al-balqa applied university ةيقيبطتلا ءاقلبلا ةعماج · 2020-01-22 · 2. the...

Al-Balqa Applied University جامعة البلقاء التطبيقية

COURSE PLAN

FIRST: BASIC INFORMATION

College

College : Medicine

Department : Basic Medical Sciences

Course

Course Title : Endocrine System

Course Code : 31500321

Credit Hours : 4

Prerequisite : None

Instructor

Name : Nabil Amer Course coordinator + other staff members as per subject.

Office No. : 2

Tel (Ext) : 3574

E-mail : [email protected]

Office Hours : Sunday , Tuesday, Thursday 10-1

Class Times Buiding Day Start Time End Time Room No.

Lecture

Hall

Complex

Sunday, Monday,

Tuesday

Wednesday &

Thursday

8:00 12:00 2

Text Books

ANATOMY:

1.Principles of Human Anatomy. By G.J. Tortora, Latest edition.

2.Clinical Anatomy for Medical Students. By R.S. Snell, Latest edition.

3.Basic Histology, by L. Carlos Junqueira. Latest edition.

4. Before we are born. By K.L. Moore and T.V.N. Persaud, Latest edition.

BIOCHEMISTRY:

1.Biochemistry by Campbell & Farrell ,latest edition

2.Lippincott’s Illustrated Reviews “Biochemistry” , latest edition

PHYSIOLOGY: 1. Textbook of Medical Physiology, by Guyton and Hall, 10

th edition, 2000.

2. Review of Medical Physiology, by William F. Ganong, 20th edition, 2001.

PATHOLOGY:

Basic Pathology, by Kumar, Cotran and Robbins, Latest edition.

PHARMACOLOGY:

Lipincott’s Illustrated Reviews: Pharmacology, Latest edition.

COMMUNITY MEDICINE:


Supplementary Departmental handouts.

SECOND: PROFESSIONAL INFORMATION

COURSE DESCRIPTION

This course covers the endocrine system from the standpoints of anatomical and histological structure,

hormones including their structures, functions, mechanisms of action receptors, and their metabolism in

addition to the endocrinology disorders including hyperactivity or hypoactivity, immune-mediated

diseases, benign and malignant tumors and pharmacological properties of hormones and drugs used in the

treatment of endocrine diseases. The course is concluded by studying the clinical aspects of the endocrine

system including signs, symptoms and disease presentation. This course covers the basic structure of

hormones, mechanism of actions, physiological functions

And abnormality of hormone secretions. The histological structures and drugs used in different disease

states.

COURSE OBJECTIVES

By the end of this course, students are expected to understand:

1. Structures of various endocrine glands, their development, their histology and their

blood supply.

2. The nature, functions, physiologic roles and mechanisms of action of hormones.

3. Hormone regulation and effects of endocrine functions.

4. Pathogenesis, morphological changes and complications of diseases affecting the

endocrine system.

5. The use of hormones and drugs in diagnosis and treatment of endocrine disorders.

COURSE LEARNING OUTCOMES

1) Knowledge and Understanding

1. The structures of various endocrine glands, their development, their histology and their

blood supply.

2. The nature, functions, physiologic roles and mechanisms of action of hormones.

Hormone regulation and effects of endocrine functions.

3. Pathogenesis, morphological changes and complications of diseases affecting the

endocrine system.

4. The use of some hormones and drugs in diagnosis and treatment of endocrine disorders

2) Professional Skills

The student should be able to differentiate the different endocrine disorders.


3) Competences (Transferable skill and attributes)

The student should be able to differentiate the different investigations required for each endocrines

disorder

COURSE SYLLABUS

No Title of Lectures

1st.Week

Learning Objectives

1 Introduction to the

Endocrine system

(course coordinator)

1. Understand the general outline of the End. S. Module.

2. Be familiar with the modalities of teaching throughout the course.

3. Acknowledge the important relation between normal and abnormal

structure and function.

