Endocrine Pathologies Flashcards
What are the effects of insulin?
Carbs: Liver: + storage of glucose as glycogen
Fats: Adipose tissue: +conversion of glucose to fat
Proteins:
- glucogenesys
+ Cellular uptake of AA
What are the effects of lack of insulin?
Fats: used as fuel source
Protein: AA used as fuel
What are the effects of glucagon?
Affect liver
- breakdown glycogen (glycogenolosis)
- Synthesis of glucose (gluconeogenesis)
Lower blood levels of AA
What messenger does glucagon use to act?
second messenger
What is diabetes?
clinical syndrome characterised by hyperglycaemia
due to absolute or relative insulin deficiency
How is diabetes diagnosed?
blood sugar > 11.1
fasting sugar> 7
HbA1c>6.5
What are the classifications of diabetes?
Primary - diabetes type 1: Absolute deficiency (insulin dependant) 10% adults - diabetes type 2: relative deficiency 88% adults
Secondary
arises from known pathology
what is pre-diabetes?
Impaired glucose tolerance
*levels higher than normal but not high enough to be diabetes
What causes diabetes type 1
Genetics: Environmental factors
Autoimune T1DM
Virus: rubella, epstein barr, cytomegalovirus
What causes diabetes type 2
Old, fat, lazy, smokers
Genetics T2DM
What is oxidative stress and what pathology is associated to?
stress fat tissues: releases cytokines which in T2DM impair insulin receptors = target cells less responsive
also damage beta cells in pancreas
Obesity associated with decrease insulin receptor density
What type of insulin deficiency is T1DM related to?
absolute deficiency (type 1 diabetes)
What type of insulin deficiency is T2DM related to?
Diabetes type 2 - relative deficiency = insuline resistance
process: target cells become resistant initial stage: hyperinsulinaemia later stage: beta cell exhaustion leads to insulnpaenia
what are the clinical features for type 1 diabetes mellitus (T1DM)
polyphagia (gluttony with no wight gain)
polyuria (fast pee)
polydipsia (thirst)
Glycosuria (sugar in pee)
what are the clinical features for type 2 diabetes mellitus (T2DM)
hyperglycaemia
glycosuria
+ risk infection
What are the complications for diabetes?
Acute
- hypoglycaemia (low sugar)
- Ketoacidosis (body can’t produce insulin)
Chronic
- vascular disease
- diabetic neuropathy
- diabetic foot (no feeling on foot)
What are the clinical features for hypoglycaemia?
CNS: fatigue HA drowsiness, speech problem
ANS: sweating, trembling, pounding heart, hunger
Severe hypo: coma, convulsion, brain damage
What are the complications of Diabetic ketoacidosis (DKA)
death Ketone acidosis (decrease PH)
What are the clinical features of ketoacidosis?
***MEDICAL EMERGENCY*** hyperglycemia acetone breath respiratory compensation mental disturbance pheripheral vasodilation
What is diabetic vascular disease and what are its complications?
group of blood vessel pathologies
atherosclerosis = diabetic Macroangiopathy (large vessel)
Arteriosclerosis = diabetic microanginiopathy (capillaries)
What are the chronic complications of diabetic foot?
low limb amputation
gangrena - necrosis
What is the first line pharmachological management of T2DM?
biguanides
+ glucose uptake
- glycogenesis
- intestinal absorption
Thyroglobulin is the percursor for which thyroid hormones?
T4 - T3
What do parafollicular cells secrete
calcitonin
How are thyroid hormones classified?
Aminoacids
contain iodine
What receptor does TSH bind to?
follicular cell receptors
What are the effects of thyroid hormones?
gene transcription
catecholamine effect
regulate normal function
What is nontoxic goitre?
enlargement of thyroid gland - normal function maintained
What is the cause of goitre?
iodine deficiency
What is hypothyroidism?
Deficiency of T3 and T4
in fetes leads to intelectual disability “cretinism”
How is hypothyroidism classified?
Primary: failure of thyroid
- Hashimoto (autoimune)
Secondary: TSH deficiency
Tertiary: TRH deficiency
What is hashimoto thyroids
primary type thyroidism
• Autoimmune disorder characterised by lymphocyte-mediated inflammation and fibrosis
What is chronic lymphocytic thyroiditis?
Secretion of IgG anticoagulant affecting
- thyroglobulin
- thyroid peroxide
Early disease: leads to goitre
What are the clinical features for chronic lymphocytic thyroiditis?
goitre
- metabolic rate
GAG - skin accumulation may lead to myxoedema and increase risk of angina
Whta hormone replacement therapy is used for Lymphocytic thyroids?
levothyroxine
What is thyrotoxicosis?
thyroid hormone excess “graves disease”
What is the pathophysiology of graves disease?
Antibodies affect TSH receptors (TSHrAbs)
+ levels T4 & T3
produce goitre
antibodies fluctuate with severity of disease
What are the clinical features of Thyroxicosis?
\+ metabolic rate \+ apetite & thirst \+ palpitations nervousness/ psychosis menstrual irregularities loss of libido
Clinical features for graves disease
ocular changes
- eyes pop out
skin changes= GAG in legs
Management of graves disease
any thyroid drugs PTU - reduce thyroid peroxidase
What is the most common type of thyroid cancer?
papillary carcinoma
what are the risk factors for thyroid cancer?
radiation
Family Hx
benign thyroid disease
What are the clinical features for thyroid cancer?
enlarge nodule, firm not tender
neck discomfort due to pressure
Management for thyroid cancer?
thyroidectomy - surgery
What is the function of parathyroid glands
secrete parathyroid hormone PTH which increases plasma levels of Calcium Ca2.
If Ca2 is high PTH is inhibited
PTH + renal excretion
calcitonin pose PTH actions on bone
What are the clinical features of hyperparathyroidism?
hypercalcaemia -bones - stones - abdo groans \+ BP
What are the clinical features of hypoparathyroidism?
hypocalacemia
+ excitability of sensory and motor nerves
- BP
