
Diabetes
the decision point used for the diagnosis of?
What HbA1c value range indicates individuals
from 5.7% to 6.4%
at high risk of developing diabetes?
What is the “normal” reference interval for
4%-5.6%
HbA1c?
True or false
True
HBA1c is accepted to be an alternative to
glucose for screening for diabetes.
What test is is firmly established as an index of HbA1c
long-term blood glucose concentration and a
measure of the risk for developing
microvascular complications in patients with
diabetes.
In patients without diabetes, how is HbA1c
HBA1c is directly related to risk of
used?
cardiovascular disease
How is HbA1c used to monitor patients who are It is recommended that HbA1c should be
compliant to the diabetic lifestyle, diet, exercise routinely monitored at least every 6 months in
etc.?
patients meeting treatment goals and who
have stable glycemic control.
What are the three general methods for HbA1c
Methods based on Charge differences.
determination?
Methods based on structural differences.
Methods based on chemical analysis.
What are the HbA1c methods based on charge
Ion Exchange Chromatography
differences?
HPLC
Electrophoresis
Isoelectric focusing
What are the HbA1c methods based on
Affinity Chromatography
structural differences?
Immunoassays
What are the HbA1c methods based on
Photometry
chemical analysis?
spectrophotometry
Is fasting required for the HbA1c test?
No
What type of tube/anticoagulant should be used Lavender EDTA, Gray oxalate or fluoride
for the HbA1c test?
Fructosamine is?
the generic name for plasma protein
ketoamines, specifically glycated serum
albumin.
How far in the past does glycated albumin
2-3 weeks
measure glucose control?
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Chem PPT Flashcards, Unit 4
When is glycated albumin most useful?
What are three test methods used to measure
glycated albumin?
What refers to an excretion rate of albumin
greater than normal but less than that detectable
by routine dipsticks methods?
What is the excretion rate?
What does a UAE rate of greater than
200µg/min indicate?
What does urinary albumin excretion precede
and is highly indicative of?
What else can UAE indicate?
What physiological factors can increase UAE?
When should sample for UAE not be collected?
What are some examples of acceptable
specimens?
At what temperature is urine stored and for how
long is it stbale?
At what temperature does albumin
concentration decrease by 0.27 % per day?
What temperature should refrigerated urine
samples be allowed to reach before analysis?
How many specimens should be assayed and
why?
Useful in conditions where HBA1c is of little
value, such as I patients with hemoglobin
variants that are associated with decreased
erythrocyte life span.
1. Affinity Chromatography
2. High Performance Liquid Chromatography
(HPLC)
3. Photometric and Spectrophotometry
High albuminuria (formerly known as
microalbuminuria).
20 to 200 µg/min (30 to 300 mg/24hours
Overt diabetic nephropathy
1) Diabetic nephropathy
2) End-stage renal disease
3) Cardiovascular mortality
Total mortality in patients with diabetes
It identifies a group of people without
diabetes who are at risk for coronary artery
disease
1) Exercise
Posture and diuresis
1) After exertion
2) In the presence of infection (UTI)
3) During acute illness
4) Immediately after surgery
After an acute fluid load
1) 24 hour collection
2) Overnight (8-12 hours times)
3) 1-2 hour timed collection
First morning sample
Urine should be stored at 4 degrees Celsius
after collection. It is stable for 1 week at 4
degrees Celsius and for at least 5 months at 80 degrees Celsius. Urine should be stored at
4 degrees Celsius after collection. It is stable
for 1 week at 4 degrees Celsius and for at least
5 months at -80 degrees Celsius.
-20 degrees celsius
10 degrees Celsius
At least 3 separate specimens, collected on
different days, should be assayed because of
high intraindividual variation and diurnal
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Chem PPT Flashcards, Unit 4
What does diagnosis require?
What testing methods are used?
What are some examples of quantitative
methods used to screen UAE?
What are the two most common cardiovascular
disorders that rely on a biochemical diagnosis?
What are the measurement of cardiac
biomarkers useful in diagnosing and detecting?
What is the most serious form of ischemic
disease?
What is an acute myocardial infarction?
When does this occur?
What is the result when this happens?
What is the condition marked by severe pain in
the chest, often also spreading to the shoulders,
arms and neck caused by an inadequate blood
supply to the heart?
What is an angina that occurs unpredictable or
suddenly increased in severity of frequency?
What is a sudden cardiac disorder that varies
from angina to unstable angina and to
myocardial infarction?
What is the weight of the average human heart?
What is the sac that encloses the heart?
variation (50% to 100% higher during the
day)
Increased UAE in at least 2 of 3 test measured
within a 3-6 month period
1) Test strips are semi-quantitative assays
used for screening
Quantitative methods
1) RIA
2) ELISA
3) Radial Immunodiffusion
Immunoturbidimetry
1) Acute ischemic disease (acute
myocardial infarction)
Heart failure (congestive heart failure)
1) Cardiac disease
2) Cardiac disorders
3) Detecting the risk of developing
cardiac disorders
4) Monitoring the disorder
Predicting the response of a disorder to a
treatment
Acute myocardial infarction (AMI)
It is an acute infarction (obstruction of
circulation) of the heart muscle occurring
during the period when circulation to a region
of the heart is obstructed and necrosis is
occurring
It occurs when there is an imbalance between
supply and demand for oxygen in the
myocardium
This can result in injury and to eventual death
of muscle cells. When blood supply is blocked
for more than a few minutes, most of the
muscle cells die.
Angina
Unstable angina
Acute coronary syndrome
325 grams in men and 275 grams in women
Pericardium
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Chem PPT Flashcards, Unit 4
What are the 3 layers of the cardiac wall?
What are the 4 chambers of the heart?
A cardiac cycle consists of what two intervals?
What is systolic pressure?
What is diastolic pressure?
What is an electrocardiogram (ECG)?
What is an ECG used to identify?
What are an ECG’s three major components
What is acute coronary syndrome?
What is the major cause of acute coronary
syndrome?
What is atherosclerosis?
Atherosclerosis, the abnormal blood flow
through the narrowing of an artery is caused by
what yellowish substance?
Detection of rise and/or fall of cardiac
biomarkers (preferably troponin) above the 99th
% of the upper reference limit, together with
evidence of ischemic symptoms with at least
one of the fallowing symptoms of ECG changes
of ischemia changes or new left bundle branch
block, development of pathologic Q waves on
the ECG, identification of an intracoronary
thrombus by angiography or autopsy is criteria
for the definition of what?
4 cardiac markers for the diagnosis of acute
myocardial infarction are?
1) Epicardium (outermost layer where
coronary arteries are found)
2) Middle layer
3) Endocardium (innermost layer most
susceptible to myocardial ischemia)
Upper chambers (right and left atria)
Lower chambers (right and left ventricles)
Systolic and diastolic
The blood pressure in the aorta is about 120
mm Hg
The blood pressure falls to about 70 mm Hg
It records changes in electrical potential and is
a graphic tracing of the variation in electrical
potential caused by the excitation of the heart
muscles.
Used to identify the anatomic, metabolic,
ionic, and hemodynamic changes in the heart
1) Atrial depolarization (p wave)
2) Ventricular depolarization (QRS complex)
Repolarization (ST segment and T wave)
Includes individuals who have a variety of
forms of unstable ischemic heart disease
Athersosclerosis
A diseased caused by plaque (a deposit of
fatty material) formed in the inner lining of
the coronary arteries that feed the surface of
the heart, contributing to significant
narrowing of the artery’s lumen.
Atherosclerotic Plaque
Myocardial Infarction
AST, SGOT - aspartate aminotransferase
LD - lactate dehydrogenase
CK - total creatine kinase
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Chem PPT Flashcards, Unit 4
A condition in which the heart has lost the
ability to pump enough blood to the body’s
tissue?
As a result to CHF, the _____ may respond by
causing the body to retain fluid (water) and salt.
A common cause of CHF; a disease of the
arteries that supply blood and oxygen to the
heart causes decreased blood flow to the heart
muscles. The heart becomes starved for oxygen
and nutrients if the arteries become blocked or
severed narrowed. This disease is known as?
A common cause of CHF include damage to the
heart muscle from causes other than artery
blood flow problems such as from infections,
alcohol or drug abuse is known as?
These are substances that are released onto the
blood when the heart is damaged or stressed.
Measurements of cardiac biomarkers are used to
help diagnose ___ ____ ____and ___ ___,
conditions associated with insufficient blood
flow to the heart as well as CHF.
These are specific proteins found in cardiac
muscles and are measured in the diagnosis of
myocardial infarction.
Three troponin subunits form a complex that
regulate the interaction of actin and myosin and
thus regulate cardiac contractions are?
a-hydroxybutyrate
Congestive Heart Failure (CHF)
kidneys
Coronary artery disease (CAD)
Cardiomyopathy
Cardiac Biomarkers
acute coronary syndrome (ACS)
and
cardiac ischemia
cTns
Troponin T (the tropomyosin-binding
component)
Troponin I (The inhibitory component)
Troponin C (the calcium-binding component)
Cardiac troponin __ and Cardiac troponin __ are Cardiac troponin I (cTnI)
the two main types of troponin used as cardiac
and
biomarkers.
Cardiac troponin T (cTnT)
Trponins are localized primarily (94%-97%) in myofibrils
the ____ with smaller cytoplasmic fraction.
In general, what is the technique of choice for
Immunoassay
measuring cTns?
The laboratory should perform biomarkers
1 hour 30 minutes
testing with a maximum turnaround time
(TAT) of how long?
What term is defines as the time from blood
Turnaround time (TAT)
collection to the reporting of results to the
provider?
What type of blood specimen appears to be the
Anticoagulated whole blood or plasma
optimal specimen for rapid processing and
testing?
What two blood tube collection additives
EDTA and Heparin
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Chem PPT Flashcards, Unit 4
interfere with troponin antibody-binding
affinity?
This type of cardiac testing is detected by a 32amino acid polypeptide secreted by the
ventricles of the heart in response to excessive
stretching of heart muscle cells
(cardiomyocytes). The release of this test is
modulated by calcium ions.
The 3 major circulating forms of BNP are?
What does a normal level of either BNP or NTproBNP rule out in am emergency setting?
True or False
An elevated BNP or NT-proBNP should never
be used to rule in acute or chronic heart failure
in emergency settings due to lack of specificity
What can be used for screening and prognosis
of heart failure?
BNP or NTproBNP are typically increased in
what kind of patients?
BNP accurately reflects what?
What is the half-life of BNP?
What is the half life of NT-proBNP?
How are the concentrations of BNP and NTproBNP measured?
What is the acceptable specimen used for
BNP?
What is the acceptable specimen used for NTproBNP
Where is CK enzyme present? (3)
Name the 3 isoemzymes of CK
Which CK isoenzyme is the dominant form in
the brain and smooth muscle?
Which CK isoenzyme is sometimes called the
cardiac isoenzyme because 10%- 20% of total
CK activity in myocardium is from CK-MB?
Which CK isoenzyme is predominant in both
heart and skeletal muscle?
What is CK-Mt
Brain Natriuretic Peptide (BNP)
1) NT-pro BNP (N-terminal protion or
fragment of proBNP)
2) proBNP
3) BNP (C-terminal part of proBNP and the
physiological active hormone
Acute heart failure
True
Either BNP or NT-proBNP
Patients with left ventricular dysfunction, with
or without symptoms
Current ventricular status
20 minutes
1-2 hours
By immunoassays
EDTA-anticoagulated whole blood or plasma
in plastic blood collection tube
Serum, heparin-plasma, EDTA plasma
collected in either glass or plastic
Heart muscle, skeletal muscle and the brain
CK1 or CKBB
CK2 or CKMB
CK3 of CKBB
CK-Mt
CK1 or CKBB
CK2 or CKMB
CK3 or CKMM
Mitochondrial isoenzyme
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Chem PPT Flashcards, Unit 4
What is C-reactive protein?
What does it mean when concentrations of Creactive protein fall below those seen in
infection but above healthy values?
What is an oxygen binding protein of cardiac
and skeletal muscle?
Myoglobin levels increase before CK2 after
what?
(Increases/decreases) in serum myoglobin occur
after trauma to skeletal or cardiac muscle as in
crush injuries or AMI
Why are false-negative results of myoglobin
seen in patients after a few hours?
True or False
Kidneys play a central role in homeostatic
mechanisms
Fill in the blank:
Kidneys filter the _______ and excrete the end
products of the body metabolism in the form of
________.
The kidneys regulate the concentrations of
which ions?
True or False?
Kidneys do not function to produce hormones
What is the functional unit of the kidney?
Name all the parts of the nephron
What is the outer region of the kidney called?
What is the inner region of the kidney called?
Where is the glomerular capillary network
formed?
What does Pars convolute become?
What does the collecting ducts form?
What does the ducts of Bellini drain into?
What is glomerulus formed by?
What is the Juxtaglomerular Apparatus?
What does it do?
What does it generate?
How does vasoconstriction work?
What do Anterior and posterior renal artery
An acute phase reactant initially developed to
evaluate patients with infection
They are shown as biomarkers of
arteriosclerotic process
Myoglobin
AMI
Increases
Because increases of serum concentrations of
myoglobin are cleared rapidly
True
Blood; Urine
Hydrogen, sodium, potassium, phosphate, and
other ions in the ECF
False
The nephron
Glomerulus, proximal tubule, loop of Henle,
distal tubule, and collecting duct
Cortex
Medulla
On the basement membrane
Pars recta
Ducts of Bellini
The renal calyx
Specialized network of capillaries on
basement membrane.
Area of specialization at area of loop of Henle
and Bowman's capsule
Maintains systemic blood pressure by
regulating blood volume and sodium
concentration
Generates angiotensin
acts to increase release of antidiuretic
hormone
arterioles and then capillaries
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Chem PPT Flashcards, Unit 4
divide into ?
What do capillaries form?
Efferent arteriole merges with what?
Renal veins emerge into what?
Kidneys receive how much of cardiac output in
adults?
What are the 3 functions of the kidneys?
Urine passes from kidneys to?
Characteristics of healthy urine?
Urination (or micturition) is adequate at?
Oliguria (<400 ml/day) is?
What does oliguria result from?
What is Anuria?
What does anuria result from?
Polyuria is what?
What causes polyuria?
What is Nocturia?
What types of homeostasis is regulated in
kidneys?
How is electrolyte homeostasis maintained?
How is water homeostasis maintained?
What hormones are produced?
Secondary endocrine function is what?
Three physiological functions of kidneys?
What does GFR measure?
What is useful about measuring GFR?
efferent arteriole
renal venules to form renal veins
inferior vena cava
about 25%
Excretion, Homeostatic regulation, Endocrine
Ureters, to bladder, exits urethra
sterile, clear, amber, slightly acidic
about 500 mL per day
decrease in the normal daily urine output
commonly accompanies states of dehydration
such as vomiting, diarrhea, perspiration or
severe burns
Absence of urine
results from serious damage to the kidneys or
from a decrease in the flow of blood to the
kidneys
increase in the normal daily urine output,
(>3,000 ml/day)
seen in diabetes mellitus and diabetes
insipidus
induced with diuretics, caffeine or alcohol
consumption
increase in the excretion of urine at night
Electrolyte and water.
