Endocrinology Flashcards

1
Q

function of the endocrine system?

A

coordinate and integrate cellular activity within the whole body regulating cellular and organ function throughout life and maintaining homeostasis.

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2
Q

Hormones are ?? produced by ??. They are released into the ?? and travel to their target. Hormones act by binding to ? receptors. Hormone levels are regulated through ? mechanisms

A

chemical messengers

endocrine glands

blood stream

specific

feedback

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3
Q

? is the control centre of the release of many hormones in the body. It can detect low or high levels of endocrine hormones in the blood stream and regulates them using ??.

A

hypothalamus

negative feedback

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4
Q

Low hormone levels -> hypothalamus produces the corresponding ? hormone which acts on the ??. which produces and secretes the corresponding ? hormone which acts on the target organ gland and stimulates hormone production. Once levels have returned to normal this stimulates the hypothalamus and pituitary to stop producing ? and ? hormones

A

releasing

pituitary gland

stimulating

releasing

stimulating

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5
Q

what is primary endocrine dysfunction?

A

dysfunction in the secreting gland

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6
Q

in primary endocrine dysfunction

Hormone overproduction is caused by ?? and ???

Hormone underproduction is caused by ?? and ???

A

autoimmune disease
exocrine gland tumour

autoimmune disease

drug side effects

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7
Q

what is secondary endocrine dysfunction?

A

failure of hypothalamus-pituitary control

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8
Q

what are the two types of pituitary tumour?

A

functional adenomas - secretes hormone

non-functional adenomas - can’t secrete hormones but if big enough can put pressure on pituitary glandular tissue preventing secretion of stimulating hormones

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9
Q

how are pituitary tumours removed?

A

trans-sphenoidal approach through nasal passage and sphenoidal sinus, its minimally invasive and has a fast recovery

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10
Q

what is hypothalamic dysfunction caused by?

A

brain tumours

brain surgery/radiotherapy

trauma

congenital disorders

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11
Q

what is growth hormone function?

A

growth and metabolism

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12
Q

growth hormone

Hypothalamus produces ????, anterior pituitary in response produces growth hormone. GH acts on the liver, bones and muscles to produce ????

A

growth hormone releasing hormone

insulin-like growth factor 1 (IGF-1)

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13
Q

how is growth hormone assessed in blood tests?

A

measure IGF-1

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14
Q

what does insufficient growth hormone lead to?

A

Growth failure in children, metabolic changes (increased fat) in adults

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15
Q

what does excessive growth hormone lead to?

A

Children - gigantism
Adults - acromegaly

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16
Q

what is the most common cause of acromegaly?

A

benign pituitary tumour

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17
Q

dental implications of acromegaly 5

A

Ill-fitting dentures due to enlargement of dental alveolar ridge

Class 3 occlusal base -> increased OVD and AOB, occlusal changes, interdental spaces

Hypercementosis - increased size of roots -> difficult XLA

Trigeminal neuralgia

Macroglossia - enlarged tongue

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18
Q

what does the thyroid hormone produce?

A

T3 and T4

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19
Q

Fall in T3 and T4 if detected by the ?. which produces ???. which stimulate pituitary gland to produce ???. which acts on the ?? to produce more T3 and T4. hypothalamus detects rise in T3 and T4 in the ?? and stops releasing TRH.

A

hypothalamus

thyrotropin releasing hormone

thyroid stimulating hormone

thyroid gland

blood stream

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20
Q

what is hyperthyroidism?

A

excess T3/T4 thyroid hormones

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21
Q

what is the causes of primary hyperthyroidism?

A

graves disease

toxic goitre or adenoma

viral thyroiditis

drugs - amiodarone

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22
Q

graves disease

?? stimulate ? receptors on thyroid gland causing ? of T3/T4 and gland ? (goitre)

A

auto antibodies

TSH

overproduction

enlargement

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23
Q

what is the cause of secondary hyperthyroidism?

A

Pituitary tumour - TSH secreting pituitary adenoma

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24
Q

what is this the clinical presentation on?

