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Year 2 Diabetes & Endocrinology (JK) > Normal growth and clinical aspects > Flashcards

Normal growth and clinical aspects Flashcards

1
Q

Where is GH released from and what is its main action?

A

anterior pituitary

promote growth

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2
Q

What is another name for GH?

A

somatotrophin

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3
Q

What is meant by GH being species specific?

A

only human GH can be used in GHD
used to use GH direct from human pituitary
due to CJD infection now use recombinant

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4
Q

What 2 hormones have a permissive effect to GH and hence are essential for normal growth?

A

insulin

thyroid hormone

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5
Q

What type of hormone is GH but what is the exception to the normal rule of this class of hormones?

A

peptide

about 50% circulates bound to carrier proteins

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6
Q

Role of GH in adults

A

maintenance of tissues and their energy supply

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7
Q

When does GH take over as the main influence on growth and what predominates before this?

A

8-10 months

nutritional intake

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8
Q

Hyperplasia

A

increased cell division

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9
Q

hypertrophy

A

increased cell size

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10
Q

Is GH effect on growth direct or indirect?

A

indirect

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11
Q

What is the name of the intermediate which allows growth?

A

IGF1

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12
Q

What is another name for IGF-1?

A

somatomedin

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13
Q

What is IGF-1 structure similar to?

A

proinsulin

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14
Q

Name 3 ways IGF-1 is insulin like

A

hypoglycaemic qualities
similar structure to proinsulin
binds to receptors similar to insulin receptor

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15
Q

Where is IGF-1’s hypoglycaemic qualities limited to and why?

A

muscle

liver and adipose tissue have few IGF-1 receptors

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16
Q

Where is IGF-1 released from and in response to what?

A

LIVER and other tissues eg bone

increased GH from anterior pituitary

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17
Q

How does IGF-1 control GH

A

negative feedback loop

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18
Q

What is IGF-2 role?

A

limited to foetus and neonatal

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19
Q

Explain the IGF-1 and GH negative feedback loop

A

IGF-1 inhibits GHRH and stimulates GHIH

GH on GH release from somatotrophs in pituitary eg self regulation

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20
Q

What does GH do to prechondrocytes in the epiphyseal plate?

A

stimulate them to become chondrocytes

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21
Q

What do these chondrocytes secrete and what is the consequence of this

A

IGF-1

become IGF-1 responsive

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22
Q

Does IGF-1 act as autocrine/paracrine/endocrine in bone growth?

A

autocrine and paracrine

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23
Q

What happens In bone growth once IGF-1 is released and then bone is now IGF-1 sensitive?

A

chondrocytes undergo cell division and produce cartilage which is the foundation for bone growth

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24
Q

Why does the epiphyseal plate close and what is the consequence of this?

A

puberty/adolescence due to sex hormones

no more longitudinal bone growth

25
What are the direct effects of GH?
increase gluconeogenesis by liver reduce ability of insulin to stimulate glucose uptake by muscle/adipose adipocytes more sensitive to lipolytic stimuli release energy stores to support growth
26
Is GH said to be anti or pro insulin?
anti
27
How is 1 way that GH is like insulin and not like cortisol
increase muscle, liver and adipose tissue amino acid uptake and protein synthesis --> anabolic
28
Where are GHRH and GHIH secreted from?
hypothalamus
29
Explain the differences in the basal plasma and 24 hour mean rates of GH in children and adults
basal GH - same | 24 hour mean - children higher due to spikes of secretion
30
What phase of sleep is GH highest and why?
deep delta sleep | general energy requirement low and energy diverted to growth
31
Why must repeated hormone measurements be taken?
to get a true picture of hormone status due to spikes
32
Does IGF-1 have spikes or constant? Result of this?
constant | buffers pulsatile variance in GH levels
33
Advantage of 50% of GH bound to carrier proteins
reservoir of GH | smooths out effects of erratic pattern of secretion
34
How would you describe GHIH secretion?
tonic | slow and responsive to needs
35
5 things that increase GHRH secretion and hence increase GH
``` actual or potential decrease in energy supply increased amino acids in plasma delta sleep stressful stimuli eg infection, stress oestrogen and androgens ```
36
Why does an actual or potential decrease in energy stimulate GHRH secretion?
GH needed for maintenance of tissue and energy supply in fasting/hypoglycaemia decreased substrate supply exercise and cold increase energy demand all stimulate increase in GH
37
Why does increased amino acids in plasma increase GH?
protein meal | GH promotes amino acid transport and protein synthesis by muscle and liver
38
4 stimuli which increase GHIH secretion and hence decrease GH
cortisol glucose FFA REM sleep
39
Why is cortisol inhibitory on growth?
promotes GHIH | increase protein catabolism
40
3 important factors in the physiology of growth
hormones nutrition genetics
41
Name some hormones important in growth
thyroid hormone, insulin, GH, IGF1, oestrogen, cortisol, androgens
42
When do sex hormones start playing a major role in growth?
puberty
43
What is TH important for in growth?
permissive to IGF-1 and GH nervous system development in utero and childhood ossification of cartilage and teeth maturation contours of face
44
What is cretinism?
hypothyroid - infant facial features decreased growth hypothyroid dwarf
45
Why do injury and disease stunt growth?
increased catabolism | glucocorticoid effects
46
what are the 2 periods of rapid growth
infancy | puberty
47
Explain infancy rapid growth
can grow 2.5cm in a few days then nothing | EPISODIC
48
Explain puberty rapid growth
androgens and oestrogens spikes in GH and IGF-1 same hormones terminate growth
49
What hormones influence bone elongation before the epiphyseal plates fuse?
GH and IGF-1
50
What hormones cause the epiphyseal plates to fuse?
sex hormones
51
What is usually the cause of hypersecretion of GH?
endocrine tumours
52
Cause of gigantism
excess GH before epiphyseal plates fuse
53
Cause of acromegaly
excess GH after epiphyseal plates fuse
54
What happens in acromegaly?
cannot increase longitudinal bone growth | grow in other directions eg hands and feet
55
What is adults feet increasing in size a sign of?
acromegaly
56
Treatment for acromegaly
remove tumour | GHIH analogues
57
List some reasons for reduced growth
``` precocious puberty genetic mutations deficient in GHRH GH secreting cells abnormal end organ unresponsive to GH hypothyroid children ```
58
How do children deficient in GH or TH differ in proportions?
both small hypothyroid - infant proportions GH - small but normal proportions

Year 2 Diabetes & Endocrinology (JK) (24 decks)

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