purpose of sertoli cell
testis formation and spermatogenesis
feedback loop from sertoli cells, from leydig cells?
Inhibin, secreted by the Sertoli cell, is believed to be involved in a feedback loop from the testis to the pituitary to inhibit FSH production
leydig -> testosterone -> inhibit LH
The first and rate-limiting step in steroidogenesis is
the conversion of cholesterol to pregnenolone by a single enzyme, CYP11A1
most circulating testosterone is bound to what 2 proteins
ALB, SHBG
diurnal variation of testosterone, highest when, lowest when
highest 6 AM, lowest midnight
two metabolites of testosterone
DHT and ee2
lab results of hypergonadotropic hypogonadism
low T, high FSH, LH
most common human sex chromosome abnormal
Klinefelter syndrome
hypergonadotropic hypogonadism or hypogonadotropic hypogonadism: sertoli cell-only syndrome (rare, lack of germ cells), Turner, Kallmann, hyperPRL, T2D, Klinefelter, androgen insensitivity syndrome (female phenotype of 46, XY), mumps (rare), pituitary tumor
hyper-hypo: Turner syndrome, Klinefelter, androgen insensitivity syndrome (female phenotype of 46, XY), mumps (rare), sertoli cell-only syndrome (rare, lack of germ cells)
hypo-hypo: Kallmann, hyperPRL, T2D, pituitary tumor
lab results of hypogonadotropic hypogonadism
low T, low or inappropriate normal GnRH, FSH, LH
Initial laboratory testing for male hypogonadism should include
early morning (8:00–10:00 AM) measurement of serum testosterone, prolactin, FSH, and LH levels
figure 17.2 page 455
later
what test to distinguish between secondary and tertiary gonadotropic disorders
GnRH stimulation test
most widely available and cost-effective mode of testosterone therapy
parenteral T
3 tests should be done following a testosterone replacement therapy
PSA, hematocrit, lipid panel
produces the hormones estrogen and progesterone -> what cell type in ovary
corpus luteum
The onset of puberty -> increasing what hormones
FSH, LH
typical duration of menstrual cycle
25-35 days
During follicular phase, low estrogen results in + or - FB?
negative FB
what happens during follicular phase
FSH and LH released -> follicle development and preparation for ovulation
what happens during luteal phase
corpus luteum -> progesterone increases, thicken uterus lining
how many hypothalamic pituitary endocrine gland axis?
4 (GHRH, GnRH, TRH, CRH)
which of these are symptoms of hypogonadotropic hypogonadism in females: amenorrhea, low energy, osteoporosis, premature ovarian failure?
amenorrhea, low energy, osteoporosis
premature ovarian failure is primary or secondary hypogonadism, this is the result of what abnormality?
primary, result of Turner syndrome
lab result of FSH and ee2 levels for Turner syndrome
FSH>30 and ee2<20
(high FSH and low ee2)
what does + beta-HCG mean?
pregnancy
most common treatment for hyperPRL
dopamine agonist
symptoms of polycystic ovary syndrome
hirsutism, overweight, infertility, hypertension
Iodiopathic hirsutism -> which of the following is the most prominent increase in lab result: total T, free T, DHEAS?
free T
polycystic ovary syndrome -> which of the following is the most prominent increase in lab result: total T, free T, DHEAS?
free T
congenital adrenal hyperplasia -> which of the following is the most prominent increase in lab result: total T, free T, DHEAS?
DHEAS
ovarian tumors -> which of the following is/are the most prominent increase in lab result: total T, free T, DHEAS?
both total and free T
adrenal tumors -> which of the following is the most prominent increase in lab result: total T, free T, DHEAS?
DHEAS
what functional part of parathyroid gland that responds to low or high calcium level
calcium-sensing receptors (CSR)
which is not function of PTH?
