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Endo: Sem 2 > Principles of Endocrine Disease and Its Assessment > Flashcards

Principles of Endocrine Disease and Its Assessment Flashcards

1
Q

what are the three level the endocrine system split into?

A

primary - end organ
secondary - pituitary
tertiary - hypothalamus

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2
Q

what are the types of endocrine disease?

A

hyper-functioning
hypo-functioning
eu-functioning

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3
Q

what is the role of the hypothalamus?

A

integration of signals and conversion of them to a chemical messenger

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4
Q

what amplifies signals from the hypothalamus?

A

pituitary gland containing hormones that get diluted and travel around the body

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5
Q

where do the hormones act?

A

end organs

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6
Q

what do end organs do?

A

switch off production of the central hormones = negative feedback

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7
Q

why is the area around the pituitary important?

A

the hypothalamus is above then there is the optic chiasm and pituitary stalk. These structures get compressed if there is a tumour

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8
Q

what is the cavernous sinus?

A

its just below hypothalamus containing cranial nerves supplying extra-ocular muslces.

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9
Q

what happens if the extra-ocular muscles are squished?

A

double vision and loss of sight from compression of optic chiasm

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10
Q

how can you see the hypothalamus?

A

from a saggital section with the pituitary fossa sitting on top of the sphenoid sinus

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11
Q

what do hormones act as?

A

receptors: surface or nuclear

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12
Q

what is different about peptide hormones?

A

they are charged and act as surface receptors

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13
Q

what are steroid hormones like?

A

they are aliphatic (fat soluble) so act on nuclear receptors

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14
Q

what is most hormone release like?

A

pulsatile and varies during the day

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15
Q

what is a dynamic test?

A

shows meaning of the two extremes shown in a one off blood test

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16
Q

apart from causing secretion from target hormone what else do hormones do?

A

cause growth of the target organs. therefore the target organ shrinks if hormone taken away

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17
Q

what is principle of endocrine testing based on?

A

law of mass action

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18
Q

how is endocrine testing carried out?

A

coloured dyes. Radioactive Immunoassay (RIA)

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19
Q

how is RIA carried out?

A

we have a binding site, usually an antibody and then the hormone. Forms an equilibirum in a test tube, so there will be some bound horomone-antibody and some free.

there is a radioactive tracer bound to the hormone

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20
Q

how do you measure the RIA results?

A
  • make sure every binding site is full of the marker
21
Q

what is the first stage of measurment?

A
  • construct a curve of known amounts of un-labelled hormone which will displace labeled hormone and drop the radioactivity
22
Q

how do we assess the radioactivity?

A

via centrifuge. the bound stuff falls to the bottom and you measure the radioactivity in there. unknown samples are then compared

23
Q

what are the two types of assays used?

A
  • total hormone assay

- free hormone assay

24
Q

total hormone assay

A

cheap, easy but have physiological problems as in plasma most hormone is bound to a binding protein (designed to protect hormone from enzymatic breakdown until reaches target site)

25
Q

which hormones are biologically active?

A

the free ones, they can activate receptors on cells

26
Q

what is a free hormone assay

A

representative of the active hormone fraction, not binding protein dependent

27
Q

what is the drawback of free hormone assays?

A

complex and expensive, have to get rid of all the binding protein and the hormone bound to it (could lose some hormone via this)

28
Q

when are free hormone assays used?

A

thyroid hormone testing

29
Q

what causes TSH release?

A

TRH

30
Q

what does TSH cause?

A

release of T3 and T4

31
Q

which is more active, T3 or T4?

A

T3

32
Q

why does T4 provide negative feedback?

A

T4 is an intravascular store of thyroid hormone, so when cell wants it, it expresses deiodinase which converts it to T3

33
Q

how do we investigate thyroid over production?

A
  • thyroid function test
  • autoantibodies
  • technesium scanning (tells type)
34
Q

how do we investigate thyroid under production?

A
  • thyroid function

- autoantibodies

35
Q

how do we investigate thyroiditis (irritation of thyroid gland)?

A
  • thyroid function
  • ESR (erythroyte sedimentation rate)
  • technesium scanning
36
Q

why is a technesium scan used?

A

technesium is taken up into the thyroid gland like iodine is, so by doing it you can see if thyroid gland is taking up iodine to show over activity

37
Q

how is the thyroid gland in proper thyrotoxicosis?

A

biologically overactive

38
Q

how is the thyroid gland in thyroiditis?

A

destructive, something makes the gland leaky so it leaks stores into the circulation but biological function is fine.

39
Q

how would technesium scan be in thyroiditis?

A

negative as it will not take up technesium as its being destroyed.

40
Q

Thyroid nodule

A

ultrasound scan and FNA

41
Q

what is the cortisol rhythm?

A

diurnal

42
Q

investigation of cushings: screening

A

test urinary free cortisol and diurnal rhythm

43
Q

confirmation of cushings diagnosis

A

low dose dexamethasone suppression testing

44
Q

differentiation of cause of cushings

A
  • high dose dexamethasone suppression test
  • plasma ACTH
  • localisation via radiology
45
Q

when is cortisol highest?

A

morning

46
Q

why is dexamethasone testing used?

A

to see the effect on ACTH and what source of ACTH might be if body is producing too much cortisol

47
Q

what should dexamethasone do in a normal person?

A

inhibit ACTH production via negative feedback

48
Q

what is psuedocushings syndrome?

A

display signs of cushings

  • depression
  • alcholism
  • anorexia nervosa
  • obesity

Endo: Sem 2 (11 decks)

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