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Flashcards in Endocrine disease Deck (81):
1

list the major endocrine glands in the human body

- pineal
- pituitary
- thyroid
- pancreas
- adrenal

2

what hormone does the pineal gland secrete

melatonin

3

what does melatonin (secreted by the pineal gland) regulate

circadian rhythm or sleep wake cycles

4

what are the chances of getting a pineal tumour

extremely rare
<1:200,000

but can be serious if do get the tumour

5

what % of pineal tumours comprises of inter cranial tumours

<1%

6

what age do pineal tumours develop

adults 35-60 years of age peak

7

list the presentations of pineal tumours

- headaches - hydrocephalus (due to enlarged ventricles which pushes)
- nausea
- blurred vision
- upward gaze palsy (parano syndrome)
- gait
- insomnia/sleep disturbances
- hearing loss

8

where is the pituitary gland situated

sits above the thalamus & hypothalamus

9

what cells are located anterior to the pituitary gland

- TRH = thyrotropin releasing hormone
- TSH = thyroid stimulating hormones
- PIF = prolactin inhibitory factor or dopamine
- PRL = prolactin
- CRH = corticotropin releasing hormone
- ACTH = adrenocorticotropic hormone (cortitropin)

10

what cells are located posterior to the pituitary gland

- GHRH = growth hormone releasing hormone (somatotrophin)
- GIH - growth hormone inhibitory factor (somatostatin)
- GnRH = gonadotropin
- FSH = follicle stimulating hormone
- LH = luteinizing hormone

11

how many % of intracranial neoplasms do pituitary tumours account for

10-15% (1 in 10)

12

what action of hormones occurs during pituitary tumours

presence of hormones, hyper secretion of hormones

13

what does destruction of pituitary i.e. ischemia (taking blood away from pituitary gland), iatrogenic cause to hormone secretion

absence or diminution of hormone secretion

14

what do pituitary tumours cause to adjacent structures

direction and extent of local expansion and invasion of adjacent structures i.e. non functioning adenoma

15

list the types of common adult pituitary tumours

- prolactinomas
- growth hormone secreting adenoma
- non secreting adenomas
- corticotroph adenoma (ACTH)
- TSH, FSH, LH are all rare (sex hormones)

16

what do ~15% of pituitary adenomas secrete

>hormone with prolactin + growth hormone the most common combination

17

what % of tumours do prolactinomas account for

30%

18

what do prolactinomas (pituitary tumours) do

DDX - dopamine inhibition (hypothalamus neurons) 2 degrees trauma

19

what do prolactinomas (pituitary tumours) usually cause in women

- amenorrhea - periods stop
- galactorrhea - 'witch's' milk

20

what do prolactinomas (pituitary tumours) usually cause in men

- testicular atrophy - dry up
- gynecomastia = man boobs
- diminished body hair
- impotence

21

what are the signs and symptoms of growth hormone secreting tumours in a pituitary tumour

acromegaly
patients report gradual enlargement and coarsening of facial features, hand and feet. Tumour may be large at time of diagnosis as signs and symptoms are slow

Gh stimulates IGF-1
if child gets gigantism
if adult gets acromegaly

22

what syndrome is associated with corticotrophin secreting adenomas (ACTH) as a result of pituitary tumours and what are the symptoms

cushing syndrome

Females : Males = 4:1
so more common in males

- truncal obesity
- abdominal stress
- moon faces
- thin skin
- high blood pressure
- glucose intolerance
- fatigue

23

who does the FSH, LH & TSH type of pituitary hormone occur mostly in

middle aged men and women

24

what symptoms does FSH, LH & TSH type of pituitary hormone cause

- visual field loss
- headache
- diplopia

25

what does FSH, LH & TSH type of pituitary hormone cause in men

decreased libido/energy

26

which pituitary hormone is are <1%

TSH

27

what does a pituitary tumour rarely cause

hyperthryroidism

28

what are the appearance of non secreting adenomas, tumours without endocrine symptoms at time of diagnosis

large but usually asymptomatic except headaches

29

what symptom do patients with non secreting adenomas (tumours without endocrine symptoms) have

severe frontal headaches, about 50% of patients

30

what is extremely rare in the non secreting adenomas of pituitary tumours

papilloedema

31

what visual field defect do patients with non secreting adenomas pituitary tumours have

monocular or binocular hemianopia superior affected first them inferior is typical

32

which part of the brain is constricted in non secretin adenoma pituitary tumour

ventricles

33

what does T3 turn into for a thyroid receptor hormone

T4

34

what do T3 + TRH affect

gene expression

35

what does genes ON increase

lipid and carbohydrate catabolism + increase protein synthesis

36

what is hyperthyroidism

hyper function of thyroid gland

37

list the aetiologies of hyperthyroidism

- hyperplasia (graves) ~ 85% - autoimmune
- hyperfunctional - diffuse/multinodular
- adenoma of thyroid - tumour
- TSH secreting adenoma of pituitary - rare

38

graves disease = thyroid associated...

ophthalmopathy

39

how much % of hyperthyroidism is associated with graves disease

100%

40

how much % of ophthalmopathy is associated with graves disease

50%

41

how much % of infiltrative dermopathy is associated with graves disease

<5%

42

what do hyperthyroid patients have symptoms of

- weight loss despite good appetite
- head or cold intolerance
- tachycardia

43

what is the prevalence of graves disease in the UK

2%

44

what is the female:male ratio of graves disease

10:1

45

what is the age range of graves disease

20-40 years

46

what does graves disease have a familial tendency with

positive family history in 30% of cases

47

what type of disease is graves disease

autoimmune

48

what is graves disease caused by

break down of self tolerance

49

in graves disease, what do the autoantibodies bind to or in the region of, and what does that result in

autoantibodies bind to or in region of TSH receptors, results in increase of T4 + T3 which = decrease of TRH from anterior pituitary - virtually undetectable

