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Endocrine & Metabolism > Week 3 - Hormones > Flashcards

Week 3 - Hormones Flashcards

1
Q

Outline the management of a patient with a GH-secreting tumour.

A
  1. Surgery (transsphenoidal hypophysectomy)
  2. Medical tx (if surg fails)
  3. Irradiation (last resort)
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2
Q

What types of medical therapy can be given to a patient to treat GH-secreting tumours?

A

Best option = Somatostatin analogs (Octreotide, sandostatin)
Next best option = DA agonists (bromocriptine, cabergoline)
Last resort = GH Receptor blocker (pegvisomant – VERY expensive)

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3
Q

What are the three types of hormones secreted from the anterior pituitary?
- and what hormones are in each group?

A

Somatomammotrophins = GH & Prolactin
Corticotrophins = ACTH, Beta-lipotropin
Glycoprotein hormones = TSH, LH, FSH

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4
Q

The highest levels of prolactin are associated with what?

A

Prolactinomas

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5
Q

How does hypothyroidism lead to high prolactin?

A

Low T3/T4 –> Hyopthalamus increases secretion of TRH –> TRH stimulates both TSH AND prolactin release from pituitary.

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6
Q

What are the main treatment options for a prolactin-secreting tumour?

A
  1. Medical: DA agonists (bromocriptine, cabergoline)

2. Surgical: transsphenoidal hypophysectomy (2nd choice)

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7
Q

What disorder is characterized by high ACTH (tumour secreting ACTH)?

A

Cushing’s Disease

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8
Q

What type of capillaries are found in the pituitary & why?

A

Fenestrated capillaries - allow releasing hormones to enter (primary plexus) & exit (secondary plexus) the blood

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9
Q

All hypothalamic releasing hormones bind what type of receptor?
- do they bind intracellularly or extracellularly?

A

Extracellular receptors:

G-protein coupled receptors

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10
Q

What hormones are secreted in a pulsatile pattern? What is this pattern called?

A

GH, LH, FSH

“ultradian rhythm” (varies over the day)

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11
Q

In what region of the hypothalamus are GHRH neurons present?

A

Arcuate nucleus

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12
Q

What is present in the Periventricular nucleus of the hypothalamus?

A

Somatostatin neurons.

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13
Q

What is Cushing’s disease?

A

Hypercortisolism due to excess pituitary secretion of ACTH

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14
Q

What type of receptor does GH bind to?

- describe the cascade after GH binds.

A

Tyrosine Kinase receptor.
- GH binds –> phosphorylation of JAK –> cross phosphorylation of receptor –> STATs bind R –> phosphorylation of STATs –> moves to nucleus –> regulates gene expression

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15
Q

GH effects on growth are mediated by what?

A

IGF-1

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16
Q

What is the most common reason for dwarfism?

A

Lack of GHRH

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17
Q

What is Cushing’s syndrome?

A

High cortisol

- either caused by pituitary, adrenals, or other source

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18
Q

What is Hashimoto’s disease?

A

Autoimmune disease of the thyroid leading to hypothyroidism

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19
Q

What is the most common cause of hyperthyroid disease? – what happens to hormones

A

Grave’s disease

  • increased T3/T4
  • complete suppression of TSH
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20
Q

What is the order of the most common causes of pituitary tumour? (ie. which hormones are most likely to be increased from pituitary tumour?)

A
  1. Prolactin
  2. GH
  3. ACTH
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21
Q

What is the agent responsible for negative feedback from the testis to FSH?

A

Inhibin

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22
Q

What is the order of hormone loss in loss of pituitary function?

A
  1. GH
  2. FSH & LH
  3. TSH
  4. ACTH
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23
Q

What is a craniopharyngioma?

A

Tumour derived from embryonic pituitary tissue.

aka. Rathke pouch tumour.

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24
Q

What is the insulin tolerance test?

- what is it used for?

A

Used when looking for GH deficiency.

  • administer insulin
  • glc should decrease (to 10 micro g/L

**test is often avoided b/c of hypoglycemia complications

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25
Q

What is required for a definitive dx of GH, enough to justify GH replacement therapy?

A
  • Lack of GH response to low glc
  • Low IGF-1
  • Symptoms: short stature, growth failure
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26
Q

Diabetes Insipidus is due to what?

A

Deficiency of ADH

- failure to concentrate urine

27
Q

What would you expect Na+ levels to be in Diabetes Insipidus?
- and if it’s different than you expect?

A

Expect high Na+ levels because kidneys cannot concentrate urine, so get excessive water loss and not an equal Na+ loss.
- if Na+ is low, that suggests psychogenic DI

28
Q

What is the main complaint in a patient with Diabetes Insipidus?

A

Polyuria & polydipsia

29
Q

What happens to K+ & Ca++ in Diabetes Insipidus?

A

Hypokalemia (b/c K+/Na+ exchange doesn’t work in kidneys?)

Hypercalcemia (why?…)

30
Q

What are some symptoms of Cushing’s disease?

