year 4 CMS > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

What are the two key parts of the endocrine system?

A
  • Hypothalamus
  • Pituitary gland

The hypothalamus is considered a part of the brain, while the pituitary gland is attached to the brain.

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2
Q

The pituitary gland has which two regions?

A
  • Anterior region
  • Posterior region

These regions produce different hormones, with a focus on anterior pituitary hormones in this lecture.

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3
Q

What does the hypothalamus do in the endocrine system?

A
  • Receives signals from the brain
  • Secretes hormones
  • Sends specialized nerve signals to stimulate the pituitary gland

This process results in the production of hormones by the pituitary gland.

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4
Q

How many hormones can the pituitary gland produce?

A

Around 12+ hormones

These hormones have various effects across the body.

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5
Q

Some hormones produced by the pituitary gland affect the end organs directly, while others stimulate what?

A

An intermediate gland

This intermediate gland produces another hormone that affects end organs.

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6
Q

The pituitary gland can influence the action of which organs?

A
  • Pancreas
  • Thyroid gland
  • Adrenal gland
  • Testes
  • Ovaries

The pituitary gland can affect their function and hormone secretion.

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7
Q

In health, having normal thyroid function is called _______.

A

euthyroid

This term describes a state of normal thyroid function.

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8
Q
A
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9
Q

What is the importance of the negative feedback loop in the endocrine system?

A

It manages physiological and haemostatic processes

Feedback loops help maintain homeostasis by regulating internal environments despite external changes.

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10
Q

What does MACIEDEC stand for in the context of homeostasis?

A

Maintaining a constant internal environment despite external change

This acronym summarizes the concept of homeostasis.

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11
Q

In a negative feedback loop, what does the output of a process do?

A

Acts as a signal that reduces the activity of that same process

This results in a return to the ‘normal’ level.

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12
Q

What role does the hypothalamus play in hormone secretion?

A

It tells the pituitary to secrete hormones

The hypothalamus regulates the activity of the pituitary gland.

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13
Q

What happens when the presence of hormones inhibits hypothalamus activity?

A

Turns the signal off, leading to a negative feedback loop

This results in the pituitary also being turned ‘off’.

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14
Q

What occurs if the level of a hormone drops?

A

The hypothalamus responds to less inhibition and restimulates the system

This is part of the negative feedback mechanism.

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15
Q

Where is the thyroid located?

A

In the lower part of the anterior neck, on either side of the laryngeal cartilage

It is close to the cricothyroid ligament.

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16
Q

What are the functions of thyroid hormones?

A
  • Regulate metabolic activity
  • Increase basal metabolic rate
  • Raise blood pressure
  • Enhance gut activity
  • Improve cognitive function

Survival is not possible without thyroid hormones.

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17
Q

What are the two forms of thyroid hormones?

A
  • Thyroxine [T4]
  • Tri-iodothyronine [T3]

T4 and T3 increase metabolic activity in peripheral tissues.

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18
Q

What stimulates the production of T4 and T3?

A

Thyroid-stimulating hormone [TSH] from the pituitary

TSH is regulated by thyrotrophin-releasing hormone [TRH] from the hypothalamus.

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19
Q

Summarize the feedback loop involving TRH, TSH, T4, and T3.

A

TRH in hypothalamus → TSH in pituitary → T4 in thyroid → T3 in thyroid

T3 is the more active form in the thyroid.

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20
Q

What is thyroid swelling and how can it be identified?

A

It moves when you swallow

Generally very common – can be due to Derbyshire neck.

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21
Q

Define goitre.

A

A lump or swelling at the front of the neck caused by a swollen thyroid

Harder to detect in fat patients; can indicate tumours of the thyroid.

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22
Q

How is Derbyshire neck related to goitre?

A

Lack of iodine leads to insufficient thyroid hormone production

People in Derbyshire lacked access to iodine-rich food sources.

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23
Q

What is required to produce one molecule of thyronine?

A

Three iodine molecules

Insufficient iodine leads to inadequate thyroid hormone production.

