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CSB336 > Endocrine system > Flashcards

Endocrine system Flashcards

1
Q

What do hormones regulate?

A
  • Growth
  • Metabolism
  • Sexual development and function
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2
Q

What do endocrine glands secrete?

A

Hormones

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3
Q

Is hormone action rapid or prolonged?

A

Prolonged

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4
Q

Where are endocrine gland secretions released?

A

Into the bloodstream

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5
Q

What is the general role of substances secreted by endocrine glands?

A

Help in the regulation and maintenance of physiological events such as metabolism, menstrual flow, and reproductive functioning

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6
Q

What do exocrine glands secrete?

A

Enzymes

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7
Q

Is the activity of enzymes short or long term?

A

Short term

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8
Q

Where are exocrine secreted substances released?

A

Directly over the target site or tissue

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9
Q

What is the general role of exocrine glands?

A

They are glands of external secretion, for example:

  • Sweat
  • Saliva
  • Digestive enzymes
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10
Q

What do the hypothalamus and pituitary monitor?

A

Chemical and physical characteristics of blood

  • BP
  • Nutrients
  • Hormones
  • Water content
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11
Q

What are the two main reasons the hypothalamus will stimulate the pituitary gland?

A
  • Deviation in homeostasis
  • Developmental changes are required
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12
Q

What response is initiated by the pituitary when there is a deviation in homeostasis?

A

Increase in cellular activity

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13
Q

What response is initiated by the pituitary for developmental changes?

A

Release of hormones from the anterior and posterior pituitary gland

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14
Q

What type of hormones are secreted by the anterior pituitary gland? List them.

A

Tropic hormones

  • Thyroid-stimulating hormone (TSH)
  • Adrenocorticotropic hormone (ACTH)
  • Luteinising hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Prolactin
  • Growth hormone (GH)
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15
Q

What makes up most of the posterior pituitary gland?

A

Nerves that have their cell bodies in the hypothalamus

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16
Q

What does the posterior pituitary gland store and release when stimulated?

A

Oxytocin and anti-diuretic hormone (ADH)

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17
Q

What are the two primary functions of the thyroid gland?

A
  • Secretion of thyroid hormones
  • Secretion of calcitonin
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18
Q

How many parathyroid glands do humans have?

A

Four

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19
Q

True or false: each parathyroid gland is richly vascularised

A
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20
Q

What do the parathyroid glands both produce and secrete?

A

Parathyroid hormone

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21
Q

The adrenal gland includes which two endocrine organs?

A
  • Adrenal medulla
  • Adrenal cortex
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22
Q

The adrenal glands are two organs, one surrounding the other: name which is the inner and outer organ.

A
  • Adrenal medulla is the inner organ
  • Adrenal cortex is the outer organ
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23
Q

What type of hormone is seceted by the adrenal medulla?

Provide three examples.

A

Catecholamines

  • Adrenaline
  • Noradrenaline
  • Dopamine
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24
Q

What type of hormone is secreted by the adrenal cortex?

A

Steroid hormones

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25
Q

What mechanism do the adrenal medulla hormones mostly work to prepare?

A

Sympathetic response (fight or flight)

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26
Q

What two corticosteroid subgroups of hormones are produced by the adrenal cortex?

A
  • Glucocorticoids
  • Mineralocorticoids
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27
Q

What two control centres regulate the release of corticosteroid hormones from the adrenal cortex?

A
  • Hypothalamus
  • Pituitary gland
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28
Q

Release of corticosteroid hormones from the adrenal cortex is mediated by signals triggered by which organ?

A

The kidney

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29
Q

What glucocorticoids are released by the adrenal cortex?

A
  • Hydrocortisone
  • Corticosterone
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30
Q

What is the function of hydrocortisone?

A
  • Regulates how the body converts fats, proteins, and carbohydrates to energy
  • Regulates BP and cardiovascular function
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31
Q

What is the function of corticosterone?

A

Works with hydrocortisone to regulate immune responses and suppress inflammatory reactions

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32
Q

What is the principle mineralocorticoid secreted by the adrenal cortex?

A

Aldosterone

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33
Q

What regulates aldosterone release?

A

RAAS

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34
Q

True or false: the pancreas is comprised of two glands mixed together into one organ

A
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35
Q

What kind of cells make up most of the first functional component of the pancreas, endocrine or exocrine?

A

Exocrine

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36
Q

What kind of cells make up most of the second functional component of the pancreas, endocrine or exocrine?

