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Faculty of Medicine
Endocrine Module
Faculty of Medicine
King Abdulaziz University
ENDOCRINE MODULE
Study Guide
Phase I, MBBS
1
TABLE OF CONTENTS
Topic
Page
THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM
4
CURRICULUM MAP
5
PHASE 2
6
STRUCTURE OF THE MODULE
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INTRODUCTION
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AIMS & OBJECTIVES
7
TEACHERS CONTACTS
8
ASSESSMENT
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ICONS
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TOPIC OUTLINES
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NO.
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
LECTURES
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Endocrine System: an overview
Histology of pituitary.
Gross anatomy of pituitary.
Hypothalamic hormones
Pituitary function and control of pituitary hormones
Pituitary & hypothalamic pathology
Hormone receptors
Histology of the thyroid and parathyroid glands
Biochemistry, biosynthesis, & metabolism of thyroid hormones
Lab. Evaluation of thyroid hormone
Physiology of thyroid hormones
Pathology of thyroid
Pharmacology of thyroid
Pathology of parathyroid
Histology of adrenals
Structure and biosynthesis of steroids
The physiology of the adrenals
The physiology of the adrenals
The pathology of the adrenals
Laboratory assessment of adrenocortical function
Corticosteroids and antagonists
Histology of mammary glands
Physiology of lactation
Pathology of breast
Insulin and glucagons
Histology of the pancreas
Faculty of Medicine
Lecture
Lecture
Lecture
Lecture
27 :
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30 :
Endocrine Module
The physiology of pancreatic hormones
The pathology of the pancreas
Anti diabetic drug therapy
Oral hypoglycemic therapy
PRACTICAL
Practical
Practical
Practical
Practical
Practical
Practical
Practical
Practical
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Histology & anatomy of pituitary
Pituitary & hypothalamic pathology
Histology of the thyroid and parathyroid gland
Pathology of thyroid / parathyroid
The histology of the adrenals.
Pathology of breast
The histology of pancreas
The pathology of pancreas
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
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Neuro-Endocrine Relationship
Thyroid function
Physiology of Parathyroid Gland
Pharmacology of Parathyroid gland
Imaging of the adrenals
Pathology of diabetes mellitus
Cushing’s disease
Problem-Based Learning (PBL) Sessions
PBL
PBL
PBL
PBL
PBL
PBL
PBL
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Hypothalamic pituitary dysfunction
Diabetes Insipidus & SIADH
Hypothyroidism / hvperthyroidism
Pharmacology of thyroid / parathyroid
Adrenal failure
Puberty
Diabetes mellitus
Directed Learning:
Directed Learning 1 : Metabolic bone disease
Directed Learning 2 : Drugs of Pituitary and hypothalamic disorders
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Faculty of Medicine
Endocrine Module
Clinical Presentation:
Clinical Presentation 1 :
Clinical Presentation 2 :
Clinical Presentation 3 :
Clinical Presentation 4 :
Clinical Presentation 5 :
Hvperthvroidism
Hvperparathvroidism
Hirsutism
Cancer Breast
Diabetes mellitus
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Undergraduate Program Learning Outcomes
Code
Learning Outcomes
Knowledge
By the end of the program the graduate will be able to:
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
A11
A12
A13
A14
A15
A16
A17
Describe normal human development across the life-span and how
these affect normal structure and function.
Describe normal structure and function of the major systems and
how they interrelate.
Describe the molecular, biochemical and cellular basis essential for
maintaining homoestasis.
Demonstrate knowledge of the basic medical sciences that explain
causes and mechanisms of disease.
Describe the alterations in structure and function of major body
systems as a result of illness or injury.
Demonstrate knowledge and understanding of the pharmacological
principles of treatment using drugs, their efficacy in the management
and symptomatic relief of diseases, as well as their side effects.
Discuss the implications of basic ethical principles, including
confidentiality, informed consent, truth telling, and justice, for the
care of patients.
recognize the legal background of medical practice
Explain the causes and mechanisms of intoxication.
Describe the role of family, community, and culture as factors
influencing patient presentations, interpretations of illness episodes
and adherence to treatment episodes.
Demonstrate knowledge and understanding of the natural history of
disease and relationships with risk factors and disease prevention.
Recognize and discuss the principles of disease surveillance and
screening, disease prevention, communicable disease control, health
promotion, and health needs assessment.
Describe strategies to support life-long learning via print and
electronic sources to assist in making diagnostic and treatment
decisions and to remain current with advances in medical knowledge
and practice.
Demonstrate knowledge of how to use the basic medical sciences
and clinical skills for clinical decision making and problem solving in
the care of patients.
Recognize the scientific basis of health, disease, and medicine in the
management of common and high impact conditions in the society.
Demonstrate knowledge of the functional approach to managing
chronic conditions, including knowledge of the impact of chronic
illness on function.
demonstrate basic knowledge of the global health care delivery
system in the community including physicians, hospitals, outpatient
centres, health agencies and the role of community agencies in that
Phase I
Endocrine Module
Faculty of Medicine
system.
A18
Recognize the management of common emergencies and the initial
and the life saving management steps for other emergencies.
A19
Identify the "Red flags" indicating seriousness in the different clinical
presentations.
Cognitive Skills
By the end of the program the graduate will be able to:
B1
B2
B3
B4
B5
B6
B7
B8
B9
B10
B11
B12
B13
B14
B15
C1
C2
C3
C4
Recognize, define and prioritize problems.
Demonstrate the ability to acquire new information and data.
Critically appraise validity and applicability of acquired information to
one’s professional decisions.
Organize, record, research, present, critique, and manage clinical
information.
Recognize the limitations of knowledge in medicine and the
importance of triangulation of evidence before reaching a decision.
Evaluate the patient’s medical problems.
Formulate accurate hypotheses to serve as the basis for making
diagnostic and treatment decisions.
Reflect on one’s thinking process and decisions and apply rational
processes.
Use appropriate intellectual strategies to deal with uncertainties
when they arise.
Demonstrate an understanding of research methodology.
Formulate research questions.
Draw research hypotheses.
Choose appropriate research methodologies and designs.
Select appropriate methods of data collection.
Analyse and interpret collected data.
Interpersonal Skills & Responsibility
By the end of the program the graduate will be able to:
Display the personal attributes of compassion, honesty, and integrity
in relationships with patients, families, communities and the medical
profession.
Exhibit appropriate value for the sensitive nature of the doctor/patient
relationship and the importance of active listening, with attention to
the patient’s familial, cultural, and spiritual circumstances.
Demonstrate professionalism and high ethical standards in all
aspects of medical practice, specifically competence, honesty,
integrity, respect for others, professional responsibility and social
responsibility.
Exhibit a capacity for self-evaluation, moral reflection and ethical
reasoning to form the basis for a self-directed, lifelong engagement
in the responsible, committed, compassionate practice of medicine.
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C5
Apply the four principles of ethical and legal knowledge, namely
respect for autonomy, beneficience, non-maleficience and justice.
C6
Demonstrate awareness and understanding of the legal and
professional responsibilities; and report inappropriate medical
practice.
Communication, Information Technology & Numerical Skills
By the end of the program the graduate will be able to:
D1
D2
D3
D4
D5
E1
E2
E3
E4
E5
E6
E7
E8
E9
work effectively as part of a health care team
communicate effectively with patients, their families and colleagues,
both verbally and in writing
retrieve information by all means including electronically
present information clearly in written, electronic and oral forms
work within a changing, multi-task environment
Psychomotor Skills
By the end of the program the graduate will be able to:
Elicit accurate comprehensive and focused medical history by
employing techniques that facilitate the patient’s sharing of
information.
Conduct a both effective and accurate comprehensive and focused
physical examination.
Formulate a differential diagnosis.
Select the appropriate laboratory tests and radiographic studies and
interpret their results and use them in making diagnostic and
treatment decisions.
Formulate and implement a plan of care for both the prevention and
treatment of disease.
Educate patients about their health problems and to motivate them to
adopt health promoting behaviors.
Use pharmacotherapeutic agents and other therapeutic modalities
effectively.
Demonstrate appropriate technique for performing Basic Life Support
and Advanced Life Support.
Undertake tasks to initiate and be involved in the care of acutely ill
patients.
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Endocrine Module
Faculty of Medicine
Curriculum Map
YOU ARE HERE…
Year 1
Year 2
Phase I
Year 3
Year 4
Year 5
Year 6
Internship
Phase III
Phase II
Endocrine System …. The modules is design to
To Study the structure and function of the endocrine organs
including the pituitary, thyroid, parathyroid, and adrenal glands in
relation health and disease states. And to study the structure and
function of the pancreas in relation to health and disease states.
To Study the inter-relationships between the various endocrine
organs in relation to health and disease states and acquire skills
and working knowledge and understanding of the principles and
concepts applicable to the Endocrine System, in general. And
provide the basis for the study of common clinical conditions and
disorders, for clinical examination and performing simple clinical
procedures related to the Endocrine System.
Phase 1, is the first stage towards achieving the objectives specified in the
curriculum. The aim is to lay down a solid foundation for the subsequent full-time
integrated study in phase 2 of the MBBS program. This foundation will include
knowledge, skills and attitudes, particularly attitudes toward the learning process.
The curriculum philosophy in Phase 1 is enforcing the development of a mixture
of teaching approaches including “student-directed learning”. By the end of
Phase 1, you should be ready to be much more involved in the control of the
learning process.
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Endocrine Module
Faculty of Medicine
First Year Courses
Semester 1
Semester 2
English language
Human Biology
Computer for
Health Sciences
Medical physics
Arabic Studies
101
Medical Chemistry
Islamic Studies
101
Foundation
Course
Highlight the course according to the curriculum Map
STRUCTURE OF THE MODULE
TIME TABLED HOURS:
TEACHING
DEPARTMENTS:
30 Lectures, 9 Practicals, 7 Tutorials, 1 Problem
Base Learning, 2 Directed learning, 5 Clinical
Presentation.
Medical Education, Anatomy, Physiology,
Biochemistry, Pharmacology, Medicine,
Obstetrics and Gyncology, Pediatirics, Surgery,
Radiology
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Phase I
Endocrine Module
Faculty of Medicine
INTRODUCTION
ENDOCRINE SYSTEM
Coordinator:
Course No.
SYS325
Contact Hours
Course Title
Endocrine
System
L
T/S
P
CL/PBL
SDL
30
7
9
5 /1
2
Credit
Hours
4
AIMS & OBJECTIVES
Aims:
The aim of this module is to:
1. Study the structure and function of the endocrine organs including the pituitary, thyroid,
