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Patho > Week 4: Endocrine > Flashcards

Week 4: Endocrine Flashcards

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1
Q

Major role of the endocrine system

A

Regulation and integration of body functions

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2
Q

Structure of the endocrine system

A

Made up of several glands which communicate using chemical messengers: hypothalamus, pituitary, pineal, adrenal, pancreas and sex organs

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3
Q

Basic features of the endocrine system

A

hormones are released from endocrine glands, travel through the blood and interact with a target organ

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4
Q

What does the chemical nature of hormones determine? (4)

A

their synthesis, release, transport and receptor site on the target site

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5
Q

What kind of hormones are water-soluble?

A

peptides and catecholamines

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6
Q

What kind of hormones are lipid-soluble?

A

steroid and thyroid hormones

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7
Q

Water-soluble hormones: Identify the structural classes, synthesis and storage, release, transport, receptor & type of cellular response

A

structural classes: Peptide and catecholamines
synthesis & storage: in advance and stored in vesicles
release: exocytosis with calcium signal
transport: without a carrier to the target tissue
receptor: on target cell surface
cellular response: second messenger systems

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8
Q

Lipid-soluble hormones: Identify the structural classes, synthesis and storage, release, transport, receptor & type of cellular response

A

structural classes: Steroid and thyroid hormones
synthesis & storage: On demand, cannot be stored
release: diffusion once made
transport: requires protein carrier to target tissue
receptor: inside cell in cytoplasm or nucleus
cellular response: alter gene transcription

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9
Q

What are the 3 causes of gland hypofunction? Give an example

A
  1. Congenital defect resulting in loss of gland or key enzyme
    Example: congenital hypothyroidism
  2. Destruction of the gland due to ischemia, infection, inflammation, autoimmunity, neoplastic growth
    Example: Addison’s
  3. Aging or atrophy of a gland
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10
Q

What are the 3 causes of gland hyperfunction? Give an example

A
  1. Excessive endogenous hormone production
    Examples: Graves’, Cushing
  2. Excessive administration of exogenous hormones
  3. Autoimmune stimulation of the gland
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11
Q

What are the 2 causes of alteration in target tissue responsiveness? Give an example

A
  1. Loss of receptors on a target tissue
    Example: Diabetes Mellitus
  2. Production of antibodies that block the ability of a hormone to bind to a receptor
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12
Q

What are the 3 functional alterations of glands?

A
  1. hypofunction
  2. hyperfunction
  3. alteration in target tissue responsiveness
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13
Q

Define and give an example of a primary endocrine disorder

A

definition: originates in the gland responsible for producing the hormone
example: hyperparathyroidism

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14
Q

Define and give an example of a secondary endocrine disorder

A

definition: caused by decreased hormone production or release from the pituitary
example: pituitary adenoma

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15
Q

Define and give an example of a tertiary endocrine disorder

A

definition: due to dysfunction of the hypothalamus
example: tumors and mass lesions of the hypothalamus

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16
Q

What are the diagnostic approaches to endocrine disorders? (5)

A

Blood tests: measure hormone levels
Urine tests: measure hormone levels or metabolites
Stimulation and suppression tests: hypofunction testing (stimulation); determine if negative feedback regulation is intact (suppression)
Genetic tests: identify genetic changes, screening
Imaging: scan for anatomical changes, density changes, uptake

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17
Q

What are the normal functions of growth hormone? (2 categories)

A

Structural: promotes growth of skeletal muscle and stimulates extension of the long bones before puberty by acting on the epiphyseal plate

Metabolic: stimulation of protein anabolism and fat catabolism while sparing glucose to maintain homeostasis

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18
Q

What is the most common cause of growth hormone excess?

A

Excess commonly caused by secretory pituitary adenoma, may occur in acute illness, chronic renal failure, cirrhosis

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19
Q

What is gigantism and how does it occur?

A

What is it: Symmetric excessive linear growth

How does it occur: Excess of growth hormone prior to closure of epiphyseal plates during childhood

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20
Q

What is acromegaly and how does it occur?

