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Applied Clinical Physiology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is endocrinology?

A

Study of endocrine glands and their secretions: hormones

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2
Q

What glands make up the endocrine system?

A
  1. Pituitary
  2. Throid
  3. Adrenal
  4. Pancreas
  5. Ovaries/Testes
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3
Q

What role does the pituitary gland have in homeostasis?

A

the master gland

extensive influence over other organs

linked to hypothalamus (which stimulates and inhibits pituitary hormones)

responsible for making hormones to stimulate organs to act

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4
Q

What does hypothalamus drive at birth?

A 
Hunger
Thirst
Temperature
Anger
Fatigue
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5
Q

What is embryonic development of pituitary?

A

Develops around 3 weeks from 2 places - outpocketing of oral ectoderm and extension of neuroectoderm from diencephalon.

Around 8 weeks gestation the infundibulum grows downwards to develop into posterior lobe.

10 weeks you can start to detect growth hormone

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6
Q

What does the pituitary gland produce?

A

Anterior:

Prolactin 
Leutinizing/follicle stimulating hormone
Adrenocorticotropic hormone
Growth hormone
Thyroid stimulating hormone

Posterior:

Antidiuretic hormone
Oxytocin (labour and lactation)

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7
Q

What issues can you have with the hormones?

A

Deficiency
Excess
resistance (a block to the action)

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8
Q

What congenital defects of the pituitary gland can you get?

A

Septo-optic dysplasia. (affects midline).

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9
Q

What is septa-optic dysplasia?

A

Optic nerve hypoplasia
Midline brain abnormalities
Hypopituitarism (lacking in all hormones)

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10
Q

What acquired disorders of pituitary/hypothalamus can you get?

A

Neoplastic:

  • Craniophayngioma
  • Optic glioma
  • Astrocytoma
  • Germ cell tumour

Inflammatory:

  • Meningitis
  • Autoimmune hypophysillis
  • Landerhans cell histiocytosis

Trauma

Cranial Irradiation

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11
Q

What is hypopituitarism?

A

Reduction of all hormones

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12
Q

What are signs and symptoms of hypopituitarism?

A

Growth Hormone changes: Hypoglycaemia in infancy , growth failure in childhood

ACTH changes cause:

  • hypoglycaemia
  • jaundice
  • hypotension

LH changes cause:

  • micropenis
  • Failure of puberty

TSH changes cause:

  • jaundice
  • poor growth
  • tiredness, dry skin, hair loss

ADH changes:
- Cranial diabetes insipidus

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13
Q

What are treatments for hypopituitarism?

A

Human growth hormone - subset injections (no oral option)

Hydrocortisone

Testosterone injections

Levothroxine

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14
Q

What are 4 stages of growth?

A

Foetal
Infancy
Childhood
Puberty

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15
Q

what is grown in infancy most dependent upon?

A

Nutrition

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16
Q

What is average rate of growth in infancy?

A

25cm/year

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17
Q

What is growth in childhood most dependent on?

A

GH/IGF axis

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18
Q

What is rate of growth in childhood?

A

4-8cm/year

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19
Q

What is growth in puberty most dependent on?

A

Sex steroids and GH

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20
Q

What is rate of growth in puberty?

A

6-10cm/year

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21
Q

What are main hormones involved in growth?

A

Growth hormone
Insulin-like growth factor
Thyroid hormone

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22
Q

what medication can influence growth?

A 
Asthma 
Sickle Cell
Arthritis
IBD
Chronic Heart Disease
CF
Renal insufficiency

Basically steroids

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23
Q

What factors influence puberty?

A

Genetic background
Environment
General health of child

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24
Q

What aspects of general health influence puberty?

A

Adequate nutrition
obesity (increased BMI=early puberty)
Emotional and behaviours difficulties
Chronic disease

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25
Q

How does environment affect puberty?

A

Difficult to prove

Phytoestrogens (from carrots coffee etc)
Pesticides/herbicides (in Florida noted)
BPA (baby feeding botles/plastics)

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26
Q

What genetic factors can affect puberty?

A

family history
siblings pubertal milestones
FSH receptor

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27
Q

What is a prader orchidometer?

A

Beads to measure testicule volume in mls.

Main points: 4mls - puberty onset

10mls - start of adolescent growth spurt

12mls - peak heigh velocity (growing at fastest rate).

Up to 20mls.

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28
Q

When does menarche occur compared to height velocity?

A

After growth spurt - will have stopped growing.