Reabsorption in proximal convoluted tubule
Bicarbonate, phosphate, high-threshold
substances, uric acid
70% reabsorbed in proximal tubule
5% in loop of Henle
10% in distal tubule
Remainder in collecting ducts
Erythropoietin, Prostaglandins and
thromboxanes, Renin, and 1,25(OH2) vitamin
D3
(site of action for hormones produced or
activated elsewhere)
Glomerular Filtration Rate (GFR), Renal
Blood Flow
Glomerular Permeability
functional capacity of the kidneys and
indicative of the number of functioning
nephrons.
targeting treatment, monitoring progression,
14
Chem PPT Flashcards, Unit 4
The renal clearance of a substance is defined as
what?
For a substance(s) or marker(s) to be used to
measure renal clearance, it must be what 7
things?
What is the concept of the renal clearance of a
substance?
predicting when renal replacement therapy
(RRT) will be required, and as a guide to
dosage of drugs excreted by the kidneys to
prevent potential drug toxicity.
as "the volume of plasma from which the
substance is completely cleared by the
kidneys per unit of time".
1. In stable concentration in the plasma
2. Physiologically inert
3. Freely filtered at the glomerulus
4. Neither secreted
5. Neither reabsorbed
6. Neither synthesized
7. Not metabolized by the kidney
Clearance (ml/min)
= U/P x V (mL/min) x 1.73/A
What are U,P, V, 1.73, and A stand for?
U= concentration of the substance in urine
P = concentration of substance in plasma
(blood)
V = total volume of urine excreted in 24 hrs
converted to mL/min
1.73 = body surface area in square meters
A = body surface of patient obtained from
patient’s height and weight (nomogram)
What markers have been used to estimate
clearance?
A variety of endogenous and exogenous
markers.
Endogenous markers:
Creatinine concentration
Low–molecular weight proteins (Cystatin C)
Exogenous markers:
Inulin
Iohexol
Radiopharmaceuticals
51Cr-ethylenediaminetetraacetic acid (EDTA)
99mTc-diethylenetriaminepentaacetic acid
(DTPA)
125 I-iothalamate
What urinary protein loss is defined?
Increased urinary protein loss (proteinuria)
results from any increase in the filtered load,
increased circulating concentration of low
molecular weight proteins, or decrease in
reabsorptive capacity
It is less than 150 mg /24 hours which is
How is the normal urinary total protein loss?
15
Chem PPT Flashcards, Unit 4
What primary part is the predominant protein in
urine in the majority of kidney diseases and is
accurately and specifically measured using
immunoassay techniques?
How is progression of kidney disease leading to
loss of function and ultimately to kidney
failure?
How many parts pathophysiology of kidney
disease are?
What is the definition of Acute kidney injury
(AKI)?
How Chronic kidney disease (CKD) is defined?
What markers used to identify CKD?
What is sevenfold to tenfold greater in patients
with CKD?
What is characterized as elevated total or lowdensity lipoprotein (LDL) cholesterol levels,
and elevated triglycerides.
What is is also affected in CKD, leading to
"adynamic" bone diseases.
mostly albumin (50% to 60%)
Albumin
These are:
Early inflammation
Accumulation and deposition of extracellular matrix
Tubulointerstitial fibrosis
Tubular atrophy
Glomerulosclerosis (scarring)
Diagnosis and screening for kidney disease
Urinalysis
Proteinuria
Hematuria
a symptoms or physical sign
systemic disease with the known renal
involvement like diabetes mellitus
1. Increase of plasma creatinine by ≥ 0.3
mg/dL
(26 µmol/L) within 48 hours
2. Increase in plasma creatinine to ≥ 1.5 times
baseline, which is known or presumed to
have
occurred within the prior 7 days
3. Reduction in urine output (documented
oliguria
< 0.5 mL/kg/hr for more than 6 hours
Is defined as abnormalities of kidney structure
or function, present for more than 3 months
with implications for health
These are plasma creatinine, estimated GFR
and measured creatinine.
Lowering blood pressure and reduction of
proteinuria have been shown to decrease the
progression of CKD
The incidence of cardiovascular disease
It is Dyslipidemia in CKD
Calcium and phosphate metabolism
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Chem PPT Flashcards, Unit 4
How Adynamic bone is defined?
How the classic signs of uremia?
bone is associated with low PTH
concentration, abnormal calcium balance,
hyperphosphatemia, acidosis and the use of
high doses of vitamin D analogs.Due to the
predominant loss of peritubular fibroblast
(specialized cells that produce collagen)
within the renal cortex that synthesize
erythropoietin, thus causing anemia
The symptoms are progressive weakness and
easy fatigue, loss of appetite followed by
nausea and vomiting, muscle wasting,
tremors, abnormal mental function, frequent
but shallow respirations and metabolic
acidosis.
What are the most characteristic laboratory
findings in Uremic syndrome?
The most characteristic laboratory findings
are increased concentrations of nitrogenous
compounds in plasma such as urea and
creatinine, as a result of reduced GFR and
decreased tubular function.
How retention of urea and creatinine and of
metabolic acids is followed?
Retention of urea and creatinine and of
metabolic acids is followed by progressive
hyperphosphatemia, hypocalcemia and
potentially dangerous hyperkalemia
Kidneys fail to maintain adequate excretory,
regulatory, and endocrine function.At least 90
organic compounds are retained in urea
What are another diseases of kidney?
These are diabetic nephropathy and
hypertensive nephropathy.
How is diabetic nephropathy defined?
It is a clinical diagnosis based on the finding
of proteinuria (albuminuria) in a patient with
diabetes
It is the most common cause of end stage
renal disease (ESRD)
What is hypertensive nephropathy
Hypertensive nephropathy considered another
accelerating force in the development of
ESRD.
What are Glomerular diseases?
•
Glomerular diseases
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Chem PPT Flashcards, Unit 4
• Immunoglobulin A
nephropathy
• Rapidly progressive
glomerulonephritis
• Acute nephritic
syndrome
• Nephrotic syndrome
What are Interstitial nephritis
diseases?
•
What is the Polycistic kindney
disease?
What causes Toxic nephropathy?
What is Obstructive uropathy?
What are the different diseases of the
kidney?
What is Dialysis of the kidney?
Interstitial nephritis
• Caused by a variety of
chemical, bacterial,
and immunological
injuries to the kidney
•
Polycystic kidney disease
• Is the most common
inherited kidney
disease presented by
hypertension and
gross hematuria.
• Toxic nephropathy
• Caused by a wide
variety of
nephrotoxins present
in the environment
like cadmium and
lead.
• Obstructive uropathy
Benign prostatic hypertrophy (BPH)
is one of the most common type.
• Tubular diseases
• Renal tubular acidoses
• Inherited tubulopathies
• Diuretics
• Diabetes insipidus
• Renal calculi
• Prostaglandins and NSAIDs in
kidney disease
• Monoclonal light chains and
kidney disease
•
•
Dialysis
Is the process of separating
macromolecules from ions and
18
Chem PPT Flashcards, Unit 4
low molecular weight compounds
in solution by the difference in
their rates of diffusion through a
semipermeable membrane.
Explain dialysis procedures?
Crystalloids (aqueous solutions of
mineral salt) passed readily through
this membrane, but larger
substances (colloids) passed very
slowly or not at all.
• Dialysis procedures include:
• Hemodialysis HD)
• Is the most common
method used to treat
advanced and
permanent kidney
failure by connecting
the patient to a
hemodialyzer into
which their blood
flows.
• Hemodiafiltration (HDF)
• Is a method of
treatment that
combines
hemodialysis and
hemofiltration that
yields more urea
clearance than
hemodialysis alone.
What is Peritoneal dialysis (PD)?
What is Kidney transplantation and
• Peritoneal dialysis (PD)
• Type of dialysis in
which dialysate is
introduced into the
patient's peritoneal
cavity and the
peritoneum employed
as the dialysis
membrane
•
Kidney transplantation
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Chem PPT Flashcards, Unit 4
how is it successful?
What are the criterias for kidney
transplants?
• Is the most effective
form of renal
replacement therapy
(RRT) in terms of
long-term survival and
quality of life.
•
Successful transplantation
requires:
• 1. Preoperative
assessment
• 2. Postoperative
assessment
• 3. Therapeutic drug
management
•
Preoperative assessment
• Criteria for acceptance
include:
• candidates
should not be
obese (body
mass index
(BMI) should
be less than 40
kg/m²)
• should NOT
have severe
chronic lung
disease,
inoperable
ischemic heart
disease, active
infective liver
or
immunological
disease,
chronic
infection like
tuberculosis,
pre-existing
malignancy or
lower urinary
tract
20
Chem PPT Flashcards, Unit 4
dysfunction
How is total body water (TBW) distributed?
How is the ECF subdivided?
What is the average adult blood volume and
plasma volune?
What are some factors that influence water and
electrolytes in the human body?
How much water do adult humans need to
intake?
What are some primary cationic electrolytes?
What are some primary anionic electrolytes?
What are the major ions in the ECF?
What are the major ions in the ICF?
What causes active transport?
What is an example of an active transport
system in the human body?
Define active transport?
Two- thirds of total body water(TBW) is
distributed into intracellular fluid (ICF)
compartment, and one third into the
extracellular fluid (ECF) compartment. These
compartments are separated by plasma
membrane.
- Interstitial fluid compartment (≈75%
of ECF)
Intravascular fluid compartment (≈25% of
ECF): these fluid compartments are separated
by capillary endothelium
The average adult has ≈ 5.0 L blood volume
(intravascular compartment) and a plasma
volume of ≈ 3.0 L when the hematocrit is
≈40%.
Factors that influence water and electrolyte
requirements include activity of the
individual, environment, and disease.
On average, an adult must take in ≈ 1.5 to 2.0
L of water daily to maintain fluid balance
Na+, K+, Ca2+, and Mg2+
Cl–, HCO3–, HPO42–, SO42–, organic ions, and
negatively charged proteins
Na+, Cl–, and HCO3–
K+, Mg2+, organic phosphates, and protein
- The unequal distribution of ions is due
to active transport of Na+ from inside
to outside the cell against an
electrochemical gradient.
ATP which is present in most cell membranes
is required for active transport.
Na + /K + -ATPase, an ubiquitous Na-H
exchanger (often referred to as an antiporter),
actively pumps H+ out of the ICF in exchange
for Na+. This is critical for maintaining
intracellular pH homeostasis.
- Can be defined as a process in which a
molecule is carried from a region of
lower concentration to a region of
higher concentration against the
concentration gradient.
Because of the resistance which occurs during
this process, it needs energy. It is thus named
21
Chem PPT Flashcards, Unit 4
as "active“ transport because of its one vital
ingredient, which is the energy that is required
for this process.
Define passive transport?
- Can be defined as a process in which a
molecule is carried from a higher
concentration to a lower concentration
along the concentration gradient and
therefore, it faces no resistance.
Because of the lack of persistence, passive
transport requires no energy for this purpose
to take place and hence the name "passive“
transport.
What is the difference between an active and a
- The main difference between active
passive transport?
transport and passive transport is the
fact that active transport needs energy
which is known as Adenosine
Triphosphate (ATP).
- Active transport requires energy
whereas passive transport does not.
Active transport involves the carrying of a
molecule or a solute against a concentration
gradient; Passive transport involves the
carrying of a molecule or a solute along the
concentration gradient.
What role does sodium have in kidney function?
• Kidney function
• Proximal convoluted tubules
• 70% to 80% of filtered
sodium is actively
reabsorbed
• water and chloride
passively reabsorbed
• Descending loop of Henle
• water but not
electrolytes is passively
absorbed
• Ascending loop of Henle
• chloride is actively
reabsorbed with the
sodium following
• Distal convoluted tubules
secretion of aldosterone, renin and antidiuretic
hormone
What role does sodium have in hyponatremia?
- Defined as a decrease plasma sodium
concentration (<130 to 135 mmol/L)
- Hypo-osmotic hyponatremia:
Hyponatremia characterized by low
22
Chem PPT Flashcards, Unit 4
What role does sodium have in hyperosmotic
hyponatremia?
What role does sodium have in isomotic
hyponatremia?
What role does sodium have in hypernatremia?
What role does sodium have in Hypovolemic
hypernatremia?
What is Normovolemic hypernatremia?
What role does potassium have in
Hypokalemia?
plasma sodium concentration, low
calculated or measured osmolality.
- Depletional hyponatremia:
Hyponatremia due to excess loss of
sodium
Dilutional hyponatremia: Hyponatremia due
to increased ECF volume
- Hyponatremia that occurs in the
presence of increased quantities of
others solutes in the ECF as a result of
an extracellular shift of water or on
intracellular shift of Na+ to maintain
osmotic balance between ECF and ICF
compartments.
The most common type is seen in severe
hyperglycemia.
A pseudohyponatremia caused by an
electrolyte exclusion effect characterized by
decrease in measured Na+ concentration but
with normal plasma osmolality, glucose and
urea levels.
- Increase plasma sodium concentration
(>150 mmol/L)
Hypovolemic hypernatremia: Hypernatremia
characterized by decrease ECF caused by
renal or extra-renal loss of hypo-osmotic
fluid, leading to dehydration.
- Hypernatremia in the presence of
excess total body water indicating a
net gain of water and sodium, with
sodium gain in excess of water.
Commonly seen in hospital patients receiving
hypertonic saline or sodium bicarbonate.
Hypernatremia in the presence of normal ECF
volume seen in diabetes insipidus.
- Decrease in extracellular potassium
(<3.5 mmol/L) either due to
redistribution of extracellular K+ into
ICF, or true K+ deficits, caused by
decreased intake or loss of potassium
rich body fluids
- characterized by muscle weakness,
irritability and paralysis.
Concentrations less than 3 mmol/L are
often associated with marked
neuromuscular symptoms.
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Chem PPT Flashcards, Unit 4
What role does potassium have in
Hyperkalemia?
Following are characteristics of what type of
electrolyte disorder?
Decreased chloride levels
causes of hypokalemia will parallel causes of
hyponatremia
respiratory acidosis, accompanied by increased
HCO3-, is another common cause of decreased
Cl with normal Na
Hyperchloremia is defined as?
Following are characteristics of what type of
electrolyte disorder?
similar to increased Na+ concentrations, as seen
in dehydration, prolonged diarrhea with loss of
sodium bicarbonate, diabetes insipidus, and
overtreatment with normal saline solutions
Hyperchloremia is seen in respiratory alkalosis
or respiratory acidosis?
How much of the total carbon dioxide of plasma
is made up of bicarbonate ions?
What is the characteristic of acid-base
imbalances?
What is the total carbon dioxide (CO2) content
of plasma consist of?
What is the normal blood PH?
Alkalemia (alklaosis) is defined as?
