ENDOCRINOLOGY started 24/05 Flashcards
(397 cards)
1
Q
ADRENALS
A
ADRENALS
2
Q
Where is aldosterone produced in the adrenal cortex?
A
Zona glomerulosa
3
Q
Where is cortisol produced in the adrenal cortex?
A
Zona fasiculata
4
Q
Where are androgens produced in the adrenal cortex?
A
Zona reticularis
5
Q
Where is epinephrine produced in the adrenals?
A
Chromaffin cells in the medulla
6
Q
What is a glucocorticoid?
A
Steroid hormone that plays a role in glucose metabolism
7
Q
What is the primary endogenous glucocorticoid?
A
cortisol
8
Q
What metabolic process does cortisol promote?
A
Gluconeogenesis
9
Q
Cortisol promotes gluconeogenesis. What is Gluconeogenesis?
A
Metabolism of glucose from non sugar source such as proteins and fats.
10
Q
Where is norepinephrine produced in the adrenals?
A
Chromaffin cells in the medulla
11
Q
Where is dopamine produced in the adrenals?
A
Chromaffin cells in the medulla
12
Q
PHEOCHROMOCYTOMA
A
PHEOCHROMOCYTOMA
13
Q
What is pheochromocytoma?
A
Tumour of the medulla of the adrenal glands that secrete high amount of catecholamine
14
Q
List four conditions which has an increased risk of pheochromocytoma development?
A
- MEN type 2
Multiple endocrine neoplasia - Neurofibromatous type 1
- Von Hippel Lindau syndrome
- Paraganglioma syndrome type 1,3,4
15
Q
What is the inheritance pattern in MEN syndrome
A
Autosomal dominant
lol men are dominant creatures
16
Q
Is MEN type 1 associated with increased risks of pheochromocytoma?
A
NO
17
Q
List the endocrine organs affected in MEN type 1 syndrome
A
- Pituitary gland
- Parathyroid gland
- Pancreas
18
Q
List the features of MEN type 2A syndrome
A
1.Pheochromocytoma
2. Medullary thyroid cancer
3. Parathyroid gland affected
19
Q
List the features of MEN type 2B syndrome
A
1.Pheochromocytoma
2. Medullary thyroid cancer
3. Mucosal neuromas
4. Marfanoid features
20
Q
There is an increased risk of pheochromocytomas in paraganglioma syndrome. What types carries this risk?
A
Type 1, 3 & 4
21
Q
What is paraganglioma syndrome?
A
Characterised by development of neuroendocrine tumors in adult hood.
Manifest as head and neck tumours, adrenal and extra adrenal pheochromocytomas
22
Q
What is the inheritance pattern in Von Hippel Lindau syndrome?
A
Autosomal dominant
Mnemonic Von HOLLER Lindau - loud and hollering therefore dominant
23
Q
What is Von Hippel Lindau syndrome?
A
Characterized by cystic, benign and malignant growth in various organs such as brain & spinal cord
24
Q
Phaeochromocytoma accounts for what % of hypertension cases?
A
0.1%
passmrcog
25
What is the incidence of pheochromocytoma in pregnancy per 50,000 women?
1 in 50,000
(passmrcog)
26
What % of pheochromocytoma are familial?
20%
(passmrcog)
27
According to passmrcog what is the % maternal mortality rate if pheochromocytoma is diagnosed antenatally?
2 - 4 %
28
According to passmrcog what is the % maternal mortality rate if pheochromocytoma is diagnosed intrapartum or postpartum?
14 - 25%
(passmrcog)
29
STEROID HORMONE SYDROMES
STEROID HORMONE SYNDROME
30
CUSHING SYNDROME
CUSHING SYNDROME
31
In Cushing syndrome there is an excess of what?
Cortisol
32
The causes of cushing syndrome can be broadly divided into _____ types
2 types
33
What two types can Cushing syndrome be divided into?
1. ACTH dependent disease
2. Non ACTH dependent
34
Name 3 causes of Cushing syndrome specifically ACTH dependent disease
1. Cushing disease - excess ACTH from the pituitary
2. Ectopic ACTH producing tumour
3. Excess ACTH administration
35
Name 3 causes of Cushing syndome specifically ACTH independent disease
1. Adrenal adenoma
2. Adrenal carcinoma
3. Excess glucocorticoid administration
36
List 3 screening / outpatient test for cushing syndrome
24 hours urinary free cortisol
1mg overnight dexamethasone suppression test
late night salivary cortisol
37
What is cushing syndrome?
Collection of signs and symptoms due to raised levels of cortisol
38
What is cushing's disease
Cushing disease is the most common cause of cushing's syndrome. Increased secretions of ACTH from the anterior pituitary stimulate cortisol production
39
What is a common cause of cushing's disease
pituitary adenoma
40
What is the hormone abnormality in Cushing syndrome?
Cortisol excess
41
What tests can be used to diagnosed Cushing syndrome?
1. Dexamethasone suppression test
2. 24 hour urinary cortisol
42
ADDISON SYDNROME
ADDISON SYNDROME
43
What are the hormonal abnormality in addison syndrome
Decrease cortisol and aldosterone
44
What are the key clinical features in Addison syndrome
1. Hypotension
2. Hyponatremia
45
What are the tests used diagnosis of Addison syndrome
9am cortisol levels
Synacthen test
46
What are the expected results in Addison disease tests?
9am cortisol levels - low levels
Synacthen test - low levels of cortisol. ACTH doesnot stimulate the adrenals to produce cortisol as the adrenal cortex is damaged
47
According to NICE guidelines what are the first line test(s) for investigating Addison's syndrome?
1. Cortisol levels
2. U&Es
48
According to NICE guidelines cortisol levels and U&Es are the first line tests for investigating Addison's syndrome.
When are cortisol levels taken?
