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Pathology 2210 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is a hormone?

A

A specific messenger molecule synthesised and secreted by a group of specialised cells called an endocrine gland

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2
Q

What are the 3 classes of hormones?

A

Steroid hormones - lipids made from cholesterol e.g. sex hormones
Amino acid derivatives - derived from amino acids, especially Tyrosine e.g. adrenaline
Peptide/protein hormones - most common one e.g. insulin

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3
Q

What hormones are released by the Posterior Pituitary?

A

ADH
Oxytocin
They are made in hypothalamus but secreted by the Post. Pit.

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4
Q

What hormones are released by the Anterior Pituitary?

A 
Thyroid Stimulating Hormone (TSH)
Follicle Stimulating Hormone (FSH)
Luteinising Hormone (LH)
Prolaction (PRL)
Growth Hormone (GH)
Adrenocorticotrophic Hormone (ACTH)
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5
Q

The pineal gland secretes __________, it promotes sleep. The levels of this hormone are dependent on exposure to _______

A

Melatonin, exposure to light

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6
Q

What is SAD?

A

Seasonal Affective Disorder is when too much melatonin is produced. Most common type is Winter Depression

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7
Q

What are the symptoms of SAD?

A 
Fatigue
Appetite change (crave sweets or starchy food)
Weight gain
Irritability
Difficulty Concentrating
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8
Q

Exposure to light for several hours of the day is a treatment for SAD because light ________ melatonin production

A

Inhibits

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9
Q

The Pituitary gland, aka __________, sits in a small bony cavity at the base of the brain called the __________

A

Hypophysis, called the Sella Turcica

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10
Q

What are some examples of Pituitary Hypofunction?

A 
Pituitary Dwarfism (Lack of GH as kid)
Panhypopituitarism (Ant.Pit. doesn't secrete any hormones, screws other glands)
Diabetes Insipidus (Failure to secrete ADH)
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11
Q

What are some examples of Pituitary Hyperfunction?

A

Gigantism (Too much GH in childhood) and Acromegaly (Too much GH in adults)
Hyperprolactinaemia (Over production of prolactin)

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12
Q

What are the Clinical features of Acromegaly?

A 
Enlarged hands and feet
Thickened skin
Enlargement of Skull and Jaw
Enlargement of lips, nose and tongue
Glucose intolerance
Hypertension
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13
Q

What causes Acromegaly?

A

A benign pituitary tumour, but anything that can cause the overproduction of GH can be a cause

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14
Q

How is Acromegaly diagnosed?

A

An oral Glucose tolerance test, If GH levels are above 2mU L then patient has acromegaly

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15
Q

How is Acromegaly Treated?

A

Bromocriptine is a dopamine agonist that lowers GH levels in 75% of patients
Removal of Tumour if possible
Radiotherapy to destroy an endocrine producing tumour

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16
Q

What is Hyperprolactinaemia?

A

Elevated levels of plasma prolactin that causes the discharge of milk or a milk-like secretion. Most common in women ages 20-35

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17
Q

What causes Hyperprolatinaemia?

A

A common pituitary tumour called an Prolatinoma, The bigger the tumour the higher the prolactin levels

Pregnancy
Hypothyroidism
Liver or Renal Failure
Medications like contraceptives, antipsychotics and antidepressents

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18
Q

What are some tests for Hyperprolactinaemia?

A

Prolactin level test
Renal function test
TSH Levels
MRI to detect possible tumour

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19
Q

What are some treatments for Hyperprolactinaemia?

A

Bromocriptine and Cabergoline inhibit prolactin synthesis
Surgery to remove tumours
Radiation therapy

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20
Q

The thymus consists of ____ lateral lobes connected by the ________

A

2 lateral lobes connected by the isthmus

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21
Q

In the thymus follicular cells produce _____ and _____. The parafollicular cells produce _______

A

T3 (triiodothyronine) and T4 (Thyroxine)

Calcitonin

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22
Q

Calcitonin acts to regulate____________________

A

Blood calcium levels

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23
Q

T3 and T4 control the rate of ________________. T4 is 10 times _____ potent than T3 but secreted ______.

