Crash Course Endocrinology

151 Pages·2012·6.71 MB·English

by  Richard Murphy

Endocrinology
First and second edition authors:
Madeleine Dubuse
Stephan Sanders
Third edition authors:
Alexander Finlayson
Stephan Sanders
4
th Edition
CRASH COURSE
SERIES EDITOR:
Dan Horton-Szar
BSc(Hons) MBBS(Hons) MRCGP
NorthgateMedicalPractice
Canterbury
Kent, UK
FACULTY ADVISORS:
Aftab Ahmad
Philip Weston
Consultant Diabetologist
RoyalLiverpool University Hospital, Liverpool
Endocrinology
Ronan O’Neill
Fourth Year Student Doctor
Richard Murphy
Fourth Year Student Doctor
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
CommissioningEditor:JeremyBowes
DevelopmentEditor:CatherineJackson
ProjectManager:AndrewRiley
Designer:StewartLarking
IconIllustrations:GeoParkin
IllustrationManager:JenniferRose
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Firstedition1998
Secondedition2002
Thirdedition2007
Fourthedition2012
ISBN:9780723436232
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Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour
understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusing
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theresponsibilityofpractitioners,relyingontheirownexperienceandknowledgeoftheirpatients,tomake
diagnoses,todeterminedosagesandthebesttreatmentforeachindividualpatient,andtotakeallappropriate
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Series editor foreword
TheCrashCourseseriesfirstpublishedin1997andnow,15yearson,wearestill
goingstrong.Medicineneverstandsstill,andtheworkofkeepingthisseries
relevantfortoday’sstudentsisanongoingprocess.Thesefourtheditionsbuildon
thesuccessoftheprevioustitlesandincorporatenewandrevisedmaterial,tokeep
theseriesuptodatewithcurrentguidelinesforbestpractice,andrecent
developmentsinmedicalresearchandpharmacology.
Wealwayslistentofeedbackfromourreaders,throughfocusgroupsandstudent
reviewsoftheCrashCoursetitles.Forthefourtheditionswehavecompletelyre-
writtenourself-assessmentmaterialtokeepupwithtoday’s‘single-bestanswer’
and‘extendedmatchingquestion’formats.Theartworkandlayoutofthetitleshas
alsobeenlargelyre-workedtomakeiteasierontheeyeduringlongsessionsof
revision.
Despitefullyrevisingthebookswitheachedition,weholdfasttotheprincipleson
whichwefirstdevelopedtheseries.CrashCoursewillalwaysbringyouallthe
informationyouneedtoreviseincompact,manageablevolumesthatintegrate
basicmedicalscienceandclinicalpractice.Thebooksstillmaintainthebalance
betweenclarityandconciseness,andprovidesufficientdepthforthoseaimingat
distinction.Theauthorsaremedicalstudentsandjuniordoctorswhohaverecent
experienceoftheexamsyouarenowfacing,andtheaccuracyofthematerialis
checkedbyateamoffacultyadvisorsfromacrosstheUK.
Iwishyouallthebestforyourfuturecareers!
Dr Dan Horton-Szar
v
Intentionally left as blank
Prefaces
Authors
Thepointofamedicaltextbookistodeliverclearandconciseinformationonaspecificfieldofmedicinethatis
alsoclinicallyrelevant.ThisnewCrashCourseEditionhasbeenrevisedtofocusmoreclearlyonthetopicof
endocrinologyandlinkthephysiologytothediseaseprocessesinamorerefinedmanner.Theinformationonspecific
andhighlyrelevantconditions,particularlydiabetes,hasbeenincreasedandthelatestguidelinesonmanagement
havebeenadded.Othermarkeddifferencesinthiseditionarealsotheremovaloftheexcessofinformationon
reproductivemedicineandachangefromMCQsandSAQstothenewSingleBestAnswerQuestions,which
arebecomingmorewidelyusedbymedicalschools.
Myhopeisthatthisbookwillbeofusetothosebeginningtheirmedicaleducationforformingtheknowledge
basethattheywillneedinmedicine,whilebeingarevisiontoolforthosewhoarealreadyfurtheralongintheprocess.