4. Appreciate the importance of basic medical sciences in clinical application.

2 Morphology of the

endocrine glands

(Anat 1)

1. Review differences between endocrine and exocrine glands.

2. List the endocrine glands.

3. Describe the structure of endocrine glands.

Describe the location, relation, blood and nerve supply and lymphatic drainage

of endocrine glands

3 Histology and

embryology of endocrine

glands 2

(Anat 2 )

1. Describe the development of the endocrine glands (thyroid, parathyroid,

pituitary, adrenal and pancreas).

2. Describe the microscopic structure and cells of the pituitary gland.

3. Describe the microscopic structure of thyroid follicle, follicular and

parafollicular cells

4 Introduction to

endocrinology II

(Phys 1 )

Discuss types of chemical messenger systems

Explain the three general classes of hormones exist

Describe the Hormone secretion after a stimulus and duration of action of different

hormones.

Describe the different types of transport of hormones in the blood

Discuss the “Clearance” of Hormones from the Blood.

What do we mean by Hormone receptors and the mechanism causing changes in

number in the cell?

Describe the types of hormones essential for life

5 Histology and


glands 2

(Anat 2 )

1. Describe the development of the endocrine glands (thyroid, parathyroid,

pituitary, adrenal and pancreas).

2. Describe the microscopic structure and cells of the pituitary gland.

3. Describe the microscopic structure of thyroid follicle, follicular and

parafollicular cells.

6 Hypothalamic-pituitary

relationship

(Phys2)

Discuss the role of Hypothalamus in Controlling Pituitary Secretion

Growth hormone

Discuss the structural relation between growth hormone and prolactin

Discuss Growth Hormone physiological Effects

Discuss Growth Hormone metabolic effects including (1) Increase rate of


protein synthesis in most cells of the body (2) Growth Hormone Enhances

Fat Utilization for Energy (3) Decreased rate of glucose utilization throughout the

body.

Describing effect of Growth Hormone on Cartilage and Bone Growth

Discuss “Insulin-Like Growth Factors” types and functions

Discuss factors and mechanisms control the release of growth hormones

Describing the Abnormalities of Growth Hormone Secretion including Pan-hypo-

pituitarism, Dwarfism,Acromegaly

7 Histology and


glands

(Anat 3 )

1. Describe the microscopic structure and cells of the parathyroid gland.

2. Describe the zones and cells of the adrenal gland.

3. Describe the microscopic structure of the pancreas.

8 Adenohypophyseal

hormones I

(Phys3)

Discuss Physiology of growth

Discuss Growth period and the hormones affecting growth

Discuss Prolactin Hormone a. Regulation of prolactin secretion b. Actions of

prolactin c. Patho-physiology of prolactin

Explain the physiological role of Pituitary Intermediate-lobe “Pars intermedia” and

the hormones release from it

Explain the physiological role of posterior Pituitary lobe

Discuss Posterior pituitary gland and its relation to the hypothalamus

Discuss Regulation of Antidiuretic Hormone Production

Discuss Physiological Functions of Antidiuretic Hormone

Discuss Oxytocin Hormone

Discuss Regulation & functions of oxytocin secretion

9 Introduction to

endocrinology I

(Bioch 1 )

1. Understand the chemical nature of hormones.

2. Understand the differences between hormones,enzymes & vitamins

3. Describe hormone biosynthesis, secretion and transport.

4. Understand targeting delivery and response of hormones

2nd

.Week

10 Pharmacology of

hypothalamic hormones

(Pharm1)

1. List synthetic analogs of hypothalamic hormones.

2. Describe mechanism of action of these synthetic analogs.

3. Characterize their clinical uses and routes of administration.

List their side effects.

11 Mechanism of hormone

actions I

(Bioch 2 )

The role of cell receptors

Characterize cAMP as a second messenger.

List intracellular actions of cAMP.

