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IMS > Topic 8 - Endocrinology > Flashcards

Topic 8 - Endocrinology Flashcards

1
Q

What are the main endocrine glands?

A
  • Hypothalamus/Pituitary
  • Thyroid
  • Parathyroid
  • Pancreas
  • Adrenal
  • Ovaries/Testicles
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2
Q

What is the pituitary gland?

A

-Controls most glands in the body

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3
Q

What are the two lobes of the pituitary gland?

A
  • Anterior pituitary

- Posterior pituitary

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4
Q

What does the anterior pituitary gland do?

A

Produces various hormones

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5
Q

What does the posterior pituitary gland do?

A

Stores various hormones

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6
Q

Which hormones does the anterior pituitary produce?

A
  • Growth hormone (GH)
  • Adrenocorticotrophic hormone (ACTH)
  • Gonadotrophins (FSH and LH)
  • Thyroid stimulating hormone or thyrotrophin (TSH)
  • Prolactin (PRL)
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7
Q

What does the Growth hormone do?

A

Used for skeletal growth.

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8
Q

What is ACTH used for?

A

Stimulating the adrenals to produce steroids.

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9
Q

What do gonadotrophins do?

A

Stimulate the ovaries and testes to produce sex hormones

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10
Q

What does TSH do?

A

Stimulates the thyroid to produce thyroid hormones

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11
Q

What does prolactin do?

A

Stimulates breast milk production

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12
Q

Which hormones does the posterior pituitary gland store?

A
  • Antidiuretic hormone (ADH)

- Oxytocin

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13
Q

What does ADH do?

A

Stimulates water reabsorption in the kidneys

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14
Q

What does oxytocin do?

A

Helps uterine contractions during labour

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15
Q

How is the pituitary gland controlled?

A

By the hypothalamus

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16
Q

What stimulates ACTH secretion?

A

Corticotrophin releasing hormone (CRH)

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17
Q

What stimulates GH secretion?

A

Growth hormone releasing hormone (GHRH)

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18
Q

What stimulates TSH secretion?

A

Thyrotropin releasing hormone (TRH)

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19
Q

What stimulates FSH and LH secretion?

A

Gonadotrophin releasing hormone (GnRH)

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20
Q

Prolactin is inhibited by what?

A

The hypothalamus

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21
Q

Which hormone switches off ACTH and CRH?

A

Cortisol

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22
Q

What hormone switches off GH and GHRH?

A

Growth hormone

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23
Q

Which hormones switch off TSH and TRH?

A

Thyroid hormones

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24
Q

Which hormones switch off FSH, LH and GnRH?

A

Sex hormones

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25
Q

Which glands are controlled by the pituitary?

A
  • Adrenals (steroids)
  • Thyroid
  • Ovary/testicle
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26
Q

Which glands are not controlled by the pituitary?

A
  • Adrenal medulla
  • Parathyroid
  • Pancreas
  • Gut Hormones
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27
Q

What do the adrenal medulla produce?

A

Adrenaline and Noradrenaline

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28
Q

What does the parathyroid do?

A

Control calcium levels

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29
Q

What does the pancreas do?

A

Control sugar levels

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30
Q

What are the components of the thyroid gland?

A
  • Midline isthmus (just below cricoid cartilage)
  • Right lobe
  • Left lobe
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31
Q

What are the structural specificities of the thyroid gland?

A
  • Thyroid cells are arranged in follicles and produce thyroid hormones
  • Contains C cells which produce calcitonin
  • Thyroid hormones regulate gene expression and aspects of organ function
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32
Q

How is calcium metabolism controlled?

A
  • 4 Parathyroid glands (located behind the thyroid)
  • Kidneys (Excrete calcium and produce active vitamin D)
  • Gut (Absorbs calcium)
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33
Q

What are the components of the adrenal glands?

A
  • Adrenal cortex

- Adrenal medulla

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34
Q

What does the Adrenal cortex produce?

A
  • Cortocosteroids (cortisol)
  • Androgens (male hormones)
  • Mineralocorticoid (Aldosterone)
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35
Q

What does the Adrenal medulla produce?

A

-Catecholamines (adrenaline, noradrenaline and dopamine)

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36
Q

What controls blood pressure?

A

The renin-angiostensin system

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37
Q

Which hormone stimulates secretion of adrenaline?

