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Y1 IMS > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the main endocrine glands

A 
Hypothalamus
Pituitary
Thyroid
Parathyroid
Pancreas
Adrenal
Ovaries/testicles
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2
Q

What is the pituitary gland and what are its two lobes

A

Controls most glands in the body
Found in the brain just below the hypothalamus
Anterior produces various hormones
Posterior stores various hormones

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3
Q

What hormones are produced by the anterior lobe of the pituitary

A

Growth hormone: for skeletal growth
ACTH: stimulate adrenals to produce steroids
Gonadotophins (FSH and LH): stimulate the testicles and ovaries to produce sex hormones
Thyroid stimulating hormone (TSH): stimulates the thyroid to produce thyroid hormones
Prolactin (PRL): stimulates breast milk production

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4
Q

What hormones are stored in the posterior lobe of the pituitary gland

A 
Antidiuretic hormone (ADH): stimulates water reabsorption by the kidneys
Oxytocin: helps uterine contractions during labour
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5
Q

What hormones are released by the hypothalamus

A

Corticotrophin releasing hormone (CRH) which stimulate ACTH secretion
Growth hormone releasing hormone (GHRH) which stimulates GH secretion
Thyrotrophin releasing hormone (TRH) which stimulates TSH secretion
Gonadotrophin releasing hormone (GnRH) stimulates FSH and LH secretion

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6
Q

How is prolactin secretion controlled

A

It is under an inhibitory effect of the hypothalamus

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7
Q

How are pituitary hormones switched off

A

Negative feedback which acts on pituitary and hypothalamus

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8
Q

What glands and hormones are not controlled by the pituitary

A

Adrenal medulla: produce adrenaline and noradrenaline
Parathyroid: controls calcium levels
Pancreas: controls sugar levels
Gut hormones

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9
Q

What is the thyroid composed of

A

Midline isthmus( just below the cricoid cartilage)
Right lobe
Left lobe

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10
Q

What are the characteristics of thyroid hormones and cells

A

Thyroid cells are arranged in follicles and produce thyroid hormones
Thyroid contains C cells which produce calcitonin
Thyroid hormones interact with their receptors in various organs, regulating gene expression and aspects of organ function
T3 is active and T4 is inactive

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11
Q

What organs are involved in calcium metabolism and how

A

Parathyroid: main glands controlling calcium metabolism
Kidneys: calcium excretion and production of active vitamin D
Gut: Absorption of calcium
Bone: storage of calcium
Thyroid: produce calcitonin

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12
Q

What are the two parts of the adrenal gland

A

CONTROLLED BY PITUITARY: Adrenal cortex: Corticosteroids (cortisol), Androgens (male hormones)
Mineralocorticoid (aldosterone) consolle by renin angiotensin system
NOT CONTROLLED BY PITUITARY (related to blood pressure):Adrenal medulla: Catecholamines (adrenaline, noradrenaline and dopamine)

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13
Q

What are the characteristics of the ovaries

A

Situated in the pelvis on either side of the uterus
Contain follicles containing oocyte at different stages of maturation
Stimulated first half of cycle by more FSH, second half of cycle by more LH
Secrete Inhibin (negative feedback), oesradiol (1st half) ,progesteron (2nd half)

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14
Q

What is testicular maldescent

A

When the testicles remain in the pelvis and don’t descend into the scrotum

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15
Q

What are the testicles composed of

A

Interstital/leydig cells: produce testosterone
Seminiferous tubules: made up of germ cells producing sperm
Sertoli cells: help in sperm production and produce inhibin
FSH controls sperm production
LH controls testosterone production

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16
Q

What are types of abnormalities within the glands

A

Hormonal over secretion
Hormonal under-secretion
Primary: problem with gland itself
Secondary problem with gland controlling the gland itself
Tumour/nodules int the gland without affecting hormone secretion

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17
Q

What are static tests

A

One blood test and immediately diagnosis hormonal over or under secretion

18
Q

How is primary hyperthyroidism diagnosed in static test

A

Elevated T3 and/or T4

Suppressed TSH

19
Q

What is a stimulation test

A

For suspected hormonal under-secretion where static test is not enough
Is individual fails to respond to a stimulation test then gland failure is diagnosed

