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Endocrinology Sample
Endocrinology Sample
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ENDOCRINOLOGY
CONTENTS
GENERAL FEATURES OF ENDOCRINOLOGY ................................................................................................................... 7
PHYSIOLOGY OF ENDOCRINOLOGY ............................................................................................................................... 7
FEATURES OF PHYSIOLOGY OF ENDOCRINOLOGY .................................................................................................... 7
SECOND MESSENGERS .............................................................................................................................................. 7
RECEPTORS PHYSIOLOGY .......................................................................................................................................... 8
LOCATION OF RECEPTORS ........................................................................................................................................ 9
GROUP I LIPOPHILIC RECEPTORS ............................................................................................................................ 10
GROUP II HYDROPHILIC HORMONES (BIND TO CELL MEMBRANE) ........................................................................ 10
G PROTEIN COUPLED RECEPTOR............................................................................................................................. 10
NITRIC OXIDE........................................................................................................................................................... 11
PITUITARY GLAND ....................................................................................................................................................... 12
DEVELOPMENT OF PITUITARY GLAND .................................................................................................................... 12
ANATOMY OF PITUITARY GLAND ............................................................................................................................ 12
PHYSIOLOGY OF PITUITARY GLAND ........................................................................................................................ 13
GROWTH HORMONE .............................................................................................................................................. 14
GIGANTISM ............................................................................................................................................................. 14
ACROMEGALY ......................................................................................................................................................... 14
DWARFISM .............................................................................................................................................................. 15
PROLACTIN .............................................................................................................................................................. 15
HYPERPROLACTINEMIA ........................................................................................................................................... 15
PITUITARY TUMOURS.............................................................................................................................................. 16
PITUITARY APOPLEXY .............................................................................................................................................. 16
SHEEHAN SYNDROME ............................................................................................................................................. 17
SYNDROME OF INAPPROPRIATE SECRETION OF ADH ............................................................................................. 17
DIABETES INSIPIDUS ................................................................................................................................................ 18
POLYURIA ................................................................................................................................................................ 18
THYROID GLAND ......................................................................................................................................................... 19
DEVELOPMENT OF THYROID ................................................................................................................................... 19
ANATOMY OF THYROID .......................................................................................................................................... 19
PHYSIOLOGY OF THYROID ....................................................................................................................................... 19
THYROID HORMONES ............................................................................................................................................. 20
HYPERTHYROIDISM ................................................................................................................................................. 20
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ENDOCRINOLOGY
HYPOTHYROIDISM .................................................................................................................................................. 21
CRETINISM .............................................................................................................................................................. 22
STRUMA OVARY ...................................................................................................................................................... 22
THYROTOXICOSIS .................................................................................................................................................... 22
GRAVES DISEASE .................................................................................................................................................... 23
GOITRE .................................................................................................................................................................... 23