True or False
Acids - are chemical substances that donate
protons (H+ ions)
True or False
Bases - are chemical substances that accept
protons
PH of a solution is defined as?
At lower concentrations, tachycardia and
cardiac conduction defects are apparent by
ECG (flattened T waves) and has been known
to lead to cardiac arrest.
- Increased plasma K+ (>5.0 mmol/L)
which may be caused by
redistribution, increased intake, or
increased retention
pre-analytical conditions such as hemolysis,
thrombocytosis, and leukocytosis have been
known to cause marked pseudohyperkalemia
Hypochloremia
Increased Chloride levels
Hyperchloremia
Seen in respiratory alkalosis because of renal
compensation for excreting HCO3-.
Bicarbonate ions makeup all but ≈2 mmol/L
of the total carbon dioxide of plasma
Alterations in HCO3- and CO2 dissolved in
plasma
Carbon dioxide dissolved in an aqueous
solution (dCO2), CO3 loosely bound to amine
groups in proteins (carbamino compon),
HCO3-, and very small quantities of CO32ions and carbonic acid acid (H2CO3).
7.35 – 7.45
an arterial blood pH > 7.45
True
True
negative logarithm of hydrogen ion activity
24
Chem PPT Flashcards, Unit 4
What is the average pH of blood (7.40)
corresponds to?
What PK is defined as?
What is PK values for acids?
What is PK values for bases?
What is the most important buffering system in
the body?
What is the effectiveness of
Bicarbonate/carbonic acid buffer system?
----------are able to increase or decrease the rate
of reclamation of bicarbonate from the -----------?
What is the normal bicarbonate/dCO2 ratio?
What is the ratio (cHPO42-/cH2PO4-) In
Phosphate buffer system At the plasma pH of
7.4?
Name the buffer system which the total
concentration of it is in both erythrocytes and
plasma accounts for about 5% of the nonbicarbonate buffer value of plasma?
What is the form of organic phosphate in
phosphate buffer system?
In phosphate buffer system----------- accounts
for about 16% of the non-bicarbonate buffer
value off erythrocytes.
What is the major part of the non-bicarbonate
buffers of erythrocyte fluid?
What is the most important buffer groups of
protein in the physiological pH range?
What protein accounts for the greatest portion
(>90%) of the non-bicarbonate buffer value of
plasma?
What are four conditions associated with
Abnormal Acid-Base Status and Abnormal
Electrolyte Composition of the Blood?
Following are characteristics of what type of
acid base condition?
production of organic acids that exceeds the
rate of elimination (e.g. production of a set the
(pH = - log aH+)
a hydrogen ion concentration of 40 nmol/L
Is the pH at which an acid is half dissociated,
existing as equal proportions of acid and
conjugate base.
Acids have pK values <7.0
Bases have pK values > 7.0
Bicarbonate/carbonic acid buffer system
is based on the fact that the lungs are able to
readily dispose of or retain CO2
renal tubules- glomerular filtrate
20:1
4:1 (pK=6.8)
Phosphate buffer system
2,3-diphosphoglycerate (present in
erythrocytes in a concentration of about 4.5
mmol/L),
organic phosphate
hemoglobin
imidazole groups of histidine (pK = 7.3)
albumin
Metabolic acidosis (primary bicarbonate
deficit)
Metabolic alkalosis (primary bicarbonate
excess)
Respiratory acidosis
Respiratory alkalosis
Metabolic Acidosis
25
Chem PPT Flashcards, Unit 4
acetic acid and β- hydroxybutyric acid in
diabetes ketoacidosis and of lactic acid in lactic
acidosis)
Following are characteristics of what type of
acid base condition?
reduced excretion of acids (H+) ask occurs in
renal failure and some renal tubular acidosis,
resulting in the accumulation of acid that
consumes bicarbonate
Following are characteristics of what type of
acid base condition?
excessive loss of bicarbonate due to increased
renal excretion (decreased tubular reclamation)
or excessive loss of duodenal fluid (as in
diarrhea)
In Metabolic Acidosis the ratio of cHCO3/cCO2 is decreased or increased?
What is the resulting drop in pH in Metabolic
Acidosis?
Anion gap is increased or decreased in
Metabolic Acidosis?
What is the first indication of a metabolic
acidosis?
What test should be used for assessing the
presence of an elevated anion gap?
What is Respiratory compensatory mechanism
in metabolic acidosis?
What is Kussmaul breathing?
When Metabolic Alkalosis occurs?
In the Metabolic Alkalosis the ratio of cHCO3/cCO2 is increased or decreased?
What is Respiratory compensatory mechanism
in metabolic alkalosis?
What are some compensatory mechanisms in
metabolic alkalosis?
Metabolic Acidosis
Metabolic Acidosis
Decreased because of the primary decrease in
bicarbonate.
The resulting drop in pH stimulates
respiratory compensation via hyperventilation,
which lowers PCO2 and thereby increases the
pH
Increased
the presence of an elevated anion gap
should be assessed in the electrolyte profiles
of all patients
The decrease in pH stimulates
hyperventilation (Kussmaul respiration)
which results in:
1. The elimination of carbonic acid as CO2
2. A decrease in PCO2 (hypocapnia)
3. A decrease in cdCO2
Is a deep and labored breathing pattern often
associated with severe metabolic acidosis,
particularly diabetic ketoacidosis (DKA) but
also kidney failure
1. Excess base is added to the system
2. Base eliminations decreased
3. Acid-rich fluids are lost
increased because of the primary increase in
bicarbonate
The patient will hypoventilate to raise PCO2,
thereby lowering the pH stored normal
It will include both respiratory and renal
compensation. The increase in pH depresses
26
Chem PPT Flashcards, Unit 4
What is respiratory acidosis?
Does respiratory acidosis occur only through
decreased elimination of CO2?
What is the most common cause of respiratory
acidosis?
What may be another cause of respiratory
acidosis?
What are some compensatory mechanisms in
respiratory acidosis?
What causes respiratory alkalosis?
Is the basic cause of respiratory alkalosis is
excess elimination of acid via the respiratory
about?
What does excessive elimination of carbon
dioxide cause?
What is the first stage of compensatory
mechanism of respiratory alkalosis?
What is the second stage of compensatory
mechanism of respiratory alkalosis?
the respiratory center, causing retention of
carbon dioxide (hypercapnia), which in turn
causes an increase in cH2CO3 and cdCO2.
The kidneys respond to the state of alkalosis
by decreased Na+-H+ exchange, decreased
formation of ammonia and decreased
reclamation of bicarbonate
Any condition that decreases elimination of
carbon dioxide through the lungs results in an
increase in PCO2 (hypercapnia) and dCO2
(respiratory acidosis).
Yes
Chronic Obstructive Pulmonary Disease
(COPD)
Rebreathing , or breathing air high in CO2
content may also cause a high PCO2
The increased PCO2 stimulates the respiratory
center, resulting in an increase pulmonary rate
and depth of respiration. Elimination of
carbon dioxide through the lungs results in a
decrease in cdCO2; thus the ratio of cHCO3/cdCO2 and pH approach normal.The kidneys
respond similarly to the way that they respond
to metabolic acidosis and namely, with
increased Na+-H+ exchange, increased
ammonia formation and increased reclamation
of bicarbonate.
A decrease in PCO2 (hypocapnia) and the
resulting primary deficit in cdCO2
(respiratory alkalosis) are caused by an
increased rate and/or depth of respiration.
Yes
Excessive elimination of carbon dioxide
reduces the PCO2 and causes an increase in
the cHCO3-/cdCO2 ratio.
In the first stage, erythrocyte and tissue
buffers provide H+ ions that consume a small
amount of HCO3-.
The second stage becomes operational in
prolonged respiratory alkalosis and the
kidneys respond by decreasing Na +-H +
exchange, decreasing formation of ammonia
and decreasing reclamation of bicarbonate.
27
Chem PPT Flashcards, Unit 4
What is Diabetes Mellitus?
What are some life-threatening episodes?
What are some complications due to DM?
About how many cases are DM Type 1?
What are some abrupt symptoms of DM Type
1?
What is the cause of DM Type 1?
What are patients with DM Type 1 dependent
on?
Do most patients with DM Type 1 have
antibodies?
When is the peak/main onset of DM Type 1?
About how many cases are DM Type 2?
Do most patients with DM Type 2 show any
symptoms?
Are patients with DM Type 1 dependent on
anything?
How are insulin levels in a DM Type 2 patient?
D most individuals with DM Type 2 have
impaired insulin action?
How is DM Type 2 characterized?
A group of metabolic disorders of
carbohydrate metabolism in which glucose is
underuse leading to hyperglycemia
Life-threatening episodes: ketoacidosis,
hyperosmolar coma
Complications: diabetic retinopathy
(blindness), diabetic nephropathy (renal
failure), neuropathy (nerve damage),
atherosclerosis
About 5% to 10%
Abrupt onset of symptoms such as polyuria,
polydipsia, and rapid weight loss.
They have insulinopenia (a deficiency of
insulin) caused by loss of pancreatic islet
β-cells
Dependent on insulin to sustain life and
prevent ketosis
Most patients have antibodies that identify an
autoimmune process
Peak incidence occurs in childhood and
adolescence (before the age of 18), but onset
in the remainder may occur at any age
About 90% of cases
Patients have minimal symptoms, and are not
prone to ketosis
Patients are not dependent on insulin to
sustain life and to prevent ketonuria
Insulin concentrations may be normal,
decreased, or increased.
Yes
This form of diabetes is characterized by
receptor deficiency.
What is DM Type 2 commonly associated with? Commonly associated with obesity; can be
improved by weight loss
What are some treatments for DM type 2?
Individuals with the disease may require
dietary manipulation, oral hypoglycemic
agents, or insulin to control hyperglycemia.
When is the peak/main onset of DM Type 2?
Peak incidence after 40 years of age, but it
may occur in younger people
What are some underlying causes of
Genetic defects of β-cell function, genetic
hyperglycemia?
defects in insulin action, exocrine pancreas
disease, and endocrinopathies (Cushing
syndrome, acromegaly, glucogonoma)
What is the functional anatomic unit of the
The lobule
liver?
28
Chem PPT Flashcards, Unit 4
What are Kupffer cells?
What do Kupffer cells contain, and what
function do they serve?
What is the main site for clearance of antigenantibody complexes from the blood?
What are the major functioning cells in the
liver? What are they responsible for?
What is the site of oxidative phosphorylation
and energy production?
What is the site of protein synthesis?
What does the smooth ER contain?
What enzyme is contained in lysozomes? What
does it act as?
What are two substances secreted by the Golgi
apparatus?
How is hepatic excretory function measured in
the liver?
What are drug metabolic tests used for in
assessing hepatic excretory function?
What plasma proteins are used in assessing
hepatic protein synthesis function?
Besides proteins, what other organic compound
is used in assessing hepatic synthetic function?
When checking ammonia metabolism in hepatic
metabolic function what ailments are being
checked for?
What are xenobiotics?
What are some clinical manifestations of liver
disease?
What is another name for jaundice?
What is jaundice characterized by?
How does portal hypertension occur?
Macrophages that live in the liver
Lysosomes which break down phagocytized
bacteria.
Lysosomes in Kupffer cells.
Hepatocytes, which are responsible for most
of its metabolic and synthetic functions
Mitochondria
Rough ER
Microsomes involved in drug and toxn
metabolism and cholesterol and bile acid
synthesis.
Hydrolytic enzymes which act as scavengers.
Bile acids and albumin.
Measurement of plasma concentrations of
endogenously produced compounds such as
bilirubin, and less commonly used bile acids.
Used as markers of function in liver
transplants and in advanced liver disease.
Plasma proteins such as albumin,
transthyretin, immunoglobulins,
ceruloplasmin, α1-antitrypsin, and αfetoprotein and coagulation proteins.
Urea
Reye syndrome and hepatic encephalopathy
Foreign substances that are cleared and
metabolized by the liver such as
bromsulfonphthalein (BSP), indocyanine
green (ICG), aminopyrine, caffeine, lidocaine
and stain rose bengal.
Jaundice, portal hypertension, Bleeding
esophageal varices, ascites, spontaneous
bacterial peritonitis, hepatic encephalopathy,
and hepatorenal syndrome.
Icterus
A yellow appearance of the skin, mucous
membranes and sclera caused by bilirubin
deposits.
When there is obstruction to portal flow
anywhere along its course
29
Chem PPT Flashcards, Unit 4
How are the causes of obstruction leading to
portal hypertension classified?
Which classification is the most common cause
of portal hypertension?
Which classification is also known as BuddChiari syndrome?
Which coagulation factors are synthesized in
the liver and measured by PT (prothrombin
time)?
What may also cause an increase in PT in
cholestasis?
What does a disorder of fibrinogen lead to in
both acute and chronic liver disease?
What does Disseminated Intravascular
Coagulation (DIC) with?
What may contribute to ineffective intravascular
coagulation?
What are enzymes released from diseased liver
tissue?
What are the cytosolic enzymes?
What are Mitochondrial and cytosolic
isoenzymes in hepatocytes?
What are the canalicular membranes of
hepatocytes?
AST activity is what times that of ALT?
Are hepatocyte activities of LD higher or lower
than that of AST and ALT relative to plasma?
Are plasma activities of LD higher or lower
than those of ALT and AST?
What is the simplest mechanism of enzyme
release from diseased liver tissue?
What enzyme does alcohol appear to induce to
expression of on the surface of hapatocytes?
The release of what two enzymes appears to be
associated with increased synthesis, membrane
fragmentation by bile acids, and solubilization
of membrane-bound enzymes of bile acids?
What is the half-life of ALT?
What is the half-life of AST?
What does the much longer half-life of ALT
lead to?
Pre-sinusoidal, sinusoidal, and post
sinusoidal.
Pre-sinusoidal
Post sinusoidal
Factor I (Fibrinogen)
Factor II (Prothrombin)
Factor V (Proaccelerin)
Factor VII (Proconvertin)
Factor X (Stuart Factor)
Vitamin K deficiency
Prolonged PTT
Hepatic necrosis
Thrombocytopenia
Aspartate aminotransferase (AST, SGOT)
Alanine aminotransferase (ALT, SGPT)
Alkaline phosphatase (ALP)
γ- glutamyltransferase (GGT)
Lactate dehydrogenase (LDH)
AST, ALT, and LD
AST, ALT
ALP and GGT
Two times
Lower
Higher
Cell injury
Mitochondrial AST
GGT and ALP
48 hours
16-18 hours
Higher activites of ALT than AST in most
forms of hepatocellular injury
30
Chem PPT Flashcards, Unit 4
What is the half-life of liver isoenzyme of ALP? 1 to 10 days
What is the reported half-life of GGT?
4.1 days
What are disorders of bilirubin metabolism?
