endocrine questions and facts Flashcards
Acromegaly :
It is a disorder of excess growth hormone production.
While growth hormone is responsible for causing acromegaly, the primary investigation is measuring insulin-like growth factor 1.
normal levels of IGF rule out acromegaly.
high levels, then do a glucose tolerance test to confirm diagnosis
Hormones produced by the anterior pituitary gland?
So,
Thyroid stimulating hormone: TSH stimulated the production of thyroid hormone
Adrenocorticotrophic hormone ACTH: Stimulates the production of cortisol and androgenic hormones by the adrenal cortex
Leuteinising hormone : LH stimulates the production of oestrogens and progestrones by the ovaries in women and the production of testosterone by the testes in men
Follicle stimulating hormone: FSH stimulates the production of oestrogen and the growth of egg cells in the ovaries in women and of sperm cells in the testes in men
Growth hormone: stimulates linear growth in children and helps maintain bone and other tissues in adults
Prolactin: stimulates milk production
Hormones produced by the posterior pituitary gland?
Vasopressin:
Regulates blood pressure
Increase reabsorption of water from the kidneys
Oxytocin:
stitimulates contraction of the uterus
Aids milk ejection during breastfeeding
What pathway does the growth factors use?
JAK/STAT
The suspicion, with the history of dry skin, hair loss, obesity and sleep apnoea, hypertension and slow pulse, is that she has hypothyroidism. This would be the cause of her secondary hypercholesterolaemia.
x
The management of acute hypercalcaemia (serum calcium >3 mmol/l) involves:
adequate rehydration: 3–4 l saline/day
intravenous bisphosphonates (eg pamidronate disodium)
identification of the cause, and its subsequent specific treatment (eg corticosteroids for sarcoid) if indicated.
Clinical presentation of primary hyperaldosteronism (Conn syndrome) ( A condition that occurs when the adrenal glands produce too much aldosterone,)
Clinical presentation of primary hyperaldosteronism (Conn syndrome) H Hypertension A Aldosterone is raised R Renin is lowered P Potassium is decreased S Sodium raised
hypothyroidism:
This patient with a high TSH level and a low T4 level has symptomatic hypothyroidism.
Presenting symptoms of hypothyroidism can vary greatly and can include: lethargy weight gain depression sensitivity to cold myalgia dry skin dry hair and/or hair loss constipation menstrual irregularities carpal tunnel syndrome memory problems and/or difficulty concentrating myxoedema coma (A medical emergency).
choice of treatment for hypothyroidism and hyperthyroidism?
Carbimazole is used in the treatment of hyperthyroidism;
hypothyroidism; the treatment of choice here would be levothyroxine.
x
Hypercalcaemia normally suppresses PTH and so PTH is, therefore, the best first test to identify the cause of hypercalcaemia – if it is detectable (in or above the normal range) the patient must have hyperparathyroidism.
orlistat
Orlistat is a derivative of lipstatin and causes weight loss by inhibiting pancreatic and gastric lipase.
This inhibits the breakdown, and therefore the absorption, of intestinal triglycerides, which has the side-effect of causing steatorrhoea.
should levothyroxine be increased in pregnancy ?
The National Institute for Health and Care Excellence (NICE) guidelines recommend increasing the dose of levothyroxine by 25–50 μg and referral to an endocrinologist at diagnosis of pregnancy.
The adrenal gland cortex is made up of 3 layers:
The adrenal gland cortex is made up of 3 layers:
Zona glomerulosa- produces aldosterone
Zona Fasciculata- produces Cortisol
Zona Reticularis- produces Testosterone
Primary hyperparathyroidism is defined as ?
Primary hyperparathyroidism is defined as:
persistent hypercalcaemia with an inappropriately elevated or normal parathyroid hormone (PTH).
There is usually hypercalciuria, as in this case.
Elevated calcium would usually suppress PTH through negative feedback.
Therefore, low or unmeasurable values indicate a non-parathyroid cause, of which malignancy is the most common. Of course, malignancy and hyperparathyroidism can co-exist causing diagnostic confusion.
overproduction of the following:
Overproduction
There are three major conditions usually caused by secretion from pituitary adenomas:
- Growth hormone (GH) excess – causing acromegaly in adults and gigantism in children
- Prolactin excess – causing galactorrhoea, amenorrhoea, erectile dysfunction or clinically silent
- Excess ACTH secretion – Cushing’s disease.
Hypopituitarism
Hypopituitarism is a rare disorder in which your pituitary gland fails to produce one or more hormones, or doesn’t produce enough hormones.
hypothyrodisim cause?
hashimotos thyroiditis is the most common cause
5x more common in women
drugs such as lithium and amiodarone can be causes
iodine deficiecny is the most common cause
hyperthyroidism?
Graves disease is the most common cause of thyrotoxicosis
Drugs: amiodarone
symptoms of hypothyroidism? vs hyperthyroidism/thyrotoxicosis
hypothyroidism: Weight gain lethargy dry,cold skin constipation menorrhagia
hyperthyroidism: weight loss increased sweating pretibial myoxedema: erythematous oedematous lesions Tremor Anxiety
hypothyroidism causes ?
it causes low sodium levels
What are the main hromones of the pancreas and what do they do ?
include insulin, glucagon, somatostatin, and amylin.
Insulin (formed in pancreatic beta cells) lowers BG levels, whereas glucagon (from pancreatic alpha cells) elevates BG levels.
Somatostatin is formed in the delta cells of the pancreas and helps in balancing insulin and glucagon. It helps the pancreas alternate in turning on or turning off each opposing hormone.
Amylin is a hormone, helps increase satiety, or satisfaction and state of fullness from a meal, to prevent overeating. It also helps slow the stomach contents from emptying too quickly, to avoid a quick spike in BG levels.
what is insulin?
Insulin is a hormone secreted by the pancreatic beta cells and increases glucose uptake by adipose tissue.
it helps lower blood glucose levels.
What is neurogeneic diabetes inspidus?
Occurs as a result of decreased circulating vasopressin (ADH)
Vasopressin is responsible for promoting the kidneys to retain fluid, therefore, decreased circulating levels of ADH results in the production of increased volumes of urine.
Symptoms of Diabetes inspidus?
Excessive urination
Excessive thirst
Nocturia
Dehydration
