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Endocrine Flashcards

1
Q

What is a hormone?

A

A chemical substance that acts like a messenger molecule in the body.

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2
Q

How does endocrine signalling work?

A

The signalling uses circulatory systems to transport the signal.

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3
Q

How does exocrine signalling work?

A

The signalling uses ducts to transport the signal.

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4
Q

How does paracrine signalling work?

A

The signalling acts on nearby cells.

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5
Q

How does autocrine signalling work?

A

The signalling acts on the signal cell.

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6
Q

What are the properties of a water-soluble hormone?

A
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7
Q

What are the properties of a fat-soluble hormone?

A
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8
Q

What are the classes of hormones?

A

Peptides
Amines
Iodothyronines
Cholesterol derivatives and steroids

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9
Q

How is hormone secretion controlled?

A

Basal secretion
Superadded rhythms
Release of inhibiting factors
Releasing of factors

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10
Q

How are hormone actions controlled?

A

Hormone metabolism
Hormone receptor induction
Hormone receptor down regulation
Synergism
Antagonism

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11
Q

Which hormones are secreted by the hypothalamus?

A

Corticotrophin-releasing hormone
Dopamine
Growth hormone-releasing hormone
Gonadotrophin-releasing hormone
Thyrotrophin-releasing hormone

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12
Q

Which hormones are secreted by the anterior pituitary?

A

TSH
ACTH
FSH
LH
Growth hormone
Prolactin

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13
Q

Which hormones are secreted by the posterior pituitary gland?

A

Oxytocin
ADH

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14
Q

Which hormones are secreted by the thyroid?

A

Triiodothyronine (T3)
Thyroxine (T4)
Calcitonin

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15
Q

What hormone is secreted by the parathyroid?

A

Parathyroid hormone

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16
Q

Which hormones are secreted by the adrenals?

A

Cortisol
Aldosterone
DHEA
Androgenic steroids
Adrenaline
Noradrenaline

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17
Q

Which hormones are secreted by the pancreas?

A

Glucagon
Insulin
Somatostatin
Pancreatic polypeptide

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18
Q

Which hormones are secreted by the gonads?

A

Oestrogen
Progesterone
Testosterone

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19
Q

What are the BMI intervals?

A

Underweight: less than 18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Obese: 30-39.9
Morbidly obese: over 40

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20
Q

What are the risk of obesity?

A

Type 2 diabetes
Hypertension
Coronary artery disease
Stroke
Osteoarthritis
Obstructive sleep apnoea
Some carcinomas

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21
Q

What affects appetite?

A

Psychological factors
Neural affronts
Gut peptides
Metabolites
Hormones
Cultural factors
Genes
Environment

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22
Q

What are the effects of Leptin and insulin?

A

Stimulate POMC/CART neurons and thus increased CART and decreased MSH levels
Inhibits NPY/AgRP neurons and thus decreases NPY and AgRP
Causes increased satiety and decreased appetite

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23
Q

What is the effect of Ghrelin?

A

Stimulates NPY/AgRP and thus increases NPY and AgRP secretion
Causes increased appetite

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24
Q

What is the effect of PYY3-36?

A

Binds to an inhibitory receptor on NPY/AgRP and thus decreases secretion of NPY and AgRP
Causes decreased appetite