parathyroid, and adrenal glands in relation health and disease states.
2. Study the structure and function of the pancreas in relation to health and disease states.
3. Study the inter-relationships between the various endocrine organs in relation to health
and disease states.
4. Acquire skills and working knowledge and understanding of the principles and concepts
applicable to the Endocrine System, in general.
5. Provide the basis for the study of common clinical conditions and disorders, for clinical
examination and performing simple clinical procedures related to the Endocrine System.
Pre- requisites:
Before the students begin the Endocrine System module, they should demonstrate the ability
to:
1. Describe basic cell biology, including the processes of mitosis and meiosis
2. Describe the structure and function of the adult circulation
3. Describe the transport of gases in the blood
4. Understand the metabolic processes involved in the maintenance of metabolic fuel
supplies
5. Describe the basic features of endocrine cells
6. Describe and understand the molecular mechanisms involved in hormone action upon
target tissues
Identify and describe the anatomical and neuron endocrine links between the
hypothalamus and the control of pituitary hormones and endocrine hormone production
7. Describe and explain the basic immune responses
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Faculty of Medicine
Objectives:
By the end of this module, the student should be able to:
1. Describe the anatomy of the pituitary gland and the anatomical relationship with the
adjacent structures at the base of the brain.
2. Understand the embryological and anatomical sub-divisions of the pituitary.
3. Describe the hormones released by the parts of the pituitary and their cellular origins and
their regulatory mechanism.
4. Describe the hypothalamic-hypophysical portal system and the hypothalamic hormones
in relation to the pituitary.
5. Explain the mechanism of action of the drugs affecting the major hypothalamic and
pituitary hormones.
6. Recognize the normal radiological anatomy of the pituitary and hypothalamic regions.
7. Recognize the pathological changes found in the pituitary and hypothalamic regions.
8. Describe diabetes insipidus in relation to fluid and electrolyte abnormalities of ADH
secretion or action.
9. Describe the most common local symptoms and signs of a space occupying lesion
affecting the hypothalamus and pituitary gland.
10. Describe the biochemical and clinical features of acromegaly.
11. Describe the causes of hyperprolactinaemia and understand the importance of diagnostic
studies in the evaluation of a suprasellar mass.
12. Discuss the concept of ligand-receptor interaction with examples in the use of
radioimmunoassay.
13. Describe the biosynthesis, transport, mode of action and metabolism of thyroid
hormones.
14. Describe the synthesis of calcitriol and its regulation.
15. Describe the histological structure of the thyroid and parathyroid glands.
16. Describe the regulation of thyroid hormones in relation to function.
17. Describe the role of the parathyroid hormone, calcitonin and calcitriol in calcium
metabolism.
18. Study the pathology of thyroid diseases including the pathogenesis of Hashimoto’s
thyroiditis and other thyroid disorders.
19. Study the pathology of hyperparathyroidism and metabolic bone disease.
20. Describe the various therapeutic modalities of thyroid diseases.
21. Discuss the causes of hyper- and hypo- calcaemia
22. Describe the biosynthesis, transport, and catabolism of adrenal steroid hormoges and
mode of action.
23. Identify the functional anatomy of the adrenal gland and the physiological effects of
glucocorticoids and other steroids.
24. Describe the pathology of the adrenal gland.
25. Describe the actions of the naturally occurring mineralocorticoid and the synthetic agent
in this group.
26. Describe the toxic effects of chronic glucocorticoid therapy.
27. Describe the histological structure of the testis and the ovary.
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Endocrine Module
Faculty of Medicine
28. Describe the regulation of the female sex hormones and mechanism of action.
29. Describe the regulation of the male sex hormones and mechanism of action.
30. Describe the pathology of the testis with examples.
31. Describe the pathology of the ovary with examples.
32. Describe the anatomy and histology of the mammary gland.
33. Describe the mechanism of action of androgens.
34. Illustrate the pathology of various types of breast cancer in relation to prognosis.
35. Discuss the possible causes of hirsutism.
36. Describe the histology of the pancreas.
37. Describe the steps of insulin synthesis and mechanism of action of insulin.
38. Explain the structure and action of glucagon.
39. Recognize the types of pancreatic carcinoma, and correlate histological findings and
prognosis in malignant tumours of the pancreas.
40. Integrate information from basic and clinical medical sciences and illustrate the relevance
to the understanding and management of diabetes mellitus.
Transferable Skills:
By the end of this module, students will demonstrate the ability to:
1. Assimilate and integrate information from lectures, practical sessions, tutorials, clinical
presentation sessions and independent learning activities.
2. Gain practical skills associated with the dissecti6n of the cadaver and the examination of
the living.
3. Interpret two-dimensional images of the Endocrine System from radiographic techniques.
4. Explain the pathology of Endocrine System and drug action in relation to the underlying
processes.
Module structure:
This module is comprised of:
Lectures on general aspects of the Endocrine System will be given for the purpose of
conveying deeper understanding of the general concepts and principles underlying normal
and abnormal structure and function during the module.
Practical sessions will be timetabled to enforce theoretical aspects of the subject but will be
used for demonstrating skills/procedures and the use of electronic teaching material will be
encouraged.
Tutorials and Clinical Presentations:
Small Group Tutorials on special topics will be organized for the purposes of enhancing the
students’ general knowledge and overall understanding of the Endocrine System. It allows
students to apply newly acquired knowledge and it is suitable for higher order cognitive
objectives.
The use of Clinical Presentations, a series of multi-disciplinary sessions of small-group
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Phase I
Endocrine Module
Faculty of Medicine
teaching led by staff from the appropriate Clinical Departments. These sessions also provide
an opportunity for students to see patient-doctor interaction and the personal and social
effects of illness. Satisfactory attendance and performance in practical classes and at clinical
sessions are part of the final assessment at such level.
Problem-based learning sessions will be encouraged and timetabled to facilitate higher
cognitive objectives: problem solving and decision making; can incorporate objectives that
cross domains. They will be organized into small groups and facilitated by a staff faculty
member.
Directed-Learning sessions will promote self-directed learning and thus, time will be available
for further study by the students using all available- learning resources including electronic
learning materials.
Cross Modular Themes:
Concurrent and previous modules:
1. The knowledge and work obtained from the cardiovascular and respiratory systems.
2. In each condition studied, students will call upon their knowledge of core courses and
modules of the second year.
General Outline:
Lectures:
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
Lecture
1 :
2 :
3 :
4 :
5 :
6 :
7 :
8 :
9 :
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Endocrine System: an overview
Histology of pituitary.
Gross anatomy of pituitary.
Pituitary function and control of pituitary hormones
Hypothalamic hormones
Pituitary & hypothalamic pathology
Hormone receptors
Histology of the thyroid and parathyroid glands
Biochemistry, biosynthesis, & metabolism of thyroid hormones
Lab. Evaluation of thyroid hormone
Physiology of thyroid hormones
Pathology of thyroid
Pharmacology of thyroid
Pathology of parathyroid
Histology of adrenals
Structure and biosynthesis of steroids
The physiology of the adrenals
The physiology of the adrenals
The pathology of the adrenals
Lab assessment of adrenocortical function
Corticosteroids and antagonists
Histology of mammary glands
Physiology of lactation
Pathology of breast
Insulin and glucagons
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Phase I
Lecture
Lecture
Lecture
Lecture
Lecture
Endocrine Module
26 :
27 :
28 :
29 :
30 :
Faculty of Medicine
Histology of the pancreas
The physiology of pancreatic hormones
The pathology of the pancreas
Anti diabetic drug therapy
Oral hypoglycemic therapy
Practicals:
Practical
Practical
Practical
Practical
Practical
Practical
Practical
Practical
Practical
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Histology & anatomy of pituitary
Pituitary & hypothalamic pathology
Histology of the thyroid and parathyroid gland
Pathology of thyroid / parathyroid
The histology of the adrenals.
Histology of testis / ovary
Pathology of breast
The histology of pancreas
The pathology of pancreas
Tutorials:
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
Tutorial
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Neuro-Endocrine Relationship
Thyroid function
Physiology of Parathyroid Gland
Cushing’s disease
Imaging of the adrenals
Imaging of ovary / testis
Pathology of diabetes mellitus
PBL: ( one )
Directed Learning:
Directed Learning 1 : Metabolic bone disease
Directed Learning 2 : Immunology of diabetes mellitus
Clinical Presentation:
Clinical Presentation 1 : Hvperthvroidism
Clinical Presentation 2 : Hvperparathvroidism
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Phase I
Endocrine Module
Faculty of Medicine
Clinical Presentation 3 : Hirsutism
Clinical Presentation 4 : Cancer Breast
Clinical Presentation 5 : Diabetes mellitus
Assessment:
Formative:
This form of assessment is designed to produce feedback to students to identify
deficiencies in the understanding of a subject or a topic; and to the teacher, thus to
enforce more guidance to students in relation to areas of deficiencies. Thus, it helps
the student to improve performance:
a. identification of areas for improvement
b. specific suggestions for improvement.
This includes a mixture of MCQs, short answer-questions (SAQs), extendedmatching questions (EMQs), problems-solving exercises and independent learning
activities in all subjects. These will be given during tutorial sessions and practicals.
The answers are presented and discussed immediately with the students after the
assessment. Results are published to students.
Summative:
This type of assessment is used for judgment or decisions to be made about a
student performance, it serves:
a. Verification of achievement for the student satisfying requirement
b. Motivation of the student to maintain or improve performance
c. Certification of performance for others
d. Grades
e. Promotion
In all subjects covered, examination papers are divided into 2 parts:
Part 1:
It contains SAQs; these are designed to test the breadth of knowledge and
understanding: Students are required to attempt all the questions set, but need only
to write a few words or short notes for each answer.
Part 2:
It contains MCQs and EMQs: Students are required to attempt all the questions set.
In addition, long assay questions (usually a choice of 1 out of 3) are given. A wide
range of questions is set to give students an opportunity to show depth of
understanding in the areas tested. Answers are sought that are accurate and
complete, and that are well-constructed and clearly argued to answer the question
set. Additional reward is given for the inclusion of experimental evidence and points
of clinical significance.
Practical examinations are given to students to assess certain transferable skills
during the course according to the objectives of the subject.
Course work:
