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Endocrine System > Neural-Endocrine System > Flashcards

Neural-Endocrine System Flashcards

1
Q

What part of the pituitary connects the hypothalamus to the pituitary?

A

Infundibulum

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2
Q

What is the name of the capillary system which exists between the anterior pituitary and hypothalamus?

A

Hypothalamohypophyseal portal system

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3
Q

What type of connection exists between the posterior pituitary and the hypothalamus?

A

Neural connection

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4
Q

Neurons from which two parts of the hypothalamus interact with the pituitary gland?

A

Paraventricular nucleus

Supraoptic nucleus

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5
Q

What is the name of the junction between the infundibulum and hypothalamus?

A

Median eminence

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6
Q

Within a depressed region in which bone does the pituitary gland sit?

A

Sphenoid bone

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7
Q

Which hormones are secreted by the posterior pituitary?

A

ADH

Oxytocin

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8
Q

Which hormones are secreted by the anterior pituitary?

A 
Growth hormone
Lutenizing hormone
Follicle stimulating hormone
Adrenocorticotrophic hormone
Thyroid stimulating hormone
Prolactin
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9
Q

The hormones secreted by the posterior pituitary are produced in the hypothalamus. T/F?

A

True

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10
Q

What is the function of the hypothalamus?

A

Controls body temperature, hunger, thirst, fatigue, sleep

Secretes neurohormones which stimulate the release of hormones from the pituitary gland

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11
Q

What regulates the secretion of follicle stimulating hormone and lutenizing hormone?

A

Gonadotrophin releasing hormone from the hypothalamus

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12
Q

What hormones control the release of growth hormone?

A

Growth hormone releasing hormone

Growth hormone inhibitory hormone (somatostatin)

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13
Q

The inhibitory effect of which molecule regulates the secretion of prolactin?

A

Dopamine

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14
Q

What is the action of growth hormone?

A

Stimulates insulin like growth factor production in the liver. This stimulates amino acid uptake and thus DNA synthesis and mitosis in cells. Growth hormone also increases gluconeogenesis, promotes fat breakdown in adipose tissue and decreases glucose uptake by cells to promote non-carbohydrate sources of energy

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15
Q

What event does lutenizing hormone stimulate in women?

A

ovulation

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16
Q

What is the role of follicle stimulating hormone in women?

A

Stimulates the growth and development of follicles during the first half of each menstrual cycle
Needed for oestrogen secretion by the developing follicle

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17
Q

What is the role of follicle stimulating hormone in men?

A

Required for spermatogenesis by sertoli cells

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18
Q

What is the role pf lutenising hormone in men?

A

Stimulates testosterone secretion by leydig cells

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19
Q

What important structure exists directly above the pituitary gland?

A

Optic chasm

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20
Q

What cells in the anterior pituitary secrete growth hormone?

A

Somatotrophs

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21
Q

What percentage of the anterior pituitary is made up of somatotrophs?

A

50%

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22
Q

What cells in the anterior pituitary secrete LH and FSH?

A

Gonadotrophs

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23
Q

What percentage of the anterior pituitary is made up of gonadotrophs?

A

10%

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24
Q

What cells in the anterior pituitary secrete ACTH?

A

Corticotrophs

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25
Q

What percentage of the anterior pituitary is made up of corticotrophs?

A

10-15%

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26
Q

What cells in the anterior pituitary secrete TSH?

A

Thyrotrophs

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27
Q

What percentage of the anterior pituitary is made up of thyrotrophs?

A

5%

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28
Q

What cells in the anterior pituitary secrete prolactin?

A

Lactotrophs

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29
Q

What percentage of the anterior pituitary is made up of lactotrophs?

A

20%

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30
Q

At what time of day is growth hormone mainly secreted?

A

At night

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31
Q

Growth hormone stimulates the production and release of IGF-1 from the liver. IGF-1 can act to propagate the action of growth hormone in which tissues?

A

Bone
Adipose tissue
Metabolism

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32
Q

What is the importance of oxytocin?

