Endocrinology A. Introduction 1. The “Master Gland” a. in “olden days b. Today 2. Hypothalamus-Pituitary Connections a. To Anterior Pituitary (Adenohypophysis) i. Embryology ii. Hypothalamo-hypophyseal portal iii. Hormones b. To Posterior Pituitary (Neurohypophysis) i. Nature Of Posterior Pituitary ii. Hormones iii. Functions c. Intermediate Lobe 3. Nature of Secretion a. Pulsative b. Daily Rhythms c. Longer Rhythms B. Hypothalamic Control 1. General Mechanisms a. Nature b. Action 2. The Hormones a. General Information i. Chemical Form ii. Peripheral Forms iii. Single Effect b. Specifics i. Thyrotropin-Releasing Hormone (TRH). (a) Structure (b) Major Target (c) Minor Target ii. Gonadotropin-Releasing Hormone (GnRH) (a) LH-RH (b) Structure (c) Targets (d) Effect of exogenous administration: (i) Pulsatile administration (ii) Continuous administration a. Long-acting versions iii. Growth Hormone-Releasing Hormone (GHRH) (a) Structure (b) Target iv. Somatostatin (a) Structure (b) Target (c) And Insulin (d) And TSH v. Corticotropin-Releasing Hormone (a) Structure (b) Target 3. Hypothalamic Abnormalities a. Typical pathologies b. Results i. Specificity ii. General C. Anterior Pituitary Hormones 1. Adrenocorticotrophic Hormone (ACTH; Corticotropin) a. Description b. CRH – ACTH – Adrenal Axis 2. Glycoprotein Hormones a. Commonalities b. Thyroid-Stimulating Hormone (TSH) c. LH and FSH i. Stimulation ii. Suppression iii. Females iv. Males 3. Growth Hormone (GH) a. Structure b. Control c. Action i. Somatomedin-C ii. Metabolic effects (a) Insulin-like
(b) Longer-term d. Everyday importance 4. Prolactin a. Cells b. Function c. Pituitary tumors D. Posterior Pituitary Function 1. Introduction a. The Hormones b. Structure c. Synthesis i. Source ii. Synthesis iii. Storage iv. Release d. Clearance 2. Hormone Actions a. ADH: i. Major Function ii. High concentration iii. Stimulus (a) Osmotic concentration (b) Decreased blood volume (c) Others (d) Inhibitors (e) Diabetes Insipidus b. Oxytocin: i. Targets: (a) Myoepithelial cells (b) Uterine Smooth Muscle E. Pituitary Disorders 1. Generalized Hypopituitarism a. Causes i. Primary (a) Pituitary tumors (b) Infarction or ischemia (c) Inflammation ii. Secondary (a) Hypothalamic tumors (b) Inflammations (c) Trauma (d) Others b. Appearance i. Onset ii. Decreased LH and FSH (a) Females (b) Men iii. Decreased GH iv. Decreased TSH v. Decreased ACTH vi. Sheehan’s Syndrome c. Diagnosis i. Visualization of the pituitary/sella turcica. (a) Skull xrays, CT scans, MRIs, PET scans (b) Cerebral angiography ii. Visual Field Testing iii. Evaluation of Thyroid Function (a) TSH, T3/T4 (b) Injection of synthetic TRH iv. Evaluation of ACTH Secretion (a) Testing “Pituitary Reserve” (i) Problem (ii) Test Purpose (iii)Best test: Insulin Tolerance v. Evaluation of Prolactin vi. Evaluation of GH (a) Routine (b) Measurement in children (c) Injection of GHRH (d) Subtlety vii. Evaluation of LH/FSH (a) Measurement of LH/FSH (b) Concentrations (c) Postmenopausal women viii. Combined Anterior Pituitary Function Test ix. Differentiating from other diseases (a) Anorexia nervosa (b) Alcoholic liver disease (c) Polyglandular Autoimmune Disease
(d)
Treatment 2. Selective Pituitary Deficiency. a. Introduction b. Isolated GH Deficiency c. Isolated Gonadotropin Deficiency i. Vs. Primary Hypogonadism ii. Exercise, Diet & Stress iii. Kallmann’s Syndrome (a) Description (b) Defects (c) Cause d. Isolated ACTH Deficiency e. Isolated TSH Deficiency 3. Hyperpituitarism a. Gigantism & Acromegaly i. Introduction ii. Appearance (a) Before Epiphyseal Closure (b) After Epiphyseal Closure (c) Diagnostic Indicators (i) Radiographic Examination (ii) GH Radioimmunoassay (iii)Somatomedin-C (d) Treatment b. Galactorrhea i. Definition ii. Cause iii. Appearance iv. Diagnostic Tests 4. Posterior Pituitary Disorders a. Diabetes Insipidus i. Introduction (a) Definition (b) Nephrogenic DI (c) Water-Drinkers ii. Cause of DI (a) Hypothalamic Nuclei (b)
Primary vs. Secondary iii.