A

Endocrine

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37
Q

What is the purpose of the first functional component of the pancreas?

A

Produce and release enzymes into ducts to assist digestion

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38
Q

What is the purpose of the second functional component of the pancreas?

A

Blood glucose level homeostasis, including release of hormones insulin and glucagon.

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39
Q

The second functional component of the pancreas (endocrine) is comprised of a number of small islands of cells. What is this region called?

A

Islet of Langerhans

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40
Q

The Islet of Langerhans inclues for types of cells involved in BGL regulation; name them.

A
  • Alpha
  • Beta
  • Delta
  • Gamma
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41
Q

What are the three derivative hormome types? Provide examples of each.

A
  • Lipid derived
    • Mostly derived from cholesterol
    • Primary class of lipid-derived hormones is steroid hormones
      • Steroid hormones are usually ketones and alcohols
  • Amino acid derived
    • ​Derived from amino acids tyrosine and tryptophan
    • Examples include thyroxine, adrenaline, and noradrenaline
  • Peptide derived
    • ​Includes oxytocin and ADH
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42
Q

Production and release of hormones is primarily controlled by what kind of feedback?

A

Negative feedback

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43
Q

Name the three mechanisms involved in hormone release and describe the stimuli for each one

A
  • Humeral
    • Control of hormone release in response to changes in ECF
  • Hormonal
    • Control of hormonal release in response to other hormones
  • Neural
    • Control of hormone release in response to direct stimulation by the nervous system
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44
Q

True or false: a hormone can have a generalised effect on a variety of cells

A

Hormones affect specific tissue cells

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45
Q

What are the specific tissue cells affected by hormones called?

A

Target cells

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46
Q

What particular feature do target cells have and what two places may they be located?

A
  • Receptors
  • Either on the plasma membrane of the cell or within the cell so that hormones can bind
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47
Q

Describe the process of homeostasis involving the endocrine system

A

Variable (factor being regulated) → Stimulus (input to respond to) → Receptor (response to stimulus) → Afferent pathway (carries information to control centre) → Control centre (assesses the nature of the stimulusm, compares it to the set point, and determines the response) → Set point (reference value that must be maintained) → Efferent pathway (carries responses generated by control centre) → Effector (carries out action to achieve the desired response)

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48
Q

How does negative feedback work?

A

Shuts off or reduces the intensity of the original stimulus

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49
Q

What is the most common homeostatic control mechanism?

A

Negative feedback

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50
Q

How does positive feedback work?

A

Enhances the original stimulus (this is harder for the body for control)

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51
Q

Insulin is released by ____ cells located in the ____.

A

Beta cells in the Islets of Langerhans (in the pancreas)

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52
Q

What is the effect of insulin on blood glucose cellular uptake?

A

Insulin hastens uptake by the cells

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53
Q

How does insulin facilitate glycogenesis?

A

By turning glucose into glycogen so it can be stored in the liver

(id est, not in the blood)

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54
Q

When is the stimulus causing insulin release reduced?

A

Once BGL levels return to normal

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55
Q

Glucagon is released by ____ cells located in the ____.

A

Alpha cells located in the Islets of Langerhans/pancreas

56
Q

What is the effect of glucagon?

A

Causes the liver to release its storage of glycogen as glucose back into the blood

57
Q

What is the term for release of glycogen storage as glucose?

A

Glycogenolysis

58
Q

What is characteristic of IDDM?

A

Pancreatic beta cell destruction with absolute insulin deficiency

59
Q

What is pancreatic beta cell destruction with absolute insulin deficiency usally associated with?

A

Autoimmune damage

60
Q

IDDM is usually diagnosed between age ____ to ____.

A

5 to 20

61
Q

True or false: IDDM requires life-line insulin injections

A

True

62
Q

What is the classical presentation of IDDM?

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Unexplained weight loss
63
Q

NIDDM is characterised by…

A

Peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells

64
Q

Which diabetes is significantly more common than the other, IDDM or NIDDM?

A

NIDDM

65
Q

NIDDM is generally associated with what three factors?

A
  • Poor lifestyle
  • Poor diet
  • Obesity
66
Q

Describe the likely presentation of NIDDM

A
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Blurred vision
  • Lower extermity paraesthesia
  • Balanits/yeast infection
67
Q

What is the definition of gestational diabetes?