Students are required to complete satisfactorily one piece of work during the course.
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Phase I
Endocrine Module
Faculty of Medicine
This may involve a variety of activities, from essays to problem-solving papers and
short answer-questions to “spotters” or presentations.
Assessment:
Total mark :
(100%)
Continuous Assessment :
(40%)
Summative Assessment (Final):
(60%)
Textbooks:
Appendix (V); Modules Text Books and References.
TEACHERS CONTACTS
Name
Department
Prof. Hassan Abduljabbar
Coordinator
E-mail
[email protected]
[email protected]
Dr. Jamal Saied
Anatomy
[email protected]
Dr. Zienab Al Refaie
Coordinator
Physiology
Prof. Sawsan Jalala
Pathology
Prof. Majda Hagras
Pharmacology
Prof. Enayat Hesham
Biochemistry
[email protected]
[email protected]
[email protected]
Endocrine Group
---
[email protected]
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Phase I
Endocrine Module
Faculty of Medicine
Exams: Written Exams will include short answer and multiple choice questions
(MCQs). They will cover material presented in lecture, readings, and discussion.
All exams must be taken on the date scheduled. In case of an emergency, the
coordinator must be notified. No make-up exams will be provided if you fail to
notify and discuss your situation with the coordinator. Practical Exam will be in an
OSPE (Objective Structured Practical Exam) format, where you will pass through
several stations representing all the subjects.
Assignment paper: The purpose of the work is to provide you with the
opportunity to explore an area of basic medical sciences or medical education in
depth. The paper is to be a 10-15 page literature review of the topic will constitute
20% of your final grade. Policy: Topics must be approved in writing by the
coordinator. Directions for topic submission will be discussed during the first
week of class. Topics that have not been approved will not be accepted.
All papers must reference a minimum of eight references from refereed journals.
All papers must be typed, double-spaced, have 1 inch margins.
Note: We will be making the journey from "womb to tomb" in 15 weeks.
Therefore, this course requires an intensive coursework load. Class attendance
and participation are extremely important to your learning and as such are
considered in the evaluation of your course grade. This course is recommended
for students that can make the required time and energy commitment. If there is
anything that the coordinator can do to assist you during the course, please feel
free to contact him.
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Faculty of Medicine
Icons (standards)
The following icons have been used to help you identify the various
experiences you will be exposed to.
Learning objectives
Content of the lecture
Independent learning from textbooks
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library,
building No. 7.
Independent learning from the Internet
Problem-Based Learning
Self- Assessment (the answer to self-assessment
exercises will be discussed in tutorial sessions)
The main concepts
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Faculty of Medicine
Topic Outlines
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Faculty of Medicine
Lecture 1: Endocrine System : An overview
Department: PHYSIOLOGY
Lecturer:
Student Notes:
(Insert here handouts and additional
Teaching Location:
pages for notes if needed)
Learning Objectives:
At the end of the lecture you should be able to:
1. Know classification of hormones.
2. Understand transport of hormones and plasma
------concentration.
3. Understand mechanism of hormone action & -------concept of second manager.
4. Identify up regulation & down regulation of --------hormone receptors.
5. Discuss intracellular machinery involved in
hormone actions, G-protein coupled receptors
and genomic actions.
6. Enumerate endocrine functions of liver, heart &
kidney.
Detailed Contents:
1.
2.
3.
4.
Cell signalling
Endocrine glands of human
Free & protein bound hormones, roles of each
Hormone receptors
 Specificity, dynamic character
 Mechanism of up & down regulation
5. Genomic action of hormones, cytoplasmic &
nuclear receptors
6. Non-genomic actions, second messenger &
signal transduction
7. G protein family & G protein coupled receptors
 Adenyl cyclase Phospholipase Tyrosine
kinase Guanylyl cyclase
8. Combined genomic and non-genomic actions
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Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 1: Endocrine System : An overview
Student Notes:
Reading:
1. Review of medical physiology 20th Ed,
William F. Ganong
2. Endocrine physiology 2nd Ed,
Susan P. Portefield
3. Human physiology & mechanism of Disease
4th Ed, Guyton Hall
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the CDROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the Endocrine
system but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.
Self-assessment
After binding of a hormone with its receptor, its
effect is triggered via:
a-Second messenger for peptide hormones.
b- New protein synthesis for catecholamines.
c-G protein coupled receptor for thyroid hormones.
d-Adenyl cyclise pathway for steroid hormones.
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Phase I
Endocrine Module
Faculty of Medicine
Lecture 2: Histology of Pituitary
Department: ANATOMY
Lecturer:
Student Notes:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Know the histological structure of pituitary gland.
2. Match the cell types with the hormones secreted.
3. Understand the -functional role-of theiiypophyseal –portal circulation in the regulation
of pituitary secretions.
4. Understand the principles governing hormone
synthesis & secretion into the circulatory system.
Detailed Contents:
1. Histological organization of pituitary gland into
adenohypophysis & neurohypophysis.
- Adenohypophysis (parsdistalis,
parstuberalis & pars intermedia).
- Neurohypophysis (parsNervosa,
Infundibulum & Median eminence.)
2. Blood supply of the pituitary gland & portal
hypophyseal circulation.
(Insert here handouts and additional
pages for notes if needed)
Reading:
1. Abdullrauf Attia, F., Mohammed Nassar, A.,
Zahir, F. special histology (First edition) 1424h.
2. William J. Krause, Human Histology ( 2nd edition)
3. Bslie P. Gartner. – James L – Hiatti. Color text
Book of histology.
4. Mariano S. H. DI Flore. Atlas of human histology
(Fourth edition) 1980.
22
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 2: Histology of Pituitary
Student Notes:
You have the opportunity to watch the
CD-ROM about the Endocrine system. You can access the CDROM during your spare time.
In the computer cluster also you have the opportunity to see some
useful web site about the Endocrine system but these should not
used in isolation. I would recommend you look at the following web
sites:
http://www.endocrine
Self-assessment
1) Regarding the pituitary gland, all the following statements
are correct, EXCEPT:
A. Adenohypopgysis contains acidophils and basophils.
B. Thyrotropes belong to the basophil group of cells.
C. Its mammotropes are acidophils and produce oxytocin.
D. Its gonadotropes are basophils and produce FSH and LH.
E. The pituicytes of its posterior lobe produce ADH.
2) Mammotrophs:
A. Secrete prolactin hormone.
B. Increased in number during pregnancy.
C. With EM they contain large granules 550-600 nm.
D. All of the above.
E. None of the above.
3) Pituicytes:
A. Are found in pars distalis.
B. Are types of glial cell.
C. Produce vasopressin.
D. Produce prolactin.
4) Basophils:
A. Are larger than acidophils in size.
B. Are more than acidophils in number.
C. Stained strongly with PAS.
D. Choices a & b.
E. Choices a & c.
5) Pars nervosa contain all the following, EXCEPT:
A. Myelinated axons.
B. Pituicytes.
C. Herring bodies.
D. Fenestrated blood capillaries.
Reticular fibbers.
23
Phase I
Endocrine Module
Faculty of Medicine
Lecture 3: Gross Anatomy of Pituitary
Department: ANATOMY
Lecturer:
Student Notes:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. The location of pituitary gland and its way of
attachment to the brain
2. The division of the gland to lobes.
- Its important relations
- Its blood supply
Detailed Contents:
1. Sites and relations of pituitary gland
2. Posterior lobe and its connection to the
brain
3. Anterior lobe with its 3 parts.
4. Blood supply of the pituitary gland
Reading:
1. Richard, S. Snell, MD, Ph.D. Clinical anatomy
for medical students (Fifth edition).
2. G.J. Romances, C.B.E. B.A., Ph. D., M.B.,
Ch.B., FRCS, Ed., FRSE Cunningham's
Manual of practical anatomy (14th edition)
1976
You have the opportunity to watch the CD-ROM
(Insert here handouts and additional
about the Endocrine system. You can access the
CD-ROM during your spare time.
pages for notes if needed)
24
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 3: Gross Anatomy of Pituitary
Student Notes:
In the computer cluster also you have the
opportunity to see some useful web site about the
Endocrine system but these should not used in
isolation. I would recommend you look at the following
web sites:
http://www.endocrine
Self-assessment
1) The following statements concerning the pituitary
gland are correct, Except:
A. It is separated from the optic chiasma by the
diaphragma sellae.
B. The sphenoid sinus is inferior to it.
C. It receives its arterial supply from the internal
carotid artery.
D. It is suspended from the floor of the third
ventricle by the pars anterior.
E. It is deeply placed within the sella turcica of the
skull.
2) The following statements concerning the pituitary
gland are correct, Except:
A. Lies in the hypophyseal fossa of the sphenoid
bone.
B. Derives its blood supply from the circle of
Willis.
C. Is entirely ectodermal in origin.
D. Has independent vascular systems for the
anterior and posterior lobe.
E. Has neural connections with the pineal body.
3) Regarding the relations of the pituitary gland the
following are correct, Except:
A. Superiorly to the diaphragma sellae.
B. Inferiorly to the body of sphenoid and its
sphenoid air sinuses.
C. Posteriorly to tubercum sellae.
D. Laterally to cavernous sinus.
E. Posterior to the basila artery.
4) Which of the following hormones is secreted by the
posterior pituitary gland?
A. TSH.
B. Growth hormone.
C. Thyroxin.
D. Antidiuretic hormone.
E. Prolactin.
25
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 4: Hypothalamic Hormones
Student Notes:
Department: PHYSIOLOGY
Lecturer:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Enumerate hypothalamic hormones
2. Discuss hypothalamic hypophyseal portal
circulation
3. Discuss hypothalamic hypophyseal tract
4. Describe control of hormone level
5. Understand feedback mechanism. The
egativefeedback paradigm : interpretations
of alterations in hormone target pairs
6. Identify circadian variations in hormone level
7. Know pulstile secretion of hypothalamic &
pituitary hormones
Detailed Contents:
1. Concept of neuro-hormones
2. Hypothalamic hormones
- GH releasing & inhibiting hormones
- CRH, TRH, Gonadotropin releasing
hormone
- Prolactin inhibiting hormone
(dopamine)
3. Nervous control of hormone secretion
4. Feedback mechanism; types & role in control of
hormone level
5. Circadian patterns of some hormones
6. Concept & significance of pulstile secretion of
some hormones
(Insert here handouts and additional
pages for notes if needed)
26
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 4: Hypothalamic Hormones
Student Notes:
Reading:
1. Review of medical physiology 20th Ed,
William F. Ganong
2. Endocrine physiology 2nd Edition
Susan P. Portefield
3. Human physiology & mechanism of
Disease, 4th Ed, Guyton Hall
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
endocrine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
1. Which of the following glands doesn’t fall under
the direct control of hypothalamic pituitary axis?
a. Thyroid gland
b. Adrenal gland
c. Testes
d. Parathyroid gland
2. Which of the following is not a neurohormone?
a.
b.
c.
d.
Dopamine
Somatostatin
Somatomedines
Thyrotropine releasing hormone
27
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 5: Pituitary Function & Control of Pituitary Hormones
Department: PHYSIOLOGY
Lecturer:
Student Notes:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:

