Endocrinology Flashcards
What is another name for the anterior pituitary
Adenohypophysis
What is another name for the posterior pituitary
Neurohypophysis
Describe the pathway of neurons from hypothalamus to anterior and posterior pituitary
Parvocellular neurons from hypothalamus to median eminence - release hypothalamic releasing/inhibitory factors into leaky capillaries which carry the factors to the anterior pituitary through portal circulation
Magnocellular neurons from hypothalamus travel directly to posterior pituitary
Difference in structure and development of anterior and posterior pituitary
Anterior = adenohypophysis
- epithelial origin
- upward growth from oral ectoderm of primary oral cavity: Rathke’s Pouch
Posterior = neurohypophysis
- neural origin
- downward growth from diencephalon
Which part of the pituitary gland is regulated by hypothalamic releasing and inhibiting factors
Anterior pituitary
Explain the events that lead to the thyroid hormone being stimulated to release thyroxine
Hypothalamus releases TRH (thyrotrophin stimulating hormone) which travels via portal circulation and stimulates the thyrotrophes in the anterior pituitary to release TSH (thyroid stimulating hormone) / thyrotrophin
This travels via blood to the thyroid gland and stimulates it to release thyroxine
What are the 5 types of endocrine cells found in the anterior pituitary and which hormones do they release and which hormones are their release regulated by
Somatotrophs - growth hormone (somatotrophin) - release is stimulated by “Growth hormone releasing hormone” and inhibited by “Somatostatin”
Lactotrophs - prolactin - release is reduced/inhibited by “dopamine” —> inhibitory control
Corticotrophs - corticotrophin and adrenocorticotrophic hormone (ACTH) - release is stimulated by “corticotrophin releasing hormone” and arginine vasopressin/ADH stimulates release of ACTH
Thyrotrophs - thyrotrophin (TSH) - release is stimulated by TRH (thyrotrophin releasing hormone”
Gonadotrophs - LH, FSH - release is stimulated by gonadotrophin releasing hormones
What is the name of the bony dish that the pituitary gland sits in
Sella turcica
How can a pituitary tumour affect your vision
Presses on optic chiasm
Causes bitemporal hemianopia
Compression of optic chiasm by tumour prevents transmission of sensory information from temporal/lateral visual fields to occciptal lobes
2 mechanisms of action of the growth hormone
1) acts directly in the muscle
2) acts on liver, stimulating it to make insulin-like growth factor (IGF-1) which then acts in liver
What is the difference between gigantism and acromegaly
Gigantism - pituitary tumour arises during puberty and secretes excess somatotrophin which causes person to become bigger and taller
Acromegaly - pituitary tumour arises after puberty and secrets excess somatotrophin,, person cannot grow taller as end plates of bones have fused so they can’t grow longer, but persons soft tissue grows eg hands nose etc
Medical term for large jaw
Prognathism
What are the posterior pituitary hormones
Arginine vasopressin (ADH - antidiuretic hormone)
Oxytocin
(They are produced in hypothalamus but stored in pituitary)
How does AVP concentrate urine at a cellular level
It binds to the V2 receptor on membrane of collecting duct cell
This stimulates a cascade of intracellular signalling
These reactions cause aquaporin 2 to be inserted into the apical membrane of the cell
Water moves through aquaporin 2 down its conc gradient from urine in nephron of kidney into cell
Then water moves out of cell into plasma through aquaporin 3 on the other side of the cell
What hormones could you measure to confirm diagnosis of acromegaly
Growth hormone (somatotrophin)
Growth hormone releasing hormone
Somatostatin
Insulin-like growth factor (IGF-1)
Which two important structures lie close to thyroid gland and could be affected by thyroid surgery
Parathyroid glands - involved in Ca2+ metabolism
Recurrent laryngeal nerve - supplies vocal chords
What is proximal myopathy
Weakness in muscle
What is centripetal obesity
Obese in centre but thin arms and legs (lemon on stick)
Symptom of Cushing disease - excess cortisol
4 causes of cushings disease
Taking steroid by mouth
Pituitary tumour (causes excess ACTH)
Adrenal adenoma or carcinoma (causes excess cortisol)
Ectopic (ie in wrong place) ACTH - due to lung cancer
What makes the brain unique in terms of energy sources
It cannot utilise fatty acids as an energy store, only glucose or ketones
Skeletal muscles can use fatty acids
Why do low insulin levels switch on lipolysis
Lipolysis results in the release of NEFA (non esterified fatty acids) which can be converted to ketones by the liver
Ketones are useful fuel for brain which cannot use fatty acids as an energy source
Where are GLUT4 receptors usually found?
Myocytes and adipocytes
Will ketone bodies be high or low in fasting state
High
Tests for diabetes Mellitus
Fasting glucose
Random glucose
Oral glucose tolerance test
HbA1C
Symptoms of type 1 diabetes mellitus
Weight loss
Hyperglycaemia
Glycosuria (polyuria, nocturia, polydipsia)
Ketones in blood and urine
Diagnostic tests for type 1 diabetes mellitus
Presence of Ketones
Antibody test - GAD or IA2
Low C peptide
What is impaired awareness of hyperglycaemia
Reduced ability to recognise symptoms of hyperglycaemia due to the counter regulatory response to hyperglycaemia - involves release of adrenaline which masks symptoms of hyperglycaemia
So get recurrent hyperglycaemia
How is type 2 diabetes managed
Oral medication (metformin) Education about changes to diet and exercise May need insulin later if do not comply to changes to diet and exercise (administering high dose of insulin can overcome the resistance)
How does PTH increase plasma ca2+ levels?