A

Glucose intolerance with onset or first presentation/regocnition duing pregnancy

68
Q

Describe the pathophysiology of gestational diabetes

A

The placenta produces hormones that encourage foetal growth and development

↓

These hormones block insulin action

↓

Insulin resistance

69
Q

True or false: gestational diabetes requires aggressive treatment to prevent morbidity and mortality

A

True

70
Q

Diabetic treatment regimens are designed for what goal?

A

Avoid high and low levels of glucose and insulin

71
Q

What can NIDDM patients generally use to manage their condion?

A

Combination of diet control, oral hypoglycaemic medicaitons

72
Q

True or false: insulin is not requred for NIDDM mx

A

False - it doesn’t require lifelong injections like IDDM, but some NIDDM cases may require insulin

73
Q

What is gluconeogenesis?

A

Metabolic pathway that results in generation of glucose from non-carbohydrate sources such as lactate, glycerol, and glucogenic amino acids

74
Q

What is glycogenolysis?

A

The process by which glycogen in the liver is converted into glucose to be released into the blood

75
Q

What is lipolysis?

A

Breakdown of lipids involving hydrolysis of triglycerides into glycerol and free fatty acids

76
Q

What are the four diabetic emergencies?

A
  • Hypoglycaemia
  • Hyperglycaemia
  • Diabetic ketoacidosis (DKA)
  • Hyperosmolar hyperglycaemic non-ketotic syndrome (HHNS)
77
Q

What is the definition of hypoglycaemia?

A

Reduction of plasma glucose concentration; BGL <4mmol)

78
Q

Hypoglycaemia is usually seen in patients with what condition?

A

IDDM

79
Q

List some of the causes of hypoglycaemia

A
  • IDDM
  • Insulin OD
  • Insulin administration not followed by a timely meal
  • Change in diabetic medication
  • Pt has overexerted themselves
80
Q

What are some common symptoms of hypoglycaemia?

A
  • Tachycardia with bounding pulse
  • Irritability/combative behaviour
  • Pale/cold/clammy skin
  • BGL <4mmol
  • ALOC
  • Behaviour mimicking CVA or intoxication
  • Weakness
  • Headache
  • Lack of coordination
  • Seizure activity
81
Q

Describe the mx of hypoglycaemia

A
  • Encourage self-administration of oral glucose if pt is conscious
  • IV glucose 10% if pt is ALOC
  • Use glucagon if unable to obtain IV access
82
Q

List some causes of hyperglycaemia

A
  • Not using enough insulin or oral hypoglycaemics
  • Not injecting insulin properly or using expired insulin
  • Infection
  • Injury
  • Poor diet choices
  • Stress
  • Certain medications (steroids)
83
Q

What are the early signs of hyperglycaemia?

A
  • Polyuria
  • Polydipsia
  • Blurred vision
  • Fatigue
  • Headache
84
Q

What are the late signs of hyperglycaemia?

A
  • Sweet smelling breath
  • N+V
  • SOB
  • Dry mouth
  • Weakness
  • Confusion
  • Coma
  • Abdo pain
85
Q

What is diabetic ketoacidosis?

A

An acute life-threatening complication of diabetes; it is a disordered metabolic state characterised by hyperglycaemia, ketoacidosis, and ketonuria

86
Q

DKA occurs as a consequence of…

A

Absolute relative insulin deficiency that is accompanied by an increase in counter regulatory hormone (glucagon, cortisol, GH, adrenaline)

87
Q

Describe the pathophysiology of DKA

Note: big process, don’t panic.

A

Marked insulin deficiency and release of catecholamine hormone

↓

Adrenaline blocks any residual insulin action and stimulates glucagon secretion

↓

The insulin deficiency combined with excess glucagon decreases peripheral glucose utilisation and increases gluconeogenesis

↓

Gluconeogenesis exacerbates hyperglycaemia

↓

Hyperglycaemia causes osmotic diuresis and dehydration characteristic of the ketoacidotic state

↓

The insulin combined with excess glucagon also activates ketogenic machinery

↓

Insulin deficiency stimulates lipoprotein lipase (breakdown of adipose stores)

↓

Increase in free fatty acids

↓

Ketone bodies are formed when free fatty acids reach the liver

↓

If the rate of ketone body formation exceeds the rate they are used in peripheral tissues, ketonaemia and ketouria develop

↓

If dehydration compromises the urinary secretion of ketones it results in system metabolic ketoacidosis