Heat intolerance, weight loss, goitre, exophthalmos (bulging eyes), increased blood pressure, swelling of legs and scaly skin plaques

A

hyperthyroidism

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25
in primary hyperthyroidism what would the TSH and T3/T4 levels be?
TSH low T3/T4 high
26
in secondary hyperthyroidism what would the TSH and T3/T4 levels be?
TSH high T3/T4 high
27
what is the blood test for graves disease?
TSH receptor antibodies (TRAb)
28
what drugs manage hyperthyroidism? 2
Antithyroid drugs block T3/T4 B-blockers control symptoms (tachycardia/tremor)
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what surgical treatments are there for hyperthyroidism and graves disease? 3
Thyroidectomy in primary dysfunction Transnasal transsphenoidal endoscopic surgery to pituitary adenoma for secondary dysfunction Eye surgery in severe Grave's disease
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how is radioactive iodine used to treat hyperthyroidism? what are the considerations?
Thyroid tissue ablation - removal Permanent hypothyroidism so need lifelong thyroxine replacement therapy Contraindicated if pregnant or breastfeeding
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what is hypothyroidism?
deficiency of T3/T4 thyroid hormones
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what are causes of primary hypothyroidism? 6
Autoimmune (Hashimoto's) thyroiditis - anti-thyroid peroxidase antibodies Idiopathic gland atrophy Radioiodine treatment/thyroidectomy surgery Iodine deficiency - essential component of thyroid hormone Drugs for hyperthyroidism can reduce too much thyroid hormone production Congenital
33
what are the causes of secondary hypothyroidism?
Hypothalamic dysfunction -> brain tumours, trauma, surgery/radiotherapy, congenital disorders
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what is this the clinical presentation of? Cold intolerance, weight gain, hair loss, bradycardia (slow pulse), macroglossia, eyelid oedema
Hypothyroidism
35
in blood test for primary hypothyroidism what are the TSH and T4/T4 levels?
TSH high T3/T4 low
36
in blood test for secondary hypothyroidism what are the TSH and T3/T4 levels?
TSH low T3/T4 low
37
what is the blood test for hashimoto's thyroiditis?
anti-thyroid peroxidase antibodies (TPOAb)
38
what is the management of hypothyroidism?
Goal of treatment is to manage symptoms Replacement with levothyroxine - TSH monitored to ensure it remains normal
39
how does thyroid cancer present? 4
Thyroid nodule or swelling Dysphagia (difficulty swallowing) Dyspnoea (difficulty breathing) Hoarse voice due to paralysed vocal cord or recurrent laryngeal nerve
40
Dental aspects of thyroid disease Goitre or thyroid lump can be detectable by dentist Oral effects - Macroglossia in hypothyroidism - Burning mouth syndrome in hypothyroidism Anti-thyroid drug side effects (Carbimozole) - Neutropenia - increased susceptibility to infection due to decreased neutrophils - Taste disturbance Sedation - Cardiovascular and respiratory depression risk in hypothyroidism - Reduced effect of LA due to hypermetabolic state of uncontrolled hyperthyroidism increasing drug clearance LA - uncontrolled hyperthyroidism is a contraindication to the use of adrenaline in LA due to risk of tachycardia/dysrhythmias
41
where are the adrenals located?
above the kidney
42
the adrenal glands produce hormones which regulate what? 3
metabolism, blood pressure and bodies response to stress.
43
in the adrenal cortex there are 3 parts: zona glomerulosa, zona fasciculata, zona reticularis. what does Zona glomerulosa produce?
mineralocorticoids such as aldosterone
44
in the adrenal cortex there are 3 parts: zona glomerulosa, zona fasciculata, zona reticularis. what does zona fasciculata produce?
glucocorticoids such as cortisol and corticosterone
45
in the adrenal cortex there are 3 parts: zona glomerulosa, zona fasciculata, zona reticularis. what does zona reticularis produce?
androgens such as dehydroepiandrosterone
46
what does the medulla of the adrenal gland produce?
adrenaline and noradrenaline
47
what is the Common precursor to steroid hormones?
cholesterol
48
Aldosterone is a mineralocorticoid produced by the adrenal cortex what is its function?
Stimulates sodium reabsorption from the kidneys and which in turn increases water reabsorption which increases blood volume resulting in an increase in blood pressure
49
