endocrine Flashcards
1
Q
endocrine disease can be a result of primary or secondary failure, what is primary failure?
A
gland failure - it can’t produce hormone
2
Q
endocrine disease can be a result of primary or secondary failure, what is secondary failure?
A
control failure - gland can make hormone but the control system is not working
3
Q
rare, inherited disorders in which several endocrine glands develop noncancerous (benign) or cancerous (malignant) tumors or grow excessively without forming tumors are known as?
A
multiple endocrine neoplasia
4
Q
where does the pituitary gland receive info from?
A
hypothalamus
5
Q
which hormones are produced by the anterior pituitary?
A
TSH ACTH GH LH FSH prolactin
6
Q
which hormones are produced by the posterior pituitary?
A
ADH
oxytocin
7
Q
hormones travel from the hypothalamus to the pituitary through what?
A
venous plexus
8
Q
pituitary tumours are usually what type?
A
adenoma
9
Q
what are the 2 types of pituitary adenomas?
A
functional adenoma and non functional adenoma
10
Q
compare a functional and non functional pituitary adenoma
A
functional - produces hormones
non functional - doesn’t produce hormones
11
Q
what issues does a non functional pituitary adenoma and a functional cause?
A
space occupying
12
Q
tumours growing out the pituitary gland push on which nerve having what effect?
A
push on optic nerve - peripheral vision damage
13
Q
as well as affecting peripheral vision, what else do pituitary tumours affect?
A
nasal field
14
Q
the technique which uses a metal tube stuck up the nose through the spend and into the sella tunica to remove a pituitary tumour is known as?
A
transphenoidal surgery
15
Q
what effect will insufficient growth hormone have in children?
A
growth failure - child will be small but in proportion
16
Q
what effect will insufficient growth hormone have in adults?
A
metabolic changes - increased fat and decreased vitality
17
Q
what effect will excess growth hormone have in children?
A
giganticism - tall but in proportion
18
Q
what effect will excess growth hormone have in adults?
A
acromegaly - what can still grow will (hands, feet, mandible, soft tissue)
19
Q
what substance would you measure to assess growth hormone levels?
A
IGF-1 (insulin like growth factor)
20
Q
is GH a anabolic or catabolic hormone?
A
anabolic
21
Q
what is excess growth hormone usually cause by?
A
functional pituitary tumour
22
Q
what diseases are those with acromegaly likely to develop?
A
type 2 diabetes
CVD (ischaemic hear disease, acromegalic cardiomyopathy)
23
Q
acromegaly sufferers have a decreased life span and often die due to what?
A
CVD
24
Q
name some oral consequence of acromegaly?
A
enlarged tongue
interdental spacing
‘shrunk’ dentures
reverse overbite
25
which is more common primary hyperthyroidism or secondary hyperthyroidism?
primary
26
high thyroid hormone levels due to a problem not associated with the thyroid gland is known as?
thyrotoxicosis
27
hypothyroidism may also be known as?
myxoedema
28
which is more common primary hypothyroidism or secondary hyperthyroidism?
primary
29
which autoimmune disease causes 70-80% of hyperthyroidism ?
graves disease
30
in graves disease, autoantibodies stimulate which receptor?
TSH receptor
31
there is an excess of which 2 hormones in hyperthyroidism?
T3 and T4
32
a less common cause of hyperthyroidism is caused by an excess of thyroid hormones from thyroid nodules, this is known as?
toxic multi-nodular goitre
33
a tumour causing hyperthyroidism is known as?
toxic adenoma
34
name 4 causes of hyperthyroidism
graves
toxic multi-nodular goitre
thyroid tumour
pituitary tumour (rare)
35
name some symptoms of hyperthyroidism
```
hot
sweaty
weight loss
diarhoea
palpitations
tachycardia
increased BP
tremor
eyelid retraction
```
36
which autoimmune disease causes 90% of primary hypothyroidism cases?
hashimotos thyroiditis
37
name some causes of primary hypothyroidism
```
hashimotos
idiopathic atrophy
thyroidectomy
iron deficicncy
drugs
congenital
```
38
what causes secondary hypothyroidism?
hypothalamic or pituitary disease
39
what are the symptoms/signs of hypothyroidism
```
tired
cold
weight gain
constipation
angina
hair loss
```
40
do autoimmune diseases affect more males or females?
females
41
which blood tests might you do for those with thyroid disease?