20
Q

What are examples of stimulation tests

A

Synacthen test
Glucagon stimulation
Insulin stress test

21
Q

What are suppression tests used for

A

Some hormonal over-secretion

22
Q

What are examples of suppression tests

A

Giving steroids and testing for endogenous steroid production (healthy person this would be switched off)
Giving glucose and testing GH secretion (glucose switches of GH secretion in normal individuals)

23
Q

What tens to cause over and under secretion

A

Over-secretion: benign tumours
Under-secretion:gland destruction due to: inflammation, infarction, other
Both can be caused by tumours/nodules with normal hormone production

24
Q

What is prolactin over-secretion

A

Due to prolactin secreting tumour
Increased breast milk production (galactorrhea)
Amenorrhea (irregular periods)
Sexual dysfunction in men
Headaches and visual field problems in large tumours
Diagnosed by static test

25
Q

What can cause mildly raised prolactin

A

Sexual intercourse
Nipple stimulation
Stress
Large number of drugs including antipsychotics and antidepressants
Non-functioning pituitary tumour, compressing the hypothalamus and interfering with the inhibitory effect on prolactin secretion

26
Q

What is the result of growth hormone over-secretion

A

In child: excessive growth spurt and increased size of feet and hands; if left untreated leads to gigantism

In adult: affects the skin, soft tissue and skeleton; acromegalic face; wide and large hands/ feet; increased sweating

27
Q

What causes Cushing’s syndrome

A

Pituitary secreting ACTH tumour (Cushing’s disease)
Adrenal tumours secreting cortisol
Cancers producing ACTH (such as lung cancers)

28
Q

How does Cushing’s present

A

Growth arrest in children
Face: Round, Acne, Hirsuitism
Fat redistribution: truncal obesity, thin extremities
Skin abnormalities: thin skin, easy bruising, striae on abdomen
Complications: hypertension, diabetes, high risk of infection, poor wound healing

29
Q

What are the causes of hyperthyroidism

A

Graves’ disease: Genetic autoimmune condition, 80%
Toxic nodule or toxic multi-nodule-goitre, 15%
Thyroiditis, 1%
Drug induced: amiodarone
Rarities

30
Q

How do people with hyperthyroidism present

A 
Hyperactivity
Irritability
Insomnia
Heat intolerance and increased sweating
Palpitations
Weight loss despite overeating
Menstrual problems
Can have thyroid eye disease (swelling, paralysis, proptosis) if Graves' disease
31
Q

How do you examine hyperthyroidism

A 
Hand tremor
Increased sweating
Fast pulse
Inspection of thyroid: Enlarged: 
Smooth: Graves' disease
Nodular: toxic nodule
Tender: thyroiditis
32
Q

What is the treatment for hyperthyroidism

A

Anti-thyroid drugs:
Disease remission in 50% of patients after treatment for 6-18months, can rarely suppress white cell production
Radioactive iodine: destroys the thyroid gland
Surgery

33
Q

What are the characteristics of growth hormone deficiency

A

Children: failure to grow
Adults: no symptoms, tiredness, depression

34
Q

How is growth hormone treated

A

Injections of growth hormone replacement, very expensive

35
Q

How do patients with steroid under-secretion present

A 
Failure to grow in children
Severe tiredness
Dizziness due to low blood pressure
Abdominal pain
Vomiting in diarrhoea
36
Q

What are the symptoms of hypothyroidism

A 
Weakness and dry skin
Sensation of cold and decreased sweating
Impaired memory
Constipation
Weight gain
Hair loss
37
Q

What causes pituitary failure

A

Large tumour
Infarction
Something else

38
Q

How to test for pituitary failure

A

Test biochemically -> Static tests -> dynamic tests -> image pituitary last

39
Q

How do steroid and thyroid hormones alter the cellular activity

A

Act within the nucleus to alter gene transcription, switching genes on and off
Binding of hormones to proteins and the binding of the receptor-hormone complex (a transcription factor) to specific DNA sequences

40
Q

What is the clinical relevance of nuclear hormone receptors

A

They are drug targets

41
Q

What do steroid hormones derive from

A

Cholesterol

42
Q

What do thyroid hormones derive from and where are they synthesised

A

Tyrosine in the thyroid gland

Y1 IMS (9 decks)

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