Endocrine Flashcards

Question

What is hypothyroidism?

Answer 1

In infants, hypothyroidism produces the clinical syndrome known as cretinism or congenital hypothyroidism, which presents as: Puffy face Enlarged tongue coarse features Protuberant abdomen Delayed physical & mental milestones It is usually due to untreated maternal hypothyroidism rarely seen any more in the developed world It is still a problem in parts of the world due to dietary iodine deficiency In Adults, hypothyroidism, when manifests as a syndrome called myxedema which is due to a reduced metabolic rate. Symptoms include: Progressive slowing of physical & mental activity increasing lethargy Sensitivity to cold Puffy face Coarse dry skin thinning of the hair (particularly the lateral eyebrows) Hoarseness and deepening of the voice Increased predisposition to hyperlipidaemia

Answer 2

Autoimmune called Hashimoto’s Disease Secondary due to total or partial removal of the thyroid gland due to either cancer or an aggressive form of Grave’s disease. Or due to certain types of drug therapy.

Answer 3

Most common in middle ages women Autoimmune destruction of thyroid Antibodies produced against thyroglobulin Clinical Presentation Same as for any form of hypothyroidism Goitre Patients likely to have other autoimmune diseases such as vitiligo or SLE.

Answer 4

3 main types: Papillary carcinoma usually in young adults is slow growing and usually has good prognosis Follicular Carcinoma middle aged people commonly metastasises via the bloodstream to the bone. Diagnosis is usually made following a spontaneous fracture. Anaplastic Carcinoma Rapidly, aggressive tumour. Poor prognosis. Can cause tracheal compression.

Answer 5

Small endocrine glands whose sole function is to secrete parathormone (PTH)

Answer 6

Important in calcium balance, acting at two sites: The bone surface where is stimulates the resorption of mineralised bone by osteoclasts with the release of calcium into the blood stream. 2) The renal tubules Stimulates reabsorption of calcium ions from urine. Generally, increased PTH secretion increases serum calcium levels Reduced PTH secretion, reduces serum calcium levels. Inappropriate secretion leads to either: pathological increase  Hypercalcemia pathological decrease  Hypocalcemia

Answer 7

PTH stimulates osteoclastic reabsorption of bone, and causes increase released of calcium from bone into the blood plasma  Hypercalcemia. Normally regulated by a feedback mechanism Two types of hyperparathyroidism Primary Hyperparathyroidism usually due to a parathyroid adenoma which secretes excess PTH  leads to increased osteoclastic activity. 2. Secondary Hyperparathyroidism Persistently low serum calcium levels seen in chronic renal disease causes continuous stimulation of the parathyroids.

Answer 8

Nausea & Vomiting Drowsiness, chronic fatigue. Dehydration Confusion and / or Depression Muscle Spasms Bone pain / tenderness Joint Pain Irregular heart beat Fractures

Answer 9

The adrenal glands have 2 distinct endocrine components: The Cortex Synthesizes, stores and secretes 3 main types of hormones (steroid hormones synthesized from cholesterol): Glucocorticoid, Mineralocorticoid (aldosterone) and sex hormones- Androgens & oestrogen The Medulla Part of the sympathetic nervous system (derived embryologically from the neural crest) Synthesizes Adrenaline & Noradrenaline (aka epinephrine & norepinephrine)

Answer 10

Glucocorticoid & Sex Hormone Secretion is under the control of ACTH, which is secreted by the pituitary gland. therefore excessive secretion of these hormones may be secondary to an ACTH – secreting adenoma of the pituitary. Aldosterone secretion is controlled by renin production by the juxtaglomerular apparatus in the kidney (refer back to previous lectures on cardiovascular system / hypertension / renal)

Answer 11

A condition caused by uncontrolled, excessive production of adrenal cortical hormones. In particular, Cortisol (glucocorticoid) Cause: Excessive therapeutic administration of corticosteroids most common cause Pituitary Adenoma Adrenal Adenoma

Answer 12

Moon Face Acne Hirsutism Severe Osteoporosis - high risk of vertebral compression fractures Skin Fragility Poor Wound healing Trunk obesity with stria Peptic ulcers Hypertension & Diabetes Hypokalaemia & psychiatric disturbances

Answer 13

Caused by chronic adrenal cortical insufficiency due to lack of glucocorticoids & mineralocorticoids Caused by: Destruction of the adrenal cortex by autoimmune disease usually autoimmune thyroiditis, autoimmune gastritis or any other endocrine autoimmune disease. Clinical Presentation Chronic Dehydration & loss of appetite. Brownish pigmentation of skin & buccal mucosa Lethargy & weakness

Answer 14

Occurs if prolonged high dose therapeutic corticosteroid therapy is abruptly stopped. Prolonged corticosteroid therapy leads to suppression of normal endogenous steroid production by the adrenal cortex Addisonian crisis presents as: Hypotensive shock Hypoglycaemia risk of sudden death

Answer 15

Insulin, Glucagon & Somatostatin

Answer 16

Secreted by the B- cells Permits transfer of blood glucose into cells Stimulates synthesis of glycogen in the liver and skeletal cells Lowers blood sugar levels ( in the absence of insulin, blood glucose levels rise and cells become depleted of glucose).

