Immunology of Endocrine Disorders

Question 1

What are Non-organ specific autoimmune diseases?

Answer 1

Affect multiple organ diseases
Assocaited with autoimmune responses to widely distributed self-molecules
Intracellular molecules for Transcription/translation

Question 2

What are organ specific autoimmune diseases?

Answer 2

Resticted to one organ or endocrine glands

Question 3

Antigens against what receptor are associated with thyroid disease?

Answer 3

TSH receptor

Question 4

Antigens against what are associated with glycaemic disease?

Answer 4

Insulin receptors

Question 5

Antigens against what are associated with myasthenia gravis?

Answer 5

Acetylcholine receptor

Question 6

Self antigens against what enzymes are associated with diabetes?

Answer 6

Glutamate decarboxylase

Question 7

Self antigens against what enzymes are associated with thyroiditis/hypothyroidism?

Answer 7

Thyroid peroxidase

Question 8

Self antigens against what enzymes are associated with Addison’s disease?

Answer 8

21-hydroxylase

Question 9

When is peak onset for autoimmune diseases?

Answer 9

15-65

Except T1D

Question 10

What is immunological tolerance?

Answer 10

Unresponsiveness to an antigen that is introduced by previous exposure to said antigen

Question 11

What are tolerogens?

Answer 11

Antigens which induce tolerance

Question 12

What is central tolerance?

Answer 12

Immature self-reactive lymphocytes
Thymus eliminates T-cells with high affinity to self antigens
Bone marrow - B cell tolerance

Question 13

What is peripheral tolerance?

Answer 13

Mature lymphocytes that recognise self antigens in peripheral tissues become incapable of activation by re-exposure, or die

Question 14

What are the mechanisms of peripheral tolerance?

Answer 14

Anergy (functional unresponsiveness)
T regulatory suppression
Deletion (cell death)

Question 15

What are the mechanisms of central tolerance?

Answer 15

Apoptosis
Change in receptors
Development of T-regulatory lymphocytes

Question 16

What factors can cause cells to overcome peripheral tolerance?

Answer 16

Inappropriate access of self-antigens
Inappropriate/increased local expression of co-stimulatory molecules
Alterations in the ways which self-molecules are presented

Question 17

When is overcoming peripheral tolerance more likely?

Answer 17

Inflammation or tissue damage

Increased proteolytic enzymes increasing the concentrations of peptides

Question 18

Which microbial antigen is associated with T1D?

Answer 18

Coxsackie B4 nuclear protein

Mumps

Question 19

What is molecular mimicry?

Answer 19

Structural similarities between self proteins and microbial antigens causing an autoimmune response

Question 20

What is epitope spreading?

Answer 20

Immune response broadens and local tissue damage accelerates

Question 21

The B27 HLA association is associated with which diseases?

Answer 21

Ankylosing spondylitis

Reiter disease

Question 22

Which HLA association is associated with T1D?

Answer 22

DR4

Question 23

Which environmental factors are associated with causing autoimmune diseases?

Answer 23

Hormones
Infections
Drugs
UV radiation

Question 24

How are autoimmune diseases treated?

Answer 24

Suppression of the damaging immune response

Replacement of the function of the organ

Question 25

How is Type 1 diabetes classified?

Answer 25

Ketoacidosis Inadequate insulin secretion Lymphocytic infiltration of islets Autoimmune, genetic, viral

Question 26

How is Type 2 diabetes classified?

Answer 26

``` More common Middle age Non-ketotic coma Normal/increased insulin Reduced cell surface receptors ```

Question 27

What are the causes of T1D?

Answer 27

Autoimmune destruction Genetic factors Viral infection

Question 28

What is the mechanism of Graves' thyroiditis?

Answer 28

IgG which binds to thyroid epithelial cells and mimics TSH

Question 29

What is the cause of Exophthalmos in graves'?

Answer 29

Infiltration of the orbital tissues by fat, mucopolysaccharides and lymphocytes Autoantibody reacting with these tissues

Question 30

Why does Hashimoto thyroiditis present early with transient hyperthyroidism?

Answer 30

Damage to thyroid follicles causing a release of thyroglobulin

Question 31

Which autoantibodies are seen in Hashimoto's thyroiditis?

Answer 31

Antibodies reacting with: Thyroid peroxidase Thyroglobulin

Question 32

What is APS-1?

Answer 32

``` Autoimmune Polyendocrine Syndrome Type 1 AIRE gene mutation Polyendocrinopathy Candidiasis Ectodermal dystrophy ```

Question 33

How does APS-1 present?

Answer 33

``` Atleast 2 of: Chronic candidiasis Hypoparathyroidism Addison's disease + Enamel hypoplasia Diarrhoea or constipation Primary ovarian insufficiency ```

Question 34

What is APS-2?

Answer 34

``` Type 1 diabetes Autoimmune thyroid disease Addison's disease More common in women Young adult onset Celiac disease ```

Question 35

What is IPEX?

Answer 35

X-linked Immunodysregulation, polyendocrinopathy, enteropathy Early onset T1D Autoimmune enteropathy - diarrhoea and malabsorption Dermatitis Eosinophilia Elevated IgE