Endocrine System Overview

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Questions and Answers

What is the consequence of a deficiency in 21-Hydroxylase?

  • Increased levels of sex hormones (correct)
  • Increased aldosterone secretion
  • Increased production of cortisol
  • Decreased sex hormone levels

Which syndrome is characterized by developmental defects affecting the ability to smell?

  • Turner’s syndrome
  • Kallmann’s syndrome (correct)
  • Sheehan’s syndrome
  • Adrenal insufficiency

In the diagnosis of an endocrine condition, what is the first essential question to ask?

  • What symptoms are being experienced?
  • What is the treatment required?
  • Is there a family history of endocrine disorders?
  • Is it a condition of excess or deficiency? (correct)

What is a primary issue in evaluating endocrine disorders?

<p>Most organs are inaccessible during physical examination (C)</p> Signup and view all the answers

What hormonal change is typical in adrenal insufficiency during hemodynamic collapse?

<p>Decreased cortisol levels (A)</p> Signup and view all the answers

Which nutritional deficiency is commonly associated with endemic goiter?

<p>Iodine deficiency (A)</p> Signup and view all the answers

Which of the following is NOT an abbreviation related to hormone action mentioned?

<p>ACTH (C)</p> Signup and view all the answers

Which condition describes hormone resistance problems?

<p>Leptin resistance (A)</p> Signup and view all the answers

What is the role of JAKs in cytokine receptor signaling?

<p>They act as activators of transcription. (C)</p> Signup and view all the answers

How does ligand binding affect nuclear receptors?

<p>It induces interaction with intracellular kinases. (D)</p> Signup and view all the answers

Which of the following is a likely consequence of activated STAT proteins?

<p>Stimulation of target gene expression. (A)</p> Signup and view all the answers

What mechanism enhances RNA polymerase II-mediated transcription?

<p>Enhancement of enzyme recruitment. (A)</p> Signup and view all the answers

Which receptors are included in cytokine signaling pathways?

<p>Growth hormone and prolactin receptors. (D)</p> Signup and view all the answers

What is the primary role of hormones in the endocrine system?

<p>To regulate physiological processes through feedback mechanisms (C)</p> Signup and view all the answers

Which of the following glands is NOT classified as an endocrine gland?

<p>Sweat Glands (D)</p> Signup and view all the answers

What might be a treatment approach for excess hormone production due to tumors?

<p>Medically reducing excesses or surgical removal of tumors (A)</p> Signup and view all the answers

Which statement best describes exocrine glands?

<p>They secrete substances into a ductal system (A)</p> Signup and view all the answers

How is the definition of endocrinology complicated?

<p>It overlaps with various other physiological processes (B)</p> Signup and view all the answers

What role does ACTH play in relation to blood pressure?

<p>Increases cortisol levels to sustain blood pressure (A)</p> Signup and view all the answers

Which hormones are primarily involved in the regulation of the menstrual cycle?

<p>LH and FSH (D)</p> Signup and view all the answers

What effect does increasing thyroid hormone levels have on TRH and TSH secretion?

<p>Inhibits both TRH and TSH (C)</p> Signup and view all the answers

What is the primary feedback mechanism of Inhibin in the menstrual cycle?

<p>Inhibits FSH secretion (C)</p> Signup and view all the answers

Which hormone is mainly responsible for the lactation process during pregnancy?

<p>Prolactin (B)</p> Signup and view all the answers

What is the primary function of vasopressin in the body?

<p>Conserves free water (A)</p> Signup and view all the answers

During the early follicular phase of the menstrual cycle, which hormones are secreted in a pulsatile manner?

<p>LH and FSH (A)</p> Signup and view all the answers

What hormonal changes occur at menopause regarding reproductive capability?

<p>Decreased production of estrogen and progesterone (D)</p> Signup and view all the answers

What is a significant result of positive feedback mediated by estrogen during the menstrual cycle?

<p>Increase in luteinizing hormone (LH) surge (B)</p> Signup and view all the answers

How does calcium feedback regulate parathyroid hormone (PTH) secretion?

<p>High calcium levels inhibit PTH production (A)</p> Signup and view all the answers

What is a primary cause of hormone excess in endocrine dysfunction?

<p>Neoplastic growth (A)</p> Signup and view all the answers

Which condition can result from an adrenal adenoma?

