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Endocrinology > Endocrine Principles > Flashcards

Endocrine Principles Flashcards

1
Q

give examples of tyrosine and tryptopgan derivatives

A

adrenaline, thyroid hormones, melatonin

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2
Q

what does tyrosine kinase do

A

adds phosphate to a tyrosine molecule

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3
Q

why do steroid hormone receptors not acts as quickly

A

as make changes in transcription

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4
Q

name 2 regulatory signalling cascade activated by GPCRs

A

cAMP, IP3

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5
Q

what is GPCRs main role in endocrinology

A

sensors on internal environment

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6
Q

what happens if there is a mutation in a GCPR

A

the hormone that is meant to bind to it will lose it effect

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7
Q

what type of receptor binds to insulin

A

intrinsic tyrosine kinase receptor (binds to pre formed dimer)

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8
Q

where are steroid hormone receptors usually

A

intracellular- cytoplasm or nucleus

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9
Q

what do steroid receptor complexes do

A

bind to DNA response elements, cause changes in gene transcription

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10
Q

name two nuclear steroid receptors

A

estrogen and androgen receptors

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11
Q

describe the process of e.g. a corticosteroid binding to a glucocorticoid receptor

A

Corticosteroids enter the cell, bind to the glucocorticoid receptor (GR) in the cytoplasm and translocate to the nucleus, where the transcription of target genes is initiated

Through transactivation, binding of the activated glucocorticoid receptor homodimer to a GRE in the promoter region of steroid-sensitive genes leads to the transcription of genes encoding anti-inflammatory mediators

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12
Q

what is released by the posterior pituitary

A

ADH, oxytocin

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13
Q

what is released by the anterior pituitary

A

GH, LH/FSH, ACTH, TSH, PRL

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14
Q

is the anterior/ posterior pituitary more under hypothalamic control

A

anterior

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15
Q

what is the major determinant of hormone concentration

A

rate of secretion

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16
Q

what is used to evaluate thyroid hormone

A

TSH assay

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17
Q

why should you not measure thyroid hormones in the acutely unwell

A

as get abnormalities (low free hormone levels and low/ normal TSH)

18
Q

hoe do you asses pituitary function

A 
9am cortisol (to check adrenal ACTH axis)
FT4, FT3, TSH
Prolactin
IGF1
LH, FSH, E2/Testosterone
U&E, Plasma/urine osmolality

Dynamic tests
Imaging (MRI) (of the pituitary gland)

Synacthen

19
Q

what is synacthen

A

Give someone synthestic ACTH to stimulate adrenal gland and test whether pituitary gland is working. This will show whether pituitary gland is producing ACTH. If pituitary gland stops producing ACTH then adrenal glands will become dormant and not respond appropriately to synthetic ACTH

20
Q

describe the HPA axis

A 
hypothalamus 
- 
secretes corticotropin releasing hormone (CRH)
-
anterior pituitary 
-
secretes adrenocorticotropic hormone (ACTH)
-
adrenal cortex 
-
secretes cortisol 
-
multiple physiological effects
21
Q

describe the secretion of cortisol

A

circadian (diurnal rhythm highest in morning, lowest at bed time)

22
Q

why is random GH assessment of little value

A

as axis so dynamic

23
Q

what might indicate GH hypersecretion

A

IGF-1

24
Q

how should you measure sex hormone axis

A

testosterone at 9am

female sex hormones depends of the timing in menstrual cycle

25
Q

what secretes prolactin

A

by lactotroph cells of the anterior pituitary

26
Q

what inhibits prolactin secretion

A

hypothalamic dopamine

27
Q

what mediates the effects of prolactin

A

Prolactin Receptor (PRLR)

28
Q

what is vasopressin

A

anti diuretic hormone

29
Q

what does angiotensin ii do

A

vasoconstrictor

30
Q

what does vasopressin V1 do

A

constricts blood vessels, increasing systemic vascular resistance and arterial pressure

31
Q

what does vasopressin V2 do

A

causes fluid re absorption in the kidneys, increasing blood volume and arterial pressure

32
Q

what is dynamic testing

A

based on demonstrating preserved altered physiology

hormone excess - suppression test
hormone deficiency- stimulation test

33
Q

why might imaging be done for the pituitary gland

A

AFTER BIOCHEN TESTS to localise/ characterise the disease

34
Q

what can cause a cortisol deficiency

A

adrenal insufficiency

  • primary adrenal failure (addisons disease)
  • pituitary disease
35
Q

what can cause cortisol excess

A

cushings syndrome

  • ptuitary origin
  • adrenal origin
  • ectopic ACTH
  • exogenous steroids
36
Q

what are the features of cushings syndrome

A 
Cushingoid facies
Acne
Hirsutism
Abdominal striae & centripetal obesity
Interscapular & supraclavicular fat pads
Proximal myopathy
Osteoporosis
Hypertension
Impaired glucose tolerance
37
Q

what is cushings disease

A

Tumour arising from the corticotroph cells of anterior pituitary

38
Q

what can cause ACTH independent cushings

A

adrenal adenoma/ carcinoma

bilateral macronodular adrenal hyperplasia

39
Q

what can cause ectopic ACTH

A

malignancy

40
Q

what can cause exogenous hormones causes cushings syndrome

A

oral, inhaled, topical, injectable steroid use

41
Q

what test is used to diagnose cushings

A

too much cortisol so do suppression test:
1mg overnight Dexamethasone suppression test
(24hour urinary free cortisol)
(Midnight cortisol)

if the low dose dexamethasone suppression test fails to suppress then diagnostic of cushings

42
Q

how do you distinguish the origin of cushings after a suppression test

A

measure ACTH
ACTH low – adrenal origin likely
ACTH raised - need distinguish Cushing’s disease and ectopic ACTH

Rise in cortisol & ACTH on CRH test indicates pituitary source (rather than ectopic)
MRI pituitary to evaluate pituitary gland

Endocrinology (46 decks)

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