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Y3 Medicine > 20 - Thyroid and Adrenal Endocrinology > Flashcards

20 - Thyroid and Adrenal Endocrinology Flashcards

1
Q

What is the difference between primary and secondary gland failure?

A

Primary: end organ hormone low but pituitary hormone high

Secondary: end organ hormone high and pituitary hormone low

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2
Q

What structures lie close to the thyroid gland?

A
  • Parathyroid glands posteriorly
  • Superior and inferior thyroid arteries
  • Recurrent laryngeal nerve
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3
Q

What is a thyroglossal cyst and how can you tell it is a thyroid lump on examination?

A

Thyroid starts in the base of the tongue and travels down. Some remnant tissue can be left behind on the travels forming a cyst

Lump will move up with swallowing and sticking tongue out

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4
Q

What cells are present in the thyroid and what is their role?

A

Follicular cells: Synthesise thyroglobulin which is then iodinated to form thyroxine which is stored in the colloid

C-Cells/Neuroendocrine cells: Secrete calcitonin

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5
Q

What malignancy causes high calcitonin levels?

A

Medullary thyroid cancer

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6
Q

Thyroid hormone is made from iodinated tyrosine. What do they bind to travel in the blood?

A

Carried by the following to nuclear receptors:

  • TBG
  • Albumin
  • Transthyretin
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7
Q

How do you do a thyroid examination?

A

1. General Inspection: agitated, fidgety

2. Hands: peripheral tremor paper, pulse rate and rhythm

3. Face: inspect eyebrows/skin/sweating, exopthalmous, eye movements, lid lag

4. Thyroid: inspect, swallow water, protrude tongue, palpate

5. Lymph nodes

6. Trachea: deviation in goitre

7. Percuss: retrosternal dullness

8. Auscultate: bruits in Grave’s

9. Special Tests: biceps, pretibial myxedema, proximal myopathy

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8
Q

What is included in a TFT panel, and what can affect this panel?

A

- TSH

- Free T3 and T4

Amount of TBG. More TBG can increase total T3/T4 but doesn’t mean free T3/T4 has increased!!!

Pregnancy, Illness, Lithium and Amiodarone can derange TFTs so do TFTs on relatively well person

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9
Q

What thyroid tests should you look at for hyperthyroidism and what will they show?

A

T3, T4, TSH

Primary Hyperthyroidism (issue with thyroid): Low TSH, Raised T3 and Raised T4

Secondary Hyperthyroidism (thyroid being stimulated): Raised TSH, Raised T3 and Raised T4. This is rare and often due to TSH secreting pituitary adenoma

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10
Q

What thyroid tests should you look at for hypothyroidism and what will they show?

A

TSH and only T4

Primary Hypothyroidism (autoimmune): raised TSH, low T4

Secondary Hypothyroidism (pituitary issue): low TSH, low T4

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11
Q

Apart from a standard TFT panel, what other investigations can you do for thyroid pathology?

A

- Thyroid autoantibodies e.g TPO, anti-TSH, anti-TG

- Serum thyroglobulin

- US

- Scintigraphy

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12
Q

What are some signs and symptoms of hyperthyroidism (a.k.a thyrotoxicosis)?

A

Due to increased sympathetic action

Symptoms: weight loss, insomnia, irritability, anxiety, heat intolerance, palpitations, tremor, diarrhoea, sweating, oligomenorrhea, infertility

Signs: sinus tachycardia, AF, fine tremor, palmar erythema, thin hair, lid lag due to increased sympathetic tone, hyperreflexia, goitre, bruits

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13
Q

How may hyperthyroidism present differently in the elderly and children?

A

Elderly: paradoxically with reduced energy levels, known as apathetic thyrotoxicosis

Children: typical symptoms plus accelerated growth and behavioural disturbance

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14
Q

What are some of the signs of hyperthyroidism due to Grave’s disease?

A

Due to cross reactivity with TSH receptors in back of orbit and skin

- Eyes: lid retraction, exophthalmos, opthalmoplegia

- Pretibial myxoedema: above lateral malleoli

- Thyroid acropachy: clubbing, painful toe and finger swelling

- Goitre

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15
Q

What are some of the different causes of hyperthyroidism?

