Endocrinology

Question 1

What is primary hypothyroidism caused by?

Answer 1

Problems with the thyroid gland

Question 2

What is secondary hypothyroidism caused by?

Answer 2

Problems with the pituitary gland

Question 3

What is tertiary hypothyroidism caused by?

Answer 3

Problems with the hypothalamus

Question 4

What are the three lobes of the anterior pituitary gland?

Answer 4

1. Anterior (distalis, tuberalis)
2. Intermediate (intermedia, nervosa)
3. Posterior (nervosa, infundibulum)

Question 5

Where does the pituitary gland sit?

Answer 5

Pituitary fossa in sphenoid bone

Question 6

What can cause bitemporal hemianopia?

Answer 6

Compression of optic chasm due to a sella/suprasellar mass

Question 7

What are the 6 hormones of the anterior pituitary?

Answer 7

ACTH, GH, PRL, TSH, FSH, LH

Question 8

How does endocrinopathology clinically present?

Answer 8

Mass lesion (headache, vision problems)
Hypopituitarism (fatigue, weight gain etc.)

Question 9

How is pituitary hypo function tested?

Answer 9

Measure pituitary hormone
Measure target hormone
Insulin tolerance test

Question 10

What does high TSH indicate in hypothyroidism?

Answer 10

Primary hypothyroidism (thyroid gland)

Question 11

What does low TSH indicate in hypothyroidism?

Answer 11

Secondary hypothyroidism (pituitary gland)

Question 12

Why are prolactin levels high in pituitary tumour patients?

Answer 12

Pituitary tumours prevent dopamine production - dopamine normally inhibits
prolactin production

Question 13

What are the classes of pituitary tumour?

Answer 13

Size (microadenoma vs macro adenoma)

Functioning vs non functioning

Question 14

What does a GH functioning tumour present as?

Answer 14

Acromegaly

Question 15

What does an ACTH functioning tumour present as?

Answer 15

Cushing’s syndrome

Question 16

What does a PRL functioning tumour present as?

Answer 16

Galactorroea (milk production outside of pregnancy)

Amenorrhoea

Question 17

What does a TSH functioning tumour present as?

Answer 17

Thyrotoxicosis (hyperthyroidism)

Question 18

What is the treatment for a pituitary tumour?

Answer 18

Conservative
Surgery
Medical
Radiotherapy

Question 19

Which hormones are tyrosine derivatives?

Answer 19

Dopamine
Thyroxine
Adrenaline/noradrenaline

Question 20

Which proteins are glycoproteins?

Answer 20

TSH
LH
FSH
hCG

Question 21

Which hormones are steroid hormones?

Answer 21

Mineralocorticoids
Glucocorticoid
Sex steroids

Question 22

Which 3 hormones does the thyroid gland produce?

Answer 22

Calcitonin
T3
T4

Question 23

How do catecholamines and peptide hormones circulate?

Answer 23

Free form (hydrophilic)

Question 24

How do thyroid hormones and steroid hormones circulate?

Answer 24

In a bound form (hydrophobic)

Question 25

How are catecholamines and peptide hormones stored?

Answer 25

Secretory granules/vesicles

Question 26

How are thyroid hormones stored?

Answer 26

In colloid as part of thyroglobulin

Question 27

How are steroid hormones stored?

Answer 27

Not stored (made on demand)

Question 28

Which 2 hypothalamic hormones control prolactin release?

Answer 28

1. Thyrotropin releasing hormone (excitatory) | 2. Dopamine (inhibitory)

Question 29

How does suckling result in oxytocin release?

Answer 29

Activation of nipple mechanoreceptors --> inhibits dopamine release --> activates neutrons producing oxytocin

Question 30

What is hyperprolactinaemia?

Answer 30

High prolactin levels Symptoms: galactorrhea, gynaecomastia, infertility Treated with D2 agonits.

Question 31

At what stages of life does the thyroid gland enlarge?

Answer 31

Adolescence Pregnancy/lactation At end of menstrual cycle

Question 32

What is the blood supply to the thyroid gland?

Answer 32

Superior and inferior thyroid arteries (from external carotid and subclavian)

Question 33

Which gland concentrates iodine in the body?

Answer 33

Thyroid gland

Question 34

What is the mechanism of action of thyroid hormones?

Answer 34

Interaction with nuclear receptors

Question 35

What are some symptoms of hypothyroidism?

Answer 35

Cold intolerance Weight gain Constipation

Question 36

What are possible causes of hypothyroidism?

Answer 36

Hashimoto's thyroiditis | Also chemo/hyper treatment

Question 37

What levels of of TSH, T4 and T3 indicate Hashimoto's thyroiditis?

Answer 37

TSH - high fT4 - low T3 - low

Question 38

What is a goitre?

Answer 38

Increase in size of thyroid gland often due to iodine deficiency

Question 39

What are some symptoms of hyperthyroidism?

Answer 39

Sweating Heat intolerance Fatigue Eye protrusion

Question 40

What are possible causes of hyperthyroidism?

Answer 40

Graves' disease (most common) | Could also be toxic thyroid nodule/tumour

Question 41

How is Graves' disease diagnosed?

Answer 41

Antibodies/thyroid uptake scan

Question 42

How is hyperthyroidism treated?

Answer 42

Antithyroid drugs/radioiodine/surgery

Question 43

How is cortisol synthesis regulated?

Answer 43

Hypothalamus releases CRH --> corticotrophs in anterior pituitary release ACTH --> adrenal cortex makes cortisol

Question 44

What are the effects of cortisol?

Answer 44

Hyperglycaemia Muscle wasting Osteoporosis

Question 45

What are some disadvantages of steroids?

Answer 45

Can suppress immune response Can contribute to osteoporosis Can cause iatrogenic Cushing's syndrome

Question 46

What is Addison's disease?

Answer 46

Chronic adrenal insufficiency (hypo function).

Question 47

What is primary adrenal insufficiency?

Answer 47

Destruction of adrenal cortex (lack of cortisol)

Question 48

What is secondary adrenal insufficiency?

Answer 48

Lack of ACTH

Question 49

What are the clinical features of Addison's disease?

Answer 49

Weakness/fatigue Hyperpigmentation Postural hypotension GI disturbances

Question 50

What are signs of malignant nodules of thyroid on US?

Answer 50

Microcalcification Hypoechoic Solid/large Irregular margin

Question 51

What are risk factors for thyroid cancer?

Answer 51

Radiation exposure Family history Hashimoto's thyroiditis Cowden's syndrome

Question 52

How does thyroid cancer clinically present?

Answer 52

Lump in neck with sudden pain Enlarging mass Unexplained hoarse voice

Question 53

What is pheochromocytoma?

Answer 53

A rare tumour of the adrenal medulla, which secretes noradrenaline/adrenaline.

Question 54

What is Conn's syndrome?

Answer 54

Too much aldosterone (often caused by benign adrenal adenoma)