Unconjugated hyperbilirubinemia, and
conjugated hyperbilirubinemia
What is increased in unconjugated
Production of unconjugated bilirubin from
hyperbilirubinemia?
heme
What is decreased in unconjugated
decreased delivery of unconjugated bilirubin
hyperbilirubinemia?
in plasma to hepatocyte
decrease uptake of unconjugated bilirubin
across hepatocyte membrane
decreased storage of unconjugated bilirubin
decreased conjugation
What is decreased in conjugated
decrease secretion of conjugated bilirubin into
hyperbilirubinemia?
canaliculi
decreased drainage
What is conjugated hyperbilirubinemia also
Cholestasis
known as?
What five viruses have been identified in
A, B, C, D, and E.
hepatic viral infection?
What is the most common cause of acute viral
Hepatitis A (HAV)
hepatitis?
What is Hepatitis A associated with?
Waterborne and foodborne contamination
Does Hepatitis A have a chronic form?
No
How is Hepatitis B virus transmitted?
Parenteral, sexual, or from mother to child
after delivery (vertical transmission).
How is Hepatitis B prevented ?
It can be prevented by passive (hepatitis B
immune globulin [HBIG]) or active (hepatitis
B recombinant vaccine) immunization
What is the most common cause of chronic
Hepatitis C virus
hepatitis?
What is the major risk factor for acquiring
Hepatitis C major risk factor include injection
Hepatitis C virus?
from drug use as well as transfusion before
testing the blood supply
What is used to detect the presence of Hepatitis HCV RNA is used to detect the presence of
C virus?
Hepatitis C virus.
The known causes of transmission of Hepatitis
Fecal-Oral and Household.
D, and E viruses are?
What is acute hepatitis?
Acute injury directed against hepatocytes
which may either be directly or indirectly.
Give an example of a drug that causes direct
Acetaminophen
injury to hepatocytes.
What is indirect injury to hepatocytes?
Indirect injury is immunologically mediated
injury that occurs with hepatitis viruses and
most drugs including ethanol.
A person with Wilson’s Disease will show an
3-10 URL
increase of ALT/AST Upper reference limit by
31
Chem PPT Flashcards, Unit 4
how much?
What is the Bilirubin level for someone with
viral, alcoholic, drug induced, autoimmune
hepatitis, and Wilson’s Disease?
What is acute alcoholic hepatitis
characteristically associated with?
What drug has a toxic metabolite that can cause
Toxic hepatitis?
What is another term for Ischemic Hepatitis?
What is increased during Ischemic Hepatitis?
What is Cholestatic Hepatitis?
What is chronic hepatitis?
What are the two major components of chronic
hepatitis?
What is ALT activity strongly correlated with
and NOT strongly correlated with?
What are the most common causes of Chronic
hepatitis?
How is idiopathic hepatitis diagnosed?
α1- Antitrypsin deficiency is diagnosed by?
How many genotypes of Chronic Hepatitis C
are there?
What is the test performed after 24 weeks after
completion of treatment for Hepatitis C?
How are the results after completion of
treatment for Hepatitis C interpreted?
What are the diseases associated with fat and
inflammation of the liver not associated with
alcoholism?
NAFLD and NASH are associated with what
diseases?
What is Autoimmune Hepatitis?
What are the most important antibodies for the
diagnosis of Autoimmune Hepatitis?
5-10 mg/dL
Leukocytosis and increased concentrations of
acute phase response proteins.
Acetaminophen
Hypoperfusion
Cytosolic enzymes
It is the obstruction of bile secretion and
dysfunction of bile canaliculi in the Golgi
apparatus of the liver cells.
It’s the continuous inflammatory damage to
hepatocytes lasting more than six months,
accompanied by hepatocytes lead generation
and scarring.
Fibrosis and necroinflammatory activity.
ALT activities are strongly correlated with
necroinflammatory activity, but not with
fibrosis.
Chronic HBV, chronic HCV, and nonalcoholic steatohepatitis (NASH).
Through liver biopsy and the absence of
markers.
α1- AT Phenotype.
24
Sensitive HCV RNA.
Results can be treated as nonresponder,
treatment responder, relapser, and sustained
virologic response (SRV)
Non-alcoholic fatty liver disease (NAFLD)
and non-alcoholic steatohepatitis (NASH)
Non-alcoholic fatty liver disease (NAFLD)
and non-alcoholic steatohepatitis (NASH)
Autoimmune Hepatitis is a rapidly
progressing form of chronic hepatitis
associated with the presence of autoimmune
markers and substantial
hypergammaglobulinemia.
Antinuclear antibody (ANA), anti-smooth
muscle antibody (ASMA), and anti-liver32
Chem PPT Flashcards, Unit 4
What is the Antigen target for Anti-LKM1
What are the Antigen targets for ASMA
What are the most common drugs involved with
drug induced chronic hepatitis?
What have been linked to chronic hepatitis?
What is Liver Disease?
What is genetic Liver Diseases that presenting
as Chronic Hepatitis?
What is Hemochromatosis?
What is Alpha I-antirypsin?
What is Wilson disease?
What is Alcoholic Liver Disease?
What is Cirrhosis?
What is Cholestatic Liver Disease
What is Primary biliary Cirrhosis (PBC)?
What is primary sclerosing Cholangitis (PSC)?
kidney microsomal antigen type I (LKM1)
Cytochrome P450 IID6
Actin, Tubulin, Vimentin, Desmin, Skelitin
Nitrofurantoin, Methyldopa, and HMG-CoA
(3-hydroxy-3-methyl-glutaryl-CoA) reductase
inhibitors.
Herbal Medications
When the liver or hepatocyte function
abnormality cause inflammation, fibrosis,
scarring.
1. Hemochromatosis
2. Alpha I – Antitrypsin (AAT)
deficiency
Wilson Disease
A rare genetic disorder, due to abnormalities
in genes that regulates iron metabolism.
Is a major protein serine protease inhibitor
(serpin) in plasma, and is decreased
homozygous deficiency and cirrhosis and
increased by acute inflammation.
An autosomal recessive disorder associated
with excessive quantities of copper in the
tissue particularly the liver and central
nervous system.
Risk factors for developing alcoholic liver
disease include duration and magnitude of
alcohol abuse, sex, presence of co-infection
with HBV or HCV, and nutritional state.
Defined anatomically as diffuse fibrosis with
nodular regeneration, represents the end-stage
of scar formation and regeneration in chronic
liver injury.
Stoppage or suppression of the flow of bile is
associated with the retention of bile within the
excretory system, which may be due to
gallstones in the bile ducts
(choledocholelithiasis), narrowing (strictures)
and tumors.
Also known as nonsuppurative destructive
cholangitis, is an uncommon autoimmune
disorder targeting intrahepatic bile ducts
primarily in middle age women (6:1 female to
male ratio).
A chronic inflammatory disease of the biliary
tree, most commonly affecting extrahepatic
bile ducts, characterized by the presence of
33
Chem PPT Flashcards, Unit 4
What is Gallstones?
What is Hepatic Tumors?
What is Hepatocellular Carcinoma (HCC)?
What are the preferred Tests of Hepatic
Function:
Bilirubin Test
ALP test
AST Test
ALT Test
Albumin Test
PT Test
What is the Specimen of choice for liver
disease?
What is serum albumin?
What is the purposed of Prothrombin time test
(PT)?
anti-neutrophil cytoplasmic antibodies
(ANCA)
Are solid formations in the gallbladder that
are composed of cholesterol and bile salts.
 the most important
primary liver tumor is
hepatocellular
carcinoma (HCC).
 the major risk factor for
development of HCC is
infection with HBV or
HCV.
the most widely used tumor marker is AFP.
A cancer arising from hepatocytes,
complication of HBV and HCV also cause
HCC.
Diagnosing jaundice, modest correlation with
severity.
Alkaline phosphatase diagnosing cholestasis
and space-occupying lesions
Aspartate Aminotransferase Sensitive test of
hepatocellular Disease; AST > ALT in
alcoholic disease, cirrhosis
Alanine aminotransferase sensitive and more
specifc of hepatocellular disease.
Indicator of chronicity and severity
Prothrombin test indicator of severity, early
indicator of cirrhosis in chronic hepatitis
Serum albumin

Useful in assessing the chronicity and
severity of liver disease.
 Serum albumin concentration is
decreased in chronic liver disease.
 Also decreased in severe acute liver
disease, in inflammatory disorders,
malnutrition, and with nephrotic
syndrome.
serial measurements of serum albumin also
are used to assess the severity of liver disease
 serial PT measurements are used to
determine in synthetic liver function.
 more reliable done albumin
measurements because fewer
34
Chem PPT Flashcards, Unit 4
What are the major organs of the G.I. Tract
include:
What are 3 major zones off the Stomach?
What is cardiac Zone Secret?
What is the body of stomach secret?
What is the Pyloric Zone Secret?
What is the function of the small intestine (SI)?
What are the 3 parts of the SI?
What is the Function of Duodenum?
What is the function of Jejunum?
What is the function of ileum?
What is the function of large intestine?
What are the 5 parts of Large Intestine?
conditions (other than warfarin
administration) affect PT then affect
albumin.
PT is the most important prognostic marker in
acute liver disease and is usually the first
function tests to become abnormal as chronic
hepatitis evolves into cirrhosis.
• Stomach
• Small intestines
• Large intestines
• Pancreas
Gallbladder
Three major zones:
 cardiac zone,
 body
pyloric zone
Secretion of Mucus
Secretion of HCL, enzymes, mucus, and
intrinsic factor.
Secretion of mucus, pepsinogen, and gastrin
Converts food into chime and
 Duodenum
 Jejunum
Ileum
Is the 1st and shortest segment of the small
intestine. It receives partially digested food
(known as chime) form the stomach and plays
a vital role in the chemical digestion of chime
in preparation for absorption in the small
intestine.
Is specialized for the absorption, by the
enterocytes, of small nutrient particles which
have been previously digested by enzyme in
the duodenum.
Mainly to absorption of B12 and bile salt and
whatever products of digestion were not
absorbed by the jejunum.
Is to absorb water from the remaining
indigestible food matter and transmit the
useless waste material from the body.
 Cecum
 Appendix
 Colon
 Rectum
anal canal
35
Chem PPT Flashcards, Unit 4
Cecum
Appendix
Colon
What is Function of Pancreas?
What is the function of Gallbladder?
What is bile?
What is Zollinger-Ellison (Z-E) syndrome?
Where was the Zollinger-Ellison (Z-E) tumor
found?
What are the characteristics of Zollinger-Ellison
(Z-E) syndrome?
What were the evidences caused increased the
concentration of high serum gastrin?
What is the definition of Gastritis?
Where were leading to Erosive gastritis (Acute
gastritis)?
What was the technique used to diagnosis for
Erosive gastritis (Acute gastritis)?
How is Nonerosive gastritis (Chronic gastritis)
associated with peptic ulcer?
Store food material where bacteria are able to
break down the cellular.
Acts as a storehouse for good bacteria,
rebooting the digestive system after diarrheal
illness.
Is to reabsorp fluids and precess waste
products from the body and prepare for its
elimination.
Are secreted into small intestine to further
break down food after it has left the stomach.
The gland also produces the hormone insulin
and secretes it into the bloodstream in order to
regulate body glucose or sugar level.
Is to store and concentrate bile, a yellowbrown digestive enzyme produce by the liver.
Is a digestive juice that secreted by the liver
and stored in gallbladder.
Important functions:
1. assists with fat digestion and
absorption in the gut
2. body to excrete waste product from
blood.
Increase absorption of fats, it’s an important
part of absorption of fat-soluble substances,
such as Vitamins A, D, E, K.
Results from a tumor (gastrinoma) of the
pancreatic islet cells
The primary tumors classically occur in the
pancreas, duodenum or intestinal lymph
nodes, but also occur in other organs
it is characterized by fulminant peptic ulcers,
massive gastric hypersecretion,
hypergastrinemia, diarrhea and steatorrhea.
The documentation of an increased basal acid
output (BAO) in gastric juice provide strong
evidence that the high serum gastrin
concentration is caused by Z-E syndrome.
Is the term used to denote mucosal
inflammation of the stomach
Occurs in individual after severe trauma, or
severe burns (Curling ulcer) and craniotomy
or traumatic head injuries
Diagnosed by endoscopy
Associated with peptic ulcer disease or gastric
carcinoma, the period after partial
36
Chem PPT Flashcards, Unit 4
What are other names of Celiac disease?
Where would Celiac disease, a lifelong
autoimmune intestinal disorder, is found in?
What is the external trigger to Celiac disease’s
development?
What antibodies used to diagnose celiac
disease?
What can be used as measurement to diagnosed
Celiac disease?
For a definitive diagnosis, what is a jejunum
biopsy required?
What does Disaccharidase deficiency lead to?
gastrectomy, pernicious anemia, H. pylori
infection and healthy elderly individuals
- non-tropical sprue
- Celiac Sprue
Gluten-Sensitive Enteropathy
individuals who are genetically susceptible
found in gluten, which is a complex group of
proteins present in wheat
Immunoglobulin A (IgA) antibodies
tissue transglutaminase (tTG)
antibodies for endomesial antibodies
(EMA)
- antireticulin antibodies (ARA)
Antigliadin antibodies
with the characteristic changes in villous
atrophy, increased intraepithelial
lymphocytes, and hyperplasia of the crypts
- Lactose intolerance
- Congenital lactase deficiency
- Acquired lactase deficiency
- Sucrase-Isomaltase and Trehalase
deficiencies
-
What are the methods to detect lactase
deficiency?
What are diseases lead to from a bacterial
overgrowth?
- Lactase in mucosal biopsy
Oral lactose tolerance
- bile salt deficiency, which causes fat
malabsorption
Vitamin B12 deficiency
What does diagnostic gold standard require?
intubation with aspiration of jejunal contents
and the demonstration of a bacterial count of
>107 organisms/mL and >104 anaerobes/mL
- Jejunal diverticuli
- Crohn disease
- Automatic neuropathy
- Scleroderma
- Pseudo obstruction
Postgastretomy
Following cholecystectomy and in some
patients with irritable bowel syndrome (IBS)
- selenohomocholyltaurine test
- Measurement of serum 7a-hydroxy-4cholesten-3-one
levels
Therapeutic trial of bile acids sequestrants
What are the small intestine abnormalities
associated with bacterial growth?
When does Bile salt malabsorption occur?
Procedure for the diagnosis of bile salt
malabsorption
37
Chem PPT Flashcards, Unit 4
What are Inflammatory bowel disease (IBD)
What can IBD be diagnosed by?
What is the diagnose of Protein-losing
enteropathy?
How does Protein-losing enteropathy
diagnosed?
What is Cystic fibrosis (CF)
What is a reliable test for pancreatic
insufficiency in infants over the age of 2 weeks
with CF, and in older children at diagnosis of
the disorder?
What are the Adult disorders of exocrine
pancreas
What are Invasive test of pancreatic exocrine
function?
What are noninvasive test of pancreatic
exocrine function?
What might lead to Carcinoid tumors?
What are the clinical presentations of
maldigestion/malabsorption?
What are the causes of chronic diarrhea?
What are the main functions of bone?
What’s the composition of bones and function
of each?