A

Important in labour - stimulates cervical dilatation and uterine contractions
important in breast feeding - stimulates let down reflex

33
Q

Describe the process by which ADH works on the collecting ducts to increase water reabsorption in the kidney?

A

ADH binds to V2 ADH receptor on the basolateral membrane of the kidney collecting ducts which stimulates a GPCR that activates adenylyl cycle;ase causing production of cAMP and PKA.
This increases the exocytosis of the aquaporin water channel containing vesicles (AVPR2) and inhibits the endocytosis of these vesicles in order to increase aquaporin 2 channel formation and insertion in the apical membrane

34
Q

Define diabetes insipidus

A

Passage of large volume (>3L) of dilute urine which results in polyuria, polydipsia and nocturne in the absence of hyperglycaemia and hypercalcaemia

35
Q

What are the possible causes of cranial diabetes insipidus?

A 
Idiopathic
Genetic
Trauma
Tumours
Infections
Inflammatory conditions of the posterior pituitary
36
Q

What are the possible causes of nephrogenic diabetes insipidus?

A

Resistance to ADH
Genetic AVPR2 mutation
Secondary to nephrogenic damage
Secondary to drug use, metabolic upset or renal disease

37
Q

How is diabetes insipidus tested for?

A

A water deprivation test

38
Q

Describe the water deprivation test for diabetes insipidus

A

Patients are deprived of fluid for 8 hours and their plasma and urine osmolality is monitored
A synthetic ADH (ddAVP) is then given and the urine osmolality is reassessed
If the problem is cranial then urine osmolality is increased by ddAVP, if the problem is nephrogenic then urine osmolality is unaffected by ddAVP

39
Q

What is the most common secretory pituitary adenoma?

A

Prolactinoma

40
Q

How common are secretory ACTH tumours?

A

20% of pituitary adenomas

41
Q

How common are secretory GH tumours?

A

15% of pituitary adenomas

42
Q

How common are secretory TSHomas?

A

<1% of pituitary adenomas

43
Q

Pituitary adenomas are often asymptomatic. T/F?

A

True

44
Q

If an incidental pituitary adenoma is found, what factors are important to check?

A

Check for hormone excess
Check for hypopituitarism
Check that the tumour has had no effects on the visual fields

45
Q

What are the clinical features of a prolactinoma?

A

Galactorrhoea
Menstrual disturbance and sub fertility in women
Reduced libido or erectile dysfunction in men

46
Q

How are prolactinomas managed?

A

Dopamine agonists such as cabergoline

Surgery if the tumour is large or affects visual fields

47
Q

What is acromegaly?

A

The excessive production of GH (and resultant excessive production of IGF-1) in adults usually caused by a pituitary adenoma

48
Q

What are the symptoms of acromegaly?

A 
Sweating
headaches
tiredness
increase in ring or shoe size
joint pains
49
Q

What are the clinical signs of acromegaly?

A

Coarse facial appearance
Enlarged tongue
Enlarged hands and feet
visual field loss

50
Q

What complications may result from acromegaly?

A

Hypertension
diabetes / impaired glucose tolerance
increased risk of bowel cancer
heart failure

51
Q

What tests can be used to diagnose acromegaly?

A

Glucose tolerance tests - glucose load fails to suppress GH and test may also reveal underlying diabetes
IGF-1 levels
MRI of the pituitary

52
Q

How is acromegaly managed?

A

Transsphenoidal route surgery (often not curative)
somatostatin analogues to inhibit GH secretions
Pituitary radiotherapy

53
Q

What are the risks associated with the use of radiotherapy in the treatment of acromegaly?

A

Hypopituitarism

Long term problems

54
Q

What is hypopituitarism?

A

Failure of anterior pituitary function

55
Q

What is the name for failure of anterior pituitary function which affects all hormone axes?

A

Panhypopituitarism

56
Q

How is hypopituitarism managed?

A

Hormone replacement

57
Q

If all hormonal axes are affected by hypopituitarism, which hormone is given first?