12 Pharmacology of anterior

pituitary hormones

(Pharm2)

1. Describe pharmacology of anterior pituitary hormones.

2. Review their pharmacological actions.

3. List synthetic analogs and describe their routes of administration.

4. Describe their clinical uses and adverse reactions.


13

Mechanism of hormone

actions II

(Bioch 3 )

1. Describe molecular aspects of hormone action.

5. Understand PIP2 turnover (Ca+2/protein kinase C systems).

3. List actions of diacylglycerol (DAG)

14 Biochemical aspects of

thyroid hormones

metabolism

(Bioch4)

1. Describe thyroid hormone biosynthesis: monoiodotyrosines,

diiodotyrosines, T3, T4 and reverse T3.

2. Describe metabolism of iodide and iodine.

3. Discuss the role of peroxidase, iodinase, coupling, protease, dehalogenase

and thyroglobulin.

4. Discuss thyroid stimulating hormone action via cAMP.

5. Describe the regulation of thyroid stimulating hormone by thyroid

releasing hormone and T4, T3, somatostatin and dopamine.

6. Discuss T4 and T3 transport.

15 Thyroid hormones I

(Phys4)

Discuss the physiological function of thyroid stimulating Hormone

Discuss Formation of thyroid hormone:

a. Discuss Iodide pump (the sodium-iodide symport) and iodide trapping

b. Discuss Oxidation of the Iodide Ion.

c. Discuss Iodination of tyrosine and formation of the thyroid hormones

(“Organification” of Thyroglobulin):

d. Discuss Storage of Thyroglobulin.

e. Discuss Release of thyroxine and tri-iodo-thyronine from the thyroid gland

Discuss Transport of thyroid hormone

16 Thyroid Hormones II

(Phys5)

Discuss Metabolism of thyroid hormones

a. Discuss Fluctuations in de-iodination

b. Discuss Thyroid Hormones Have Slow Onset and Long Duration of Action

Explain Thyroid Hormones Activate Nuclear Receptors

What are the physiological effects of thyroid hormones?

Discuss Increase Basal metabolic effects, Effects of thyroid hormones on

cardiovascular system, the nervous system, skeletal muscle, sexual function,

gastrointestinal tract, respiration

Discuss other effects of thyroid hormone

Discuss the factors affecting TSH and TRH (thyroid releasing hormone) are:

Hypothyroidism, Hyperthyroidism

17

Pathology of the

anterior & posterior

pituitary gland

(Path1)

Pituitary gland pathology:

- Hyperpituitarism and Pituitary Adenomas (Prolactinomas, Somatotroph Cell

Adenomas, Corticotroph Cell Adenomas), Other Anterior Pituitary Neoplasms

- Hypopituitarism

- Posterior Pituitary Syndromes

18

19

Pathology of the thyroid

gland and parathyroid

glands

(Path 2 +3 )

- Hyperthyroidism

- Hypothyroidism

- Thyroiditis (Hashimoto Thyroiditis,de QuervainThyroiditis, Subacute

Lymphocytic Thyroiditis

- Graves Disease

- Diffuse and Multinodular Goiter

- Neoplasms of the Thyroid (Adenomas , Carcinomas )

- Hyperparathyroidism (Primary Hyperparathyroidism ,Secondary

Hyperparathyroidism)


- Hypoparathyroidism

20 Thyroid and

antithyroid drugs

(Pharm3)

1. Characterize the pharmacology of thyroid hormones.

2. Describe the pharmacology of antithyroid drugs.

3. Describe the clinical uses, routes of administration and adverse reactions

21 Calcium & Phosphate

(Phys6)

Discuss Physiology of calcium & phosphate

Discuss Inorganic phosphorus Active transport in the proximal tubule of the kidney

Discuss Inorganic phosphorus Active transport in the duodenum and small intestine

Discuss Inorganic phosphorus Active transport Bone structure:

I. Discuss Bone Non-Cellular component:

A. Discuss Bone Inorganic component (Bone Salts) 65%.

B. Discuss Bone Organic Matrix of Bone (35%).

Discuss Bone Tensile and Compressional Strength.

II. Discuss Bone Cellular component

A. Discuss Bone Osteoblasts:

B. Discuss Bone osteoclasts:

22 Hormonal control of

calcium metabolism I

(Phys7)

Explain steps for the Mechanism of Bone Calcification.

