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Endocrine Flashcards

1
Q

Embryology of thyroid

A

First and second pharyngeal pouches
Forms from base of tongue
In 3rd week - endoderm cells of primitive pharynx proliferate creating thyroid diverticulum
Proliferation of cells bifurcates and descends into neck as two-lobed diverticulum
7th week - anterior neck forms 2 lateral lobes connected by central isthmus

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2
Q

Results for primary hyperthyroidism

A

Low TSH
High T3 T4

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3
Q

Results for secondary hyperthyroidism

A

High TSH
High T3 T4

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4
Q

Results for Primary hypothyroidism

A

High TSH
Low T3 T4

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5
Q

Results for secondary hypothyroidism

A

Low TSH
Low T3 T4

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6
Q

Causes of hyperthyroidism

A

Grave’s disease
Toxic multi nodular goitre
Drugs - amiodarone

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7
Q

Causes of hypothyroidism

A

Drugs - lithium
Hashimoto’s thyroiditis - autoiminue, ass/ T1DM
Subacute thyroiditis - De Quervain’s
Iodine deficiency

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8
Q

Embryology of parathyroid

A

Inferior parathyroid comes from 3rd pharyngeal pouch
Superior comes from 4th pharyngeal pouch

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9
Q

Blood supply to parathyroid

A

Thyroid arteries

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10
Q

What stimulates release of PTH

A

Hypocalcemia, hypomagnesium, hypophosphate

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11
Q

Actions of PTH

A

Increased levels of serum calcium by
Increasing osteoclasts to increase calcium reabsorption from bone to blood
Increases calcium reabsorption in distal convuluted tubule - less excreted in urine
Convert vit d to calciférol in kidneys to promote calcium absorption in the intestines

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12
Q

Hypothalamus-pituitary axis

A

Dopamine inhibits prolactin
TRH stimulates TSH + T3 T4
CRH stimulates ACTH + cortisol
Somatostatin - GH
GHRH + GH + IGF’S
GnRH + FSH LH + Andogrens estrogen and progesterone

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13
Q

What causes congenital adrenal hyperplasia

A

Defect in 27 hydoxylase enzyme

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14
Q

Physiology of CAH

A

27 Hydoxylase enzyme converts progesterone to aldosterone and cortisol
Progesterone also is converted to testosterone
Defect in 27 hydoxylase causes more conversion to testosterone

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15
Q

Blood results for CAH

A

High testosterone
Low aldosterone and cortisol

HYPONATRAEMIC HYPERKALAEMIC HYPOGLYCAEMIA

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16
Q

How is CAH inherited?

A

Autosomal recessive

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17
Q

Signs and symptoms of CAH

A

Female - tall, deep voice, early puberty, facial hair, absent periods
Male - tall, deep voice, large penis, small testicles, early puberty

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18
Q

ACTH and melatonin

A

Byproduct of production of ACTH is melanocyte stimulating hormone
Ant. pit. releases more ACTH in response to low cortisol more converted to MSH
MSH caused hyperpigmentation by melatonin

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19
Q

Management of CAH

A

Replace glucocorticoid (Cortisol) with hydrocortisone
Replace mieralcorticoid (aldosterone) with fludrocortisone

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20
Q

Embryology of gonads

A

5th weeks - gonadal ridge develops
6th week - primordial germ cells migrate from yolk sac to gonadal ridge
7th week - primordial Ferm cells promote sexual differentiation
8th Week - Wolfian and Mullerian duct differentiate into rest of reproductive system

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21
Q

Male development

A

Gene expression in sex-determining region of Y choromosome (SRY) is prompted
Promotes testis determining factor production - gonadals transform to testis
Wolffian ducts transform to internal male reproductive system

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22
Q

What types of cells do testes form?

A

Germ cells - produces spermatogonia
Leydig cells - synthesis of testosterone
Sertoli cells - synethesis anti-mullerian hormone

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23
Q

Female development

A

No SRY
Development of ovaries doesn’t being until week 9
10th week - ovarian cortex and inner medulla distinguishable
Mullerian dust -> female genitalia
Lack of testosterone degenerates Wolffian duct
Lack of anti-mullerian hormone allows mullein duct to persists

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24
Q

Type of Ovarian cells

A

Germ cells - produce oogonia
Granulosa cells - synthesis estradiol
Theca cells - produce synthesise progesterone

