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Human Diseases > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are hormones?

A

Molecules secreted by endocrine glands into the blood with regulatory actions at distant sites

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2
Q

What are the two types of receptors that endocrine glands act via?

A

Cell surface eg insulin
Intracellular eg thyroxine, steroid hormones

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3
Q

Hormones are regulated by __________ ______

A

Feedback loop

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4
Q

List all the endocrine glands. (6 points)

A
  1. Pituitary gland
  2. Thyroid and parathyroid glands
  3. Adrenal glands (medulla and cortex)
  4. Pancreas (islets of Langerhans)
  5. Ovaries
  6. Testes
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5
Q

Hypothalamus: CRH (corticotropin-releasing hormone)
Pituitary: ACTH (adrenocorticotropic hormone)
Target organ: _______
Product: ________

A

Adrenal cortex
Cortisol

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6
Q

Hypothalamus: TRH (thyrotropin-releasing hormone)
Pituitary: TSH (thyroid stimulating hormone)
Target organ: _______
Product: ________

A

Thyroid
Thyroxine

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7
Q

Hypothalamus: GHRH (growth-hormone-releasing hormone)
Pituitary: GH
Target organ: _______
Product: ________

A

Liver
Insulin-like growth factor-1 (IGF-1)

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8
Q

Hypothalamus: GnRH (gonadotropin-releasing hormone)
Pituitary: LH (luteinising hormone), FSH (follicle-stimulating hormone)
Target organ: _______
Product: ________

A

Gonads
Testosterone, Oestrogen, Gametogenesis

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9
Q

What are the hormones produced from non-pituitary axes? (What are their control systems?)

A

Adrenaline (CNS)
PTH (Plasma calcium)
Aldosterone (Plasma volume via kidneys - renin and angiotensin)
Insulin & glucagon (Plasma glucose)

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10
Q

What are the mechanisms of endocrine disease?

A

Destruction of gland - autoimmune, cancer, surgery, tuberculosis
Stimulation of gland - autoimmune, tumour formation causing hypersecretion of hormone, mechanical pressure effects from tumour

Tuberculosis destroys adrenal gland

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11
Q

What is the endocrine syndrome where the adernal cortex produces too much cortisol?

A

Cushing’s Syndrome

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12
Q

What are the possible causes of Cushing’s syndrome?

A

Exogenous steroids
ACTH-secreting pituitary tumour
Cortisol-secreting adrenal adenoma or carconima

Exogenous = prescribed to suppress inflammation

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13
Q
  • Moon face
  • Buffalo hump
  • Abdominal obesity
  • Proximal muscle weakness
  • Abdominal striae – stretch marks
  • Thin skin
  • Bruising
  • Osteoporosis
  • Hirsutism (androgenic) = females grow man like hair
  • Hypertension
  • Oedema
  • Raises blood glucose level (GH/ adrenaline/ glucagon)
    These clinical features are indicative of ___________ syndrome
A

Cushing’s

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14
Q

How to investigate Cushing’s syndrome?

A

Raised urine or serum cortisol (measured over 24 hours)
Fails to suppress cortisol production with dexamethasone
ACTH level (pituitary driven cushings = high ACTH; adrenal driven cushings eg adrenal tumour = low/normal ACTH)
Imaging of pituitary/adrenals

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15
Q

Treatment of Cushing’s syndrome usually surgical eg ___________ or _________

A

Adrenalectomy (removal of adrenal gland or tumour)
Hypophysectomy (removal of pituitary gland or tumour)

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16
Q

What is the name of the hypo-adrenalism disease?

A

Addison’s disease

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17
Q

What are the possible causes of Addison’s disease?

A
  1. Autoimmune destruction of adrenal cortex
  2. Suppression of HPA axis following steroid therapy
  3. Adrenal metastases
  4. TB
  5. Surgical removal of tumours/glands
  6. Pituitary failure (ACTH lack)

HPA = hypothalamic-pituitary-adrenal

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18
Q
  • Tiredness
  • Weight loss
  • Pigmentation in skin, palmar creases, buccal
  • Hypotension
  • Hypoglycaemia
    What could these clinical features indicate?
A

Hypoadrenalism

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19
Q

Why do people with hypoadrenalism get pigmentation?

A

ACTH is made in the pituitary from a precursor hormone (pro-opiomelanocortin) which also cleaves into melanocyte-stimulating hormone (MSH) which stimulates the pigment cells in the skin. Increased MSH alongside increased ACTH due to feedback loop.

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20
Q

What are the clinical features of Addisonian Crisis?

A

Vomiting
Dehydration
Hypotension
Hypoglycaemia
Electrolyte disturbances

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21
Q

Investigation of hypoadrenalism:

A

Low cortisol levels
High ACTH (High if due to primary adrenal failure; low if due to pituitary failure)
Adrenal antibodies
Imaging of adrenals

22
Q

What is the treatment for hypoadrenalism?

A

Hydrocortisone (pharmaceutical name for cortisol)
Fludrocortisone (synthetic mineralcorticoid equivalent of aldosterone)
Increase (double the dosage) of hydrocortisone to cover/help illness or stress
Intravenous fluids/electrolytes/glucose and hydrocortisone for Addisonian Crisis

23
Q

What hormones are in excess in hyperthyroidism?

A

Thyroxine (T4)
Tri-iodothyronine (T3)

24
Q

What are the possible causes of hyperthyroidism?