A

Pituitary hormone ACTH

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38
Q

Where can aldosterone be produced?

A

Adrenal medulla

39
Q

Lack of which hormone can be lethal?

A

Cortisol

40
Q

Which cells produce testosterone?

A

Interstitial or Leydig

41
Q

Which cells produce sperm?

A

Germ cells in the seminiferous tubules

42
Q

Which cells produce inhibin in the testes?

A

Sertoli cells (also help in sperm production)

43
Q

What tests are used to detect hormonal abnormalities?

A
  • Static tests
  • Stimulation tests
  • Suppression tests
44
Q

What is the static test for primary hypothyroidism?

A

-Thyroid hormones T3 and T4
-TSH
(positive = T3 and/or T4 elevated, suppressed TSH)

45
Q

When is a stimulation test used?

A

For suspected hormonal under-secretion where a static test isn’t enough

46
Q

When is a suppression test used?

A

For some hormonal over-secretion

47
Q

What are some examples of stimulation tests?

A
  • ACTH test for adrenal insufficiency
  • Glucagon stimulation
  • Insulin stress test for pituitary failure
48
Q

What are some examples of suppression tests?

A
  • Giving steroids and testing for endogenous steroid production
  • Giving glucose and testing for GH secretion (glucose switches it off in normal individuals)
49
Q

What are the types of diseases of the endocrine glands?

A
  • Over-secretion (benign tumours)
  • Under-secretion (gland destruction_
  • Tumours/nodules (with normal hormone production)
50
Q

What can gland destruction be attributed to?

A
  • Inflammation (eg. autoimmune)
  • Infarction
  • Other
51
Q

How does prolactin over-secretion present?

A
  • Galactorrhoea
  • Amenorrhoea in women
  • Sexual dysfunction in men
  • Headaches and visual field problems in large tumours
52
Q

What usually causes prolactin over-secretion?

A

A pituitary tumour secreting prolactin (prolactinoma)

53
Q

How is a prolactinoma diagnosed?

A

-Static test
if inconclusive:
-Pituitary MRI

54
Q

What may cause mildly raised prolactin levels?

A
  • Sexual intercourse
  • Nipple stimulation
  • Stress
  • Large number of drugs (antidepressants/antipsychotics)
  • Non-functioning pituitary tumour
55
Q

How can prolactinomas be treated?

A

Medically - doesn’t usually require surgical intervention

56
Q

What does GH excess cause in children?

A
  • Excessive growth spurt and increased size of feet and hands
  • If left untreated: gigantism
57
Q

What does GH excess cause in adults?

A
  • Acromegalic face
  • Wide and large hands/feet
  • Increased sweating
58
Q

How is GH excess diagnosed?

A
  • Suppression tests
  • Glucose is given followed by GH measurement
  • Imagining is necessary to confirm presence of a pituitary tumour
59
Q

How is a GH excreting pituitary tumour treated?

A
  • Surgical removal of the tumour

- Radiotherapy and medical therapy may be needed to remove remnants

60
Q

What can cause Cushing’s syndrome?

A
  • Pituitary secreting ACTH tumour (Cushing’s disease)
  • Adrenal tumours secreting cortisol
  • Cancers producing ACTH (eg. lung cancer)
61
Q

How does Cushing’s present?

A
  • Growth arrest in children
  • Face: Round, acne, hirsuitism
  • Fat distribution: truncal obesity, thin extremities
  • Skin abnormalities: Thin, easy to bruise, striae on abdomen
  • Complications: Hypertension, diabetes mellitus, high infection risk, poor wound healing
62
Q

How is Cushing’s diagnosed?

A
  • Suppression tests

- Dexamethasone suppression test to suppress endogenous cortisol production

63
Q

How is Cushing’s treated?

A 
Pituitary and adrenal:
-Surgery
-Radiotherapy/medical treatment in pituitary
Cancer related:
-Treating original cancer
64
Q

What can cause thyroid hormone overproduction?

A
  • Primary hyperthyroidism

- Secondary hyperthyroidism (pituitary TSH secretion)

65
Q

What can cause hyperthyroidism?

A
  • Graves disease (80%)
  • Toxic nodule or toxic MNG (15%)
  • Thyroiditis (1%)
  • Drug induced
  • Rarities
66
Q

Which drug can cause hyperthyroidism?