Appearance (a)
Polyuria (b)
Polydipsia iv.
Diagnosis (a)
Testing (i) Water
Deprivation Test a. Pre-Test b. Collections c.
Termination d. Vasopressin e. Evaluation i.
ii.
Positive iii. Nephrogenic
DI (ii) ADH Measurement v.
Treatment (a)
Hormonal (i) Vasopressin (ii) Synthetic Analog (b)
Nonhormonal (i) Diuretics (ii) Reduced Na Intake b.
Compulsive Water Drinkers i.
Identity ii.
Volume (a)
Nocturia (b)
Polydipsia iii.
Hyponatremia iv.
Treatment II.
Thyroid Disease A.
Glandular Structure 1.
Formation a.
Initiation b.
Migration c.
Appearance B.
Hormone Synthesis 1.
Thryoglobulin a.
Identity b.
Location 2.
Iodine a.
Capture b.
Conversion c.
Incorporation i.
Organification ii.
Result iii.
Coupling d.
Reabsorption i.
Colloid Droplet ii.
Lysosomes iii.
Diffusion C.
Thyrotropin (TSH) 1.
Thyrocyte Activity 2.
Mechanisms a.
Binds to Receptors b.
Activates Adenylate Cyclase c.
Control D.
Circulation of Thyroid Hormones 1.
Thyroxine-Binding Globulin 2.
Thryroxine-Binding PreAlbumin 3.
Free 4.
T4-to-T3 Conversion E.
Hormone Actions 1.
Increased Protein Synthesis 2.
Increased Oxygen Concentration F.
Euthyroid Goiter 1.
Definition 2.
Appearance 3.
Treatment G.
Euthyroid Sick Syndrome 1.
Definition 2.
Causes 3.
Appearance H.
Hyperthyroidism 1.
Definition 2.
Major Cause Categories 3.
Specific Causes a.
Graves’ Disease b.
Inappropriate TSH c.
Elevated Concentrations of HCG d.
Thyroiditis e.
Iodine Ingestion 4.
Signs/Symptoms a.
Many/Varied Signs b.
Eye Signs c.
Infiltrative Dermopathy d.
Thyroid Storm 5.
Diagnosis 6.
Treatment a.
Iodine Administration b.
Propylthiouracil/Methimazole c.
Radioactive Iodine d.
Surgery I.
Hypothyroidism (Myxedema) 1.
Definition 2.
Forms a.
Primary b.
Secondary 3.
Signs/Symptoms 4.
Diagnosis a.
Primary Hypothyroidism b.
Secondary Hypothyroidism c.
TRH Test d.
T3/T4 5.
Treatment J.
Thyroiditis 1.
Definition 2.
Types a.
Silent Lymphocytic Thyroiditis b.
Hashimoto’s Thyroiditis III.
Endocrine Pancreas A.
Normal Physiology 1.
Islets of Langerhans a.
Description b.
Cell Complement 2.
Hormone Secretion a.
Fasting i.
Description ii.
Glucagon iii.
FFA Utilization b.
Feeding i.
Description ii.
Insulin B.
Diabetes Mellitus 1.
Definition 2.
Classification a.
Type I (IDDM; Juvenile Onset) i.
Age at Onset ii.
Prevelance iii.
DKA iv.
Insulin v.
Genetics b.
Type II (NIDDM) i.
Age at Onset ii.
Characteristics iii.
DKA iv.
Obesity v.
Treatment vi.
Genetics vii.
Cells viii.