1. Enumerate anterior pituitary hormones
2. Growth hormones
 Know receptors of GH
 Identify growth & metabolic effects of GH
Understand diabetogenic effects of GH,
---GH insulin interactions
 Identify somatomedines
 Discuss control of growth hormone release
3. Understand Physiology of growth & mechanism
of its disturbance
4. Identify ACTH, TSH, FSH & LH hormones
5. Antidiuretic hormone
 Describe receptors of ADH
Understand actions of ADH & role in ---------regulation of renal water excretion
 Discuss control of ADH secretions
 Know Physiological basis of regulation of
extracellular fluid volume & osmolality
Detailed Contents:
1- Growth hormone promotes protein
deposition in tissues.
2- Growth hormone and carbohydrate
utilization.
3- Insulin like growth factors.
4- Regulation of growth.
5- Role of hypothalamus in control of growth
hormone secretion.
6- Abnor malities of growth hormone secretion.
7- Press or effect of ADH.
8- Osmoitic regulation of ADH production.
28
(Insert here handouts and additional
pages for notes if needed)
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 4: Pituitary Function & Control of
Pituitary Hormones
Student Notes:
Reading:
1. Review of medical physiology 20th Ed,
William F. Ganong
2. Endocrine physiology 2nd Ed,
Susan P. Portefield
3. Human physiology & mechanism of Disease
4th Ed, Guyton Hall
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
Endocrine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
1. Growth Hormone Secretion is increased
by:
a. Somatostatin
b. Insulin administration
c. Obesity
d. Somatomedines
2. Antidiuretic hormone
a. Is formed in the posterior pituitary gland
b. Increases Na+ re-absorption
c. Secretion is more affected by changes in
volume than osmolality
d. Reaches the anterior pituitary through
phypothalamo –hypophyseal portal
circulation
3. Regarding ACTH:
a. Its secretion is inhibited by cortisol
b. Is high in patients receiving glucocorticoid
therapy
c. Stimulates secretion of aldosterone
d. Combines with nuclear receptors
29
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 6: Pituitary & Hypothalamic Pathology
Student Notes:
Department: PATHOLOGY
Lecturer:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
ANTERIOR PITUITARY
1.
Discuss hyperpitutarism, and identify the most
common causes
2.
Identify the common types of pituitary
adenomas
3.
Correlate pathological changes related to pituitary
adenomas to their clinical effects
4.
Discuss the common causes and
pathogenesis of hypopituitarism
POSTERIOR PITUITARY
5.
Discuss pathogenesis of some Posterior
pituitary disorders (Diabetes insipidus)
MULTIPLE ENDOCRINE NEOPLASIA
Identify the different types of MEN
Detailed Contents:
ANTERIOR PITUITARY
1. Hyperpitutrism and Pituitary Adenomas
including.
a. Prolactinomas
b. Growth hormone (Somatotroph cell)
adenoma
c. Corticotroph celladenoma
d. Other neoplasms
2. Causes, pathogenesis and effects of
hypopituitarism:
a. Nonsecretory chromophobe pituitary
adenoma
b. Sheehan’s syndrome
c. Empty Sella syndrome
d. Hypothalamic surpracellar tumor ,
Posterior Pituitary:, Diabetes
insipidus
e.
MULTIPLE ENDOCRINE NEOPLASIA (MEN)
MENI,
MEN II,
MEN III
30
(Insert here handouts and additional
pages for notes if needed)
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 6: Pituitary & Hypothalamic Pathology
Student Notes:
Reading:
1. Kumar, Cotran, Robbins, Basic Pathology
7th edition ( pp 721-726 & pp 752-753)
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
endorine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
31
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 7: Hormone receptors
Student Notes:
.
Department: CLINICAL BIOCHEMISTRY
Lecturer:
Teaching Location: Classroom
Learning Objectives:
At the end of the lecture you should be able to:
1. Classify hormones according to chemical
composition, solubility properties, site of
receptors & nature of signal transmitted by
them.
2. Describe the receptors of steroid & thyroid
hormones, and receptors for hydrophilic
hormones.
3. Know the role of the second manager
4. Describe the biosynthesis of peptide
hormones
Detailed contents:
1. Definition of hormones & their classification
according to chemical composition,
solubility properties, site of receptors….etc
2. Receptors of steroid and thyroid hormones
3. Different types of receptors of hydrophilic
hormones
4. Role of the second manager
5. Biosynthesis of peptide hormones
(Insert here handouts and additional
pages for notes if needed)
32
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 7: Hormonal receptors
Student Notes:
.
Reading:
1. Text book of Biochemistry with clinical
correlation. 4th ed Editor: Thomas M.
Devlin Published by: Wiley- Liss
2. Harper’s Biochemistry 23rd edition
Editor: Robert K. Murray, Dary K.
Granner Published by : APPLETON &
LANGE
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
endocrine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
1. Concerning hormone receptors:
a. G-protein coupled receptors are located in the
cytoplasm
b. Adrenalin often uses cATP as a second
manager
c. The main effect of insulin receptors is to
stimulate
protein synthesis directly
d. Tyrosine kinase receptors are located on the cell
surface
2. Extent of protein binding of a hormone:
a. Is greater for peptide than thyroid hormone
b. Doesn’t affect excretion rates and half life
c. Is high for steroid hormone
d. Is minimal for thyroid hormones
33
Phase I
Endocrine Module
Faculty of Medicine
Lecture 8: Histology of the Thyroid and Parathyroid Glands
Department: HISTOLOGY
Student Notes:
Lecturer:
Teaching Location:
Learning Objevtives:
At the end of the lecture you should be able to:
1. Know the microscopic structures of thyroid &
parathyroid glands
2. Correlate between the structure & function of
these glands
3. Identify the mechanism of hormonal control of
each gland and what is meant by the feed —
back mechanism
4. Know some functional disorders due to hyper
or hypo secretion of the glands.
Detailed Contents:
1. Histological structure of thyroid gland Stroma, parenchyma (thyroid follicular cells &
Para follicular cells)
2. Parathyroid gland (chief cells & oxyphil cells)
3. Functions of thyroid & parathyroid glands.
Reading:
1. Abdullrauf Attia,F. , Mohammed Nassar, A.,
Zahir, F. special Histology( First edition) 1424h.
2. William J. Krause,Human Histology (2 edition).
3. Bslie P. Gartner. James L- Hiatti. Color text
Book of histology.
4. Mariano S.H. DI Fiore. Atlas of human histology
(Fourth edition)1980.
34
(Insert here handouts and additional
pages for notes if needed)
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 8: Histology of the Thyroid and
Parathyroid Glands
Student Notes:
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
1) In follicular cells of the thyroid gland
Iysosomes are essential because their enzymes:
A. synthesize thyroglobulin
B. iodination ofthyroglobulin
C. hydrolysis of thyroglobulin
D. ReleaseofT3&T4
2) Thyroid parafollicular cells secrete:
A. thyroxin
B. calcitonin
C. thyroid stimulating hormone
D. angiotensin
3) The target cells for the calcitonin hormone
are:
A. parafollicular cells
B. osteoclast
C. osteocytes
D. thyroid follicular cells
4) Oxyphil cells of the parathyroid gland are
characterized by the following, EXCEPT:
A. few in number and large in size
B. Strongly basophilic
C. They represent degenerated chief cells
D. Appear at age about 5-7 years
5) The target cell for the parathyroid hormone
is/are:
A. Osteoblasts.
B. Osteoclasts.
C. Osteocytes.
D. All of the above.
35
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 9: Biochemistry, Biosynthesis & Metabolism of Thyroid Hormones
Student Notes:
Department: CLINICAL BIOCHEMISTRY
Lecturer:
Teaching Location: Classroom
Learning Objectives:
At the end of the lecture you should be able to:
1. Discuss the biosynthesis, secretion, transport
and action of thyroid hormone.
2. Describe the principle of negative feedback
system as it applies to thyroid hormones
production.
3. Discuss the regulation of thyroid hormones.
Detailed Contents:
1. Biosynthesis, secretion, transport and action
of thyroid hormones.
2. Regulation of thyroid hormones.
(Insert here handouts and additional
pages for notes if needed)
36
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 9: Biochemistry, Biosynthesis & Metabolism of
Thyroid Hormones
Student Notes:
Reading:
1. Textbook of Biochemistry with clinical
correlations. 4th edition Editor: Thomas M.
Devlin, Published by: Wiley – Liss
2. Harper's Biochemistry, 23rd edition: Editor:
Robert K. Murray, Daryl K. Granner. Published
by: APPLETON & LANGE
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
endocrine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
37
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 10: Laboratory Evaluation of Thyroid Hormone
Department: CLINICAL BIOCHEMISTRY
Lecturer:
Student Notes:
(Insert here handouts and additional
pages for notes if needed)
Teaching Location: Classroom
Learning Objectives:
At the end of the lecture you should be able to:
1. Describe the appropriate thyroid function
testing protocol to evaluate or monitor
patient with thyroid disease
2. Interpret laboratory information with regard
to suspected thyroid disorders
Detailed Contents:
1. Assay of thyroid function
2. Thyroid disorder and
laboratory data.
correlation
38
of
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 10: Lab Evaluation of Thyroid Hormone
Student Notes:
Reading:
1. Textbook of Biochemistry with clinical
correlations. 4th edition Editor: Thomas M.
Devlin, Published by: Wiley – Liss
2. Harper's Biochemistry, 23rd edition: Editor:
Robert K. Murray, Daryl K. Granner. Published
by: APPLETON & LANGE
3. Clinical Bioschemistry
Editor: Allan Gaw, Robert A. Cowan, Denis
Reilly Published by: CHURCHILL, LIVING
STONE
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
endocrine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.
Self-assessment
39
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 11: Physiology of Thyroid Hormones
Student Notes:
Department: PHYSIOLOGY
Lecturer
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Discuss Physiology effects of thyroid
hormones
2. Understand mechanism controlling thyroid
hormones secretions
3. Know Physiology of goiter
Detailed Contents:
1. Calorigenic action of thyroid hormone &
effects secondary to calorigenesis
2. Effects on cardiovascular, skeletal muscle &
nervous system
3. Relation of catecholamines
4. Effects related to growth
5. Metabolic effects of thyroid hormones
6. Regulation of thyroid secretion and TSH
receptors
7. Other factors affecting thyroid growth
8. Physiological basis of altered thyroid function
(Insert here handouts and additional
pages for notes if needed)
40
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 11: Physiology of Thyroid Hormones
Student Notes:
Reading:
1. Review of medical physiology 20th Ed,
William F. Ganong
2. Endocrine physiology 2nd edition
Susan P. Portefield
3. Human physiology & mechanism of
disease, 4th Ed, Guyton Hall
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
endocrine system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.endocrine
Self-assessment
1. Thyroid hormone increases all the following
except:
a. Heart rate
b. Oxygen consumption by the tissues
c. Basal metabolic rate
d. Plasma level of cholesterol
2. Regarding T3 & T4, all of the following are true
except:
a. Iodine is essential for their synthesis
b. They are nor formed during fetal life
c. T3 is more active than T4
d. They bind receptors inside the nucleus of
their target cells
41
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 12: Pathology of Thyroid
Student Notes:
Department: PATHOLOGY
(Insert here handouts and additional
Lecturer:
pages for notes if needed)
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Know the causes of hyperthyroidism &
hypothyroidism
2. Discuss pathogenesis of Graves diseases
3. Discuss the etiology & pathogenesis of diffuse
Nontoxic goiter
4. Classify thyroiditis and correlate pathological findings to
disease entity
5. Classify tumors of the thyroid gland (adenoma,
carcinoma & lymphoma) and know the behavior of the
different morphologic patterns
Detailed Contents:
1. Graves disease
2. Nontoxic nodular goiter
3. Thyroid tumors
e. Benign (adenomas)
f. Malignant (carcinomas)
4. Thyroiditis
e. Hashimoto’s thyroiditis
f. Subacute granulomatous thyroiditis
g. Subacute lymphocytic thyroiditis
42
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 12: Pathology of Thyroid
Student Notes:
Reading:
1. Kumar, Cotran, Robbins, Basic Pathology
8th Edition Pp 643-653
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the cardiovascular
system but these should not used in isolation. I
would recommend you look at the following web
sites:
http://www.studeneconsult.com
www.webpath.com
Self-assessment
A 35 year old lady complaining of intolerance to
heat,fine tremors, and exophthalmos. On
examination her thyroid gland is enlarger. The
most likely diagnosis is :
a- Nodular goiter.
b- Graves disease.
c-lymphocytic thyroiditis.
d- Papillary carcinoma.
43
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 13: Pharmacology of Thyroid
Department: PHARMACOLOGY
Student Notes:
44
.
Phase I
Endocrine Module
Lecturer
Faculty of Medicine
(Insert here handouts and additional
:
pages for notes if needed)
Teaching Location :
Learning Objectives:
At the end of the lecture you should be able to:
1. Know the actions of thyroid hormones.
2. List the thyroid hormone preparations,
therapeutic uses, actions and adverse effects.
3. Describe the antithyroid agents, their mechanism
of action, therapeutic uses and adverse effects.
Detailed Contents:
1. Actions of thyroxine on metabolism, mental
and physical activity.
2. Uses of thyroid hormone and preparation T3
& T4.
3. Antithyroid drugs, thioamides
(propylthiouracil, carbimazole and
methimazole), Ionic inhibitors (Thiocyanate),
Iodides, Radioactive iodine.
4. Antithyroid drugs mechanism of action, uses,
and adverse effects.
Remember:

Iodide is used for treating thyroid storm.

Potentially life threatening agranulocytosis
has occur with thioamides use.

Radioactive iodine should not be used in
pregnant because of its action on the thyroid
of the fetus.
45
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 13: Pharmacology of Thyroid
Student Notes:
Reading:
1.
Lippincott’s Pharmacology, 3rd Edition,
Chapter 23 pp 277
2. Katzung & Trevor’s Pharmacology ;
Examination & board review 7th ed chapter
38
Will be available in Dept. Library:
www.pharmacologyonline.org
Lecture pharmacology of thyroid continue
Self Assessment:
Treatment of thyroid storm
Example of MCQ
1. Concerning thyroxine (T4) all of the following are
true EXCEPT:
A. It is effective orally
B. It is biological t1/2 is 7 days
C. It is converted to T3 & rT3 in peripheral tissues
D. It is extensively bound to plasma proteins
E. It is 4 times more potent than T3
2. Concerning carbimazole all of the following are
true EXCEPT:
A. Inhibits thyroid peroxidase enzymes
B. Blocks coupling of iodotyrosines
C. Blocks uptake of iodide by thyroid follicle cells
D. It is converted by methimazole in the body
E. Is given orally
46
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 14: Pathology of Parathyroid
Department: PATHOLOGY
Student Notes:
Lecturer:
(Insert here handouts and additional
pages for notes if needed)
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Understand the causes and pathogenesis of
hyperparathyroidism (primary and secondary)
2. Discuss the pathogenesis of hyperparathyroidism
effects on bone and kidneys, and identify the
morphologic changes in these systems.
3. Know the causes and effects of
hypoparathyroidism
Detailed Contents:
1. Hyperparathyroidism (causes, pathogenesis &
effects)
a. Primary
b. Secondary
2. Hypoparathyroidism (causes & effects)
47
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 14: Pathology of Parathyroid
Student Notes:
Reading:
1. Kumar, Cotran, Robbins, Basic Pathology,
8th Edition pp 643-653
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I would
recommend you look at the following web sites:
http:// www.studeneconsult.com
www.webpath.com
Self-assessment
Which of the following is a cause of secondary
hyperpara thyroidism?
a- Para thyroid adenoma.
b- Para thyroid carcinoma.
c- Chronic renal insufficiency.
d- Parathyroid hyperlesia.
48
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 15: Histology of Adrenals
Department: HISTOLOGY
Lecturer:
Student Notes:
(Insert here handouts and additional
pages for notes if needed)
At the end of the lecture you should be able to:
1. Know the histological structure of adrenal gland &
classify the cortexintoIzones
2. Correlate between the structure & function of
cortex & medulla
3. Identify the mechanism of hormonal control of the
gland
4. Know some functional disorders due to hyper or
hypo secretion of the gland
1. Histological structure of adrenal gland
 Adrenal cortex (zona glomerulosa, zona
fasciculate & zona reticularis)
 Adrenal medulla (chromaffin cells & ganglion
cells)
2. Function of adrenal cortex & medulla
Reading:
1. Abdulirauf Attia,F. , Mohammed Nassar, A., Zahir,
F
special Histology( First edition) 1424h.
2. William 3. Krause,Human Histology (2 edition)
3. Bslie P. Gartner. — James L- Hiatti. Color text
Book of histology.
4. Mariano S.H. DI Fiore. Atlas of human histology
(Fourth edition)1980.
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
49
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 15: Histology of Adrenals
Student Notes:
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I would
recommend you look at the following web sites:
htp://www.endocrine
Self-assessment
1) Zona glomerulosa cells with E/M are rich with
SER because they secrete:
A. Protein.
B. Enzymes.
C. Steroid hormones.
D. Glycoprotein.
2) ACTH stimulates the production of:
A. Aldosterone.
B. Cortisol and corticosterone.
C. Androgen from the zona reticularis.
D. All of the above.
3) With EM all of the following are characteristic
feature of zona fasiculata, EXCEPT:
A. SER.
B. Mitochondria with tubular cristae.
C. Lipid.
D. Glycogen granules.
4) Zona reticularis secretes:
A. androgen
B. cortisol
C. aldosterone
D. angiotensin II
5) The cells of the adrenal medulla are:
A. Chromaffin cells.
B. Ganglion cells.
C. Glial cells.
D. Both a & b.
6) The adrenal medulla contains the following,
EXEPT:
A. Catecholamine secreting cells.
B. Sympathetic ganglion cells.
C. Fenestrated capillaries.
D. Chief cells.
50
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 16: Structure and Biosynthesis of Steroids
Student Notes:
Department: CLINICAL BIOCHEMISTRY
Lecturer:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Described structure, biosynthesis, secretion,
excretion and regulation of adrenal steroids.
2. Discuss the biochemical effects of adrenal
steroids.
3. Evaluate the adreriocortical function
Detailed Contents:
1. Biosynthesis of adrenal steroid hormones:
- Mineral ocorticoids
- Glucocorticoids
- Androgens
2. Secretion, transport and metabolism of adrenal
steroids.
3. Regulation of adrenal steroids synthesis.
4. Mechanism of action and metabolic effects of
adrenocorticoids.
5. Laboratory assessment of adrenocortical functions
(Insert here handouts and additional
pages for notes if needed)
51
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 16: Structure and Biosynthesis of Steroids
Student Notes:
Reading:
1. Text book of Biochemistry with clinical
correlations. 4th edition. Editor: Thomas M.
Devlin Published by: Wiley — Liss
2. Harper’s Biochemistry , Editor: Robert K.
Murray, Daryl K. Granner Published by:
APPLETON & LANGE
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I
would recommend you look at the following web
sites:
http://www.endocrine
Self-assessment
52
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 17-18: The Physiology of the Adrenals
Department: PHYSIOLOGY
Lecturer:
Student Notes:
Teaching Location: Classroom
Learning Objectives:
At the end of these 2 lectures you should be able to:
At the end of the lecture you should be able to:
1. Cortisol & glucocorticoids
 Understand Physiological effects of cortisol (Insert here handouts and
hormone
additional pages for notes if
 Know concept of permissive action
 Discuss regulation of cortisol hormone secretion
needed)
2. Aldosterone hormone
 Identify actions of aldosterone
 Understand regulation of aldosterone secretion &
role of Angiotensin II
3. Know Physiological aspects of hyper & hypocorticism
& hyperaldosteronism
4. Adrenal androgens
5. Adrenal medullary hormones
 Describe control of synthesis and release
 Unumerate
Physiological
actions
of
catecholamines
 Know features of pheochromocytoma
Detailed Contents:
1- Effects of cortisole on metabolism.
2- Cortisole is important in resistiny stress and
inflammation.
3- Role of ACTH in regulation of cortisole secretion.
4- Cortisol control system.
5- Renal and circulatory effects of aldsterone.
6- Aldosterone escape phenomenon.
7- Possible nongenomic actions of aldosterone and
other steroid hormons.
53
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 17-18: The Physiology of the Adrenals
Student Notes:
Reading:
1. Review of medical physiology 20th Edition
William F. Ganong
2. Endocrine physiology 2nd edition
Susan P. Portefield
3. Human Physiology & mechanism of disease
4th edition, Guyton Hall
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I
would recommend you look at the following web
sites:
http://www.endocrine
Self-assessment
Which of the following is true regarding actions of
cortisol:
a- Stimulates immune system.
b- Facilitates conversion of protein to
glycogen.
c- Promotes lipogenesis.
d- Enhances insulin action.
54
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 19: The Pathology of the Adrenals
Student Notes:
Department: PATHOLOGY
Lecturer:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
Adrenal Cortex:
1. Know the causes and the common associated
syndromes of adrenocortical hyperfunction.
2. Know the causes and the common associated
syndromes of adrenal insufficiency.
3. Classify the neoplasms of adrenal cortex and
know its effects.
Adrenal Medulla
1. Discuss the morphology and diagnosis of
Pheochromocytoma, and correlate with the
clinical picture.
Know the pathogenesis of Neuroblastom
Detailed Contents:
Adrenal Cortex:
1. Adrenocortical hyperfunction; causes of:
a. Cushing's
b. Hyperaldosteronism
c. Adrnogenital syndromes
2. Adrenal insufficiency; causes of
3. Chronic insufficiency ( Addison's disese)
4. Acute insufficiency (Waterhouse-Friderichsen
syndrome)
Adrenal Medulla
1. Tumors
a. Pheochromocytoma
b. Neuroblastoma
(Insert here handouts and additional
pages for notes if needed)
55
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 19: The Pathology of the Adrenals
Student Notes:
Reading:
1. Kumar, Cotran, Robbins, Basic Pathology,
8th Eidition pp 656-664
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I
would recommend you look at the following web
sites:
http:// www.studeneconsult.com
www.webpath.com
Self-assessment
Which of the following conditions is associate with
cushinp syndrome?
a- Hypotension.
b- Loss of weight.
c- Osteoporosis.
d- Hypoglyceia.
56
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 20: Laboratory Assessment of Adrenocortical function
Student Notes:
Department: CLINICAL BIOCHEMISTRY
Lecturer:
Teaching Location: Classroom
Learning Objectives:
(Insert here handouts and additional
pages for notes if needed)
At the end of the lecture you should be able to:
1. Know how we can evaluate adrenocortical
function as serum cortisol, serum
aldosterone
Detailed Contents:
1. Common tests of evaluation of adrenocortical
function
as
serum
cortisol,
serum
aldosterone
2. Special tests of adrenocortical function as
dexamethasone suppression test and CRH
stimulation test
57
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 20: Laboratory Assessment of
Adrenocortical function
Student Notes:
Reading:
1. Textbook of Biochemistry with clinical
correlations. 4th edition Editor: Thomas M.
Devlin, Published by: Wiley – Liss
2. Harper's Biochemistry, 23rd edition: Editor:
Robert K. Murray, Daryl K. Granner. Published
by: APPLETON & LANGE
3. Clinical Bioschemistry
Editor: Allan Gaw, Robert A. Cowan, Denis
Reilly Published by: CHURCHILL, LIVING
STONE
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
http://www
Self-assessment
58
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 21: Corticosteroids and Antagonists
Student Notes:
Department: PHARMACOLOGY
Lecturer:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Describe the major naturally occurring synthetic
glucocorticoids.
2. Describe their actions, therapeutic uses and
adverse effects.
3. Describe the actions of naturally occurring
mineralocorticoid and one synthetic agent.
4. Know the glucocorticoid and mineralocorticoid
effects of adrenocortical steroids.
5. Understand the adrenocortical antagonists
Detailed Contents:
1. Pharmacological action of glucocorticoids in
metabolism, catabolism and immunity
2. Kinetics of glucocorticoids
3. Corticosteroids with gluco & mineralocorticoids
activity
4. Clinical indication of glucocorticoids.
5. Toxicity due to chronic use; adrenal suppression
crushing syndrome, fat redistribution etc
6. Precautions during therapy with glucocorticoids
and contraindications
7. Pharmacological action of mineralocorticoids
8. Corticosteroid antagonist (aminoglutethimide,
metyrapone, mifepristone, ketaconazole,
Eplerenone)


