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Endocrine Week 3 2017/18 > 6: Basic principles of endocrinology > Flashcards

6: Basic principles of endocrinology Flashcards

1
Q

What the major endocrine glands of the body?

A

Pituitary

Hypothalamus

Pineal

Thyroid and parathyroids

Adrenals

Pancreas

Ovaries and testes

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2
Q

What are the three main classes of hormone and examples of each?

A

Peptide hormones - insulin, glucagon, prolactin, GH

Steroid hormones - cortisol, testosterone, oestrogen

Tyrosine derivatives - adrenaline, thyroid hormones

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3
Q

Which kinds of receptor have a role in the endocrine system?

A

G-protein coupled receptors

Tyrosine kinase receptors

Nuclear receptors

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4
Q

Mutations causing the loss of function of ___ receptors can cause endocrine disease.

A

G-protein coupled receptors

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5
Q

Where are

a) G-protein coupled receptors
b) Tyrosine kinase receptors
c) Steroid receptors

found?

A

a) Cell membrane

b) Cell membrane

c) Nucleus

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6
Q

What produces the cellular effect in

a) G-protein coupled receptors
b) Tyrosine kinase receptors
c) Steroid receptors?

A

a) Receptor activates signalling cascade (e.g cAMP)

b) Autophosphorylation of beta subunits

c) Hormone binds to DNA and alters gene transcription

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7
Q

Which axis regulates the activity of peripheral endocrine glands?

A

Hypothalamic - pituitary axis

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8
Q

Which hormones are secreted by the anterior pituitary?

A

All of them apart from ADH and oxytocin:

Growth hormone

FSH & LH

ACTH

TSH

PRL

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9
Q

Which hormones are produced by the posterior pituitary gland?

A

ADH

Oxytocin

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10
Q

What can be measured to diagnose and monitor endocrine diseases?

A

Hormone concentrations

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11
Q

What is the main determinant of hormone concentration?

A

Rate of secretion

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12
Q

What hormones are released from the hypothalamus and pituitary in the thyroid axis?

A

Hypothalamus - TRH

Anterior pituitary - TSH

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13
Q

In which diseases is TSH secretion

a) raised
b) suppressed?

A

a) Raised TSH secretion = hypothyroidism

b) Suppressed TSH secretion = hyperthyroidism

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14
Q

When may TSH not be a reliable indicator of thyroid status?

A

Anterior pituitary tumours

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15
Q

Pituitary dysfunction produces (primary / secondary) thyroid disease.

A

secondary thyroid disease

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16
Q

What anterior pituitary diseases can produce a secondary

a) hyperthyroidism
b) hypothyroidism?

A

a) hyperthyroidism - thyrotropinoma / TSHoma

b) hypothyroidism - anterior pituitary dysfunction

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17
Q

Why are thyroid hormone levels of limited value in acutely ill patients?

A

Fluctuate with disease

> Non-thyroid illness

Can throw your differential

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18
Q

What are two emergency conditions associated with

a) hyperthryoidism
b) hypothyroidism?

A

hyperthyroidism > Thyroid storm

hypothyroidism > Myxoedema coma

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19
Q

How is function of the pituitary gland assessed?

A

Hormone levels

MRI scan

Synacthen test

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20
Q

Which hormones are released from the hypothalamus and anterior pituitary in the adrenal axis?

A

Hypothalamus - corticotrophin-releasing hormone (CRH)

Anterior pituitary - adrenocorticotrophic hormone (ACTH)

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21
Q

Cortisol release by the adrenal glands is released in what kind of rhythm?

A

Circadian rhythm

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22
Q

When are cortisol levels supposed to be measured?

A

9am

23
Q

What are the two hormones secreted by the hypothalamus to regulate growth hormone secretion by the anterior pituitary?

A

Somatostatin - inhibits growth hormone secretion

Growth hormone-releasing hormone (GHRH)

24
Q

Which organ does GH act on?