Cortisol levels taken between 8am - 9am
49
If Addison's syndrome is suspected, how would you interpret cortisol < 100
units nanomol/L
Admit or urgent referral to endocrine as adrenal insufficiency likely
50
If Addison's syndrome is suspected, how would you interpret cortisol 100 - 500
units nanomol/L
Refer to endocrine for synacthen test
51
What is the most common cause of Addison's disease?
Autoimmune adrenalitis
52
What is secondary adrenal insufficiency?
Refers to insufficient adrenal hormones production due to a cause external to the adrenals.
Specifically deficient ACTH production by the pituitary
53
What is tertiary adrenal insufficiency
Refers to insufficient adrenal hormones production due to a cause external to the adrenals.
Specifically deficient CRH production by the hypothalamus
CRH refers to corticotrophic releasing hormone
54
What change would be expected to calcium levels in Addison's syndrome?
Hypercalcemia
55
What change would be expected to glucose levels in Addison's syndrome?
Hypoglycemia
56
What change would be expected to sodium levels in Addison's syndrome?
Hyponatremia
57
What change would be expected to potassium levels in Addison's syndrome?
Hyperkalemia
58
What change would be expected to acid base status in Addison's syndrome?
Metabolic acidosis
59
What change would be expected to white blood cell counts in Addison's syndrome?
1. Eosinophilia
2. Lymphocytosis
60
CONNS SYNDROME
CONNS SYNDROME
61
What is the hormone abnormality in Conn's syndrome?
Aldosterone excess
62
What is the key clinical feature in Conn's syndrome?
1. Hypertension
2. Hypokalemia
63
What tests can be used to diagnosed Conn's syndrome?
1. Aldosterone renin ratio
2. Saline salt supression test
3. Fludrocortisone suppression test
64
What is secondary hyperaldosteronism?
Excessive production of aldosterone by the adrenals due to excessive renin secretion
65
Name two causes of secondary hyperaldosteronism
1. Renal artery stenosis
2. Renin producing tumor
66
Decrease intravascular volume can cause secondary hyperaldosteronism, list some cause.
Decrease intravascular volume due to low oncotic pressure from low albumin
1. Cirrhosis with decrease albumin production
2. Nephrotic syndrome with increase albumin loss at kidneys
3. Ascites with decrease intravascular volume
4. Diuretics
5. CCF
67
Comment on the calcium level in Conn's syndrome
Hypocalcemia
Aldosterone causes increase urinary excretion of calcium
68
Comment on the potassium level in Conn's syndrome
Hypokalemia
69
Comment on the blood pressure Conn's syndrome
Hypertension
70
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
71
What is the most potent stimulator of aldosterone?
Hyperkalemia
72
What is aldosterone?
Aldosterone is a mineralocortocoid steroid hormone.
73
Where exactly in the adrenal gland is the aldosterone produced?
Adrenal cortex
74
Which zone in the adrenal cortex is aldosterone produced?
Zona glomerulosa
75
What is the main mechanism by which aldosterone leads to retention of water
Upregulates Na/K pumps in the distal convoluted tubules and collecting ducts of the kidneys
Resulting in sodium reabsorption in exchange for potassium ion loss. Water follows sodium via an osmotic gradient
76
Aldosterone upregulate Na/K pumps in the DCT and collecting ducts.
State another mechanism by which it works?
Upregulate epithelial sodium channels resulting in increased sodium reabsorption
ADH also stimulate ENaCs
77
True or False
Aldosterone have a role in H+ / K+ ion exchange thus regulating acid/base balance
True
78
Name the ways in which aldosterone is stimulated?
1. RAAS
2. Hyperkalemia directly stimulate aldosterone
3. ACTH stimulate its production
79
Aldosterone is responsible for what % of mineralocorticoid activity in the human body?
> 90%
80
What is the primary endogenous mineralocorticoid in humans?
Aldosterone
81
Aldosterone is the primary endogenous mineralocorticoid in humans.
Name any other example
Progesterone
82
Give an example of a synthetic mineralocorticoid
Fludrocortisone
83
Name examples of mineralocorticoid inhibitors or antagonist
1. Spironolactone
2. Eplerenone
84
Fill in the blank
Renin is secreted by the ____________ arterioles of the kidney from specialized cells called __________ of the juxtaglomerular apparatus
Renin is secreted by the afferent arterioles of the kidney from specialized cells called granular cells of the juxtaglomerular apparatus
85
RICHA SAXENA
From which part of the renal tubule does aldosterone reabsorb sodium?
DCT
Distal convoluted tubule
86
HYPOTHALMIC PITUITARY THYROID AXIS
HYPOTHALMIC PITUITARY THYROID AXIS
87
Regarding the thyroid function test, comment on free T3 & T4 levels in pregnancy.
Decrease in Free T3 & T4 levels
Done as a mechanism to conserve energy
88
Regarding the thyroid function test, comment on Total T3 & T4 levels in pregnancy.
Increase total T3 & T4 levels
89
Regarding the thyroid function test, explain why Total T3 & T4 levels increase in pregnancy.
Due to increased serum concentration of thyroid hormone binding proteins
90
Regarding the thyroid function test, comment on TSH levels in pregnancy.
Decreased TSH in pregnancy
91
Regarding the thyroid function test, comment on TSH levels in pregnancy.
Decreased TSH in pregnancy
92
Regarding the thyroid function test, explain why TSH levels are decreased in pregnancy.
TSH is decreased in pregnancy as hCG stimulate thyroid hormone production which as a negative feedback on the axis
93
HYPOTHYROIDISM
HYPOTHYROIDISM
94
What are the most common cause of hypothyroidism in the UK?
1. Autoimmune thyroiditis
2. Side effect of treatment for hyperthyroidism
95
List 3 causes of autoimmune thyroiditis leading to hypothyroidism
1. Hashimoto
2. Ord's
3. Reidel's
96
What is the most common cause of autoimmune thyroiditis in the UK?