TSH
T4
T3
42
raised TSH and raised T3 indicates which type of thyroid disease?
secondary hyperthyroidism (pituitary cause)
43
low TSH and raised T3 indicates which type of thyroid disease?
primary hyperthyroidism (graves or adenoma)
44
low TSH and low T4 indicates which type of thyroid disease?
secondary hypothyroidism (pituitary cause)
45
raised TSH and low T4 indicates which type of thyroid disease?
primary hypothyroidism (gland failure)
46
what treatment is there for hyperthyroidism?
carbimazole
beta blockers (reduce BP and help anxiety)
radioidine (carries hypothyroid risk)
surgery - partial thyroidectomy
corticosteroids (treat graves opthalmopathy)
47
what treatment is there for hypothyroidism?
T4 (thyroxine) tablets
48
name the 2 types of thyroid cancer and which is most common?
papillary (80%)
| follicular
49
the hypothalamus releases _ which travels to the anterior pituitary, stimulating the release of TSH?
TRH - thyrotropin releasing hormone
50
what happens when the blood concentration of thyroid hormones increases above the threshold?
THR secreting neurons in the hypothalamus are inhibited
51
which disease is characterised by adrenal glands do not produce enough steroid hormones?
addisons disease
52
which disease is characterised by excessive adrenal action?
cushings
53
name the 3 layers of the adrenal gland from outermost to inner most
```
zona glomerulosa (outer)
zona fasicularis
zona reticularis (inner)
```
54
which hormone does the zone glomerulosa of the adrenal gland secrete?
aldosterone
55
which hormone does the zona fascicularis of the adrenal gland secrete?
cortisol
56
which hormone does the zona reticular of the adrenal gland secrete?
adrenal androgens
57
which hormone released but the hypothalamus causes the anterior pituitary to release ACTH?
CRH (corticotropin releasing hormone)
58
CRH from the hypothalamus causes release of which hormone from the anterior pituitary?
ACTH (adrenocorticotropic hormone)
59
which 3 hormones does the adrenal cortex produce?
androgens (DHEA)
aldosterone
cortisol
60
where in the adrenal gland is aldosterone produced?
zona glomerulosa
61
what does aldosterone do?
- regulates salt and water
- enhances sodium reabsorption and potassium loss causing water to be absorbed alongside sodium
- this increase in fluid causes an increase in BP
62
decreased blood flow to the kidneys activates which system?
renin-angiotensin system
63
once the renin-angiotensin system is activated, which substance is released and from where?
renin from juxtaglomerular apparatus
64
renin cleaves _ to form _?
angiotensinogen to form angiotensin 1
65
angiotensin 1 is converted to angiotensin 2 by what?
ACE
66
angiotensin 2 causes release of which hormone?
aldosterone
67
which 2 drugs inhibit the renin-angiotensin system?
```
ACE inhibitors (angiotensin converting enzyme inhibitors)
AT2 blockers (angiotensin ii blockers)
```
68
what are ACE inhibitors and AT2 blockers used to treat?
high BP
69
what 2 reactions may patients take to ACE inhibitors?
angio-odeama
| lichenoid reaction
70
which type of hormone is cortisol?
glucocorticoid (steroid hormone)
71
where in the adrenal gland is cortisol produced?
zona fasciculata
72
what physiological effects does cortisol have on the body?
antagonist to insulin (difficult for glucose to move insulin into cells)
lowers immune reactivity
increases BP
inhibits bone synthesis
73
cortisol doesn't work through surface receptors, how does it work?
works in cell nucleus where it alters protein transcription
74
name some therapeutic steroids
hydrocortisone
prednisolone
dexamethasone
75
what is the name given to man made steroids used therapeutically?
corticosteroids
76
over production of cortisol by the adrenal gland causes which disease?
cushings
77
what may cause adrenal hyperfunction?
primary - tumour of adrenal gland
| secondary - tumour of pituitary
78
over production of aldosterone by the adrenal gland causes which disease?
conns syndrome
79
reduced function of the adrenal gland due damage causes which disease?
addisons disease
80
is addisons disease due to primary or secondary hypofunction?
primary
81
name some signs and symptoms bushings disease?