aldosterone regulation out-with the hypothalamus and pituitary gland happens through what system?
renin-angiotensin system
50
what is the renin-angiotensin for aldosterone control used for?
regulate blood pressure
51
Renin angiotensin system to regulate blood pressure Decreased blood flow to the kidneys due to reduced ?? or ?. Kidneys release ? which converts ? into ??. Lungs produce ??? which converts angiotensin I to ?. This raises the blood pressure by stimulating the adrenal glands to produce ?. which promotes ? and ? retention, ? of blood vessels and enhances the vasoconstriction effect of ?. Restoring blood pressure to normal
blood pressure volume renin angiotensinogen angiotensin I angiotensin converting enzyme ACE angiotensin II aldosterone salt water constriction noradrenaline
52
inhibiting aldosterone production is used to treat what?
hypertension
53
what 2 drugs inhibit aldosterone?
ace inhibitors angiotensin II receptor blockers
54
how do ACE inhibitors work?
block angiotensin II formation used to treat hypertension caused by excessive artery constriction
55
how do angiotensin II receptor blockers work?
Block angiotensin II receptors in smooth muscle and adrenal gland preventing aldosterone secretion
56
Cortisol is a ? produced by the ??
glucocorticoid adrenal cortex
57
what is the function of cortisol?
stress response
58
cortisol Controlled by ???? which follows a ? rhythm (? in AM, ? in PM) to prepare the body for the days activities. Additional cortisol can be produced by the ??when its stimulated by the ?? during times of ? or ?
hypothalamic-pituitary-adrenal axis circadian high low adrenal cortex pituitary gland stress illness
59
name 4 physiological effects of the steroid cortisol
antagonist to insulin reduces inflammation and immune response raises blood pressure inhibits bone formation
60
cortisol ? to insulin increases blood ? through ?, ? and ? breakdown and inhibiting ?? by tissues.
antagonist glucose gluconeogenesis fat protein glucose uptake
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cortisol reduces ? and ? - crucial in preventing ? to minor infection or injuries
inflammation immune response overreaction
62
cortisol Raises ?? -> increases the ? of blood vessels to other ? to ensure adequate ? to vital organs during ?
blood pressure sensitivity vasoconstrictors blood flow stress
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cortisol Inhibits ?? -> decreases the activity of ? (cells responsible for ??) leading to decreased ??over time
bone formation osteoblasts bone synthesis bone density
64
Regulation of cortisol Hypothalamus secretes ??? which binds to receptors on pituitary gland increasing production of ??. Binds to receptors on the ??, stimulating the release of cortisol. Increasing cortisol inhibits production of ??? and ??
corticotropin releasing hormone CRH adrenocorticotropic hormone ACTH adrenal cortex corticotropin releasing hormone adrenocorticotropic hormone
65
steroid/cortisol is used to treat what? 2
autoimmune disease due to immunosuppression rheumatoid arthritis and asthma due to decreased inflammatory response
66
name the side effect of cortisol based on its description Hypertension - enhanced mineralocorticoid effects ? - increased blood sugar levels ? - inhibits bone formation ? - immunosuppression Cataracts ? - raised cholesterol levels
hypertension type 2 diabetes osteoporosis increased risk of infections and cancer atherosclerosis
67
what diseases are associated with hyperfunction of the adrenal gland?
cushing syndrome conns syndrome
68
what is cushing syndrome?
excess glucocorticoid - cortisol
69
what are the 3 types of cushing syndrome?
ACTH driven cushing syndrome ACTH independent cushing syndrome pseudo-cushing syndrome
70
what is ACTH dependant cushing syndrome caused by?
1. Excess ACTH produced by tumour stimulates the adrenal cortex to overproduce cortisol 2. Ectopic ACTH secretion - other tumours can cause it, most commonly from non-endocrine malignant tumours such as small cell lung carcinomas
71
what is ACTH independent cushing syndrome caused by? 3
1. Tumours within adrenal gland 2. Bilateral adrenal hyperplasia - adrenal glands enlarge stimulating cortisol production 3. Iatrogenic Cushing Syndrome - steroid drugs
72
what is pseudo-cushing syndrome?
Adopt similar clinical features to Cushing syndrome but they don’t necessarily have increased glucocorticoid. 1. Obesity 2. Alcoholism
73