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29
Q

When does facial hair/shaving occur compared to height velocity?

A

After growth spurt/stopped growing.

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30
Q

what is precocious puberty?

A

Early puberty.

True = early activation of hypothalamic-pituitary-gonandal axis

Pseudo = sex steroids secreted without activation of axis

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31
Q

What are some causes of true precocious puberty?

A 
Organic CNS disruption:
Tumours of hypothalamic-pituitary region. 
-Head Injury
-Meningitis
-Neurofibromatosis
- Cerebral Palsy
- Hydrocephalus

Cranial Surgery or Radiotherapy

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32
Q

What are some causes of pseudo-precocious puberty?

A

Sex Steroids from adrenal:

  • Congenital adrenal hyperplasia
  • Adrenal tumour
  • Premature adrenarche (release of androgens)
  • Cushing’s syndrome
Sex steroids from gonad:
- Ovarian tumour
McCune-Ablright Syndrome
-Testotoxicosis
-HCG secreting germ cell tumours

Exposure to exogenous steroids

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33
Q

What does Tanner staging mean in growth?

A

A2 G4 P3 (2/2)

A=axillary hair
G=genitalial
P=pubic hair
final = testicular volume.

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34
Q

Causes of delayed puberty?

A

Constitutional Delay of growth and puberty

Chronic disease

Central causes: Tumour/Irradiation/trauma
gonadotropin deficiency

Peripheral causes:

  • Testicular damage
  • Gonandal dysgenesis
  • Chemo
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35
Q

What is treatment of delayed puberty?

A

Testosterone injections/gel

LH/FSH injections

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36
Q

What controls fluid in the body normally?

A

Hypothalamic centres - regulates thirst

It stimulates intake of free water and stimulaters ADH release

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37
Q

What is ADH

A

Anti Diuretic Hormone

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38
Q

Where does anti diuretic hormone made?

A

Made by hypothalamus

Stored in pituitary gland

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39
Q

What action does ADH have?

A

Stimulates the distal and collecting tubules of the kidneys - this increases reabsorption of the free water into cardiovascular system.

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40
Q

What is plasma osmolality?

A

The concentration of all chemical particles in the fluid part of the blood

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41
Q

What is normal level for plasma osmolality?

A

285-295mOsm/L

42
Q

What is urine osmolality?

A

Number of dissolved particles per unit of water in urine.

43
Q

What is normal level for urine osmolality?

A

500-800mOsm/kg water

Large value = concentrated urine.

44
Q

What is diabetes insipidus?

A

Not related to sugars.

Acute or chronic condition

Inadequate secretion of ADH from the posterior pituitary gland (CranialDI)

Insufficient renal response to adequate levels of ADH (Nephrogenic DI)

Both result in the kidneys making a lot of urine.

45
Q

What are causes of cranial diabetes insipidius?

A

Cerebral malformations (eg SOD)

Acquired disease eg surgery

Familial - genetic mutation.

46
Q

What is presentation of diabetes insipidus?

A

Polyuria

Polydipsia (excess thirst)

Can also be constipation]
Fever
Vomiting
Loss of weigh
FTT
Dehydration (need U&Es as common presentation)
47
Q

What investigations are done for diabetes insipisdus?

A

Habitual excessive drinking - when parents stop flavoured drinks but water still available then will the child still drink lots.

If they do then will do water deprivation test.

Drug DDAVP (ADH equivalent) given. If fails to concentrate urine then implies it is nephrogenic.

48
Q

Where is the thyroid gland?

A

In the neck, surrounding the trachea.

49
Q

What do the thyroid hormones effect?

A

Growth
Neurological development
Metabolism
Cardiovascular function

50
Q

What is embryology development of thyroid gland?

A

First endocrine gland to develop.

24 days - it descends but still attached to Tongue.

Descends to final position about 7 weeks.

51
Q

What 2 hormones does thyroid produce?

A

Thyroxine T4
Tri-iodothryonine T3

Both act on pituitary

52
Q

What is diagnostic tests for congenital hypothyroidism?

A

All babies screened in first 5 days of life - the Guthrie Test

53
Q

What are symptoms of congenital hypothyroidism?

A 
Sleepiness
Poor feeding
Constipation
Goitre
Oedema
Jaundice
54
Q

What is treatment for congenital hypothyroidism?

A

Thryoxine tables

55
Q

What is occurrence of congenital hypothyroidism?

A

1 in 4000 births

56
Q

What could causes of congenital hypothyroidism?