```
centripetal obesity (moon face, buffalo hump)
hypertension
thin skin
muscle weakness
diabetes melliyus features
```
82
name some signs/symptoms of addisons disease
postural hypotension
weight loss
hyperpigmentation
vitiligo
83
high ACTH and high cortisol indicate which type of adrenal disease?
secondary hyperfucntion
84
low ACTH and high cortisol indicate which type of adrenal disease?
primary hyperfucntion
85
low ACTH, low cortisol and positive synacthen indicate which type of adrenal disease?
secondary hypofucntion
86
high ACTH, low cortisol and negative synacthen indicate which type of adrenal disease?
primary hypofucntion
87
injecting ACTH to see if there is an increase in cortisol is known as what?
synacthen (positive means cortisol does increase)
88
how is addisons disease managed?
hormone replacement (cortisol and fluorocortisone)
89
when may steroid prophylaxis be given?
when there is an increase in physiological requirement
- infection
- surgery
- physiological stress
90
which patients may be given steroid prophylaxis?
addisons disease patients and those on therapeutic steroids
91
when there is not enough steroids for body demands this is known as an?
addisonian crisis
92
why is an IGF test taken and not a GH one?
GH is produced at night
93
which type of bones can't grow after puberty as the growth plates have fused?
endochondrial
94
which type of bones grow in patients with acromegaly?
membranous
95
name 2 common causes of destruction of adrenal gland tissue in addisons disease?
autoimmune destrcution
| TB
96
name the 2 types of diabetes?
mellitus and insipidus
97
what test is used to test type 1 and 2 diabetes?
glucose tolerance test
98
what is type 1 diabetes also known as?
insulin deficiency
99
what is type 2 diabetes also known as?
insulin resistance
100
which type of diabteets involves immune mediated pancreatic B cell destruction?
type 1 - insulin deficiency
101
define hyperglycaemic?
high blood sugar
102
what is ketacidosis?
when blood sugar is so high ketones build up and can kill
103
which diabetics take insulin ?
type 1
104
what circulating antibodies are present in those with type 1 diabetes?
GAD (glutamic acid decarbonase)
ICA (islet cell antibodies)
IAA (insulin antibodies)
105
what are the symptoms of type 1 diabetes?
polyuria (large urine production)
polydipsia (excessive thirst)
tiredness
106
which is most common, type 1 or 2 diabetes?
2
107
which diabetics are prone to hyperglycaemia?
type 1
108
which diabetics are prone to hyperinsulinaemia?
type 2
109
high insulin in blood is known as?
hyperisulinaemia
110
name the 2 types of insulin injection routines?
basal-bolus control
| split-mixed control
111
which insulin regime offers more control and flexibility?
basal-bolus control
112
how is type 1 diabetes managed?
subcutaneous insulin
113
what happens to a type 1 diabetic if they have too much insulin and not enough glucose?
hypoglycaemic
114
what ways may type 2 diabetes be managed?
```
weight loss
diet restrctions
surgery (gastric bypass)
oral hypoglycaemic agent
insulin sensitisers
```
115
name 2 common oral hypoglycaemic medications?
sulphonylureas
| biguanides
116
list some chronic complications caused by diabetes
```
CVD - angina, MI
neuropathy
claudication
poor wound healing
infection
renal disease!!
eye disease
```
117
which eye diseases are diabetics prone to?
cateracts
maculopathy
proliferative retinopathy
118
high blood glucose injures nerves causing what?
neuropathy
119
what effects does neuropathy have?
```
general sensation affected (hand and feet)
motor neuropathy (Muscle weakness)
autonomic regulation (bladder and bowel dysfunction)
```
120
which type of diabetes causes more problems with surgery?
type 1
121
what most dentists consider with diabetic patients?
time of appointment - food intake may be disrupyed
acute emergencies
infection risk
poor wound healing
122
high blood sugar and NO insulin causes what?
ketoacidosis
123
which typeof diabetics usually present with diabetic symptoms ?
type 1
124
which type of diabetics go hypo?
type 1
125
when should a type 1 diabetic have their dental appointment?
just after meal time