Ord's thyroiditis
97
What are the antibodies found in Hashimoto thyroiditis?
1. anti TPO
Anti thyroid peroxidase antibody
2. anti TG
Anti thyroglobulin anti body
98
What distinguishing feature as it relates to the thyroid is seen in Hashimoto thyroiditis ?
Goiter
99
What distinguishing feature as it relates to the thyroid is seen in Ord's thyroiditis ?
Atrophic thyroid gland
100
What distinguishing feature as it relates to the thyroid is seen in Reidel's thyroiditis ?
Fibrotic thyroid gland
101
What is the most common cause of autoimmune thyroiditis in UK and Europe?
Ord's
102
What % of pregnancies are affected by hypothyroidism including subclinical hypothyroidism?
2.5%
source passmrcog
103
What is the most common cause of autoimmune thyroiditis in most of the world?
Hashimoto
104
What is De Quevain's thyroiditis?
Painful inflammation of the thyroid gland often triggered by viral infection
Has 3 distinct phases
105
What % of women have thyroid peroxidase antibodies present at 14 weeks gestation?
10%
106
De Quevain's thyroiditis refers to painful inflammation of the thyroid gland often triggered by viral infection.
It has 3 distinct phases.
List them.
1. Transient hyperthyroid phase
Typically have neck pain and fever.
2. Transient hypothyroidism
3. Euthyroid phase as the thyroid return to normal functioning
107
True or False
De Quevain's thyroiditis is autoimmune mediated
False
Typically triggered by a viral infection
108
What % of pregnancies are complicated by overt hypothyroidism?
0.1% to 0.3%
109
In 1,000 pregnancies how many are complicated by overt hypothyroidism?
1 - 3 per 1,000
110
True or False
De Quevain's thyroiditis have positive antibodies
False
Inflammatory condition triggered by a viral infection
111
What is the most common cause of hypothyroidism in the developing world?
Iodine deficiency
112
What is the most common cause of hypothyroidism worldwide?
Iodine deficiency
113
In the UK and most developed countries 90% of cases of hypothyroidism are _____________ or ____________
In the UK and most developed countries 90% of cases of hypothyroidism are autoimmune or iatrogenic
114
ACROMEGALY
ACROMEGALY
115
What is acromegaly?
Condition characterised by high levels of growth hormone
116
Comment on the features of nose, lips, hands and feet in acromegaly
Enlargement of nose, lips, hands and feet in acromegaly
117
Comment on the features of skin acromegaly
Thickening of skin
118
Comment on the features of the internal organs in acromegaly
Organomegaly
Example cardiomegaly & hepatomegaly
119
Comment on the features of the tongue in acromegaly.
Give the medical terminology
Enlarged tongue or Macroglossia
120
Comment on the features of the jaw in acromegaly.
Give the medical terminology
Enlarged jaw or Prognathia
121
Comment on the features of the teeth in acromegaly.
Give the medical terminology
Teeth spacing or interdental seperation
122
Comment on any possible visual changes with acromegaly.
Bitemporal hemianopia
123
Name 2 conditions that can be accompany acromegaly
1. HTN
2. Diabetes
124
According to plabable notes what is the initial test for acromegaly diagnosis?
Insulin like growth factor 1
125
Where is Insulin like growth factor 1 produced?
In the liver
126
Comment on the relevance of Insulin like growth factor 1 in acromegaly.
Insulin like growth factor is produced by the liver when stimulated by growth hormone.
Occasionally used to monitor disease
127
According to plabable notes what is the definitive test for acromegaly diagnosis?
Oral glucose tolerance test with serial growth hormone measurements
128
Explain the results of oral glucose tolerance test with serial growth hormone measurements in a patient WITHOUT acromegaly
In normal patients growth hormone is suppressed with glucose
source plabable
129
What % of cases of acromegaly is due to benign pituitary adenoma?
> 90
passmrcog
130
What is gigantism?
Excessive production of growth hormone before epiphyseal plate closure resulting in very tall stature
131
What is the key difference between acromegaly and gigantism?
Acromegaly occurs with excessive growth hormone production after epiphyseal plate closure while gigantism occur before resulting in tall stature
132
LACTATION & PROLACTIN HORMONE
LACTATION & PROLACTIN HORMONE
133
According to the UK Medical Information (UKMI) what is the drug of choice to stimulate lactation?
Domperidone
134
Name two dopamine agonist
1. Carbegoline
2. Bromocriptine
135
Comment on the effects of carbegoline and domperidone on lactation
likely to reduce milk production by antagonizing prolactin
136
What are galactagogues?
Substances that increase milk supply
137
True or False
Any drug that inhibits prolactin production will caues a reduction in milk production
True
138
True or False
Dopamine is a prolactin antagonist
True
139
True or False
Any drug that increases dopamine levels will reduce milk production
True
140
Carbegoline and Bromocriptine are dopamine agonist, via which receptors do they work?
D2 receptors
141
What two hormones are structurally similar to prolactin?
1. Human placental lactogen
2. Growth hormone
Mnemonic Prolactin and lasko makes you grow
142
Comment on the hypothalmic pituitary prolactin axis
The hypothalamus produces PRH - prolactin releasing hormone
PRH stimulate lactotrophs of the anterior pituitary to produce prolactin
Prolactin target tissue is the breast
143
Where are dopamine receptors found?
Dopamine receptors are found on lactotrophs in the anterior pituitary
144
Explain how hypothyroidism triggers hyperprolactinemia
In primary hypothyroidism the hypothalamus produces TRH which is thyrotropin releasing hormone.
TRH stimulate lactotrophs of the anterior pituitary to produce prolactin
145
Explain how Acromegaly triggers hyperprolactinemia
There are two mechanisms
Acromegaly is typically caused by a pituitary adenoma producing growth hormone.