Adverse effects, especially adrenal
suppression, seriously limit the use of
glucocorticoids beyond 2 weeks
Gradual tapering of the drug needed. Abrupt
withdrawal of the drug is contraindicated
(Insert here handouts and additional
pages for notes if needed)
59
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 21: Corticosteroids and Antagonists
Student Notes:
Reading:
1. Lippincott’s Pharmacology, 3rd edition
chapter 26 pp 307
2. Katzung & Trevor’s Pharmacology;
Examination & Board Review 7th Ed,
chapter 39
CD will be available in the department library.
http://www.pharmacologyonline.org
Self-assessment
Describe an appropriate protocol for withdrawal of
glucocorticoids from a patient who has been taking
large doses for 6 months?
Example of MCQ
1. Corticosteroids are usually indicated in all of the
following conditions EXCEPT:
A. Nephrotic syndrome.
B. Collagen diseases.
C. Herpes simplex of the eye.
D. Addison's disease
E. Severe acute asthma.
2. Which of the following synthetic steroids is given
orally as mineralocorticoid replacement in
adrenocortical insufficiency?
A. Spironolactone.
B. Betamethasone
C. Dexamethazone
D. Fludrocortisone
60
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 22: Histology of Mammary Glands
Student Notes:
Department: HISTOLOGY
Lecturer:
(Insert here handouts and additional
pages for notes if needed)
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Know the histology of mammary gland
2. Know the compare between mammary gland in the
resting & lactating stages
Detailed Contents:
1. Structure of mammary gland
a. Adult resting mammary gland
b. Mammary gland during pregnancy
c. Lactating mammary gland
Reading:
1. Abdulrauf Attia,F. , Mohammed Nassar, A.,
Zahir, F special Histology( First edition) 1424h.
2. William 3. Krause,Human Histology (2 edition)
3. Bslie P. Gartner. — James L- Hiatti. Color text
Book of histology.
4. Mariano S.H. DI Fiore. Atlas of human
histology (Fourth edition)1980
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
61
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 22 : Histology of Mammary Glands
Student Notes:
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.endocrine
Self-assessment
1) Features of the mammary gland include all of
the following, EXCEPT:
A. Simple cuboidal epithelium in intralobular ducts
and alveoli.
B. Apocrine secretion of lipids.
C. Responsiveness to both steroid and peptide
hormones.
D. Striated ducts that are active in transport of
ions and water.
E. Myoepithelial cells.
2) A non-lactating mammary gland cannot produce
milk because the gland contains few or no:
A. Lobules.
B. Lactiferous sinuses.
C. Intralobular ducts.
D. Alveoli.
E. Fat cells.
3) The cuboidal epithelial cell of alveoli in the
mammary gland:
A. synthesize and secrete steroid hormones
B. release proteins by exocytosis and lipid by an
apocrine secretion mechanism
C. contract in response to oxytocin from the
posterior pituitary gland
D. synthesize immunoglobulin A (IgA)
4) The main histological change that mammary
glands undergo during pregnancy is an increase
in the:
A. number of fat cells
B. number of lobes
C. amount of intralobular connective tissue
D. number of alveoli
E. number of alveoli
62
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 23: Physiology of lactation
Department: PHYSIOLOGY
Student Notes:
Lecturer:
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Disscus role of estrogen on growth of breast ductal
system
2. Discribe role of progesterone on lobule-alveolar system
3. Initiation of lactation
4. Prolactin hormone
 Enumerate Physiological effects
 Uderstand Hypothalamic control of its secretion
 Explain suppression of ovarian cycles during
lactation
5. Describe Physiological basis of hyperprolactinemia
6. Oxytocin
 Enumerate actions of oxytocin hormone
 Understand neuroendocrine reflexes
Detailed Contents:
12345-
Growth of ductal system.
Development of lobule – alveolar system.
Intiation of lactation.
Effect of prolactin on gonadotropin secretion.
Ejection process in milk secretion.
63
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 23:Physiology of lactation
Student Notes:
Reading:
1. Review of medical physiology 20th Edition
William F. Ganong
2. Endocrine physiology 2nd edition
Susan P. Portefield
3. Human physiology & mechanism of
disease 4th edition, Guyton Hall
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
http://www
Self-assessment
1. Choose the most accurate about prolactin:
a.
b.
c.
d.
It is a neurohormone
It is tonically stimulated by dopamine
It enhances reproductive function
It can be inhibited by catecholamines
2. Oxytocin hormone:
a. Induces uterine relaxation
b. Enhances milk production
c. Stimulates milk ejection
d. Stimulates lipogenesis
64
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 24: Pathology of Breast
Department: PATHOLOGY
Student Notes:
Lecturer :
Learning Objectives:
At the end of the lecture you should be able to:
Inflammatory and Non-neoplastic Breast Lesions:
1. Identify the inflammatory lesions of the breast
and its clinical importance
2. Morphological differentiation of the non-neoplastic
breast lesions from the benign and malignant
tumors.
IL Tumors of Breast:
Learn the morphologic differences between benign and
malignant breast tumors.
1. Know the significant of carcinoma in-situ
2. Describe morphology of different types of breast
tumors and correlate with prognosis
(Insert here handouts and additional
pages for notes if needed)
Detailed Contents:
1. Inflammatory and Non-neoplastic Breast Lesions
Acute mastitis and breast abscess.
Mammary duct ectasia
Fat necrosis
Fibrocystic changes
Epithelial hyperplasia
Sclerosing adenosis & Radical scar
2. Tumors of Breast
A) Benign Breast Tumors
1. Fibroadenoma
:Morphology, Types &
Clinical significance
2. Phytlodes tumour : Morphology, Differential
diagnosis
3. Intraductal papilloma: Morphology & Clinical
significance
65
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 24: Pathology of Breast
Student Notes:
3. Carcinoma of Breast
• Incidence, epidemiology & risk factors, Pathogenesis
(genetic changes, hormonal influences, environmental
influences)
• Morphology: Classification
a. In-situ carcinoma: Clinical significance, types,
prognosis.
b. Invasive carcinoma morphological types,
grading and
staging of breast cancer and correlation to
clinical course.
c. Paget’s disease of the breast.
Reading:
Kumar, Cotran, Robbins, Basic Pathology,
8th Edition pp 628-635
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
In the computer cluster also you have the opportunity to
see some useful web site about the endocrine system
but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.endocrine
Self-assessment
66
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 25: Insulin and Glucagons
Student Notes:
Department: CLINICAL BIOCHEMISTRY
Lecturer:
Teaching Location: Classroom
Learning Objectives:
At the end of the lecture you should be able to:
1. Describe structure, biosynthesis, secretion and
mechanism of action of insulin and glucagons
2. Discuss the role of insulin and glucagons in metabolic
integration and control of metabolism
3. Understand
disease.
the
biochemical
bases
of
related
Detailed Contents:
Insulin:
Structure, synthesis, biosynthesis, regulation of
secretion, mechanism of action and metabolic effects of
insulin.
Glucagons:
Structure, biosynthesis, regulation of secretion,
mechanism of action and metabolic effects of glucagons
(Insert here handouts and additional
pages for notes if needed)
67
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 25: Insulin and Glucagons
Student Notes:
Reading:
1. Textbook of Biochemistry with clinical correlation, 4th
edition. Editor: Thosma M. Devlin, Publisher: Wiley –
Liss
2. Harper's Biochemistry, 23rd edition, Editors: Rober K
Murray, Daryl K. Granner
Publisher: APPLETON & LANGE
4. Biochemistry, Editor: Christopher K. Mathew,
K.E. Van Holde, Publisher: The Benjamin /
Cummings Publishing Company, Inc.
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
In the computer cluster also you have the opportunity to
see some useful web site about the endocrine system
but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.endocrine
Self-assessment
1. Insulin
a. Potentates effect of growth hormones
b. Increase blood fatty acids and ketone body
concentration
c. Secretion increase when sympathetic nerves are
stimulated
d. Increase catabolism of proteins
2. Glucagone hormone
a. Is a steroid hormone secreted by pancreatic islet
delta cells
b. Secretion is inhibited during fasting
c. Acts only in increasing intracellular calcium content
d. Stimulates glycogenolysis in liver
68
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 26: Histology of the Pancreas
Student Notes:
Department: HISTOLOGY
(Insert here handouts and additional
Lecturer:
pages for notes if needed)
Teaching Location:
Learning Objectives:
At the end of the lecture you should be able to:
1. Know the histological structure of pancreas
2. Correlate
4. Between structure and function of exocrine and
endocrine pancreas
Detailed Contents:
1. Exocrine pancreas (acini & ducts)
2. Endocrine pancreas (alpha, Beta, Delta,
pancreatic polypeptide & ganglion cells
3. Function of exocrine & endocrine part
Reading:
1. Abdulrauf Attia,F. , Mohammed Nassar, A.,
Zahir, F special Histology( First edition) 1424h.
2. William 3. Krause,Human Histology (2 edition)
3. Bslie P. Gartner. — James L- Hiatti. Color text
Book of histology.
4. Mariano S.H. DI Fiore. Atlas of human histology
(Fourth edition)1980.
69
.
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 26: Histology of the Pancreas
Student Notes:
You have the opportunity to watch the CD-ROM
about the Endocrine system. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the opportunity
to see some useful web site about the endocrine
system but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.endocrine
Self-assessment
1) The centroacinar cells of the pancreatic acinus
represent::
A. The main pancreatic duct.
B. The initial part of the intercalated duct.
C. The distal part of the intercalated duct.
D. The proximal part of the intralobular duct.
2) Regarding the pancreas, the following
statements are true, Except:
A. It possesses islets of Langerhans.
B. It possesses serous demilunes.
C. It contains more beta cells than alpha cells.
D. Its acinar cells contain a rounded, basally
located nucleus.
3) All the following are secreted bt the islets of
Langerhans, EXCEPT:
A. somatostatin.
B. Gastrin.
C. Glucagon.
D. Insulin.
E. Serotonin.
70
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 27: The Physiology of Pancreatic Hormones
Student Notes:
Department: PHYSIOLOGY
Lecturer:
Learning Objectives:
At the end of the lecture you should be able to:
1.
2.
3.
4.
5.
6.
Glucose homeostasis

Describe insulin receptors

Enumerate Physiological effects of insulin

Identify glucose transporters

Know insulin & potassium ions

Understand control of insulin secretions
Glucagons hormones

Describe Physiologic effects of glucagons

Explain mechanism controlling glucagons secretions
Know identify insulin/glucagons ration & its significance
Identify Physiological effects of pancreatic somatostatin
Identify pancreatic polypeptide hormone
Know Physiology of disturbed glucose homeostasis
Detailed Contents:
1234567-
Activation of target cell receptor by insulin.
Insulin promotes muscle glucise uptake and metabolism.
Insulin promotes liver uptake and storage of glucose.
Effects of insulin on fat and protein metabolism and growth.
Factors which stimulate or inhibit insulin secretion.
Role of insulin in switching between carbohydrate and lipid
metabolism.
Blood glucose regulation.
71
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 27: The Physiology of Pancreatic
Hormones
Student Notes:
Reading:
1. Review of medical physiology 20th edition
William F. Ganong
2. Endocrine physiology 2nd edition
Susan P. Portefield
3. Human physiology & mechanism of disease
4th edition, Guyton Hall
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
In the computer cluster also you have the opportunity to
see some useful web site about the endocrine system
but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.endocrine
Self-assessment
Insulin increases the entry of glucose into:
abcd-
Renal tubular cells.
Skeletal muscle.
Most neurones in the brain.
Mucosa of the small intestine.
72
Phase I
Endocrine Module
Faculty of Medicine
Lecture 28: The Pathology of the Pancreas
Student Notes:
Department: PATHOLOGY
Lecturer:
Teaching Location:
(Insert here handouts and additional
pages for notes if needed)
Learning Objectives:
At the end of the lecture you should be able to:
1. Learn the morphology of diabetes mellitus
effects on different tissues
2. Learn the morphology of some islet cell tumors.
Detailed Contents:
1. Teaching material:
a. gross specimen
b. kodachromes
c. microscopic slides
TRANSFERABLE SKILLS:
Identify the characteristics lesions of diabetes mellitus
complications
73
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 28: The Pathology of the Pancreas
Reading:
Student Notes:
1. Kumar, Cotran, Robbins, Basic Pathology,
8th Edition pp 563-575
You have the opportunity to watch the CD-ROM about
the Endocrine system. You can access the CD-ROM
during your spare time.
In the computer cluster also you have the opportunity to
see some useful web site about the endocrine system
but these should not used in isolation. I would
recommend you look at the following web sites:
http://www.endocrine
Self-assessment
74
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 29: Anti Diabetic Drug Therapy
Department: PHARMACOLOGY
(Insert here handouts and additional
Lecturer:
pages for notes if needed)
Teaching Location :
Learning Objectives:
At the end of the lecture you should be able to:
1. Identify sources insulin and available
preparations
2. Describe its endocrine effect on certain
tissues & its major hazards.
3. Factors affecting insulin release.
Detailed Contents:
1. Sources of insulin: Animal (pork and beef)
and human insulin ( r DNH techno)
2. Pharmacological effects of insulin on glucose
metabolism in liver; glycogen and protein
synthesis in muscles; triglyceride storage in
adipose tissues.
3. Available insulin preparations: classified in
view of onset of action and duration.
4. Hazards of insulin : hypoglycaemia,
immunologic reactions, lipodystrophy.
Remember:

Insulin promotes cellular potassium uptake.

