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Phase 2a > Endocrinology > Flashcards

Endocrinology Flashcards

(126 cards)

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1
Q

what does endocrine mean

A

substance released into the blood and causes an effect

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2
Q

what does paracrine mean

A

substance which acts on cells within same vicinity and causes an effect

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3
Q

what does autocrine mean

A

a cell-produced substance which acts on the cell that produced it to cause an effect

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4
Q

which type of hormones have slow clearance and a long half life

A

fat soluble/steroid

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5
Q

which type of hormones have fast clearance and short half life

A

water soluble/peptide

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6
Q

what is negative feedback

A

stimulus causes a hormone to be released which directly counteracts stimulus

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7
Q

what is positive feedback

A

stimulus causes a hormone to be released which increases the stimulus

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8
Q

what is an exocrine hormone

A

secretions secreted through a duct to site of action

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9
Q

where is a peptide hormone receptor located

A

cell membrane

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10
Q

where is a steroid hormone receptor located

A

cytoplasm

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11
Q

what hormones have a receptor in the nucleus

A

thyroid
oestrogen
vitamin D

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12
Q

where does ANP act

A

in the heart

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13
Q

where is IGF-1 released

A

liver

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14
Q

where is erythropoietin released

A

kidneys

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15
Q

where are gastrin and incretin released

A

in the GI tract

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16
Q

what is appetite

A

desire to eat food

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17
Q

what is hunger

A

need to eat

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18
Q

what is anorexia

A

lack of appetite

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19
Q

what is satiety

A

feeling of fullness/ disappearance of appetite after a meal

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20
Q

what are the BMI values

A 
under 18.5 = underweight
18.5-24.9 = normal
25 - 29.9 = overweight
30 - 39.9 = obese
above 40 = morbidly obese
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21
Q

what is the role of the hypothalamus in hunger

A

lateral hypothalamus = hunger centre

ventromedial hypothalamic nucleus = satiety centre

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22
Q

what do alpha cells of the pancreas secrete

A

glucagon

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23
Q

what do beta cells of the pancreas secrete

A

insulin

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24
Q

what is the main function of insulin

A

suppress hepatic glucose output = decreased gluconeogenesis and glycogenolysis
increase glucose uptake into insulin sensitive tissue
suppress lipolysis and breakdown of muscle

