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CNM BIOMEDICINE I > 9. ENDOCRINE SYSTEM > Flashcards

9. ENDOCRINE SYSTEM Flashcards

The structure and function of the endocrine system. The clinical presentations, investigation procedures and some orthodox treatments of endocrine pathologies.

1
Q

What stimulates the production of thyroid hormones?

A

TSH, exercise, stress, malnutrition, insulin & growth hormone

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2
Q

Define ‘metabolic rate’

A

The sum of all chemical processes in our cells.

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3
Q

What reduces thyroid hormones in the body?

A

Low TSH, high T3

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4
Q

Which gland in the body produces melatonin?

A

Pineal gland

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5
Q

Describe the main function of the endocrine system

A

The endocrine system coordinates the activity of organs through hormones (chemical messengers released into the blood by glands that produce them).

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6
Q

Name four endocrine tissues

A

Adipose tissue
Heart
GIT
Liver
Kidneys
Skin
Placenta

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7
Q

Name two ways in which hormone secretion is regulated

A
  1. Nervous system signals
  2. Chemical changes in the blood
  3. Other hormones
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8
Q

Explain how the hypothalamus and the pituitary gland are connected

A

The anterior lobe of the pituitary is connected to the hypothalamus through a network of blood capillaries while the posterior lobe is connected through a stalk of nerve fibres.

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9
Q

What is Hashimoto’s Thyroiditis?

A

An autoimmune condition of thyroid hormone deficiency caused by the body’s immune system attacking the thyroid

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10
Q

List four key symptoms of Hashimoto’s Thyroiditis

A

Tiredness, Weight gain, Constipation, Depression, Cold intolerance

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11
Q

What would you expect blood tests to reveal in Hashimoto’s?

A

High TSH

Low thyroid hormones (T4 and T3)

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12
Q

Name four nutrients that are essential for the synthesis of thyroid hormones

A

Iodine
Selenium
Tyrosine
Zinc

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13
Q

What are two signs of hypothyroidism?

A 
Goitre
Myxoedema
Loss of eyebrows
Thin hair
Dry, brittle skin
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14
Q

Name two endocrine glands

A
  • Pituitary
  • Thyroid
  • Adrenals
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15
Q

Describe ‘down regulation’ and name one example

A

Down regulation occurs if a hormone is present in excess. This means that the number of target cell receptors for that hormone may decrease. An example of this is the hormones that increase during puberty.

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16
Q

Describe ‘up regulation’ and name one example

A

A deficiency in a certain hormone causes an increase in the number of receptors on target cells. This occurs when there is an increased number of oxytocin receptors in third trimester of pregnancy.

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17
Q

Explain the difference between receptors for protein-based hormones and lipid hormones.

A

The receptors for protein-based hormones are part of the cell membrane, whilst lipid hormone receptors are within the cell.

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18
Q

With regards to hormones released from the hypothalamus, name:

a. Three releasing hormones
b. Two inhibiting hormones

A 
a. GHRH (Growth Hormone Releasing Hormone)
TRH (Thyroid Releasing Hormone)
PRH (Prolactin Releasing Hormone)
GnRH (Gonadotropin Releasing Hormone)
CRH (Corticotropin Releasing Hormone)

b. GHIH (Growth Hormone Inhibiting Hormone)
PIH (Prolactin Inhibiting Hormone)

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19
Q

Name two hormones that are released by the posterior pituitary gland

A 
Oxytocin
Antidiuretic Hormone (ADH)
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20
Q

Name one hypothalamic hormone that stimulates the release of both ACTH and MSH.

