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Revision Notes - Year 1 > Endocrine - 128 > Flashcards

Endocrine - 128 Flashcards

0
Q

Where is CRH released from? In response to what?

A

Released from the hypothalamus in response to stress

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1
Q

What is Cushing’s Syndrome?

A

Excess levels of cortisol of any aetiology

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2
Q

What does CRH control the release of?

A

ACTH from the anterior pituitary

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3
Q

What is ACTH responsible for?

A

The release of glucocorticoids and other steroids from the adrenal cortex

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4
Q

What do high cortisol levels exert negative feedback on? What does this do?

A

The pituitary gland. This decreases the amount of ACTH it releases

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5
Q

What affect do adrenal tumours have on cortisol?

A

They directly release it

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6
Q

What affect do pituitary tumours have on cortisol?

A

They act to increase cortisol release from the adrenal gland

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7
Q

What is the most common cause of Cushing’s Syndrome?

A

Exogenous administration of glucocorticoids - this could be due to diseases such as asthma or rheumatoid arthritis

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8
Q

What is the function of calcitonin?

A

Decreases blood calcium levels and blood phosphate levels by helping them get deposited in bone and by stimulating excretion by the kidneys.
Calcitonin is controlled by blood calcium levels and digestive chemicals

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9
Q

What are the differences between T3 and T4 and what do they do?

A

T3 = triiodotyronine. T4 = thyroxine.
T3 is more effective but T4 is more adundant.
They regulate metabolism (breakdown of carbs, fats and synthesise proteins). They can only be made by follicular cells when iodides are available.

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10
Q

How do T3 and T4 get into the blood?

A

They are carried by thyroxine binding globin (TBG)

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11
Q

What is the function of PTH? How does it work?

A

Increases blood calcium levels and decreases blood phosphate levels.
It causes Ca and PO4 to be released from bone into the blood by increasing osteoclast activity. PTH causes the kidneys to remove PO4 ions from the urine. PTH also increases vitamin D production so that more Ca is absorbed during digestion.

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12
Q

How is PTH regulated?

A

By blood calcium levels

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13
Q

What cell types does the endocrine portion of the pancreas contain?

A

Alpha cells - secrete glucagon
Beta cells - secrete insulin
Delta cells - secrete somatostatin

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14
Q

What is the role of glucagon?

A

Works on the liver to cause the production of glucose. It is regulated by blood glucose levels directly and is secreted when levels drop, e.g. before a meal.
Glucagon prevents hypoglycaemia

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15
Q

What is the role of insulin?

A

Works on the liver to remove glucose from the blood. It does this by: making glycogen, preventing gluconeogenesis, increase glucose transport into cells.
It is regulated by blood glucose levels directly and prevents hyperglycaemia

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16
Q

What is the most common cause of hypercalcaemia?

A

Primary hyperparathyroidism

Malignancy

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17
Q

What does excess GH cause in both adults and children?

A

Adults - acromegaly

Children - gigantism

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18
Q

What is the most common cause of excess GH?

A

Pituitary adenoma

19
Q

Name some signs/symptoms of acromegaly

A

Coarsening of facial features and soft tissues of hands & feet
Exaggerated growth of mandible
Hypertrophy of connective tissue of liver, kidney and heart
Lowered glucose tolerance - ~10% become diabetic

20
Q

How is acromegaly diagnosed?

A

Oral glucose tolerance test -> acromegaly confirmed if elevated GH levels are not suppressed

Blood tests to look at serum IGF-1 -> elevated in acromegaly

MRI scan and echo would also be done

21
Q

How would you treat acromegaly?

A

Surgery (if cause by pituitary adenoma)

Drug treatment - somatostatin analogues used, e.g. somatuline (lanreotide)

22
Q

What are the most common causes of hyperthyroidism?

A

Most (~90%) are due to autoimmune thyrotoxicosis - Grave’s Disease ~75% of which.

23
Q

What are some clinical features of hyperthyroidism?