First step: osteoid formation

Second step: mineral precipitation (mineralization) and bone hardening

Discuss the process of mineralization.

Discuss Precipitation of calcium in Non-osseous tissues under abnormal conditions

Describe the calcium exchange between bone and extra-cellular fluid

23 Hormonal control of

calcium metabolism II

(Phys8)

Discuss Vitamin D metabolism

Discuss Intestinal Epithelia can absorb Ca2 by para-cellular and trans-cellular

transport

Explain Parathyroid hormone (PTH)

Discuss Parathyroid hormone (PTH) effects

Discuss Model of calcium reabsorption in the distal convoluted tubule (DCT).

Discuss Control of parathyroid secretion by calcium ion concentration

Discuss Parathyroid hormone-related protein (PTHrP)

Explain Calcitonin

Explain Calcitonin actions:

Explain Effects of other hormones and humoral agents on calcium metabolism

24 Pharmacology of

parathyroid hormone,

vitamin D, calcitonin

(Pharm4)

1. Characterize the pharmacology of the parathyroid hormone, vitamin D and

calcitonin.

2. List synthetic analogs and describe their routes of administration, clinical

uses and their adverse reactions.

3rd.Week


25 Regulation of glucose

metabolism

(Bioch5)

1. Describe enzymatic changes of glucose metabolic pathways in the well-fed

state and during starvation in various tissues (liver, brain, muscle and

adipose tissues).

2. Describe the regulation of glycogen metabolism, glycolysis, hexose

monophosphate pathway and gluconeogenesis by insulin/counter-

regulatory hormones ratio.

26 Endocrine functions of

the pancreas

(Phys9)

Insulin chemistry and synthesis

Insulin receptor

Metabolic effect of insulin on glucose level:

Principal actions of insulin

(1) Short term effects of insulin

A. Insulin promotes muscle glucose uptake and metabolism

B. Insulin Promotes Protein Synthesis and Storage

Insulin Promotes K entry to cells

27 Regulation of insulin

secretion

(Phys11)

1. Plasma Glucose level

a. Effects of the plasma glucose level on insulin plasma level:

b. Mechanism of release of insulin from B cell

2. Protein and fat derivatives:

3. Autonomic nerve:

4. Effects of K depletion:

5. Gastrointestinal Hormones

A. Incretin

Incretin effect:

i. Insulin synthesis and release:

ii. Suppression of glucagons,

iii. Slowing gastric emptying, bowel motility and acid secretion,

iv Increasing satiety تََشبُّع and decrease food intake

The two main candidate molecules that fulfill criteria for an incretin are:

Œ Glucagon-like peptide -1 (GLP-1):

• Gastric inhibitory peptide (also known as: glucose-dependent insulin-tropic

polypeptide or GIP).

B. Other GIT hormones: secretin, cholecystokinin (CCK), gastrin

28 Pathology of the

endocrine pancreas,

(Path4)

Endocrine pancreas

- Diabetes Mellitus (Diagnosis, Classification,Insulin Resistance ,Beta Cell

Dysfunction, Monogenic Forms of Diabetes, Complications of Diabetes)

- Pancreatic Neuroendocrine Tumors (Insulinomas, Gastrinomas)

29 Diabetes Mellitus

(Phys11)

The key features of insulin deficiency

First: effect of insulin deficiency on carbohydrate metabolism

Second: effect of insulin deficiency on fat metabolism

Third: Effect of insulin deficiency on protein metabolism

Long-term changes in B cell responses:

Glucagon

A. Effects of glucagon on glucose metabolism

First: Breakdown of liver glycogen (glycogenolysis)

Second: Preventing conversion of glycogen to pyruvate but to glucose in the liver:

Third: Increased gluconeogenesis in the liver

B. Other Effects of Glucagon

Regulation of glucagon secretion:

1 .Blood glucose level:


2. Protein level:

3. Fat level:

4. Exercise:

5. Autonomic control:

Somatostatin

Human pancreatic polypeptide

Organization of the pancreatic islets:

Insulin excess:

Compensatory mechanisms:

30 Steroidogenesis

(Bioch6)