What are the two main types of bone cells?
such as cholestyramine
Crohn disease, ulcerative colitis and a number
of microscopic inflammatory bowel disorders
diagnosed by fecal lactoferrin or calprotectin
determinations
patients with hypoalbuminemia in whom renal
loss, liver disease and malnutrition have been
excluded
measuring the fecal clearance of alpha-1 antitrypsin as a marker of G.I. protein loss
the most common severe autosomal recessive
disease affecting the pancreas
measurement of pancreatic elastase-1 in feces
- Acute pancreatitis
- Chronic pancreatitis
Carcinoma of the pancreas
- Lundh test
- Secretin stimulating test
Secretin CCK test
- Fecal chymotrypsin
- Fecal elastase 1
- NBT-PABA
- Pancreolauryl
13C mixed chain tryglyceride absorption
- Pancreatic tumors
- Insulinomas
- Gastrinomas
- VIPomas (Werner-Morrison
syndrome)
- Detection of chromogranin A
- Somatostatinomas
Glucagonomas
Evidence of general ill health, isolated
nutritional deficiencies, abdominal symptoms,
watery diarrhea and possibly steatorrhea.
Carbohydrate malabsorption, laxative use,
VIPoma, ulcerative colitis, crohn’s disease.
Mechanical, protective and metabolic.
Cortical bone (80% of mineral) to primarily
mechanical and protective, trabecular bone
(20% of mineral) function is more
metabolically active.
Osteoclasts and osteoblasts.
38
Chem PPT Flashcards, Unit 4
What is the function of osteoclasts?
What is the function of osteoblasts?
What are the remodeling or turnover of bone
cycles?
How do osteoblasts form bone?
What is bone growth and turnover influenced
by?
What are the percentages of bone content and
the specific mineral?
What does the concentration of these
electrolytes in plasma depend on?
What principal hormones regulate these
processes?
What is the 5th most common element in the
body?
What is the body’s content of calcium?
What states does calcium exist in the blood?
What is the calcium regulating hormone?
What are the physiological functions of
intracellular calcium?
What is extracellular calcium needed for?
What does a decrease in serum free calcium
concentration cause?
What does an increase in serum free calcium
concentration cause?
What is the clinical significance of calcium?
What Spectrophotometric methods can you use
to measure total calcium?
Osteoclasts resorb bone, which is the process
that osteoclasts break down bone and release
minerals, resulting in a transfer of calcium
from bone fluid to blood.
Osteoblasts function is to synthesize new
bone. It’s a cell that secretes the matrix for
bone formation; a cell that makes bone.
Activation, resorption, reversal, formation,
rest phase.
By synthesizing the organic matrix, including type I
collagen and participating in the mineralization of
newly synthesized matrix.
Metabolism of calcium, phosphate,
magnesium and by many hormones specially
parathyroid hormone (PTH)< 1,25dihydroxyvitamin D (1,25 [OH]2D) and
several cytokines.
Bone contains nearly all the calcium (99%),
most of the phosphate (85%), and much of the
magnesium (55%) of the body.
The net effect of bone mineral deposition and
resorption, intestinal absorption and renal
excretion.
PTH and 1,25(OH)2D.
Calcium, and is the most prevalent cation.
99% predominantly as extracellular crystals of
hydroxyapatite, Ca10(PO4)6(OH)2.
Ionized (50%), bound to plasma proteins,
primarily albumin (40%), complex with small
ions (10%).
PTH and 1,25(OH)2D.
Muscle contraction, hormone secretion,
glycogen metabolism and cell division.
Bone mineralization, blood coagulation, and
other functions.
Neuromuscular excitability and tetany.
It reduces neuromuscular excitability.
Hypocalcemia and hypercalcemia.
1) o-Cresolpthalein Complexone method
2) Arseno III method
3) Ion-Selective Electrode methods
4) Atomic Absorption Methods
39
Chem PPT Flashcards, Unit 4
What are the Specimen requirements for the
total calcium measurements?
1) Serum and heparinized plasma are the
preferred specimens for total calcium
determination.
2) Citrate, oxalate,and EDTA anticoagulants
should not be used because they interfere by
forming complexes with calcium.
3) Co-precipitation of calcium with fibrin in
heparinized plasma or lipids has been reported
with storage or freezing.
4) Urine specimens a should be preserved by
adding 20 to 30 mL of 6 mol/L HCl per 24
hours specimen (1 to 2 mL for a random
specimen) to prevent calcium salt
precipitation.
What area some interferences for the total
measurement of calcium?
What can you use to measure free (ionized)
Calcium?
What are some interferences with the
measurements of Free (Ionized) Calcium?
what are the specimen requirements of free
(ionized) Calcium?
1) Hemolysis, icterus, lipemia, paraproteins,
magnesium and gadolinium chelates in
contrast agents interfere with photometric
methods.
2) Remedy: use of bichromatic analysis,
multi-wavelength corrections, or blanking to
reduce interference
Ion- Specific Electrode methods
Ionic strength of the specimen
anionic surfactants and ethanol
effect of pH
1) Specimens must be collected and handled
anaerobically and promptly to minimize
alterations in pH and free calcium due to the
loss of CO2 and the metabolism of blood
cells.
2) Syringes and evacuated tubes should be
filled completely and sealed to prevent the
loss of CO2 (increase in pH).
3) Specimens should be handled to prevent
the production of lactic acid (decrease in pH)
by erythrocytes or white blood cells during
anaerobic metabolism or glycolysis.
40
Chem PPT Flashcards, Unit 4
4) Specimen should be collected, transported
and maintained on ice to prevent anaerobic
metabolism.
5) Free calcium is measured in heparinized
whole blood, heparinized plasma or serum.
6) Free calcium is stable in whole blood
specimens for 1 hour at room temperature and
for 4 hours at 4°C.
What are the effects of anticoagulants on Free
(Ionized) Calcium?
What are the patient Preparation and Sources of
Preanalytical Error for Total and Free Calcium
Measurements?
7) The free calcium concentration and the
actual pH of the specimen should be reported
on each specimen. The pH is useful in
verifying that the specimen has been properly
handled.
1) Heparin is the only acceptable
anticoagulant for free calcium determinations
2) Liquid heparin should be avoided since it
may falsely low free calcium levels.
3) Citrate, oxalate, and EDTA bind calcium
and unacceptably decrease free calcium
concentration
1) Use of tourniquet (if required), should be
applied just before sampling and released
within 1 minute.
2) Fist clenching or other forearm exercise
should be avoided before phlebotomy to
prevent decrease in pH (due to lactic acid
production) and an increase in free calcium.
3) Avoid sudden changes in posture.
4) Inactivity such as bed rest can lead to bone
resorption and increase total and free calcium
in blood.
5) Hyperventilation decreases concentration
of free calcium.
6) Exercise increases the concentration of free
calcium.
7) Both serum free calcium and calcium
excretion are lower during the night
41
Chem PPT Flashcards, Unit 4
What is Phosphate?
Inorganic phosphate is the fraction measured
in?
In blood, organic phosphate esters are located
primarily within?
Inorganic phosphate is a major component of?
How is phosphate measured?
What is are the preferred specimens?
Citrate, oxalate and EDTA should not be used
because?
Is concentration of inorganic phosphate about
0.2 to 0.3 mg/dL or 0.06 to 0.10 mmol/L lower
or higher in heparinized plasma than in serun?
True or false phosphate concentrations in
plasma or serum are decrease by prolonged
storage with cells at room temperature ?
What is the name for specimens that are
unacceptable because erythrocytes contain high
concentrations of organic phosphate esters,
which hydrolyze to inorganic phosphate ?
What molecule is increases in hemolyzed
specimens stored at 4*C more rapidly at room
temperature 37*C
Phosphate is ____1_ in separated serum for
days at 4*C and for ___2___ when frozen
provided evaporation is prevented
What molecule is the fourth most abundant
cation in the body ?
55%of the total body _______is in the skeleton
and 45% is intracellular
Within the cell most of the magnesium is bound
to ______ and ________________notably ATP
What molecule is a cofactor for more than 300
enzymes required for enzyme substrate complex
formation and an allosteric activator of many
enzyme systems
Which molecule is metabolized in a cell to
produce energy for performing work?
True or false ? the potential energy in an ATP
Phosphorus in the form of inorganic and
organic phosphate is an important and widely
distributed element in the human body.
Plasma and serum by clinical laboratories.
Cells and incorporated into nucleic acids,
phospholipids, phosphoproteins, and highenergy compounds, such as ATP.
Hydroxyapatite in bone.
Based on the reaction of phosphate ions with
ammonium molybdate to form a
phosphomolybdate complex that is measured
spectrophotometrically.
Serum and heparinized plasma
They interfere with the formation of the
phosphomolybdate complex.
Lower in heparinized plasma than in serum
False
Hemolyzed
Inorganic phosphate
1. stable
months
Magnesium
Magnesium
1. proteins
negatively charged molecules
Magnesium
Glucose
True
42
Chem PPT Flashcards, Unit 4
molecule is derived mainly from its three
phosphate groups
Which process is not part of the cellular
respiration pathway that produces large amounts
of ATP in a cell?
Inonezed calcium is characterized as ?
Which is the physiological active form of
calcium ?
Phosphomolybdate is used to measure which of
the following ?
TSH is secreted by the ?
Which of the pituitary hormones regulates renal
free water excreation to maintain homeostasis
Serum thyroid-stimulating hormone levels are
decreased in ?
Tetraiodothyronine describes which thyroid
hormone?
The principle method used to measure hormone
levels in blood in most clinical labs is ?
Free thyroxine assays measure ?
What would be the predicted results for the
following lab tests for a patient with
hypothyroidism ?
Crushing syndrome is characterized by?
What are some of the parathyroid hormone
hyposecreation symtoms ?
What are some of the Parathyroid hormone
fuctions are ?
Where is the parathyroid horomone located ?
What are the thyroid glands composed of ?
True or false? PTH acts directly on bone and
kidney
What technique is used for the measurement of
parathyroid hormone?
Specimen used for the measurement of
parathyroid hormone
Sources of Vitamin D.
Fermentation
Free or unbound
Ionized
Inorganic phosphorus
Anterior pituitary
Antidiuretic hormone
Primary hyperthyroidism
T4 (thyroxine)
Immunoassays
Only the unbound thyroxine level
Elevated TT4 below normal FT4 elevated
TSH
Excess secretion of pituitary ACTH
1.Low blood calcium (hypocalcemia
2. Nerve discharge and seizutes
3. Muscle sparms
Raises blood calcium
Stimulates release of calciumfrom bones
Indirectly increases activity of and number
of osteoclast
Stimulates final conversion of vitamin Din the
kidneys Calcidiol into calcitriol, calcitriol aids
calcium absorption in the small intestine
Bilaterally in the neck two on the left and two
on the right
Chief and oxyphil cells that synthesize ,store
and secrete PTH
True
Two-site or sandwich immunoassays
Serum or EDTA plasma
It is produced endogenously by exposure of
skin to sunlight and absorbed from foods
43
Chem PPT Flashcards, Unit 4
Main circulating form of Vitamin D.
Biologically active form of Vitamin D.
Metabolites of vitamin D.
What is the rle of 1,25(OH)2D in small
intestine?
primarily fish liver oils, fatty fish, egg yolks
and liver.
25-hydroxyvitamin D [25(OH)D]
1,25-dihydroxyvitamin D [1,25(OH)2D]
-Cholecalciferols (Vitamin D3)
-Ergocalciferols (Vitamin D2)
It stimulates calcium absorption, primarily in
the duodenum, and phosphate absorption in
the jejunum and ileum.
Effects of 1,25(OH)2D on BALP and OC?
By stimulating osteoblast, 1,25(OH)2D also
increases the circulating concentration of
bone alkaline phosphatase (BALP) and the
non-collagenous bone protein osteocalcin
(OC).
Role of 1,25(OH)2D in kidneys.
In the kidneys, 1,25(OH)2D inhibits its own
synthesis and stimulates its metabolism.
Clinical significance of Vitamin D and its
Useful in evaluating hypocalcemia, vitamin D
metabolites.
status, bone disease and other disorders of
mineral metabolism.
Useful in detecting inadequate or excessive
hormone production in the evaluation of
hypercalcemia, hypercalciuria, hypocalcemia
and bone and mineral disorders.
Measurement techniques of Vitamin D
-Competitive Protein Binding Assay (CPBA)
metabolites
-Immunoassay
-UV absorbance after separation by -High
Performance Liquid Chromatography (HPLC)
-Liquid Chromatography Tandem Mass
Spectrometry (LC-MS/MS)
What is Calcitonin?
It is a 32-amino acid linear polypeptide
hormone that is produced in humans primarily
by the parafollicular cells (also known as Ccells) of the thyroid.
What is Parathyroid hormone-related protein (or It is a protein member of the parathyroid
PTHrP) ?
hormone family. It is occasionally secreted by
cancer cells (breast cancer, certain types of
lung cancer including squamous cell lung
carcinoma). However, it also has normal
functions.
Role of PTHrP.
It acts as an endocrine, autocrine, paracrine,
and intracrine hormone.
What happened If PTHrP stimulate?
PTHrP can simulate most of the actions of
PTH including increases in bone resorption
and distal tubular calcium reabsorption, and
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Chem PPT Flashcards, Unit 4
inhibition of proximal tubular phosphate
transport.
By Which method PTHrP can be measured?
By Which way PTHrP can be protected?
What is Osteoporosis?
What is cause by Osteomalacia and Rickets?
Osteomalacia or rickets done by which
deficiency?
What is the types of Disorders of Bone and
mineral in chronic kidney disease (Renal
Osteodystrophy)?
Define Paget Disease of Bone.
Pituitary Gland also called what?
Pituitary gland located in a bone cavity, known
as _____, found at the base of the __________
The anterior lobe of the pituitary gland is
known as?
The posterior lobe of the pituitary gland is
known as?
Anterior Pituitary Cells is responsible for
Anterior Pituitary Cells synthesize both _____
and ______ hormones in response to signals
from the hypothalamus
Trophic hormones stimulate its target organ to
PTHrP can be measured by competitive and
noncompetitive immunoassays
A combined mixture of aprotinin, leupeptin,
pepstatin, and EDTA provides the greatest
protection.
Osteoporosis is a disease of bones where bone
mineral density is reduced and the amount and
variety of proteins in bone is altered.
Osteomalacia and Rickets Caused by a
mineralization defect during bone formation,
resulting in an increase in osteoid, the
unmineralized organic matrix of bone.
Osteomalacia or rickets is usually due to
either vitamin D deficiency or phosphate
depletion.
-High-turnover bone disease
Osteitis fibrosa or secondary
hyperparathyroidism
-Low-turnover bone diseases
osteomalacia
adynamic (aplastic) bone disease
Paget Disease of Bone is a localized disease
of bone characterized by osteoclastic bone
resorption, followed by replacement of bone
in a chaotic fashion.
a disease that affects the skull, femur, pelvis
and vertebra.
the most common finding leading to the
diagnosis of Paget disease is increased serum
activity of ALP.
hypophysis
1. sella turcica
skull
Adenohypophysis) / Anterior pituitary
Neurohypophysis) /Posterior pituitary
hormone production.