PENDRED SYNDROME ............................................................................................................................................. 24
THYROIDITIS ............................................................................................................................................................ 24
HASHIMOTOS THYROIDITIS .................................................................................................................................... 25
DE QUERVAIN THYROIDITIS .................................................................................................................................... 25
THYROID NODULE ................................................................................................................................................... 25
MALIGNANCY OF THYROID GLAND ......................................................................................................................... 26
FOLLICULAR CARCINOMA ....................................................................................................................................... 27
PAPILLARY CARCINOMA .......................................................................................................................................... 28
MEDULLARY CARCINOMA ....................................................................................................................................... 29
ANAPLASTIC CARCINOMA ....................................................................................................................................... 29
ANTITHYROID DRUGS.............................................................................................................................................. 30
THYROID SURGERY .................................................................................................................................................. 30
THYROID STORM ..................................................................................................................................................... 31
THYROID IMAGING.................................................................................................................................................. 31
THYROGLOSSAL CYST .............................................................................................................................................. 31
CALCIUM METABOLISM .............................................................................................................................................. 32
GENERAL FEATURES OF CALCIUM METABOLISM ................................................................................................... 32
DEVELOPMENT OF PARATHYROID GLAND .............................................................................................................. 32
ANATOMY OF PARATHYROID GLAND ..................................................................................................................... 32
PHYSIOLOGY OF PARATHYROID GLAND .................................................................................................................. 33
CALCIUM ................................................................................................................................................................. 33
PARATHROMONE .................................................................................................................................................... 34
CALCITONIN ............................................................................................................................................................ 34
HYPERPARATHYROIDISM ........................................................................................................................................ 34
OSTEITIS FIBROSIS CYSTICA ..................................................................................................................................... 35
PARATHYROID HYPERPLASIA .................................................................................................................................. 35
PARATHYROID ADENOMA ...................................................................................................................................... 35
PRIMARY HYPERPARATHYROIDISM ........................................................................................................................ 36
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ENDOCRINOLOGY
ENDOCRINOLOGY
ENDOCRINOLOGY
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ENDOCRINOLOGY
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ENDOCRINOLOGY
PHYSIOLOGY OF ENDOCRINOLOGY
FEATURES OF PHYSIOLOGY OF ENDOCRINOLOGY
Hormone synthesized as peptide precursor
NOT a peptide hormone
Which hormone has NO Intracellular Storage
Vasodilator
Hormone NOT acts by increasing protein synthesis
SECOND MESSENGERS
Bio organic computer
Transmission of regulatory signals through ECF
NOT an example for transmission of
regulatory signals
Various cells respond differentially to second
messenger because they have
Used for cell signaling
Second messengers are
Secondary messengers
Acts as second messenger
Intraneuronal second messenger
Hormone using phospholipase C as messenger
NOT a second messenger
Production of cAMP from ATP requires
Membrane bound enzyme catalyzing formation of cyclic
AMP from ATP
Membrane bound enzyme that catalyses formation of
cAMP from ATP
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PHYSIOLOGY OF ENDOCRINOLOGY
ENDOCRINOLOGY
cAMP acts through
All known effects of cyclic AMP in eukaryotic cells result
from
Secondary derivative of biologically important
nucleotides
cAMP mediates
cAMP mediates
Decrease in cAMP is caused by
Adenyl cyclase is inhibited by
Cyclic AMP is inactivated by
NOT using cAMP as second messenger
NOT mediated by cAMP
NOT using cAMP as second messenger
cGMP as second messenger for
cGMP act on
Secretion of atrial natriuretic peptide
increases when there is
Cyclic GMP is a second messenger of
Second messenger is produced from
A phosphorylated derivative is acted upon by
Phospholipase C as a part of second messenger system
Substances act to increase release of Ca++ from
endoplasmic reticulum
Calcium release from endoplasmic reticulum is
triggered by
Inositol triphosphate and diacyl glycerol
are derived from
RECEPTORS PHYSIOLOGY
Membrane receptor
