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Phase 2 Revision > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the role of the endocrine system?

A

To maintain a homeostatic environment through hormones

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2
Q

How does a hormone work?

A

Post stimulus, the endocrine system will release a hormone into the bloodstream to target cell where they bind to specific receptors for a long term slow response

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3
Q

What are the 3 types of signalling?

A

Endocrine - signalling using the circulatory system to receptor elsewhere
Paracrine - signalling to a neighbouring cell
Autocrine - signalling on the signalling cell

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4
Q

What are the 3 types of hormones? Where do they bind?

A

Amino Acid Derivative - bind to receptors on plasma membrane
Peptide Hormone - bind to receptor on plasma membrane
Lipid Derivative (steroid / thyroid hormone) - hydrophobic so usually lipid bound, bind to receptor in cytoplasm

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5
Q

What endocrine cell secretes glucagon?

A

Alpha Cell on the pancreas

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6
Q

Where does glucagon go when secreted from the pancreas?

A

To the liver

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7
Q

What type of hormone is glucagon?

A

AA or peptide

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8
Q

What is the effect of glucagon binding?

A

It stimulates the liver to breakdown glycogen to secrete glucose into blood to raise blood glucose levels

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9
Q

What hormones does the Hypothalamus produce?

A

ADH, oxytocin and regulatory hormones

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10
Q

What do the regulatory hormones do?

A

Regulate the hormones of the anterior lobe of the pituitary gland

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11
Q

What hormones does the posterior pituitary secrete?

A

Oxytocin and ADH

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12
Q

What hormones does the anterior pituitary secrete?

A

Produces and secretes ACTH, TSH, GH, FSH, LH and Prolactin, but only once hypothalamus has secreted regulating hormones to stimulate the release

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13
Q

What does the pineal gland secrete?

A

Melatonin

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14
Q

What does the thyroid gland secrete?

A

Thyroid hormones - T3 (triiodothyronine), T4 (thyroxine)

Calcitonin

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15
Q

What does the parathyroid gland do?

A

Regulates calcium and phosphate

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16
Q

What does the thymus secrete

Hint: after atrophy in adults

A

Thymosin

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17
Q

What hormone does the heart secrete?

A

Natriuretic peptide

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18
Q

What hormones does the digestive tract secrete?

A

Gastrin, somatostatin, secretin, CCK, GIP, VIP

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19
Q

What hormones does the pancreas secrete?

A

Insulin and glucagon

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20
Q

What hormones does the adrenal cortex release?

A

Cortisol and aldosterone

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21
Q

What hormones does the adrenal medulla secrete?

A

Adrenaline and noradrenaline

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22
Q

What hormones does the kidney secrete?

A

Erythropoietin and calcitriol

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23
Q

What hormone does adipose tissue secrete?

A

Leptin

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24
Q

What hormones do the testis secrete?

A

Androgens (testosterone) and Inhibin

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25
Q

What hormones do the ovaries release?

A

Oestrogen, progesterone and inhibin

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26
Q

What is the role of ADH?

A

Targets kidney tubules for water retention (regulation)

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27
Q

What is the role of oxytocin?

A

Human behaviour

Reproduction (contraction of uterus in childbirth and targets breast for lactation)

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28
Q

What is the role of ACTH?

A

Regulates cortisol

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29
Q

What is the role of TSH?

A

Stimulates thyroid to release hormones

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30
Q

What is the role of GH?

A

Growth

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31
Q

What is the role of Prolactin?

A

Breast development

Milk production

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32
Q

What is the role of FSH?

A

Regulate the role of the ovaries and testis and gonadotropic regulating behaviour
Growth
Puberty
Reproduction

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33
Q

What is the role of LH?

A

Ovulation

Formation of corpus luteum

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34
Q

What is the role of T3 & T4?

A

Metabolism
Temperature
HR

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35
Q

What is the role of calcitonin?

A

Regulates calcium and phosphate

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36
Q

What is the role of melatonin?

A

Sleep

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37
Q

What is the role of PTH?