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25
What is the effect of cholecystokinin?
Delays gastric emptying Gall bladder contraction Insulin release Signals of satisfaction via the vagus nerve
26
What is type I diabetes?
An autoimmune condition with a genetic component that causes beta-cell damage resulting in profound insulin deficiency.
27
What is type II diabetes?
Insulin resistance caused by at least 1 of the following: - Impaired insulin secretion and progressive beta-cell damage but with initial continued insulin secretion - Excessive hepatic glucose output - Increased counter-regulatory hormones, including glucagon
28
What are examples of basal insulin?
NPH insulin Insulin glargine Insulin detemir Insulin degludec
29
What are examples of prandial/meal-time insulin?
Insulin Lispro Insulin glulisine EDTA/citrate human insulin Faster-acting insulin aspart
30
What are the advantages of basal insulin?
- Simple for the patient to as they can adjust it themselves and it’s based on fasting glucose measurements - Can be carried on with oral therapy - Less risk of hypoglycaemia at night
31
What are the disadvantages of basal insulin?
- Doesn’t cover meals - Best used with long-acting insulin analogues which are considered expensive
32
What are the advantages of premixed insulin?
- Combined both basal and prandial components in a single insulin preparation - Can cover insulin requirements throughout most of the day
33
What are the disadvantages of premixed insulin?
- Not physiological - Requires consistent meal and exercise patterns - Cannot separately titrate individual insulin components - Increased risk for nocturnal hypoglycaemia - Increased risk for fasting hyperglycaemia if basal component does not last long enough - Often requires accepting higher HbA1c goal of <7.5% or <=8%
34
What are the causes of hypoglycaemia?
- Long duration of diabetes - Tight glycaemia control with repeated episodes of non severe hypoglycaemia - Use of drugs and alcohol - Sleeping - Increased physical activity - Increased age
35
How is level 1 hypoglycaemia classified?
- Alert value - Plasma glucose <3.9 mmol/l (70 mg/dl) - No symptoms
36
How is level 2 hypoglycaemia classified?
- Serious biochemical - Plasma glucose <3.0 mmol/l (55 mg/dl) - Non-severe symptomatic: Patient has symptoms but can self-treat and cognitive function is mildly impaired
37
How is level 3 hypoglycaemia classified?
- Serious biochemical - Plasma glucose <3.0 mmol/l (55 mg/dl) - Severe symptomatic: Patients has impaired cognitive function sufficient to require external help to recover
38
What are the effects of hypoglycaemia on the brain?
- Cognitive dysfunction - Blackouts - Seizures - Comas - Psychological effects
39
What are the effects of hypoglycaemia on the heart?
- Increased risk of myocardial ischaemia - Cardiac arrhythmias
40
What are the effects of hypoglycaemia on circulation?
- Inflammation - Blood coagulation abnormalities - Haemodynamic changes - Endothelial dysfunction
41
What are the effects of hypoglycaemia on the musculoskeletal system?
- Falls - Accidents - Driving accidents - Fractures - Dislocation
42
What are the common autonomic symptoms of hypoglycaemia?
- Trembling - Palpitations - Sweating - Anxiety - Hunger
43
What are the common neuroglycopenic symptoms of hypoglycaemia?
- Difficulty concentrating - Confusion - Weakness - Drowsiness - Dizziness - Vision changes - Difficulty speaking
44
What are the common non-specific symptoms of hypoglycaemia?
- Nausea - Headache
45
What is the treatment of hypoglycaemia?
1. Recognise symptoms so they can be treated as soon as they occur. 2. Confirm the need for treatment, if possible. Blood glucose <3.9 mol/l is the alert value. 3. Treat with 15g fast-acting carbohydrates to relieve symptoms. 4. Retest in 15 minutes to ensure blood glucose is >4.0 mol/l and retreat if needed. 5. Eat a long acting carbohydrate to prevent reoccurrence.
46
When should screening for the risk of severe hypoglycaemia be performed?
- Low HbA1c; high pre-treatment HbA1c in T2DM - Long duration of diabetes - A history of previous hypoglycaemia - Impaired awareness of hypoglycaemia (IAH) - Recent episodes of severe hypoglycaemia - Daily insulin dosage >0.85 U/kg/day - Physically active (e.g. athlete) - Impaired renal and/or liver function
47
What does the presence of the parathyroid hormone induce?
- Increased calcium ion reabsorption - Decreased phosphate reabsorption by increasing urinary phosphate excretion and decreasing serum phosphate - Increased 1 alpha-hydroxylation of 25-OH vitamin D - Increased bone remodelling - Increases calcium ion absorption due to the increase in 1,25 (OH)^2 vitamin D