A

CRH (Corticotropin Releasing Hormone)

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21
Q

Name two functions for each of the following anterior pituitary hormones:

a. Growth Hormone
b. ACTH
c. Prolactin

A

a. Growth Hormone: Growth and repair; Metabolism
b. ACTH: Circadian Rhythm; Steroid hormone output
c. Prolactin: Milk production (with oxytocin); prevents pregnancy; breast maturation

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22
Q

Name two factors that stimulate production of the following hormones:

a. Growth Hormone
b. ACTH
c. Prolactin (not birth)

A

a. Growth Hormone: Night time, hypoglycaemia, exercise, childhood/adolescence
b. ACTH: hypoglycaemia, exercise, stressors (eg. emotions, fever), interleukin-1 (inflammatory cytokine)
c. Prolactin: suckling of infant, sleep

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23
Q

When are TSH levels at their

(a) Lowest
(b) Highest

A

(a) During early evening

(b) During the night

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24
Q

Name one function of melanocyte stimulating hormone (MSH)

A

It plays a role in skin, hair and eye pigmentation

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25
Q

Name TWO functions of oxytocin

A
  • It contracts the uterus in childbirth
  • It contracts the lactating breast
  • It is a bonding hormone (mother with baby, social bonding, trust, skin contact, ‘cuddle hormone’).
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26
Q

List TWO factors (not suckling) that stimulate oxytocin production

A
  • Childbirth

- Skin to skin contact / cuddles

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27
Q

What is colostrum?

A

The first breast-fluid produced after parturition, which contains water, lacto-sugar and antibodies

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28
Q

Describe the main function of colostrum

A

Coslostrum acts as a laxative to encourage bowel movement, particularly bilirubin and wastes that have accumulated in the foetal intestines.

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29
Q

Describe how ADH prevents loss of fluid from the body

A

ADH reduces urine output by stimulating reabsorption of water from the kidneys and vasoconstriction in skin lowers loss of water through sweating.

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30
Q

Name ONE factor that:

a. Stimulates production of ADH
b. Inhibits production of ADH

A

a. Increased osmotic pressure, hypovolaemia

b. Reduced osmotic pressure, alcohol, increased fluid intake

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31
Q

Using definitions, explain the difference between acromegaly and gigantism

A

Acromegaly is the result of excess growth hormone post puberty while Gigantism is an excess of growth hormone while the bones are still developing (pre-puberty onwards)

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32
Q

List TWO signs / symptoms of acromegaly

A
  • Large, prominent facial features, large hands and feet
  • Tiredness
  • Deep voice
  • Impotence
  • Joint pain
  • Bone deformities
  • Soft-tissue swellings
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33
Q

Explain why Type 2 diabetes is a potential complication of acromegaly and gigantism

A

Excess growth hormone leads to increased blood glucose levels which can lead to insulin resistance

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34
Q

Name the following pathology and list ONE cause:

“Galactorrhoea, amenorrhoea, decreased libido / sexual dysfunction and sub-fertility”

A

Hyperprolactinaemia.

Pituitary tumour, acromegaly, pharmacologic (antipsychotics)

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35
Q

What is meant by galactorrhoea?

A

The flow of milk from the breast not associated with childbirth.

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36
Q

Using definitions describe the difference between diabetes insipidus and Type 2 diabetes

A

Diabetes insipidus is the deficiency of ADH production or recognition, causing the kidneys to over-excrete water.
Type 2 diabetes is a metabolic disorder associated with hyperglycaemia, characterised by a deficiency of insulin due to insulin resistance.

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37
Q

List TWO causes of diabetes insipidus

A
  • Cranial: brain trauma, tumour, encephalitis

- Renal: Chronic kidney disease, hypercalcaemia, hypokalaemia

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38
Q

Name TWO signs / symptoms of diabetes insipidus

A
  • Polydipsia (extreme thirst), high water consumption
  • Polyuria (excessive urine output)
  • Weight loss
  • Low blood pressure, syncope
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39
Q

With regards to diagnostic tests for diabetes insipidus, describe what you would expect to find with:

a. Urine volume over 24 hours
b. Urine concentration (urine specific gravity)
c. Sodium levels (blood biochemistry)

A

a. Higher than normal volume
b. Low, urine being more diluted than normal
c. High sodium levels in urine

40
Q

State which gland produces melatonin

A

Pituitary gland

41
Q

Describe how age affects melatonin levels

A

Melatonin levels decline with age

42
Q

Name ONE factor that stimulates melatonin

A

Darkness

43
Q

Name TWO factors that reduces melatonin levels

A

Daylight

Irregular sleep patterns (night-shifts)