A

Regulation of calcium and phosphate

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38
Q

What is the role of thymosin?

A

T cell production

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39
Q

What is the role of natriuretic peptide?

A

Blood pressure regulation

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40
Q

What is the role of gastrin?

A

Stimulates gastric acid secretion and aids motility

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41
Q

What is the role of somatostatin?

A

Inhibits GH

Affects neurotransmission / cell proliferation

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42
Q

What is the role of secretin?

A

Regulates water homeostasis

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43
Q

What is the role of CCK (cholecystokinin)?

A

Stimulates digestion of fat and protein

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44
Q

What is the role of GIP (gastric inhibitory peptide)?

A

Stimulates insulin secretion

Minor role in inhibiting gastric acid secretion

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45
Q

What is the role of VIP (vasoactive intestinal peptide)?

A

Vasodilation
Muscle regulation
Epithelial cell secretion

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46
Q

What is the role of insulin?

A

Lower blood glucose

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47
Q

What is the role of glucagon?

A

Increase blood glucose

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48
Q

What is the role of erythropoietin?

A

Stimulate RBC production in bone marrow

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49
Q

What is the role of calcitriol?

A

Active form of vit D, increases calcium

50
Q

What is the role of cortisol?

A 
Stress
can help with blood glucose
metabolism
inflammation
memory
51
Q

What is the role of aldosterone?

A

Sodium reabsorption

Potassium secretion

52
Q

What is the role of Adrenaline?

A

Fight or flight

53
Q

What is the role of noradrenaline?

A

Rest and digest

54
Q

What is the role of leptin?

A

Fat metabolism

55
Q

What is the role of testosterone?

A

Male characteristics

Sperm production

56
Q

What is the role of oestrogen?

A

Female characteristics

Egg production

57
Q

What is the role of progesterone?

A

Menstrual cycle

58
Q

What is the role of inhibin?

A

Inhibits FSH?

59
Q

What is the role of the thyroid gland?

A

To produce TH for regulating metabolism

60
Q

Where is the thyroid?

A

Below the hyoid and larynx, superior to the trachea

61
Q

What is the blood supply for the thyroid?

A

Superior and inferior a thyroid artery, a branch off the aorta

62
Q

What connects the 2 lobes of the thyroid gland together?

A

The isthmus

63
Q

What part of the thyroid produces T3and T4?

A

Follicular cells

64
Q

Explain the mechanism of TRH to increasing TH levels

A

Stimulus causes hypothalamus to secrete TRH to the anterior pituitary where TSH is released. TSH binds to GPCR on thyroid membrane and activates it, causing GTP to GDP and cause cAMP cascade, increasing TH levels

65
Q

Where is thyroglobulin synthesised? What happens after synthesis?

A

In the endoplasmic reticulum inside follicles. Golgi apparatus packages it up and into the colloid

66
Q

Why is thyroglobulin important in thyroid function?

A

It has many tyrosine molecules needed for the synthesis of T3 and T4

67
Q

Explain process of T3 and T4 production

A

By the aid of Na/I symporters, iodide gets from blood into follicular cell. Iodide then uses pendrine (I/Cl exchange transporter) to get into colloid. Peroxidase oxidises I- to I where it binds to a tyrosine ring (from the thyroglobulin). MIT (monoiodotyrosine) has one iodine attached to tyrosine, DIT (diiodotyrosine) has two iodine molecules attached. MIT&DIT / DIT&DIT can form ester bonds to create T3 or T4.

68
Q

How is T3 and T4 released from thyroglobulin structure?

A

Pinocytosis packages up the molecules into the follicular cells where lysosomes minds to endosomes with the thyroglobulin and release the tyrosine from the structure. T3 and T4 are released to separate and MIT / DIT molecules can be deionated to release and restart.

69
Q

What type of hormones are T3 and T4?

A

Lipid hormones - they travel in the blood attached to proteins

70
Q

Which hormone is secreted on higher quantities?

A

T4 (80%) but T3 is 10x more activated so T4 gets converted to T3 at target cells.

71
Q

What is the action of TH at the cell?