A
  • Weight loss (despite normal/increased appetite)
  • diarrhoea
  • breathlessness on exertion
  • sinus tachycardia
  • tremor
  • muscle weakness
  • fatigue
  • sweating etc etc
24
Q

Name the clinical features of Grave’s disease

A 
Those of hyperthyroidism PLUS:
- symmetrical goitre with bruit
- chemosis
- eyelid retraction 
- excess eye watering
etc
25
Q

What would the thyroid function test show in a patient with hyperthyroidism?

A

TSH would be undetectable

26
Q

What is the most common cause of hypothyroidism, both worldwide and in developed countries?

A

Worldwide: not enough dietary iodide

Developed countries: Hashimoto’s thyroiditis

27
Q

Name some symptoms of hypothyroidism

A

Tiredness, weight gain etc

28
Q

How would you diagnose and treat hypothyroidism?

A

Primary hypothyroidism - increased TSH concentration
Secondary hypothyroidism - decreased free T4 & decreased TSH

Treatment = levothyroxine

29
Q

Where is the problem in primary adrenal failure?

A

The adrenal gland. It causes adrenocorticol insufficiency

30
Q

What is Addison’s disease?

A

Adrenal hypofunction - caused by the destruction of adrenal tissue. Usually autoimmune in origin.

31
Q

In the developing world what is the main cause of Addison’s?

A

Tb

32
Q

How might Addison’s disease first present? How would this be diagnosed?

A

Addisonian crisis. Measuring paired cortisol and ACTH. Presence of adrenal antibodies is helpful. Patients will have: hyperkalaemia, hyponatraemia, hypoglycaemia, increased urine Na.

33
Q

How would you treat Addison’s?

A

IV fluids, hydrocortisone (initially) thereafter maintain patient on oral glucocorticoids

34
Q

What is the difference between Cushing’s syndrome and Cushing’s disease?

A

Syndrome: describes signs/symptoms associated with high cortisol levels
Disease: pituitary-dependent cause, e.g. adenoma. Very rare

35
Q

What is the difference between primary and secondary hypogonadism?

A

Primary: within the testes. Decreased testosterone, increased FSH/LH. MORE COMMON

Secondary: problem elsewhere. Decreased testosterone, decreased FSH/LH

36
Q

Give an example of a primary and secondary cause of hypogonadism

A

1 - Klinefelters: 2 or more X chromosomes.

2 - Kallmann’s

37
Q

How would you treat androgen deficiency?

A

Testosterone therapy, gonadotrophin therapy

38
Q

In 80-90% of cases of male infertility what is the cause?

A

Impaired sperm production - either oligospermia or azoospermia. Could also be due to varicocoele.

39
Q

How could you treat male infertility?

A

Intracytoplasmic sperm injection

40
Q

How would a baby with foetal androgen deficiency present?

A

Phenotypically female at birth, blind vagina, small clitoris, testes present, bilateral inguinal hernia.

41
Q

What hormones regulate Ca homeostasis?

A

PTH, calcitonin, Vitamin D metabolites

43
Q

What is Conn’s syndrome?

A

Endocrine hypertension caused by excess secretion of aldosterone from the adrenal gland. Causes can include adenoma.
Treated with a low Na diet and spironalactone

44
Q

43 year old lady presents with: 12 months weight gain, leg oedema, oligomenorrhoea, poor sleeping pattern.
O/E she is: Centrally plethoric, BP 180/110 mmHg.
Serum K is slightly low, 9 am cortisol = 250 nmol/l (

A

Cushing’s syndrome

45
Q

What test results would you see for a patient with Cushing’s?

A

Dexamethasone is given. In a patient with Cushing’s this fails to suppress cortisol.

46
Q

What test do you do to diagnose Addison’s?

A

Give them ACTH -> if they are normal this will spark the production of cortisol. If they have Addison’s, no cortisol is produced as the kidneys are in crisis.
Patients have hyperkalaemia with low sodium, low glucose

Revision Notes - Year 1 (41 decks)

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