A

Grave’s (most common): autoimmune, usually women 40-60, IgG antibodies that can stimulate TSH receptors in thyroid, orbit and skin. Associated with other autoimmune conditions and can be triggered by stress, infection, pregnancy

Nodular Hyperthyroidism: can be toxic adenoma or toxic multinodular goitre that releases T3/T4. More in elderly than Grave’s

Ectopic Thyroid tissue: metastatic follicular thyroid cancer, struma ovarii

Thyroiditis: inflammation of thyroid due to viral infection, child birth or medication like amiodarone

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16
Q

What autoantibody is present in Grave’s disease?

A

TSI (stimulates TSH)

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17
Q

What investigations should you do to diagnose hyperthyroidism and find the underlying cause? What do these tests show?

A

TFTs: low TSH, raised free T3/T4

Thyroid autoantibodies: TPO, TSHrAB

Bloods: normocytic anaemia, raised Ca, raised LFTs, raised ESR, neutropenia in Grave’s

US: for nodular disease

Isotope Scan (Te/Iodine): Grave’s will have uniform uptake, nodular disease will only have increased uptake in nodular areas, thyroiditis will not have uptake

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18
Q

What is subclinical hyperthyroidism and how is it managed?

A

Low TSH

Normal T3/T4

Only treat if symptoms

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19
Q

What are the different treatment options for hyperthyroidism?

A

Medical (1st Line)

- Thionamides: carbimazole and propylthiouracil

- Beta-blockers: propanolol to control symptoms rapidly

Surgical:

  • Thyroidectomy

Radioactive Iodine:

  • Single dose of I-131
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20
Q

How do you start someone on Carbimazole for hyperthyroidism?

A

Two methods:

Titration: Take 20-40mg/day for 4 weeks then titrate according to TFTs

Block-Replace: Give carbimazole-levothyroxine simultaneously to prevent iatrogenic hypothyroidism.

If Grave’s keep on for 12-18 months then withdraw. If relapse need surgery or radioactive iodine

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21
Q

What do you need to warn people about when starting them on carbimazole? (Thionamide)

A

- Will take 4-6 weeks to normalise thyroid levels

- Risk of agranulocytosis (bone marrow suppression) (If unexplained fever/sore throat need urgent FBC to exclude pancytopenia. Stop drug if neutrophils low)

  • May get generalised rash but will stop when stop taking drug
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22
Q

The definitive treatment of hyperthyroidism is radioactive iodine or surgery, driven by patient choice. What are the disadvantages of radioactive iodine?

A

I131

- Contraindications: pregnancy and lactation

- Can flare up eye disease

- Common post-treatment hypothyroidism that needs lifetime levothyroxine

- Patient emits small amount of radiation after so needs to avoid pregnant people and children for a few weeks

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23
Q

What are the complications of thyroidectomy surgery used to treat hyperthyroidism?

A

- Hoarse voice if damage recurrent laryngeal nerve

- Bleeding

- Infection

- Hypoparathyroidism so low Ca

Control thyroid before surgery and use beta-blockade during anaesthetic induction to prevent peri-op AF

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24
Q

What are some of the complications of hyperthyroidism that is left untreated or poorly treated?