A

As lipids they can pass through the membranes easily and enter the nucleus where there are 2 receptors - retinoid X receptor, thyroid hormone receptor, which initiate transcription for mRNA response

72
Q

What is the effect of increasing metabolic rate?

A

Promote growth
CNS development
Metabolism - increased o2 consumption, increased glucose absorption, increased gluconeogenesis, increased glycogenolysis, increased lipolysis, increased protein synthesis and increased BMR.
Cardiovascular -increased cardiac output, increased heart rate, increased respiration

73
Q

What is the blood supply / drainage of the kidneys?

A

Abdominal aorta supplies the kidneys with blood, the renal veins drain into the inferior vena cava

74
Q

General anatomy surrounding the kidneys

A

Ureter leaves kidneys and enters bladder to store urine
Adrenal glands sit above the kidney
Liver is superior to the right kidney
Diaphragm sits above the liver and separates the thoracic and abdominal cavities

75
Q

What does erythropoietin do in the kidneys?

A

During hypoxia,the kidneys produce erythropoietin which stimulates erythropoiesis - production of RBC, increasing O2 carrying capacity

76
Q

What do the kidneys do in response to a decrease in BP?

A

Produces Renin (enzyme) which converts angiotensinogen (produced by liver) to angiotensin I. This is not very potent so travels to the lungs and ACE converts it into angiotensin II which increases BP.

77
Q

What happens in the kidneys during hypocalcaemia?

A

Parathyroid releases PTH. Liver produces calcidiol which travels via the blood to the kidneys. PTH stimulates calcidiols conversion to calcitriol (active form of vit D) and it targets:
the intestine - increases calcium and phosphate absorption
the bone - increases bone resorption for increased calcium
kidney nephrons - increases reabsorption of calcium

78
Q

What is another effect of calcitriol on the body

A

immune system - induces immune cell differentiation

79
Q

Explain the adrenal medulla

A

It is the centre of the adrenal gland. It is stimulated by sympathetic nerves from the spinal cord to secrete adrenaline and noradrenaline. Increase in these hormones will increase in the fight or flight response in acute stress.

80
Q

Explain the adrenal cortex

A

The adrenal cortex has three layers:
The glomerulosa - most external, produces mineralcorticoids such as aldosterone
The fasciculata - in the middle, produces glucocorticoids such as cortisol
The reticularis - the most internal, produces androgens
These are responses to long term stresses

81
Q

What is the process for adrenal cortex to release its hormones?

A

Long term stresses cause the hypothalamus to release corticotropin releasing hormones which target the anterior pituitary releasing ACTH. acth enters circulation and targets the cortex stimulating it release its hormones. Glucocorticoids provide the negative feedback to the hypothalamus.

82
Q

Explain aldosterone action when there is a decrease in BP

A

A drop in BP causes sodium and water reabsorption, and potassium secretion in exchange which increases blood pressure. Aldosterone secreted from the glomerulosa of the adrenal cortex stimulates the process primarily working in the DCT and CD of nephrons. It also aids in the secretion of the K+.

83
Q

Explain the role of glucocorticoids

A

Responsible for the negative feedback. It stimulate the liver to make more glycogen stores, gluconeogenesis, protein catabolism, induces insulin resistance and increases fat deposition. This increases glucose until its shunted out if the liver and into the bloodstream and hyperglycaemia

Cortisol also increases blood pressure and suppresses immune system to decrease pain sensation but increases risk of infection. It also increases osteoclasts activity in bone leading to osteopenia and increased risk of osteoporosis. Large role in stress

84
Q

What are androgens effects on the body?

A

Promote prostate growth and masculine features in men
Important for libido in women, increased androgens means decreased libido.
Minimal link to stress

85
Q

How does ATII respond to a decrease in BP?

A

Decrease in BP decreases filtration rate and pressure in afferent arterioles of nephrons which stimulates renin release from juxtaglomerular cells to stimulate the RAAS system. ATII is the final product and stimulates the zona glomerulosa to secrete aldosterone to increase BP.