48
Why is the parathyroid hormone important?
It helps with the maintenance of nerves and muscles.
49
What causes hypocalcaemia?
Low serum albumin
50
What are the symptoms of hypocalcaemia?
- Parasthesia - Muscle spasm, particularly in the hands and feet, larynx and causing premature labour - Seizures - Basal ganglia calcification - Cataracts - ECG abnormalities, particularly long QT intervals
51
What can cause hypocalcaemia?
- Vitamin D deficiency - Kidney failure - Acute pancreatitis - Hypoparathyroidism
52
What can cause hypoparathyroidism?
- Surgery - Radiations - Some syndromes - Genetics - Auto immune diseases - Infiltration - Magnesium deficiency
53
What does hypoparathyroidism induce?
Decreased serum calcium due to: - Decreased renal calcium reabsorption and thus increased relative calcium excretion - Increased renal phosphate reabsorption and thus increased serum phosphate - Decreased bone resorption - Decreased formation of 1,25(OH)^2 vitamin D and thus decreased intestinal calcium absorption
54
What induces pseudohypoparathyroidism?
A resistance to the parathyroid hormone.
55
What are the symptoms of pseudohypoparathyroidism?
- Short stature - Obesity - Round facies - Mild learning difficulties - Subcutaneous ossification - Short fourth metacarpals - Other hormone resistance
56
What can cause hypercalcaemia?
- Malignancy, particularly bone mets, myeloma, PTHrP, lymphoma - Primary hyperparathyroidism - Thiazides - Thyrotoxocosis - Sarcoidosis - Familial hypocalciuric / benign hypercalcaemia - Immobilisation - Milk-alkali - Adrenal insufficiency - Phaeochromocytoma
57
What are the symptoms of hypercalcaemia?
- Thirst and polyuria - Nausea - Constipation - Confusion leading to a coma - Renal stones - ECG abnormalities, particularly a short QT
58
Why could there be a false positive when testing for hypercalcaemia?
- Tourniquet being left on for too long when acquiring the sample - Sample being old and haemolysed
59
What causes primary hyperparathyroidism?
- 80% due to single benign adenoma - 15-20% due to four gland hyperplasia (May be part of MEN I or II) - <0.5% malignant
60
What are the symptoms of primary hyperparathyroidism?
- Osteitis fibrosa cystica - Osteoporosis - Kidney stones - Confusion - Constipation - Acute pancreatitis
61
What does primary hyperparathyroidism induce?
Hypercalcaemia by causing: - Increased bone resorption - Increased renal reabsorption of calcium - Increased calcium absorption
62
What is the effect of LH?
Stimulates production of sex hormones by gonads
63
What is the effect of FSH?
Stimulated production of sperm and eggs
64
What is the effect of TSH?
Stimulates the release of TH
65
What’s the effect of TH?
Regulates metabolism
66
What is the effect of PRL?
Promoted milk production
67
What is the effect of GH?
Induces targets to produce insulin-like growth factors (IGF), which stimulates the body’s growth and a higher metabolic rate
68
What’s the effect of ACTH?
Induces targets to produce glucocorticoids, which regulates the metabolism and the stress response
69
What is the target of LH?
The reproductive system
70
What is the target of FSH?
The reproductive system
71
What is the target of TSH?
The thyroid gland
72
What are the targets of PRL?
Mammary glands
73
What are the targets of GH?
Liver, bones and muscles
74
What are the targets of ACTH?
The adrenal glands
75
What is the effect of GnRH?
Stimulates LH and FSH release
76
What is the effect of TRH?
Stimulates the release of TSH
77
What is the effect of PRH?
Stimulates the release of PRL
78
What is the effect of PIH?
Inhibits the release of PRL
79
What is the effect of GHRH?
Stimulates the release of GH
80
What is the effect of GHIH?
Inhibits the release of GH
81
What is the effect of CRH?
Stimulates the release of ACTH
82
What is the effect of ADH?
Water balance
83
What are the targets of ADH?
Kidneys, sweat glands and the circulatory system
84
What is the effect of OT?
Triggers uterine contractions during birth
85
What is the target of OT?
Female reproductive system
86
What are the diseases of the pituitary?
Benign pituitary adenoma Craniopharyngioma Trauma Apoplexy / Sheehans Sarcoidosis / tuberculosis
87
What are the effects of pituitary tumours causing upward pressure?
Headaches and visual field defects
88
What are the effects of pituitary tumours causing sideways pressure?
Cranial nerve palsies and temporal lobe epilepsy
89
What are the effects of pituitary tumours causing downwards pressure?
Cerebrospinal fluid rhinorrhea
90
What are some conditions caused by pituitary tumours?
Prolactinoma Acromegaly Cushing’s disease

Phase 2a (3 decks)

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