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5 Human Diseases > Endocrinology > Flashcards

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 gain, goitre, exophthalmos (bulging eyes), increased blood pressure, swelling of legs and scaly skin plaques

A

hyperthyroidism

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25
Q

in primary hyperthyroidism what would the TSH and T3/T4 levels be?

A

TSH low
T3/T4 high

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26
Q

in secondary hyperthyroidism what would the TSH and T3/T4 levels be?

A

TSH high
T3/T4 high

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27
Q

what is the blood test for graves disease?

A

TSH receptor antibodies (TRAb)

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28
Q

what drugs manage hyperthyroidism? 2

A

Antithyroid drugs block T3/T4

B-blockers control symptoms (tachycardia/tremor)

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29
Q

what surgical treatments are there for hyperthyroidism and graves disease? 3

A

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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30
Q

how is radioactive iodine used to treat hyperthyroidism? what are the considerations?

A

Thyroid tissue ablation - removal

Permanent hypothyroidism so need lifelong thyroxine replacement therapy

Contraindicated if pregnant or breastfeeding

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31
Q

what is hypothyroidism?

A

deficiency of T3/T4 thyroid hormones

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32
Q

what are causes of primary hypothyroidism? 6

A

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

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33
Q

what are the causes of secondary hypothyroidism?

A

Hypothalamic dysfunction -> brain tumours, trauma, surgery/radiotherapy, congenital disorders

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34
Q

what is this the clinical presentation of?

A

Cold intolerance, weight gain, hair loss, bradycardia (slow pulse), macroglossia, eyelid oedema

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35
Q

in blood test for primary hypothyroidism what are the TSH and T4/T4 levels?

A

TSH high
T3/T4 low

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36
Q

in blood test for secondary hypothyroidism what are the TSH and T3/T4 levels?

A

TSH low
T3/T4 low

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37
Q

what is the blood test for hashimoto’s thyroiditis?

A

anti-thyroid peroxidase antibodies (TPOAb)

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38
Q

what is the management of hypothyroidism?

A

Goal of treatment is to manage symptoms

Replacement with levothyroxine
- TSH monitored to ensure it remains normal

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39
Q

how does thyroid cancer present? 4

A

Thyroid nodule or swelling

Dysphagia (difficulty swallowing)

Dyspnoea (difficulty breathing)

Hoarse voice due to paralysed vocal cord or recurrent laryngeal nerve

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40
Q

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

A
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41
Q

where are the adrenals located?

A

above the kidney

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42
Q

the adrenal glands produce hormones which regulate what? 3

A

metabolism, blood pressure and bodies response to stress.

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43
Q

in the adrenal cortex there are 3 parts: zona glomerulosa, zona fasciculata, zona reticularis.

what does Zona glomerulosa produce?

A

mineralocorticoids such as aldosterone

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44
Q

in the adrenal cortex there are 3 parts: zona glomerulosa, zona fasciculata, zona reticularis.

what does zona fasciculata produce?

A

glucocorticoids such as cortisol and corticosterone

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45
Q

in the adrenal cortex there are 3 parts: zona glomerulosa, zona fasciculata, zona reticularis.

what does zona reticularis produce?

A

androgens such as dehydroepiandrosterone

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46
Q

what does the medulla of the adrenal gland produce?

A

adrenaline and noradrenaline

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47
Q

what is the Common precursor to steroid hormones?

A

cholesterol

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48
Q

Aldosterone is a mineralocorticoid produced by the adrenal cortex
what is its function?

A

Stimulates sodium reabsorption from the kidneys and which in turn increases water reabsorption which increases blood volume resulting in an increase in blood pressure

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49
Q

aldosterone regulation out-with the hypothalamus and pituitary gland happens through what system?

A

renin-angiotensin system

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50
Q

what is the renin-angiotensin for aldosterone control used for?

A

regulate blood pressure

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51
Q

Renin angiotensin system to regulate blood pressure

Decreased blood flow to the kidneys due to reduced ?? or ?. Kidneys release renin 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

A

blood pressure
volume

renin
angiotensinogen
angiotensin I

angiotensin converting enzyme ACE
angiotensin II

aldosterone
salt
water
constriction
noradrenaline

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52
Q

inhibiting aldosterone production is used to treat what?

A

hypertension

53
Q

what 2 drugs inhibit aldosterone?

A

ace inhibitors
angiotensin II receptor blockers

54
Q

how do ACE inhibitors work?

A

block angiotensin II formation

used to treat hypertension caused by excessive artery constriction

55
Q

how do angiotensin II receptor blockers work?

A

Block angiotensin II receptors in smooth muscle and adrenal gland preventing aldosterone secretion

56
Q

Cortisol is a ? produced by the ??