A

What is it:
-Tissue thickening and growth on hands, feet, nose and mandible
- Arthritis due to growth of joint cartilage and increased bone absorption
- General systemic disorder of the lungs, liver, spleen and kidneys, enlargement of intestines
- Hypertension, coronary artery atherosclerosis, CHF
How does it occur: excess of GH during adulthood

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21
Q

What are the consequences of growth hormone deficit in adults (4) vs. children (5)?

A

adults: normal height, increased body fat, decreased lean body mass, decreased bone mineral density
children: short stature, obesity, immature appearance/voice, delay in skeletal maturation, hyperlipidemia

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22
Q

What are the clinical manifestations of congenital growth hormone deficit? (6)

A

Short stature, obesity, immature appearance/voice, delay in skeletal maturation, hyperlipidemia, normal intelligence

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23
Q

What is the cause and what are the clinical manifestations (4) of acquired growth hormone deficit?

A

cause: abnormalities of the hypothalamus and pituitary
CM: Obesity, delayed skeletal maturation, increased cardiovascular mortality, other syndromes

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24
Q

Which two hormones are involved in endocrine regulation of calcium balance?

A

Two hormones regulate calcium levels: calcitonin & parathyroid hormone

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25
Where does calcitonin come from and what is it's general action?
released from thyroid gland when calcium levels are high - stimulates uptake of calcium
26
Where does parathyroid hormone come from and what is it's general action?
released from parathyroid gland when levels are low - promotes release of calcium and phosphate into the blood
27
What are the 3 specific actions of parathyroid hormone?
1. Stimulates osteoclasts to promote release of calcium and phosphate 2. Stimulates enzymes in liver and kidney to produce an active form of vitamin D which increases calcium absorption in the GI tract 3. Stimulates renal tubules to promote calcium reabsorption and decrease phosphate reabsorption
28
What is hypoparathyroidism?
decreased secretion of PTH or decreased hormonal response to PTH in the tissues
29
What is the cause and major consequence of hypoparathyroidism?
cause: due to removal or autoimmune destruction of parathyroid gland consequence: decreased calcium levels which leads to increased neuromuscular activity and tetany
30
What are the symptoms of hypoparathyroidism (5)?
tetany, chvostek sign, trousseau sign, parasthesias, prolonged QT interval
31
What is the definition of hyperparathyroidism?
enhanced activity of parathyroid gland
32
What are the causes of primary hyperparathyroidism? (3)
adenoma, hyperplasia, carcinoma of parathyroid glands
33
What are the causes of secondary hyperparathyroidism? (2)
chronic renal failure, renal phosphate retention
34
What are the symptoms of hyperparathyroidism? (5)
Fatigue, hypertension, constipation, renal stones, bone pain
35
What is the normal function of thyroid hormone (5)?
major metabolic hormone, important for growth and development - Permissive for growth-promoting actions of GH - Essential for development of the nervous system - Increases protein synthesis of many types of cells - Regulates the rate of oxidative phosphorylation - Controls O2 consumption and the production of heat, which determines the BMR
36
What are the two hormones produced by the thyroid?
thyroid hormone & calcitonin
37
What is the normal function of calcitonin?
reduces plasma calcium levels by causing calcium to be deposited into the bone
38
Which hormones comprise thyroid hormone? Which is the major form of TH? Which is the most potent form of TH?
Thyroid hormone includes thyroxine (T4) and triiodothyronine (T3) Major/most potent form & active form = T3
39
Normal feedback loop for thyroid hormone?
1. Hypothalamus stimulated (by sleep, cold temperature, stress) releases thyrotropin-releasing hormone or TRH 2. TRH stimulates the pituitary gland to produce TSH 3. TSH stimulates the thyroid gland to secrete TH 4. When level of hormones reaches a certain threshold, the hormones communicate with the hypothalamus to stop the hormone cascade
40
What is a permissive hormone, and how does thyroid hormone function as one?