This pituitary adenoma can produce both growth hormone and prolactin
or
Pituitary adenoma can compress the pituitary stalk blocking dopamine from binding to receptors on lactotrophs causing inhibition
146
Explain how PCOS triggers hyperprolactinemia
The mechanism is not well understood.
Proposed theories:
There is decreased dopamine production in PCOS.
Also, high estrogen levels stimulate lactotrophs to produce prolactin
(google)
147
Explain how Chronic Kidney Disease causes hyperprolactinemia
In CKD there is decreased urinary clearance of prolactin
Also, build up of uremic toxins have an inhibitory effect on dopamine.
(google)
148
Explain how liver disease triggers hyperprolactinemia
In liver disease there is decreased hepatic clearance of prolactin and estrogens.
High estrogen levels can stimulate lactotrophs
(google)
149
Explain how stress triggers hyperprolactinemia
Stress triggers the hypothalmic pituitary adrenal axis with cortisol release.
Activation of HPA axis triggers prolactin release
(google)
150
Explain how chest wall stimulation trigger hyperprolactinemia
Chest wall stimulation triggers a neural pathway that mimics the sucking reflex
Sucking reflex involves sensory receptor to the hypothalamus with the release of PRH and prolactin.
(google)
151
Explain how pregnancy trigger hyperprolactinemia
High levels of estrogen and progesterone in pregnancy stimulate lactotrophs to produce prolactin
(google)
152
Explain how opiates trigger hyperprolactinemia
Opiates inhibits dopaminergic neurons leading to less dopamine release.
(google)
153
Explain how H2 antagonist such as ranitidine trigger hyperprolactinemia
H2 antagonist inhibits dopaminergic neurons leading to less dopamine release.
(google)
154
Explain how antidepressants such as SSRIs and TCAs amitripylline trigger hyperprolactinemia
SSRIs and TCAs increase serotonin in synapses. Serotonin stimulate the release of prolactin releasing factor such as oxytocin and VIP - vasoactive intestinal peptide.
Serotonin stimulate GABAnergic neurons which inhibit dopamine release from dopaminergic neurons.
google
155
Explain how calcium channel blocker verapamil trigger hyperprolactinemia
Blocks N type calcium channels involved in dopamine release
google
156
Explain how antihypertensive metyldopa trigger hyperprolactinemia
Inhibits the enzyme that converts L-dopa to dopamine
google
157
What are the most important hormones for the sucessful maintenance of lactation
(Sizer & Niel)
1. Prolactin
2. Oxytocin
158
Name 4 other hormones that are structurally similar. One of which are only produced in females.
1. FSH
2. LH
3. hCG
4. TSH
159
What is dopamine effect on prolactin
Inhibitor
160
What is somatostatin effect on prolactin
Inhibitor
161
What is TRH - thyrotrophin releasing hormone effect on prolactin
Stimulant
162
What is oxytocin effect on prolactin?
Stimulant
163
What is vasopressin effect on prolactin?
Stimulant
164
What is angiotensin 2 effect on prolactin
Stimulant
165
What is the primary function of oxytocin in breast feeding?
Milk ejection or let down
Oxytocin stimulate myoepithelial cells to contract.
The smooth muscle surrounding the alveoli of the breast is called myoepithelial cells
166
How does oxytocin act as a stimulant for prolactin release?
Oxytocin influence prolactin release indirectly.
Oxytocin stimulate the release of vasoactive intestinal peptide VIP which act directly on lactotrophs to release prolactin.
167
According to passmrcog which hormones are required for alveolar morphogenesis during pregnancy?
3 'P's
1. Progesterone
2. Prolactin
3. human placental lactogen
168
According to passmrcog which hormones are required for ductal morphogenesis during pregnancy?
1. estrogen
2. growth hormone
169
How many amino acids does growth hormone has?
191
170
How many amino acids does human placenta lactogen has?
191
171
How many amino acids does prolactin has?
198
Mnemonic prolactin is the pro so it has more aminoacids
172
What is the molecular weight of growth hormone in daltons
22,124 daltons
173
What is the molecular weight of human placental lactogen in daltons
22,125 daltons
174
What is the molecular weight of prolactin in Kdaltons
22 KDa
175
SEX HORMONE BINDING GLOBULIN
SEX HORMONE BINDING GLOBULIN
176
Where is sex hormone binding globulin produced?
In the liver
177
Explain the results of oral glucose tolerance test with serial growth hormone measurements in a patient with acromegaly
In patients with acromegaly growth hormone is not suppressed with glucose
source plabable
178
What is the function of sex hormone binding globulin?
Protein produced by the liver which binds to sex hormones such as testosterone.
Effectively making testosterone in effective as it is not used by the body
179
True or False
SHBG acts as a transport protein carrying these hormones in an inactive form and influencing their bioavailability
True
180
70% of testosterone is bound to _________ in the body?
Sex hormone binding globulin
source passmrcog
181
25 - 30% of testosterone is bound to _________ in the body?
Albumin
source passmrcog
182
According to passmrcog, what % free testosterone is found in males?
1.5 - 3.0%
183
According to passmrcog, what % free testosterone is found in females?
1%
184
What effects would low levels of sex hormone binding globulin have on the female body?
High levels of free or active testosterone
Effects include acne or hirsutism
185
What effects would high levels of sex hormone binding globulin have on the female body?
Low levels of free or active testosterone
186
List 6 cause of low levels of sex hormone binding globulin
1. Obesity
2. PCOS
3. Hypothyroidism
4. Cushing syndrome
5. Androgens including anabolic steroids
6. Acromegaly
187
Comment on the effect combined oral contraceptives have sex hormone binding globulin
The estrogen component of combined oral contraceptive stimulate the liver to produce SHBG.