44
Q

State TWO functions of melatonin

A
  • Sets the circadian rhythm

- Potent antioxidant

45
Q

With regards to iodine atoms, describe the difference between thyroxine and triiodothyronine

A

Thyroxine has four iodine atoms while triiodothyronine has three iodine atoms

46
Q

Name the thyroid cell which store the following:

a. Iodine
b. Calcitonin

A

a. Follicular cells

b. Parafollicular cells

47
Q

Name ONE amino acid needed for production of thyroid hormones

A

Tyrosine

48
Q

Name TWO minerals which are essential for the conversion of T4 to T3

A

Selenium and Zinc

49
Q

Name the most biologically-active thyroid hormone

A

T3 (Triiodothyronine)

50
Q

Describe how thyroid hormones are measured

A

Thyroid hormone levels are measured in terms of free T4 and T3

51
Q

State TWO functions of thyroid hormones

A
  • Thyroid hormones increase metabolic rate and heat production.
  • They are essential for normal growth and development as well as CNS function.
  • They work in conjunction with adrenaline, noradrenaline, insulin and growth hormone.
52
Q

List TWO factors that:

a. Stimulate thyroid hormone production
b. Reduce thyroid hormone production

A

a. TSH; exercise; stress; malnutrition; low blood glucose; low T3 to T4
b. Low TSH; high T3

53
Q

Explain why TSH levels are measured in the morning

A

TSH levels are measured in the morning as it is the highest and most reliable / consistent value.

54
Q

Name ONE antibody used to identify autoimmune thyroid disease

A

Anti-thyroglobulin antibodies (TgAb)

55
Q

List TWO signs of hypothyroidism

A 
Goitre
Myxoedema
Dry, brittle skin
Thin hair
Loss of eyebrows
56
Q

List FOUR symptoms of hypothyroidism

A 
Tiredness
Malaise
Weight gain
Cold intolerance
Constipation
Depression
57
Q

Name TWO causes of hypothyroidism

A
  • Hashimoto’s thyroiditis (autoimmune)
  • Iodine deficiency
  • Fluoride
  • Thyroid destruction (surgery, radioactive iodine, tumour, medications)
58
Q

Define Grave’s disease

A

Grave’s is hyperthyroidism and is characterised by hyper-metabolism and elevated serum levels of free thyroid hormones (also know as thyrotoxicosis).

59
Q

Describe the pathophysiology of Grave’s disease

A

Increased IgG antibodies bind to TSH receptors and stimulate production of thyroid hormones.

60
Q

List FOUR signs / symptoms of Grave’s disease

A 
Nervousness
Irritability
Hyperactivity
Unexplained weight loss
Muscle weakness
Heat sensitivity
Goitre
Exopthalmos
61
Q

Describe in detail how blood calcium levels are affected by the following hormones:

a. Calcitonin
b. Parathyroid hormone

A

a. Produced by the parafollicular cells of the thyroid gland and lowers blood calcium by inhibiting calcium reabsorption from the bone and kidneys and inhibiting osteoclast activity.
b. Produced by the parathyroid and increases blood calcium by increasing osteoclast activity, increasing kidney reabsorption of calcium and magnesium and increasing production of calcitriol which increases calcium absorption in the GIT.

62
Q

Name TWO signs / symptoms of hyperparathyroidism

A

Hypercalcaemia (risk of kidney stones, osteoporosis or osteopenia, low energy and depression)
Nausea, vomiting, constipation, anorexia, muscle paralysis

63
Q

Name TWO signs / symptoms of hypoparathyroidism

A

Hypocalcaemia (muscle cramps and spasms, tingling lips, fingers and toes, dry hair, brittle nails, dry scaly skin, cataracts, weakened tooth enamel in children)

64
Q

Name TWO hormones produced by the adrenal cortex

A

Cortisol (a glucocorticoid)
Aldosterone (a mineralocorticoid)
Androgen (sex hormone)

65
Q

State the main function of adrenaline and noradrenaline

A

Both adrenaline and noradrenaline intensify the sympathetic response.

