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Year 2 Clinical Pathology > Endocrine Investigations > Flashcards

Endocrine Investigations Flashcards

1
Q

What are the 2 principles of dynamic investigations?

A

1) Attempted stimulation for hypo-function

2) Attempter suppression for hyper-function

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2
Q

What is the basic feedback loop in the endocrine system?

A
  • Hypothalamus stimulates anterior pituitary which stimulates endocrine organ
  • Hormone produced by endocrine organ negatively feeds back to the hypothalamus and anterior pituitary
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3
Q

In the male reproductive system, what 2 hormones are released by the hypothalamus?

A

1) FSH releasing factor

2) LH releasing factor

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4
Q

In the male reproductive system which 2 hormones are released by the pituitary gland?

A

1) FSH

2) LH

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5
Q

FSH released by the pituitary gland in the male reproductive system acts on what cells to cause what 2 actions?

A

1) Sertoli cells in seminiferous tubules
Causes
1) Maturation of sperm
2) Release of inhibin

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6
Q

Inhibin has what 2 actions in the male reproductive system?

A

Inhibits release of FSH from pituitary gland and inhibits release of FSH releasing factor from hypothalamus

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7
Q

LH released by the pituitary gland in the male reproductive system acts on what cells, causing the release of what hormone?

A

Acts on Leydig cells (L for LH, L for Leydig cells)

Causing them to release testosterone

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8
Q

What are the 2 actions of Testosterone released from the Leydig cells on the male reproductive signalling pathway?

A

Inhibits release of LH from the pituitary gland and LH releasing factor from hypothalamus

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9
Q

What hormone is released from the hypothalamus in the female reproductive system?

A

GnRH

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10
Q

GnRH causes the release of what 2 substances from the anterior pituitary in the female reproductive system?

A

Release of FSH and LH

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11
Q

LH acts on what 2 structures in the female reproductive system having what action?

A

1) Corpus luteum to release progesterone

2) Follicle to release estradiol and inhibin

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12
Q

FSH acts on what structure in the female reproductive system to cause the release of what?

A

Follicle to release inhibin and estradiol

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13
Q

Which 2 hormones act on the follicle in the female reproductive system?

A

FSH and LH

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14
Q

Inhibin is released from what structure in the female reproductive system and has what action?

A

Released from the follicle

Inhibits the release of hormones from the anterior pituitary

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15
Q

Estradiol is released from what structure in the female reproductive system and has what action?

A

released from the follicle

Inhibits release of hormone from the anterior pituitary AND the hypothalamus

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16
Q

Progesterone is released from what structure in the female reproductive system and has what actions?

A

Released from the corpus luteum and inhibits release of hormones from the hypothalamus and anterior pituitary

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17
Q

Give the 2 possible reasons for high TSH with high thyroxine?

A

1) pituitary gland overproduction

2) Feedback fails

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18
Q

What is important to note about random hormone values in both over and under production?

A

Random hormone values can be identical in over and under production, dynamic testing is needed to confirm

19
Q

Why is it important to record the time of day that a cortisol sample is taken?

A

Shows high diurnal variation

20
Q

When are cortisol levels highest?

A

8-10am

21
Q

When are cortisol levels lowest?

A

11pm-1am

22
Q

What is the difference between Cushing’s disease and Cushing’s syndrome?

A

Cushing’s disease = due to pituitary gland tumour producing ACTH
Cushing’s syndrome = excess of ACTH for another reason

23
Q

What are the 8 features of Cushing’s syndrome?

A

1) Obesity - moonface, central obesity
2) Skin - thin, purple striae, bruising
3) Hypertension
4) Glucose intolerance
5) Menstrual disturbances/ impotence
6) Thin limbs/ muscle weakness
7) Back pain due to osteoporosis
8) Psychiatric disturbances - depression, psychoses

24
Q

What suppression test is used in suspected Cushing’s syndrome?

A

Dexamethasone suppression
Give patient an artificial steroid which doesn’t cross react with assays ie dexamethasone
This should tell pituitary to stop producing ACTH thus cortisol production will decrease
Cortisol should be undetectable about 10 hours later

25
Q

What is Addison’s disease?

A

Adrenal failure

26
Q

What are the 2 reasons for adrenal failure?

A

1) Adrenal atrophy

2) Adrenal destruction

27
Q

What are the 6 clinical features of adrenal failure/Addison’s disease?

A

1) Tiredness
2) Weight loss
3) Pigmentation
4) Hypoglycaemia
5) Abdominal pain
6) Hypovolaemic collapse

28
Q

How would you investigate suspected adrenal failure using dynamic investigation?

A

Give the patient ACTH to try to stimulate the adrenal glands to produce cortisol

29
Q

Give a secretory system which works in annual cycles?

A

Hair growth

30
Q

Give a secretory system which works in monthly cycles?

A

Menses

31
Q

Give a secretory system which shows diurnal variation?

A

Cortisol

32
Q

Give a secretory system which show rapid amplitude cycles?

A

Insulin

33
Q

Give a secretory system which is stress related?

A

Anterior pituitary hormones

34
Q

Give a secretory system which is stimulus related?

A

Insulin

35
Q

Give 3 hormones which work over the course of minutes?

A

1) Insulin
2) PTH
3) GH

36
Q

Give a hormone which works over the course of hours?

A

ACTH

37
Q

Give 2 hormones which work over the course of days?

A

LH and FSH

38
Q

Give 2 hormones which work over the course of months?

A

TSH and prolactin

39
Q

Before the rise of testosterone in adulthood, during which 2 other periods in life is there a peak of testosterone levels?

A

Foetus

Infancy

40
Q

Does an increase in TFTs confirm thyroid disease?

A

No can occur in other cases

41
Q

What are the 5 reasons to examine urine in endocrine disease?

A

1) Integration of fluctuating single serum hormone
2) Integration of multiple hormones
3) Analysis of unstable serum hormones
4) Collection at time of symptoms
5) Avoid venepuncture

42
Q

Serum circulating hormones exist in equilibrium between what 2 forms?

A

Free and protein bound

43
Q

Give a hormone which exists as a ‘free’ serum hormone?

A

T4 and T3

44
Q

Give 3 binding proteins in serum?

A

TBG, Albumin and TBPA

Year 2 Clinical Pathology (64 decks)

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