Ronan O’Neill
Asamedicalstudent,endocrinologycanbeadifficultsubjecttofathom.Therearenumerousintricatesystemsand
oftencomplexterminologiesthathavetobeunderstoodandretainedwhenstudying.Ihopethatthiseditionof
CrashCourseEndocrinologywillprovideyouwithareliable,conciseandreadablesourceofinformationwhether
you’renewtothetopicoryousimplyneedsomereassurancethenightbeforeyourfinalsexam.Goodluck!
Richard Murphy
Faculty Advisors
Weliveinexcitingtimesintheworldofdiabetesandendocrinology.Ourunderstandingofthediseasesaswellas
ourabilitytomanagetheconditionshavemovedonenormouslysincethelasteditionofthisbook.Recentadvances
inthetreatmentoftype2diabetesandthenationalguidelinesarounddiabetesandendocrineconditionsareall
updatedforthisedition.Withthesedevelopmentsandthelimitationsofspacethiseditionconcentrateson
diabetesandendocrinologyandoldsectionsonpregnancyetc.havebeendropped.
Thetwoauthors,bothmedicalstudents,aretobecongratulatedonproducingaguidetodiabetesand
endocrinologythatshouldfindaplaceoneverymedicalandnursingstudentsbookshelf.Theyhaveproduceda
bookthatprovidesnotonlyinformativetextbutalsoself-assessmentquestionstoguidethelearner.
Aftab Ahmad
Philip Weston
vii
Acknowledgements
Ithinkit’sonlyfairthatIstartbythankingmypartnerincrimeandco-author,
MrRichardMurphy.Hewaswillingtotakeontheridiculoustaskofhelpingto
publishamedicaltextbookwhilestillgoingthroughmedicalschool.
IalsowanttothankDrsWestonandAhmadwhoofferedmethisopportunityand
thengavemethespacetogetonwiththeworkuntilIneededthem.
Thenextbigthankyouistomymum,dad,brothersand,ofcourse,mydogMax.
Theyweretheretoencouragemethewholewaywiththisbook,whichwasat
timesthebaneofmylifeandIcan’tthankthemenoughforit.
Nowtheacknowledgementsgettricky,butinnoparticularorder,Iwouldlike
tothankmyfriendsinLiverpool.ReneeandLisawhoatthisverymomentare
lookinglikeapairofzombiesasweprepareforourexams.AlsoAsaandFlisswho
putupwithmywhingingthroughouttheyear.
FinallyI’dliketothankalltheseotherpeopleforbeingthereformewhenIneeded
them.BrenndyWright,SteveO’Hare,Tom,Paddy,Mollyandeveryoneinthe
LiverpoolWildernessMedicineSociety.
Ronan O’Neill
IwouldliketothankRonanforgivingmetheopportunitytoco-authorthis
book.SpecialthankstoVerity,JonoandOwenfortheircontinuoussupportand
constantcomedyoverthepastthreeyears.IwouldalsoliketothankDrsWeston
andAhmedfortheiradviceduringthewritingofthebook.
Richard Murphy
Figure acknowledgements
Fig.9.5ReproducedwithpermissionfromR.GraingerandD.Allison,eds,
DiagnosticRadiology:atextbookofmedicalimaging,4thEdition,Churchill
Livingstone,Elsevier
Figure11.12adaptedfromDLlewellyn-Jones,FundamentalsofObstetricsand
Gynaecology,6thedition,1994,bypermissionofSuzanneAbrahamandMosby.
GuidelinesfromNICEinChapter5:NationalInstituteforHealthandClinical
Excellence(2004)Adaptedfrom‘CG15Type1diabetes:diagnosisand
managementoftype1diabetesinchildren,youngpeopleandadults’.London:
NICE.Availablefromhttp://www.nice.org.uk.Reproducedwithpermission.