A

glucocorticoid
adrenal cortex

57
Q

what is the function of cortisol?

A

stress response

58
Q

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 ?

A

hypothalamic-pituitary-adrenal axis

circadian

high

low

adrenal cortex

pituitary gland

stress

illness

59
Q

name 4 physiological effects of the steroid cortisol

A

antagonist to insulin

reduces inflammation and immune response

raises blood pressure

inhibits bone formation

60
Q

cortisol

? to insulin increases blood ? through ?, ? and ? breakdown and inhibiting ?? by tissues.

A

antagonist

glucose

gluconeogenesis

fat

protein

glucose uptake

61
Q

cortisol reduces ? and ? - crucial in preventing ? to minor infection or injuries

A

inflammation
immune response
overreaction

62
Q

cortisol Raises ?? -> increases the ? of blood vessels to other ? to ensure adequate ? to vital organs during ?

A

blood pressure
sensitivity
vasoconstrictors
blood flow
stress

63
Q

cortisol Inhibits ?? -> decreases the activity of ? (cells responsible for ??) leading to decreased ??over time

A

bone formation
osteoblasts
bone synthesis
bone density

64
Q

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 ??

A

corticotropin releasing hormone CRH

adrenocorticotropic hormone ACTH

adrenal cortex

corticotropin releasing hormone

adrenocorticotropic hormone

65
Q

steroid/cortisol is used to treat what? 2

A

autoimmune disease due to immunosuppression

rheumatoid arthritis and asthma due to decreased inflammatory response

66
Q

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

A

hypertension

type 2 diabetes

osteoporosis

increased risk of infections and cancer

atherosclerosis

67
Q

what is diseases are associated with hyperfunction of the adrenal gland?

A

cushing syndrome

conns syndrome

68
Q

what is cushing syndrome?

A

excess glucocorticoid - cortisol

69
Q

what are the 3 types of cushing syndrome?

A

ACTH driven cushing syndrome

ACTH independent cushing syndrome

pseudo-cushing syndrome

70
Q

what is ACTH dependant cushing syndrome caused by?

A
  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
Q

what is ACTH independent cushing syndrome caused by? 3

A
  1. Tumours within adrenal gland
  2. Bilateral adrenal hyperplasia - adrenal glands enlarge stimulating cortisol production
  3. Iatrogenic Cushing Syndrome - steroid drugs
72
Q

what is pseudo-cushing syndrome?

A

Adopt similar clinical features to Cushing syndrome but they don’t necessarily have increased glucocorticoid.
1. Obesity
2. Alcoholism

73
Q

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

A

cushing syndrome - excess glucocorticoid - cortisol

74
Q

what blood tests are used to investigate cushing syndrome?

A

cortisol, glucose, ACTH

75
Q

investigations for cushing syndrome

Blood tests -> cortisol, glucose, ACTH

Urinary cortisol levels

Imaging - CT/MRI

A
76
Q

treatment for cushing syndrome? 4

A

Transsphenoidal surgery if pituitary cause

Adrenalectomy

Surgery for ectopic tumour that is ACTH producing

Medication to block cortisol synthesis

77
Q

what is conns syndrome?

A

excess mineralocorticoid aldosterone

78
Q

what are the causes of conns syndrome? 2

A

adrenal adenoma
bilateral adrenal hyperplasia

79
Q

what are these clinical features of?

Hypertension

Polyuria - dilute urine

Muscle weakness

A

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
Q

what are the blood tests to investigate conns syndrome?

A

Renal function - high Na low k

Renin and aldosterone levels

81
Q

investigations for conns syndrome

Blood tests
- Renal function - high Na low k
- Renin and aldosterone levels

Imaging CT

A
82
Q

what is the management for conns syndrome? 2

A

Surgery

Spironolactone treatment with potassium sparing diuretic drug

83
Q

what disease is caused by Hypofunction of adrenal gland - adrenal insufficiency

A

addison’s syndrome

84
Q

what is addison’s syndrome?

A

not enough cortisol and aldosterone produced

85
Q

what is addison’s syndrome caused by?

A

Destruction of the adrenal cortex by autoantibodies

86
Q

what are these the clinical features of?

Fatigue, weight loss, muscle weakness

Hypotension

Hyperkalaemia

Hyperpigmentation

A

addisons syndrome - hypofunction of adrenal gland - too little cortisol and aldosterone

87
Q

explain the following clinical features of addison’s syndrome

Fatigue, weight loss, muscle weakness

Hypotension?

Hyperkalaemia?

Hyperpigmentation - brown/black dots on oral mucosa ?