A

Cortisol

58
Q

What factors can cause hypopituitarism?

A 
tumours
radiotherapy
infarction
infiltrations
trauma
congenital disorders
59
Q

Hypogonadoptrophic hypogonadism can be cause by hyperprolactinaemia as a result of any drug which interferes with dopamine action. This includes…?

A 
Antipsychotics
Antiemetics (metoclopramide, domperidone)
Antidepressants (SSRIs, MOA-1, TCA)
Opiates
H2 receptor antagonists
60
Q

Dopamine agonists can be used to treat prolactinomas. Give examples of these drugs.

A

Cabergoline
Quiagolide
Bromocriptine

61
Q

Cabergoline is a oral dopamine agonist used in the treatment of prolactinomas. What are the risks associated with this drug?

A

Cardiac fibrosis

Valvopathy

62
Q

What type of receptors does ADH bind to in vascular smooth muscle to cause vasoconstriction?

A

V1 receptors

63
Q

What is desmopressin and when may it be used?

A

A synthetic analogue of ADH which is used for maintenance therapy in cranial diabetes insipidus or acute therapy

64
Q

What drug is the mainstay of treatment for hypothyroidism?

A

Levothyroxine

65
Q

Carbimazole and propulthiouracil (PTU) can be used to treat hyperthyroidism. Why is carbimazole the preferred treatment?

A

Carbimazole is the more potent drug

66
Q

How do thianamides such as carbimazole and Propylthiouracil work to treat hyperthyroidism?

A

They inhibit idodide oxidation, iodination of tyrosine and coupling of iodotyrosines to reduce thyroid hormone synthesis

67
Q

In addition to its ability to reduce thyroid hormone synthesis, what other effects does Propylthiouracil exhibit to treat hyperthyroidism?

A

Inhibits peripheral conversion of T4 to T3

68
Q

In addition to the use of thionamides in the treatment of hyperthyroidism, what drugs can be used in symptom management?

A

Beta blockers or calcium channel blockers

69
Q

What medications may be used pre-operatively in patients with hyperthyroidism?

A

Potassium iodide

70
Q

Glucocorticoids are protein-bound steroid hormone which have many systemic effects. These include…?

A

Anti-inflammatory by inhibiting transcription of genes for pro-inflammatory cytokines
Reduced T lymphocytes
Counter regulatory metabolic effects - gluconeogenesis, increased adiposity
improved alertness
mineralocorticoid effect

71
Q

What preparation of glucocorticoids is closest to physiological cortisol?

A

Hydrocortisone

72
Q

Glucocorticoids are commonly prescribed drugs. How might they be administered?

A 
Topically
Nasally
Inhaled
Orally
Subcutaneously
IM
IV
73
Q

Fludrocortisone is an oral mineralocorticoid used in the treatment of which diseases?

A

Addison’s disease

Postural hypotension

74
Q

Spironolactone is a competitive antagonist of mineralocorticoid, androgen and progesterone receptors. Thus, the use of this drugs as a mineralocorticoid receptor blocker can have the unwanted side effects of…?

A

Gynaecomastia

Hyperkalaemia

75
Q

Eplerenone is a selective mineralocorticoid antagonist. When might it be used clinically?

A

In the treatment of primary aldosteronism, heart failure and hypertension

76
Q

Bisphosphonates are used in the treatment of osteoporosis, Paget’s disease and metastatic bone disease to reduce bone resorption. Give examples of these drugs?

A

Alendronate, Pamidronate, zolendronate

risedronate

77
Q

What is the mechanism of action of denosumab in the the treatment of osteoporosis?

A

Monoclonal antibody inhibits RANKL to reduce resorption

78
Q

Teriparatide is a drug which increases bone formation. This is a recombinant for of which endogenous hormone?

A

PTH

79
Q

How can the use of glucocorticoids affect bone density?

A

Decrease bone density by decreasing calcium absorption and increasing PTH leading to increased bone resorption and decreased bone formation

Endocrine System (12 decks)

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