1. Describe the biosynthesis of steroid hormones.

2. Describe defects and consequences of congenital adrenal hyperplasia.

31 Insulin and oral

hypoglycemic agents

(Pharm5)

1. Discuss the pharmacology of insulin.

2. Discuss the pharmacology of oral hypoglycemic drugs.

3. Describe clinical uses, administration and adverse reactions.

32 Mineralocoticoid:

(Phys 13)

Functions of aldosterone:

1. Aldosterone reabsorb Na+ and H2O and secrete K+

2. Excess aldosterone increases tubular hydrogen ion secretion and causes alkalosis.

3. Effect of aldosterone on sweat and salivary glands and intestinal epithelial cells:

Regulation of aldosterone secretion:

Relation of mineralo-corticoid to gluco-corticoid:

Mineralocorticoid deficiency causes

Excess Mineralocorticoid causes

Glucocorticoid

Effects of cortisol in physiological level

1. Effect of cortisol on carbohydrate metabolism

A. Stimulation of Gluconeogenesis.

B. Cortisol causes a moderate decrease in glucose utilization by most cells in the

body

2. Effect of cortisol on protein metabolism:

A. Effect of glucocorticoids on extra hepatic tissues:

B. A. Effect of glucocorticoids on hepatic tissues:

3. Effect of cortisol on fat metabolism

33 Pharmacology of

mineralocorticoids

(Pharm6)

1. Characterize the pharmacology of mineralocorticoids in terms of

pharmacokinetics, mechanisms of actions and adverse reactions.

2. Describe the synthetic analogs and their routes of administrations.

3. Understand the rationale of replacement therapy.

4th.Week

34 Adrenal medullary

hormones

(Phys12)

Adrenal medulla structure and function of medullary hormones:

1. Catecholamines:

2. Chromogranin A:

3. Adrenomedullin

Effects of epinephrine and nor-epinephrine:

Catecholamines (norepinephrine and epinephrine) mimicking the effects of

noradrenergic nervous discharge


Catecholamines (norepinephrine and epinephrine) exert metabolic effects

Catecholamines (norepinephrine and epinephrine) effects on CVS system

Catecholamines increase alertness.

The catecholamines have several different actions that affect blood glucose.

Effects of dopamine:

Adrenal Cortex

The adrenal cortex three distinct layers secretions:

35 Glucocorticoids

(Phys 14)

Glucocorticoids in pathological and pharmacological quantities glucocorticoids

have other effects including:

1. Anti-inflammatory effects of high levels of cortisol

2. Effect on blood cells and on immunity in infectious diseases.

3. Permissive action:

5. Delayed wound healing.

Effects of cortisol insufficiency:

The cortisol control system:

Adrenal androgens:

Natriuretic hormones

Natriuretic peptide receptors:

Secretion and metabolism

Physiological effects:

Pineal Gland:

Melatonin

Adipose tissue as endocrinal gland:

A. adipocytokines (or adipokines or Protein):

Leptin

•Adiponectin:

Ž Adipsin& Acylation Stimulating Protein

B. Steroidgenic enzymes:

Hunger & satiety:

Ghrelin

Obestatin

36 Pharmacology of

glucocorticoids

(Pharm7)

1. Characterize the pharmocology of glucocorticoids in terms of

pharmacokinetics, mechanism of action and adverse reactions.

2. Describe the synthetic analogs and their routes of administration.

3. Understand the rationale of replacement therapy.

37 Epidemiology of

thyroid diseases

(C.M.)

1. Describe factors influencing the frequency and severity of different types of

thyroid diseases in various populations (globally, regionally and locally).

2. Describe the pattern and prevention of thyroid diseases distribution in

globally and among Jordanians.

38 Pathology of the

adrenal glands

(Path5)

- Adrenocortical Hyperfunction (Hyperadrenalism): Hypercortisolism and Cushing

Syndrome ,Hyperaldosteronism ,Adrenogenital Syndromes

- Adrenal Insufficiency: Acute Adrenocortical Insufficiency, Chronic

Adrenocortical Insufficiency: Addison Disease, Secondary Adrenocortical

Insufficiency

- Adrenocortical Neoplasms

- Tumors of the Adrenal Medulla: Pheochromocytoma, Neuroblastoma


- Multiple Endocrine Neoplasia syndromes: MEN1, MEN2

1.