86
Q

What controls the Hypothalamic Pituitary Thyroid Axis?

A

HPTA is under the control of neurons in the medial region of the paraventricular nucleus of the hypothalamus (PVN) that synthesises and releases TRH into the pituitary portal circulation. Negative feedback of TH control TRH / TSH levels to maintain HPTA. inaccurate levels of TH affect TRH and TSH inversely proportionately

87
Q

How does TSH enter thyroid follicles?

A

Through the rich capillary blood supply surrounding them

88
Q

What produces calcitonin?

A

The parafollicular (c) cells

89
Q

What is the diancephalon?

A

The caudal (posterior) part of the forebrain!containing the epithalamus, thalamus, hypothalamus and ventral thalamus, and the third ventricle

90
Q

Where is GnRH released from?

A

The hypothalamus

91
Q

What does GnRH do?

A

The anterior pituitary has blood vessels connecting it and the hypothalamus and the rest of the body. When the hypothalamus releases GnRH it travels in portal blood to AP to stimulate FSH & LH release

92
Q

Where do LH & FSH travel to in men?

A

The interstitial space surrounding the seminiferous tubules of the testes

93
Q

What cells are in the seminiferous tubules?

A

Leydig (interstitial) cells
Serotonin (nurse) cells
Spermatogonia (male germ cells) are also found here

94
Q

Explain the production and action of testosterone

A

LH enters interstitial space and targets leydig cells, causing them to secrete testosterone. Testosterone stimulates sertoli cells and bone and muscle growth, maintains libido, male secondary sex characteristics, accessory glands and organs of male reproductive system. Negative feedback prevents excessive LH release

95
Q

What does FSH do in men?

A

Targets sertoli cells, stimulating ABP (antigen binding protein) which promotes synthesis of spermatogenesis and spermogenesis. ABP binds to androgens within seminiferous tubules stimulating the sperm production. FSH has negative feedback controlled by inhibin - secreted by sertoli cells

96
Q

Where does LH & FSH travel to in women?

A

Eggs in the ovaries

97
Q

What is the role of the follicles in the ovaries?

A

Each month some mature, but only 1 will ovulate to produce an egg. This leaves many primordial follicles and some primary follicles in the ovary with 1 ovulating follicle, starting the menstrual cycle.

98
Q

What are the 2 phases of the menstrual cycle?

A

Follicular and luteal. Last 14 days each.

99
Q

Explain the changes in hormone concentrations over a month

A

An increase in GnRH from hypothalamus, causing an increase in LH and FSH.
FSH rises then falls. LH rises and remains steady.
FSH rises during follicular phase as it enters ovaries and stimulates follicle maturation (1° to 2°). Whilst maturing, follicles produce oestrogen which in the first ten days has a negative feedback on the pituitary, inhibiting LH at low concs, hence the steady level (despite GnRH stimulation). FSH is secreted primarily in response to low oestrogen so as it rises, FSH falls, hence the rise and fall.
After 10 days, oestrogen continues to rise but now has a positive feedback and stimulates LH secretion.

100
Q

What hormones does the ovaries produce?

A

Oestrogen, progesterone & inhibin.

101
Q

What is oestrogen important for?

A

Stimulating muscle, bone and endometrial growth, maintains female secondary characteristics and glands.

102
Q

What triggers ovulation?

A

The spike in LH from the change to positive feedback causes the most mature follicle to release the oocyte (egg).

103
Q

What happens after ovulation?

A

LH, GnRH and FSH will drop. The follicle will develop into corpus luteum (dead follicle). It is now the luteal phase (14 days)

104
Q

What occurs in the luteal phase?

A

The corpus luteum slowly degrades but also secretes oestrogen, progesterone and inhibin. At the 14th day the oestrogen will fall slightly as the inhibin and progesterone rises.
Don’t need follicle maturation so inhibin has a negative feedback of FSH. Progesterone has negative feedback on GnRH. This also affects LH and FSH, both decreasing.

105
Q

What is the main role of progesterone in women?