A. increase renal tubule calcium reabsorb
B.
decrease phosphate excretion
C. enhance hydroxylation of vitamin D-25OH
B -> should be "increase phosphate excretion"
functions of skin, liver, kidney in synthesis of vitamin D
skin: 7-dehydrocholesterol -(UV)-> vit D3
liver: D3 -> 25OH-vitamin D
kidney: 25OH-vitamin D -> 1,25(OH)2 vitamin D
most common cause for secondary hyperparathyroidism is
chronic renal failure (or kidney diseases)
2 main types of bones in skeleton
cortical (long bones) and trabecular (vertebrae)
what type of bone is preferentially lost in primary hyperPTH
cortical bone
what are bone resorption markers
pyridinium crosslinks, hydroxyproline, Tartrate-resistant acid phosphatase (TRAP), telopeptide
what are bone formation markers
alkaline phosphatase, osteocalcin, procollagen peptides
primary hyperPTH->what is the lab result for serum Ca, serum Phos, PTH, 25-OH-D, 1,25-D, urine Ca, serum Cl, serum ALP, metabolic acidosis/alkalosis
hyperCa, hypoP, high PTH, low 25-OH-D, high 1,25-D, high urine Ca, hyperCl, metabolic acidosis, high serum ALP
most common PTH testing assay
sandwich ELISA
associated with secondary hyperPTH is hypercalcemia or hypocalcemia
hypocalcemia (without active vit D -> low Ca and PTH released too much to compensate)
people with CKD (chronic kidney disease) -> lab results for serum phos, 1,25-D, serum Ca, PTH
hyperphosphatemia, low 1,25-D, hypocalcemia, high PTH
people with FHH (familial hypocalciuric hypercalcemia) -> lab results for serum Mg, PTH, CSR (normal or mutation), end-organ (normal or damaged), surgery (yes or no)
elevated serum Mg, PTH, mutant CSR, normal end-organ, surgery ineffective
Addison disease -> hypercalcemia or hypocalcemia
hypercalcemia (low aldosterone so high osmolality -> more concentrated Ca in blood)
hyperthyroidism -> hypocalcemia or hypercalcemia
hypercalcemia
people with hypoparathyroidism -> lab results for serum calcium, urine calcium, serum phosphate, PTH level
your blood calcium level is low, your blood phosphate level is high, and your parathyroid hormone level is low, hypercalciuria (risk of kidney stones)
what is ricket
softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency
lab finding for both ricket and osteomalacia
secondary hyperPTH
what is the most prevalent metabolic bone disease in adults
osteoporosis
osteoporosis happens more to female or to male
female
the following diseases are potential for developing osteoporosis, except what: Cushing syndrome, hyperPTH, disorder of vitamin D, hyperthyroidism, adrenal insufficiency
adrenal insufficiency
4 hormones secreted by the kidneys
renin, erythropoietin, 1,25-D, prostaglandins
substances reabsorbed in proximal tubule
Na, Cl, H2O, glucose
substances secreted in proximal tubule
H+, drugs
what leaves the descending loop and what leaves the ascending loop of Henle
water leaving the descending loop and sodium and chloride leaving the ascending loop
substances secreted by the distal tubule
NH3
substances reabsorbed in distal tubule
K, H2O
substances reabsorbed in collecting duct
urea
substances secreted by the collecting duct
NH3, H+
where is urea synthesis
liver
is CRE reabsorbed by the tubules
no
primary ECF cation
Na
main ICF cation
K
CRE clearance formula
(conc urine CRE clr)*(vol U24h)*1.73 divided by (serum CRE conc)*1440min*A
Cockcroft-Gault formula for eGFR
GFR=(140-age)*weight*0.85(if female) divided by 72*(serum CRE)
clinical significance of CysC
what testing method?