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24
Q

What happens to the thyroid gland in endemic goitre?

A

Hypothalamus produces more TRH; pituitary secretes TSH; thyroid grows

The thyroid cannot produce hormones due to lack of iodine.

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25
What are some sources of **iodine**?
* Fish * Seaweed * Green vegetables * Potatoes * Sweetcorn * Eggs ## Footnote Iodised table salt was produced to reduce the risk of developing endemic goitre.
26
What is **hypothyroidism**?
Inability to produce enough thyroid hormone ## Footnote Presents as low T3/T4 levels.
27
List some causes of **hypothyroidism**.
* Iodine deficiency * Drugs interfering with iodine metabolism * Autoimmune destruction of the thyroid * Iatrogenic causes ## Footnote Iatrogenic causes refer to issues arising from treatment.
28
What is a common treatment for hypothyroidism following a **thyroidectomy**?
Thyroid supplements ## Footnote Patients may require supplements to compensate for the removal of the thyroid.
29
What is **radio-iodine treatment** used for?
Treating an overactive thyroid ## Footnote An injection of concentrated radioactive iodine irradiates the thyroid gland.
30
Where are the **adrenal glands** situated?
Just above the kidney ## Footnote Although they are located above the kidneys, they are not directly related.
31
What are the **steroid hormones** produced by the adrenal glands?
* Glucocorticoids (e.g.: cortisol) * Mineralocorticoids (e.g.: aldosterone) * Adrenaline and noradrenaline * Androgens ## Footnote These hormones play roles in metabolism, salt and water balance, heart rate, blood pressure, and sexual characteristics.
32
What is the difference between **corticosteroids** and **steroids**?
Steroid hormones are a broad class; corticosteroids are a specific class produced by the adrenal glands ## Footnote Corticosteroids fall under the umbrella term of steroid hormones.
33
What hormone does the **hypothalamus** produce to initiate cortisol secretion?
Corticotrophin-releasing hormone (CRH) ## Footnote CRH interacts with the pituitary gland to secrete adrenocorticotrophic hormone (ACTH).
34
What does **ACTH** do?
Acts on the adrenal cortex to produce cortisol ## Footnote ACTH is secreted by the pituitary gland in response to CRH.
35
Describe the **negative feedback loop** involved in cortisol secretion.
* Increased cortisol inhibits hypothalamus production of CRH * Less CRH leads to less ACTH from the pituitary * This stops adrenal cortex from producing cortisol ## Footnote This feedback mechanism helps regulate cortisol levels in the body.
36
What is a **synthetic analogue** in chemistry?
A man-made compound with some atoms replaced or a different functional group ## Footnote Synthetic analogues are similar to natural compounds but not identical.
37
Name some **synthetic analogues** of cortisol.
* Hydrocortisone * Prednisolone * Betamethasone * Fluticasone ## Footnote These drugs act in the feedback loop similarly to cortisol.
38
What happens when **hydrocortisone** is administered?
* Inhibits hypothalamus from producing CRH * Leads to less ACTH from the pituitary * Stops adrenal cortex from producing its own cortisol ## Footnote This mimics the natural feedback mechanism of cortisol.
39
What is **Cushing’s syndrome** also known as?
hyper-adrenal-cortex-ism ## Footnote It refers to the condition of excess cortisol.
40
What type of hormone is **cortisol**?
Glucocorticoid ## Footnote Cortisol is responsible for controlling metabolic pathways across the body.
41
In Cushing’s syndrome, what is secreted in excess by the **adrenal cortex**?
Cortisol ## Footnote This syndrome describes the group of characteristics created by excess cortisol.
42
What does the acronym **DAMPBUTS** stand for in relation to Cushing’s syndrome symptoms?
* Diabetes * Acne and skin changes * Moon face * Peripheral wasting and weakness * Buffalo hump * Central obesity * Thin hair * Striae ## Footnote These are common symptoms associated with Cushing’s syndrome.
43
Cushing’s disease is distinguished by the presence of a **pituitary adenoma** that secretes what?
ACTH ## Footnote Cushing’s disease is a specific cause of Cushing’s syndrome.
44
What can cause **iatrogenic Cushing’s syndrome**?
