Crash Course Endocrinology PDF
Preview Crash Course Endocrinology
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 ©2012ElsevierLtd.Allrightsreserved. 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Firstedition1998 Secondedition2002 Thirdedition2007 Fourthedition2012 ISBN:9780723436232 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress Notices Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusing anyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuchinformationormethods theyshouldbemindfuloftheirownsafetyandthesafetyofothers,includingpartiesforwhomtheyhavea professionalresponsibility. Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemostcurrent informationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobeadministered,to verifytherecommendeddoseorformula,themethodanddurationofadministration,andcontraindications.Itis theresponsibilityofpractitioners,relyingontheirownexperienceandknowledgeoftheirpatients,tomake diagnoses,todeterminedosagesandthebesttreatmentforeachindividualpatient,andtotakeallappropriate safetyprecautions. Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assumeanyliability foranyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligenceorotherwise,or fromanyuseoroperationofanymethods,products,instructions,orideascontainedinthematerialherein. The Publisher's policy is to use paper manufactured from sustainable forests PrintedinChina 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
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