A
  • Heart failure
  • Angina
  • AF
  • Osteoporosis
  • Opthalmopathy
  • Gynaecomastia
  • Thyroid storm
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25
What are some signs and symptoms of thyroid eye disease?
**Symptoms:** eye discomfort, incresed tear production, photophobia, diplopia **Signs:** exophthalmos, proptosis, papilloedema, opthalmoplegia
26
How is thyroid eye disease managed?
- Control hyper/hypothyroidism - Stop smoking (biggest risk factor) - Artificial tears - High dose steroids if severe - Surgical decompression if severe
27
What are some causes of a goitre?
28
What are some signs and symptoms of hypothyroidism?
**Symptoms (similar to depression):** weight gain, constipation, fatigue, cold intolerance, menorraghia, poor memory **Signs:** bradycardia, hyporeflexia, dry skin, non-pitting oedem, round puffy face, thickening of skin Often subtle signs/symptoms and diagnosed incidentally
29
What are some of the causes of hypothyroidism?
**_Primary (high TSH)_** **- Hashimotos:** commoner in women **- Iodine deficiency!!!!!!!!** **- Drug induced:** anti-thyroid drugs, amiodarone, lithium, iodine **- Post thyroidectomy/Iodine treatment/Radiation Therapy** **- Pregnancy induced** **_Secondary: (low TSH)_** **- Hypopituitarism:** low fT4 and low TSH, investigate pituitary
30
What autoantibodies are present in Hashimoto's disease?
**TPO:** thyroid peroxidase antibodies **TG:** antithyroglobulin
31
What are some causes of hypothyroidism in neonates/infancy?
**Iodine deficiency:** causes severe mental retardation (cretinism) **Familial thyroid dyshormonogenesis:** autosomal recessive defect in thyroid hormone synthesis
32
What are some investigations done to diagnose hypothyroidism and what do they show?
**TFTs:** high TSH (low in secondary), low fT4 **TPO**: diagnoses autoimmune hypothyrodism **Triglycerides/Cholesterol:** raised
33
How is hypothyroidism treated?
**LEVOTHYROXINE** - Starting dose usually 50-100ug, if elderly or IHD then 25ug - Check TSH at 4 weeks on blood test - Want TSH to be normal not suppressed - If **secondary then get T4 to upper normal** because cannot rely on TSH - Once right levels **check TSH yearly**
34
When someone is being treated with levothyroxine, what are the causes of a persistently high TSH or suppressed TSH?
**- Persistently high (underreplacement)** - Poor compliance - Malabsorption (Crohn's, PPI) **- Suppressed (overreplaceement)**
35
What are the risks of over replacement with levothyroxine?
- AF - Osteoporosis
36
Why can amiodarone cause thyroid issues?
**Iodine rich drug that is structurally like T4** **- Hypothyrodism**: inhibits T4 conversion to T3 **- Hyperthyroidism**: destructive thyroiditis causing hormone release **Check TFTs 6 monthly** on Amiodarone
37
What is subclinical hypothyroidism and how is it managed?
**- Elevated TSH but normal T3/T4** - If asymptomatic do not treat as often spontaneously resolves - If TSH\>10 and asymptomatic start treatment as high risk of progression - If planning pregnancy or symptomatic start treatment - If positive thyroid antibodies check TFTs yearly
38
What are some signs and symptoms of a thyrotoxic crisis?
Lifethreatening hypermetabolic state by excess release of thyroid hormone - Agitation - Confusion - Fever - Coma - Tachycardia - Hypertension - AF - Acute abdomen - Heart failure
39
What are some triggers of a thyrotoxic crisis?
- Untreated hyperthyroidism - Recent thyroid surgery or radioiodine - Infection - MI - Trauma
40
A thyrotoxic crisis can lead to heart failure and pulmonary oedema. How is a thyrotoxic crisis managed?
Start treatment before test results!!! Management: Symptoms- Paracetemol Underlying event: B- blockers Anti thyroid Lugol’s Iodine Dexamethasone
41
What hormones does the adrenal cortex produce?
SALT, SUGAR, SEX **- Mineralcorticoids:** Aldosterone (stimulated by angiotensin II, acts on DCT to cause sodium retention and potassium loss) **- Glucocorticoids:** Cortisol (stimulated by ACTH) **- Adrenal Androgens:** DHEA (more important in women, stimulated by ACTH, converted into testosterone)
42
What pattern is cortisol released in and what is it carried by in the blood?