Intracellular receptor
Intracellular receptor
Steroid receptor superfamily belongs to
Steroid receptor superfamily present in
Lipophilic acting on nuclear receptor
Cytoplasmic receptor
NOT highly specific binding with single
type of nuclear receptor
Acts through tyrosine kinase receptor
Receptors which are transcription factors
Steroids bind to
Binds to steroid receptors
Belongs to steroid receptor super family
Does NOT bind to steroid receptors
Steroid hormone do NOT have attachment site for
Receptors on cell membrane that activates ion channel
after binding with agonists
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PHYSIOLOGY OF ENDOCRINOLOGY
ENDOCRINOLOGY
Does NOT act by intracellular receptor
Does NOT have intracellular receptor
NOT have cell surface receptor
Which DOES NOT have Cell membrane receptor
True about receptor action
Operating time of following receptor is in milliseconds
C terminal end of androgen receptor is concerned with
Receptor mediated action NOT seen in
Receptor blocking agent has
Adrenaline, noradrenaline and dopamine acts through
Dopamine, norepinephrine, serotonin all have the
following type of receptors
GABA B is associated with
GH, prolactin and erythropoietin are
associated with
EDF, PGDF and insulin receptors are
associated
Aldosterone receptor NOT present in
Mineralocorticoid receptor NOT found in
Insulin
Adrenaline
Thyroxine
Steroids
Binding sites are non specific and one drug can displace
other
Ligand gated ion channels
Ligand binding
General anesthetics
Increased Affinity for receptor and Intrinsic activity
Seven pass receptor
7 pass receptor
G protein coupled receptor
JAK STAT receptor
Tyrosine kinase receptor
Liver
Liver
LOCATION OF RECEPTORS
Muscarinic receptors
Nicotinic receptors
Alpha adrenergic receptors
Vasopressin receptors
Histamine receptors
Serotonin receptors
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PHYSIOLOGY OF ENDOCRINOLOGY
ENDOCRINOLOGY
NUCLEAR RECEPTORS
Thyroid Hormones
C-GMP
ANF
NO
LH
Adrenaline
D1 to D5
MSH
ACTH
Alpha 2 adrenergic
Beta adrenergic
Parathromone
V2
Glucagon
HCG
Angiotensin
II(Epithelium)
Somatostatin
Calcitonin
Lipotropin
5HT1
H2
M2
Ca/IP3/DAG
Oxytocin
M1,M3
V1(Vascular smooth
muscle)
GnRH
GHRH
Angiotensin
II(Vascular
&Smooth muscle)
PDGF
Substance P
Gastrin
CCK
TRH
Alpha 1 adrenergic
5HT2
H1
Kinase/Phosphatase
Growth Hormone
Prolactin
Insulin
EGF
FGF
IGF I & II
NGF
PDGF
Erythropietin
M-CSF
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PHYSIOLOGY OF ENDOCRINOLOGY
ENDOCRINOLOGY
G protein activation leads to
Metabotropic receptor
G protein coupled receptor is
G protein coupled receptor
In G protein coupled receptor, amino
terminal end faces
In G protein couples receptor, carboxy
terminal end faces
Carboxy terminal end is associated with
Normally GDP is associated with
G protein receptor complex
Gh
NITRIC OXIDE
Nitric oxide
Nitric oxide
Nitric oxide
Nitric oxide
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PITUITARY GLAND
ENDOCRINOLOGY
present mainly in
Mechanism of action of nitric oxide
Causes release of NO from endothelial cell
Nitric Oxide does NOT act via
Primary action of nitric oxide in gastrointestinal tract
Inhaled gas used to prevent pulmonary artery pressure
in adults and infants
Nitric oxide produces its antiaggregatory action by
increasing levels of
Inhaled gas used to decrease pulmonary artery pressure
in infants and adults
Increasing nitric oxide
Release of NO is associated with
cGMP
ADP, acetylcholine
Membrane bound receptor
Smooth muscle relaxation
Nitric oxide
cGMP
Nitric oxide
Glycerine trinitrate, sodium nitroprusside, hydralazine
Hydralazine, Nitroprusside, Nitroglycerine
PITUITARY GLAND
DEVELOPMENT OF PITUITARY GLAND
Pituitary gland arises from
Adenohypophysis arise from
Anterior Pituitary develops from
Posterior pituitary develops from
Diverticulum from floor of diencephalon
form
Oncocytes are associated with
Oncocytes are NOT seen in
Ectoderm
Roof of Stomodeum
Craniopharyngeal tube, Rathkes Pouch
rd
Floor of 3 ventricle in the region of Infundibulum
Posterior pituitary
Kidney, Salivary glands, endocrine glands
Pineal gland
600 mg
Situated deep in sella, Sphenoidal air cells lie inferior to
it, Supplied by a branch of internal carotid artery
Pituicytes
Somatotroph
Corticotrophs
Thyrotrophs
Thyrotrophs
Cavernous sinus
Sphenoid air cells
Diaphragmatic sella
Superior & Inferior Hypophyseal artery branch of
Internal Carotid artery
Hypophysis cerebri
Portal vessels to adenohypophysis, Inferior hypophyseal
veins to dural venous sinuses, Capillaries to median
eminence and hypothalamus
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PITUITARY GLAND
ENDOCRINOLOGY
NOT a route of Venous drainage from neurohypophysis
Pituitary bright spot is due to
Herring body
Best view to visualize pituitary fossa on X-ray skull
Best view for detecting sella turcica on X ray
J shaped sella is seen in
Adrenal medulla
GH FSH/LH TSH - ACTH
Anterior Pituitary
Growth hormone, Prolactin
TSH, ACTH, LH
LH, HCG
Early morning
Anterior Pituitary
Prolactin
Position 3 and 8
V1 vascular smooth muscle, V2 collecting duct, V3
anterior pituitary
Intramedullary collecting duct
Water transport across collecting duct
IP3 - DAG
Caudal ventrolateral medulla
Postoperative increase in secretion, Neurosecretion,
Increased secretion when plasma osmolality is high, Act
on distal tubule and increase permeability
Fluoxetine
Alcohol
Renal hyposensitivity to ADH
Increased secretion when plasma osmolality is low
Increasing thirst
Inability of kidney to concentrate urine
Non selective V1 and V2 blocker
Relcavaptan, nelivaptan
Lixivaptan, mozavaptan, tolvaptan
Salivary gland, mammary gland, parotid
Oxytocin
Oxytocin
Oxytocin
Oxytocin
Serum IGF-1
HESX1 gene
Empty sella syndrome
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PITUITARY GLAND
ENDOCRINOLOGY
MC endocrinal abnormality associated
with empty sella
Transection of pituitary stalk
NOT occur after transection of pituitary stalk
No abnormality
Diabetes insipidus, hyperprolactinemia, hypothyroidism
Diabetes mellitus
GROWTH HORMONE
Somatomedin mediates
Most physiological effects of growth hormone mediated
by
NOT a neurotransmitter
Anabolic action of protein is mediated by
Potent stimulator of growth hormone
Growth hormone secretion inhibited by
9 year old boy, growth retardation propensity to
hypoglycemia. Short stature, micropenis, increased fat
and high pitched voice. Bone age 5 years.