what are these the clinical features of? Weight gain in the middle of the body, face, neck (buffalo hump) Muscle wasting and weakness Osteopenia - risk of bone fractures Hypertension T2 diabetes Increased infection risk
cushing syndrome - excess glucocorticoid - cortisol
74
what blood tests are used to investigate cushing syndrome?
cortisol, glucose, ACTH
75
investigations for cushing syndrome Blood tests -> cortisol, glucose, ACTH Urinary cortisol levels Imaging - CT/MRI
76
treatment for cushing syndrome? 4
Transsphenoidal surgery if pituitary cause Adrenalectomy Surgery for ectopic tumour that is ACTH producing Medication to block cortisol synthesis
77
what is conns syndrome?
excess mineralocorticoid aldosterone
78
what are the causes of conns syndrome? 2
adrenal adenoma bilateral adrenal hyperplasia
79
what are these clinical features of? Hypertension Polyuria - dilute urine Muscle weakness
conns syndrome polyuria is a bit confusing as aldosterone increases water retention but also causes loss of K which causes diabetes insipidus leading to increased frequency of peeing.
80
what are the blood tests to investigate conns syndrome?
Renal function - high Na low k Renin and aldosterone levels
81
investigations for conns syndrome Blood tests - Renal function - high Na low k - Renin and aldosterone levels Imaging CT
82
what is the management for conns syndrome? 2
Surgery Spironolactone treatment with potassium sparing diuretic drug
83
what disease is caused by Hypofunction of adrenal gland - adrenal insufficiency
addison's syndrome
84
what is addison's syndrome?
not enough cortisol and aldosterone produced
85
what is addison's syndrome caused by?
Destruction of the adrenal cortex by autoantibodies
86
what are these the clinical features of? Fatigue, weight loss, muscle weakness Hypotension Hyperkalaemia Hyperpigmentation
addisons syndrome - hypofunction of adrenal gland - too little cortisol and aldosterone
87
explain the following clinical features of addison's syndrome Fatigue, weight loss, muscle weakness Hypotension? Hyperkalaemia? Hyperpigmentation - brown/black dots on oral mucosa ?
Hypotension - drop in blood pressure during postural change as less water and sodium increased potassium hyperpigmentation - high ACTH levels stimulate the production of melanocytes
88
what are the blood tests for addisons syndrome? 4
Hormone levels - ACTH, cortisol, aldosterone Synacthen test Renal function glucose
89
in addisons syndrome caused by pituitary failure what are blood test levels for ACTH and cortisol
low ACTH and low cortisol
90
in addisons syndrome caused by adrenal gland dysfunction what are the blood test levels for ACTH and cortisol?
high ACTH low cortisol
91
what is synacthen test?
used for addisons syndrome Pt given ACTH then a blood test for cortisol
92
in synacthen test Pt given ACTH then a blood test for cortisol. what does a positive response mean?
pituitary failure
93
in synacthen test Pt given ACTH then a blood test for cortisol. what does a negative response mean?
adrenal gland dysfunction
94
what is tested in the blood to investigate renal function?
sodium and potassium levels
95
what is the medical emergency associated with addisons syndrome - adrenal hypofunction?
adrenal crisis
96
what is the management for addisons syndrome? 4
hormone replacement therapy regular monitoring emergency preparedness - hydrocortisone injection and medical alert bracelet lifestyle adjustments - diet, stress, hydrated
97
adrenal crisis is caused by sudden and severe ? in adrenal hormones (? and ?) that are crucial in maintaining ??, ?? and ??. This leads to severe ?, ?? and sharp decline in ??.
decrease cortisol aldosterone blood sugar blood pressure electrolyte balance dehydration electrolyte imbalances blood pressure
98
what are the triggers for adrenal crisis? 4
Concurrent illness surgery failure to take medications dental treatment
99
what is this the clinical presentation of? Pain in lower back, abdomen or legs GI: abdominal pain, vomiting, diarrhoea Hypoglycaemia CVS: dehydration, hypotension, hypovolaemic shock Fever Confusion
adrenal crisis
100
what is the management of adrenal crisis?
999 Lie patient flat Give O2 Pt hydrocortisone injection Transfer patient to hospital
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103
