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I&I SC2 > Immuno-endocrinology > Flashcards

Immuno-endocrinology Flashcards

Thymus, thyroid and bone

1
Q

The thymus declines in time. How many percent remains and can enlarge again?

A

10%, can enlarge again

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2
Q

What happens with the feedback system when testosterone levels are very high?

A

Suppression of pituitary stimulating hormones

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3
Q

Name an example of a hormone that is produced by the thymus

A

LH

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4
Q

Why do you need your thymus for selection?

A

Selection between self- and non-self

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5
Q

You have to get rid of more then 90% of your lymphocytes, why? (2)

A
  • Autoreactivity
  • Bind with too much affinity to their receptor
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6
Q

How do you call an autoimmune disease in which the endocrine system is involved?

A

Polyendocrine autoimmune disease

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7
Q

Name and autoimmune disease in which a genetic defect affects the thymic function

A

Polyglandular autoimmune syndrome

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8
Q

In what process in substance P involved?

A

Pain

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9
Q

In which diseases does substance P play a role? (5)

A
  • Migraine
  • Chronic obstructive lung disease
  • Arthritis
  • Cystitis
  • IBD
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10
Q

What does the ‘P’ in substance P stand for?

A

Powder

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11
Q

Substance P is produced by?

A

Neurones

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12
Q

What is the advantage of radio labeling substance P?

A

When the peptide goes to search for its receptor and finds it, accumulation of radioactivity happens which can be imaged

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13
Q

Name an example of connection between your neural- and immune system

A

Radiolabeled substance P that is released by neurons bind to receptors in the thymus

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14
Q

What is the function of somatostatin?

A

Excites brain, but inhibits the release of hormones

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15
Q

What is special about the receptors for somatostatin and cortistatin?

A

They are also expressed in the immune system (Thymus, and often spleen)

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16
Q

What happens to the receptors for neuropeptides during the development from stem cell to effector cell in the thymus?

A

They change

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17
Q

Name and example of immune cell type that can be stimulated by neuropeptides

A

Thymocytes

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18
Q

Which kind of dysregulations are associated with an enlarged thymus (thymoma)? (2)

A
  • Immune dysregulation (including humoral and cellular immunodeficiency and autoimmune disease)
  • Endocrine dysregulation
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19
Q

Which three categories of thymoma’s occur in humans?

A
  • Lymphocytic
  • Epithelial
  • Mixed
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20
Q

Which catagory of thymoma occurs the most in humans?

A

Mixed

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21
Q

Which genetic defect is causing polyglandular autoimmune syndrome?

A

Autoimmune regulator (AIRE) deficiency

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22
Q

What can cause enlargement of the thymus during autoimmune disease?

A

Stimulation of the thymus by (for example) overproduction of thyroid hormones

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23
Q

Grave’s disease stimulates/inhibits your thyroid?

A

Stimulates

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24
Q

What is good syndrome?

A

Rare association of thymoma/increased thymus and immunodeficiency (immune dysregulation syndrome)

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25
Q

Immune dysregulation consists of.. (4)

A
  • Immune deficiency
  • Auto immunity
  • Allergy
  • Auto-inflammation
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26
Q

Name clinical manifestations in Good’s syndrome (4)

A
  • Thymoma
  • Infections
  • GI disease
  • Autoimmune disease
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27
Q

The principal immunological findings in Good’s syndrome are… (6)

A
  • Hypogammaglobulinemia
  • Few or absent B cells
  • Abnormal CD4:CD8 ratio
  • CD4 T cell lymphopenia
  • Impaired T cell mitogenic response
  • Cutaneous anergy
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28
Q

During T cell development in the thymus, the receptor of which hormone is expressed?

A

Thyroid stimulating hormone (TSH)

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29
Q

What is the function of TSH in T cell development?

A

TSH stimulates T cell development –> more differentiation

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30
Q

Which syndrome occurs when you have too much growth hormone?

A

Acromegaly

31
Q

Describe the link between thymectomy and Ulcerative Colitis

A

After thymectomy, the percentage of patients in remission increases

32
Q

What causes autoimmune disease?

A

Loss of tolerance

33
Q

Which two categories of autoimmune diseases exist?

A
  • Systemic
  • Organ specific
34
Q

Name examples of systemic autoimmune diseases (3)

A
  • Systemic lupus erythematosus (SLE)
  • Rheumatoid arthritis (RA)
  • Systemic sclerosis
35
Q

Name examples of organ specific autoimmune diseases (3)

A
  • Diabetes mellitus type 1
  • Autoimmune hepatitis
  • Autoimmune thyroid disease
36
Q

What are the most common clinical expressions of autoimmune thyroid dysfunction? (2)

A
  • Hashimoto’s thyroiditis (HT)
  • Graves’ disease
37
Q

Which three structures can be found in healthy thyroid tissue?

A
  • Thyroid follicle
  • Colloid
  • Follicular cells
38
Q

Of what does a follicle consist?

A

Colloid + surrounding follicular cells

39
Q

What is the function of the colloid?

A
40
Q

What is the function of the thyroid hormone T4?

A

Regulates a.o. metabolism, mood, and body temperature

41
Q

What is the function of the thyroid hormone T3?

