Week 9 Flashcards by William Rochford

What are some of the Major Endocrine glands?

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What are the 3 modes of endocrine secretion?

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What is the role of Negative feedback in the hypothalamic-pituitary-thyroid axis?

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What is a Hormone?

Chemical messengers that induce a response in the target tissue/organ

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What are some hormone examples of Steroids?

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What are some hormone examples of Peptides?

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What are some Hormone examples of Proteins?

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What are some Hormone examples of Glycoproteins?

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What are some Hormone examples of Amino acid derivatives?

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What 3 factors control Hormone release from Endocrine glands?

Humoral
Neural
Hormonal

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What may the patterns of hormone secretion throughout the day look like?

A - Diurnal variation
B - Constant value
C - As needed

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How do we test for Endocrine disorders?

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How do we access Pituitary in surgery?

Through Sphenoid air sinus (top of nasal cavity)

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What are some Neurohormones controlling the release of ant. pituitary hormones?

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What are some Neurohormones released from the post. pituitary?

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What hormones are produced in the Paraventricular nuc. in the hypothalamus?

CRH
TRH
OXT
VP / ADH

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What hormones are produced in the Supraorbital nuc. in the hypothalamus?

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What hormones are produced in the Preoptic nuc. in the hypothalamus?

GnRH

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What hormones are produced in the Arcuate nuc. in the hypothalamus?

GnRH
PIH (dopamine)

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What hormones are produced in the Periventricular nuc. in the hypothalamus?

PIH (dopamine)
SS

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Describe Diabetes Insipidus

Very thirsty
Need to pee often

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Describe Oxytocin’s production, binding, and release

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Describe the hypothalamic control of milk production and ejection

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What are some of the simplified cascades of Hormones from the ant. pituitary?

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What are the **3 parts** of the Adenohypophysis?

- pars Distalis - pars Tuberalis - pars Intermedia

What are the **2 parts** of the Neurohypophysis?

- pars Nervosa - Pituitary Stalk

Describe the **Embryonic development** of the pituitary gland

What may happen if there is residual tissue of pharyngeal hypophysis that becomes neoplastic?

**Craniopharyngioma** (hormone secreting tumour)

What are the **different cell types** of the Ant. Pituitary?

Label this cross section of the Ant. Pituitary

Describe the indepth table of Ant. Pituitary hormones

Describe the mechanism controlling **Growth Hormone release**

Describe **feedback inhibition** of Growth Hormone release

What are the levels of Growth hormones throughout the day?

Pulsitile and Diurnal

What are the **Physiologial actions** of Growth Hormone? (Diagram)

What are the **Physiological actions** of Growth Hormone? (text)

What are some Pathologies associated with **Growth Hormone deficiency**?

What are some Pathologies associated with **Growth Hormone excess**?

What are some **physical signs** of Acromegaly?

How do hormones get from **small bodied neurons** to ant. pituitary?

Release hormones into **primary capillary plexuses** or **median eminence** which then carries them to ant. pituitary

How do hormones get from **large bodied neurons** to post. pituitary?

They **dirrectly innervate** the post. pituitary

What are the Hypothalamic neurohormones': - Structure - Hypothalamic nuclei of origin - Effect on ant. pituitary

In what structure are **Oxytocin** and **Vasopressin** synthesised and processed?

**Secretory Vesicle**

What is the function of **signal peptides** in pre-pro Vasopressin / Oxytocin?

**Dirrects pre-pro Vasopressin / Oxytocin into the ER**, where the signal protein is then cleaved off

What **2 other structures** are present in pre-pro Vasopressin?

Neurophysin II Copeptin

What **other structure** is present in pre-pro Oxytocin?

Neurophysin I

What can **Copeptin** be used to measure?

**AVP levels** (produced in same proportion, longer half life)

What is the function of **Neurophysin I / II**?

To **protect Oxytocin / Vasopressin as they move through circulation** to the target tissue before releasing Achieves this by **binding Oxytocin / Vasopressin**

What may cause the **release of AVP** from the SON & PVN?

- **Increase Blood Osmolality** (osmoreceptors in lamina terminalis) - **Decrease Blood Vol** (carotid sinus, aortic arch, left atrium) - **RAAS** (angiotensin II)

How does **cell differentiation** occur in the Ant. Pituitary gland during development?

Via the **Dorsal gradient** (fibroblast growth factor 8 FGF8) and the **Ventral gradient** (bone morphogenic protein 2 BMP2) These oppose each other. The **Ventral diencephalon expresses FGF8** **Rathke's pouch expresses BMP2** Depending where the **progenitor cells** lie on these gradients, they will differentiate into a specific cell type

What are the **5 cell types of the Ant. Pituitary** from Superior to Inferior?