1. trophic
non- trophic
target hormones (TSH)
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Chem PPT Flashcards, Unit 4
release what?
Non-trophic hormones acts directly without the
production of a what?
What are the Anterior Pituitary Gland
hormones?
What are 3 glycoprotein hormones that process
a common alpha subunit and a distinct beta
subunit that confers biologic specificity.
ACTH, PRL, and GH what type of hormones?
What cells do not synthesize any known
hormone but serve as a storage area for
hormones produced by the hypothalamus
2 hormones that are stored in the posterior
pituitary gland are
Disorders of the pituitary gland either pituitary
adenoma or pituitary hyperplasia are Primary or
Secondary factors?
disorders of the hypothalamus or ectopic origin
are primary or secondary factors?
Hyposecretion can be decreased secretion of
one hormone, a group of hormones, or all
hormones (panhypopituitarism). This is what
type of disorder?
What causes hypersecretion of one hormone
which commonly results in hyposecretion of
remaining pituitary hormones (due to
destruction of pituitary gland by the growing
tumor)
What is a protein hormone synthesized and
released from the anterior pituitary is response
to stimulation from the hypothalamic growth
hormone releasing factor (GHRH). This is also
know as?
What is Growth hormone stimulated by?
How does growth hormone affect metabolic
processes?
During daytime hours, plasma concentration
target hormone (PRL)
 Melanocyte Stimulating Hormone
 Prolactin (PRL)
 Growth Hormone (GH); Somatotropin
 Luteinizing Hormone (LH)
 Follicle-Stimulating Hormone (FSH)
 Thyroid-Stimulating Hormone (TSH)
Adrenocorticotrophic Hormone (ACTH)
TSH, LH and FSH
polypeptide
Posterior Pituitary
1.Oxytocin
2. Anti-diuretic Hormone (ADH);
Vasopressin
Primary
Secondary
Anterior Pituitary Disorder
Pituitary adenoma
Growth Hormone
exercise, physical and emotional stress,
hypoglycemia, increased amino acid levels
(arginine), hormones (testosterone, estrogen,
thyroxine)
by stimulating protein synthesis and fat and
glucose metabolism
Growth Hormone
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Chem PPT Flashcards, Unit 4
remains stable and relatively low. Secretory
spikes occur approximately 3 hours after meals
and after exercise. Marked rise approximately
90 minutes after the onset of sleep;
concentrations reached a peak value during the
period of deepest sleep.
Depressed by abnormally high levels of
glucocorticoids. This is all done by what type of
hormone?
IGF is a family of small peptides formed in the
liver under the control of GH that exhibit
similar activity as _______.
Where do IGF's circulate?
Active in stimulating many aspects of cell
growth particularly that of what type of tissue?
The most important of the IGFs is IGF-I. In
addition to its growth promoting effects on
cartilage and insulin -like activity in other
tissues, it increases _______ in adipose tissue
and stimulates glucose and amino acid transport
into muscle and heart muscle.
Synthesis of what two substances is enhanced
by IGF-I, which also has positive effects on
calcium, magnesium and potassium
homeostasis.
What are 2 examples of Hypersecretion of
Growth Hormone?
What is Acromegaly in adults?
What is pituitary gigantism in children?
What is an example of Hyposecretion of
Growth Hormone?
What is Pituitary Dwarfism?
insulin
in blood, complexed to specific plasma
binding proteins (Insulin-like growth factor
binding protein [IGFBP]-3)
cartilage
glucose oxidation
1. collagen
proteoglycans
 Acromegaly in adults
Pituitary gigantism in children
An extremely rare syndrome that results when
the anterior pituitary gland produces excess
growth hormone (GH) after epiphyseal plate
closure at puberty.
It results from pituitary adenoma secreting
GH and compression of adjacent tissues of the
pituitary gland, causing hyposecretion of other
trophic hormones.
Pituitary dwarfism



Growth hormone deficiency
A condition in which the pituitary gland
does not make enough growth hormone.
This results in a child's slow growth
pattern and an unusually small stature but
proportionally built.
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Chem PPT Flashcards, Unit 4
Name 3 Analytical Methods used for Growth
Hormone testing.
What does PRL stand for?
Give at least 3 aliases for PRL.
What is PRL is a hormone secreted by?
What is under inhibitory control by the
hypothalamic dopamine?
What occurs during Hypersecretion
(Hyperprolactenemia) of PRL?
What occurs during Hyposecretion
(Hypoprolactenemia) of PRL?
What is the main analytical method used for the
testing of Prolactin (be specific)?
What occurs during a Two-site immunometric
(“sandwich”) assay?
What does ACTH stand for?
What is ACTH?
Where is ACTH secreted from?
What are some aliases for ACTH?
What does ACTH act primarily on?
What does ACTH do to the Adrenal Cortex?
When does ACTH production is increased?
Give an example of Hypersecretion of ACTH.
What is Cushing’s Syndrome?
 Immunoassays
 Mass spectrometry methods
Stimulation tests - Insulin tolerance tests
Prolactin
- Lactogen
- Lactotropin
- luteotropin
- mammotropin
- galactopoietic
- lactation
- lactogenic
luteotropic hormone
Specialized cells within the adenohypophysis
termed lactotrophs
A polypeptide
 Prolactinomas
 Galactorrhea
 Infertility & amenorrhea in women
Oligospermia or Impotence in men
Lack of lactation in postpartum women
Immunoassays:
Two-site immunometric (“sandwich”) assay
The signal antibody is labeled with a detection
molecule such as an enzyme, fluorophore, or
chemiluminescent tag.
Adrenocorticotrophic Hormone
A peptide hormone secreted by the
adenohypophysis is one of the derivatives of
pro-opiomelanocortin (POMC
Adenohypophysis
 Corticotropin
 Corticotrophin
 Adenocorticotrophin
Adenocorticotropin
Adrenal cortex
Stimulating its growth and the synthesis and
secretion of corticosteroids, most importantly,
cortisol.
During times of stress
Cushing’s Syndrome
A disease is caused by a tumor (pituitary
adenoma) or excess growth (hyperplasia) of
the pituitary gland. or excess production of a
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Chem PPT Flashcards, Unit 4
What is Cushing’s Syndrome characterized by?
What are useful tests for the diagnosis of
Cushing syndrome/disease?
What is Hyposecretion of ACTH?
What are 3 signs of Hyposecretion of ACTH
What are some of the tests used for the
diagnosis of secondary adrenal insufficiency
due to CRH-ACTH deficiency?
Describe Thyroid Stimulating Hormone (TSH)
What are some of the steps involved in thyroid
hormone synthesis?
What is a Follicle stimulating hormone (FSH)?
What is a Luteinizing hormone (LH)?
non-endocrine tumor
 truncal obesity
 hyperglycemia
 hypertension
protein wasting
1. 24 hour excretion of urinary-free cortisol
2. Dexamethasone suppression tests (both
overnight with 1 mg and 48 hours with 2 mg
per day)
3. Demonstration of loss of the diurnal
variation with inappropriately increased
cortisol concentrations in the evening as
assayed by plasma or salivary cortisol.
ACTH deficiency or secondary
hypoadrenalism
 weight loss
 weakness
gastrointestinal problems
Cosyntropin test, Overnight metyrapone test,
Insulin tolerance test, Cosyntropin infusion
tests over several days.
Thyroid Stimulating Hormone (TSH) is a
glycoprotein peptide hormone synthesized by
the thyrotroph cells of the adenohypophysis
that promotes the growth and uptake of iodine
by the thyroid gland and stimulates the
synthesis and secretion of thyroid hormones
from the thyroid gland.
It is also called thyrotropin.
Uptake of iodine, organification of iodine
onto tyrosine, coupling of tyrosines,
proteolytic release of stored thyroid hormone
from thyroglobulin stores.
A Gonadotropins that is synthesize in the
adenohypophysis and stimulates the growth
and maturation of ovarian follicles, stimulates
estrogen secretion, promotes the endometrial
changes characteristic of the first phase
(proliferative phase) of the menstrual cycle,
and stimulates spermatogenesis in the male.
It is also called follitropin.
A Gonadotropin that synthesize in the
adenohypophysis and acts with FSH to
promote ovulation and secretion of androgens
and progesterone.
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Chem PPT Flashcards, Unit 4
It initiates and maintains the second
(secretory) phase of the menstrual cycle.
In females, it is concerned with corpus luteum
formation.
In males, it stimulates the development and
functional activity of testicular Leydig cells
and testosterone production.
LH is also called interstitial cell stimulating
hormone and lutropin
What is the difference between Hypersecretion
Hypersecretion results in sexual precocity
and Hyposecretion?
which is usually a result of brain tumors in the
region of the hypothalamus while
Hyposecretion results in sexual
underdevelopment and infertility
What is Anti-diuretic hormone (ADH)?
Anti-diuretic hormone (ADH) is an hormones of the
Neurohypophysis also known as arginine vasopressin
and vasopressin.Formed by neuronal cells of
hypothalamic nuclei and stored in the
neurohypophysis.
Osmolality of the blood is the main regulator of ADH
secretion.
The major physiological function is the
control of water homeostasis, which allows
the kidney to reabsorb water and concentrate
urine.
What are the functions of ADH?
•to stimulate contraction of the muscles of
capillaries and arterioles, increasing blood
pressure
•promote contraction of the intestinal
musculature, increasing peristalsis
•exert contractile influence on the uterus
•have a specific effect on the epithelial cells of
renal collecting tubules
How is the concentration of plasma ADH?
Plasma ADH concentrations are
“inappropriately” increased relative to a low
plasma osmolality and to a healthy or
increased plasma volume
What are some of the symptoms in patients with The typical patient with SIADH has:
hyponatremia ,hypoosmolar plasma (< 280
Syndrome of Inappropriate ADH secretion
mOsm/kg) ,urine osmolality >100 mOsm/kg ,
(SIADH)?
urine sodium concentration that is
inappropriately elevated (> 40 mmol/L).
What causes Diabetes insipidus?
Diabetes insipidus results from destruction of
the posterior pituitary gland or the
hypothalamus causing insatiable thirst,
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Chem PPT Flashcards, Unit 4
The three main categories of diabetes insipidus
are?
What causes HDI, NDI, and Polydipsia?
Where is oxytocin synthesized?
What are the primary functions of oxytocin?
What is the primary stimulus for release of
oxytocin?
What reaction would occur with stimulation of
stretch receptors in the uterus and in the vaginal
mucosa?
What is the purpose of oxytocin in a Male?
What gland lies at the upper pole of each
kidney, pyramidal in shape, and weighs
approximately 4 grams regardless of age,
weight, or sex?
Name the 2 sections to an adrenal gland?
What are the 3 layers that make up the adrenal
cortex?
Which layer of the adrenal cortex is the
outermost zone and constitutes approximately
15% of the cortex?
Name the middle layer that composes about
75% of the cortex with large and lipid laden
cells?
polydipsia, and polyuria.
Hypothalamic diabetes insipidus (HDI) ,
Nephrogenic diabetes insipidus (NDI), and
Psychogenic or primary polydipsia.
. Hypothalamic diabetes insipidus (HDI) also
called neurogenic, central or cranial diabetes
insipidus,
It is caused by a failure of the pituitary gland
to secrete normal amounts of ADH in
response to osmoregulatory factors
Nephrogenic diabetes insipidus (NDI) results
from the failure of the kidney to respond to
typical or increased concentrations of ADH.
Psychogenic or primary polydipsia a chronic,
excessive intake of water suppresses ADH
secretion and produces hypotonic polyuria
In the hypothalamus as part of a
preprohormone, along with a separate
neurophysin binding protein
 Promotes uterine contractions
 Lactation
And contributes to the second stage of labor
in pregnancy
Suckling
Initiates action potentials in afferent nerve
fibers that ultimately stimulate the release of
oxytocin from the neurohypophysis.
Unknown function. Oxytocin is present in
males and females, but its physiological
effects are known only for females.
The adrenal gland
Each gland consists of a yellow outer cortex, and a
grey inner medulla
 zona glomerulosa
 zona fasciculata
zona reticularis
Zona Glomerulosa
Zona Fasciculata
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Chem PPT Flashcards, Unit 4
Name the innermost a zone that contains
irregular looking cells with little lipid content?
What are the three major classes of steroid
hormones secreted by the adrenal cortex?
What are steroid hormones?
CPPP is an abbreviation for?
Where are steroid hormones primarily
synthesized?
What is the major site for steroid metabolism?
Where are steroid hormones stored in the body?
What is the function of aldosterone?
Name the sites where mineralocorticoids can
bind to in order to promote sodium reabsorption
and potassium and hydrogen ion excretion?
The production and secretion of aldosterone are
regulated by?
What is the primary carrier of aldosterone?
Major glucocorticoid synthesized from
cholesterol in the zona fasciculata and
reticularis of the human adrenal cortex.
Cortisol is principally bound and transported to
corticosteroid binding globulin (CBG) and is
metabolized and conjugated where?
Between what percentages of cortisol is carried
by CBG?
What percentage of cortisol is loosely bound to
albumin, and the percentage of unbound (free).
Glucocorticoids bind to the glucocorticoid
receptor (GR) which can be found where?
True or false
Glucocorticoids have multiple effects on
metabolism of glucose and carbohydrates,
Zona Reticularis

Mineralocorticoids
 Aldosterone
 Glucocorticoids
 Cortisol
 Adrenal androgens
 Dehydroepiandrosterone (DHEA)
Androstenedione
They are steroids that work as hormones
Cyclopentanoperhydrophenanthrene. The
basic structure to the nucleus of steroid
hormones.
Steroid hormones are synthesized primarily
from cholesterol in the adrenal glands and
gonads
The liver
Steroid hormones are not stored in hormoneproducing cells and therefore must be
produced as needed
Regulate salt homeostasis (sodium
conservation and potassium loss) and
extracellular fluid volume
 Cytoplasmic mineralocorticoid receptor
(MR)
in the distal convoluted tubule (DCT)
Collecting ducts of the nephron, colon, and
salivary glands
renin in angiotensin system
Albumin
Cortisol
In the liver
80% and 90%
7% loosely bound to albumin and 2%-3% is
unbound(free)
Found in many tissues including lymphocytes,
hepatocytes and bone.
true
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Chem PPT Flashcards, Unit 4
increases protein catabolism and have several
effects on lipid metabolism
True or False
Glucocorticoids also are powerful antiinflammatory hormones.
Cortisol release is controlled through what type
of system?
Provide androgenic effects through their
peripheral conversion to testosterone, which in
turn binds to the androgen receptor (AR).