A

Amiodarone

67
Q

How does hyperthyroidism present?

A
  • Hyperactivity
  • Irritability
  • Insomnia
  • Heat intolerance/Increased sweating
  • Palpitations
  • Weight loss despite overeating
  • Menstrual problems
68
Q

What would you examine for in suspected hyperthyroidism?

A
  • Thyrotoxicosis: Hand tremor, Increased sweating, Fast pulse
  • Inspection of thyroid gland: Smooth (Graves’ disease), Nodular (toxic nodules), Tender (thyroid inflammation)
  • Thyroid eye disease: Swelling around eyes, Protrusion of the eyeball, Paralysis of eye muscles
69
Q

How is hyperthyroidism tested for?

A

Static tests!

  • Raised thyroid hormone
  • Suppressed TSH
70
Q

How is hyperthyroidism treated?

A
  • Anti-thyroid drugs (disease remission in 50% patients after 6-18 months, but can rarely suppress WBC production)
  • Radioactive iodine (destroys thyroid gland)
  • Surgery
71
Q

How does GH deficiency present in children?

A

Failure of growth

72
Q

How does GH deficiency present in adults?

A
  • Nothing
  • Tiredness
  • Depression
73
Q

How is GH deficiency tested for?

A

Stimulation tests

  • Glucagon stimulation test
  • Insulin stress test (lowers blood glucose to force more GH secretion)
74
Q

How is GH deficiency treated?

A

GH replacement injections

75
Q

What causes steroid under-secretion?

A
  • Adrenal failure

- Pituitary failure

76
Q

How does steroid under-secretion present?

A
  • Failure to grown in children
  • Severe tiredness
  • Dizziness due to low blood pressure
  • Abdominal pain, vomiting and diarrhoea
77
Q

How is steroid under-secretion tested for?

A

Stimulation tests

  • Synacthen test (giving ACTH) if primary adrenal failure suspected
  • GST or IST if secondary adrenal failure suspected
78
Q

How is steroid under-secretion tested?

A

-Replacing the missing hormone (tablets)
Failure to diagnose may result in death. If this is suspected, Cortisol should be given even before the investigation results are back.

79
Q

What is primary hypothyroidism?

A

Thyroid failure and inability to produce thyroid hormones.

  • Usually autoimmune
  • Can be drug induced
80
Q

What is secondary hypothyroidism?

A

Failure to produce TSH

-Usually part of complete pituitary failure

81
Q

What are the symptoms of severe hypothyroidism?

A
  • Weakness and dry skin
  • Sensations of cold and decreased sweating
  • Impaired memory
  • Constipation
  • Weight gain
  • Hair loss
82
Q

How is hypothyroidism diagnosed?

A

-Static test of thyroid function

83
Q

How is hypothyroidism treated?

A

Thyroid hormone replacement (tablets)

84
Q

What causes sex hormone deficiency?

A
  • Primary: ovarian or testicular failure

- Secondary: pituitary failure

85
Q

How does sex hormone deficiency present in males?

A
  • Erectile dysfunction

- Reduced libido

86
Q

How does sex hormone deficiency present in females?

A

-Menstrual abnormalities (amenorrhoea)

87
Q

What can cause amenorrhoea?

A
  • Uterine problems
  • Ovarian problems
  • Pituitary problems
  • Hypothalamic problem
88
Q

How is sex hormone deficiency diagnosed?

A

Static tests

  • Testosterone in males
  • Oestradiol in females
  • FSH/LH
89
Q

How is sex hormone deficiency treated?

A
  • Hormone replacement therapy

- Pituitary hormone replacement

90
Q

What are the causes of pituitary failure?

A

-Large tumour
-Infarction
-Other
(multiple hormones affected, static and stimulatory tests for diagnosis)

91
Q

How would pituitary hormone deficiency be tested for?

A

Endocrine tests:
-Basal tests: thyroid function, E2, Prolactin
-Dynamic tests: Glucagon stimulation, Insulin stress test
MRI imaging

92
Q

What can cause increased parathyroid hormone production? (pituitary independent)

A
  • Primary hyperparathyroidism
  • Cancers
  • Drugs
  • Other
93
Q

What does hypercalcaemia cause?

A
  • Thirst and passing too much urine
  • Constipation
  • Abdominal pain

IMS (13 decks)

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