Hyperglycemia 3.
Signs/Symptoms a.
Initial Presentation i.
Type I ii.
Type II b.
Symptomatic Hyperglycemia i.
3 P’s ii.
Others c.
Late Complications i.
And Hyperglycemia ii.
Microvascular iii.
Macrovascular iv.
Retinopathy v.
Nephropathy vi.
Polyneuropathy vii.
Foot ulcers/Joint problems 4.
Diagnosis a.
National Diabetes Data Group i.
FBG ii.
OGTT iii.
Impaired Glucose Tolerance b.
American Diabetes Association 5.
Treatment a.
Insulin i.
Human ii.
Absorption Rate b.
Complications of Treatment i.
Hypoglycemia ii.
Dawn Phenomenon iii.
Local Allergy iv.
Generalized Allergy c.
Oral Hypoglycemics: Sulfonylureas i.
Action ii.
Examples iii.
Complication d.
Anti-Hyperglycemics i.
Biguanides ii.
Alpha-Glucosides iii.
Thiazolidinediones 6.
Diabetic Ketoacidosis a.
Definition b.
Mechanism i.
Shift to Fat Catabolism ii.
Produces Ketone Bodies iii.
Disposal of Acids iv.
Acetone v.
Ventilation vi.
Ratio Change c.
Signs/Symptoms d.
Diagnosis e.
Treatment 7.
Hypoglycemia a.
Definition b.
Pathophysiology i.
Neuron Fuel ii.
Insulin and the CNS iii.
CNS Monitor iv.
Glucagon c.
Classification i.
Drug-Induced (a)
Frequency (b)
Drugs (c)
Alcohol (d)
Others ii.
Non-drug Induced (a)
Fasting Hypoglycemia (i) Introduction (ii) Causes a. Liver b. Fatty Acid
Oxidation c. Islet
cell Adenomas d. Mesenchyme
Tumors e. Renal Failure (b)
Reactive Hypoglycemia (i) Causes d.
Signs/Symptoms i.
Patterns (a)
Adrenergic Symptoms (b)
CNS Symptoms ii.
Other Information e.
Diagnosis i.
Requirements ii.
Glucose Concentrations iii.
Associations f.
Treatment i.
Oral Carbohydrate ii.
IV Glucose iii.
Glucagon IV.
Adrenal Glands A.
Anatomy 1.
Components of the Glands a.
Steroidogenic Tissue b.
Chromaffin Tissue 2.
Origination a.
Steroid-producers b.
Catecholamine-producers 3.
Description 4.
Histology a.
Cortical Layers b.
Cell Appearance 5.
Fetal Cortex B.
Cortical Hormones 1.
Introduction a.
Categories i.
Mineralcorticoids ii.
Glucocorticoids iii.
Androgens 2.
Synthesis a.
And Cholesterol b.
Formulae c.
Concentrations & Activities 3.
Binding a.
Cortisol b.
Aldosterone c.
Reservoir 4.
Degradation a.
Site b.
Elimination C.
Mineralcorticoid Function 1.
Mineralcorticoid Deficiency 2.
Aldosterone Activity a.
Major Role b.
Excess Aldosterone i.
Sodium Retention ii.
Sodium Concentration iii.
Total Result iv.
And Potassium (a)
Excess Aldosterone: Hypokalemia (b)
Deficient Aldosterone: Hyperkalemia v.
And H+ c.
Aldosterone and Other Secretions i.
Sweat and Salivary Glands ii.
Intestinal Secretion 3.
Cellular Mechanism of Aldosterone a.
Entry b.
Receptor c.
Result d.
Timing 4.
Regulation of Aldosterone Secretion a.
Major Controllers i.
Increased [K+] ii.
Renin-Angiotensin System b.
Minor Controllers D.
Glucocorticoid Function 1.
Introduction a.
Absence b.
Activity 2.
Carbohydrate Metabolism a.
Gluconeogenesis b.
Decreased Utilization c.
“Adrenal Diabetes” 3.
Protein Metabolism a.
Decreased Cellular Protein b.
Increased Plasma Proteins c.
Effects on Amino Acids 4.
Fat Metabolism a.
F.A. Mobilization b.
Obesity 5.
Stress Resistance a.
Introduction
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