***- Highest at 8am**,* lowest at midnight. Therefore get ***early morning sample*** - Carried by ***CBG and albumin*** - Anything that increases CBG (e.g oestrogen) may increase total cortisol but doesn't increase free cortisol
43
What is released by the adrenal medulla?
- Adrenaline - Noradrenaline - Dopamine - Metanephrines Under sympathetic nervous system control!!!!!
44
What are the causes of primary and secondary adrenal insufficiency?
**_Primary (destruction of whole of adrenal gland/defect in synthesis)_** - Addison's disease (autoimmune) - TB - Adrenal metastases **_Secondary_** - Long term steroids (only symptoms when withdrawal)
45
What are some symptoms of Addison's disease? (primary adrenal insufficiency)
**_Often non specific and gradual onset:_** - Fatigue and weakness - Anorexia - Weight loss - Nasea - Abdominal pain - Increased pigmentation **- Mineralcorticoid deficiency:** postural hypotension/dizzy **- Glucocorticoid deficiency:** hypoglycaemia **- Androgen deficiency:** reduced libido, loss of pubic/axillary hair
46
Why do people with Addison's disease get hyperpigmentation?
**Low cortisol levels** so no negative feedback on pituitary so **more ACTH** made **ACTH binds to melanocortin 1 receptor** on the surface of dermal melanocytes producing more melanin
47
What are some confirmatory and supportive investigations done to diagnose Addison's disease?
**_Supportive:_** **- U+Es:** hypoNa, hyperK, raised urea due to low aldosterone **- Hypoglycaemia due** to low cortisol **- Anaemia** **_Confirmatory:_** **- Low 9am cortisol** but raised ACTH **- Synacthen stimulation test:** 30min cortisol \>550 then can exclude Addison's
48
What is a Synacthen Test?
Do plasma cortisol before and 30 min after **250 mcg** **IM administration of ACTH** Should produce an increase in cortisol \>550 if normal, if this does not occur can diagnose Addison's
49
How are patient's with Addison's disease treated?
Lifelong glucocorticoid and mineralcorticoid replacement: **- Hydrocortisone** for glucocorticoid **- Fludrocortisone** for mineralcorticoid
50
What advice do you need to give patients when starting them on treatment for Addison's disease?
**- Double dose of steroids** when ill until illness has resolved - Need to get **IV or IM glucocorticoids** if vomiting/diarrhoea - Give **emergency number for endocrine team** **- Steroid emergency card**
51
How are patients with Addison's followed up in primary care?
- Yearly BP and U+Es - Watch for other autoimmune conditions e.g pernicious anaemia
52
How may a patient in an Addisonian crisis present and what are some causes of this?
**Background of Addison's:** - Shock (tachycardia, low BP, raised HR, oliguria) - Hypoglycaemia **_Causes:_** forgotten to take long term steroid, not increased steroids in period of illness/surgery, bilateral adrenal haemorrhage (meningococcaemia)
53
An Addisonian crisis can be fatal, how is this treated?
**Bloods:** ACTH, Cortisol, U+Es **Cultures:** if think infection has triggered, e.g bloods, sputum START TREATMENT STRAIGHT AFTER TAKING BLOODS **- Hydrocortisone 100mg** IV **- IV fluid boluses** to support BP **- Monitor blood glucose** for hypoglycaemia and correct
54
How is secondary adrenal insufficiency caused and how is it treated?
Due to any cause of **hypopituitarism** or abrupt withdrawal of long term steroids - Give hydrocortisone - Do not need fludrocortisone
55
What are some of the causes of hyperaldosteronism?
**_Primary (excess of aldosterone independent of RAAS)_** **- Conn's:** adrenal adenoma producing aldosterone **- Bilateral adrenocortical hyperplasia** **_Secondary (due to high renin from low renal perfusion)_** **- Renal artery stenosis** **- Diuretics** **- CCF** **- Liver failure**
56
What are some of the symptoms of hyperaldosteronism?
There is sodium and water retention: - Asymptomatic - Hypertension - Signs of hypoK: cramps, paraesthesia, weakness
57
How is hyperaldosteronism treated?
**Conn's:** laparoscopic adrenalectomy with spironolactone for BP control 4 weeks before surgery **Hyperplasia:** spironolactone or amiloride
58
When should you consider Conn's syndrome as a diagnosis, and what do you find on investigations?
##Footnote - Hypokalaemia - Low renin - High aldosterone levels - CT/MRI may show adenoma
59