A

Metabolic processes

T4 is 10 times less potent than T3 but secreted more

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24
Q

The 4 parathyroid glands produce _________________ which regulates calcium homeostasis

A

Parathyroid Hormone (PTH)

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25
Q

What are the signs and symptoms of Hyperthyroidism?

A 
Palpitations
Weight loss despite normal or increased appetite
Fatigue and muscle weakness
Tremors
Increased Sweating
Heat Intolerance
Wide/Swollen/Red eyes
Goiter
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26
Q

What causes Hyperthyroidism?

A

Graves’ disease is most common cause (60-80% of cases)
Toxic Multi-nodular Goiter
Treatments involving Thyroid Hormones and Iodine
Thyroiditis
Tumours

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27
Q

What is Graves’ Disease

A

It is an autoimmune disease caused by an antibody active against the TSH receptor that stimulates the excess secretion of thyroid hormones

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28
Q

How can we diagnose Hyperthyroidism?

A

TSH levels test
T3 and T4 level tests
Radionuclide uptake (distinguishes between causes, Graves’ will have high uptake, thyroiditis will have low upstake)

29
Q

What is the likely diagnosis?
TSH levels: High
T4 levels: High
T3 levels: -

A

Secondary Hyperthyroidism, possible pituitary problem

30
Q

What is the likely diagnosis?
TSH levels: Low
T4 levels: High
T3 levels: -

A

Primary Hyperthyroidism

31
Q

What is the likely diagnosis?
TSH levels: Low
T4 levels: Normal
T3 levels: High

A

T3 Toxicosis

32
Q

What is the likely diagnosis?
TSH levels: Low
T4 levels: Normal
T3 levels: Normal

A

Sub-clinical hyperthyroidism

33
Q

How do we treat Hyperthyroidism?

A

Treatment depends on the cause
Goal is to treat with fewest side effects and low incidence of of Hypothyroidism
Antithyroid drugs, radioactive iodoine and surgery are main options for persistent hyperthyroidism

34
Q

The 2 antithyroid drugs are _________ and ________

A

Methimazole (Tapazole) and Propylthiouracil (PTU)

35
Q

Propylthiouracil is used in pregnant patients because________________________________________

A

Methimazole has been linked to rare congenital abnormalities

36
Q

What causes Hypothyroidism?

A 
Thyroiditis
Removal of Thyroid
Iodine deficiency
Drug Therapy
Pituitary issues
37
Q

What are the signs/symptoms of Hypothyroidism?

A 
Decreased sweating
Dry and coarse skin
Lethargy
Cold skin
Thick Tongue
Facial Edema
38
Q

How do we manage Hypothyroidism?

A

Hormone Replacement Therapy

Monitor Thyroid Function

39
Q

What causes Hyperparathyroidism?

A

Usually resultant from a hormone secreting parathyroid tumour

40
Q

What are the signs of Hyperparathyroidism?

A

High blood calcium

Calcium in urine

41
Q

How do we treat Hyperparathyroidism?

A

Saline rehydration followed furosemide diuresis, calcitonin and bisphosphonates
Removal of Parathyroids or Tumour

42
Q

What causes Hypoparathyroidism?

A

Removal of Parathyroids during thyroid surgery
Autoimmune diseases
Mg deficiency

43
Q

What are the signs of Hypoparathyroidism?

A

Low blood Ca levels
Tremors
Tetany

44
Q

How do we treat Hypoparathyroidism?

A

High Ca diet

Vitamin D

45
Q

The adrenal cortex secretes:

A

Glucocorticoids
Mineralocorticoids
Sex Hormones

46
Q

Glucocorticoids are secreted in response to _________ which is secreted by the ________ pituitary. The major glucocorticoid is _________

A

Adrenocorticotrophic Hormone
Anterior Pituitary
Cortisol

47
Q

What are the 3 main actions of Glucocorticoids?