A

Endometrial growth - either to be shed or implanted egg. The degeneration of the corpus luteum allows new follicles to mature and its hormones decrease so progesterone is no longer inhibiting GnRH allowing it to rise again, starting a new cycle.
The now lack of progesterone means endometrial growth is no longer maintained (shedding).

106
Q

What is endometriosis?

A

The presence of endometrial glands and storms outside the endometrial cavity and uterus musculature

107
Q

What is the anatomy involved in endometriosis?

A

Vagina, cervix, fallopian tubes, uterus and ovaries
Endometrium is the innermost layer - closest to the uterine cavity, then myometrium and perimetrium
Myometrium has branches of uterine artery called spiral arteries which carry blood, hormones and nutrients into the endometrium

108
Q

What are the clinical signs of endometriosis?

A

Very bad periods, chronic fatigue, infertility, chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, painful defecation

109
Q

What are the 4 D’s of endometriosis (clinical signs)?

A

Dysmenorrhea, dyschezia, dysuria, dyspareuria

Painful periods, poo, pee, sex

110
Q

What are common differential diagnoses for endometriosis?

A

Adenomyosis
Fibroids
Pelvic inflammatory disease
Ovarian cysts

IBD
IBS
Interstitial cystitis

111
Q

What investigations are done for endometriosis?

A

Gold standard - Laproscopy

FBC - for infection, anaemia, U&E for kidney function
Abdominal & transabdominal ultrasound
MRI/CT

112
Q

What are the risk factors for endometriosis?

A 
Low birth weight
Early menarche
Short menstrual cycles
Late menopause
Red meat
Obesity
Chemical
Genetics
113
Q

Protective factors for endometriosis?

A

Omega 3
Fruit and Veg
Multiple pregnancies
Prolonged lactation

114
Q

What is the basic pathophysiology behind endometriosis?

A

Pituitary gland releases LH which induces ovulation - initiates egg release from the ovary on day 14. Upon no fertilisation, menstruation will occur in 14 days during which the ovaries are still producing oestrogen and progesterone. By day 28, hormone levels will drop allowing menstruation. In endometriosis, the ectopic tissue will also shed (dysmenorrhea).if it’s in bowel/rectum/genital tract/bladder you’ll also get dyschezia, dyspareuria or dysuria

116
Q

How does the retrograde menstruation theory work?

A

Endometrial tissue travels back up Fallopian tubes into peritoneal cavity during menstruation

117
Q

How does the vascular and lymphatic dissemination theory work?

A

Endometrial tissue moves via vasculature or lymphatics elsewhere

118
Q

How does the coelomic metaplasia of multipotent cell theory work?

A

Ectopic tissue comes from coelomic cells undergoing metaplasia (usually develop into peritoneum / ovary surface cells but instead go to endometrium cells but not present in uterus)

119
Q

How does the impaired immunity theory work?

A

It’s unknown

120
Q

In terms of pathology, what are the 3 types of endometrial tissue formation?

A

Ovarian lesion - ovarian cyst formed by ectopic tissue
Superficial peritoneal tissues - on pelvic organ / peritoneum, ‘gunshot’
Deep infiltrative endometrium - solid EM mass >5mm deep under peritoneal surface

121
Q

What is the management of endometriosis?

A

NSAIDs

Hormonal -
GnRH agonist: stimulates GnRH to stimulate oestrogen & progesterone to maintain endometrium (no periods)
Combined oral contraceptive pill: same as above
Prostagens: same as above
IUD (mirena): releases hormones locally to inhibit periods

Surgical -
Laparoscopic ablation (of ectopic EM tissues)
Open surgery with local resection
Hysterectomy +/- oopherectomy

122
Q

What are the complications of endometriosis?

A 
Infertility
Ovarian failure
Development of adhesions
Mental health issues
Autoimmune disease
129
Q

What are the 4 theories behind the pathophysiology of endometriosis?

A
  1. Retrograde menstruation
  2. Vascular and lymphatic dissemination
  3. Coelomic metaplasia of multipotent cell
  4. Impaired immunity

Phase 2 Revision (6 decks)

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