Normal insulin function Insulin is produced by ?? in the ??? in the ? Eat food, blood glucose ?, islets of Langerhan's secrete ?, this stimulates the ? of glucose into the cells, the cells use glucose for energy and the blood glucose returns to normal (?mM). Any remaining glucose not used by cells is converted into ? and is stored in the ? for later use. At night or during fasting blood glucose levels ? (hypoglycaemia), stimulates the ? cells in the pancreas to produce the hormone ?, this stimulates the liver to undergo ? (glycogen broken down to glucose) and ? (synthesis of glucose from non-carbohydrate precursors)
B cells islets of langerhans pancreas increases insulin uptake 4-6mM glycogen liver drop alpha glucagon glycogenolysis gluconeogenesis
104
what is type 1 diabetes mellitus
Absolute insulin deficiency
105
what is type 1 diabetes mellitus caused by?
Autoimmune destruction of the beta cells of the islets of Langerhan's in the pancreas that produce insulin. Lack of insulin leads to hyperglycaemia (high blood glucose).
106
what autoantibodies are associated with type 1 diabetes mellitus?
GAD glutamic acid decarboxylase ICA islet cell antibodies IAA insulin autoantibodies
107
remember for type 1 diabetes by the time the disease presents there is a lots of islet cell destruction so will require insulin from diagnosis
108
what is ketoacidosis?
Body cells cant access glucose for metabolism so they start to metabolise fat which results in ketones as an end product
109
is ketoacidosis more common in type 1 or type 2 diabetes mellitus?
type 1 as there is not insulin production also more common in children
110
what is this the clinical presentation of? Excessive thirst and hunger Unexplained weight loss Blurred vision Poor wound healing Increased risk of infections Fatigue Frequent urination
type 1 diabetes
111
Type 1 diabetes causes frequent urination presence of ? in the ? raises the ?? reducing water ? in the kidneys increasing ?? Urinary glucose can be monitored with dipstick urine analysis
glucose urine osmotic pressure reabsorption water volume
112
what is type 2 diabetes mellitus?
defective or delayed insulin synthesis due to B cell dysfunction impaired response to insulin by tissues - insulin resistance - less glucose taken into cells pt are unable to maintain glucose homeostasis leading to hyperglycaemia
113
what medication can lead to medication-induced diabetes?
corticosteroidsw
114
what is this the clinical presentation of? Commonly asymptomatic and picked up on routine screening Weight gain muscle atrophy digestive problems bone fracture risk risk of skin infections neuropathic damage (sensory issues) cardiovascular disease nephropathies (renal function deteriorates)
type 2 diabetes
115
what is the blood glucose of someone with diabetes?
≥11.1mmol/l
116
what is the fasting blood glucose of someone with diabetes? (fasting for at least 8hrs)
≥7mmol/l
117
what are the glucose levels in a glucose tolerance test for someone with diabetes? (2hrs after 75g oral glucose)
≥11.1mmol/l
118
what is the HbA1c for someone with diabetes? degree of hyperglycaemia over the preceding 3 months. Can be used to monitor glycaemic control
≥48mmol/l (≥6..5%)
119
what is impaired glucose tolerance?
glucose levels above normal but not high enough for diabetes diagnosis
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what are the macrovascular long term complications of diabetes?
atherosclerotic plaque formation in large blood vessels
122
what are the microvascular long term complications of diabetes?
damage to small blood vessels (retinopathy, nephropathy, neuropathy)
123
what is diabetic foot?
peripheral blood vessel to foot is damaged neuropathy means foot is numb so wont feel injury poor wound healing leads to infection and necrosis due to compromised blood supply tissue death can occur leading to amputation of toes, foot, leg
124
erectile dysfunction is a complication of diabetes due to compromised blood supply
125
remember diabetes has an increased susceptibility to infection
126
what are the dental implications of diabetes?
increased perio and ginigivitis risk recurrent bacterial/fungal infections poor wound healing dry socket reduced salivary function - dry mouth - caries risk dysaesthesia - burning/tingling feeling sialosis - enlargement of salivary gland
127
dental management in diabetic patients on day of treatment? 7
see first in the morning diabetic control? ensure pt eaten and taken medication check blood glucose if type 1 or poorly controlled warning signs before hypoglycaemia? prevent and treat infections ASAP good OH and preventative care
128