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Phase 2a > Endocrine > Flashcards

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
Q

What is the effect of cholecystokinin?

A

Delays gastric emptying
Gall bladder contraction
Insulin release
Signals of satisfaction via the vagus nerve

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26
Q

What is type I diabetes?

A

An autoimmune condition with a genetic component that causes beta-cell damage resulting in profound insulin deficiency.

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27
Q

What is type II diabetes?

A

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

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28
Q

What are examples of basal insulin?

A

NPH insulin
Insulin glargine
Insulin detemir
Insulin degludec

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29
Q

What are examples of prandial/meal-time insulin?

A

Insulin Lispro
Insulin glulisine
EDTA/citrate human insulin
Faster-acting insulin aspart

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30
Q

What are the advantages of basal insulin?

A
  • 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
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31
Q

What are the disadvantages of basal insulin?

A
  • Doesn’t cover meals
  • Best used with long-acting insulin analogues which are considered expensive
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32
Q

What are the advantages of premixed insulin?

A
  • Combined both basal and prandial components in a single insulin preparation
  • Can cover insulin requirements throughout most of the day
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33
Q

What are the disadvantages of premixed insulin?

A
  • 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%
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34
Q

What are the causes of hypoglycaemia?

A
  • 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
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35
Q

How is level 1 hypoglycaemia classified?

A
  • Alert value
  • Plasma glucose <3.9 mmol/l (70 mg/dl)
  • No symptoms
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36
Q

How is level 2 hypoglycaemia classified?

A
  • 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
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37
Q

How is level 3 hypoglycaemia classified?

A
  • 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
Q

What are the effects of hypoglycaemia on the brain?

A
  • Cognitive dysfunction
  • Blackouts
  • Seizures
  • Comas
  • Psychological effects
39
Q

What are the effects of hypoglycaemia on the heart?

A
  • Increased risk of myocardial ischaemia
  • Cardiac arrhythmias
40
Q

What are the effects of hypoglycaemia on circulation?

A
  • Inflammation
  • Blood coagulation abnormalities
  • Haemodynamic changes
  • Endothelial dysfunction
41
Q

What are the effects of hypoglycaemia on the musculoskeletal system?

A
  • Falls
  • Accidents
  • Driving accidents
  • Fractures
  • Dislocation
42
Q

What are the common autonomic symptoms of hypoglycaemia?

A
  • Trembling
  • Palpitations
  • Sweating
  • Anxiety
  • Hunger
43
Q

What are the common neuroglycopenic symptoms of hypoglycaemia?

A
  • Difficulty concentrating
  • Confusion
  • Weakness
  • Drowsiness
  • Dizziness
  • Vision changes
  • Difficulty speaking
44
Q

What are the common non-specific symptoms of hypoglycaemia?

A
  • Nausea
  • Headache
45
Q

What is the treatment of hypoglycaemia?

A
  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
Q

When should screening for the risk of severe hypoglycaemia be performed?

A
  • 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
Q

What does the presence of the parathyroid hormone induce?

A
  • 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
Q

Why is the parathyroid hormone important?

A

It helps with the maintenance of nerves and muscles.

49
Q

What causes hypocalcaemia?

A

Low serum albumin

50
Q

What are the symptoms of hypocalcaemia?

A
  • 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
Q

What can cause hypocalcaemia?

A
  • Vitamin D deficiency
  • Kidney failure
  • Acute pancreatitis
  • Hypoparathyroidism
52
Q

What can cause hypoparathyroidism?

A
  • Surgery
  • Radiations
  • Some syndromes
  • Genetics
  • Auto immune diseases
  • Infiltration
  • Magnesium deficiency
53
Q

What does hypoparathyroidism induce?

A

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
Q

What induces pseudohypoparathyroidism?

A

A resistance to the parathyroid hormone.

55
Q

What are the symptoms of pseudohypoparathyroidism?