A

85% dysgenesis: Genesis/hypoplasia/ectopic

Synthetic defects: TSH deficiently, T4 synthesis

Maternal disease

T21

57
Q

What is acquired hypothyroidism?

A

Usually autoimmune - Hashimotos thyroiditis

58
Q

What are symptoms of acquired hypothyroidism?

A 
Tireness
Poor appetite
Weight gain
Lethargy
Delayed Puberty
Goitre
Bradycardia
Cold pasty skin
59
Q

What is treatment for acquired hypothyroidism?

A

Levothroxine

60
Q

What is hyperthyroidism?

A

Graves disease - autoimmune

61
Q

What are symptoms of acquired hyperthyroidism?

A 
Anxiety
Increased appeptite
Weight loss
Heat intolerance
Sleep disturbance
Goitre
Tachycarida
Sweating
Tremor
62
Q

How do you treat acquired hyperthyroidism?

A

Anti-thyroid drugs.

Carbimazole

63
Q

What is neonatal thyrotoxicosis?

A

Type of hyperthyroidism in babies.

Caused by trans-placental transfer of maternal TSH receptor antibodies

Stimulates the neonatal thyroid gland.

64
Q

What are signs and symptoms?

A

All normally dissipate when start treatment:

Goitre
Tachycardia
Cardiac failure.
Jitters

65
Q

What drugs would be given for neonatal thyrotoxicosis?

A

Carbimazole
Propanalol for jitters
prednisolone for eye disease
chloral hydrate to calm

66
Q

What hormones does adrenal gland get involved with?

A

Sugar Salt Sex

Glucocorticoids
Mineralcorticoids
Androgens

Different layers of adrenal gland make different hormones

67
Q

What is embryology development of adrenal gland?

A

Cortex and medulla made from different cell types.

Important by week 30 to mature the embryo

68
Q

Which adrenal layers produce which hormones?

A

Cortex - Zone Glomerulosa:
Mineralocorticoids. Aldosterone

Cortex - Zone Fasciculata: Glucocorticoids - Cortisol

Cortex - Zone Reticularis - sex steroids/androgens.

Medulla - Catecholamines - adrenaline/noradrenaline/dopamine.

69
Q

What does cortisol do in the body?

A

body’s natural steroid

Helps with blood sugar level (stimulates glucose production by freeing up ingredients in storage)

Helps body deal with stress (anti-inflammatory)

Helps to control BP and blood circulation

70
Q

What happens with hypo secretion of adrenal cortex?

A

Addisons disease

Adrenal insufficiency.

71
Q

What are symtpoms of Addison’s disease?

A

Hyposecretion of adrenal gland (glucocorticoids/mineralcorticoids)

Fatigue
Muscle Weakness
Anorexia
Hypotension
Darkening of skin
Joint and muscle pain
72
Q

What happens in hyper secretion of adrenal cortex?

A

Increased levels of cortisol in body - it is Cushing’s syndrome

73
Q

What are symptoms of Cushing’s syndrome?

A

Hypersecretion of cortisol.

Increased weight 
Central truncal obesity
Acne
Thin Skin
Moon Face
Buffalo hump
74
Q

What happens with adrenal medulla hypo secretion?

A

Not too much as other parts of body can produce adrenaline etc.

75
Q

What are 3 main clinical adrenal examples?

A

Cushings - children on steroids. Glucocorticoid excess

Addision’s disease - generally in older child. Gluococoritoid insufficiency

Congenital adrenal hyperplasia - enzyme defect of steroid synthesis.

76
Q

What is Addisonian crisis?

A

Adrenal glands don’t work
Low cortisol
Leads to liver function decrease and stomach digestive enzyme decrease.
Leads to low sugar (liver) and vomiting/cramps etc
Lead to extremely low sugar
Low fluid volume.

Adrenal gland also causes low aldosterone
Causes kidney to loose wate rand sodium 
Makes heart irregular
Low fluid volume
Low blood pressure
Shock

The 2 combined = death

77
Q

What is congenital adrenal hyperplasia?

A

Inherited disorder of adrenal glands
Enzyme defect of steroid synthesis

When one of the enzymes involved is malfunctioning so cortisol production is impaired.

Results in cortisol deficiently
Excess pituitary ACTH secretion (pituitary senses not enough cortisol so sends more ACTH to compensate)
Adrenal gland hyperplasia (gland becomes thickened)

78
Q

What is most common type of congenital adrenal hyperplasia called?

