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CP > Investigating the Endocrine System > Flashcards

Investigating the Endocrine System Flashcards

1
Q

what is a hormone?

A

hormones are ‘messenger molecules’ secreted by endocrine glands

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2
Q

what are the different types of intercellular signaling?

A
  1. endocrine signaling
    - signalling cell sends signalling molecules to travel through the bloodstream before meeting target cell
  2. paracrine signalling
    - signalling cell sends signalling molecules straight to target cell
  3. autocrine signalling
    signalling cell is also the target cell
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3
Q

how do hormones decide which cells to influence

A

they can only influence cells that have specific target receptors for that particular hormone

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4
Q

what are the different types of hormones?

A

Peptide hormones
steroid hormones
tyrosine-based hormones

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5
Q

give some examples of peptide hormones

A

PTH
ACTH
TSH

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6
Q

Give some examples of steroid hormones

A

testosterone
oestradiol
cortisol

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7
Q

give some examples of tyrosine-based hormones?

A

thyroxine t4

triiodothyronine T3

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8
Q

what are the three ways a steroid hormone can interact with a cell?

A
  1. classical model
  2. Receptor mediated endocytosis
  3. Signalling through cells-surface receptors
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9
Q

what is the classical model of how a steroid hormone interacts with a cell?

A

the steroid hormone dissociates from its plasma carrier protein and diffuses across the cell membrane. after gaining entry to the cell, the free hormone binds to an intracellular receptor and alters gene transcription

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10
Q

what is receptor-mediated endocytosis in relation to how a steroid hormone interacts with a cell?

A

the steroid hormone, bound to its plasma carrier protein, is bought into the cell via a cell-surface receptor. the complex is broken down inside the lysosome and free steroid hormone diffuses into the cell, where it subsequently exerts its action at the genomic level or undergoes metabolism

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11
Q

what is signalling through cell surface receptors in relation to how a steroid hormone interacts with a cell?

A

the free steroid hormone alters intracellular signalling by binding to cell-surface receptors. the steroid hormone could exert these effects directly or could alter signalling by blocking the actions of peptide hormones

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12
Q

what are the causes of abnormal increase in plasma TBG concentrations?

A

genetic cause
pregnancy
oestrogen (cop)

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13
Q

what are the causes of an abnormal decrease in plasma TBG concentrations?

A 
Genetic causes
protein-losing states
malnutrition 
malabsorption
acromegaly
cushing's disease
high dose corticosteroids
severe illness
androgens
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14
Q

what does a change in the level of TBG result in

A

a change in the level of free hormones

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15
Q

if Thyroxine is low and TSH is low what does this indicate?

A

pituitary failure

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16
Q

if thyroxine is low but TSH is high what does this indicate?

A

unresponsive thyroid

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17
Q

if Thyroxine is high but TSH is low what does this indicate?

A

thyroid gland overproduction

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18
Q

if both TSH and thyroxine is high what does this indicate?

A

pituitary gland overproduction or feedback fails

19
Q

If TSH is elevated and free T4 is elevated what does this suggest?

A

suggest a TSH secreting tumor

20
Q

if TSH is elevated but the free t4 levels are normal what does this suggest as the cause

A

subclinical hypothyroidism

21
Q

if the TSH levels are elevated but the free t4 levels are low what does this suggest as the cause?

A

hypothyroidism

22
Q

if the TSH levels are decreased but the levels of free T4 are elevated what does this suggest as the cause?

A

Hyperthyroidism

23
Q

if the TSH levels are decreased but the levels of free T4 are normal what does this suggest as the cause?

A

T3 toxicosis or subclinical hyperthyroidism

24
Q

if the TSH levels are decreased and the levels of free t4 is also low, make a suggestion for the cause

A

central hypothyroidism

severe illness

25
Q

what is levels of TSH and free T4 in secondary hypothyroidism

A

Normal TSH and a low fT4

26
Q

why do some patients suffering from non-thyroidal illness show abnormalities within their thyroid function test?

A

TSH level may transiently rise into the hypothyroid range in the recovery phase following a period of illness

illness can also reduce the levels of TBG or modify it capacity to bind to T3 and T4, increasing the levels of free thyroid hormone levels

27
Q

how often should we repeat TFTS in a healthy person

A

3 years

28
Q

how often should we repeat TFTs after monitor ing of treatment in GRAVES disease?

A

1-2 months after radioactive iodine and if the patient remains thyrotoxic then biochemical monitoring at 4-6 week intervals

after thyroiddectomy measured 6-8 weeks post op

29
Q

what is the minimum period to achieve stable concentrations after a change of dose of thyroxine?

A

2 months

30
Q

on patients stabilised on longterm thyroxine therapy how often should they have their serum TSH checked?

A

annually

31
Q

what are the 2 types of adrenal medullary tumours?

A

Phaeochromcytoma (adults)

neuroblastoma (children)

32
Q

what is phaeochromocytoma?

A

tumour of neuroendocrine chromaffin cells - the majority in the adrenal medulla

33
Q

what can excessive and often episodic release of catecholamines result in what PAROXYSMAL features?

A

Hypertension
sweating, pallor
panic attacks\headaches
abdominal pain

34
Q

how is phaechromocytoma diagnosed?

A
  • difficult due to false negatives and false positive
  • plasmametanephrines
    unstable - collect on ice
  • 24 hour urine fractionated metanephrines
35
Q

how do we investigate the causes of hypoglycaemia and confirm the presence of an isulinoma?

A

Whipples triad

signs and symptoms of hypoglycaemia

low plasma glucose level

resolution of symptoms once glucose level rises

36
Q

what are some endogenous causes that are insulin mediated of hypoglycaemia?

A 
Insulinoma
nesidoblastosis
NIPHS
insulin antibodies reactive
alimentary hypoglycaemia 
reactive hypoglycaemia associated with type 2 DM 
Idiopathic
37
Q

what are some endogenous causes that are insulin Independent of hypoglycaemia?

A 
Critical Organ failure
- hepatic disease
- cardiac failure
- renal failure
Sepsis 
Hormone deficiency 
- cortisol
- groth hormone
-Hypopituitariusm 
Insulin recepto antibodies 
NON-Islet cell tumour
38
Q

what are some exogenous causes of hypoglycaemia?

A

therapeutic drugs
factitious
alcohol

39
Q

what are some therapeutic drugs that can have a direct effect and cause hypoglycaemia

A 
Insulin
sulfonylureas
Quinine
Disopyramide
B2-adrenoreceptor agonists
Pentamide
others
40
Q

what drugs interact with insulin or sulphonylureas and cause hypoglycaemia

A

Biguanides
PPARy agonist
B-adrenoreceptor blockers
ACE inhibitors

41
Q

where does insulinoma arise from

A

arises from the islets of langerhans

42
Q

how is insulinoma diagnosed?

A

diagnosed through a simple fasting blood test,

  • low blood sugar
  • high insulin
  • high levels of C peptide
43
Q

what is ectopic ACTH secretion most commonly associated with

A
  • benign carcinoid tumours of the lung
  • small cell tumours of the lung
  • islet cell tumours of the pancreas
  • medullary carcinoma of the thyroid
  • tumours of the thymus gland

CP (14 decks)

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