Growth hormone deficiency is associated with
Deficiency of growth hormone
Insulin provocative test is useful in differentiation of
short stature as a result of
TRH stimulation test is useful in diagnosis of disorders
of
Tests for growth hormone
Laron syndrome
Growth hormone releasing factor
(GRFoma)
GIGANTISM
Gigantism occur in
NOT a feature of gigantism
Enuch
Mental retardation
ACROMEGALY
MC cause of Acromegaly
Acromegaly is due to excess of
Depressed nasal bridge NOT seen in
Hypoglycemia is NOT a feature of
Paradoxical response to GH release to TRH is seen in
Heel pad thickness is increased in
MC cause of increased heel pad thickness
Acromegaly is associated with
Confirmatory investigation for acromegaly
TRH stimulating test useful in diagnosing
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PITUITARY GLAND
ENDOCRINOLOGY
Serum IGF-1 test for
Drug of choice in acromegaly
Drug used for Acromegaly
True about Octreotide
Long acting octreotide
Side effect of octreotide
NOT true about octreotide
Octreotide NOT used in
Octreotide NOT used in
NOT true about octreotide
Acromegaly
Octreotide
Pegvisomant (GRH receptor Antagonist)
Used in secretory diarrhea
Sandostatin
Delays gall bladder emptying
An absorbent
Glioma
Glucoganoma
Effective orally
DWARFISM
Etiology of Nutritional dwarfism
Disproportionate Dwarfism
Chronic malnutrition
Hypothyroidism
PROLACTIN
Prolactin is secreted by
Only hormone for which no stimulator has been
isolated
Normal prolactin level
Normal prolactin level in a woman of reproductive age
Milk production
Anterior Pituitary
Prolactin
10 25 microgram/L
25 ng/ml
Secretion by contraction of lactiferous sinus,
Neuroendocrine part of posterior pituitary is involved,
Oxytocin involved, Affected by emotion
Increased estradiol
Decreases gonadotrophin action
TSH, GH, Prolactin
Amenorrhoea, Galactorrhea, Infertility
Chlorpromazine
Dopamine
Prolactin
L- DOPA, Bromocriptine
Dopamine
Dopamine
Bromocriptine
Dopamine
TSH test
HYPERPROLACTINEMIA
Causes of Hyperprolactinoma
Hyperprolactinemia caused by
Investigation of choice for hyperprolactinemia
Gynaecomastia is NOT seen in
NOT true about hyperprolactinemia
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PITUITARY GLAND
ENDOCRINOLOGY
associated with adenoma
PITUITARY TUMOURS
Pituitary tumour
MC type of Pituitary adenoma
MC Pituitary tumour
30 year old woman, secondary amenorrhoea for 3 years
along with galactorrhoea
NOT true about prolactinoma in pregnancy
Middle age female increasing visual loss, breast
engorgement, irregular menses. investigation of choice
26 year female, prolactin 65 ng/L second month
Treatment of Choice for Prolactinoma
MC cause of Panhypopituitarism
Galactorrhoea
Amenorrhoea, Galactorrhoea, Bitemporal hemianopia
Amenorrhoea, galactorrhoea, increased prolactin. CT
scan reveal
Loss of erection, low testosterone, high prolactin
Tumour less than 1 cm
Percentage of conversion of microadenoma to
macroadenoma
Visual defect caused by tumor of Pituitary gland
pressing Optic chiasma
Lactational amenorrhoea is due to
Weak Giants
Expansion & Ballooning of sella
Enamel like superstructure is seen in
Somatotrophic adenoma
NOT a feature of pituitary eosinophilic
adenoma
Gold standard investigation for pituitary
adenoma
Earliest method of diagnosing pituitary tumors
Best way to distinguish between pituitary tumor from
ectopic ACTH producing tumor
Most preferred approach for pituitary surgery at
present time