<p>Cushing syndrome (C)</p> Signup and view all the answers

What characterizes pituitary adenomas?

<p>Benign tumors typically associated with hormone excess (D)</p> Signup and view all the answers

What mechanism can indicate autonomous function in endocrine tumors?

<p>Impaired feedback inhibition of ACTH secretion (C)</p> Signup and view all the answers

What role does the MEN1 gene play in tumorigenesis?

<p>It requires one mutant copy to start tumorigenesis (A)</p> Signup and view all the answers

What is indicated by ACTH suppression after high-dose dexamethasone testing?

<p>Partial feedback sensitivity of tumor cells (B)</p> Signup and view all the answers

Which of the following is a typical characteristic of adenocarcinomas related to endocrine dysfunction?

<p>They can be malignant like adrenocortical carcinoma (D)</p> Signup and view all the answers

What can result from the loss of function in the normal MEN1 gene?

<p>Tumorigenesis may occur (C)</p> Signup and view all the answers

What is the significance of a midnight salivary cortisol test in this patient's case?

<p>It can confirm elevated cortisol levels due to nocturnal variations. (D)</p> Signup and view all the answers

Which condition is the patient most likely experiencing based on her symptoms?

<p>Cushing's syndrome (B)</p> Signup and view all the answers

What is the possible consequence of using oral contraceptives in this patient?

<p>They disrupt the pulsatile release of gonadotropin. (C)</p> Signup and view all the answers

What does slightly elevated LDL and ALT indicate about the patient's health?

<p>She is at risk for cardiovascular diseases. (D)</p> Signup and view all the answers

Why might the patient be experiencing irregular menses?

<p>Hormonal imbalance possibly related to cortisol levels. (C)</p> Signup and view all the answers

What lifestyle factor has contributed to the patient's weight gain?

<p>Repeated attempts to control her diet without success. (D)</p> Signup and view all the answers

What does the patient's normal electrolyte levels suggest?

<p>There is no underlying kidney disease. (A)</p> Signup and view all the answers

What can be inferred about the patient's family history?

<p>Genetic predisposition to hypertension or metabolic syndrome. (A)</p> Signup and view all the answers

Flashcards

Endocrine glands

Internal secretions that directly enter the bloodstream, influencing cellular responses and regulating physiological processes.

Exocrine glands

External secretions that are released into a lumen or duct, like the GI tract, for specific functions.

Hormones

Chemical messengers produced by endocrine glands that regulate physiological processes in the body.

Endocrinology

The field of medicine focusing on the study and treatment of endocrine glands and hormone-related disorders.

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Hormone replacement

The process of regulating hormone levels to correct imbalances related to deficiencies or excesses.

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Hormone Excess (Hyperfunction)

A type of endocrine dysfunction where the body produces too much of a specific hormone.

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Neoplastic Growth

A tumor in an endocrine gland, often benign, that can lead to hormone excess.

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Adenocarcinoma or adrenocortical carcinoma

A type of tumor that can be either benign or malignant, found in the adrenal gland and can lead to hormone excess.

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Pituitary Adenoma

A type of tumor in the pituitary gland that can cause hormone excess.

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Adrenal Adenoma

A type of benign tumor in the adrenal gland that can lead to excess aldosterone production.

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Cushing Syndrome

A condition that results from excess cortisol in the body, often caused by an adrenal tumor.

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Impaired Feedback Inhibition

When the body's normal feedback mechanisms that regulate hormone production fail, leading to excessive hormone secretion.

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MEN1 Gene

A gene that plays a role in tumor suppression, a mutation in this gene can increase risk of endocrine tumors.

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Endocrine disorders

A group of conditions characterized by an imbalance in the production, secretion, or action of hormones. This can lead to excess or deficiency of specific hormones, resulting in various physiological changes and health problems.

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Enzyme defects in hormone production

A category of endocrine disorders arising from defects in enzymes involved in hormone production. These defects can lead to deficiencies in specific hormones and excess production of others.

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21-Hydroxylase deficiency

A specific enzyme defect in adrenal hormone production. This deficiency leads to an increase in sex hormones, a decrease in cortisol and aldosterone, and can cause various complications including salt wasting, ambiguous genitalia, and adrenal insufficiency.