188
COCPs generally cause a reduction in androgen particularly testosterone activity, name one condition where this is useful
PCOS
189
Name one physiological cause of increase in sex hormone binding globulin
1. Pregnancy
190
List 3 drugs that increase sex hormone binding globulin levels
1. Estrogen of COCPs
2. Clomifene
3. Anticonvulsants
191
Excluding medications name 4 cause of increase sex hormone binding globulin levels
1. Hyperthyroidism
2. Liver cirrhosis
3. Anorexia nervosa
4. Pregnancy
192
Explain how clomifene causes a increase in SHBG - sex hormone binding globulin
Clomifene is used to induce ovulation.
Clomifene stimulates the pituitary gland to produce FSH and LH which causes the ovaries to produce estrogen. Estrogen stimulates the liver to make SHBG.
193
Explain how hyperthyroidism causes a increase in SHBG - sex hormone binding globulin
Thyroid hormone has a direct effect on the liver and stimulate its production of SHBG.
(google)
194
Explain how pregnancy causes a increase in SHBG - sex hormone binding globulin
The high levels of estrogen in pregnancy stimulates the liver to produce SHBG
195
Explain how liver cirrhosis causes a increase in SHBG - sex hormone binding globulin
1. Liver cirrhosis leads to decrease clearance of SHBG
2. Liver cirrhosis causes decrease clearange of estrogen which stimulate hepatic production of SHBG
(google)
196
PANCREAS
PANCREAS
197
Where is glucagon produced?
Alpha cells of the pancreas
198
Where is insulin produced?
Beta cells of the pancreas
199
Where in the pancreas is somatostatin produced?
Delta cells of the pancreas
Also pylorus
200
Where is pancreatic polypeptide produced?
Gamma cells
201
Where is Ghrelin produced in the pancreas?
Epsilon cells
202
What is the function of somatostatin?
Inhibitory hormone
1. Inhibits the secretion of insulin and glucagon from the pancreas
2. Inhibits secretion of pancreatic digestive enzymes
3. Acts on the gastrointestinal system inhibiting release of gastrin and therefore gastric acid. Also, inhibits duodenal secretin production.
203
What is the function of pancreatic polypeptide?
Regulates digestion and appetite
Re digestion it inhibits gastric emptying, gall bladder contraction and pancreatic exocrine secretion
Re appetite promotes satiety
204
What is glucagon effect on plasma glucose levels
It raises it
205
What is glucagon effect on glycogenolysis
Stimulates glycogenolysis
This is the breakdown of glycogen to glucose
206
List the drug classes that can cause hyperprolactinemia
1. Antipsychotics example risperidone
2. Antidepressants SSRI & TCAs
3. Opiates
4. H2 antagonist example ranitidine
5. Antihypertensive methyldopa
6. Estrogen containing drugs
7. CCB Verapamil
207
What is glucagon effect on gluconeogenesis
Stimulates gluconeogenesis
The formation of glucose from amino acids
208
What is glucagon effect on glycolysis
Inhibits glycolysis
The conversion of glucose to pyruvate
209
Name 6 glucagon stimulants
1. Hypoglycemia
Neurotransmitters:
2. Epinephrine
3. Acetylcholine
Aminoacids
4. Arginine
5. Alanine
6. Cholecystokinin
210
Name 5 glucagon Inhibitors
1. Somatostatin
2. Insulin
3. Ureamia
4. Increased free fatty acids in blood
5. Increased free keto acids in the blood
211
Explain how free fatty acids acts as an inhibitor of glucagon
Free fatty acids compete with glucose as an energy source, signaling the body that sufficient fuel is available and glucose production is not necessary
212
Explain how ketone bodies acids acts as an inhibitor of glucagon
Keto acids or ketone bodies act as alternative fuel sources, reducing the need for the liver gluconeogenesis via glucagon help
213
Explain how epinephrine acts as a stimulant of glucagon
Epinephrine stimulate glucagon release by activating beta adrenergic receptors on pancreatic alpha cells.
High glucose levels are needed for the fight or flight response
214
Explain how arginine acts as a stimulant of glucagon
Arginine acts a direct stimulator of alpha cells which leads to glucagon release
215
Explain how alanine acts as a stimulant of glucagon
Alanine can be converted to glucose in the liver-gluconeogenesis.
When alanine levels rise it signals the body's need for more glucose triggering glucagon release to increase glucose production in the liver
216
State hypoglycemia effect on glucagon
Stimulant
217
State insulin effect on glucagon
Inhibitor
218
State somatostatin effect on glucagon
Inhibitor
219
State epinephrine effect on glucagon
stimulant
220
State arginine effect on glucagon
stimulant
221
State alanine effect on glucagon
stimulant
222
State uremia effect on glucagon
inhibitor
223
State acetylcholine effect on glucagon
stimulant
224
State free fatty acid effect on glucagon
inhibitor
225
State keto acid effect on glucagon
inhibitor
226
State acetylcholine effect on glucagon
stimulant
227
State cholecystokinin effect on glucagon
stimulant
228
HYPOTHALMIC PITUITARY OVARIAN AXIS
HYPOTHALMIC PITUITARY OVARIAN AXIS
229
What is the predominant estrogen produced by the ovaries?
Estradiol
230
What is the predominant estrogen produced by the placenta?
Estriol
231
What is the predominant estrogen produced by the adipose tissue?
Estrone
232
Estrone is the predominant estrogen produced by the adipose tissue. How is it abbreviated?
E1
233
Estradiol is the predominant estrogen produced by the ovaries. How is it abbreviated?
E2
234
Estriol is the predominant estrogen produced by the placenta. How is it abbreviated?
E3
235
Estrone, Estradiol, and Estriol are all estrogens.
Of the three which is least potent
Estriol which is found in placenta
236
Estrone, Estradiol, and Estriol are all estrogens.
Of the three which is Most potent
Estradiol which is produced in ovaries.
Most abundant estrogen produced by ovaries and most potent
237
Estrone, Estradiol, and Estriol are all estrogens.
Arrange in order of most potent to least potent
1. Most potent is estradiol
2. Estrone
3. Estriol
238
Where are theca cells located?