A
  • Short stature
  • Obesity
  • Round facies
  • Mild learning difficulties
  • Subcutaneous ossification
  • Short fourth metacarpals
  • Other hormone resistance
56
Q

What can cause hypercalcaemia?

A
  • Malignancy, particularly bone mets, myeloma, PTHrP, lymphoma
  • Primary hyperparathyroidism
  • Thiazides
  • Thyrotoxocosis
  • Sarcoidosis
  • Familial hypocalciuric / benign hypercalcaemia
  • Immobilisation
  • Milk-alkali
  • Adrenal insufficiency
  • Phaeochromocytoma
57
Q

What are the symptoms of hypercalcaemia?

A
  • Thirst and polyuria
  • Nausea
  • Constipation
  • Confusion leading to a coma
  • Renal stones
  • ECG abnormalities, particularly a short QT
58
Q

Why could there be a false positive when testing for hypercalcaemia?

A
  • Tourniquet being left on for too long when acquiring the sample
  • Sample being old and haemolysed
59
Q

What causes primary hyperparathyroidism?

A
  • 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
Q

What are the symptoms of primary hyperparathyroidism?

A
  • Osteitis fibrosa cystica
  • Osteoporosis
  • Kidney stones
  • Confusion
  • Constipation
  • Acute pancreatitis
61
Q

What does primary hyperparathyroidism induce?

A

Hypercalcaemia by causing:
- Increased bone resorption
- Increased renal reabsorption of calcium
- Increased calcium absorption

62
Q

What is the effect of LH?

A

Stimulates production of sex hormones by gonads

63
Q

What is the effect of FSH?

A

Stimulated production of sperm and eggs

64
Q

What is the effect of TSH?

A

Stimulates the release of TH

65
Q

What’s the effect of TH?

A

Regulates metabolism

66
Q

What is the effect of PRL?

A

Promoted milk production

67
Q

What is the effect of GH?

A

Induces targets to produce insulin-like growth factors (IGF), which stimulates the body’s growth and a higher metabolic rate

68
Q

What’s the effect of ACTH?

A

Induces targets to produce glucocorticoids, which regulates the metabolism and the stress response

69
Q

What is the target of LH?

A

The reproductive system

70
Q

What is the target of FSH?

A

The reproductive system

71
Q

What is the target of TSH?

A

The thyroid gland

72
Q

What are the targets of PRL?

A

Mammary glands

73
Q

What are the targets of GH?

A

Liver, bones and muscles

74
Q

What are the targets of ACTH?

A

The adrenal glands

75
Q

What is the effect of GnRH?

A

Stimulates LH and FSH release

76
Q

What is the effect of TRH?

A

Stimulates the release of TSH

77
Q

What is the effect of PRH?

A

Stimulates the release of PRL

78
Q

What is the effect of PIH?

A

Inhibits the release of PRL

79
Q

What is the effect of GHRH?

A

Stimulates the release of GH

80
Q

What is the effect of GHIH?

A

Inhibits the release of GH

81
Q

What is the effect of CRH?

A

Stimulates the release of ACTH

82
Q

What is the effect of ADH?

A

Water balance

83
Q

What are the targets of ADH?

A

Kidneys, sweat glands and the circulatory system

84
Q

What is the effect of OT?

A

Triggers uterine contractions during birth

85
Q

What is the target of OT?

A

Female reproductive system

86
Q

What are the diseases of the pituitary?

A

Benign pituitary adenoma
Craniopharyngioma
Trauma
Apoplexy / Sheehans
Sarcoidosis / tuberculosis

87
Q

What are the effects of pituitary tumours causing upward pressure?

A

Headaches and visual field defects

88
Q

What are the effects of pituitary tumours causing sideways pressure?

A

Cranial nerve palsies and temporal lobe epilepsy

89
Q

What are the effects of pituitary tumours causing downwards pressure?

A

Cerebrospinal fluid rhinorrhea

90
Q

What are some conditions caused by pituitary tumours?

A

Prolactinoma
Acromegaly
Cushing’s disease

Phase 2a (3 decks)

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