Short-acting soluble insulin is the only form
that is given intravenously.
75
Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 29: Anti Diabetic Drug Therapy
Student Notes:
Reading:
1. Lipincott’s Pharmacology, 3rd Edition,
Chapter 24 281
2. Katzung & Trevor’s Pharmacology ;
Examination & board review 7th ed chapter 41
CD will be available in Dept. Library
www.pharmacologyonline.org
Self Assessment:
Treatment of hyperglycemic coma
Example of MCQ
1. The insulin preparation that can be
administered intravenously is
A. Soluble (regular) insulin.
B. Isophane (NPH) insulin.
C. Lente insulin.
D. Ultralente insulin.
E. Semilente insulin.
2- Which one of the following is the longestacting insulin preparation?
B.
C.
D.
E.
A. Human NPH insulin
A. Porcine regular crystalline zinc insulin
B. Human ultralente insulin
C. Pork lente insulin
D. Insulin lispro
76
.
Phase I
Endocrine Module
Faculty of Medicine
Lecture 30: Oral hypoglycemic therapy
Department: PHARMACOLOGY
Student Notes:
Lecturer:
(Insert here handouts and additional
Teaching Location:
pages for notes if needed)
Learning Objectives:
At the end of the lecture you should be able to:
1. Identify classes of oral hypoglycaemic agents.
2. Describe their mechanism of action, clinical
pharmacology and adverse effects.
Detailed Contents:
1. Oral hypoglycaemic agents: sulfonylurea,
Biguanides, α-glucosidase, insulin sensitizers, and
repaglinide.
3. Clinical pharmacology of representative examples
(brief mechanism, clinical indication, adverse drug
reaction
Remember:

Tight glucose control to prevent the
microvascular complications.

Biguanides are contraindicated in patients
with renal disease

Glucagon is useful for the emergency
treatment of severe hypoglycemia in certain
circumstances
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Phase I
Endocrine Module
Faculty of Medicine
Continue … Lecture 30: Oral hypoglycemic therapy
Student Notes:
Reading:
1. Lippincott’s Pharmacology, 3rd Edition,
Chapter 24 page 281
2. Katzung & Trevor’s Pharmacology ;
Examination & board review 7th ed chapter 41
CD will be available in Dept. Library
www.pharmacologyonline.org
SELF DIRECTED LERNING:
Effect of sulfonylurea on cardiovascular system
Example of MCQ
1- Sulphonylureas act on pancreatic B-cells by
blocking
A. Na+ channels
B. N-type Ca++ channels
C. L-type Ca++ channels
D. ATP-sensitive K+ channels.
E. Voltage-activated K+ channels
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Phase I
Endocrine Module
Faculty of Medicine
Practical 1: Histology & Anatomy of Pituitary
TUTOR:
Department: HISTOLOGY
SUMMARY:
-
Histology slides: pituitary gland ( H & E)
-
Gross anatomy specimens:
a. Pituitary gland ( on whole & sagittal brain models)
b. Pituitary gland in sell tunica (on sagittal head)
OBJECTIVES:
1. Histology lab.: By the end of this lab. The student should be able to:
a. Identify the anterior, intermediate & posterior lobes
b. Recognize the different cells of anterior lobe and numerous blood
sinusoids.
2. Anatomy lab: By the end of this lab. The student should be able to:
a. Recognize & identify the pituitary gland on plastic models and
preserved specimens and available in the lab.
READING:
1.
Abdullrauf Attia, F., Mohammed Nassar, A., Zahir, F. special histology
(First edition) 1424h.
2. William J. Krause, Human Histology ( 2nd edition)
3. Bslie P. Gartner. – James L – Hiatti. Color text Book of histology.
4. Mariano S. H. DI Flore. Atlas of human histology ( Fourth edition) 1980.
5. G.J. Romanes, C.B.E. B.A., Ph. D., M.B., Ch. B., F.R.C.S., Ed., F.R.S.E.
Cunningham's Manual of practical anatomy (14th edition) 1976.
79
Phase I
Endocrine Module
Faculty of Medicine
Practical 2: Pituitary & Hypothalamic Pathology
TUTOR:
Department: PATHOLOGY
SUMMARY:
1. Explain the morphologic changes in pituitary adenomas.
2. Know the morphologic classification of the pituitary tumors (based on the
cellular criteria)
Teaching material:
a. gross specimen
b. kodachromes
c. microscopic slides
d. electron micrographs
OBJECTIVES:
1. Differentiate between normal histology of anterior pituitary and microscopic
features of pituitary adenomas.
2. Correlate morphology of pituitary adenomas with clinical effects
READING:
Kumar, Cotran, Robbins, Basic Pathology 8th Edition, pp 638-943
80
Phase I
Endocrine Module
Faculty of Medicine
Practical 3: Histology of Thyroid and Parathyroid Glands
TUTOR:
Department: HISTOLOGY
SUMMARY:
1. Slide of thyroid gland ( H & E)
2. Slide of parathyroid gland ( H & E)
OBJECTIVES:
1. Identify the microscopic structure of thyroid gland with its thyroid follicles
and abundant capillary network adjacent to follicles.
2. Identify the structure of parathyroid gland with 2 major parenchymal cell
type (principal & oxyphils) and numerous capillaries
READING:
1. Abdullrauf Attia, F., Mohammed Nassar, A., Zahir, F. special Histology (First
edition ) 1424h
2. William J. Krause, Human Histology (2nd edition).
3. Nslie P. Gartner. – James L – Hiatti. Color textbook of histology.
4. Mariano S.H. DI Fiore. Atlas of human histology (Fourth edition) 1980
81
Phase I
Endocrine Module
Faculty of Medicine
Practical 4: Pathology of Thyroid / Parathyroid
TUTOR:
Department: PATHOLOGY
SUMMARY:
Be able to identify the pathological changes in certain thyroid lesions
Teaching material:
a. gross specimens of nodulangoiter, thyroid atenomo and thyroid
caicivoma.
b. kodachromes
c. microscopic slides of colloid goiter.
OBJECTIVES:
1. Differentiate morphologically between benign and malignant thyroid lesions.
2. Describe the diagnostic histologic criteria of some thyroid neoplasms
READING:
Kumar, Cotran, Robbins, Basic Pathology 8th Edition, pp 643-653
82
Phase I
Endocrine Module
Faculty of Medicine
Practical 5: The Histology of the Adrenals
TUTOR: Department: HISTOLOGY
SUMMARY:
Adrenal gland slide ( H & E)
OBJECTIVES:
1. Identify microscopic structure of adrenal gland. Locate the capsule, cortex
and medulla.
2. Differentiate between the 3 zones of cortex and their cellular arrangement
READING:
1. Abdullrauf Attia, F., Mohammed Nassar, A., Zahir, F. special Histology (First
edition ) 1424h
2. William J. Krause, Human Histology (2nd edition).
3. Bslie P. Gartner. – James L – Hiatti. Color textbook of histology.
4. Mariano S.H. DI Fiore. Atlas of human histology (Fourth edition) 1980
83
Phase I
Endocrine Module
Faculty of Medicine
Practical 6: Pathology of Breast
TUTOR:
Department: PATHOLOGY
SUMMARY:
Be able to identify the morphologic criteria for the benign and malignant breast
lesions
Teaching material:
a. gross specimen
b. kodachromes
c. microscopic slides
OBJECTIVES:
1. Identify non-neoplastic lesions of breast
2. Differentiate morphologically between benign and malignant neoplasms of thebreast
READING:
Kumar, Cotran, Robbins, Basic Pathology 8th Edition, pp 628-635
84
Phase I
Endocrine Module
Faculty of Medicine
Practical 7: The Histology of Pancreas
TUTOR:
Department: HISTOLOGY
SUMMARY:
Slide pancreas ( H & E)
OBJECTIVES:
1. Identify the exocrine pancreas represented by pancreatic acini & ducts.
2. Demonstrate the islets scattered within the glandular tissue with extensive
fenestrated capillary network
READING:
1. Abdullrauf Attia, F., Mohammed Nassar, A., Zahir, F. special Histology (First
edition ) 1424h
2. William J. Krause, Human Histology (2nd edition).
3. Bslie P. Gartner. – James L – Hiatti. Color textbook of histology.
4. Mariano S.H. DI Fiore. Atlas of human histology (Fourth edition) 1980
85
Phase I
Endocrine Module
Faculty of Medicine
Practical 8: The Pathology of Pancreas
TUTOR:
Department: PATHOLOGY
SUMMARY:
Identify the characteristic lesions of diabetes mellitus complications
Teaching material:
a. gross specimen
b. kodachromes
c. microscopic slides
OBJECTIVES:
1. Learn the morphology of diabetes mellitus effects on different tissues.
2. Learn the morphology of some islet cell tumors
READING:
Kumar, Cotran, Robbins, Basic Pathology 8th Edition, pp 563-575
86
Phase I
Endocrine Module
Faculty of Medicine
Tutorial 1: NEURO ENDOCRINE RELATIONSHIP
TUTOR:
Department: PHYSIOLOGY
SUMMARY:
Case studies will be presented, discussed, and analyzed by the students.
Students will be guided into how to address questions, discuss the problem at
hand and arrive at the appropriate conclusions
OBJECTIVES:
By the end of this tutorial , students should be able to understand and
explain:
i.