66
Q

Name TWO factors that stimulate adrenaline and noradrenaline

A 
Exercise
Fasting
Shock
Elevated temperature
Emotional stress
Caffeine
Infection
Disease
67
Q

Name TWO factors that inhibit adrenaline and noradrenaline

A

Eating
Sleeping
Calmness
Diaphragmatic breating

68
Q

Name FOUR functions of cortisol

A
  1. Stimulates gluconeogenesis
  2. Proteolysis (amino acids from protein)
  3. Lipolysis
  4. Production of glucose by the liver
  5. Reduces immune response and tissue repair
  6. Anti-inflammatory
  7. Weak reabsorption of sodium and water from kidney
69
Q

State TWO functions of aldosterone

A
  • Maintains the water and electrolyte balance by:
    1. Stimulating reabsorption of sodium in the kidneys
    2. Causing retention of water in the kidneys to increase blood volume and pressure
    3. Stimulating excretion of potassium in urine
70
Q

Name ONE factor that stimulates aldosterone production

A
  • Low blood pressure or blood volume

- High blood potassium

71
Q

Name ONE factor that inhibits aldosterone production

A

Low blood potassium

72
Q

Using definitions, explain the difference between Cushing’s syndrome and Addison’s disease

A

Cushing’s syndrome is an excessive amount of glucocorticoids (hypercortisolaemia)
Addison’s disease is due to hypo-functioning of the adrenal cortex, causing a deficiency of mineralocorticoids and glucocorticoids.

73
Q

Name TWO causes of Cushing’s syndrome

A
  1. Corticosteroid therapy
  2. Adrenal ademoma
  3. Pituitary adenoma (Cushing’s disease)
74
Q

List THREE signs / symptoms of Cushing’s syndrome

A
  • Central weight gain
  • Moon face
  • Buffalo hump
  • Insulin resistance
  • Abdominal stretch marks
  • Easy bruising
75
Q

List ONE cause of Addison’s disease

A
  • Atrophy of the adrenal glands (85% autoimmune)

- Secondary to a disease or abrupt cessation of steroids

76
Q

List TWO signs / symptoms (not skin pigmentation) of Addison’s disease

A
  • Weakness
  • Fatigue
  • Hypotension
  • Muscle weakness
  • Increased thirst
  • Malaise
  • Depression
  • Impotence / amenorrhoea
77
Q

Explain why hyperpigmentation occurs in Addison’s disease

A

Adrenal failure leads to a lack of adrenal hormone production and a breakdown of the normal negative feedback mechanism. The hypothalamus produces an excess of corticotrophin releasing hormone (CRH), which causes the pituitary to erroneously produce melanocyte stimulating hormone which causes the skin to darken.

78
Q

Explain what is meant by ‘Addison’s crisis’ and name ONE characteristic sign / symptom

A

A complication of Addison’s disease when the individual has no capacity to cope with stress (e.g. psychological, infection etc.)

SIGNS AND SYMPTOMS:
* Severe lethargy and low blood pressure (low sodium).
* Hypoglycaemic, syncope (fainting).
* Severe pain, renal failure, fever.

79
Q

Name TWO functions of androgens

A

Androgens are male sex hormones that:
1. Stimulate production of pubic and axillary hair.
2. Stimulates growth: Increases muscle mass.
3. Are converted to testosterone then oestrogen (in females it promotes libido).

80
Q

List ONE factor that stimulates androgen production

A

Androgens are stimulated by CRH which in turn stimulates ACTH

81
Q

Describe the difference between ‘alpha cells’ and ‘beta cells’ in the pancreas

A

Alpha cells produce ‘glucagon’.
Beta cells produce ‘insulin’.