Prescribing steroids at too high a dose for too long ## Footnote This can lead to the development of Cushing’s syndrome.
45
What are potential sources of ACTH secretion that complicate the diagnosis of Cushing’s syndrome?
* Lung cancers * Gut cancers ## Footnote These tumors can secrete their own ACTH.
46
What is the opposite condition of Cushing’s disease, characterized by low cortisol levels?
Adrenal insufficiency ## Footnote Symptoms can be non-specific and difficult to diagnose.
47
List some symptoms of **adrenal insufficiency**.
* Non-specific malaise * Weight loss * Nausea and vomiting * Abdominal pain * Fatigue * Depression * Muscle and joint pain ## Footnote These symptoms can be quite non-specific.
48
What is **Addison's disease** also known as?
Primary adrenal insufficiency ## Footnote It can lead to symptoms associated with adrenal insufficiency.
49
What can cause **Addison's disease**?
* Autoimmune destruction of adrenal glands * Autoimmune thyroiditis * Autoimmune type 1 diabetes ## Footnote These autoimmune conditions can lead to Addison's disease.
50
What is **adrenal insufficiency** caused by?
Secondary adrenal atrophy ## Footnote This condition occurs when the adrenal glands do not produce enough cortisol due to atrophy.
51
What does the **hypothalamus** produce that stimulates the pituitary gland?
CRH (Corticotropin-Releasing Hormone) ## Footnote CRH leads to the production of ACTH by the pituitary gland.
52
What hormone does the **pituitary gland** produce in response to CRH?
ACTH (Adrenocorticotropic Hormone) ## Footnote ACTH stimulates the adrenal cortex to produce cortisol.
53
What effect do **exogenous steroids** have on the hypothalamus?
Inhibition of CRH production ## Footnote This leads to decreased ACTH and subsequently less cortisol production by the adrenal cortex.
54
What happens to the adrenal cortex when it is used less due to steroid usage?
Atrophy (it gets smaller) ## Footnote This results in decreased production of cortisol by the adrenal cortex.
55
What can happen if the adrenal glands become atrophic due to steroid usage?
Inability to respond to stress, illness, or surgery ## Footnote This can lead to an adrenal crisis, also known as an Addisonian crisis.
56
What is an **Addisonian crisis**?
Acute adrenal insufficiency ## Footnote It occurs when the body cannot produce enough cortisol during stress or illness.
57
List some **non-specific symptoms** of an Addisonian crisis.
* Malaise * Weight loss * Nausea * Vomiting * Abdominal pain * Fatigue * Depression * Muscle and joint pain ## Footnote These symptoms can be mistaken for other illnesses.
58
Why is it important for patients at risk of adrenal insufficiency to be educated?
To manage their wellbeing during illness or surgery ## Footnote Proper education can help prevent an adrenal crisis.
59
An Addisonian crisis can be caused by not taking steroids that should normally be taken when __________.
Unwell ## Footnote This highlights the importance of adherence to steroid therapy.
60
What is the purpose of a **steroid emergency card** for patients with Addison's disease?
Informs the patient what to do if unwell, manages 'sick days', and guides healthcare professionals on symptom management ## Footnote Useful for patients who take steroids or have Addison's disease.
61
Patients taking **exogenous glucocorticoids** can cause adrenal insufficiency by suppressing which axis?
Hypothalamo-pituitary-adrenal axis ## Footnote This suppression can occur through various routes including oral and topical preparations.
62
Name two conditions for which **steroids** are commonly prescribed.
* Asthma * Chronic obstructive pulmonary disease (COPD) ## Footnote These conditions may require steroid treatment, which can affect adrenal function.
63
Patients with Addison's disease have **primary adrenal failure** and cannot produce their own _______.
steroids ## Footnote They must take steroids daily to avoid becoming unwell.
64
What can happen if patients with Addison's disease do not take extra steroid tablets during surgery or stress?
They can develop an **Addisonian crisis** ## Footnote This is a serious condition that requires immediate medical attention.
65
An **adrenal crisis** affects all targets of hormones from the adrenal glands, including which steroid hormones?
