Title Louisa Leone MD1 2023 Block 6 Endocrine Notes.pdf ✅

Louisa Leone - MD1 2023 - Block 6 (Endocrine) Notes 2 Table of Contents Week 6.1 Glucose and Diabetes .............................................................................................................. 8 6.1.1 Anatomy of the Pancreas and GIT Development ....................................................................... 8 6.1.2 Anatomy of the Scalp and Face .................................................................................................. 9 6.1.3 Anatomy and Histology of the Endocrine System ................................................................... 12 6.1.3.1 Histology of the Endocrine System .................................................................................. 12 6.1.3.1 Anatomy of the Pituitary Gland and Endocranium ........................................................... 16 6.1.4 Physiology of Glucose and Insulin Regulation ........................................................................ 20 6.1.5 Biochemistry ............................................................................................................................ 22 6.1.6 Clinical: Type 1 Diabetes ......................................................................................................... 24 6.1.7 Pharmacology: Insulin (Crossover with Week 6.2) ................................................................. 28 Week 6.2 Diabetes................................................................................................................................. 32 6.2.1 Anatomy of the Mouth and Pharynx ........................................................................................ 32 6.2.2 GIT Anatomy ........................................................................................................................... 36 6.2.3 Biochemistry – Insulin Resistance ........................................................................................... 43 Insulin Resistance in T2D ............................................................................................................. 43 ADH Resistance ............................................................................................................................ 44 Pseudohypoparathyroidism ........................................................................................................... 44 6.2.4 Pathology of Diabetes .............................................................................................................. 45 Histopathological Changes in the Pancreas .................................................................................. 45 Complications of Diabetes ............................................................................................................ 46 Pathology of Diabetic Complications ........................................................................................... 47 6.2.5 Clinical – Type II Diabetes ...................................................................................................... 52 Type 2 Diabetes ............................................................................................................................. 52 6.2.5.3 Comparing Type 1 and Type 2 Diabetes ........................................................................... 54 6.2.6 Clinical – Diabetes and Pregnancy .......................................................................................... 55 6.2.7 Pharmacology – Medications in Type II Diabetes ................................................................... 57 6.2.8 Testing Endocrine Function ..................................................................................................... 60 Principles of Endocrine Testing .................................................................................................... 60 Clinical Presentation and Rational Targeted Investigations .......................................................... 60 Special Considerations in Hormone Testing ................................................................................. 60 Local Organ Investigations ........................................................................................................... 60 Growth Hormone .......................................................................................................................... 60 A Case of Short Stature ................................................................................................................. 61 Adrenal Glands ............................................................................................................................. 61 Hyperprolactinaemia ..................................................................................................................... 62 Cushing’s Syndrome ..................................................................................................................... 62
Louisa Leone - MD1 2023 - Block 6 (Endocrine) Notes 3 Androgen Problems ...................................................................................................................... 62 Insulinoma ..................................................................................................................................... 63 6.2.9 Metabolic Syndrome ................................................................................................................ 63 Traditional Cardiovascular Risk Score ......................................................................................... 63 New Risk Factors .......................................................................................................................... 63 The Randle Cycle – Metabolic Consequences of Energy Excess ................................................. 63 Why is Hyperglycaemia Bad? ....................................................................................................... 64 Dyslipidaemia ............................................................................................................................... 64 Triglyceridaemia ........................................................................................................................... 64 Dietary Interventions .................................................................................................................... 65 PCSK9 Inhibitors .......................................................................................................................... 65 Fibrates .......................................................................................................................................... 66 6.2.10 Obesity, Weight Loss and Pre-Diabetes ................................................................................. 67 Introduction to Obesity ................................................................................................................. 67 Assessment of Patients with Obesity ............................................................................................ 68 Management of Obesity ................................................................................................................ 69 Obesity Pharmacotherapy ............................................................................................................. 70 Predictors of Long-Term Weight Loss Success ............................................................................ 73 Outlook on Obesity Management ................................................................................................. 73 6.2.11 Management of T1D and T2D in Ambulatory Care ............................................................... 74 Case 1: Type 1 Diabetes ................................................................................................................ 74 Case 2: Type 2 Diabetes ................................................................................................................ 74 Case 3: MODY 3 (HNF1A-MODY) ............................................................................................. 75 Case 4: Hyperglycaemic Hyperosmolar Syndrome ...................................................................... 76 6.2.12 Metabolic and Molecular Determinants of Ageing ................................................................ 78 Week 6.3 The HPA Axis ........................................................................................................................ 79 6.3.1 Understanding Diabetes in Aboriginal and Torres Strait Islander Populations ........................ 79 Sociocultural Determinants of Health ........................................................................................... 79 Complications and Co-Morbidities ............................................................................................... 79 Prevention and Management ......................................................................................................... 79 Diabetes Policies and Strategies ................................................................................................... 80 Models of Care at the Primary Healthcare Setting ........................................................................ 80 Conclusion .................................................................................................................................... 80 6.3.2 Physiology of the HPA Axis ..................................................................................................... 81 Six Classes of Steroid Hormones .................................................................................................. 81 Steroid Biosynthesis ...................................................................................................................... 81 The Adrenal Gland ........................................................................................................................ 82
Louisa Leone - MD1 2023 - Block 6 (Endocrine) Notes 4 The HPA Axis ................................................................................................................................ 82 ACTH ............................................................................................................................................ 83 Cortisol .......................................................................................................................................... 83 The Hypothalamus ........................................................................................................................ 85 The Hypothalamic Hypophyseal Portal System ........................................................................... 85 Anterior Pituitary Hormones ......................................................................................................... 85 The Posterior Pituitary .................................................................................................................. 86 6.3.3 Anatomy of the Liver, Spleen, and Pancreas ........................................................................... 88 The Liver ....................................................................................................................................... 88 The Extrahepatic Biliary System .................................................................................................. 89 The Pancreas ................................................................................................................................. 90 Spleen ............................................................................................................................................ 90 6.3.4 Pituitary Clinical Cases ............................................................................................................ 92 6.3.5 Clinical Syndromes of Adrenal Excess and Deficiencies ........................................................ 94 6.3.6 Pathology of the Pituitary Gland .............................................................................................. 96 Classification of Pituitary Pathology ............................................................................................ 96 Pituitary Adenomas (PitNETs) ...................................................................................................... 96 Pituitary Apoplexy ........................................................................................................................ 97 Craniopharyngioma ....................................................................................................................... 97 Week 6.4 The HPG Axis ....................................................................................................................... 99 6.4.1 Anatomy of the Breast.............................................................................................................. 99 External and Internal Features ...................................................................................................... 99 Functional Unit of the Breast ...................................................................................................... 100 Blood Supply of the Breast ......................................................................................................... 100 Lymphatic Drainage .................................................................................................................... 101 Innervation of the Breast ............................................................................................................. 101 6.4.2 Physiology of the HPG Axis .................................................................................................. 102 Overview of the HPG Axis ......................................................................................................... 102 The HPG Axis in Males .............................................................................................................. 102 The HPG Axis in Females ........................................................................................................... 102 6.4.3 Physiology of the Female Reproductive System and Pregnancy ........................................... 105 Meiosis: Gametogenesis in Females ........................................................................................... 105 Structure of the Mammalian Ovary and Growth of Ovarian Follicles ........................................ 105 Fertilisation ................................................................................................................................. 106 Early Embryonic Development ................................................................................................... 108 Physiology of Pregnancy and Maternal Adaptations .................................................................. 110 6.4.4 Pharmacology – Contraceptives............................................................................................. 115