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Kallmann's Syndrome

A condition caused by a deficiency in the production of gonadotropin-releasing hormone (GnRH), leading to impaired puberty and infertility. It can be inherited or caused by environmental factors.

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Turner's Syndrome

A condition that affects females, caused by a complete or partial absence of one or both X chromosomes, leading to a range of physical and developmental abnormalities, including short stature, heart defects, and infertility.

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Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

A specific syndrome characterized by an increase in vasopressin (ADH) production, leading to water retention and hyponatremia. It is associated with various conditions, including infections, medications, and tumors.

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Leptin Resistance

A condition where the body's cells become resistant to leptin, a hormone that regulates appetite and energy expenditure. This can lead to increased appetite, weight gain, and metabolic complications.

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Endocrine disorders

A group of disorders characterized by an imbalance in hormone production or action, leading to either excess or deficiency of specific hormones. These imbalances can affect many physiological functions and require appropriate diagnosis and management.

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Cytokine Receptors

These receptors are activated by ligands that bind to them. This binding triggers the receptor to interact with intracellular kinases, like JAKs, which activate a series of signaling pathways leading to gene transcription and protein production.

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Receptor Coactivator Complex

A complex of proteins that bind to DNA near the promoter region of a gene. This binding recruits various enzymes, such as histone modifying enzymes, and additional transcription factors, to increase the rate of RNA polymerase II-mediated transcription.

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STAT (Signal Transducer and Activator of Transcription) Proteins

A family of proteins that, when activated, translocate to the nucleus and bind to specific DNA sequences, triggering the expression of target genes.

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JAK Kinases (Janus Kinases)

These kinases play an important role in activating STAT proteins, which in turn regulate gene transcription.

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Nuclear Receptor Mutations

Mutations in these receptors can lead to various endocrine diseases by disrupting the normal regulation of hormones and signaling pathways.

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Hormonal feedback regulation

The process by which hormones regulate the production and release of other hormones, creating a balanced system.

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Hypothyroidism feedback loop

A decrease in thyroid hormone levels triggers an increase in the release of TRH and TSH, leading to increased thyroid hormone production and a return to normal levels.

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Positive feedback in ovulation

A surge in estrogen during the menstrual cycle triggers a spike in LH release, leading to ovulation.

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ACTH's role in stress response

The release of ACTH, a stress-related hormone, increases cortisol production, which helps regulate blood pressure and immune response.

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Vasopressin's role in blood pressure

The hormone vasopressin conserves water by increasing reabsorption in the kidneys, helping to maintain blood volume and pressure.

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Hypothalamus in stress response

The process where the hypothalamus stimulates the release of hormones from various glands, including the pituitary and adrenal, in response to stress.

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Hormonal changes in reproduction

A series of coordinated hormonal changes that occur throughout a woman's reproductive life, from puberty to menopause.

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Ovulation

A crucial event in the menstrual cycle where the mature follicle bursts, releasing the egg.

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Inhibin's role in follicular growth

A hormone produced by the granulosa cells in the ovaries that regulates follicular growth and inhibits FSH release.

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Growth factors in ovarian development

Growth factors like EGF and IGF1 influence the follicle's responsiveness to hormones, affecting its growth and development.

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What is Cushing's Syndrome?

A condition characterized by excess cortisol production, often caused by a tumor in the adrenal gland. It can lead to various symptoms, such as weight gain, fatigue, hypertension, and mood swings.

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What is a Midnight Salivary Cortisol Test?

A test used to assess cortisol levels in the body. It checks the amount of cortisol in saliva collected at different times of the day, often at midnight.

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What is Metabolic Syndrome?

A group of metabolic abnormalities including increased abdominal fat, high blood pressure, elevated blood sugar, and abnormal cholesterol levels. It is commonly associated with increased risk of heart disease and type 2 diabetes.

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What are Proton Pump Inhibitors?

A medication that blocks the production of stomach acid, often used to treat heartburn and ulcers.

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What are Prokinetics?

A type of medication that speeds up the movement of food through the digestive tract and can be used to treat symptoms like nausea and vomiting.

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What is Gonadotropin-releasing Hormone (GnRH)?

A hormone that helps regulate the menstrual cycle and plays a crucial role in ovulation. It is produced by the pituitary gland.

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What is an ACTH Stimulation Test?