Outer layer of the ovarian follicle
239
Theca cells are located on the outer layer of the ovarian follicle, what hormone do they respond to?
LH
240
What is the function of the theca cells in the follicular phase of the menstrual cycle ?
Produce androgens
241
Which specific theca cells produce androgens ?
Theca interna cells
242
What type of cells are theca externa cells?
Smooth muscle cells
243
What name given to theca cells in the luteal phase of menstrual cycle?
Theca lutein cells
244
What are theca lutein cells
These are specialized cells found in the corpus luteum.
The corpus luteum is a temporary endocrine gland that forms after ovulation
245
Comment on the size of thecal lutein cells
They are smaller than granulosa lutein cells
246
Comment on the nucleus of thecal lutein cells
They have darker staining nucleus
247
Comment on the location of thecal lutein cells
They are located peripherally within the folds of the granulosa lutein cells
248
Comment on the function of thecal lutein cells
Produce androgens such as androstenedione and progesterone
249
Where are granulosa cells located?
Located inside the follicle lining the inner wall
250
What hormone does granulosa cells respond to?
FSH
251
In the follicular phase what is the function of granulosa cells?
Produce estrogens
252
In the follicular phase granulosa cells produce estrogens. Explain this mechanism
Granulosa cells convert androgens to estrogens with the help of the enzyme aromatase
253
In the luteal phase of the menstrual cycle, granulosa cells are known as?
Granulosa lutein cells
254
In the luteal phase of the menstrual cycle, granulosa cells are known as Granulosa lutein cells.
Comment on their location
Located centrally in the corpus luteum
255
In the luteal phase of the menstrual cycle, granulosa cells are known as Granulosa lutein cells.
Comment on their size
Larger than thecal lutein cells
256
In the luteal phase of the menstrual cycle, granulosa cells are known as Granulosa lutein cells.
What are their functions?
1. Convert androgens to estradiol via aromatase
2. Produce progesterone
257
What hormone stimulate aromatase production in granulosa cells?
FSH
258
What hormone stimulate androgen production in theca interna cells?
LH
259
Which hormone stimulate contraction of the smooth muscle cells of the theca externa?
LH
260
LH stimulate contraction of the smooth muscle cells of the theca externa.
Why does this occur?
This increases intrafollicular pressure which results in rupture of the mature oocyte
261
What are the two main cell types of the ovary?
1. Theca cells
2. Granulosa cells
262
Name the structure from which the corpus luteum develop?
Ovarian follicle
263
In the menstrual cycle the theca cells are luteinized into theca lutein. What other name is it called?
Small lutein
264
In the menstrual cycle the granulosa cells are luteinized into granulosa lutein. What other name is it called?
Large lutein
265
What cells make up the corpus lutein?
Granulosa lutein and theca lutein
266
Which cells produce the majority of progesterone in the luteal period?
Large luteal cells or granulosa lutein
267
Large luteal cells or granulosa lutein
produces the majority of progesterone in the luteal period.
From what is progesterone synthesized?
Cholesterol
268
The corpus luteum is a temporary endocrine structure, it secrete progesterone and estradiol. What type of hormone are these?
Steroid hormones
269
The corpus luteum is a temporary endocrine structure, it secrete progesterone and estradiol. What is the specific progesterone produced?
17a hydroxyprogesterone
270
The corpus luteum is a temporary endocrine structure, it secrete progesterone and estradiol. What is the specific progesterone produced?
17a hydroxyprogesterone
271
The corpus luteum is a temporary endocrine structure, it secrete progesterone and estradiol. What other hormone does it produce?
Inhibin A
272
In the menstrual cycle if fertilization doesnot occur what happens to the corpus luteum?
It stop secreting progesterone and degenerate to corpus albicans
273
In the menstrual cycle if fertilization occurs what happens to the corpus luteum?
It continue secreting progesterone and becomes corpus luteum graviditatis
274
What hormone triggers the transformation of the corpus luteum to corpus luteum graviditatis?
hCG
275
Which prostaglandin causes contraction of the theca externa smooth muscle cells resulting in rupture of the mature oocyte?
PGF2alpa
276
What is the common precursor for androgens and progesterone produced by the ovaries?
Cholesterol
277
The theca cells produce androgen in the form of _____________?
Androstenedione
278
True or False
The theca cells are not able to convert androgen to estradiol themselves
True
279
During a 28 days menstrual cycle which hormone typically reaches its peak on day 21?
Progesterone
280
During a 28 days menstrual cycle when does estrogen peak?
Before ovulation on day 14
281
During a 28 days menstrual cycle when does LH peak?
Before ovulation on day 14
282
During a 28 days menstrual cycle when does FSH peak?
Before ovulation on day 14
283
In WHO type 1 ovulation failure comment on gonadotrophic and estrogenic levels
HYPOgonadotrophic HYPOestrogenic
284
In WHO type 2 ovulation failure comment on gonadotrophic and estrogenic levels
NORMOgonadotrophic NORMOestrogenic
285
In WHO type 3 ovulation failure comment on gonadotrophic and estrogenic levels
HYPERgonadotrophic HYPOestrogenic
286
WHO type 3 ovulation failure make up what % of ovulation disorders
5%
287
WHO type 2 ovulation failure make up what % of ovulation disorders
80%
288
WHO type 1 ovulation failure make up what % of ovulation disorders
15%
Mnemonic 15 years old will present with anorexia
289
During pregnancy, ductal morphology is stimulated by which hormone(s)?
1. Estrogen
2. Growth hormone
290
During pregnancy, alveolar morphology is stimulated by which hormone(s)?
1. Progesterone
2. Human placental lactogen
3. Prolactin
The 3 Ps
291
PUBERTY
PUBERTY
292
What is the definition of delayed puberty in females
Delayed puberty in girls is defined as the absence of breast development beyond 13 years of age.