A

21-hydroxlyase deficiency “salt-wasting”

Deficiency in apfersterone and cortisol but male hormone still produced.

79
Q

what are issues for boys with congenital adrenal hyperplasia?

A

Severe (salt wasting) :
Baby looks normal at birht
1-2 weeks old - poor feeding, vomiting, wt loss
U&Es: Na<115

Mild:
Presents later 2-4yrs 
Tall stature
Penis enlargement and pubic hair, 
Due to excessive male hormone
80
Q

What are issues for girls with congenital adrenal hyperplasia?

A

Severe:

Baby had excessive male hormone in utero
Genetalia will look like boy - may need karotype to determine sex.
Internal structures still same, may need surgery for outer structures

Mild:

Too much male hormone.
Tall stature
Pubic hair
Enlarged clitioris

81
Q

What needs to happen with a child with adrenal hyperplasia is ill?

A

Need to double the amount of hydrocortisone until well

In an emergency (very unwell) then have emergency hydrocortisone injection and/or glucagel. Then ambulance.

82
Q

What are differences of sex development?

A

Congenital conditions in which development of chromosomal, gonadal or anatomic sex is atypical

83
Q

What are types of differences of sex development?

A 
True genital ambiguity (e.g. CAH girls) 
Genital anomalies (including hypospadia)

46XY DSD - under virilised male
46XX DSD - over virilised female.

84
Q

What is diabetes mellitus?

A

Type 1 diabetes - mellitus meaning sweet tasting urine.

85
Q

What is occurrence of diabetes mellitus?

A

1 in 400-500 children and adolescents

86
Q

What causes diabetes mellitus?

A

Autoimmune destruction of beta cells in islets of langerhans.

87
Q

What are signs of diabetes mellitus?

A

Persistent hyperglycaemia
Fasting blood glucose >7mmol/l
normal is 4-7

88
Q

What are long term complications of diabetes mellitus?

A

Retinopathy
Renal failure
Cardiovascular disease
Neuropathy

89
Q

What process occurs in diabetes mellitus?

A 
Lack of insulin
Glucose can't be used = hyperglycaemia
High glucose concentration in the blood 
Spills into urine - osmotic diuresis - polyuria
Excessive thirst and weight loss
Cells can't use the glucose
Switch to metabolising fats 
Ketones
Acidosis
90
Q

What should happen in glucose homeostasis?

A

After eating
Insulin rises - facilitates entry of glucose into cells via glucose specific transporters
Insulin stimulates glycogen synthesis in liver and muscles

When fasting
Glucose concentration and insulin secretion fall
Stimulates glycogenolysis in liver and muscles. And stimulates hepatic gluconeogenesis from amino acids and ketones.

91
Q

What is insulin?

A

Anabolic hormone that has key role in glucose metabolism

Has important effect on fat and protein metabolism

92
Q

What happens in diabetic ketoacidosis?

A

Lipolysis if not enough glucose going into cells (its in the blood)
Produces free fatty acids and ketone bodies.
Accumalte in blood = metabolic acidosis
Dehydration, acidosis and hyperosmolaility = decreased consciousnesss, coma, death.

93
Q

How would someone present with diabetes?

A

2-3 week history of lethargy, wt loss, polyuria, thirst

If not noticed - could present with DKA. Abdo pain, vomiting, coma.

94
Q

What is treatment for diabetes type 1

A

Insulin

Subcut.

May need more in puberty growth spurt.

Can have pump therapy - better glycaemia control.

95
Q

What can be consequence of insulin treatment of diabetes?

A

Hypoglycaemia.

excess insuline or inadequate carb intake.

Feel shaky
Tachycardia
Drowsy
Irritable

96
Q

What is level of blood glucose for hypoglycaemia

A

<4mmMol/L

97
Q

What is treatment for hypoglycaemia?

A

2 x dextrose tables

100mls sugary drink e.g. lucosade.

98
Q

What is diabetes type 2?

A

Pancreas can still secrete insulin but you have peripheral insulin resistance.

Increased by fatty deposits in pancreas as become overweight.

99
Q

What is treatment of type 2 diabetes?

A

Dietary control of carbs

metformin

100
Q

What is homeostasis?

A

Propety of human biological system where the self-regulating process tends to maintain the balance for survival. Regulation takes place in defined internal environment.

Variable - Change detected by receptor - inputs to control centre - outputs to effector - variable responds to the effector to increase or decrease.

Applied Clinical Physiology (14 decks)

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