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Clinical Pathology > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Define Endocrinology

A

The study of hormones, action and interactions , and the medical conditions associated with deficient and excessive secretion.

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2
Q

Define Hormone

A

A substance that is secreted by an endocrine gland and is transported in the blood to regulate the function of another tissue or gland.

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3
Q

What are the main endocrine glands?

A 
Pineal Gland
Pituitary Gland
Hypothalamus
Thyroid Gland
Thymus
Adrenal Gland
Pancreas
Ovaries
Testis
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4
Q

What is the role of the hypothalamus?

A

Convert neurological signals to stimulatory hormones and is affected by sleep patterns and stress responses

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5
Q

Describe the pituitary gland

A

Located in the base of the brain
Connected to Hypothal via pituitary stalk
Anterior and Posterior lobes
Stimulated by the hypothal

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6
Q

What hormones are associated with the hypothal?

A 
GHRH
Somatostatin
GnRH
TRH
CRH
Dopamine
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7
Q

What hormones are associated with the anterior pituitary gland?

A 
GH 
FSH
LH
TSH
ACTH
PROLACTIN
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8
Q

Define Diurnal Variation

A

Due to the neuronal and sight stimulus required, hormones are often secreted in a pulsatile manner, with frequency and amplitude of pulse varying through out the day.

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9
Q

What is Hypopituitarism?

A

Decreased secretion of the hormones produced in the pituitary gland

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10
Q

What are the causes of Hypopituitarism?

A 
Pituitary tumours
Brain tumours
Infection (TB, sarcoidosis)
Haemorrhage (Sheehan’s syndrome)
Autoimmune
Trauma
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11
Q

Describe the steps following CRH release from the hypothal

A
  1. Corticotrophin releasing hormone is released episodically from the hypothal
  2. ACTH acts on the adrenal stimulating the adrenal cortex pathway
  3. Cortisol is the main analyte produced
  4. Negative feedback loop controls the pathway
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12
Q

What is Cortisol involved in?

A

It promotes gluconeogenesis, glycogenesis and increased fatty metabolism.
It controls salt and water balance as well as blood pressure regulation

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13
Q

What is the 9am reference range for cortisol?

A

200-600nmol/L

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14
Q

What are the characteristics of Addison’s Disease?

A

Destruction of the adrenal cortex and disorders of steroid metabolism

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15
Q

What are the clinical signs of cortisol deficiency?

A

Inability to mount a stress response to illness/trauma
Dizziness
Lethargy
Low BP

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16
Q

How is cortisol deficiency diagnosed?

A 
9am cortisol
Short Synacthen Test
ACTH
Urea/Electrolytes
Adrenal imaging
17
Q

What are the primary and secondary causes of Cushing’s Syndrome?

A

Primary:
Adrenal Tumours
Iatrogenic-Hydrocortisone administration

Secondary:
ACTH secreting tumours (pituitary and ectopic)

18
Q

What are the signs and symptoms of Cushing’s Syndrome?

A 
Moonfaced
Increased abdominal fat
Buffalo hump
Thin skin leading to striation
Easy bruising
Muscle wasting
Hirsuitism
Hypertension
Glucose Intolerance
19
Q

How is Cushing’s Syndrome diagnosed?

A

Screening:
Urine free cortisol
Overnight dexamethasone suppression test
Salivary cortisol

Diagnostic:
ACTH
High dose Dexamethasone

20
Q

Describe the steps of HP-Thyroid

A
  1. TRH acts on the thyrotrophs in the anterior pituitary causing the release of TSH
  2. TSH acts on thyroid gland stimulating the production of T3/T4
  3. A negative feedback loop controls the cycle
21
Q

What is the reference range for TSH?

A

0.3-5mU/L

22
Q

What are T3 and T4 responsible for?

A

Normal maturation and metabolism of all body tissues

23
Q

What is the reference range for free T4?

A

8-19pmol/L

24
Q

What is the reference range for free T3?

A

2-6pmol/L

25
Q

What are the signs and symptoms of hypothyroidism?

A 
Tiredness, lethargy
Weight gain
Cold intolerance
Raised cholesterol
Inattention
26
Q

What are the primary and secondary causes of hypothyroidism?

A

Primary:
Destruction of the gland (autoimmune)
Congenital Defects
Drugs (lithium/amiodarone)

Secondary:
Panhypopituitarism
Isolated TSH

27
Q

What are the primary and secondary causes of hyperthyroidism?

A

Primary:
Graves disease
toxic goitre
Thyroiditis

Secondary:
Exogenously administer iodine-containing drugs
Excessive T4 and T3 ingestion
TSHoma

28
Q

What are the signs and symptoms of hyperthyroidism?

A 
Weight loss
Sweating and heat intolerance
Fatigue
Palpitations
Agitation and tremors
Generalised muscle weakness
Angina/ heart failure
Diarrhoea
Oligomenorrhoea/ subfertility
Goitre
Eye lid retraction and lid lay.
29
Q

How is hyperthyroidism diagnosed?

A

Serum TSH and Serum fT4
Serum fT3
Imaging of the pituitary.

30
Q

Describes the steps in HP-Prolactin

A
  1. Controlled by inhibition of secretion
  2. Dopamine is the principle factor
  3. Prolactin self-regulates
  4. Secretion seems to be stimulated by factors that suppress dopamine
  5. It is affected by physiological factors such as lactation
31
Q

What are the causes of hyperprolactinaemia?

A

Primary:
Prolactinoma
Pituitary tumour

Other causes:
Chronic renal failure
Pregnancy
Primary Hypothyroidism
Drugs- antipsychotics
Macroprolactin
32
Q

What are the signs and symptoms of hyperprolactinaemia?

A 
Amenorrhea
Galactorrhea/ gynaecomastia
Oligospermia
Impotence/ decrease sexual interest
Visual Disturbance
Headache
Hypopituritarism
33
Q

How is hyperprolactinaemia diagnosed?

A 
Prolactin
Medical/ drug  history
Rule out macroprolactin
Imaging
Pituitary Hormones
34
Q

What is GH responsible for?

A

Lipogenesis
Bone growth
Protein synthesis
Increase blood glucose and FFA production.

35
Q

What are the effects of GH excess and deficiency?

A

Deficiency:
Hypoglycaemia in neonates
Short stature in Children
Difficult to detect in adulthood

Increased growth:
Acromegaly
Gigantism

36
Q

How is GH excess/deficiency diagnosed?

A 
GH dynamic function
OGTT
Insulin stress test
IGF-1
Clinical examination

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