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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 6 INTRODUCTION 7 AIMS & OBJECTIVES 7 TEACHERS CONTACTS 8 ASSESSMENT 9 ICONS 11 TOPIC OUTLINES 12 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 1 : 2 : 3 : 4 : 5 : 6 : 7 : 8 : 9 : 10 : 11 : 12 : 13 : 14 : 15 : 16 : 17 : 18 : 19 : 20 : 21 : 22 : 23 : 24 ; 25 : 26 : 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 : 28 : 29 : 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 I 2 3 4 5 6 7 8 : : : : : : : : 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 1 2 3 4 5 6 7 : : : : : : : 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 1 2 3 4 5 6 7 : : : : : : : 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 3 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 4 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. 6 Phase I Endocrine Module Faculty of Medicine 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. 7 Phase I 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. 8 Phase I 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 9 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 10 Phase I Endocrine Module 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. 11 Phase I 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 12 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 : 10 : 11 : 12 : 13 : 14 : 15 : 16 : 17 : 18 : 19 : 20 : 21 : 22 : 23 : 24 ; 25 : 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 13 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 I 2 3 4 5 6 7 8 9 : : : : : : : : : 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 1 2 3 4 5 6 7 : : : : : : : 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 14 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. 15 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] 16 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. 17 Phase I Endocrine Module 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 18 Phase I Endocrine Module Faculty of Medicine Topic Outlines 19 Phase I Endocrine Module 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 20 . 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. 21 . 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 77 . 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 78 . 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 87 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. 90 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 91 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 93 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: 94 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” 95 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 96 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, 97 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 99 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 100 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 101 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 ………………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ……………………………………………………………………… ………… …………………………………………………………… 102 Notes Phase I Endocrine Module 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 104 Phase I Endocrine Module Faculty of Medicine Further Reading 105