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Medical Pathophysiology > Week 2 - Endocrine system > Flashcards

Week 2 - Endocrine system Flashcards

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USMLE® Step 1 flashcards
1
Q

how do hormones travel?

A

1 Can be dissolved in the blood plasma (water soluble)
2 can travel in the blood bound to plasma proteins
3 Then they diffuse across capillary walls to reach target cells

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2
Q

What is a hormone?

A

A molecule produced by an endocrine gland that act on target organs.

They regulate physiology and behaviour

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3
Q

What can hormones be classified into?

A

Proteins
Polypeptides
Lipids

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4
Q

How do hormones work?

A

The hormone binds to the target cells which has receptors

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5
Q

Where are the hormone binding events?

A

Ion channels
Receptor binding - GPCR/second messengers
Activation/inhibition of gene expression

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6
Q

What are the different types of cell communication?

A

Neural - neurotransmitters etc

Endocrine - hormones release into the bloodstream, travel to target tissues and regulate distant organs

Paracrine - the secretions act on and regulate nearby cells

Exocrine - secretions released into body cavity via a duct e.g. saliva into the mouth

Autocrine - the secretions/chemical messenger act on the same cell that produced the secretions

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7
Q

how do hormones travel?

A

1 Can be dissolved in the blood plasma (water soluble)
2 can travel in the blood bound to plasma proteins
3 Then they diffuse across capillary walls to reach target cells

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8
Q

what is the concentration of a hormone in blood plasma dependent on?

A

the rate of secretion and the rate of removal

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9
Q

how are hormones removed?

A

excreted from kidneys
metabolised in blood or target cells

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10
Q

what is antagonism?

A

where the hormone reduces the number of receptors available for a second hormone

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11
Q

what is permissiveness?

A

where the hormone increases the number of receptors available for the second hormone

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12
Q

what is the anterior pituitary?

A

the master gland

controls the functions of other endocrine glands

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13
Q

what are the different cells in the pancreas?

A

Alpha cells: produce glucagon
Beta cells: produce insulin
Delta cells: somatostatin

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14
Q

Describe the exocrine function of the pancreas?

A

Secretes digestive enzymes such as lipases, proteases and amylase into the small intestine via the pancreatic duct

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15
Q

Describe the endocrine function of the pancreas?

A

The pancreas releases hormones via specialised cells to control blood glucose levels

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16
Q

what is glucagon?

A

produced via alpha cells
Increases blood glucose levels
converts glycogen to glucose

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17
Q

what is insulin?

A

produced via beta cells
decreases blood glucose levels
coverts glucose to glycogen

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18
Q

describe diabetes mellitus

A

when you have high blood sugar level (hyperglycaemia)

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19
Q

what are the types of diabetes?

A

Type 1- where the pancreas fails to produce insulin via beta cells

Type 2- where organs stop responding to insulin

Gestational- comes on during pregnancy

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20
Q

Treatment for type 1 diabetes?

A

you need to keep blood glucose levels down so you can give insulin injections

‘Artificial Pancreas’- automated insulin delivery

Beta cell transplant

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21
Q

Treatment for type 2 diabetes?

A

you need to get the cells to respond to insulin again

Lifestyle changes

Metformin medication

Insulin/non insulin therapy

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22
Q

where are the sites in the body where the drugs for type 2 diabetes act?

A

skeletal muscle
liver
brain
pancreas
small intestine
adipose tissue

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23
Q

what is the HbA1c test?

A

used to monitor blood glucose levels

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24
Q

symptoms of hyperglycaemia (high blood sugar)

A

frequent hunger/thirst, fatigue, dry mouth, increased volume of urination

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25
Q

what are microvascular and macrovascular complications of diabetes?

A

Microvascular:
retinopathy
Nephropathy
neuropathy

Macrovascular:
heart disease
cerebrovascular disease
peripheral artery disease

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26
Q

what is diabetic retinopathy?

A

a complication that you get from diabetes

it’s where the blood vessels in the retina increase in size, bulge and eventually burst causing a haemorrhage

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27
Q

what is diabetic nephropathy?

A

a complication that you get from diabetes that causes damage to the kidney where the blood vessel bursts so proteins enter into the urine

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28
Q

why is hypertension (high blood pressure) dangerous when you have diabetes

A

because it worsens complications and increases risk of heart attack and stroke

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29
Q

how to control blood pressure when you have diabetes?