* Glucocorticoids (e.g.: cortisol) * Mineralocorticoids (e.g.: aldosterone) * Adrenaline and noradrenaline ## Footnote These hormones are crucial for various bodily functions including metabolism and blood pressure regulation.
66
True or false: Patients with Addison's disease can produce their own steroids in times of stress.
FALSE ## Footnote They rely on external steroid intake as their adrenal glands do not function properly.
67
What is **secondary adrenal atrophy** in patients taking exogenous steroids?
The body cannot produce its own steroids ## Footnote This condition can occur due to the use of steroids like hydrocortisone.
68
What is the threshold for producing **significant adrenal insufficiency** with long-term oral steroids?
≥5mg of prednisolone/day for 4 weeks ## Footnote Equivalent doses for other steroids also apply.
69
What is the threshold for producing **significant adrenal insufficiency** with high-dose short courses of steroids?
≥40mg prednisolone for 7 days, repeated or also taking long-term lower doses ## Footnote Patients with COPD may take a low dose of steroids regularly.
70
What is the threshold for producing **significant adrenal insufficiency** with inhaled steroids?
≥1000mcg/day betamethasone ## Footnote The usual dose is 800mcg/day.
71
What is the usual recommended dose of **inhaled steroids** for adults?
Two puffs (200mcg), twice a day which is 800mcg ## Footnote Going slightly over this can risk secondary adrenal suppression.
72
What are the **combinations** of steroids that can lead to secondary adrenal atrophy?
* Inhaled * Oral * Creams * Injections * Nasal ## Footnote Care must be taken not to exceed safe limits.
73
What is an **Addisonian crisis**?
A condition that occurs in stressed/unwell patients or those undergoing surgery/dental procedures ## Footnote It may lead to an increased requirement for corticosteroids.
74
What are the **symptoms** of an Addisonian crisis?
* Malaise * Weight loss * Nausea * Vomiting * Hypotension * Other non-specific symptoms ## Footnote Management focuses on prevention.
75
What is the **first step** in managing an Addisonian crisis?
Recognise the symptoms ## Footnote This can be difficult due to the non-specific nature of the symptoms.
76
What is the **second step** in managing an Addisonian crisis?
Don’t stop the steroids ## Footnote Steroids must be maintained as normal even if the patient cannot eat properly.
77
What is the **third step** in assessing risk for Addisonian crisis?
Assess the risk based on Addison's disease or steroid treatment ## Footnote Addison's disease presents a higher risk of crisis.
78
What is the **fourth step** in managing patients at risk of Addisonian crisis?
Determine if they need steroid cover ## Footnote Further reading articles provide more information on this topic.
79
Do patients with **Addison’s disease** need steroid cover?
No cover ## Footnote Additional dose 1hr before surgery, double dose pre-op and for 24hrs after, 100mg hydrocortisone injection pre-op.
80
What is the steroid cover protocol for patients on **exogenous steroids**?
No cover ## Footnote Double dose pre-op, 100mg hydrocortisone injection pre-op, double dose for 24hrs.
81
What should patients understand about taking their **steroids** post-operatively?
They need to take their steroids ## Footnote This is crucial despite having a dry socket, any infection, or post-operative pain.
82
List the symptoms of an **adrenal crisis**.
* Hypotension (can be postural) * Malaise * Fatigue * Vomiting ## Footnote Patients should be aware of these symptoms and take additional steroids if needed.
83
What should patients do if they have concerns about an **adrenal crisis**?
Contact a doctor or speak to the A&E department ## Footnote This is important if emergency symptoms of an adrenal crisis arise.
84
What is the recommendation for patients who might be **extremely stressed** during dental treatment?
May require some steroids ## Footnote The number of people who have had an adrenal crisis after dental treatment is very small, and most evidence is anecdotal.
85
What are the **post-operative instructions** for patients regarding fluids?
Maintain fluids ## Footnote This is part of the critical post-operative care.
86