Permissive hormone = exert profound effects on the ability of cells to respond to other hormones TH increases cellular responsiveness to catecholamines
41
Define hypothyroidism. How is it diagnosed?
deficiency of thyroid hormone In children = cretinism Adults = myxedema TSH & TH levels -TSH will be elevated & TH decreased in primary hypothyroidism; both decreased in secondary hypothyroidism
42
Define hyperthyroidism
overproduction of TH
43
Causes of hypothyroidism
congenital or acquired, almost always primary, may be secondary Most common cause = Hashimoto's disease
44
S/S of hypothyroidism (child (2) vs. adult (8))
Child or infant - mental retardation, growth deficiencies Adult - generalized and consistent with overall decrease in metabolism; weakness & fatigue, cold intolerance, dry skin, bradycardia, delayed deep tendon reflexes, anemia, hyponatremia and depression
45
What is the common cause of hyperthyroidism? What is it's etiology?
Graves' disease Etiology: Involves autoimmune production of an antibody against the TSH receptor that continually stimulates TSH action leads to excess TH and goiter
46
What are the consequences of Graves' disease (5)?
- Hypermetabolism: weight loss, muscle weakness, increased ventilation to meet O2 demand, increased heat production - Increase in SNS activity
47
Treatment of Graves' disease
surgery or radioactive iodine to ablate part of the thyroid; thiouracil to block TH synthesis, lithium to block TSH secretion and iodine to block the additional production of TH
48
1. What is thyrotoxicosis? 2. If left untreated, what can it give rise to?
1. Characterized by increased synthesis and secretion of T3 and T4 which gives rise to increased metabolic rate 2. Thyroid storm
49
What is goiter?
enlargement of thyroid gland
50
How can goiter occur in hypothyroidism?
thyroid gland enlarges in an attempt to produce more thyroid hormones
51
How can goiter occur in hyperthyroidism?
thyroid enlarges due to overstimulation
52
Is Hashimoto's Thyroiditis hypothyroidism or hyperthyroidism? What is it?
Primary hypothyroidism | autoimmune destruction of the thyroid gland at the thyroid peroxidase, thyroglobulin and TSH receptors
53
Tx of Hashimoto's
replacement of thyroid hormone
54
What is myxedema?
presence of non-pitting mucus type edema caused by an accumulation of hydrophilic mucopolysaccharide substance in the connective tissues
55
What is congenital iodine deficiency syndrome (cretinism)?
hypothyroidism due to decrease in iodine after birth
56
Structure of the adrenal gland
two bean-shaped glands on the top of the kidneys | two regions: medulla (inner portion) & cortex (outer portion)
57
Normal function of the two regions of the adrenal gland
Adrenal Medulla: produces catecholamines released after sympathetic stimulation: epinephrine & norepinephrine Adrenal Cortex: produces three steroid hormone types: mineralocorticoids, glucocorticoids, sex hormones
58
What are the general functions of the hormones released by the adrenal medulla?
Released in response to sympathetic stimulation - occurs in response to short-term stress
59
What are the general functions of the hormones released by the adrenal cortex?
Mineralcorticoids: regulation of minerals - sodium and potassium (eg. Aldosterone) - Stimulate sodium and water retention to maintain fluid and electrolyte homeostasis Glucocorticoids: promotion of cellular metabolism and response to long-term stress by regulating glucose levels (eg. Cortisol) - Protect against hypoglycemia by promoting gluconeogenesis & glycogenolysis Sex hormones: androgens and some estrogens
60
What is the normal feedback loop for cortisol?
1. Stress stimuli 2. Hypothalamus stimulates pituitary gland by releasing CRH 3. Pituitary gland secretes ACTH 4. Adrenal glands release cortisol
61
Define adrenal insufficiency
reduction of one or more hormones secreted from the adrenal complex
62
Define primary adrenal insufficiency and give an example. Why does hyperpigmentation occur?
Primary adrenal insufficiency: damage to adrenal cortex Example: autoimmune diseases and TB Hyperpigmentation: increased ACTH stimulates melanocytes (this does not occur in a diminished level of ACTH)
63
Define secondary adrenal insufficiency and give an example.
occurs when there is a lack of ACTH from anterior pituitary | Example: exogenous glucocorticoid therapy or pituitary or hypothalamic tumor
64
What causes adrenal crisis and what are the s/s (7)?
