Endocrine Pathologies

Question 1

What are the effects of insulin?

Answer 1

Carbs: Liver: + storage of glucose as glycogen

Fats: Adipose tissue: +conversion of glucose to fat

Proteins:
- glucogenesys
+ Cellular uptake of AA

Question 2

What are the effects of lack of insulin?

Answer 2

Fats: used as fuel source
Protein: AA used as fuel

Question 3

What are the effects of glucagon?

Answer 3

Affect liver

• breakdown glycogen (glycogenolosis)
• Synthesis of glucose (gluconeogenesis)

Lower blood levels of AA

Question 4

What messenger does glucagon use to act?

Answer 4

second messenger

Question 5

What is diabetes?

Answer 5

clinical syndrome characterised by hyperglycaemia

due to absolute or relative insulin deficiency

Question 6

How is diabetes diagnosed?

Answer 6

blood sugar > 11.1
fasting sugar> 7
HbA1c>6.5

Question 7

What are the classifications of diabetes?

Answer 7

Primary
- diabetes type 1: Absolute deficiency (insulin dependant) 10% adults
- diabetes type 2: relative 
deficiency 
88% adults   

Secondary
arises from known pathology

Question 8

what is pre-diabetes?

Answer 8

Impaired glucose tolerance

*levels higher than normal but not high enough to be diabetes

Question 9

What causes diabetes type 1

Answer 9

Genetics: Environmental factors
Autoimune T1DM
Virus: rubella, epstein barr, cytomegalovirus

Question 10

What causes diabetes type 2

Answer 10

Old, fat, lazy, smokers

Genetics T2DM

Question 11

What is oxidative stress and what pathology is associated to?

Answer 11

stress fat tissues: releases cytokines which in T2DM impair insulin receptors = target cells less responsive
also damage beta cells in pancreas

Obesity associated with decrease insulin receptor density

Question 12

What type of insulin deficiency is T1DM related to?

Answer 12

absolute deficiency (type 1 diabetes)

Question 13

What type of insulin deficiency is T2DM related to?

Answer 13

Diabetes type 2 - relative deficiency = insuline resistance

process: 
target cells become resistant 
initial stage: hyperinsulinaemia
later stage: beta cell exhaustion 
leads to insulnpaenia

Question 14

what are the clinical features for type 1 diabetes mellitus (T1DM)

Answer 14

polyphagia (gluttony with no wight gain)
polyuria (fast pee)
polydipsia (thirst)
Glycosuria (sugar in pee)

Question 15

what are the clinical features for type 2 diabetes mellitus (T2DM)

Answer 15

hyperglycaemia
glycosuria
+ risk infection

Question 16

What are the complications for diabetes?

Answer 16

Acute

• hypoglycaemia (low sugar)
• Ketoacidosis (body can’t produce insulin)

Chronic

• vascular disease
• diabetic neuropathy
• diabetic foot (no feeling on foot)

Question 17

What are the clinical features for hypoglycaemia?

Answer 17

CNS: fatigue HA drowsiness, speech problem

ANS: sweating, trembling, pounding heart, hunger

Severe hypo: coma, convulsion, brain damage

Question 18

What are the complications of Diabetic ketoacidosis (DKA)

Answer 18

death
Ketone acidosis (decrease PH)

Question 19

What are the clinical features of ketoacidosis?

Answer 19

***MEDICAL EMERGENCY***
hyperglycemia
acetone breath
respiratory compensation
mental disturbance
pheripheral vasodilation

Question 20

What is diabetic vascular disease and what are its complications?

Answer 20

group of blood vessel pathologies

atherosclerosis = diabetic Macroangiopathy (large vessel)

Arteriosclerosis = diabetic microanginiopathy (capillaries)

Question 21

What are the chronic complications of diabetic foot?

Answer 21

low limb amputation

gangrena - necrosis

Question 22

What is the first line pharmachological management of T2DM?

Answer 22

biguanides
+ glucose uptake
- glycogenesis
- intestinal absorption

Question 23

Thyroglobulin is the percursor for which thyroid hormones?

Answer 23

T4 - T3

Question 24

What do parafollicular cells secrete

Answer 24

calcitonin

Question 25

How are thyroid hormones classified?

Answer 25

Aminoacids | contain iodine

Question 26

What receptor does TSH bind to?

Answer 26

follicular cell receptors

Question 27

What are the effects of thyroid hormones?

Answer 27

gene transcription catecholamine effect regulate normal function

Question 28

What is nontoxic goitre?

Answer 28

enlargement of thyroid gland - normal function maintained

Question 29

What is the cause of goitre?

Answer 29

iodine deficiency

Question 30

What is hypothyroidism?

Answer 30

Deficiency of T3 and T4 in fetes leads to intelectual disability "cretinism"

Question 31

How is hypothyroidism classified?

Answer 31

Primary: failure of thyroid - Hashimoto (autoimune) Secondary: TSH deficiency Tertiary: TRH deficiency

Question 32

What is hashimoto thyroids

Answer 32

primary type thyroidism • Autoimmune disorder characterised by lymphocyte-mediated inflammation and fibrosis

Question 33

What is chronic lymphocytic thyroiditis?

Answer 33

Secretion of IgG anticoagulant affecting - thyroglobulin - thyroid peroxide Early disease: leads to goitre

Question 34

What are the clinical features for chronic lymphocytic thyroiditis?

Answer 34

goitre - metabolic rate GAG - skin accumulation **may lead to myxoedema and increase risk of angina**

Question 35

Whta hormone replacement therapy is used for Lymphocytic thyroids?

Answer 35

levothyroxine

Question 36

What is thyrotoxicosis?

Answer 36

thyroid hormone excess "graves disease"

Question 37

What is the pathophysiology of graves disease?

Answer 37

Antibodies affect TSH receptors (TSHrAbs) + levels T4 & T3 produce goitre antibodies fluctuate with severity of disease

Question 38

What are the clinical features of Thyroxicosis?

Answer 38

``` + metabolic rate + apetite & thirst + palpitations nervousness/ psychosis menstrual irregularities loss of libido ```

Question 39

Clinical features for graves disease

Answer 39

ocular changes - eyes pop out skin changes= GAG in legs

Question 40

Management of graves disease

Answer 40

any thyroid drugs PTU - reduce thyroid peroxidase

Question 41

What is the most common type of thyroid cancer?

Answer 41

papillary carcinoma

Question 42

what are the risk factors for thyroid cancer?

Answer 42

radiation Family Hx benign thyroid disease

Question 43

What are the clinical features for thyroid cancer?

Answer 43

enlarge nodule, firm not tender neck discomfort due to pressure

Question 44

Management for thyroid cancer?

Answer 44

thyroidectomy - surgery

Question 45

What is the function of parathyroid glands

Answer 45

secrete parathyroid hormone PTH which increases plasma levels of Calcium Ca2. If Ca2 is high PTH is inhibited PTH + renal excretion calcitonin pose PTH actions on bone

Question 46

What are the clinical features of hyperparathyroidism?

Answer 46

``` hypercalcaemia -bones - stones - abdo groans + BP ```

Question 47

What are the clinical features of hypoparathyroidism?

Answer 47

hypocalacemia + excitability of sensory and motor nerves - BP