39 Feedback Session 1. Review the whole course of endocrinology.

2. Discuss the negatives during the course and how to make

it better next year.

Final Exam ( Theory + Practicals ) = 65 %

PRACTICAL LABORATORY SESSIONS

No Title Objectives

1 Morphological and

microscopic anatomy of

endocrine glands

(Anat)

1. Identify different parts of the thyroid gland and study its relations.

2. Identify the adrenal gland and study its relations.

3. Identify the pituitary gland and study its relations.

4. Identify the ultra-structural components of the following glands and

correlate between them:

a. Pituitary gland

b. Thyroid gland

c. Parathyroid glands

d. Pancreas

e. Adrenal glands

2 Pathology of Endocrine

glands I

(Path)

A. Pathology of the thyroid gland.

1. Describe the morphology of various types of thyroiditis.

2. Describe the features of nodular colloid goitre.

3. Describe the features of adenomas.

4. Describe the features of various carcinomas.

B. Pathology of the pituitary gland.

1. Identify various types of adenomas and the significance of using

immunological stains in their categorization.

2. Describe the morphology of craniopharyngioma.

3 Pathology of Endocrine

glands II

(Path)

A. Parathyroid gland.

1. Identify the morphological features of hyperplastic gland and compare with

adenoma.

B. Endocrine pancreas.

1. Identify the morphological features of the pancreas in diabetes.

2. Identify the morphological features of islet cell adenoma.

C. Adrenal gland

1. Identify the morphological features of atrophic and hyperplastic glands.

Compare with the features of cortical adenoma.

2. Identify the morphological features of pheochromocytoma.

3. Identify the morphological features of neuroblastoma.


COURSE LEARNING RESOURCES

Lectures, Labs, clinical case discussion, video sessions and seminars.

ONLINE RESOURCES

{Write some useful websites related to the course and other material that help students to complete the course

successfully.}

This system is taught by more than one staff. Each staff is free to give online links to the students as learning resources.

ASSESSMANT TOOLS

)Write assessment tools that will be used to test students ability to understand the course material and gain the

skills and competencies stated in learning outcomes

ASSESSMENT TOOLS %

Mid Exam (Theory) 35

Final Exam (Theory + Practicals + Clinical

Cases ) 65

TOTAL MARKS 100

THIRD: COURSE RULES

ATTENDANCE RULES

Attendance and participation are extremely important, and the usual University rules will apply. Attendance will be

recorded for each class. Absence of 10% will result in a first written warning. Absence of 15% of the course will result

in a second warning. Absence of 20% or more will result in forfeiting the course and the student will not be permitted

to attend the final examination. Should a student encounter any special circumstances (i.e. medical or personal), he/she

is encouraged to discuss this with the instructor and written proof will be required to delete any absences from his/her

attendance records.

Use of Mobile Devices, Laptops, etc. During Class, unexpected noises and movement automatically divert and capture

people's attention, which means you are affecting everyone’s learning experience if your cell phone, laptop, etc. makes

noise or is visually distracting during class. For this reason, students are required to turn off their mobile devices and

close their laptops during class.


GRADING SYSTEM

Example:

A + = 3 %

A- = 7 %

B+= 10 %

B= 13 %

B- = 17 %

C+= 17 %

C= 13 %

C- = 10 %

D+ = 6 %

D=2 %

D-(45-49) = 2 %

Less than 45 F

*Percentages are according to the number of students who passed the exam.

REMARKS

{The instructors can add any comments and directives such as the attendance policy and topics related to ethics} .

COURSE COORDINATOR

Course Coordinator: Dr. Nabil Amer - Department of Basic Sciences

Signature: Signature:

Date: Date:

al-balqa applied university ةيقيبطتلا ءاقلبلا ةعماج · 2020-01-22 · 2. the...

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