A

lifestyle changes
treatment with ACE inhibitor and Angiotensin 2 receptor blocker

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30
Q

what is considered as high blood pressure?

A

systollic over 130 mmHg
diastolic over 80 mmHg
on 2 different days

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31
Q

what is dyslipidaemia?

A

imbalance of lipids

32
Q

how do you manage lipids in diabetes

A

via an annual screening for diabetic patients via blood tests

33
Q

what are statins? (DRUGS)

A

they lower lipids by inhibiting hmg-coa to reduce cholesterol in the liver

34
Q

what is the hypothalamic pituitary adrenal axis?

A

the interaction between the hypothalamus, the adrenal glands and the pituitary gland

It responds to stress and results in the production of cortisol, nor/adrenaline

35
Q

what is the adrenocorticotrophic hormone (ACTH)

A

the hormone that responds to stress
secreted from anterior pituitary
acts on adrenal glands causing them to release cortisol

Produced from the POMC gene

36
Q

what are POMC products?

A

the products that are produced from the POMC gene
Enzymes cleave the POMC gene into smaller products/peptides

37
Q

some examples of POMC products/peptides

A

Alpha-MSH - it effects and alters skin pigmentation via GPCRs

Beta-endorphin - has pain relief effects via opioid receptors

38
Q

what are the diseases related to adrenocorticotrophic hormone (ACTH)

A

Cushing’s syndrome
Addison’s Syndrome
Secondary Adrenal Insufficiency

39
Q

what is Cushing’s syndrome?

A

excess cortisol production by excess ACTH release

REMEMBER THAT ATCH RESULTS IN THE PRODUCTION OF CORTISOL FROM THE ADRENAL GLANDS

40
Q

what is Addison’s syndrome?

A

also known as PRIMARY adrenal insufficiency

it’s the lack of ATCH secretion

REMEMBER THAT ATCH RESULTS IN THE PRODUCTION OF CORTISOL FROM THE ADRENAL GLANDS

41
Q

What is secondary adrenal insufficiency

A

when the pituitary gland doesn’t produce enough ATCH

42
Q

what are the different tests to diagnose ATCH diseases

A

measure your cortisol levels from 9am to midnight

Synacthen tests - to diagnose Addisons disease - this is where you are injected with a synthetic ACTH to measure the amount of cortisol produced

Dexamethasone Suppression test (DMT) - to diagnose Cushing’s syndrome - this is a steroid that carries out negative feedback to the pituitary gland to suppress the secretion of ATCH

43
Q

What is the difference between Cushings syndrome and Cushings disease?

A

Cushings syndrome refers to general excessive levels of cortisol

Cushings Disease refers to excessive levels of cortisol caused by a pituitary tumour secreting ACTH

44
Q

Symptoms of Cushing’s syndrome?

A

hypertension
purple striae
excessive bruising
hirsutism
truncal obesity
back pain

45
Q

what are the causes of Cushing’s syndrome?

A

Normal: excess cortisol made by excess ACTH production (NEGATIVE FEEDBACK LOOP)

Cushing’s Disease:

Adrenal Tumours:

Ectopic ACTH secretion:

46
Q

Describe the negative feedback loop for ACTH and cortisol?

A

When there is an excess amount of ACTH, there is an excess production of cortisol, so the negative feedback loop tries to counteract this by getting the levels back to normal

47
Q

How do you diagnose Cushing’s disease?

A

MRI
Cortisol saliva test
Checking blood ACTH levels

48
Q

How to treat Cushing’s disease?

A

Surgery to remove pituitary tumour

Medication to inhibit the adrenal glands from producing cortisol

Radiation therapy to control pituitary tumour growth

49
Q

What are the regions of the adrenal glands?

A

Adrenal cortex
Adrenal medulla

50
Q

What are the zones of the adrenal glands?

A

Zona glomerulosa
Zona reticularis
Zona Fasciculata

51
Q

What are the adrenal sex steroids?

A

Testosterone (androgen)
Oestrogen

52
Q

What are glucocorticoids?

A

A type of steroid hormone.
They contribute to the breaking of glycogen and the forming of glucose.
They stop the secretion of ACTH (negative feedback loop)

an example is cortisol

53
Q

What are mineralocorticoids?

A

They are a steroid hormone.
They promote reabsorption of Sodium in the kidneys and promote excretion of potassium.