293
What is the definition of delayed puberty in males?
Delayed puberty in males is defined as the absence of testicular development beyond 14 years of age.
294
Delayed puberty in males is defined as the absence of testicular development beyond 14 years of age.
Give another definition.
Delayed puberty in males is defined as testicular volume < 4mls beyond 14 years of age.
295
What is the definition of normal puberty in girls?
Capable of sexual reproduction
296
What is precocious puberty?
Development of secondary sexual characteristics at < 8 years of age
297
What is the most common cause of delayed puberty in females?
Constitutional delay
298
What is the most common cause of delayed puberty in males?
Constitutional delay
299
What is constitutional delay of puberty?
Constitutional delay of puberty
characterized by a slower than average rate of physical development, including pubertal changes often associated with a family history of delayed puberty
300
Delayed puberty occurs in what % of children?
source passmrcog
3%
301
What is the first sign of puberty in girls?
Breast development
302
Breast development is the first sign of puberty in girls. What is another name for this?
Thelarche
303
What classification system can be used to classify puberty?
Tanner classification
304
Tanner classification can be used to classify puberty.
How many stages are in this classification?
5
305
What are the parameters of the tanner classification
1. Breast development
2. Pubic hair development
3. Growth
4. Other
306
What tanner stage is adult genitalia?
Stage 5
307
What tanner stage does cessation of growth occur, usually around 16 years?
Stage 5
308
What tanner stage does pubic hair show an adult spread to medial thigh but not up to linear alba?
Stage 5
309
What tanner stage does breast show adult contour with nipple projection only?
Stage 5
310
What tanner stage in menarche?
Stage 4
311
What tanner stage does period become regular?
Stage 4
312
What tanner stage is growth < 7cm per year?
Referred to as deceleration.
Stage 4
313
What tanner stage does the areola and nipple project above the breast to form a secondary mound?
Stage 4
314
What tanner stage does pubic hair have a adult pattern but without spread to medial thigh
Stage 4
315
What tanner stage is axillary hair development?
Stage 3
316
What tanner stage is acne development?
Stage 3
317
What tanner stage is growth 8cm per year? Referred to as peak velocity
Stage 3
318
What tanner stage is pubic hair coarser and pigmented spreading across mons pubis?
Stage 3
319
What tanner stage does breast tissue grow beyond areola but without contour seperation
Stage 3
320
What tanner stage does clitoral enlargement with labial pigmentation?
Stage 2
321
What tanner stage does uterine enlargement occur?
Stage 2
322
What tanner stage does growth of 7 - 8cm occur, referred to accelerated growth?
Stage 2
323
What tanner stage does spare hair along labia occur?
Stage 2
324
What tanner stage does spare hair along labia occur?
Stage 2
325
What tanner stage does breast buds occur?
Stage 2
326
What tanner stage does adrenarche occur?
Stage 1
327
What tanner stage does ovaries growth and development occur?
Stage 1
328
What tanner stage does growth of 5 - 6cm occurs, referred to as basal level growth?
Stage 1
329
What tanner stage is prepubertal vilus hair only is seen?
Stage 1
330
What tanner stage is prepubertal elevation of the papilla or nipple only is seen?
Stage 1
331
Comment on breast development in Tanner stage 1
Prepubertal elevation of the nipple or papilla only
332
Comment on pubic hair in Tanner stage 1
Prepubertal villus hair only
333
Comment on growth in Tanner stage 1
Basal level of 5 - 6cm per year
334
Comment on other changes that occur in Tanner stage 1
1. Ovaries grow and enlarge
2. Adrenarche
335
Tanner stage 1 is characterized by prepubertal villus hair.
What is prepubertal villus hair?
Refers to the short, fine and unpigmented hair that covers most of the body during childhood.
Often called ‘peach fuzz’
It is distinct from terminal hair which is thicker , longer and more noticeable that develop in pubic areas and armpits
336
Adrenarche occurs in Tanner stage 1
Define adrenarche
Adrenarche is a period during which the adrenal glands begin to produce more adrogens.
Precursor to puberty
337
Comment on breast development that occur in Tanner stage 2
Breast buds appear under an enlarged areola
mean age 11.2 years
338
Comment on pubic hair development that occur in Tanner stage 2
Spare hair along labia with labial pigmentation
mean age 11.9 years
339
Comment on growth that occur in Tanner stage 2
Accelerated growth around 7cm to 8cm per year
340
Comment on other changes that occur in Tanner stage 2
Uterine enlargement
Clitoral enlargement with labial pigmentation
341
Comment on breast development that occur in Tanner stage 3
Breast tissue grow beyond areola but without contour speration
mean age 12.4 years
342
Comment on pubic hair development that occur in Tanner stage 3
Hair coarser and pigmented spreads across mons pubis
mean age 12.7 years
343
Comment on growth in Tanner stage 3
Peak velocity of 8cm per year
mean age 12.5 years
344
Comment on other features seen in Tanner stage 3
1. Axillary hair
2. Acne
mean age 13.2 years
345
Comment breast development seen in Tanner stage 4
Projection of the areola and nipple to form a secondary mound above the breast
mean age 13.1 years
346
Comment pubic hair seen in Tanner stage 4
Adult pattern but without spread to medial thigh
mean age 13.4 years
347
Comment growth seen in Tanner stage 4
Deceleration
< 7cm per year
348
Comment other features seen in Tanner stage 4
1. Menarche
mean age 13.3 years
2. Regular periods
mean age 13.9 years
349
Comment breast development seen in Tanner stage 5
Adult breast contour with projection of papilla only
mean age 14.5years
350
Comment pubic hair development in Tanner stage 5
Adult spread to medial thigh but not up to linear alba
mean age 14.6 years
351
Comment growth in Tanner stage 5
Cessation of growth around 16 years
352
Comment on any other features in Tanner stage 5
Adult genitalia
353
MENOPAUSE
MENOPAUSE
354
What is the definition for premature menopause in the UK
Premature menopause refers to menopause at or before 40 years old
355
According to NICE guidelines what is peri menopause?