GuidelinesfromNICEinChapter8:NationalInstituteforHealthandClinical
Excellence(2008)Adaptedfrom‘TA161Alendronate,etidronate,risedronate,
raloxifene,strontiumranelateandteriparatideforthesecondarypreventionof
osteoporoticfragilityfracturesinpostmenopausalwomen–Quickreference
guide’.London:NICE.Availablefromhttp://www.nice.org.uk.Reproducedwith
permission.
viii
Contents
Serieseditorforeword . . . . . . . . . . . . . . . v Hormonesoftheadrenalmedulla. . . . . 49
Prefaces . . . . . . . . . . . . . . . . . . . . . . vii Disordersoftheadrenalmedulla . . . . . 50
Acknowledgements. . . . . . . . . . . . . . . . . viii Investigationsandimagingoftheadrenal
1. Overviewoftheendocrinesystem . . . . . 1 glands . . . . . . . . . . . . . . . . . 51
Roleoftheendocrinesystem . . . . . . . . 1 5. Thepancreas . . . . . . . . . . . . . . 53
Hormonesandendocrinesecretion . . . . . 1
Anatomy . . . . . . . . . . . . . . . . 53
Organizationoftheendocrinesystem. . . . 1
Microstructure. . . . . . . . . . . . . . 54
Hormonetypesandsecretion. . . . . . . . 4
Development . . . . . . . . . . . . . . 55
Hormonereceptors. . . . . . . . . . . . . 6
Hormones. . . . . . . . . . . . . . . . 55
Relationshipofthenervousand
Endocrinecontrolofglucose
endocrinesystems . . . . . . . . . . . . 8
homeostasis . . . . . . . . . . . . . . 58
2. Thehypothalamusandthepituitary Diabetesmellitus. . . . . . . . . . . . . 60
gland . . . . . . . . . . . . . . . . . . 11
Managementofdiabetes. . . . . . . . . 64
Anatomy . . . . . . . . . . . . . . . . 11 Examinationofthediabetic
Development . . . . . . . . . . . . . . 12 patient. . . . . . . . . . . . . . . . . 65
Microstructure. . . . . . . . . . . . . . 15 Otherdisordersofthepancreas. . . . . . 66
Hormones. . . . . . . . . . . . . . . . 16
6. Upandcominghormones . . . . . . . . 69
Hormonalfeedback . . . . . . . . . . . 18
Endocrinecellsinthegastrointestinal
Disordersofthehypothalamus . . . . . . 19
tract . . . . . . . . . . . . . . . . . . 69
Disordersoftheanteriorpituitary . . . . . 20
TheAPUDconcept. . . . . . . . . . . . 69
Disordersoftheposteriorpituitary . . . . 24
Gastrointestinaltractpeptides. . . . . . . 70
3. Thethyroidgland . . . . . . . . . . . . 25 Pinealgland . . . . . . . . . . . . . . . 73
Anatomy . . . . . . . . . . . . . . . . 25
7. Endocrinecontroloffluidbalance . . . . 75
Microstructure. . . . . . . . . . . . . . 26
Fluidbalance . . . . . . . . . . . . . . 75
Development . . . . . . . . . . . . . . 27
Hormonesinvolvedinfluidbalance . . . . 77
Thyroidhormones . . . . . . . . . . . . 27
Otherhormonesinvolvedinthe
Disordersofthethyroidgland . . . . . . 30
regulationoffluidbalance. . . . . . . . 80
4. Theadrenalglands. . . . . . . . . . . . 37 Disordersoffluidbalance. . . . . . . . . 80
Anatomy . . . . . . . . . . . . . . . . 37
8. Endocrinecontrolofcalcium
Development . . . . . . . . . . . . . . 38
homeostasis. . . . . . . . . . . . . . . 83
Microstructure. . . . . . . . . . . . . . 39
Theroleofcalcium. . . . . . . . . . . . 83
Hormonesoftheadrenalcortex. . . . . . 41
Mechanismsinvolvedincalcium
Mineralocorticoidsandaldosterone . . . . 41
homeostasis . . . . . . . . . . . . . . 84
Glucocorticoidsandcortisol. . . . . . . . 41
Hormonesinvolvedincalcium
Androgens. . . . . . . . . . . . . . . . 43 homeostasis . . . . . . . . . . . . . . 85
Disordersoftheadrenalcortex . . . . . . 44 Disordersofcalciumregulation . . . . . . 89
ix