Basic Principles

Question 1

At what stage in pregnancy is a goitre seen

Answer 1

Perinatal period

Question 2

Many endocrine disorders are associated with defects in what

Answer 2

GPCRs

Question 3

What do GPCRs act as

Answer 3

Biological sensors

Question 4

What is a good example of intrinsic tyrosine kinase activity

Answer 4

Insulin receptor

Question 5

What are 2 examples of cytokine receptors

Answer 5

Prolactin receptor and growth hormone

Question 6

What are cytokine receptors linked to

Answer 6

Tyrosine kinase activity

Question 7

Steroid hormones are typically intracellular or extracellular

Answer 7

Intracellular

Question 8

Where exactly are steroid hormone receptors located

Answer 8

either in the cytoplasm or the nucleus

Question 9

What are included in the nuclear receptor family

Answer 9

Oestrogen, androgen receptos

Question 10

What do steroid/receptor complexes do ?

Answer 10

Bind DNA response elements

Question 11

When do receptors translocate to the nucleus

Answer 11

Only when a hormone or a ligand is present

Question 12

Give an example of a steroid hormone receptor and what it does

Answer 12

Testosterone

It causes alterations in gene transcriptions with interactions with DNA

Question 13

What can a circulating corticosteroid that is bound to by either a hormone or a ligand cause

Answer 13

Transactivation or transrepression

Question 14

What is the master regulator of hormones

Answer 14

Pituitary gland

Question 15

At what sites can the pathways be disrupted

Answer 15

Hypothalamus
Pituitary gland
Peripheral glands e.g. thyroid, adrenal, cortex or gonad

Question 16

What does a disruption in a pathway result in

Answer 16

Endocrine problems

Question 17

Where is the site of central regulation from the hypothalamus

Answer 17

Anterior pituitary gland

Question 18

What are the 5 hormones secreted by the anterior pituitary gland

Answer 18

Growth hormone 
LH/ FSH
Adrenocorticotropic hormone 
Thyroid stimulating hormone 
Prolactin (PRL)

Question 19

What is secreted by the posterior pituitary gland

Answer 19

ADH or vasopressin

Question 20

What factors affect the ability to accurately measure hormone levels

Answer 20

Pattern of secretion 
The presence of carrier proteins
Interfering agents 
Stability of hormone (consider 1/2 life) 
Absolute concentrations

Question 21

What is a major determinant of hormone concentration?

Answer 21

Rate of secretion

Question 22

Measuring hormones is typically determined by highly refined by what

Answer 22

Feedback loops - ie. need to know the right time to measure the right hormone levels (circadian rhythm)

Question 23

What types of hormones are commonly evaluated

Answer 23

Thyroid hormones
Steroid hormone production (e.g. cortisol)
Growth hormone evaluation
Reproductive and sex hormone (e.g. testosterone)
Prolactin
Calcium and parathyroid homrone

Question 24

Why might reproductive hormones be evaluated

Answer 24

Infertility
Puberty
Loss of libido
Erectile dysfunction

Question 25

What is the function of renin and aldosterone and what gland are the associated with

Answer 25

Adrenal gland | They regulate salt and water balance

Question 26

When might TSH not be a reliable marker of Thyroid status

Answer 26

If the patient had a primary hypothalamic pituitary problem e.g. a tumour and was therefore unable to secrete TSH

Question 27

What does the thyroid axis rely on

Answer 27

highly regulated feedback control

Question 28

What does the patient have if they have a raised TSH

Answer 28

Hypothyroid

Question 29

What does the patient have if they have a suppressed TSH

Answer 29

Hyperthyroid

Question 30

What hormone has the strongest circadian rhythm in humans

Answer 30

Cortisol

Question 31

When are the cortisol levels highest

Answer 31

First thing in the morning

Question 32

When should cortisol be measured

Answer 32

First thing in the morning when they should be at their peak

Question 33

Describe the release of growth hormone from the pituitary

Answer 33

Under pulsatile release from and short lived in the blood

Question 34

What happens if there is excess growth hormone before puberty was complete

Answer 34

Marked elongation within the long bones of the body

Question 35

What happens if the growth hormone was in too little quantities around puberty

Answer 35

Dwarfism

Question 36

Describe the relationship between gamete production and sex hormone synthesis

Answer 36

These are coordinated so there is a close relationship

Question 37

What is prolactin secreted by

Answer 37

Lactotroph cells of the anterior pituitary

Question 38

The effects of Prolactin are mediated by what

Answer 38

The prolactin receptor (PRLR)

Question 39

Where is thirst tightly regulated within

Answer 39

The hypothalamus

Question 40

What are the 3 main steroid hormones that can lead to specific endocrine disorders

Answer 40

Aldosterone Cortisol Testosterone

Question 41

What happens if the body can't produce the precursors of steroid hormones

Answer 41

There will be an excess of the hormone

Question 42

When is biochemical testing typically perfumed with regards to imaging

Answer 42

Before imaging

Question 43

To test for hormone excess, what test do we do

Answer 43

Suppression test

Question 44

To test for hormone deficiency, what test do we do

Answer 44

Stimulation test

Question 45

In what situation might there be a need for combined imaging/ biochemical testing

Answer 45

Adrenal vein sampling or petrosal sinus sampling

Question 46

If there is a cortisol deficiency, what does this mean

Answer 46

You have adrenal insufficiency

Question 47

If there is primary adrenal failure, what disease is this known as

Answer 47

Addison's disease

Question 48

Cortisol excess is more commonly known as what

Answer 48

Cushing's syndrome

Question 49

Stimulation test with cortisol is known as what

Answer 49

Synacthen tes

Question 50

What is the cortisol suppression test known as

Answer 50

Dexamethasone suppression test

Question 51

What are some symptoms of Cushing's syndrome

Answer 51

``` Cushingoid facies Acne Hirsutism Abdominal striae and centripetal obesity Inter scapular and supraclavicular fat pads proximal myopathy osteoporosis hypertension impaired glucose tolerance ```

Question 52

What is important to know before removing any adnreal gland

Answer 52

Whether it is unilateral or bilateral

Question 53

What are some causes of Cushing's syndrome

Answer 53

High levels of ACTH Increased production of cortisol Ectopic ACTH Exogenous steroids (causing ACTH to be switched on)

Question 54

Investigation for Cushings can be done as an outpatient or always an inpatient

Answer 54

Outpatient

Question 55

If there is a failure to suppress in a low dose dexamethasone suppression test what does this indicate

Answer 55

Cushing's syndrome

Question 56

If the ACTH is low, what does this indicate

Answer 56

Adrenal origin is likely

Question 57

What can be lost if there is a pituitary tumour or an adrenal tumour

Answer 57

The circadian rhythm

Question 58

What is MEN

Answer 58

Multiple endocrine neoplasia

Question 59

What gene is affected in MEN1

Answer 59

MEN 1 gene - 11q

Question 60

What gene is affected in MEN2

Answer 60

RET gene - 10q

Question 61

What are 2 of the most important things to try and avoid with patients with MEN1

Answer 61

Premature morbidity and mortality