88
Q

Summarise the pathophysiology of DKA

A
  • Hyperglycaemia of DKA evolves through accelerrated gluconeogenesis, glycogenolysis, and decreased glucose utilisation
  • Hyperglycaemia-induced osmotic diuretics leads to dehydration, hyperosmolarity, electrolyte loss, and subsequent decrease in glomerular filtration
  • Ketone bodies occur when free fatty acids are converted in the liver
89
Q

List some of the causes of DKA

A
  • Inadequate insulin dise
  • Failure to take insulin
  • Infection
  • Increased stress (trauma, surgery)
  • Increased dietary intake
  • Decreased metabolic rate
  • Significant emotional stress
90
Q

Describe the common presentation of DKA

A
  • Slow onset (12-48 hours)
  • Diuresis
  • Dry mucous membranes
  • Polyuria
  • Polydipsia
  • Acidosis
  • Kussmaul respirations
  • Sweet-smelling breath
91
Q

Describe the mx of DKA

A
  • Confirm hyperglycaemia
  • General cares
  • IV access
  • Fluid therapy
92
Q

What is a hyperosmolar hyperglycaemic non-ketotic state (HHNS)?

A

A life-threatening diabetic emergency mainly seen in NIDDM patients that’s less common than DKA

93
Q

HHNS is more common in which pt group?

A

Elderly

94
Q

HHNS is characterised by…

A

Hyperglycaemia

Hyperosmolarity

Dehydration

PN: significant ketoacidosis

95
Q

HHNS develops from…

A

Sustained hyperglycaemia which produces a hyperosmolar state followed by a hyperosmolar state

96
Q

What two symptoms do most HHNS pts commonly present with?

A

Severe dehydration

Neurological deficit

97
Q

List the causes of HHNS

A
  • Increased insulin requirements (stress, infection, trauma, burns, AMI)
  • Cardiac disease
  • Renal disease
  • Age
98
Q

Describe the common presentation of HHNS

A
  • Very gradual onset
  • Polyuria
  • Polydipsia
  • Postural syncope
  • Dry mucous membranes
  • Tachycardia
  • Lethargy
  • Confusion
  • Coma
99
Q

Describe the mx of HHNS

A

General symptom mx

100
Q

Name three disorders of the thyroid gland

A
  • Hyperthyroidism/thyrotoxicosis
  • Hypothyroidism
  • Thyroid storm
101
Q

What is hyperthyroidism/thyrotoxicosis?

A

Excessive production of thyroid hormone by the thyroid gland overstimulates metabolism and exacerbates the effect of the sympathetic nervous system

102
Q

List some causes of hyperthyroidism

A
  • Thyroiditis (inflammation)
  • Grave’s disease
  • Toxic thyroid adenoma
  • Toxic multinodular goitre
  • Excess iodine
  • Tumours of the ovaries/testes/thyroid gland
103
Q

Which is the more common cause of hyperthyroidism, the entire gland overproducing the hormone, or overproduction by a single nodule (hot nodules)?

A

The entire gland overproducing the hormone

104
Q

True or false: hyperthyroidism can be symptomatic or asymptomatic

A
105
Q

List some symptoms of hyperthyroidism/thyrotoxicosis

A
  • Weight loss
  • Anxiety
  • Heat intolerance
  • Hair loss
  • Muscle aches
  • Weakness
  • Fatigue
  • Hyperactivity
  • Irritability
  • Exophthalmos
106
Q

What is thyroid storm?

A

An acute life-threatening hypermetabolic state induced by excessive relesae of thyroid hormones in an individual with hyperthyroidism; it is the most extreme state of hyperthyroidism

107
Q

True or false: thyroid storm can be the initial presentation in children and especially neonates with hyperthyroidism

A
108
Q

What are thyroid storm symptoms related to?

A

Severely exaggerated effects of thyroid hormones due to increased release or intake (less common) of thyroid hormone

109
Q

What are some possible causes of thyroid storm?

A
  • Severe undertreated hyperthyroidism
  • Infection associated with hyperthyroidism
  • Trauma
  • Surgery
  • Severe emotional stress
  • Stroke
  • DKA
  • CHF
  • PE
110
Q

Symptoms of thyroid storm include…

A
  • Tachycardia
  • AF
  • Hypertension
  • Cardiac failure
  • Arrhythmias
  • Hyperpyrexia
  • Sweating
  • Shaking
  • Abdo pain
  • Agitation
  • Restlessness
  • Confusion
  • Diarrhoea
  • Seizures
  • Coma
111
Q

What is hypothyroidism?