A
  • cervical fat pad
  • proximal muscle wasting
  • progressive & central obesity
  • striae on trunk
31
Q

When during the day does cortisol peak?

- what is the clinical relevance of this?

A

Peak in morning.
- therefore, if expecting a disease with low cortisol, there is no point to test in a.m. b/c it will be higher than average.

32
Q

What are the three hallmark symptoms of low Testosterone?

A
  • loss of sex drive
  • loss of am erections
  • low volume/delayed ejaculations
33
Q

How is hypogonadism diagnosed in younger men?

A
  • all three hallmark symptoms of low testosterone, plus a lab test showing low testosterone.
34
Q

What is PADAM?

A

Partial Androgen Deficiency in the Aging Male

35
Q

What happens to a patient who is given continuous LHRH?

A

Stops producing LH

(but FSH is unaffected)

36
Q

What happens to a patient who is given pulsatile LHRH?

A

They produce LH leading to increased testosterone production.

37
Q

What happens to a patient who is given GnRH antagonist?

A

Stop producing FSH and LH

38
Q

What are some causes of hypogonadism?

A
  • brain (pit. tumour –> check FSH, LH, prolactin)
  • chronic debility, alcoholism, HIV
  • drugs (corticosteroids, opiates)
39
Q

Why are testosterone blood tests usually unhelpful in women?

- when might it be used?

A

Testosterone is produced within the cell, used in the cell, then degraded in the cell, so doesn’t usually get into the blood stream.
- may be used to look for high testosterone (in case extra is being produced and leaks into the blood).

40
Q

What can high testosterone in women cause?

- how is this different from males?

A

Females:
- upper abdominal obesity
- increased risk of CVD
Males show these symptoms with low testosterone

41
Q

What is the main thing to determine before assessing/treating low testosterone in men?

A

Is it primary or secondary?

ie. is the problem in the testis or the brain?

42
Q

What is the lab test for diagnosing hypogonadism?

A

9am testosterone

43
Q

In females, what regulates ovarian testosterone?

A

LH & FSH (which are regulated by testosterone & progesterone feedback)

44
Q

In females, what regulates adrenal testosterone?

A

Cortisol

45
Q

What drug can be given to patients with central diabetes insipidus? & what does it do?

A

For mild deficiency: Chlorpropamide - enhances ADH action

For severe deficiency: ddAVP - ADH analog

46
Q

What is the treatment of nephrogenic diabetes insipidus?

A

Dietary: Na+ restriction
Meds: diuretics (decrease Na+ absorption); prostaglandin synthase inhibitors - enhance water resorption

47
Q

Under what value does the Na+ level have to get in order to present with neurologic symptoms of hyponatremia?

A

Na+ < 120mmol/L

48
Q

What are some complications of steroid abuse? (explain mechanism)

A

When lots of anabolic steroids are given, a lot of testosterone gets converted to estrogens..
- leads to gynecomastia, decreased testicular size, infertility, erythrocytosis
Other toxic effects: CVD, Hepatotoxicity, Psychological problems

49
Q

How does exercise affect hormones?

A

Exercise (a stressor on the body) decreases GnRH;

  • can lead to amenorrhea/oligomenorrhea in women.
  • variable effect in men.
50
Q

What is testosterone metabolized into?

A

DHT (more active form of testosterone)

51
Q

What does aromatase do?

A

Converts Androstenedione (pre-testosterone molecule) and testosterone into estrogens.

52
Q

What do 5-alpha-reductase inhibitors do?

A

Prevent conversion of testosterone into DHT

  • lessens male-pattern balding
  • lessens BPH
53
Q

What are the symptoms of low T in men?

A
  • low libido
  • decreased am erections
  • low volume & delayed ejaculation
54
Q

What hormones are produced by the acidophils?

A

GH & Prolactin

55
Q

What are the 3 parts of the anterior pituitary?

A
  • anterior lobe (pars distalis)
  • intermediate lobe
  • pars tuberalis
56
Q

What are the two parts of the posterior pituitary?

A
  • posterior lobe (pars nervosa)

- infundibular stalk

57
Q

What is another name for the anterior pituitary?

A

Adenohypophysis

58
Q

Histologically, where are posterior pituitary hormones stored?

A

Herring bodies (terminal ends of axons in the pituitary)

59
Q

What connects the hypothalamus to the posterior pituitary?

A

Hypothalamohypophyseal tract

60
Q

Where are ADH & oxytocin synthesized?

A

Hypothalamus (then travel through neurons to the posterior pituitary)

61
Q

What is secreted by basophils in the pituitary?

**an easy way to remember this?

A

FSH
LSH
ACTH
TSH

(the base is FLAT)

62
Q

What is produced by cells in the pineal gland?

- what is its action?

A

Melatonin

- regulates circadian rhythm

63
Q

What is “brain sand”?

A

Concretions in the pineal gland; increase in number with increasing patient age.
(extra knowledge: scientific name is “corpora aranacea”)

Endocrine & Metabolism (5 decks)

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