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)