A
  1. Raise blood glucose by decreasing use by non-essential tissues and promote fat breakdown and use for energy
  2. Inhibit protein synthesis and promote the conversion of proteins to glucose in the liver
  3. Suppress inflammation reaction
48
Q

What are the functions Mineralocorticoids?

A
  • Balance water and electrolytes by promoting Na and water resorption
  • Promote K excretion
  • Increase Blood Volume
49
Q

The major mineralocorticoid is _________. It is secreted in response to a reduction in _________ and _________. It acts to increase Na and Water resorption.

A

Aldosterone

Renal blood pressure and flow

50
Q

The adrenal medulla produces ____________ which stimulate the _________ nervous system. i.e. Adrenaline, Noradrenaline

A

Catacholamines

Stimulate the sympathetic NS

51
Q

Cushing’s Diseases is a caused by ____function of the adrenal _______. ______ levels of cortisol give rise to it.

A

Hyperfunction, adrenal cortex

Excess levels of cortisol

52
Q

What are the signs and symptoms of Cushing’s Disease:

A 
Weight gain
Headache
Thirst
Muscle Weakness
Lethargy/depression
Abdominal pain
Hypertension
Osteoporosis
53
Q

Cushing’s disease can be ACTH dependent or ACTH independent. Explain the differences

A

ACTH dependent cases are caused by over production of ACTH by a pituitary tumour

ACTH independent cases are caused by adrenal adenomas or carcinomas

54
Q

To diagnose Cushing’s disease a ____________ test is performed. If cortisol levels are ______ a day then they have Cushing’s disease.

A

24 hour urine test

300ug/day

55
Q

After cushing’s disease is confirmed, ACTH levels are measure at ___, at this time ACTH levels are usually ____. If ACTH levels are greater than ____ per mL then it is ACTH __________. If ACTH levels are less than ___ per mL then it is ACTH __________.

A

4pm, levels usually low

10pg per mL, Dependent

5pg per mL, Independent

56
Q

What are the principle treatments for Cushing’s disease?

A

Reduce the overdose of glucocorticoids
Inhibit glucocorticoid synthesis
Surgery to remove tumours

57
Q

Addison’s disease is a condition caused by _________ production of ______ steroids

A

Insufficient

Adrenal

58
Q

What causes Addison’s disease?

A

Destruction of the adrenal cortex

Usually Autoimmune but can be due to infection, surgery, neoplasia, haemorrhage and trauma

59
Q

_______ to the adrenal cortex bring about destruction of the adrenal glands

A

Antibodies

60
Q

There are 3 Adrenal Cortex Antibodies(ACAs) what are they?

A
  • Antibodies to steroid 21 hydroxylase (21-OH) which is the most common and specific one
  • Antibodies to steroid 17 hydroxylase (17-OH)
  • Antibodies to cytochrome P-450, They are not specific because they are found in other tissues
61
Q

Children have a ____ risk of developing Addison’s disease compared to adults. When they express ____ they have a __% chance of developing Addison’s.

A

High
ACAs
30

62
Q

Destruction of the adrenal cortex results in __________ of the feedback inhibition of the _________ and ________

A

Interruption

Hypothalamus and Ant. Pit.

63
Q

To diagnose Addsion’s disease ______ electrolyte levels are measured. __________ is most common (90% of patients) finding because aldosterone levels are low. _________ is found in 60-70% of patients.

A

Serum electrolytes
Hyponatremia
Hyperkalemia

64
Q

Serum cortisol levels are at their highest between ___ and ___

A

6am and 8am

65
Q

What are some tests for Addison’s disease?

A

The corticotropin (Cortrosyn) stimulation tes
Insulin tolerance test
Metyrapone test

66
Q

What are the main treatments for Addison’s disease?

A

Replacement of Mineralocorticoids and Glucocorticoids

67
Q

What are some medicines used to restore corticosteroid levels?

A

Cortone
Cortef
Florinef
Dexone

68
Q

How do we ascertain the level of mineralocorticoid replacement needed?

A

Monitoring electrolyte levels

Evaluating clinical findings like dizziness and weight gain

Pathology 2210 (20 decks)

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