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25
What is gonadranche
Gonadal activation by LH and FSH Males - LH works on leading cells to produce testosterone, FSH works of Sertoli cells to produce sperm Females - LH works on ovarian follicles to produce progesterone and androstenedione
26
What is adrenarche
Adrenal gland activated Pubic hair, oily skin and hair, body odour
27
What is thelarche
Breast development Precedes menarche by 2 years
28
What stage is Menarche?
Usually Tanner stage 4
29
Central causes of precious puberty
GnRH -dependent - -Idiopathic -Hypothyroidism - Obesity -Silver-rusell syndrome
30
Peripheral causes of precious puberty
GnRH independent - Congenital adrenal hyperplasia -Gonadal tumour -HCG secreting tumours in liver
31
When would you say someone has delayed puberty
Girls - no breast development by 13 Boys - testicular not filled to 4mls by 14 Primary amenorrhea by 16
32
How is Kellman's Syndrome inherited
X-linked recessive trait
33
What Is Kellman's syndrome
Delayed puberty secondary to hypogonadatrophic hypogonadism Failure of GnRH secreting hormone to hypothalamus
34
What does Kellman's syndrome cause
Delay in puberty Anosmia
35
Action of cortisol
Stress response Insulin counter-regulatory hormone Increased gluconeogenesis, hepatic glycogenolysis and ketogenesis
35
Normal puberty in girls - Tanner Stages
Stage 1 - pre-adolescent Stage 2 - breast bud formation, sparse growth of pubs hair Stage 3 - Further enlargement and elevation of breast and papilla with no separation of their contours , hair spreads over junction of pubis and becomes darker, axillary hair - adult in quantity and type Stage 4 - Projection of areola and papilla to form a secondary mound Stage 5 - mature stage with projection of papilla only, adult hair in quantity and type
36
Tanner stages in Males
S1 - pre-adolescent S2 - Enlargement of scrotum and testes and changes in scrotal skin S3 - Further growth of testes and scrotum, enlargement of penis S4 - Increase in breadth of penis and development of glans S5 - Adult genitals
37
What does vasopressin / ADH do?
Increases water permeability of collecting ducts Increases water reabsorbed back into the circulation
38
What illnesses do you see SIADH in?
Pneumonia Lymphoma Meningitis Cranial abscess Trauma
39
SIADH
High levels of ADH Hyponatreamia Pass small amount of concentrate urine Serum osmolality is less than urine osmolality Water retention due to water reabsorption in distal collecting tubules High sodium con. in urine
40
Signs of diabetes insipidus
Polyuria Polydipsia Increase freq and nocturnal enuresis
41
What is nephrogenic diabetes insipdus
Insensitivty to ADH at the collecting duct In kidney -Desmopressin has no affect on urinary concentration
42
What is cranial diabetes insides
lack of production of ADH (vasopressin)
43
What is nephrogenic diabetes insipdus
lack of response to ADH
44
Where is ADH produced
hypothalamus
45
Where is ADH released
posterior pituitary
46
Causes of nephrogenic diabetes insipdus
Medications - lithium Genetic mutations - X-linked inheirtance Hypercalcamia Hypokalaemia Kidney disease
47
Causes of cranial diabetes insipidus
Brain tumours Brain injury Brain surgery Wolfram syndrome - genetic condition optic atrophy, deafness and diabetes mellitus
48
What do investigation show
low urine osmolality High/ normal serum osmolality >3 litres in collection in 24 hours Water deprivation test
49
How does water deprivation test work? Desmopressin deprivation test
Avoid fluid for 8 hours Test urine osmality - if low, give ADH (Desmopressin)
50
What result rules of diabetes insidious
high urine osmality in Desmopressin deprivation test
51
Results of cranial disipidus
Urine osmality low pre Desmopressin High post Desmopressin Kidneys can respond to ADH
52
Results of nephrongenic
Low urine osmality pre Low post Kidneys can't respond to aDH
53
where is renin secreted from
Juxtaglomerular cells in afferent arterioles in kidney
54
When is renin secreted
in response to Low blood pressure
55
How does renin increase blood pressure
Converts angiotensin to angiotensin I in liver Moves to lung to be converted to angiotensin II
56
how does angiotensin II act on blood pressure
causes vasoconstriction Stimulates release of aldosterone
57
Three functions of aldosterone
Increases sodium reabsorption in distal tubule Increase potassium secretion in distal tubule Increase hydrogen secretion in collecting tubule When Na is reabsorbed, water follows by osmosis, = increase intravascular volume = increase blood pressure
58
what is the most common cause for primary testicular failure
Kleinfelter's syndrome
59
Features of Kleinfelter's syndrome
47 XXY Caused by nondisjunction at stage 1 or 2 of meiosis
60
Blood results in Addison's
hyponatreamic hyperkalemia Lack of cortisol
61

TAS (18 decks)

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