82
Q

State the normal blood glucose range

A

4-7mmol/L

83
Q

Name TWO ways in which insulin functions to lower blood glucose levels, amino acids and fatty acids

A

Insulin:
1. Stimulates cells to uptake glucose from blood.
2. Promotes synthesis of proteins, glycogen (glycogenesis) and fats (lipogenesis).

84
Q

Name TWO factors that:

a. Stimulate insulin production
b. Inhibit insulin production

A

a. Stimulated by:
* Directly: High blood glucose, elevated blood amino
acids, eating, sweet taste (incl. artificial sweeteners).
* Indirectly: GH and ACTH acting to elevate blood sugar levels.
b. Reduced by:
* Low blood glucose
* starvation
* glucagon.

85
Q

List ONE function of glucagon

A

Glucagon acts on the liver to elevate blood glucose levels by:
* Converting glycogen to glucose in liver and skeletal muscle (glycogenolysis).
* Gluconeogenesis from lactic acid and amino acids.
* Lipolysis to break down stored fat to use for metabolism.

86
Q

Name TWO factors that:

a. Stimulate glucagon production
b. Inhibit glucagon production

A

a. Stimulated by:
* Low blood sugar
* exercise
* stress (fight-or-flight).

b. Reduced by:
* Insulin
* hyperglycaemia.

87
Q

Using definitions compare Type I diabetes with Type 2 diabetes

A

Type 1 diabetes is an auto-immune condition causing destruction of pancreatic ß-cells, resulting in an absolute deficiency of insulin causing persistent hyperglycaemia.

Type 2 diabetes is a chronic state of hyperglyceamia which develops when pancreatic beta cells can no longer secrete insulin to compensate for insulin resistance.

88
Q

Name ONE cause of secondary diabetes

A
  • Due to certain
    medications (cortisone)
  • Pancreatitis
89
Q

Which type of diabetes is a woman with gestational diabetes at higher risk of developing post childbirth?

A

Type II diabetes

90
Q

State TWO possible dietary causes of Type I diabetes

A
  • infant exposure to dairy products (cow’s milk / β casein)
  • vitamin D deficiency
  • omega-3 deficiency
  • early exposure to gluten
91
Q

Name ONE viral cause of Type I diabetes

A
  • polio
  • rotavirus
92
Q

List THREE signs / symptoms of Type I diabetes

A
  • Polydypsia - excessive thirst
  • Polyuria - excessive urination
  • Glycosuria - glucose in urine
  • Polyphagia - excessive appetite
  • Unexplained weight loss
  • Weakness, extreme fatigue and mental status changes
  • Blurred vision
  • Slow healing of cuts / infections
  • Ketoacidosis - Fruity smelling breath (exhaled acetone), shortness of breath.
93
Q

State TWO lifestyle factors that contribute to the development of Type 2 diabetes

A
  • Obesity and weight gain
  • low fibre diet
  • high glycaemic index (GI) diet (sugar, white rice, white bread)
  • lack of exercise
94
Q

Name TWO diagnostic tests for identifying diabetes mellitus

A
  • Fasting / random blood glucose test.
  • Oral glucose tolerance test.
  • Glycated haemoglobin: HbA1c > 48 mmol / mol = diabetes.
  • Urine test (assists diagnosis only).
95
Q

Name THREE complications of diabetes mellitus

A

Chronic hyperglycaemia causes micro- and macro-vascular complications:
* Heart disease, hypercholesterolaemia, hypertension.
* Retinopathy.
* Nephropathy (diabetic kidney disease).
* Peripheral neuropathy.

96
Q

Describe specifically how ketoacidosis develops

A

When glucose supply is low or when cells cannot utilise glucose, the mitochondria can use ketones to make energy.
Ketones (or keto-acids) are derived from the breakdown of fatty acids and are acidic which can be toxic if they accumulate to excessive levels.
This may result in coma or death.

97
Q

Name FOUR signs / symptoms of hypoglycaemia

A
  • Shaking and trembling.
  • Sweating.
  • Pins and needles in the lips and tongue.
  • Extreme hunger and irritability.
  • Headache.
  • Slurred speech, confusion, tiredness.
  • Ketoacidosis and coma.

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