A

Graves disease (autoimmune stimulation)
Multinodular goitre
Thyroid adenoma
TSH excess (very rarely)

25
Q

Features of hyperthyroidism (sped up metabolism):

A
  • Feels hot
  • Sweaty palms
  • Weight loss
  • Increased appetite
  • Poor sleep
  • Loose bowels
  • Tremor
  • Tachycardia/atrial fibrillation
  • Goitre
  • Graves eyes (exophthalmos, lid retraction/lag, eye movement restriction)
26
Q

How to diagnose hyperthyroidism?

A

Blood test: raised T4 and T3; suppressed TSH; thyroid stimulating antibodies (cause Grave’s disease so check if it’s Grave’s disease level)
Thyroid imaging and isotope scans

27
Q

How to treat hyperthyroidism?

A

Radioactive iodine (most common and effective)
Surgical thyroidectomy
Anti-thyroid drugs (only temporary)
Beta-blockers for symptom control

28
Q

What is hypothyroidism sometimes called (old-fashioned term)?

A

Myxoedema

Infiltration of interstitial tissues with proteinaceous fluid

29
Q

What are the hormone levels like in hypothyroidism?

A

Lack of T4 and T3
High TSH

30
Q

What are possible causes of hypothyroidism?

A

Autoimmune destruction of thyroid
Surgical removal of thyroid
Radio-iodine treatment (can easily destory too much cells in the thyroid gland)
Secondary to TSH lack in pituitary disease

31
Q

What are the clinical features of hypothyroidism?

Opposite of hyperthyroidism

A
  • Feels cold (may get hypothermia)
  • Dry skin, thin hair
  • Slow, tired, confused
  • Slow pulse
  • Weight gain
  • Poor appetite
  • Sluggish bowels
    Myxoedema
  • Coarse facial features
  • Bags under eyes
  • Croaky voice
32
Q

Diagnosis of hypothyroidism based on blood test results:

A

Low T4 and T3
High TSH
Thyroid autoantibodies

33
Q

How to treat hypothyroidism?

A

Thyroxine tablets

34
Q

What hormone is in excess in acromegaly?

A

Growth hormone

35
Q

What causes acromegaly?

A

Pituitary tumour secreting GH

36
Q

When suspected, what investigations can be carried out to diagnose acromegaly?

A

Measure GH and IGF-1 in the blood
High GH level (that does not get suppressed by high glucose given, which it normally would)
Raised IGF-1
Pituitary MRI (to check for presence of tumours)
Visual field testing (important for all pituitary tumours)

37
Q
  • Enlarged hands, feet, jaw (malocclusion), skull (change in hat, shoes, dentures, rings sizes)
  • Coarse facial features - nose, brow, tongue
  • Thick skin
  • Arthritis including TMJ
    What are these clinical features of?
A

Acromegaly

38
Q

What are the metabolic features of a patient with acromegaly?

A

Hypertension
Hyperglycaemia (due to insulin resistance)
Headache due to pituitary tumour
Bitemporal hemianopia due to the compression of optic chiasm by the pituitary tumour

39
Q

What is hyperparathyroidism caused by?

A

Parathyroid adenoma, sometimes hyperfunction of all 4 glands, rarely carcinoma

40
Q

What does hyperparathyroidism cause?

A

Hypercalcaemia

41
Q

What causes hypercalcaemia?

A

Hyperparathyroidism
Vitamin D excess
Cancers

42
Q

What are the clinical features of hypercalcaemia?

A
  • Often asymptomatic or non-specific
  • Kidney stones (stones), bone pain (bones), ingestion due to excressive production of gastric acid OR constipation OR bowel colic (abdominal groans) and psychic moans
  • Dry eyes and mouth
  • Thirst and polyuria, due to inability to concentrate urine
43
Q

How to diagnose hyperparathyroidism OR hypercalcaemia caused by hyperparathyroidism?

A

Blood test: high plasma calcium with raise PTH
Imaging of parathyroids

44
Q

If hypercalcaemia not caused by hyperparathyroidism (caused by other factors), what will be shown in the blood test result?

A

Low PTH

45
Q

Treatment of hyperparathyroidism usually involves ________ ________ of parathyroid glands.

A

Surgical removal

46
Q

What does hypoparathyroidism cause?

A

Hypocalcaemia

47
Q

What can cause hypoparathyroidism?

A

Autoimmune destruction
Damage to parathyroids during thyroid surgery

48
Q

What are the clinical features of hypocalcaemia?

A
  • Tingling (a sensation)
  • Paraesthesiae (tingling/prickling/burning sensation caused by pressure on or damage to peripheral nerves)
  • Cramps (involuntary muscle contraction)
  • Tetany (abnormal serum electrolyte concentration causing overstimulation of peripheral nerves and can cause muscle cramps)
49
Q

How to diagnose hypocalcaemia caused by hypoparathyroidism?

A

Low plasma calcium
Low PTH

50
Q

How to differentiate hypocalcaemia caused by other causes (eg vitamin D deficiency) from hypocalcaemia caused by hypoparathyroidism?

A

High PTH in other causes of hypocalcaemia

51
Q

How to treat hypocalcaemia?

A

Vitamin D analogues (less urgent situation; high doses needed)
Calcium injection (emergency)

PTH for replacement is not available

Human Diseases (24 decks)

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