A

A common disorder where the thyroid gland doesn’t produce enough thyroid hormone

112
Q

What is primary hypothyroidism?

A

Inadequate function of the thyroid gland itself

113
Q

What is secondary hypothyroidism?

A

Inadequate stimulation by TSH from the pituitary gland

114
Q

What is tertiary hypothyroidism?

A

Inadequate release of thyrotropin releasing hormone from the hypothalamus

115
Q

What is the most common cause of primary hypothyroidism?

A

Iodine deficiency

116
Q

What is the most common cause of hypothyroidism in areas of the world that have adequate dietary iodine?

A

Hashimoto’s thyroiditis (autoimmune disease)

117
Q

What are the symptoms of hypothyroidism?

A
  • Poor ability to tolerate cold
  • Fatigue
  • Constipation
  • Depression
  • Weight gain
  • Goitre
  • Myxoedema coma (extreme hypothyroidism causing symptoms related to slowing functions of multiple organs)
118
Q

Describe hypothyroidism mx

A

Rx symptoms of myxoedema coma (bradycardia, hypoventilation, hypothermia) and transport to hospital

119
Q

What are two significant disorders of the adrenal gland?

A

Cushings syndrome and Addison’s disease

120
Q

What is Cushing’s syndrome?

A

Hypersecretion of corticosteroid by the adrenal glands

121
Q

What can cause Cushing’s syndrome?

A
  • Adrenal gland tumour
  • Corticosteroid administration
  • Pituitary tumour causing enlargement of both adrenal glands
122
Q

What are some signs and symptoms of Cushing’s syndrome?

A
  • Increase in proportion of body fat to limbs (rapid weight gain)
  • Depression
  • Irritability
  • Muscle atrophy
  • Hirsuteness (excessive hair growth)
  • Psychosis (extreme cases)
123
Q

What is Addison’s disease?

A

A long term endocrine disorder in which the adrenal glands do not produce enough steroid hormone; it is primary adrenal insufficiency and hypocortisolism

124
Q

Addision’s disease arises from problems with the adrenal gland when…

A

Insufficient cortisol (steroid hormone) is produced

125
Q

What two things can cause Addison’s disease?

A
  • Tuberculosis
  • Immune damage to adrenal glands
126
Q

What are the symptoms of Addison’s disease?

A
  • Fatigue
  • Light-headedness
  • Difficulty standing
  • Muscle weakness
  • Fever
  • Weight loss
  • Anxiety
  • GIT symptoms
  • Personality changes
  • Joint pain
  • Salt cravings
  • Hypotension
127
Q

What is an Addisonian crisis? Describe what occurs.

A

Medical emergency severe adrenal insufficiency during which the adrenal glands cannot increase production of corticosteroid hormone to help the body cope with stress

128
Q

What can cause Addisonian crisis?

A
  • Stress (emotional or physical)
  • Illness/infection
  • EtOH intoxication
  • Hypothermia
129
Q

What are the symptoms of Addisonian crisis?

A
  • Sudden pain in legs/lower back/abdomen
  • Severe V+D
  • Dehydration
  • Hypotension
  • Syncope
  • Hypoglycaemia
  • Confusion, psychosis
  • Lethargy
  • Hyponatraemia
  • Hyperkalaemia
  • Hypercalcaemia
  • Seizures
130
Q

Describe mx of Addisonian crisis

A
  • General cares
  • IV hydrocortisone
  • Fluid therapy
  • Hypoglycaemia rx if indicated
131
Q

What are the indications for hydrocortisone?

A
  • Moderate or severe asthma
  • Acute exacerbation of COPD
  • Severe allergic reaction or anaphylaxis
  • Symptomatic adrenal insufficiency
132
Q

What are the contraindications for hydrocortisone?

A

KSAR

133
Q

What are the precautions for hydrocortisone?

A

Hypertension

134
Q

What are the side effects of hydrocortisone?

A

Nil

135
Q

What is the adult dosage of hydrocortisone for symptomatic adrenal insufficiency?

A

100mg IV* or IM, single dose only

*Note: IV administration is slow push over one minute

*Note: presentation is 100mg vial that is reconstituted with 2mL sodium chloride 0.9% or water for injection*

CSB336 (14 decks)

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