Promotes electrolyte balance of sodium and potassium across cell membranes throughout the body

an example is aldosterone, which is secreted from the adrenal glands

54
Q

What is Addison’s disease?

A

Adrenal hyPOfunction (the adrenal glands can’t function properly)

The adrenal glands produce low levels of cortisol

55
Q

Common causes of Addison’s disease?

A

Autoimmune adrenalitis
Tuberculosis
Adrenalectomy

56
Q

Common features of Addison’s disease?

A

Weight loss
nausea
lethargy
pigmentation

57
Q

How do you diagnose Addison’s disease?

A

Check for hyperpigmentation
Blood tests to check ATCH and cortisol levels
synacthen test

58
Q

How can you treat Addison’s disease?

A

Corticosteroid supplement
Mineralocorticoid replacement

59
Q

What is Conn’s syndrome?

A

Where the adrenal glands produce excess aldosterone

60
Q

Where is the thyroid gland?

A

located below the larynx
above the thyroid cartilage

61
Q

What does the thyroid gland do?

A

Produces thyroxine -T4
Produces tri-iodothyronine - T3, which are crucial for metabolic control

Produces calcitonin - decreases calcium levels in the blood by inhibiting breakdown of bone

62
Q

What is TSH (thyroid stimulating hormone)

A

a hormone produced via the pituitary gland which stimulates the thyroid gland to produce T3 and T4.

It’s a negative feedback loop

63
Q

What is hyPOthyroidism?

A

It is when your thyroid gland is underactive, leads to slowing of metabolic processes

64
Q

What are the types of hyPOthyroidism?

A

Hashimoto’s thyroiditis - autoimmune which usualy cause primary hypothyroidism

Primary hypothyroidism - caused by the gland itself

Secondary hypothyroidism - pituitary disease

Tertiary hypothyroidism - hypothalamic disease

65
Q

Explain what Hashimoto’s thyroiditis is and what it is caused by?

A

It’s where the thyroid gland gradually gets destroyed, it causes hyPOthyroidism.

It can be caused by an autoimmune reaction to:
thyroglobulin
thyroid peroxidase
TSH receptor

To test for hASHIMOTO’S thyroiditis test for autoantibodies against the above

66
Q

How do you diagnose Hashimoto’s thyroiditis?

A

Carry out a blood test and check for TSH, T4 levels and anti thyroid antibodies

67
Q

Symptoms of hyPOthyroidism?

A

fatigue
dry skin
muscle cramps
dyspnea
etc

68
Q

How do you diagnose hyPOthyroidism?

A

Do a screening of serum TSH

If your TSH (thyroid stimulating hormone from the pituitary gland) is high, you may have primary hyPOthyroidism

If your TSH, T4, T3 levels are all low you may have a pituitary tumour so you may have secondary or tertiary hyPOthyroidism

To test for Hashimoto’s thyroiditis, test for autoantibodies against thyroglobulin, thyroid peroxidase, TSH receptor

69
Q

What is the treatment for hyPOthyroidism?

A

Hormone replacement of the hormones T3 and T4
Keep checking TSH levels 4-8 weeks after hormone replacement

70
Q

Who are the special circumstances for with hyPOthyroidism?

A

Pregnant women
People with Downs Syndrome
People with type 1 diabetes

This is because there is a higher incidence in these groups

71
Q

What is hyPERthyroidism?

A

When you have an overactive thyroid gland.
It can cause Graves disease

72
Q

What are some symptoms of hyPERthyroidism?

A

Weight loss
excessive sweating
hyperactivity

LESS common:
nausea
exacerbation of angina

73
Q

what is a goiter\?

A

A swollen thyroid gland caused by hyPERtyroidism

74
Q

How do you diagnose hyPERthyroidism?

A

Diffuse the goiter and if the patient HAS hyPERtyroidism, the TSH levels are suppressed and the T4 levels are elevated

75
Q

Treatment for hyPERthyroidism?

A

Radioactive synthesis - however this can cause hyPOtyroidism in the future

Carry out surgery on large goiters

Propylthiouracil - to block the synthesis of thyroid hormones (T3, T4) to stop the thyroid gland from being too overactive

Propanolol - used to treat and reduce symptoms such as anxiety, trembling etc

76
Q

What is thyroiditis?

A

It’s caused by a viral infection

Presents as a tender thyroid

Medical Pathophysiology (11 decks)

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