Endocrinology Flashcards by Rebecca Oliver

Where is the inferior parathyroid derived from?

Third pharyngeal pouch

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Where is the superior parathyroid derived from?

Fourth pharyngeal pouch

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Most common cause of congenital adrenal hyperplasia?

21-hydroxylase deficiency

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Features of 21-hydroxylase deficiency in CAH?

Virilisation of girls
Precocious puberty in boys

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Features of 11-beta hydroxylase deficiency in CAH?

Virilisation in female genitalia
Precocious puberty in boys
Hypertension
Hypokalaemia

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Features of 17-hydroxylase deficiency?

Non-virilising in females
Inter-sex in boys
Hypertension

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What happens to the electrolytes in Cushing’s syndrome?

High sodium
Low potassium

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Where is melatonin synthesised from?

Melatonin is synthesised in the pineal gland from serotonin

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What is the age range for normal puberty in boys?

9-14 years

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What is the age range for normal puberty in girls?

8-14 years

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Outline the normal sequence of puberty in girls?

Breast development
Height spurt
Menarche

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What is the normal sequence of puberty in boys?

Testicular growth
Enlargement of the penis
Pubic hair development
Facial hair
Height growth

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What are the causes of advanced bone age?

Endocrine causes - precocious puberty, adrenal pathology (CAH, adrenocorticol tumour), intracranial lesions (astrocytoma, craniopharyngioma), Cushing’s syndrome, hyperpituitarism, hyperthyroidism

Genetic causes - Soto’s syndrome, McCune Albright, Beckwith-Wiedemann, Homocystinuria, Marshall-Smith

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Causes of delayed bone age?

Constitutional growth delay
Chronic disease
Neglect
IUGR
Genetic disorders (trisomy 21, trisomy 18, Turner syndrome)
Congenital dwarfism
Endocrine (hypothyroidism, hypopituitarism, hypogonadism, Cushing disease, diabetes, Addison’s disease, hypoparathyroidism)

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Hormone profile in Kallman’s syndrome?

Reduced testosterone
Reduced LH/ FSH

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Where is PTH secreted from?

Chief cells in the parathyroid hormone

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What are the actions of PTH?

Bone - Binds to osteoblasts which signal to osteoclasts to cause resorption of bone and release calcium

Kidney - Active reabsorption of calcium and magnesium from the distal convoluted tubule. Decreases reabsorption of phosphate

Intestine - Increases intestinal calcium absorption by increasing activated vitamin D. Activated vitamin D increases calcium absorption

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Where is glucagon released?

Alpha cells in the Islet of Langerhans

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Where is Insulin released?

Beta cells in the Islet of Langerhans

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Where is Somatostatin released?

Delta cells in the Islet of Langerhans

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Which hormone DECREASES prolactin secretion?

Dopamine

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Which hormone INCREASES prolactin secretion?

Thyrotropin releasing hormone

(also pregnancy, oestrogen, breastfeeding, sleep, stress, metoclopramide, antipsychotics)

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Congenital adrenal hypoplasia =

Children often present in the neonatal phase with an adrenal crisis (hyponatraemia, hyperkalaemia, hypotension, dehydration, hypoglycaemia)

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Where is secretin released?

Mucosal cells in the duodenum and jejunum

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What are the likely blood results for adrenal insufficiency e.g. Addisons disease?

Low cortisol High renin Low sodium High potassium Hypoglycaemia Metabolic acidosis

Which amino acid are all catecholamines derived from?

Tyrosine

Where is adrenaline and noradrenaline secreted from?

The chromaffin cells of the adrenal medulla

What is the most common thyroid malignancy?

Papillary carcinoma

What is the hormone profile for PCOS?

Raised LH:FSH ratio Insulin resistance High dehydroepiandrosterone (DHEA-S) High free and total testosterone Normal oestrogen

Causes of hypokalaemia with hypertension?

Conn's syndrome Cushing's syndrome Liddle syndrome 11 beta hydroxyls deficiency (cause of CAH)

Causes of hypokalaemia without hypertension?

Diuretics GI losses Renal tubular acidosis (type 1 and 2) Bartter's syndrome Gitelman syndrome

Which drugs cause gynaecomastia?

Spironolactone Digoxin Cimetidine Cannabis Oestrogen Anabolic steroids Finesteride

What are the properties of octreotide?

Mimics somatostatin Inhibits growth hormone and insulin

Function of ADH?

Purely concerned with water reabsorption therefore SIADH leads to normovolaemic hyponatraemia

What are psammoma bodies?

Clusters of microcalcifications - typically seen in papillary carcinomas (thyroid)

Which two hormones are released from the posterior pituitary?

ADH Oxytocin

What are the criteria for diagnosis of McCune Albright syndrome?

Polyostotic fibrous dysplasia Cafe-au-lait skin pigmentation Autonomous endocrine hyperfunction (manifesting as hyperthyroidism, acromegaly, Cushing syndrome)

Where in the adrenal gland is cortisol produced

Zona fasciculata of the adrenal

Adrenal insufficiency causes...?

Hyponatraemia and Hyperkalaemia

Which cells produce testosterone?

Leydig cells secrete testosterone in response to LH stimulation

Treatment of minimal change disease?

Steroids (prednisolone) ACEi Diuretics Immunosuppresants (cyclophosphamide)

Where does the left testicular vein drain into?

Left renal vein

Where does the right testicular vein drain into>

Inferior vena cava

Which pump defect is associated with distal renal tubular acidosis?

H+/K+ ATPase

Which abnormality predisposes to testicular torsion?

A patent processus vaginalis

Triad of thrombocytopenia, renal failure and microangiopathic haemolytic anaemia?

Haemolytic uraemia syndrome

What are the blood results for HUS?

Low platelets High WCC Increased urea Increased creatinine Increased LDH Urine dipstick will show haematuria and proteinuria

Renal scarring investigation?

DMSA

Vesico-ureteric reflux disease?

Micturating cystourethrogram

Which nerve innervates the posterior skin of the scrotum?

Pudendal nerve

In what manner is growth hormone released?

Pulsatile manner

Features of hypercalcaemia?

Bones, stones, moans, groans

What are the features of polyglandular endocrinopathy type 1?

Mucocutaneous candidiasis Addison's disease Parathyroid gland dysfunction

What are the features of polyglandular endocrinopathy type 2?

Most common type Addisons disease and thyroid dysfunction +/- T1DM

What is the typical finding on a muscle biopsy in patients with thyroid disease?

Checkerboard pattern of necrosis and regeneration

What is somatostatin also known as?

Growth hormone inhibiting hormone

What does 5 alpha reductase deficiency cause?

XY males but have external female genitalia - androgen insensitivity syndrome

Which hormones are decreased in a stress reponse?

Insulin Testosterone Oestrogen

Causes of hypogonodotrophic hypogonadism?

Kallman's syndrome Prader-Willi syndrome Bardet-Biedl syndrome

Causes of Hypergonadotrophic hypogonadism?

Noonan's Turners Prader-Willi Klinefelters

Identical twin risk of T1DM?

30-50%

Alcohol .... glucogenolysis?

Alcohol inhibits glycogenolysis

Which mutations account for MODY?

Glucokinase mutations