A test that assesses the function of the adrenal glands by stimulating the production of cortisol. It involves administering synthetic ACTH and measuring the cortisol response.

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What is Adrenal Insufficiency?

A condition characterized by low levels of cortisol, often caused by damage to the adrenal glands or the pituitary gland. It can lead to fatigue, weakness, and low blood pressure.

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Study Notes

Endocrine System Approach

  • Endocrine system evaluated by measuring hormone levels
  • Hormone synthesis and replacement are common
  • Diagnosing deficiency vs excess is key
  • Hormone deficiency diagnosed by stimulating hormone
  • Hormone excess diagnosed by suppressing hormone
  • Treatment involves physiological hormone replacement for deficiency, and medical or surgical for excess
  • Many endocrine disorders treatable once diagnosis confirmed

Endocrine Glands

  • Endocrine glands difficult to define anatomically
  • Interdigitation with other physiologic processes is common (e.g., blood pressure, intravascular volume)
  • Thyroid gland can be part of ENT
  • Examples of organs with interdigitation functions:
    • Cardiovascular system (hormone roles in vascular tone and natriuresis)
    • Kidneys (involved with erythropoiesis and Renin-Angiotensin Axis)

Endocrine Disorders - Causes

  • Hyperfunction (Excess):
    • Neoplastic: Benign and malignant growths (e.g., pituitary adenoma, adrenal adenoma)
    • Ectopic: Hormone production from non-endocrine tissues (e.g., ectopic ACTH)
    • Autoimmune: Immune system attacks the gland (e.g., Graves' disease)
    • latrogenic: Iatrogenic: Treatment-induced (e.g., excess steroid administration)
    • Infectious/inflammatory: (e.g., subacute thyroiditis)
    • Activating receptor mutations: Receptor defects leading to constant activation (e.g., activating LH receptor mutations)
  • Hypofunction (Deficiency):
    • Surgery (most common):
      • Thyroidectomy
    • Infection:
      • Adrenal insufficiency secondary to tuberculosis
    • Inflammation:
    • Infarction:
    • Pituitary or adrenal damage
    • Tumors:
      • Advanced sarcoma
    • Autoimmune: (e.g., Hashimoto's thyroiditis)
    • latrogenic: (e.g., radiation-induced hypopituitarism)

Endocrine Disorders - Pathologic mechanisms

  • Enzyme defects
  • Developmental defects
  • Hormone resistance:
  • Result of inherited defects in membrane receptors, nuclear receptors.
  • Example: Type 2 diabetes.
  • Hormone mutations:
  • Nutritional/vitamin deficiency
  • Hemorrhage/Infarction
  • Iatrogenic factors/exposure
  • Activating mutations

Endocrine Testing

  • Specializations differ, but labs confirm the diagnosis
  • Endocrinology: Diagnosis made primarily from labs, not physical examination
  • Physical exams focus on hormone excess or deficiency
  • Imaging to confirm anatomic abnormalities

Hormone Measurements

  • Measuring hormone levels is done with immunoassays
  • Detects hormones in picomolar or nanomolar ranges using specific antibodies
  • 24-hour urine collection gives integrated assessment of hormone production/metabolites

Dynamic Testing

  • Suppression Tests: Used in suspected hormone excess (e.g., Cushing's syndrome).
  • Stimulation Tests: Used in suspected hormone deficiency (e.g., ACTH stimulation test).
  • Used when baseline tests are inconclusive, and hormone levels overlap with pathologic ranges.

Hormone Secretion and Transport

  • Circulating hormone levels depend on secretion rate and half-life
  • Longer half-life means longer stimulating action
  • Peptides have short half-lives, because of enzymatic degradation
  • Proteins are stored in vesicles, while steroids are not
  • Protein hormones secreted as soon as they are synthesized.
  • Steroid hormones are proportional to the synthesis rate.

Hormone Action mechanisms

  • Hormones divided into membrane receptors and nuclear receptors
  • Membrane Receptors:
    • Bind peptide hormones and catecholamines.
    • Divided into categories:
      • Seven transmembrane GPCRs
      • Tyrosine kinase receptors
      • Cytokine receptors
      • Serine kinase receptors
  • Nuclear Receptors:
    • Bind small molecules (steroids & vitamin D).
    • 100 members:
      • Ligand-receptor complex directly sends the signal

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