True or False
Between ages 7 and 8, the urinary excretion of
17 ketosteroids (the breakdown products of
adrenal androgens) increases as an early sign
that puberty will begin in the coming 3 to 5
years
True or false
DHEA and its sulfated form, DHEA-S, and
estradiol are predominantly bound to albumin,
whereas testosterone and dihydrotestosterone
(DHT) are mostly bound to sex hormonebinding globulin (SHBG).
How do we measure 17- hydroxycorticosteroids
(17-OHCS)?
17-hydroxyprogesterone, 11-desoxycortisol are
17-ketogenic steroids.
Cortisol also an 17-ketogenic steroid can be
measured by?
What is a Adrenocorticotropic Hormone
(ACTH) Stimulation (Cosyntropin) Tests?
Cosyntropin is given to a patient with a low
baseline cortisol, what if cortisol level
increases?
What if cortisol level does not change?
A direct and selective test of anterior pituitary
gland function.
True
hypothalamic-pituitary-end organ negative
feedback system.
Androstenedione
true
true
Measured by the Porter-Silber reaction
Measured by Zimmermann reaction
Designed to document the functional capacity
of the adrenal glands to synthesize cortisol.
The test determines whether the adrenal
glands are responsive to ACTH.
If cortisol level increases the problem lies
with the anterior pituitary (secondary adrenal
insufficiency)
If cortisol level does not change, problem lies
in the adrenal cortex (primary adrenal
insufficiency)
Corticotropin-Releasing Hormone (CRH)
Stimulation Test
Injection of ovine CRH stimulates ACTH
secretion in healthy subjects within 60 to 180
minutes; glucocorticoids inhibit this effect (as
in cases of Cushing syndrome)
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Chem PPT Flashcards, Unit 4
What test is used to test the integrity of the
hypothalamic pituitary adrenal axis?
An indirect test of hypothalamic pituitary
adrenal axis function
involves the administration of metyrapone
causing a decrease in cortisol
The decrease in cortisol is expected to allow an
increase in ACTH secretion,What test is this?
This type of test involves the administration of
potent glucocorticoid dexamethasone, and
measuring serum or urine cortisol
concentrations to evaluate the hypothalamic
response. What test is this?
Patients with Cushing syndrome of any cause
will fail to suppress their morning plasma
cortisol concentration to less than 2 µg/dL in
response to a 1 mg dose of dexamethasone
administered at 10:00PM.
What is a Mineralocorticoid Stimulation Tests
Insulin-Induced Hypoglycemia Stimulation
Test
Insulin is given to produce hypoglycemia
which is a physiologic stimulus for release of
CRH; plasma ACTH and cortisol
concentrations are then measured and will be
increased if the hypothalamic pituitary adrenal
axis is intact
Metyrapone Stimulation Test
Dexamethasone Suppression Test
Used to determine the function of the reninangiotensin-aldosterone system by stimulating
the renin-angiotensin system based on volume
depletion maneuvers such as sodium
restriction, upright posture or diuretic
administration.
A normal response is a two to threefold
increase in plasma renin, indicating that the
JGA is responding properly to decreased
plasma volume
Mineralocorticoid Stimulation Tests
What test makes use of either saline infusion,
oral salt loading, or mineralocorticoid
administration, each of which should suppress
the secretion of aldosterone by the adrenal gland
What is Adrenal insufficiency (Addison
Results from progressive destruction or
disease) ?
dysfunction of the adrenal glands by an
autoimmune process, the systemic disorder,
and inborn error of metabolism (endogenous
causes), or by an exogenous cause, such as
infection.
The most common cause of primary adrenal
insufficiency is infectious diseases like
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Chem PPT Flashcards, Unit 4
What is Hypoaldosteronism?
Hypoaldosteronism is seen in?
Glucocorticoid Excess (Cushing syndrome)is a
result of what?
What are the characteristics of a person with
Glucocorticoid Excess (Cushing syndrome)?
Exogenous Cushing syndrome is a caused of
what?
What are the clinically significant analytes
of virilizing adrenal adenomas?
A. Increased DHEA-s,DHEA
B. Androstenedione
C. Testosterone
D. All Of The Above
DHEA in high concentrations can be found
in virilizing ovarian tumors in women.
A. True
B. False
Adenomas can produce Aldosterone?
A. True
B. False
Conn Syndrome has several symptoms that
are clinical in nature. Identify two of them.
A. Increased rennin
B. HypoKalemic Alkalosis
C. Hypertension
tuberculosis, fungal infections and
cytomegalovirus infection.
Deficient aldosterone production occurring in
conditions other than Addison disease.
Seen in patients with:
inadequate production of renin by the kidney
which leads to secondary aldosterone
deficiency (hyporeninemic
hypoaldosteronism)
inherited enzyme defects in aldosterone
biosynthesis
acquired forms of primary aldosterone
deficiency (post-surgical or due to heparin
therapy)
Endogenous Cushing syndrome is a result of
autonomous excessive production of cortisol.
Characteristic clinical features include truncal
obesity, moon facies, a buffalo hump on the
upper back below the neck, supraclavicular fat
pads, myopathy, hypertension, hirsutism,
hypokalemic alkalosis, carbohydrate
intolerance, secondary osteoporosis, disturbed
productive function and neuropsychiatric
symptoms.
Exogenous Cushing syndrome is caused by
excessive oral or parenteral glucocorticoid
therapy.
D
A
B
B and C
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Chem PPT Flashcards, Unit 4
D. Testosterone
Incidentalomas are functioning and
malignant.
A. True
B. False
Incidentalomas can be found by using two
types of technology. Pick Two.
A. MRI
B. CT
C. None of The Above
D. Ultrasound
A laboratory can confirm the incidentaloma
with what two hormones?
A. Aldosterone
B. Testosterone
C. Cortisol
D. GRH
Hyperaldosteronism is the oversecretion of
what hormone?
A. Renin
B. Aldosterone
C. GRH
D. Adrenocortcosteroids
Outside stimulus can activate the renninangiotensin system in secondary
hyperaldosteronism.
A. True
B. False
Choose two causes of Mineral Corticoid
excess.
A. Bilateral idiopathic hyperplasia
B. Aldosterone producing adenoma
C. None of the Above
D. All of the Above
If the PAC/PRA given range ratio
concentration value is from 20-25. Presume:
A. Primary Aldosteronism
B. Secondary Aldosteronism
C. Hypokalemia
D. Diastolic hypertension
Dictate the four analytes for determining
Adrenocortical function.
A. Urine, Blood
B. Saliva
C. Hair
D. All of the Above
B
A and B
A and B
B
True
D
A and C
D
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Chem PPT Flashcards, Unit 4
Cortisol can be measured in several
analytes. Name three.
A. serum
B. heparinized plasma, EDTA Plasma
C. Whole Blood
D. A and B
Cortisol Concentration is lowest in the
morning.
A. True
B. False
Can Cortisol be associated with Stress,
Pregnancy, and Hypoglycemia?
Free Cortisol can be detected by the following
methods including:
A. Ultrafiltration, Gel Filtration
B. Equilibrium
C. Dialysis
D. All of the above
Should a 24 hour urine specimen be collected
with boric acid and refrigerated?
For collection of Aldosterone, the patient should
be upright for:
A. 30-120 minutes during collection
B. 30-60 before collection
C. 30-120 minutes standing or seated
before collection
D. 30-120 minutes sedentary
EDTA is the preferred tube for collecting the
plasma specimen?
Can Aldosterone decline after 24 hours stored at
room temperature?
The most stable long term way to store
Aldosterone is:
A. Refrigerated
B. Frozen
C. Urine with boric acid
D. All of the above
A measurement of 17-OHP is used to diagnose
what illness?
A. Adrenal Hyperplasia
B. Congenital Adrenal Hyperplasia
C. Renal Hyperplasia
D. None of the Above
For 4 days at 4 degrees centigrade can
specimens, including unseperated blood of 17OHP can be stored?
D
B
Yes
D
Yes
C
Yes
Yes
D
B
Yes
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Chem PPT Flashcards, Unit 4
11 beta desoxycortisol can be measured using
what techniques?
A. LC-MS/MS
B. Immunoassay
C. Both options Above
D. None of the above
For the above analyte what are the preferred
specimens?
A. Serum
B. Plasma
C. Urine
D. All of the above
For rennin activity plus it’s concentration the
lab can use..
A. Immunoassays
B. Immunoradiometric assays
C. Immunochemiluminometric assays
D. All of the above
RBC’s when hemolyzed cause a problem
for rennin activity and concentration
measurement. Identify the agent they
release.
A. Angiotensins
B. Potassium
C. Calcium
D. Hemogloblin
Cryoactivation should be avoided at all costs for
rennin activity and concentration
measurements?
The thyroid gland butterfly shaped and located
just inferior to the ___.
The thyroid gland has 2 lobes connected by the
___.
The thyroid glands secretory unit is the ___.
The thyroid gland produces two hormones:
C
What is the butterfly-shaped gland situated just
below the “Adam's Apple” or larynx?
The thyroid gland is composed of two lobes
connected by a narrow band of thyroid tissue
called _______.
What is the secretory unit of the thyroid gland?
Thyroid follicle is also known as _____
What is thyroid hormone T3?
What is thyroid hormone T4?
Thyroid gland
D
D
A
Yes
larynx
isthmus
Follicle or acini
Triiodothyronine (T3)
Tetraiodothyronine or Thyroxine (T4)
Isthmus
Thyroid follicle
Acini
Triiodothyronine
Tetraiodothyronine or thyroxine
58
Chem PPT Flashcards, Unit 4
Thyroid gland contains 2 cell types:
Which cell type produces the hormones T3 and
T4?
Which cell type produces the hormone
calcitonin ?
What is a glycoprotein in which the thyroid
hormones are stored in the thyroid gland?
Biological function of Thyroid Gland:
T4
T3
FT4
FT3
TSH
rT3
What is the basic element involved in the
synthesis of thyroid hormones.
What is organification?
What are first two steps of organification?
What are the second two steps of
organification?
Follicular cells
Parafollicular cells
Follicular cells
Parafollicular cells
Thyroglobulin
- Control basal metabolic rate and
calorigenesis\
-Enhance mitochondrial metabolism and
sensitivity of adrenergic receptors to
catecholamines
-Stimulate neural development, adrenergic
activity, promote sexual maturation
-Increase synthesis and degradation of
cholesterol and triglycerides, stimulation of
protein synthesis and carbohydrate
metabolism
-Increases the requirement for vitamins, and
calcium and phosphorus metabolism
Total thyroxine
Total triiodothyronine
Free thyroxine
Free triiodothyronine
Thyrotropin (thyroid stimulating hormone)
Reverse triiodothyronine
Dietary Iodine
The process of biosynthesis of thyroid
hormones
1) Trapping of circulating iodide by the
thyroid gland
2) Incorporation of iodine into
thyroglobulin tyrosines producing
monoiodinated tyrosines (MIT) and
the di-iodinated tyrosines (DIT)
1) Coupling of two iodinated tyrosyl
residues to form the thyronines (T4
and T3) within the protein backbone of
59
Chem PPT Flashcards, Unit 4
The normal thyroid gland produces about __%
T4 and about __% T3. However, T3 possesses
about four times the hormone “strength” as T4.
Free (unbound) T4 (FT4) is the primary or
secondary secretory product of the normal
thyroid gland?
What is T4?
Which is the most predominant form of thyroid
hormone?
What percentage of T4 is converted to T3?
What is T3?
Which thyroid hormone is more physiologically
active and more potent that T4?
T3 acts as what kind of regulator?
When T4 and T3 are in circulation, which
carrier proteins are they bound to?
What is TBG
What is TBPA
What is TTR
What is TBA
What percentage of the above proteins are
bound to T4?
What percentage of the above proteins are
bound T3?
How are thyroid hormones regulated?
Thyrotropin-releasing hormone (TRH) is
released from what?
Thyroid stimulating hormone (TSH) is from
what?
Thyroid hormones are produced from?
How does the biostnthesis of thyroid
hormones occur?
the thyroglobulin (Tg) protein in the
follicular lumen
Endocytosis followed by proteolytic cleavage
of thyroglobulin (Tg) releases the
iodothyronines into the circulation
80% T4
and
20%T3
FT4 is the primary secretory product
Tetraiodotyronine Thyroxine
T4
80%
Triiodotyronine
T3
Predominant thyroid negative feedback
regulator
TBG
TBPA
TTR
TBA
Thyroxine-binding globulin
Thyroxine-binding prealbumin
Transthyretin
Thyroxine-binding albumin
99.97&
99.7%
Negative feedback system
from hypothalamus
from pituitary
from follicular cells of thyroid glands
•
The biosynthesis of thyroid
hormones occurs by a process
termed “organification”, which
involves:
• 1. Trapping of
circulating iodide by
the thyroid
60
Chem PPT Flashcards, Unit 4
gland
• 2. Incorporation of
iodine into
thyroglobulin
tyrosines
producing
monoiodinated tyrosines
(MIT)
and the diiodinated tyrosines (DIT)
• 3. Coupling of two
iodinated tyrosyl
residues to form
the thyronines (T4
and T3) within the
protein
backbone of the
thyroglobulin (Tg)
protein in the
follicular lumen.
What is the percentage of T3 and T4
that the thyroid gland produces?
What is the difference of T3 and T4
and their functions?
•
Endocytosis followed by
proteolytic cleavage of
thyroglobulin (Tg) releases the
iodothyronines into the
circulation.
•
The normal thyroid gland
produces about 80% T4 and
about 20% T3, however, T3
possesses about four times the
hormone "strength" as T4.
•
Free (unbound) T4 (FT4) is the
primary secretory product of the
normal thyroid gland.
•
T4 (Tetraiodotyronine,
Thyroxine)
• most predominant
form
80% is converted to
•
T3
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Chem PPT Flashcards, Unit 4
How does T3 and T4 circulate in the
blood?
What is the regulation and control of
thyroid hormones?
What are the different thyroid
disorders?
•
T3 (Triiodotyronine)
• more physiologically
active (more potent
than T4)
• predominant thyroid
negative feedback
regulator
•
T4 and T3 in circulation are
bound to carrier proteins
• Thyroxine-binding
globulin (TBG)
• Thyroxine-binding
prealbumin (TBPA;
transthyretin [TTR])
• Thyroxine-binding
albumin (TBA)
•
These proteins bind 99.97% of
T4 and 99.7% of T3, thus very
small fraction is unbound and
available for biological activity.
•
Regulation and control
• Controlled by Negative
Feedback System
• Thyrotropin-releasing
hormone (TRH) from
hypothalamus
• Thyroid stimulating
hormone (TSH) from
pituitary
Thyroid hormones from follicular
cells of thyroid glands
•
Euthyroid
• having normal thyroid
function
•
Hyperthyroidism
(Thyrotoxicosis)
• a condition caused by
excessive production of
iodinated thyroid
hormones
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Chem PPT Flashcards, Unit 4
What are the different thyroid
disorders?