A

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
Q

what are the blood tests for addisons syndrome? 4

A

Hormone levels - ACTH, cortisol, aldosterone

Synacthen test

Renal function

glucose

89
Q

in addisons syndrome caused by pituitary failure what are blood test levels for ACTH and cortisol

A

low ACTH and low cortisol

90
Q

in addisons syndrome caused by adrenal gland dysfunction what are the blood test levels for ACTH and cortisol?

A

high ACTH
low cortisol

91
Q

what is synacthen test?

A

used for addisons syndrome

Pt given ACTH then a blood test for cortisol

92
Q

in synacthen test Pt given ACTH then a blood test for cortisol.

what does a positive response mean?

A

pituitary failure

93
Q

in synacthen test Pt given ACTH then a blood test for cortisol.

what does a negative response mean?

A

adrenal gland dysfunction

94
Q

what is tested in the blood to investigate renal function?

A

sodium and potassium levels

95
Q

what is the medical emergency associated with addisons syndrome - adrenal hypofunction?

A

adrenal crisis

96
Q

what is the management for addisons syndrome? 4

A

hormone replacement therapy

regular monitoring

emergency preparedness - hydrocortisone injection and medical alert bracelet

lifestyle adjustments - diet, stress, hydrated

97
Q

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 ??.

A

decrease
cortisol
aldosterone
blood sugar
blood pressure
electrolyte balance
dehydration
electrolyte imbalances
blood pressure

98
Q

what are the triggers for adrenal crisis? 4

A

Concurrent illness

surgery

failure to take medications

dental treatment

99
Q

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

A

adrenal crisis

100
Q

what is the management of adrenal crisis?

A

999
Lie patient flat
Give O2
Pt hydrocortisone injection
Transfer patient to hospital

101
Q
A
102
Q
A
103
Q

Normal insulin function

Insulin is produced by ?? in the ??? in the ?

Eat food, blood glucose increases, islets of Langerhan’s secrete insulin, this stimulates the uptake of glucose into the cells, the cells use glucose for energy and the blood glucose returns to normal (4-6mM). Any remaining glucose not used by cells is converted into glycogen and is stored in the liver for later use.

At night or during fasting blood glucose levels drop (hypoglycaemia), stimulates the alpha cells in the pancreas to produce the hormone glucagon, this stimulates the liver to undergo glycogenolysis (glycogen broken down to glucose) and gluconeogenesis (synthesis of glucose from non-carbohydrate precursors)

A

B cells
islets of langerhans
pancreas

increases
insulin
uptake
4-6mM
glycogen
liver

drop
alpha
glucagon
glycogenolysis
gluconeogenesis

104
Q

what is type 1 diabetes mellitus

A

Absolute insulin deficiency

105
Q

what is type 1 diabetes mellitus caused by?

A

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
Q

what autoantibodies are associated with type 1 diabetes mellitus?

A

GAD glutamic acid decarboxylase

ICA islet cell antibodies

IAA insulin autoantibodies

107
Q

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

A
108
Q

what is ketoacidosis?

A

Body cells cant access glucose for metabolism so they start to metabolise fat which results in ketones as an end product

109
Q

is ketoacidosis more common in type 1 or type 2 diabetes mellitus?

A

type 1 as there is not insulin production

also more common in children

110
Q

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

A

type 1 diabetes

111
Q

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

A

glucose
urine
osmotic pressure
reabsorption
water volume

112
Q

what is type 2 diabetes mellitus?

A

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
Q

what medication can lead to medication-induced diabetes?

A

corticosteroidsw

114
Q

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)

A

type 2 diabetes

115
Q

what is the blood glucose of someone with diabetes?

A

≥11.1mmol/l

116
Q

what is the fasting blood glucose of someone with diabetes?

(fasting for at least 8hrs)

A

≥7mmol/l

117
Q

what are the glucose levels in a glucose tolerance test for someone with diabetes?

(2hrs after 75g oral glucose)

A

≥11.1mmol/l

118
Q

what is the HbA1c for someone with diabetes?

degree of hyperglycaemia over the preceding 3 months. Can be used to monitor glycaemic control

A

≥48mmol/l
(≥6..5%)

119
Q

what is impaired glucose tolerance?

A

glucose levels above normal but not high enough for diabetes diagnosis

120
Q
A
121
Q

what are the macrovascular long term complications of diabetes?

A

atherosclerotic plaque formation in large blood vessels

122
Q

what are the microvascular long term complications of diabetes?

A

damage to small blood vessels (retinopathy, nephropathy, neuropathy)

123
Q

what is diabetic foot?

A

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
Q

erectile dysfunction is a complication of diabetes due to compromised blood supply

A
125
Q

remember diabetes has an increased susceptibility to infection

A
126
Q

what are the dental implications of diabetes?

A

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
Q

dental management in diabetic patients on day of treatment? 7

A

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

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5 Human Diseases (16 decks)

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