Cause: Occurs due to insufficient glucocorticoids (rapid withdrawal of exogenous glucocorticoids or Addison's) S/S: confusion, headache, N/V, muscular weakness, hypotension, dehydration, vascular collapse
65
What is Addison's disease?
Primary adrenal insufficiency - atrophy of adrenal glands due to autoimmune response
66
What are the consequences of Addison's on adrenal function?
- Loss of 90% of adrenal cortices resulting in an insufficiency of tissue required to produce hormones - Decrease in adrenal secretion of cortisol and increase in ACTH release
67
S/S of Addison's (13)
- Hyperpigmentation: increased ACTH stimulates melanocytes - Hypoglycemia - Hypotension - Decrease in cardiac size - Decreased mineralcorticoid activity - fluid and electrolyte imbalances, changes in WBC - Weakness, fatigue, anemia, anorexia, vomiting, diarrhea, muscle and joint pain
68
Treatment of Addison's
replacement of missing hormones | Hydrocortisone to counter the loss of mineral and glucocorticoids
69
What is Cushing's syndrome?
physical and physiologic manifestation of overproduction of cortisol
70
What is the cause of Cushing's?
excess production of ACTH from pituitary tumor
71
S/S of Cushing's (9)
- Fat redistribution: moon face or buffalo hump - Altered protein metabolism: muscle wasting particularly in extremities - Accelerated bone metabolism - osteoporosis, renal calculi - Altered glucose metabolism - presents like DM - Loss of immune cell activity - increased risk of infection - Increased androgens - hirsutism, acne, irregular menstruation
72
Treatment of Cushing's
depends on underlying cause: surgery, radiation or medicine
73
Insulin: where is it released from, when is it released, consequences of release on blood glucose levels
Where is it released: Beta-islet in pancreas When is it released - in response to high BG levels - in response to parasympathetic stimulation (eating) - In response to hormones produced by GI tract when food is being metabolized Consequences of release on BG levels - Causes recruitment of glucose transporters to the cell surface - Insulin takes glucose into cells, lowering BG levels - Glucose used for energy metabolism, converted to glycogen or fats for storage or used to synthesize proteins
74
Glucagon: where is it released from, when is it released, consequences of release on blood glucose levels
Where is it released: Alpha-islet in pancreas When is it released - in response to low BG levels - Strenuous exercise when fuel requirements are increased Consequences of release on BG levels - Raises BG levels by converting glycogen into glucose - Stimulation of glycogenolysis, lipolysis and gluconeogenesis
75
Define: glycolysis; glycogenesis; glycogenolysis; gluconeogenesis
glycolysis: breakdown of glucose, occurs in response to increased glucose levels glycogenesis: glycogen synthesis, occurs during rest periods and in response to high glucose levels glycogenolysis: catabolism of stored glycogen in liver to raise BG levels - occurs when BG levels decrease gluconeogenesis: formation of glucose from sources other than carbohydrates when carbohydrates are unavailable
76
Type I DM: cause, underlying impact on insulin release, consequences and treatment
Cause: autoimmune, viral or genetic destruction of B-islet cells coupled with an environmental trigger Underlying impact on insulin release or action: complete or near absence of insulin Consequences: high plasma glucose levels, DKA (fats used in the absence of insulin, results in formation of ketones) Treatment: exogenous insulin
77
Type II DM: cause, underlying impact on insulin release and treatment
Cause: genetic component but obesity Underlying impact on insulin release or action: decreased responsiveness to insulin due to decreased receptor number or sensitivity, high BG levels Treatment: dietary changes and exercise, may need exogenous insulin, medication therapy
78
Which type of diabetes is more common? (1) | Which type is more likely to experience DKA? (2)
1. Type II | 2. Type I
79
Long-term consequences of diabetes (4)
Microvascular disease - thickening of arterioles and capillaries; ischemia can damage vulnerable tissues such as in the eye Atherosclerosis: increased r/f plaque formation which can lead to coronary artery disease and stroke Neuropathies: often seen with changes in Schwann cells Infection: loss of sensation, decreased perfusion and increased glucose fosters microbial growth + impaired WBC

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