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25
what are the clinical values for diabetes diagnosis
plasma glucose more than 11mmol/L | fasting glucose more than 7mmol/L
26
what are the clinical values for diagnosing type 2 diabetes
HbA1c of more than 48mmol/mol
27
what is mild hypoglycaemia
less than 4mmol/L with no symptoms
28
what is serious hypoglycaemia
less than 3mmol/L often symptomatic
29
what is severe hypoglycaemia
less than 2mmol/L symptomatic with impaired cognitive function
30
why does hypoglycaemia occur
increased levels of insulin usually due to insulin injections in diabetics or healthy individuals with insulinomas
31
how do you treat hypoglycaemia
administer 15g fast acting carb test blood glucose 15 mins after and check its above 4mmol/L administer long acting carb to prevent recurrence
32
what is whipples triad
1. symptoms of hypoglycaemia 2. blood glucose <50mg/dL 3. relief of symptoms following ingestion of glucose
33
presentation of pituitary tumours - 3 key things
1. pressure on local structure 2. pressure on normal pituitary 3. functioning tumour
34
cushings disease definition
increased secretion of ACTH from the anterior pituitary gland causing chronic, excessive and inappropriate elevated levels of circulating plasma glucocorticoids (cortisol)
35
what is cushings syndrome
increased cortisol levels | due to a cause not directly acting on the anterior pituitary
36
what can cause cushing syndrome
prescribed glucocorticoid drugs excess cortisol production from: - adrenal tumour - hyperplastic adrenal gland - adrenal gland with nodular adrenal hyperplasia ACTH producing tumours e.g. small lung cell cancers CRH producing tumours
37
what are the main functioning pituitary tumours
1. prolactinoma 2. GH producing tumour = can cause acromegaly 3. ACTH producing tumour = can cause cushings
38
how do somatostatin analogues work
inhibit multiple hormones and shrink tumours may have side effects not available orally e.g. LANREOTIDE
39
how are dopamine agonists useful
``` useful for prolactinoma (and GH secreting tumour) no damage to pituitary work quickly orally available relatively ineffective e.g. CABERGOLINE, BROMOCRITINE ```
40
how do GH receptor antagonists work
act as competative antagonists to GH doesnt change GH levels but blocks receptors so less IGF1 produced daily subcutaneous injection e.g. PEGVISOMANT
41
what is the circadian rhythm
changes in hormone levels through the day hormone levels peak just after waking then decrease after this until sleep where they rise again e.g. cortisol
42
what is primary adrenal insufficiency (addisons)
due to impairment at adrenal glands = destruction of adrenal cortex = low cortisol but high ACTH (feedback)
43
what is secondary adrenal insufficiency
due to impairment at pituitary and/or hypothalamus = reduced adrenal cortex stimulation = low ACTH therefore low cortisol
44
what is tertiary adrenal insufficiency
due to hypothalamic disease and decrease in CRH
45
what is thyroid peroxidases TPOs
antibody found in almost all individuals with autoimmune hypothyroidism also associated with graves disease = hyperthyroidism marker in healthy individuals for increased chance of developing autoimmune thyroid diseases
46
what is the mechanism of thyroid destruction in autoimmune disease
cytotoxic T lymphycyte mediated thyroglobulin and TPO antibodies may cause secondary damage but alone = no effect rare = antibodies against TSH receptors block effect of TSH
47
what causes predisposition to autoimmune thyroid disease
1. female 2. HDL-DR3 and other immunoregulatory genes 3. environmental factors = stress 4. high iodine intake 5. smoking
48
what autoimmune disease are related to autoimmune thyroid disease
``` type 1 diabetes Addisons disease vitiligo coeliac disease pernicious anaemia ```
49
what is hyperthyroidism
abnormally high T4 and T3 levels
50
what are the main pituitary mass legions (?)
craniopharyngioma rathke's cysts meningioma lymphocytic hypophysitis
51
what are the definitive signs of puberty
``` females = menarche, breast bud presence (depend on oestrogen) males = first ejaculation, testes over 3mL large ```
52
what are the female secondary sexual characteristics
breast/genitalia growth | pubic/auxiliary hair growth
53
what are the male secondary sexual characteristics
external genitalia/auxiliary hair growth | larynx/laryngeal enlargement
54
what is thelarche
``` breast development = first visible change of puberty induced by oestrogen = ductal proliferation site specific adipose deposition enlargement of areola and nipple ```
55
what is adrenarche
developmental process where specialised subset of cells arise forming the zona reticulata occurs at 2/3 end at 9/10 caused by increased in DHEA and DHEA-s
56
what is pubarche
most pronounced clinical result of adrenarche | = appearance of pubic hair
57
what are the indications for late puberty in women