1) acts on kidney to increase calcium reabsorption into the blood from urine, and to increase phosphate excretion into the urine
2) acts in kidney to increase 1 alpha hydroxylase activity which increases 1,25(OH)2 cholecalciferol synthesis. This acts on the gut to increase calcium and phosphate absorption from food into blood
3) acts on bones to increase bone resorption. PTH binds to receptors on osteoblasts, causing osteoclast activating factors to be released. This causes the osteoblast to change into an osteoclast. The osteoclast ‘consumes’ the bone, releasing calcium into blood
How is PTH secretion regulated
G protein coupled calcium sensing receptors on the chief cells in the parathyroid gland sense the levels of calcium in the circulation.
The chief cells secrete pre-pro-PTH which is then cleaved to form PTH.
The secretion is inversely proportional to the level serum calcium. (Negative feedback at the level of the parathyroid)
Describe the formation of calcitriol
- 2 sources of Vitamin D3 to the blood, one is vitamin D2 from diet which is converted to D3, the second is 7-dehydrocholesterol which is converted by UVB to previtamin D3 which is converted to vitamin D3
- the vitamin D3 in the blood is converted to 25(OH)cholecalciferol by 25-hydroxylase in the liver
- 25(OH)cholecalciferol is converted by 1alpha hydroxylase to 1,25(OH)2 cholecalciferol aka calcitriol
Describe the action of calcitriol on the bone
- When there is low serum calcium, the calcitriol increases the calcium resorption - osteoclast activity - so bones are consumed and calcium is released into ciculation (calcitriol binds to calcitriol receptor on osteoblast, releasing osteoclast activating factors which change it to an osteoclast)
- when there is normal serum calcium, the calcitriol works to increase bine formation - osteoblast activity
How does the removal of the thryoid gland affect serum calcium
It doesnt
How is calcitonin released
Calcitonin is released from parafollicular cells in the thryoid gland, the parafollicular cells detect the increase in plasma Ca2+ and release calcitonin
How does Fibroblast Growth factor 23 (FGF23) regulate serum phosphate?
- Inhibits the sodium/phosphate cotransporter so less phospahte is absorbed from the urine into the blood
- inhibits calcitriol so less phosphate is absorbed from the gut (decreases intestinal phosphate reabsoprtion)
Does hypercalcaemia result in more or less membrane excitability
Less - the large number of calcium ions block Na+ ions from entering through their channels into the cell and depolarising the membrane
Name 2 signs of neuromuscular irritability due to hypocalcaemia
Chvostek’s sign - tap the facial nerve just below the zygomatic arch and the facial muscles will begin to twitch
Trousseau’s sign - you get an inflation of the blood pressure cuff for several minutes, inducing carpopedal spasm (frequent and involuntary muscle contractions of the hands and feet) —> tetany: muscle contracts but cant relax
What are the causes of hypocalcaemia
- vitamin D deficiency:
malabsorption/dietary insufficiency, inadequate sun exposure, renal disease, liver disease, vitamin D receptor defects - low PTH levels: hypoparathyroidism
Surgical (neck surgery), autoimmune, magnesium deficiency (need magnesium for PTH), congenital
What are the physiological manifestations of vitamin D deficiency
Loss of bone density - soft bones
In children: rickets
In adults: osteomalacia
What are the symotoms of hypercalcaemia
“Stones, abdominal moans and psychic groans”
Stones = renal effects: nephrocalcinosis, kidney stones, renal colic
Abdmoninal moans = GI effects: anorexia, nausea, dyspepsia, constipation, pancreatitisb
Psychic groans = CNS effects: fatigue, depression, impaired concentration, altered mentation, coma
Causes of hypercalcaemia
- primary hyperparathryoidism: too much PTH often due to parathryoid gland adenoma, no negtaive feedback
- malignancy: bony metastases peoduce local factors to activate osteoclasts, increasing calcium resorption
- vitamin D excess: rare
Describe the circualtion of the adrenal glands
1) both right and left adrenal glands have many arteries but only one vein each
- right/left adrenal arteries (top)
- right/left middle adrenal arteries
- right/left inferior adrenal arteries
- right adrenal vein
- left adrenal vein
2) right adrenal vein drains into the inferior vena cava directly, whilst the left adrenal vein drains into the renal vein
Describe the microanatomy of the adrenal cortex and what hormones each part produces
Adrenal cortex:
Produces corticosteroids
(From outside going in)
zona glomerulosa - produces mineralcorticoids (aldosterone)
zona fasciculata, zona reticularis - produce glucocorticoids (cortisol) and sex steroids (androgens and oestrogens)
Adrenal medulla:
Produces catecholamines - adrenaline/epinephrine and noradrenaline/norepinephrine
What is the precursor for steroids
Cholesterol
All steroids come from cholesterol
What is the common precursor/pathway for the formations of aldosterone and cortisol?
Cholesterol — (side chain cleavage) —> pregnonolone — (3 Beta hydroxy steroid dehydrogenase) —> progesterone
Describe the formation of aldosterone from cholesterol
Cholesterol (Side chain cleavage) Pregnenolone (3 beta hydroxy steroid de hydrogenase) Progesterone (21 hydroxylase) 11 deoxycorticosterone (11 hydroxylase) Corticosterone (18 hydroxylase) Aldosterone
Describe the formation of cortisol from cholesterol
Cholesterol (Side chain cleavage) Pregnenolone (3 beta hydroxy steroid de hydrogenase) Progesterone (17 hydroxylase) 17 hydroxy progesterone (21 hydroxylase) 11 deoxy cortisol (11 hydroxylase) Cortisol
What is the mechanism of action of aldosterone
Stimulates Na+ reabsorption from urine into blood in convoluted tubule and cortical collecting duct in kidney —> due to osmosis, the increased Na+ reabsorption increases water absorption, raising blood volume
Stimulates K+ and H+ secretion into urine in convoluted tubule and cortical collecting duct