50

what is increased during graves disease

- sympatho adrenergic activity
&
- metabolic rate

51

what is suppressed during graves disease

TSH = excess T/T

52

list the symptoms/outcomes of graves disease

- exophthalmus/proptosis
- warm pulsating goitre
- tachycardia
- fine tremor
- pretibial myxoedema (rash on ankles)

53

how many % of patients does exophthalmus/proptosis occur in

60%

54

which tool measures the elevation of the eye

exophthalmometer

55

what readings from an exophthalmometer indicates exophthalmus

>21mm or a difference between eyes of >2mm

56

what is the cause of exophthalmus

swollen extra ocular muscles = painful
EOMs push onto ONH

57

why do the EOMs increase in size

- infiltratiion of T-cells to retro-bulbar space
- inflammation/oedema
- accumulation of ECM matrix components i.e. GAGS hyaluronic acid and chondroitin sulphate
- increase number of adipocytes
- preadipocyte fibroblasts express TSH receptor and are thus targets for autoantibodies

58

why are the EOMs effected

- EOMs are highly innervated compared with skeletal muscles
- EOMs have unusually high vascular supply (more prone to antibodies arriving there) compared to skeletal muscles
- embryological differences with neuroectodermal origin compared with mesodermal origin for skeletal muscles

59

list the how abnormality of eye motility is effected from graves disease

- elevation usually first to be effected (IR restricts up gaze)
- then abduction (may have esodeviation due to tethered MR)
- usually associated with diplopia
- oblique muscles usually not involved

60

what would you refer a px with exophthalmus for

CT scan to exclude tumour

61

what will a CT scan for exophthalmus show

enlargement of EOMs

62

what does fluorescin staining show of a px with exophthalmus

- stressed cells
- dry eye as can't close eyes properly

63

what are the treatment considerations for graves disease

- hyperthyroidism treatment does not correlate well with improvement in graves ophthalmapothy
- can't get graves ophthalmapothy with no thyroid gland
- both hyperthyroidism an graves ophthalmopathy have an underlying autoimmune aetiology that affects the thyroid, eyes and skin
- so unless the underlying autoimmune disorder is addressed there is no reason for the eyes, skin and thyroid to recover by merely rating one tissue

64

what is hyperthyroidism - goitres due to

- lack of iodine in diet
- impaired synthesis of thyroid hormone (T3, T4)
- no negative feedback on TSH
- get a rise in TSH in serum
- TSH causes hypertrophy and hyperplasia of thyroid follicular cells

65

what causes hashimoto's thyroiditis

hypothyroidism - no T4 secretion and iodinisation

66

what destroys the thyroid in hashimoto's thyroiditis

autoimmune T cells destroy thyroid

67

what is the female:male ratio of hashimoto's thyroiditis

10:1

68

what is the most common age range of hashimoto's thyroiditis

45-65 years

69

how many patients of hashimoto's thyroiditis have ocular signs e.g. dry eyes

only 2%

70

which tablets are required to be taken for life to manage hashimoto's thyroiditis

levothyroxine (precursor to thyroxine) sodium tablets for life

71

what happens during the cause of hypothyroidism - hashimoto's

1. CD8 + cytotoxin T cells destroy thyrocytes
2. CD4+ T-helper cells secretes interferons (cytokines) that activate macrophages that damage thyrocytes
3. autoantibodies to thyroid cells that trigger natural killer cell mediated cytotoxicity

72

what does a normal thyroid gland show in a microscopic diagram

follicles

73

what are the symptoms of hypothyroidism - hashimoto's

- fatigue, constipation, dry skin and weight gain
- cold intolerance
- slowed movement and loss of energy
- decreased sweating
- peripheral neuropathy

74

what is the cause of type 1 diabetes

B-cell destruction in islets of langerhans = no insulin production - no glucose uptake into cells

75

what is the cause of type 2 diabetes

insulin resistance and B-cell dysfunction

76

what does insulin provide for adipose tissue

- increase in glucose uptake
- increase in lipogenesis
- decrease in lipolysis

77

what does insulin provide for striated muscles

- increased glucose uptake
- increased glycogen synthesis
- increased protein synthesis

78

what does insulin provide for the liver

- decreased gluconeogenesis
- increased glycogen synthesis
- increased lipogenesis

79

what destructs the B cells in type 1 diabetes (destruction of islets of langerhan)

T-cell

80

what results in insulin resistance in type 2 diabetes

- adipocytes release adipokines = cytokines from adipose tissue + fatty acids + inflammatory cytokines that result in insulin resistance
- B cells hypertrophy then atrophy (b cell failure = decreased)

81

what can type 2 diabetes cause

- microangiopathy cerebral vascular infarcts hemorrhage
- retinopathy
- cataracts
- glaucoma
- hypertension
- myocardial infarction
- atherosclerosis
- islet cell loss:
insulitis type 1
amyloid type 2
- nephrosclerosis, glomerulosclerosis, pyelonephritis
- peripheral neuropathy
- autonomic neuropathy
- peripheral vascular atherosclerosis
- gangrene (due to reduced blood supply)
- infections