- **Corico** tropes - **Somato** tropes - **Lacto** tropes - **Thyro** tropes - **Gonado** tropes

What controls **Thyroid secretion**?

**Thyroid Stimulating Hormone** (TSH) secreted by ant. pituitary

What is the function of **Cuboidal epithelial cells**?

**Secretion of colloid into follicles of thyroid gland** Main component of colloid is **thyroglobulin**, which contains the thyroid hormones.

What must first happen to thyroid gland secretions before they can function in the body?

What cells produce **Calcitonin**?

C cells

What **%** of metabolically active hormones secreted by the thyroid gland are T4 & 3?

**93%** & **7%**

What happens to **almost all** of T4 eventually?

Converted into T3

What's the difference between T3 & T4?

T3 x4 as potent as T4 but is present in the blood in much lower quantities and persists for a shorter time

What is needed to form thyroxine and how much of it is needed?

Iodine 50mg/year

What is the link between T3 & 4 and metabolic rate?

What does the TG do to **Iodide** (not iodine)?

**Sequestered**, XS excreted by kidney

Describe Iodide trapping in TG

Describe the **synthesis and secretion of Thyroglobulin**

Synthesised and secreted **into follicles by ER and Glogi apparatus**

Describe **Thyroglobulin** and its function

Large Glycoprotein molecule

What is the function of the **enzyme Peroxidase**?

Describe the **Organification of Thyroglobulin**

**The binding of the oxidised iodine to thyroglobulin**

Describe the production of T3 & 4

Describe the **storage of T3 & 4** in the **TG**

Describe the **Release of T3 & 4** within the **epithelial cells in TG**

Describe the action of **Proteases** in TG

Describe the relationship between **T3 & T4** transport in blood and **plasma proteins**

Describe how T3 & 4 bind in their **target cells**

In target cells, T3 & 4 **bind with intracellular proteins** for storage T4 more strongly bound

Describe the **onset and duration** of action of T3 & 4

What are the **major physiological effects** of the Thyroid hormones?

**Mobilisation of Carbohydrate, Fat, and Protein stores** (dirrect and indirrect actions)

What are the **major physiological effects** of the Thyroid hormones in relation to **BMR and weight**?

Describe the **physiological regulation** of T3 & 4

Roughly describe the **-ve feeback** in the regulation of T3 & 4 secretion

Describe **Hyperthyroidism**

What are the **symptoms of Graves' Disease**?

Describe **Hypothyroidism**

What are the **symptoms of Hypothyroidism**?

How do T3 & 4 effect **cellular transcription of genes**?

- T4 is converted into T3 via de-iodination - T3 interacts with the thyroid hormone receptor - Leads to increases or decreases in transcription of genes that lead to the formation of proteins

Describe the **Non-genomic cellular effects** of T3 & 4

Some responses seen are **too fast for the gene transcription** to be responsible Presumed to work through **activation of intracellular 2nd messangers** e.g. cAMP and protein kinase signalling cascades

What are the **Major physiological effects** of the Thyroid Hormones?

What happens during **pharmacological regulation of T3 & 4 secretion by iodides**?

What is a **Goitre**?

**Swollen** thyroid gland

What factors make you more likely to get a Goitre?

Female Young adulthood

What is the difference between Toxic and Non-toxic Goitre?

Toxic is Thyrotoxic and shows **signs of thyrotoxicosis**

What diet issue may lead to Goitre?

**Iodine insufficiency**

What are the two catagories of Goitre?

**Euthyroid** - Diffuse - younger people - Multinodular - older **Hypothyroid** - Iodine deficiency - endemic - Goitrogens (drugs: lithium, amiodarone - diet: cabbage, turnips)

What is the pathogenesis of Goitre?

- Reactive - Iodine block - Genetic

How would you establish if a Solitary thyroid nodule is in fact solitary?

Ultrasound

What are some signs and symptoms of Solitary thyroid nodules?

**Benign masses** - Usually moveable - Soft - Non-tender **Malignancy** - Hard nodule - Fixation to surrounding tissue - Regional lymphadenopathy

What signs and symtoms may a patient present regarding **thyroid hormone levels** in the case of a Solitary thyroid nodule?

Most are asymptomatic however some show signs of: **Hyperthyroidism** - Nervousness - Heat intolerance - Diarrhoea - Muscle weakness - Loss of weight + appetite **Hypothyroidism** - Cold intolerance - Constipation - Fatigue - Weight gain

What **local issues** may occur due to Solitary thyroid nodule?