lack of breast development by 13 more than 5 years between breast development and menarche lack of pubic hair by 14 absent menarche by 15-16
58
what are the indications for late puberty in men
lack of testicular enlargement by 14 lack of pubic hair by 15 more than 5 years to complete genital enlargement
59
what are the hormone levels in a male with primary hypogonadism
raised LH/FSH | low testosterone
60
what is the effect of anabolic steroid use in men
low testosterone and suppressed LH
61
what are the hormone levels in primary ovarian failure in women
high LH and FSH FSH is greater than LH low oestrogen
62
what are the effects of metformin on glucose control
1. increase peripheral insulin sensitivity (?) 2. increased glucose uptake and use by skeletal muscle 3. decreased hepatic gluconeogenesis 4. decreased intestinal glucose absorption
63
what are the side effects of metformin
``` GI disturbances nausea vomiting lactic acidosis weight neutral or loss ```
64
describe the action of sulphonylureas E.G. GLICLAZIDE
block potassium channels on pancreatic beta cells = stimulating insulin secretion
65
what are the side effects of sulphonylureas
GI disturbances hypoglyceamia weight gain
66
describe the action of a DPP4 inhibitor
DPP4 = enzyme in vascular endothelial lining which INactivates incretin hormones = DPP4 inhibitor = competitive agonist of DP44 enzyme = result in enhanced incretin effect= more insulin secreted
67
what are the side effects of DPP4 inhibitors
GI disturbances | acute pancreatitis
68
describe the action of a GLP-1 receptor agonist
GLP1 agonists activate GLP1 GLP1 acts to increase concentration of incretin also cause delay in gastric emptying
69
what are the side effects of GLP1 agonists
``` GRUPH GI disturbances Respiratory tract infection UTI Peripheral oedema Hepatotoxicity ```
70
describe the action of thiazolidinediones (TZD) e.g. pioglitazone
acts to increase bodies response to own insulin | act to decrease glucose and FFA levels
71
what are the side effects of TZDs
weight gain hypoglycaemia (low risk though) heptatomegaly fracture risk
72
describe the action of SGLT2 inhibitors
act to inhibit SGLT2 transporter prevents glucose reabsorption in the PCT of the nephron = results in increased glucose loss in urine = decrease blood glucose levels
73
what is bariatric surgery
acts to decrease stomach size or bypass sections to promote weight loss
74
where is leptin expressed most
in white fat cells
75
what is the role of leptin
switch off appetite + immunostimulation | lack of leptin = constant appetite
76
what is peptide YY
secreted by neuroendocrine cells in the ileum/pancreas/colon in response to food hormone that binds to neuropeptide Y (NPY) receptor inhibit gastric motility and therefore reduce appetite
77
what is the role of cholycystokinin CCK in appetite
released in response to meal and increased duodenal pH delays gastric emptying cause gall bladder contraction stimulates insulin secretion stimulates vagus nerve = feeling of satiety
78
what secretes CCK
secreted by enteroendocrine cells in the duodenum
79
what is the role of ghrelin
cause an increased in growth hormone release stimulates appetite increases food intake promotes fat storage
80
what produces ghrelin
stomach
81
name 3 hormones/receptors that suppress your appetite
leptin peptide YY CCK
82
name a hormone that stimulates appetite
ghrelin
83
what is the role of incretins
augment insulin secretion from beta cells (some) inhibit glucagon release from alpha cells = decrease blood glucose levels DPP4 = inactivates incretins
84
how does hyperglycaemia stimulate insulin secretion (in 4 steps)
1. hyperglycaemia leads to increase glucose uptake in cells 2. glucose metabolism = increase ATP = K+ channels close 3. causes depolarisation of cell membrane = Ca2+ channels open and Ca2+ enter 4. increased Ca2+ in cell = exocytosis of insulin vesicles = insulin released by pancreatic beta cells
85
describe short acting soluble insulins
start working within 30-60mins | last for 4-6 hrs
86
describe short acting insulin analogues
faster onset and shorter duration of action than soluble | routinely used in DMT1
87
describe longer acting insulin
insulin + protamine/zinc intermediate lasting 12-24hrs long acting lasting >24hrs
88
when should you avoid doing an HbA1c test
type 1 DM pregnant children haemoglobinopathies
89
what is used to treat hypothyroidism
levo-thyroxine lifelong treatment | aim = TSH levels >0.5
90
what is used to treat hyperthyroidism
1. betablockers for rapid attacks/tachycardia 2. carbimazole = antithyroid drug = blocks T3/T4 synthesis (may need levothyroxine to replace lost T3/4) 3. radioiodine therapy = shrink thryoid gland + decrease number of T3/4 producing cells * radioiodine = risk of hypothyroidism
91
what drugs can cause hyperthyroidism/hyperthyroidism
amioderone lithium (rare) iodine ipilimumab
92
what 3 things characterise diabetic ketoacidosis DKA
1. hyperglycaemia 2. raised plasma ketones 3. metabolic acidosis