What are the **roles of bones**?
* Provide fulcrum for muscles * Provision of height and walking ability * Hold teeth in place * Protection of internal organs and brain ## Footnote Bones are essential for various functions in the body.
87
Bones are a source of **calcium** which is controlled precisely by the body. What systems can be affected by changes in serum calcium levels?
* Cardiovascular system * Blood pressure and heart rate * Central and peripheral nervous system * Gastrointestinal tract * Cognitive functions ## Footnote Serum calcium levels play a crucial role in multiple bodily systems.
88
What is the major hormone influencing calcium levels in the body?
Parathyroid hormone (PTH) ## Footnote PTH is critical for bone metabolism and calcium homeostasis.
89
Removal of the **thyroid gland** will also remove which glands that affect bone metabolism?
Parathyroid glands ## Footnote This removal can significantly impact calcium homeostasis.
90
How are serum calcium levels controlled by **PTH**?
Through a feedback system ## Footnote This feedback system does not involve the hypothalamus or the pituitary.
91
What happens when there is a drop in serum calcium levels?
* Detected by parathyroid glands * PTH is produced * Stimulates osteoclasts to dissolve bone * Releases calcium into circulation ## Footnote This process is crucial for maintaining calcium levels in the body.
92
What long-term effects does **PTH** have on the kidneys?
* Stimulates metabolism of Vitamin D3 into calcitriol * Calcitriol increases calcium absorption from the gut ## Footnote These actions help to elevate calcium levels in circulation.
93
What is **hypoparathyroidism**?
Inability to maintain calcium levels, leading to hypocalcaemia ## Footnote This condition can arise from various causes, including autoimmune conditions and thyroidectomies.
94
List some causes of **hypoparathyroidism**.
* Autoimmune conditions * Destruction of the gland * Diabetes * Adrenal insufficiency * Thyroidectomies ## Footnote These factors can lead to the unintentional removal of parathyroid glands.
95
What is the primary hormone produced by **overstimulated parathyroid glands** in hyperparathyroidism?
Parathyroid hormone (PTH) ## Footnote This hormone leads to increased calcium absorption and higher blood calcium levels.
96
Name the **two causative groups** of hyperparathyroidism.
* Primary causes * Secondary causes ## Footnote Each group has distinct underlying conditions contributing to hyperparathyroidism.
97
List the **primary causes** of hyperparathyroidism.
* PTH secreting tumour * Parathyroid gland tumour * Other cancers generating their own PTH ## Footnote These conditions directly stimulate the production of PTH.
98
List the **secondary causes** of hyperparathyroidism.
* Renal failure * Vitamin D deficiency * Hypocalcaemia (due to Vitamin D deficiency) ## Footnote These conditions affect the metabolism of calcium and vitamin D, leading to secondary hyperparathyroidism.
99
What are the **symptoms** associated with **hypercalcemia** in hyperparathyroidism?
* Stones * Bones * Abdominal groans * Psychic moans ## Footnote These symptoms reflect the systemic effects of elevated calcium levels.
100
True or false: Patients with hyperparathyroidism are **more likely to develop kidney stones**.
TRUE ## Footnote The increased calcium levels contribute to the formation of kidney stones.
101
What condition is associated with **osteoporosis** or **pathological fractures** in hyperparathyroidism?
Hypercalcemia ## Footnote Elevated calcium levels can weaken bones, leading to osteoporosis and fractures.
102
Fill in the blank: **Calcium** is involved in the __________ nervous system.
central nervous system (CNS) ## Footnote Calcium plays a crucial role in various neurological functions.
103
What can result from high calcium levels in the context of hyperparathyroidism?
* Constipation * Gut obstruction * Psychiatric problems ## Footnote These issues arise due to the effects of calcium on the gastrointestinal and nervous systems.
104
Overall, the body is designed to return to a __________ balance.
homeostatic ## Footnote The body employs feedback loops to maintain balance, although these may sometimes fail.
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