2.
Intercellular communication, cell to cell relation
Direct communication
Paracrine communication
Endocrine communication
Neural communication
Role of the hypothalamus in nuero-endocrine communication
READING:
1. Review of medical physiology 20th edition, William F. Ganong
2. Endocrine physiology 2nd edition, Susan P. Portefield
3. Human physiology and mechanism of disease 4th edition, Guyton Hall
Note will be handed out by instructor
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Phase I
Endocrine Module
Faculty of Medicine
Tutorial 2: Thyroid Function
TUTOR:
Department: PHYSIOLOGY
SUMMARY:
Case studies will be presented, discussed, and analyzed by the students.
Students will be guided into how to address questions, discuss the problem at
hand and arrive at the appropriate conclusions
OBJECTIVES:
1.
2.
3.
4.
5.
Integration of knowledge presented in lectures.
Applying the information gained to a practical situation.
Enhancing and deepening the understanding of the topic presented.
Simulating real situations where decision making is essential.
Encouraging independent thinking and analysis
READING:
Note will be handed out by instructor
88
Phase I
Endocrine Module
Faculty of Medicine
Tutorial 3: PHYSIOLOGY OF PARATHYROID GLAND
TUTOR:
Department: PHYSIOLOGY
SUMMARY:
OBJECTIVES:
By the end of this lecture, students should be able to understand and
explain:
1. Calcium homeostasis
 Role of calcium ions in physiological processes
 Serum calcium level
 Calcium distribution in the body and calcium pools
 Bone forming and bone eroding cells
2. Phosphate homeostasis
3. Parathormone; physiological effects and mechanism controlling its secretion
4. Calcitonin hormone; physiological effects and mechanism controlling its
secretion
5. Vitamin D; synthesis, actions & control of secretion
6. Physiologic mechanism of distributed calcium homeostasis
READING:
1. Review of medical physiology 20th edition, William F. Ganong
2. Endocrine physiology 2nd edition, Susan P. Portefield
3. Human physiology and mechanism of disease 4th edition, Guyton Hall
89
Phase I
Endocrine Module
Faculty of Medicine
Tutorial 4: Pharmacology of Parathyroid
TUTOR:
Department: PHARMACOLOGY
SUMMARY:
OBJECTIVES:
At the end of be tutorial you should be able to:
1. List the major & minor hormonal regulators of bone mineral homeostasis
2. Describe the major effects of parathyroid hormone on the intestine, the kidney & bone
3. Describe the major effects of vitamin D derivatives on the intestine, the kidney & bone
4. Describe the therapeutic & toxic effects of bisphossphonates
5. Describe the therapeutic & toxic of fluoride ion
6. Mention the treatment of hypocalcemia, hypercalcemia & osteoprosis
TOPICS:
1. Major endogenous substances involved in bone mineral homeostasis e.g.
parathyroid hormone & vitamin D
2. Minor endogenous substances involved in bone mineral homeostasis e.g. calcotonin,
estrogen & glucocorticoids
3. Parathyroid hormone increased serum calcium and decreased serum phosphate,
while vitamin D increased both serum calcium & phosphate
4. Calcitonin has been used in conditions in which an acute reduction of serum calcium is needed e.g. Paget’s disease & hypercalcemia
5. Bisphosponates inhibit osteoclastic activity and reduce the resorption of bone
6. Treatment of osteoprosis e.g. Teriparatide (PTH), estrogen and selective estrogen
receptor modifiers (SERMs) as tamoxifen raloxifene and toremifene
REMEMBER:
1. Calcitonin is not useful in treating conditions in which bone mass is reduced e.g.
Osteoprosis
2. Although human calcitonin is available, salmon calcitonin is most often used because
of its longer half-life and greater potency
3.Because bisphosphonates are very irritating to the esophagus, the patient should be
informed about taking large quantities of water with tablets and avoiding situations
(lying down) that permit esophageal reflux
4. Thiazide diuretics reduce the excretion of calcium by the kidney and have been used to
__decrease kidney stone formation.
5. The loop diuretic e.g. furosemide, are used to reduce serum calcium in acute
kjjjypercalcemia.
6. Estrogens slow the rate of resorption but do not increase bone formation.
7. Teriparatide (PTH) is the only agent on the market that promotes new bone formation.
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Phase I
Endocrine Module
Faculty of Medicine
READING:
1. Katzung & Trevor’s Pharmacology; Examination & Board Review, 7th Edition
chapter 42
Will be available in department library
www.pharmacologyonline.org
www.wikipedia.com
Self Assessment:
Treatment of hypocalcemia and hypercalcemia
1. Which of the following vitamin D preparations would be the most appropriate in a
patient with poor renal function?
A. Calcifediol
B. Calcitriol
C. Cholecalciferol
D. Ergocalciferol
2. Intermittent administration of PTH produces which of the following?
A. Impaired Ca++ absorption in the gut
B. Inhibition of I-hydroxylase
C. Net increase on bone formation
D. Net increase in bone resorption
3. Which one of the following conditions is an indication for the use of calcitonin?
A. Osteoprosis
B. Paget’s disease
C. Rickets
D. Intestinal osteodystrophy
E. Hypoparathyroidism
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Phase I
Endocrine Module
Faculty of Medicine
Tutorial 5: Imaging of the Adrenals
TUTOR:
Department: RADIOLOGY
SUMMARY:
2. To show them normal U.S, CT, MRI and isotope scan of adrenal gland.
3. To show them – adrenal adenoma on different modality.
- Cushing aldostemoma on different modality.
- pheochromocytoma on different modality
OBJECTIVES:
1. To recognize different radiological modality can be used to manage adrenal
gland.
2. To recognize the normal radiological anatomy and appearance of adrenal
gland.
3. To recognize the appearance of different adrenal pathology using different
radiological modalities.
READING:
92
Phase I
Endocrine Module
Faculty of Medicine
Tutorial 6: Pathology of Diabetes Mellitus
TUTOR:
Department: PATHOLOGY
SUMMARY:
1. The small group of students are further subdivided into two or three smaller
groups. Each group is assigned a section of the topic to be discussed.
Each group is required to read about the subject and prepare a paper using
the available resources (library books, electronic resources, others)
OBJECTIVES:
Integrate information form basic and clinical lectures and practical sessions in
addition to newly acquired knowledge.
1. Discuss the pathogenesis of the complications of diabetes mellitus
2. Correlate the pathogenesis to morphologic findings indifferent systems
(kidney, retina, nerves) and hence the clinical presentation.
3. Assess the prognosis of diabetes mellitus based on the evaluation of
pathology seen in various organs
READING:
1. Kumar, Cotran, Robbins, Basic Pathology 8th Edition pp 563-575.
2. Other pathology books
3.
Electronic resources
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Phase I
Endocrine Module
Faculty of Medicine
Tutorial 7: Cushing's disease
TUTOR
Department: MEDICINE
SUMMARY:
Cushing syndrome duet to elevation in cortisol level either due to adenoma of
adrenal or pituitary adenoma
OBJECTIVES:
1. Symptoms
2. Causes
3. Investigation
READING:
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Phase I
Endocrine Module
Faculty of Medicine
Independent learning
“Independent learning is a very essential skill for tomorrow’s doctors.
We will train you to gain this important skill by asking you to read
independently about specific topics in endocrine system”
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Phase I
Endocrine Module
Faculty of Medicine
Study Histology of blood vessels and
Relate structure to function in the circulation
You may use the following objectives as guidelines:

Describe the histological structure of different blood vessels

Recognise specific cell types for the different tissues as well as those
common to many tissues.

Relate the structure to function in all types of blood vessels.

Ganong, Review of Medical Physiology, 20th edition, page: 556 – 559

Wheather’s Functional Histology (3rd ed) pp. 140 - 152
I would recommend you to use the key word – blood vessels &
histology–in the search engine google (www.google.com).

http://www. Google.com
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Phase I
Endocrine Module
Faculty of Medicine
PBL
PBL process
 The clinical scenario

Key information
 Explore the problem
 What you know
 What you need to know
 Identify learning issues
 Self/group study
 Share the knowledge
 Solve the problem
 Give feedback & reflect
Only ONE will be chosen
PBL #1: Hypothalamic Pituitary Dysfunction,
PBL #2: Diabetes Insipidus & SIADH,
PBL #3: Hypothyroidism / Hyperthyroidism,
PBL #4: Pharmacology of Thyroid / Parathyroid,
PBL #5: Adrenal Failure,
PBL #6: Puberty,
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Phase I
Endocrine Module
Faculty of Medicine
PBL #7: Diabetes Mellitus.
Direct Learning #1: Metabolic bone disease
TUTOR:
Department: MEDICINE
SUMMARY:
1. The bone can be affected by multiple hormonal change and by calcium
deficiency.
2. One of the commonest cause it low calcium level which duet low Vit. D
intake.
3. The patient usually complain of bone pain and fatigability.
OBJECTIVES:
1.
2.
3.
4.
5.
Types of metabolic bone disease ( causes)
Signs and symptoms
Laboratory finding.
Radiological finding
Prevention and treatment
READING:
Medicine
98
Phase I
Endocrine Module
Faculty of Medicine
Direct Learning #2: Drugs of Pituitary & Hypothalamic
Disorders
TUTOR:
Department: PHARMACOLOGY
SUMMARY:
OBJECTIVES:
At the end of the module you should be able to:
Describe the major hypothalamic – releasing hormones
Describe the major anterior pituitary hormones and their effects
Describe the major posterior pituitary hormones and their effects
Identify the links between hypothalamic, pituitary & target organ hormones
Describe the major drugs used as substitutes for the natural hypothalamic and
pituitary hormones
6. Know the drugs used as agonists and antagonists on the hypothalamic – pituitary
axis, their therapeutic uses, mechanism of action and adverse effects.
1.
2.
3.
4.
5.
TOPICS:
1. Hypothalamic hormones of clinical significance e.g. Growth hormone-releasing
hormone (GHRH), somatostatin, Somatotropin release inhibiting hormone (SRIH),
Thyrotropin releasing hormone (TRH), Corticotropin releasing hormone (CRH),
Gonadotropin releasing hormone (GnRH or LHRH) and prolactin inhibiting hormone
(PIH).
2. Anterior pituitary hormones of clinical significance e.g. Growth hormone
(somatotropin), Thyroid stimulating hormone (TSH), Adrenocorticotropin (ACTH),
Follicle stimulating hormone (FSH), Lutinizing hormone (LH), Menotropin (hMG) and
prolactin
3. Posterior pituitary hormones of clinical significance e.g. Oxytocin and vasopressin
(antidiuretic hormone, ADH)
4. Mechanism of action, pharmacological actions & clinical uses of somatrem,
octreotide, cosyntropin, leuprolide, goserelin, urofollitropin, human chronic
gonadotropin, menotropin, bromocriptine & desmopressin
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Phase I
Endocrine Module
Faculty of Medicine
REMEMBER:
1. Many of the natural hormones are used as drugs
2. The frequency of administration of leuprolide determines its effect:
 Acute administration will increase FSH / LH and sex steroids
 Chronic administration will decrease FSH / LH and sex steroids
3. Chronic leuprolide administration leads to androgen blockage in men, which is
useful in treating hormone dependent cancers such as prostatic carcinoma
READING:
1. Katzung & Trevor’s Pharmacology; Examination & Board Review, 7th Edition
chapter 37
2. Lippincott’s Pharmacology, 3rd Edition chapter 23
SELF ASSESSMENT:
Mention a drug used to stop lactation, and its mechanism of action
1. Which of the following best describes the action of somatostatin?
A. Inhibition of growth hormone release
B. Inhibition of prolactin release
C. Stimulation of insulin release
D. Stimulation of LH release
E. Stimulation of TSH
2. Hormones that are useful in the diagnosis of endocrine insufficiency include:
A. Corticotropin releasing hormone
B. Cosyntropin
C. Gonadotropin releasing hormone
D. Thyrotropin releasing hormone
E. All of the above
3. Drugs useful in treatment of infertility include all of the following EXCEPT:
A. Bromocriptine
B. Clomiphene
C. Gonadotropin releasing hormone
D. Human chorionic gonadotropin
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Phase I
Endocrine Module
Faculty of Medicine
E. Prolactin
ENDOCRINOLOGY System
Clinical Presentation:
Clinical Presentation 1 : Hyperthyroidism
Clinical Presentation 2 : Hvperparathyroidism
Clinical Presentation 3 : Hirsutism
Clinical Presentation 4 : Cancer Breast
Clinical Presentation 5 : Diabetes mellitus
Five cases will be presented by medical staff
(Medical staff will be selected by head of department )
Hyperthyroidism ( Medical )
Hyperparathyrodism ( Medical )
Hirsutism ( Gynecology )
Breast Cancer ( Surgical )
Diabetes mellitus ( Medical )
Detailed of the presentation
Signs and symptoms
Clinical findings
Investigation
Management
Discussion including path physiology
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Phase I
Endocrine Module
Faculty of Medicine
 Learning issues
At the end of the first session you will be able identify the learning
issues which related to the above clinical problem. Try to
summarize these learning issues in the table below. We
recommend you to learn about these issues. This will help you to
solve the problem in the next session.
Learning issues
 …………………………………………………………………………

………………………………………………………………………

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
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
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………………………………………………………………………
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…………
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Notes
Phase I
Endocrine Module
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103
Faculty of Medicine
Phase I
Endocrine Module
Faculty of Medicine
Key Facts


Causes of chest pain include:






Myocardial infarction
Pulmonary embolus
Aortic dissection
Peumothorax
Herps Zoster
Pericarditis


Secondary prevention of myocardial
infarction:
Emergency Care of acute myocardial
infarction:





Risk factors can be divided into
those which are modifiable such as
smoking,
hypertension
and
hypercholesterolaemia and those
which are not modifiable such as
age, sex, ethnic origin, family history,
and past medical history.
IV access
Asprin
Analgesia with opiates
Oxygen if breathless
Thrombolysis if indicated
Indications for thrombolysis
Secondary preventive treatment is
targeted on the modifiable risk
factors.
Unequivocal
acute
myocardial
infarction in the absence of contraindications i.e. chest pain for more
than 12 hours with ECG showing ST
elevation or a new LBBB.
Contraindications to thrombolysis:









Suspected aortic dissection
Recent haemorrhage
Major surgery or trauma within
previous two weeks
Active peptic ulceration
CVA in previous six months
Uncontrolled hypertension
Aggressive CPR
Warfrin therapy
Proliferative
diabetic
retinopathy
Arrhythmic
complications
myocardial infarction:



Atrial flutter
First
second
or
third
(complete) degree heart block
Asystole
Electromechanical
dissociation
of
Ventricular fibrillation
Ventricular tachycardia
Atrial fibrillation
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Phase I
Endocrine Module
Faculty of Medicine
Further
Reading
105