Answer 17

Opposes the function of insulin

Answer 18

has many functions & found widely throughout the body In the pancreas  inhibits release of insulin & glucagon from the Islets. in other organs, has other functions.

Answer 19

function is unknown

Answer 20

The most common and important disease associated with the endocrine pancreas. It is a chronic disease of carbohydrate, fat and protein metabolism resulting from an inadequate action of the hormone INSULIN . It is a multisystem disease.

Answer 21

Cells in our body use glucose as a source of immediate energy. If we exercise, we require a higher concentration because muscles require glucose for energy. Glucose is a preferred source of energy as it provides both energy and water through the Krebs Cycle and aerobic metabolism. Your body can use protein & fat, but their breakdown creates ketoacidosis which is not its optimal state. Excess of ketoacids produces metabolic acidosis. Functioning body tissues continuously absorb glucose from the blood stream. People without diabetes are able to eat a meal of carbohydrates and can replenish circulating blood glucose in approximately 10 minutes after eating. As BG levels rise, pancreas activates insulin- sensitive cells to produce insulin. Glucose enters in the liver activated enzymes which convert glucose to glycogen  glycogen is stored in muscle, liver & fat. When BG levels drop after a meal has been digested, insulin secretion stops and glycogen synthesis stops. When there is a requirement for energy, the liver breaks down stored glycogen & converts it back into glucose If we eat beyond what our energy requirements are, we continue to have elevated blood glucose levels and excess glycogen continues to be stored. Sedentary, overweight or obese people will accumulate triglycerides in their muscle cells. This causes the cells to use fat rather than glucose to produce muscular energy Blood glucose levels are normally being monitored continuously and normally throughout every minute of the day. A delicate balance between the pancreas, intestine, brain and adrenals is vital to maintain normal BG levels. Too little  Hypoglycaemia (not enough energy for cells) Too much  Hyperglycaemia (too much, can have a paralyzing effect on cells)

Answer 22

There are 2 main forms: Type 1 Diabetes aka Insulin Dependant Diabetes Mellitus or Juvenile Onset Diabetes. Type 2 Diabetes aka Non – Insulin Dependant Diabetes. But there are also 2 further classifications: Type 3 Diabetes (very rare!) specific type of diabetes causes by rare genetic defects to the Islets. Type 4 Gestational Diabetes

Answer 23

Usually presents in childhood or adolescence. Autoimmune Majority of patients have circulating antibodies to the endocrine cells of the Islets which produce insulin. There is lymphocytic infiltration and destruction of the insulin producing cells of the Islets. This destruction leads to insulin deficiency which in turn leads to hyperglycaemia and other secondary metabolic complications.

Answer 24

1 in 10 people over the age of 40 have Diabetes in the UK (approx. 4.9million people) with an estimated 13.6 million being at risk or pre-diabetic in the UK. It is the leading cause of preventable sight loss. Type 2 Diabetes leads to almost 9600 leg, toe or foot amputations every year (that’s 185 a week). Over 700 people with diabetes die prematurely every week. 1 in 6 people in the UK hospitals, have diabetes. 10% of total NHS funding is spent on type 2 diabetes More common than type 1 Unlike Type 1 where there is an absolute absence of insulin, in Type 2 the insulin blood levels are initially normal, and may even initially rise in the early stages. eventually insulin levels fall below normal. this is due to INSULIN RESISTANCE

Answer 25

Obesity, Low levels of physical activity, unhealthy diet, genetics

Answer 26

Appears to be mediated by abdominal obesity Studies have shown a strong link between excess upper body fat and Type 2 Diabetes. Combination of excess risk factors associated with increased abdominal fat which lead to continuous increased inflammation in the body, and abdominal fat causing further increased inflammation in the body. Abdominal fat also has an effect on mediation of hormones. Prolonged Inflammation plays a key role in insulin resistance and the Exact pathogenesis is unclear.

Answer 27

Significantly increased mortality risk due to the complications of diabetes mellitus. Complications of DM include: Increased risk of infections Increased severity of atherosclerosis & its complications Extensive small vessel disease (arteriosclerosis) Renal Glomerular Disease Retinal Vascular Disease Peripheral Nerve Damage As a result of these complication, diabetes has a predisposition to develop: Ischemic Heart Disease Cerebrovascular Disease Peripheral Gangrene of lower limbs Chronic Renal Disease Reduced Visual Acuity due to Diabetic Retinopathy – leading to blindness Peripheral Neuropath

Answer 28

Most commonly presents as a glove & stocking distribution Leads to loss of sensation, including the loss of pain sensation normal pain withdrawal reflex is lost Therefore areas of skin become repeatedly damaged from friction e.g. ill fitting footwear. This can lead to formation of an ulcer.

Endocrine Flashcards

(53 cards)