A

Regulates metabolism, digestive tract, and bone health

42
Q

How is the thyroid hormone regulated?

A

THR (hypothalamus) –> TSH (pituitary) –> T4 (thyroid) –> inhibits production of THR and TSH

43
Q

What is the immunopathophysiology of Hashimoto?

A
  • Massive T/B-lymphocyte and NK cell infiltrate
  • Locally activated Tg-specific T-lymphocytes
  • Autoantibodies to Tg and TPO
  • Immune cells cause damage to thyroid tissue
44
Q

Which immune cells play a role in Hashimoto? (3)

A
  • Auto-reactive CD4+/CD8+ T cells
  • Macrophages induce damage to thyrocytes
  • NK cells
45
Q

What is the immunopathophysiology of Graves’ disease? (4)

A
  • Limited immune cell (T lymphocyte) infiltrate
  • Locally activated TSH receptor specific T-lymphocytes
  • Stimulating autoantibodies against TSHR
  • Limited thyroid destruction
46
Q

What is thyroglobulin (Tg)? What do you see during immunofluorescence?

A

Precursor protein for thyroid hormone -> thyroid follicles completely green

47
Q

What is thyroid peroxidase (TPO)? What do you see during immunofluorescence?

A

Enzyme involved in iodination of Tg -> thyroid follicular cells light up green

48
Q

To what are stimulating autoantibodies directed in GD? Causes what?

A

TSH-receptor (TSHR), stimulates production of thyroid hormone

49
Q

How does antibody dependent cell mediated cytotoxicity work with respect to the thyroid? (4)

A
  • Antibodies bind antigens on thyroid cells
  • Fc receptors on NK cells recognize the antibodies
  • Crosslinking of Fc receptors leads to NK cell activation
  • Thyroid cells die by apoptosis
50
Q

Hashimoto is hyper/hypo thyroid

A

Hypothyroid

51
Q

Graves’ disease is hyper/hypothyroid

A

Hyperthyroid

52
Q

How do you diagnose a HT patient?

A
  • Very high levels of TPO Ab (correlate with amount of tissue damage)
  • Very low TSHr Ab (esp blocking)
  • T4, T3 go down
  • TSH goes up
53
Q

How do you diagnose a GD patient?

A
  • Almost 100% of patients has TSHr Ab (esp stimulation)
  • T4, T3 go up
  • TSH goes down
54
Q

A patient with HT can present with hyperthyroidism (instead of hypo), why would that be?

A

Destruction of the follicles –> thyroid hormone is released into the system

55
Q

What are environmental risk factors for thyroid disease? (4)

A
  • Dietary iodine intake
  • Smoking
  • Infection
  • Stressful live events
56
Q

What are susceptibility genes for GD? (2)

A
  • HLA-DR3
  • CD40
57
Q

What are susceptibility genes for HT?

A
  • CTLA-4
  • PTPN22
58
Q

What are the three factors of the multifactorial pathogenesis of autoimmune thyroid disease?

A
  • Cellular interactions
  • Genetic factors
  • Environmental factors
58
Q

How does neonatal GD come to be?

A

Transplacental transport of maternal IgG in the third trimester

59
Q

Why is neonatal GD self limiting?

A

Maternal antibodies are broken down after birth

60
Q

What happens in Graves’ Ophthalmopathy? (2)

A
  • Extraocular muscle enlargement
  • AND/OR orbital tissue/fat expansion
61
Q

What is the immune mechanism of Graves’ Ophthalmopathy?

A

Orbital fat: fibroblasts that express the TSHr become activated by stimulatory autoantibodies

Result: Production of cytokines AND proliferation of fibroblasts/production of connective tissue components

62
Q

Which signaling pathway is also activated in patients with Graves’ Ophthalmopathy?

A

Stimulatory autoantibodies against the TSHr also activate indirectly IGF-1R signaling –> promotes cell proliferation, growth and survival

63
Q

Which type of bone cells are there? (4)

A
  • Osteoclasts
  • Osteoblasts
  • Osteocytes
  • Bone marrow cells
64
Q

What is the function of osteoclasts?

A

Dissolve and break down old or damaged bone cells

65
Q

What is the function of osteoblasts?

A

Form new bones and add growth to existing bone tissue

66
Q

What is the function of osteocytes?

A

Involved in the perseverance of the bony matrix

67
Q

What is the function of bone marrow cells?

A

BM releases blood cells into the bloodstream when they are mature and when required

68
Q

Which types of bone marrow cells exist? (2)

A
  • Mesenchymal stem cells
  • Hematopoietic stem cells
69
Q

Functions of the skeletal system (5)

A
  • Support/movement
  • Protection of organs
  • Blood formation
  • Calcium/phosphate balance
  • Source of growth factors
70
Q

What’s the function of the calcium/phosphate balance as main mineral reservoir?

A

Stores calcium phosphate and releases them according to the body’s physiological needs

71
Q

Describe the differentiation of osteoblast lineage cells

A

Mesenchymal progenitors –> pre-osteoblast –> mature osteoblast –> osteocytes

72
Q

Which cells are marked by Sox9?

A

All osteoblast progenitors

73
Q
A

I&I SC2 (13 decks)

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