A

Liver

Also adipose tissue

25
Q

What is released by the liver in response to growth hormone?

A

IGF-1

Insulin-like growth factor 1

26
Q

GH must be measured through ___ testing.

A

dynamic testing

27
Q

Which hormones are released from the hypothalamus and anterior pituitary in the gonadal axis?

A

Hypothalamus - gonadotrophin-releasing hormone (GnRH)

Anterior pituitary - lutenising hormone (LH) , follicle-stimulating hormone (FSH)

28
Q

When should testosterone levels be measured?

A

9am

29
Q

When should female sex hormones be measured?

A

Depends on timing of menstrual cycle

30
Q

Which hormone is released by lactotroph cells in the anterior pituitary?

A

Prolactin

31
Q

Which hormone inhibits the release of prolactin?

A

Dopamine

32
Q

What is the target tissue of prolactin?

A

Breast

33
Q

When is hyperprolactinaemia physiological?

A

Pregnancy

Lactation

Nipple stimulation

34
Q

Which medications cause hyperprolactinaemia?

A

Dopamine antagonists (remember they act to inhibit prolactin release)

35
Q

Which gland secretes ADH and oxytocin?

A

Posterior pituitary

36
Q

The secretion of ADH is important in controlling what?

A

Blood pressure (via control of fluid volume)

37
Q

How does ADH increase blood pressure?

A

a) Causes vasoconstriction, increasing TPR

b) Stimulates increased fluid absorption by the kidneys, increasing blood volume

38
Q

Name three important steroid hormones.

A

Cortisol

Testosterone

Aldosterone

39
Q

What are the dynamic tests done to diagnose

a) hormone excess
b) hormone deficiency?

A

Hormone excess > Suppression test

Hormone deficiency > Stimulation test

40
Q

What causes cortisol deficiency?

A

Adrenal insufficiency

e.g Addison’s disease (primary adrenal insufficiency)

Pituitary gland disease

41
Q

What causes cortisol excess?

A

Cushing’s syndrome - overproduction of ACTH by anterior pituitary

42
Q

What is the stimulation test used to investigate suspected Addison’s disease?

A

Synacthen test

43
Q

What is the dynamic test used to investigate suspected Cushing’s syndrome?

A

Dextromethasone suppression test

44
Q

What causes Cushing’s syndrome?

A

Excess ACTH production (usually by anterior pituitary)

Cortisol excess

45
Q

What is the presentation of Cushing’s syndrome?

A

Hypertension

Impaired glucose tolerance

Moon face

Acne

Hirsutism

Abdominal obesity and striae

46
Q

Apart from pituitary cell tumours, what else can cause Cushing’s syndrome?

A

Adrenal tumours

Malignancy

!!! Steroid use !!!

47
Q

Which type of tumour can produce ectopic ACTH and bring on Cushing’s syndrome?

A

Small cell carcinoma of lungs

48
Q

Why can steroid use cause Cushing’s syndrome?

A

Steroids have similar structure to cortisol

49
Q

Which causes of Cushing’s syndrome are ACTH-related and ACTH-independent?

A

ACTH-related - pituitary tumour, ectopic ACTH

ACTH-independent - adrenal tumour, steroids

50
Q

Which suppression test is used to diagnose Cushing’s syndrome?

A

Dextromethasone suppression test

51
Q

If ACTH is low after a dextromethasone suppression test, the cause of Cushing’s is related to what?

A

Adrenal glands

52
Q

If ACTH is high after a dextromethasone suppression test, the cause of Cushing’s disease could be what?

A

Pituitary gland-related

Ectopic ACTH-related

53
Q

How would you differentiate pituitary-related Cushing’s from ectopic ACTH production?

A

Do a CRH (corticotrophin releasing hormone) test - ACTH and cortisol will be high

Endocrine Week 3 2017/18 (11 decks)

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