**Dysphagia** and **hoarseness** due to potential impact on recurrant laryngeal n.

What may be used for Diagnosing Thyroid issues?

What **imaging studies** may be done to help diagnose a thyroid disorder?

Give some exaples of causes of diseases of the Thyroid

What are the **most common types of Hyperthyroidism**?

- **Graves disease** (may present as diffuse toxic goitre) - Functional Goitre - Toxic Adenoma

What are the **most common causes of Hypothyroidism**?

- **Congenital** - **Autoimmune** Defective TH production Loss of parenchyma Deficient TSH

Describe **Graves Disease**

Describe **Hashiomoto Thyroidism**

**Chronic autoimmune** Increased risk of lymphoma

Describe the **Neoplasms of Thyroid gland**

Describe thyroid **Follicular Adenoma**

Describe thyroid **Papillary Carcinoma**

Travels through **LYMPH NODES**

Describe thyroid **Follicular Carcinoma**

Travels through BLOOD, may end up in bones

Name and describe the **3 types of Hyperparathyroidism**

What structures in the **pancreas** are responsible for **Exocrine** and **Endocrine** functions?

Name the **cells** of the Endocrine Pancreas

What are the **hormones** produced by each cell type in Endocrine Pancreas

What is the **main function of Endocrine hormones** from the pancreas?

**Control of blood glucose** in absorptive and post-absorptive states (insulin & glucagon) **Stimulate** or **inhibit** digestive enzymes and HCO3- secretion in GI tract

Roghly outline the **synthesis and processing of Insulin**

Describe the **microvasculture & innervation** of the Endocrine Pancreas

Roughly describe the **factors regulating insulin secretion**

Roughly describe the **physiological actions of Insulin**

Roughly outline the **factors regulating Glucagon release**

Roughly describe the **physiological actions of Glucagon**

What is the overall prevalence of **Autoimmune disorders** in most western populations?

**5**-**8**%

What are two examples of a **single gene mutation causing an Autoimmune disease**?

Describe both **Deletional** and **Regulatory Tolerance**

**Deletional** (recessive) - Self-reactive T cells are deleted in the thymus. Occasionally, self-reactive T cells may escape deletion and cause tissue damage in the periphery **Regulatory** (dominant) - T cell specific for self antigen becomes a regulatory T cell (T reg). Cytokines produced by T reg inhibit other self-reactive T cells

What are some **mechanisms thought to be involved in the breakdown of tolerance**?

Describe what happens in **Rheumatic fever**

- Group A Steptococcus infection - Antibodies against strep carbohydrate - These antibodies cross react on cardiac myosin - T cells produced - Heart valve damage

What are some common signs of **Systemic Lupus Erythematosus** (SLE)?

- Butterfly rash - Raised red patches on skin - Light sensitivity - Mouth ulcers - Heart / lung inflammation - Seizures - Proteinuria

What are some **treatments for SLE**?

- **Systemic corticosteroids** - Monoclonal antibodies

Describe Grave's disease **AND** How it's treated

Describe Hashimoto's thyroiditis **AND** How it's treated

Describe Myasthenia Gravis **AND** How it's treated

Describe Autoimmune Pernicious Anemia **AND** How it's treated

Describe Autoimmune Hemolytic Anemia **AND** How it's treated **AND** Its side effects

Describe MS **AND** How it's treated

What is **Rheumatoid Arthritis**?

What is the **Epidemiology** of Rheumatoid Arthritis?

Joints affected by **RA**?

What are some of the **effects of RA on different organs**?

How is **RA** diagnosed?

For the treatment of **RA** name some: - **Symptomatic meds** - **Disease modifying drugs** - **Bological modifiers**

Describe **Coeliac disease**

When should we perform **Thyroid Function Tests**?

Describe **Hypothyroidism**

Describe **Subclinical Hypothyroidism**

What are the Symptoms of Hypothyroidism

What are some **causes of Hypothyroidism**?

Describe **Hashimoto's**

What are some causes of **Congenital Hypothyroidism**?

Describe the relationship between **Amiodarone and the Thyroid**

What is the **treatment for subclinical hypothyroidism**

How do you differentiate between **thyrotoxicosis WITH hyperthyroidism** (grave's) and **Thyrotoxicosis WITHOUT hyperthyroidism** (transient thyroiditis)

Measure TSH receptor antibodies to confirm Grave's disease

What is used to treat **Transient Thyrotoxicosis without hyperthyroidism**?

β-blockers

What are the **symptoms of hyperthyroidism**?