•
Hypothyroidism
• a condition of deficient
thyroid gland activity
•
Thyroiditis
• a condition characterized
by inflammation of the
thyroid gland
Thyroid storm
• a life-threatening condition
that develops in a minority
of cases of untreated
thyrotoxicosis
(hyperthyroidism, or
overactive thyroid)
Toxic multi-nodular goiter
• a condition in which the
thyroid gland contains
multiple lumps (nodules)
that are overactive and
that produce excess
thyroid hormones. Also
known as Parry disease
and Plummer disease.
•
•
What is a goiter?
What is sporadic goiter?
Name hypothyroidism disorders?
-
An enlargement of the thyroid gland that
causes a swelling in the front part of the
neck
- Occur when the thyroid gland produces
either too much thyroid hormone
(hyperthyroidism or toxic goiter) or not
enough (hypothyroidism or non-toxic
goiter).
Can form if the diet includes too many goiterpromoting foods, such as soybeans, rutabagas,
cabbage, peaches, peanuts, and spinach. These
foods can suppress the manufacture of thyroid
hormone by interfering with the thyroid's
ability to process iodide.
-Myxedema
-Cretinism
-Primary hypothyroidism
Endogenous causes
Exogenous causes
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Chem PPT Flashcards, Unit 4
What are characteristics of Myxedema?
What is Cretinism?
What are some differences between Dwarfism
and Cretinism?
What are the clinical symptoms of
hypothyroidism?
What are the physical signs of hypothyroidism?
What endogenous disorders cause primary
hypothyroidism?
-Central hypothyroidism
Secondary hypothyroidism
a severe form of hypothyroidism in which
there is accumulation of mucopolysaccharides
in the skin and other tissue, leading to a
thickening of facial features and a doughy
induration of the skin.
Is the archaic term used to describe severe
hypothyroidism that develops in the newborn
period. Appropriate term is congenital
hypothyroidism
Dwarfism is caused by hypopituitarism and
Cretinism is cause by hypothyroidism.
Dwarfism has decreased Growth Hormone
secretion while cretinism has decreased T4
and T3. Dwarfs are mentally normal while
patients with cretinism have a low IQ.
Mental dullness, somnolence, increased
sleeping, lethargy, easy fatigability,
hoarseness, hair loss, weight gain, cold
intolerance, menstrual irregularities,
infertility, growth failure, delayed puberty in
adolescents, constipation, muscle weakness or
cramps, and depressed affect or frank clinical
depression.
Bradycardia, decreased pulse pressure, cool
and/or dry skin, puffy eyes, loss of the outer
lateral eyebrows, delayed relaxation phase of
reflexes, myopathy, carotenemia, occasional
galactorrhea, short stature in affected children,
radiologic evidence of delayed bone age in
children, congestive heart failure, coma may
rarely occure (severe hypothyroidism)
Autoimmune thyroid diseases such as
Hashimoto thyroiditis, atrophic thyroiditis,
late-stage graves disease, and postpartum
thyroiditis. Inborn errors in thyroid hormone
biosynthesis such as Na+/ iodine pump
dysfunction, inadequate organification/
iodination-TPO dysfuntion, defective
thyroglobulin, deiodinase deficiency, and
pendred syndrome-hypothyroidism and
deafness. Developmental disorders involving
the thyroid gland such as congenital
hypothyroidism: aplasia, hypoplasia, and
ectopic thyroid: lingual thyroid, thyroglossal
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Chem PPT Flashcards, Unit 4
What exogenous disorders cause primary
hypothyroidism?
For primary hypothyroidism what happens to
T3, T4, FT4I, and T3U and TSH.
In primary hypothyroidism, why does TSH
concentration increase when concentrations of
T3, T4, FT4I, and T3U?
For secondary hypothyroidism what happens to
T3, T4, FT4I, and T3U and TSH?
In secondary hypothyroidism, why do the
concentrations of T3, T4, FT4I, T3U and TSH
decrease?
What is Hypothyroidism?
What disease caused by Hypothyroidism?
What is Hashimoto’s Disease?
duct cyst. Consumptive hypothyroidism
(increased metabolism of T4, and T3 by
tumors)
Iodine excess/ deficiency, drugs, thionamides,
lithium, nitroprusside, amiodarone,
biologicals like interferon and interleukin-2,
dietary goitrogens, radiation-induced
hypothyroidism, surgical removal of the
thyroid gland, and viral or bacterial
thyroiditis.
Concentrations of T3, T4, FT4I, and T3U
decrease while TSH concentration increases.
Due to the negative feedback mechanism, the
low concentrations of T3, T4 is sensed by the
pituitary gland causing it to secrete more TSH
in order for the thyroid to secrete more T3 and
T4, however since the thyroid is not
functioning properly T3 and T4 are not
secreted, which causes more secretion of TSH
by the pituitary gland.
Concentrations of T3, T4, FT4I, T3U and TSH
decreases.
Because the pituitary gland is not properly
functioning causing a decrease in TSH
secretion, which in turn causes the decrease in
T3 and T4 secretion by the thyroid.
A Condition of deficiency thyroid gland
activity leading to lethargy, muscle weakness,
and intolerance to cold.
Hashimoto’s Disease (Hashimoto’s
thyroiditis)
 Is an autoimmune disease, a disorder
in which the immune system turns
against the body's own tissues. In
people with Hashimoto's, the immune
system attacks the thyroid, leading to
hypothyroidism.
 People who have family members who
have thyroid disease or other
autoimmune diseases usually develops
the disease. (Genetic component)
Hashimoto's affects about seven times as
many women as men, suggesting that sex
hormones may play a role. Furthermore, some
women have thyroid problems during the first
year after having a baby.
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Chem PPT Flashcards, Unit 4
What is autoimmune disease?
Immune system disorders cause
abnormally low activity or over activity
of the immune system. In cases of
immune system over activity, the body
attacks and damages its own tissues. For
example, Immune deficiency diseases
decrease the body's ability to fight
invaders, causing vulnerability to
infections.
What is thyroid disease?
Any dysfunction of the butterfly-shaped gland
at the base of the neck (thyroid).
– Autoimmune hypothyroidism
– Inborn errors in thyroid
hormone biosynthesis
– Developmental disorders
– Iodine deficiency or excess
– Drug-induced
– Surgical and radiation-induced
– Viral or bacterial thyroiditis
– Central hypothyroidism
– Subclinical hypothyroidism
Monocarboxylate Transporter (MCT) 8
mutation (Allan-Herndon-Dudley syndrome)
Hashimoto’s disease, which leads to destruction of
the
Thyroid follicular cells through a cell-mediated
autoimmune
Process, Initially, the gland is usually enlarge for
instance,
goiter
Are rare cause of primary hypothyroidism
because of
Biochemical defects of iodine transport from
loss-of-function mutations in sodium iodide
symporter transporter system.
Worldwide, the most common cause of goiter
is iodine deficiency producing endemic goiter
with or without nodularity.
Excess iodine can cause a transient state of
reduces thyroid function.
Various drugs effect thyroid function.
Surgical removal of TG will produce
hypothyroidism. External irradiation of the
TG (treatment of lymphoma or Hodgkin
Disease) or ingestive iodine also has been
What are the other Causes of Hypothyroidism
included:
What is autoimmune Hypothyroidism?
What is the Etiology of Inborn error in thyroid
hormone biosynthesis?
What is the etiology of Iodine Deficiency or
excess?
What is the etiology of drug-induced?
What is the etiology of surgical and radiationInduced?
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Chem PPT Flashcards, Unit 4
What is the etiology of Viral or Bacterial
Thyroiditis?
What is the etiology of Subclinical
hypothyroidism?
What is the other name for
hyperthyroidism/thyrotoxicosis disease?
What are the causes of
hyperthyroidism/thyrotoxicosis disease?
What are the clinical techniques involved in
hyperthyroidism treatment?
What are endogenous thyroid disorders?
What are exogenous thyroid disorders
What are clinical symptoms of
hyperthyroidism?
What are physically sign of hyperthyroidism?
What are the specific causes of
hyperthyroidism?
known to cause hypothyroidism.
Although rarely occurring, some (1) viral
infections (such as, sub-acute thyroiditis or
giant cell thyroiditis), or 2 bacterial infections
(acute thyroiditis or abscesses) of TG will
seriously damage the TG and lead to
hypothyroidism.
A persistent elevation in TSH (6 to 12 weeks
or longer) in the setting of FT4 concentrations
that are repeatedly found within reference
interval.
Graves' disease
 Endogenous causes
Exogenous causes
– Anti-thyroid drugs
– Radioiodine ablation
Surgical removal of thyroid gland
- Autoimmune thyroid disease
- Graves disease
- Hashitoxicosis
- Postpartum thyroiditis
- Toxic nodule, multinodular goiter,
adenoma
Stumi ovari
- Thyroid destruction
Iodine induced hyperthyroidism Thyroid
hormone ingestion (thyrotoxicosis factitia)
- Nervousness, erratic behavior,
restlessness, sleeplessness
- Weightloss, excessive sweating
- Heat intolerance
- Menstrual irregular
Diarrhea
- Tachycardia
- Atrial arrhythmia
- Systolic murmurs
- Increased pulse pressure
- Bounding pulse
- Warm/ damn skin
- Tremors
- Increased reflexes
Eyelid retraction
T3 toxicosis, graves’ disease, hashimoto’s
disease and postpartum thyroiditis, toxic
nodular or multinodular goiter, gain-of67
Chem PPT Flashcards, Unit 4
What is Graves’ disease also known as?
What is Graves’ disease or hyperthyroidism?
What are the signs and sympptomes of
hyperthyroidism?
What are the hyperthyroidism’s laboratory
evaluation?
Graves disease is an autoimmune disorder that
involves ?
What are some of the Grave’s disease
symptoms in the human body
Thyroid hormone affect a numerous of body
funtions includind ?
The primary treatment goals for graves disease
function mutations in thyroid-stimulation
hormone receptor, central hyperthyroidism,
human chorionic gonadotropin, iodineinduced hyperthyroidism, thyroid-storm and
apathic hyperthyroidism, subclinical
hyperthyroidism, pregnancy and other
exogenous causes.
Toxic diffuse goiter and Flajani-BasedowGraves disease.
Is an autoimmune disease that affects the
thyroid, resulting in hyperthyroidism and an
enlarged thyroid.
Include irritability, muscle weakness, sleeping
problems, a fast heartbeat, poor tolerance of
heat, diarrhea, and weight loss. Other
symptoms may include thickening of the skin
on the shins, known as pretibial myxedema,
and eye problems such as bulging, a condition
known as Graves' ophthalmopathy. About
25% to 80% of people with the condition
develop eye problems.
• Laboratory Evaluation of
Hyperthyroidism:
• ↑ FT3
• ↑ FT4
• ↑ FT4I
• ↑ T3U
• ↑ THBR (thyroid
hormone binding ratio)
• ↓ TSH
Over activity of the throid gland
(hyperthyroidism)
Bulging eyes
Sweating
Thick red skin usually on the shings or tops of
the feet
Enlarge thyroid
Metabolism
Heart and nervous system function
Body temperature
Muscle strength
Menstrual cycle
Tremor
Exophthalmos
Inhibit the production of thyroid hormones
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Chem PPT Flashcards, Unit 4
are to ?
Some treatment for Graves’s disease are ?
Lessen the severity of symptoms
Anti thyroid medication
Radioactive iodine
Surgery
Disorders associated with thyroid hormone
excess or deficiency in absence of thyroid
disease
What happens in primary hypothyroidism?
What happens in primary hyperthyroidism?
What hormone is the American Thyroid
Association’s recommended for screening test?
What is the method for Measurement of
Thyroid Stimulating Hormone (TSH)?
-Significant nutritional deprivation
-Acute severe illness
-Chronic illness
TSH increased, FT4 decresed.
TSH decreased, FT4 increased.
Measurement of Thyroid Stimulating
Hormone (TSH)
Measurements are done using the two-site
"sandwich" heterogenous immunoassay
involving enzyme, fluorometric substrate or
chemiluminescent labels.
A. TSH
Both serum and plasma are used for what type
of measurements.
TSH is stable for how many days at 2 to 8°C,
and for at least 1 month when stored frozen.
For newborn screening, whole blood may be
collected by heel puncture how many hours
after birth.
Secretion of TSH is circadian with big
concentrations occurring between ______(time
of day), and the lowest between _______(time
of day).
Measurement is done using electron capture gas
chromatography, high performance liquid
chromatography, and isotope dilution tandem
mass spectrometry. This is the Measurement of
what?
What is the preferred specimen (EDTA and
heparin plasma can also be used) for Total
Thyroxine .
Because total T4 alone provides limited clinical
information, FT4 measurements are preferred.
True or False?
What does T3 stand for?
What is the techniques of choice to measure T3
in body fluids predominantly serum or plasma?
Give 2 examples.
Serum specimens should be tested within
______ hours of collection.
5 days
48 to 72
1. 2:00 to 4:00 AM
5:00 to 6:00 PM
Total Thyroxine (T4)
Serum
True
Triiodothyronine
Immunoassays
 Radio immunoassay
Non-isotopic immunoassays
24
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Chem PPT Flashcards, Unit 4
What temperature must serum specimens be
stored at after 24 hours?
What does ‘rT3’ stand for?
Measurement are done, using which
immunoassay?
True or False: rT3 measurement has limited
diagnostic value.
True or False: The diagnosis of non-thyroidal
illnesses can usually be established without
measuring rT3.
2 to 8°C
Reverse Triiodothyronine
Radio immunoassay
True
True
What are the methods of measurement of Free
Thyroid Hormones?
Direct assays
•serve as reference methods
–Direct Equilibrium Dialysis
–Ultrafiltration
Indirect or estimate assays
•for general laboratory use
–Two-step and One-step immunoassay
What type of measurement are used in
•competitive, heterogenous method
Thyroxine Binding Globulin (TBG)?
•measurement of bound conjugate by
chemiluminescence
•enhance microparticle turbidimetry
Measurement of Thyroglobulin (Tg) is done by: Competitive and noncompetitive
immunossasys
What are the 4 autoantibodies of clinical interest
 Thyroid-stimulating antibodies
which are found in thyroid disease?
(TSAb),
 TSH receptor-binding inhibitory
immunoglobulins (TBII),
 Antithyroglobulin antibodies (Anti-Tg
Ab)
Antithyroid peroxidase antibody (Anti-TPO
Ab)
Of the 4 clinically important autoantibodies
Anti-TPO Ab has emerged as the most
which is generally the most useful?
generally useful marker for the diagnosis and
management of autoimmune thyroid disease
Determination of Thyroid Autoantibodies
Measurement includes:
includes what tests/measurements?
 Indirect immunofluorescence
 Agar gel diffusion precipitin technique
 Agglutination (hemagglutination or
latex particle agglutination)
 RIA (Radio immunoassay)
 Complement fixation
 ELISA techniques
Chemiluminescence based immunometric
assays
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Chem PPT Flashcards, Unit 4
Please refer to picture below.
After screening using TSH, if the result of the
TSH is elevated what hormone is needed to be
tested in order to determine the type of
thyroidism does the patient has?
FT4
71