PITUITARY APOPLEXY
Hypocalcemia seen in
Associated with pituitary apoplexy
NOT a cause of pituitary apoplexy
Hypopituitarism
Diabetes mellitus, sickle cell anemia, hypertension
Hyperthyroidism
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PITUITARY GLAND
ENDOCRINOLOGY
SHEEHAN SYNDROME
Postpartum pituitary necrosis
Empty sella, amenorrhea, failure of lactation
NOT a cause of primary amenorrhoea
Most effective drug in Sheehans syndrome
Drug essential in Sheehan syndrome
Loss of libido in postpartum necrosis best treated with
Sheehans syndrome
Sheehan syndrome
Sheehan syndrome
Corticosteroids
Cortisone
Low dose testosterone
ADH
Free form
Free form
Medullary Collecting duct
Collecting duct
Supraoptic nucleus
Hyperosmolality
Angiotensin II, Standing, Hyperosmolarity
Angiotensin II, Aldosterone, ADH, ANP
Excess ADH
Ectopic ADH by Small Cell Cancer
Oat cell cancer
Lung abscess, vinca alkaloids, bronchial adenoma
Vincristine, vinblastine, cyclophosphamide
Hyponatremia, Low Plasma osmality, High urine
Osmolality, Hyponatremia
Increased urine Na+, Increased urine osmolality
Na+ < 135, Uric acid < 4 mg/dl, K+ normal
Hyponatremia and urine sodium excretion > 20 mEq/L
Water intoxication, expanded fluid volume,
hypomagnesemia, concentrated urine
Increased urine Na+, Increased urine osmolality
SIADH
Hypogammaglobulinemia
Normal Blood Pressure
Does NOT occur in SIADH (excess Vasopressin)
Low BP due to volume depletion
Interstitial nephritis
Fludrocortisones, demeclocycline, hypertonic saline
Demeclocycline
Medullary collecting duct
V2/V1a antagonist (Conivaptan)
Desmopression
Desmopressin
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PITUITARY GLAND
ENDOCRINOLOGY
DIABETES INSIPIDUS
Normal serum osmolality
Normal urine osmolality
MC cause of diabetes insipidus in pregnancy
Causes of diabetes insipidus
Nephrogenic diabetes is caused by
NOT a cause of diabetic insipidus
Inheritance of Diabetes insipidus
Central diabetes insipidus
Nephrogenic diabetes
A child is crying excessively even after being given feed.
He is passing large quantities of urine and reportedly
getting dehydrated. Urine examination shows no
proteinuria and a specific gravity of 1004. most likely
diagnosis
Diabetes insipidus is associated with
Diabetes insipidus associated with
Diabetes insipidus
Hypertonic contraction of fluid volume is caused by
Recessive Nephrogenic diabetes
X linked nephrogenic diabetes
Urinary Osmolality in Diabetes Insipidus
Hyponatremia NOT seen in
Diagnosis of diabetes insipidus require
Hickey hare test
Drug of choice for lithium induced diabetes mellitus
Treatment of lithium induced diabetes insipidus
Main stay of treatment for nephrogenic diabetes
insipidus
Drug of choice for central /neuogenic diabetes insipidus
Chlorpropamide is used in
NOT used for diabetes insipidus
Drug NOT used in diabetes insipidus
POLYURIA
Polyuria is caused by
9 year old female polyuria, polydipsia, metabolic
acidosis, on slit lamp examination crystal deposits are
seen in cornea
Cerebral salt wasting syndrome
Head injury, raised ICT, put on ventilator and started on
IV fluids and diuretics. 24 hours later urine output 3.5
litres. sodium 156 mEq/L, osmolarity 316 mOsm/kg
Decreased serum and urine osmolality along with
reduced serum sodium
Investigations done in women with polyuria > 6L/day
Psychogenic polydipsia
Water deprivation test, Plasma and urine osmolality
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