rise more quickly than CRE in AKI, useful in early changes of kidney function
immunoassay
clinical significance of B2M
elevated -> indicate inflammation, renal failure, organ rejection (transplant patient)
clinical significance of myoglobin
what testing method
serum level elevated -> skeletal and cardiac muscle injury, can cause renal failure
IA
what level of ALB to CRE ratio is diagnostic of ALBuria
greater than 30 mg/g
the first FDA-cleared test to diagnose patient developing moderate to severe AKI
Nephrocheck
preferred what time for urine specimen collection
initial morning, midstream catch -> analysis within 1 hour (RT) or 8 hours (fridge, 2-8C)
possible instability outcomes for urine specimens
bacteria -> false-pos nitrite test, urea degraded to NH3 and elevate pH, CO2 loss to atm -> elevate pH
normal urine pH range
4.7-4.8
Four major types of cardiovascular disease
Coronary Heart Disease
Cerebrovascular disease
Peripheral arterial disease
Aortic atherosclerotic disease
Chest pain, heart attack, heart failure -> what cardiovascular disease
CHD(Coronary)
Blood supply cut off to the brain, stroke, Transient ischemic attack (mini stroke)-> what cardiovascular disease
Cerebrovascular disease
Blockage in the arteries of extremities-> what cardiovascular disease
PAD(Peripheral)
Aneurysms, tears in thoracic or abdominal aorta-> what cardiovascular disease
Aortic atherosclerosis
blood vessel lumen narrows due to lipid plaque formation-> what cardiovascular disease
Atherosclerosis (chronic)
Chest pain, ischemia(lack of blood supply) that ranges from angina( no cell death); acute myocardial infarction (cell death)-> what cardiovascular disease
Acute coronary syndrome (ACS)
3-protein complex cardiac marker w/ high sensitivity & specificity (gold standard)
Troponin (TnT, TnI, TnC)
Cardiac Markers for diagnosis of ACS or acute MI
CK-MB, troponin
Cardiac Markers to differentiate lung disease from heart failure
BNP and NT-proBNP
biomarkers to diagnose pulmonary embolism
troponin, BNP and NT-proBNP, D-dimer
cardiac markers for CV risk stratification
troponin, CRP, HCY
nonspecific biomarkers of cardiac dysfunction
BNP and NT-proBNP
Symptoms of heart failure
Shortness of breath, fatigue, lower extremity edema
recommended laboratory clinical tests for heart failure
from the AU: ISE, BUN/CRE, glucose, liver enzymes (AST, ALT, LD), lipid panel
from the Centaur: TSH, BNP
others: blood count, UA, ECG
Measurement of what peptide is helpful in distinguishing cardiac from noncardiac causes of dyspnea?
B-type natriuretic peptide (BNP)
Which peptides are elevated in patients with ventricular dysfunction and cardiac hypertrophy?
BNP & NT-proBNP
An acute marker for inflammation that is used in evaluation of CVD & CHD risk
C-Reactive protein (CRP)
When an embolus becomes lodged within the pulmonary arteries
Pulmonary embolism
Elevated concentrations of this amino acid is the common factor leading to arterial damage
Homocysteine
Blood test that is indicative of current or recent coagulation and subsequent fibrinolysis
D-dimer test
Cells responsible for the liver's regenerative properties.
Hepatocytes
Macrophages that engulf debris, toxins, and bacteria.
Kupffer cells
Liver performs 4 functions
Excretion, Secretion, Metabolism, Detoxification
major heme waste product
Bilirubin
is insoluble in water and cannot be conjugated by the liver
unconjugated bilirubin
conjugation of bilirubin occurs in the presence of which enzyme
uridine diphosphate glucuronosyltransferase(UDPGT)
french word that means yellow
jaundice
clinical condition in which scar tissue replaces healthy liver tissue
cirrhosis
used to describe a group of disorders caused by infectious, metabolic, toxic, or drug-induced diseases -> build up fats in liver
Reye’s Syndrome
Three scoring of bilirubin, INR (how much time for blood to clot), creatinine, age, WBC count, BUN, and albumin levels
MELD Score (Model for End-Stage liver disease)
colorless end product of bilirubin metabolism oxidized by intestinal bacteria to brown pigment
Urobilin
test measure liver function of removing NH3
ammonia concentration, GGT
purpose of Ehrlich reagent
most quantitative method for urobilinogen
bilirubin analysis -> testing methods involve diazo reagent and a red-purple product
which method uses an accelerator (caffeine-benzoate)
Malloy-Evelyn
Jendrassik-Grof (uses accelerator)
decreased GFR, anemia, high BUN, CRE, edema; hyaline and granular cast, RBC cast; direct injury, drug, bacteria
acute glomerulonephritis
scarring, slight proteinuria and hematuria, uremia as first signs
chronic glomerulonephritis
massive proteinuria and hypoALBemia, lipid everywherer
Nephrotic syndrome
microorganisms, high nitrite, bacteriuria, leukocytes in urine, hematuria, WBC cast
pyelonephritis (infection)