ENDOCRINE

Question 1

What is the arrangement of the endocrine system

Answer 1

1. hypothalamus (recieves signals from nerves/ peripheries)
2. piturity gland: secrete hormones to specific glands- thyroid, adrenal, overaries/ testes/ pancreas

Question 2

How does the endocrine system work?

Answer 2

feedback loops

Question 3

What is the role of the thyroid

Answer 3

regulate metabolic activity: secrete T4 &Calcitonin

Question 4

How does the thyroid hormone work?

Answer 4

stimulated by PTH
1. T4-> T3

Hypothalamus (pth)
thyroid (t4->t3)

Question 5

What is a goitre

Answer 5

thyroid gland is not getting enough iodoine
hypothalamus hormone produces TRH which cause thyroid to grown (goitre)

Question 6

What is hypothyroidism and the causes of it?

Answer 6

Hypothyroidism: low T3/ T4
causes: idodine deficiency, drugs (carbazepine), goitre
- autoimmune destruction of thyroid (HASHIMOTOS)
- thyroidectomy

Question 7

Signs and symptoms of hypothyroidism

Answer 7

• slow heart rate
• low bp
• low energy
• weight gain
• loss of appetite
• cold tolerance
• hair and nail changes
  -depression

Question 8

What is congential hypothyroidism and how does it present

Answer 8

t3 and t4 required for growth and development

• results in a short stature and developmental delay

Question 9

What is meant by hyperthyroidism

Answer 9

increased t3 & t4

Question 10

what are the signs and symptoms of hyperthyroidism

Answer 10

• tachycardia
• anxious
  -loss of weight
• heat intolerance
  -temor
• mania
• heart murmer
• diarrohea
  -bulging of eyes

Question 11

What are the causes of hyperthyroidism

Answer 11

Autoimmune stimulation: Graves disease
- thyroid tumour

Question 12

Management

Answer 12

suppress activity: remove gland, radio-iodine

Question 13

What is hashimotos

Answer 13

autoimmune disorder attacking thyorid gland- less t3&t4 produced

Question 14

what is graves disease

Answer 14

Auto immune disease causing increase in t3/t4

Question 15

What is the role of adrenal + give examples

Answer 15

produces hormones:
glucorticoids - manage sugar and energy: glucose metabolsim

mineralocorticoids: aldosterone salt & water - heart rate, blood sugar

corticosteroids: andrenaline

andogren: masculitinity

Question 16

Give the pathway for adrenal cortex stimulation

Answer 16

hypothalamus: CRH
Pituitary gland: ACTH
Adrenal gland: cortisol

Question 17

How does synthetic corticosteroids affect feedback loop

Answer 17

act same way as corticosteroids:
stops hypothalamus producing CRH
- Less ACTH
- Less cortiosl

Question 18

What is cushing syndrome

Answer 18

excess cortisol production from adrenal cortex

Question 19

What are the signs and symptoms of cushing syndrome

Answer 19

• diabetes, moon face, buffalo hump, acne, thin hair, facial hair, thin skin, peripheral wasting and weakness

Question 20

What are the causes of Cushing syndrome

Answer 20

• iatrogenic damage
• iatrogenic damage- steroid prescription
• cushing disease
• other tumours secreting ACTH

Question 21

What is cushing disease

Answer 21

piturity adenoma secreting ACTH

Question 22

What is adrenal insufficency

Answer 22

Low cortisol levels

Question 23

What are the signs and symptoms of adrenal insufficiency

Answer 23

Non-specific:
Malaise, weight loss, nause, vomiting, abdominal pain, fatigue, depression, muscle pain, joint pain

Question 24

What are the causes of adrenal insufficency

Answer 24

1. primary adrenal insufficiency: ADDISIONS DISEASE
2. Secondary adrenal insuffiency: atrophy of adrenal glands due to exogenous steorids. Therefore, hypothalamus stimulates adrenal gland less:
   - adrenal gland unable to respond to illness etc

Question 25

What does adrenal insufficency affect?

Answer 25

affects mineralocorticoids, glucocorticoids, (salt water balance), catecholamines ( maintain blood pressure)→ more profound effects

Question 26

Pt who has addisions what do they take

Answer 26

take daily endogenous steroids

Question 27

Who is at risk of secondary adrenal insufficency

Answer 27

1. Long term oral steroids (>5mg prednisolone/da for 4 weeks)
2. High dose short courses (40>mg prednisolone for 7 days repeated/ also taking long term lower doses)
3. Inhaled steroids (>1000mcg/day) usual dose is 800mcg/day

Question 28

How do you manage a pt at risk of secondary adrenal insufficency

Answer 28

1. don’t stop taking steroids
2. assess risk (addisions higher than steroid tx)
3. assess steroid cover
4. educate pt and ensure enough steroids
5. maintain fluids
6. prescribe steroids/ extra if needed

Question 29

What are the signs of adrenal crisis

Answer 29

Postural hypotension, malaise, fatigue, vomiting

Question 30

What is the role of PTH

Answer 30

control calcium homeostasis & bone metabolism

Question 31

Where is PTH secreted from

Answer 31

parathyroid hormone

Question 32

Describe how PTH works

Answer 32

LOW BLOOD CALCIUM LEVEL:

1. Detected by parathyroid gland→ PTH is produced
2. PTH mainly affects bone (osteoclasts to dissolve bone, release calcium into blood)
3. Small effects on kidney (stimulates vitamin D3 is calcitriol stimulates absorption of calcium from the gut)
   Increasing levels of calcium

Question 33

What is hypoparathyroidism

Answer 33

Parathyroidism glands working less: lower blood calcium- less pTH

Question 34

What are the causes of hypoparathyroidism

Answer 34

1. autoimmune
2. thyroidectomy
3. hypocalcemia

Question 35

what are the causes of hyperparathyroidism

Answer 35

overreactive parathyorid gland: mobile and absorb more calcium

primary:
- pTH secreting tumour
- tumour of parathyroid gland
- other cancers

secondary causes:
- renal failure
vitamin deficiency- cannot asborb calcium

Question 36

What is the consequence of hyperparathyroidism

Answer 36

Hypercalcaemia

Stones, bones (osteoporosis/ pathological fractures), abdominal groans (constipation, obstruction of gut), psychic moans