Aged > 45 years with clinical symptoms such as vasomotor instability and irregular periods
356
According to NICE guidelines what is menopause?
Aged > 45 years with absent periods for 12 months and not taking contraception
357
According to NICE guidelines when is FSH considered in assessment of perimenopause or menopause
Aged < 45years with symptoms suggestive of menopause or perimenopause
358
According to NICE guidelines FSH may be considered in aged < 45years with symptoms suggestive of menopause or perimenopause.
What can lead to inaccurate FSH levels?
If the patient is taking hormonal contraceptive
359
According to NICE guidelines in the first line management of vasomotor symptoms what must be considered?
If the patient has a uterus or not
360
According to NICE guidelines what is the first line management of vasomotor symptoms in patients with a uterus?
Hormonal replacement with estrogen and progesterone
361
According to NICE guidelines what is the first line management of vasomotor symptoms in patients without a uterus?
Hormonal replacement with estrogen only
362
According to NICE guidelines what is the second line management of menopausal vasomotor symptoms ?
1. SSRIs
2. SNRIs
3. Clonidine
363
According to NICE guidelines what traditional remedies can treat menopausal vasomotor symptoms ?
1. Isoflavones
2. Black cohosh
3. St John's wart
364
According to NICE guidelines traditional remedies such as Isoflavones can treat menopausal vasomotor symptoms.
What is Isoflavone?
Plant based phytoestrogen found in soy and legumes
365
According to NICE guidelines traditional remedies such as black cohosh can treat menopausal vasomotor symptoms.
What is black cohosh?
herbal supplement with estrogenic properties
366
According to NICE guidelines what traditional remedies such as black cohosh can treat menopausal vasomotor symptoms.
What are some draw backs to its usage?
1. Uncertain safety profile
2. drug interactions may occur
367
According to NICE guidelines what traditional remedies such as isoflavone can treat menopausal vasomotor symptoms.
What are some draw backs to its usage?
1. Uncertain safety profile
2. drug interactions may occur
368
According to NICE guidelines what traditional remedies such as St Johns wort can treat menopausal vasomotor symptoms.
What are some draw backs to its usage?
1. Uncertainty about appropriate dosing
2. Variability in preparation strength
3. Drug interactions with warfarin and tamoxifen
369
According to NICE guidelines what traditional remedies such as St Johns wort can treat menopausal vasomotor symptoms.
Name two drugs that it can cause serious drug interaction with?
1. Warfarin
2. Tamoxifen
370
According to NICE guidelines HRT for the treatment of menopausal vasomotor symptoms should not be routinely offerred to ?
Women with a history of breast cancer
371
According to NICE guidelines SSRIs such as fluoxetine and paroxetine for the treatment of menopausal vasomotor symptoms should not be routinely offerred to ?
Patient taking Tamoxifen
372
According to NICE guidelines how is low moods associated with menopause treated?
1. HRT
2. CBT
373
True or False
low moods associated with menopause can be treated with SSRIs and SNRIs
False
No effectiveness
374
According to NICE guidelines what is the first line treatment for low libido associated with menopause treated?
1. HRT
375
According to NICE guidelines what is the second line treatment for low libido associated with menopause treated?
HRT with testosterone added
376
According to NICE guidelines what is the treatment for urogenital atrophy associated with menopause treated?
1. Vaginal estrogens
2. Moisturizers and lubricants
377
PLACENTAL HORMONES
PLACENTAL HORMONES
378
Which hormone is the major estrogen of pregnancy?
Estriol
379
Estriol is the major estrogen of pregnancy, where is it produced?
Placenta
380
Estriol is the major estrogen of pregnancy and is produced by the placenta.
What is it produced from?
16 OH DHEAS
16 hydroxy dehydro epi androsterone sulphate
381
Where is pregnenolone produced?
Synthesized by the placenta
382
Pregnenolone is synthesized by the placenta. What is it derived from?
Cholesterol
383
Pregnenolone is synthesized by the placenta and is derived from cholesterol. What happens next?
Converted to DHEA in the fetal adrenal gland.
DHEA - dehydroepiandrosterone
384
What is the function of DHEA in the fetus?
DHEA stimulate the placenta to produce estrogen thus sustaining the pregnancy
385
When does DHEA production stop in the featus?
DHEA production stops at birth
386
DHEA production stops at birth , when does it resume next?
Around age 7 years
387
What is the function of DHEA in children?
DHEA stimulate the adrenals to produce the androgen testosterone influencing growth and development.
Also, influence brain development
388
What is the maternal blood flow through the uterine artery at term?
units ml/min
Repeat from passmrcog endocrine section
750mls
389
What is the blood flow through the uterine artery in a non pregnant female?
units ml/min
Repeat from passmrcog endocrine section
45ml/min
390
The maternal blood flow through the uterine artery at term is 750ml/min.
What % of the cardiac output does this represent?
Repeat from passmrcog endocrine section
12%
391
RICHA SAXENA
Which of the following placenta hormones helps to ensure adequate foetal nutrition?
Human placental lactogen
392
What is another name for human placental lactogen?
Human chorionic somato-mammo-tropin
393
How does human placenta lactogen ensure fetal nutrient?
HPL cause an insulin insensitivity in the mother which increases circulating glucose and delivery to fetus
394
RICHA SAXENA
What type of compound is Beta hCG?
Glycoprotein hormone
395
RICHA SAXENA
Which hormone maintains the corpus luteum during the initial stage of pregnancy?
hCG
396
RICHA SAXENA
When does beta hCG in pregnancy would be at peak?
8 - 12 weeks
397
Sizer & Neil
What type of compound is human placental lactogen?
Answer given Protein
Google says polypeptide hormone
