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Endocrine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the major endocrine glands of the body?

A

Thyroid, adrenal, pituitary (+ hypothalamus), calcium/ parathyroid

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2
Q

What are different types of hormones?

A

Proteins and peptides, steroids, tyrosine and tryptophan derivatives

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3
Q

What are different types of hormone receptors?

A

G-protein coupled receptors, receptor tyrosine kinase families, receptors associated with tyrosine kinase activity, steroid hormone receptors

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4
Q

What is the structure of G-protein coupled receptors?

A

7 transmembrane domain and associated G-protein complex

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5
Q

What is the function of G-protein coupled receptors?

A

Main sensors of internal environment and activation of a limited number of regulatory signalling cascades

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6
Q

What are many endocrine disorders associated with?

A

Defects in G-protein coupled receptors

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7
Q

What is the insulin receptor?

A

Receptor tyrosine kinase

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8
Q

What receptors are linked to tyrosine kinase activity?

A

Cytokine receptors

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9
Q

Where are steroid hormones typically located?

A

Intracellularly = either in cytoplasm or nucleus

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10
Q

How do steroid hormone receptors act?

A

Steroid/receptor complex binds DNA response elements = results in changes in gene transcription

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11
Q

What are some factors that influence the ability to accurately measure hormone levels?

A

Pattern of secretion, presence of carrier proteins, interfering agents, stability of hormone, absolute concentrations

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12
Q

What is the major determinant of hormone concentration?

A

Rate of secretion = typically determined by highly refined feedback loops

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13
Q

What are some commonly measured hormones?

A

Thyroid hormones, steroid hormone production, growth hormone evaluation, reproductive and sex hormones, prolactin, calcium and parathyroid hormone

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14
Q

What are more specialist hormone tests?

A

Renin/aldosterone, catecholamines, gut hormones

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15
Q

How is thyroid hormone measured?

A

Using highly sensitive TSH assay = relies on highly regulated feedback control

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16
Q

What do variations in thyroid hormone levels mean?

A

Raised TSH = hypothyroid

Lowered TSH = hyperthyroid

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17
Q

When is TSH an unreliable marker of thyroid hormone?

A

During pituitary dysfunction

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18
Q

What is sick euthyroid syndrome?

A

Non-thyroidal illness = characterised by low free hormone levels and inappropriately low/normal TSH

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19
Q

When is thyroid function measured in sick euthyroid syndrome?

A

When considered central to the clinical picture = of limited use in acutely unwell patient

20
Q

What does measuring 9am cortisol give an indication of?

A

HPA axis function (pituitary function)

21
Q

What are some markers used to measure pituitary function?

A

FT4, FT3, TSH, IGF1, LH, FSH, E2/testosterone, U & Es, plasma/urine osmolarity

22
Q

What are some tests that can be done to investigate pituitary function?

A

Dynamic tests = formal assessment of HPA axis

Imaging = MRI

23
Q

How is the growth hormone axis assessed?

A

Formal assessment requires dynamic assessment

IGF1 measurement may indicate GH hypertension

24
Q

What does the evaluation of female sex hormones depend on?

A

The timing in the menstrual cycle

25
Q

What secrets prolactin (PRL)?

A

Lactotroph cells of the anterior pituitary

26
Q

What controls prolactin release?

A

Under tonic inhibition by hypothalamic dopamine

Secretion regulated by a short loop negative feedback

27
Q

What mediates the effects of prolactin?

A

Prolactin receptor (PRLR)

28
Q

Why is it important to understand the principles of steroid hormone synthesis?

A

Helps to understand adrenal physiology and hormone production

29
Q

What can defects in steroid hormone synthesis cause?

A

Specific endocrine disorders

30
Q

Does biochemical testing occur before imaging is done?

A

Yes

31
Q

What is dynamic testing done for?

A

Hormone excess/deficiency = hormone excess gets suppression test, hormone deficiency gets stimulation tests

32
Q

What is imaging used for?

A

To localise or characterise disease

33
Q

When is combined imaging/biochemical testing used?

A

Adrenal vein sampling, petrosal sinus sampling

34
Q

What occurs due to cortisol deficiency?

A

Adrenal insufficiency = May be due to primary adrenal failure (eg Addison’s) or pituitary disease

35
Q

What may be a cause of cortisol excess?

A

Cushing’s syndrome

36
Q

What are some examples of dynamic tests?

A

Stimulation test = Synacthen test

Suppression test = dexamethasone suppression test

37
Q

What are some features of Cushing’s syndrome?

A

Cushingoid facies, acne, hirsutism, abdominal striae, centripedal obesity, intracapsular and supraclavicular fat pads, proximal myopathy, osteoporosis, hypertension, impaired glucose tolerance

38
Q

What are the different forms of Cushing’s syndrome?

A

Cushing’s disease, ACTH independent Cushing’s, ectopic ACTH, exogenous steroids

39
Q

What are some features of Cushing’s syndrome?

A

Pituitary origin, rumour arising from corticotroph cells of anterior pituitary, most common form, more common in females, most are microadenomas

40
Q

What occurs in ACTH independent Cushing’s?

A

Bilateral macronodular adrenal hyperplasia = causes by adrenal adenoma/carcinoma

41
Q

What is the main cause of ectopic ACTH?

A

Malignancy

42
Q

What screening tests are done for Cushing’s syndrome?

A

1mg overnight dexamethasone suppression test, 24hr urinary free cortisol, midnight cortisol

43
Q

What is the formal diagnostic test done for Cushing’s syndrome?

A

Low dose dexamethasone suppression test = lack of suppression means positive for Cushing’s

44
Q

How does measuring ACTH help diagnose Cushing’s syndrome?

A

ACTH low = adrenal origin likely

ACTH raised = need more investigations to determine between Cushing’s syndrome and ectopic ACTH

45
Q

What does a rise in cortisol and ACTH on CRH tests indicate?

A

Pituitary source of Cushing’s syndrome

46
Q

Why is an MRI of the pituitary done in suspected Cushing’s syndrome?

A

To evaluate the pituitary gland

Imaging also done for possible ectopic ACTH

47
Q

When is inferior petrosal sinus sampling done in Cushing’s syndrome?

A

Used to lateralise tumour prior to surgery

Endocrine (42 decks)

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