93
what investigations are done in DKA
1. blood glucose test >11.0mmol/L 2. blood ketones = finger prick near patient test 3. blood pH/carbonate = acidaemia 4. urine dipstick = heavy glycosuria and ketonuria 5. Cr and Urea high due to dehydration
94
how is DKA managed
fluids IV insulin - 6 units per hr starting dose electrolytes (K+)
95
what is hyperglycaemic hyperosmolar state
1. marked hyperglycaemia 2. hyperosmolality 3. milds/no ketosis most common cause is INFECTION (particularly pneumonia) = dehydration = decreased consciousness = polyuria
96
how is hyperglycaemic hyperosmolar state managed
same as for DKA fluids insulin 3 units/hour, only if severe LMWH because hyperosmolality causes blood viscosity to increase = clots, MI, stroke
97
what is a thyroid storm
``` rare/life-threatening = rapid deterioration of thyrotoxicosis high fever tachycardia extreme restlessness delirium/coma/death ```
98
how is a thryoid storm managed
1. propranolol 2. large doses of carbimazole 3. potassium iodide = block release of T3/4 from gland 3. hydrocortisone = inhibit conversion of T4 to T3
99
whats the most common cause of hyperthryoidism
graves disease
100
what does IGF1 do
stimulate growth by protein synth increase lipolysis stimulate hypertrophy and hyperplasia of bone, skeletal muscle decrease blood glucose
101
symptoms of cushings
``` Cataracts Ulcers Striae Hypertension and hyperglycaemia Increase risk infection Necrosis Glucosuria ```
102
what is the first line treatment for acromegaly
transphenoidal surgical resection to remove adenoma from pituitary
103
describe the ECG features in hypokalaemia
U have no Pot (K+) and no Tea but a long PR and a long QT - flat T waves - ST depression - long PR and QT - pathological U waves
104
describe the Tx fro Conns syndrome
laproscopic adrenalectomy | aldosterone antagonist = spironolactone
105
what is the commonest cause of primary adrenal insufficiency (addisons) worldwide and in UK
``` UK = addisons worldwide = TB ```
106
what is the Tx for adrenal insufficiency (addisons)
``` glucocorticoids = hydrocortisone/prednisolone mineralocorticoids = fludrocortisone ```
107
describe the pathophysiology of SIADH
too much ADH = insertion aquaporin 2 = water retention = blood dilution = hyponatraemia too much ADH = decreased RAAS-aldosterone = secretion of Na+ = excess water removed WITH Na+ = hyponatraemia with NORMOVOLAEMIA
108
what drug is used in the Tx of SIADH
demeclocycline = inhibit action of ADH on kidney
109
what drugs can cause hyperkalaemia
``` NSAIDs ACEi = block aldosterone binding spironolactone ciclosporin heparin ```
110
what is the blood plasma value for hyperkalaemic and hypokalaemic
over 5.5mmol/L emergency = over 6.5mmol/L under 3.5mmol/L emergency = under 2.5mmol/L
111
what is the blood plasma values for hypercalcaemia and hypocalcaemia
>2.6mmpl/L on 2 or more occasions | <2.1mmol/L
112
what is chvosteks sign and what condition would you see it in
tapping over facial nerve in parotid gland region = ipsilateral twitch = hypocalcaemia
113
what is trousseaus sign and what condition would you see it in
carpopedal spasm induced by inflation of BP cuff to 20 above systolic = hypocalcaemia
114
what ECG changes would you see in hyper and hypocalcaemia
``` hyper = short QT, tented T hypo = long QT ```
115
how to work out plasma osmolality
(Na x 2) + glucose + urea
116
what antibodies are present in DMT1
anti-GAD pancreatic islet autoantibodies islet antigen 2 antibodies
117
what drugs are used to lower cortisol
metyrapone | ketoconazole
118
what disease causes bulging eyes and why
graves disease | swelling and oedema of extra-occular muscles
119
what is kallmans syndrome
decreased GnRH causes anaemia genetic failure to start or finish puberty
120
what is a pheochromocytoma
catecholamine secreting tumour = adrenaline diagnosed by blood conc of hormones treat with surgery and alpha blocker then beta blocker
121
what is a prolactinoma
prolactin secreting tumour cause headaches + period changes check prolactin levels treat with dopamine agonists (cabergoline)
122
what is hyperparathyroidism
``` increase PTH caused by parathyroid adenoma/hyperplasia primary secondary or tertiary bones, groans, stones, psychic moans primary = high Ca secondary = low Ca treat by surgical removal of cancer calcium correction treat underlying possible bisphosphonates for osteoporosis ```
123
name a calcium mimetic
cinacalcet
124
what is hypoparathyroidism
low PTH = rare symptoms same as hypocalcaemia (chovstek + trousseau) high phosphate and low calcium treat with IV calcium + vitamin D analogue
125
name a vitamin D analogue
alfacalcidol
126
what is a carcinoid tumour
seratonin secreting tumour pain/weight loss/palpable mass causes carcinoid syndrome diagnose with serum 5-Hydroxyindoleacetic acid (seratonin bkd/n product) + liver ultrasound treat with somatostatin analogue = octreotide

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