What are phaeochromocytomas and paragangliomas?
Rare **catecholamine producing tumours** that arise from chromaffin cells, **usually in the adrenal medull**a (phaeochromocytoma) or **extra-adrenal chromaffin tissue** **near blood vessels** (paragangliomas) **Highly familial,** especially in bilateral, extraadrenal malignant tumours
60
What are some of the clinical features of a phaeochromocytoma and why are they so dangerous left untreated?
**Classic triad:** episodic headache, sweating, tachycardia **Other symptoms:** palpitations, hypertension, diziness, panic attacks/anxiety, pallor If left untreated can cause hypertensive crisis, encephalopathy, hyperglycaemia, pulmonary oedema, cardiac arrhythmias and death!!!!!
61
What investigations should you do if you suspect phaeochromocytoma?
**- 24H urine metanephrines** **and catecholamines** **- Plasma metanephrines** **- Localisation of tumour with abdominal CT/MRI** - If cannot find then do whole body MRI **- MIBG scan** (chromaffin seeking isotope) or **PET scan** to rule out metastases
62
When should you do genetic testing for phaeochromocytomas and what should be done if there is a mutation found?
**_Genetic testing:_** young age, multifocal/extraadrenal/malignant disease If mutation should have **annual screening** for new or recurrent disease and start **genetic testing first degree relatives** **Mutations:** Von Hippel Lindau, SDH, Men2A/2B
63
How should a phaeochromocytoma be managed?
**- Alpha +/- Beta blockage:** usually *start with alpha blocker **(phenoxybenzamine)** before **beta blocker (bisoprolol)** t*o avoid unopposed alpha-adrenergic stumulation and the risk of hypertensive crisis. *Beta-blocker* for *reflex tachycardia* **- Surgical excision** **- Lifelong surveillance**
64
What is the difference in symptoms between adrenal hormone excess and adrenal hormone deficiency?
65
How does secondary adrenal insufficiency differ from primary insufficiency?
In summary, primary adrenal insufficiency is due to dysfunction of the adrenal glands themselves, while secondary adrenal insufficiency is caused by dysfunction or suppression of the pituitary gland, leading to decreased ACTH production. Due to hypopituitarism of ACTH: - Still got HypoNa **- No hyperK** as mineralcorticoids still produced **- No hyperpigmentation** as no ACTH raise
66
Why is Addison's disease and long-term steroids important information for an anaesthetist to know before putting a patient to sleep?
Need to give them IV hydrocortisone at induction of anaesthesia to prevent an adrenal crisis then IV infusion until can take orally again
67
What is Cushing's syndrome and what are some causes of this?
Clinical state produced by chronic glucocorticoid excess (raised cortisol) **_Causes:_** **-Steroids** **- Pituitary:** adenoma secreting ACTH causing bilateral adrenal hyperplasia **- Adrenal:** tumour **- Ectopic ACTH:** small cell lung cancer
68
What are some of the signs and symptoms of Cushing's disease?
**Symptoms:** increased weight, mood change, erectile dysfunction, irregular menses, acne **Signs:** central obesity, buffalo hymp, moon face, skin thinning, abdominal striae, easy bruising, proximal myopathy May also have diabetes, osteoporosis and hypertension. 5 year mortality of 50% untreated
69
What investigations should be done to diagnose Cushing's disease?
**1st Line: (confirm diagnosis with raised plasma cortisol)** - Overnight dexamethasone suppression test - 24h urinary free cortisol - Low dose dexamethasone suppression test **2nd Line (localise the source)** - Plasma ACTH - CRH test - MRI
70
What are some causes of pseudocushings? (false +ve dexamethasone suppression test)
- Obesity - Alcohol excess - Depression
71
Why can you not just measure basal cortisol to diagnose Cushing's?
Follows a circadian rhythm and affected by illness, time of day and stress (e.g venepuncture)
72
What are some signs in a patients examination that may suggest their Cushing's is caused by ectopic ACTH production or an adrenal tumour?
**Ectopic ACTH due to malignancy:** history of smoking, weight loss, hypoK **Adrenal Tumour:** significant and accelerated hirtuism
73
Once Cushing's syndrome is diagnosed, what tests are done to figure out the cause?
**_ACTH:_** - **If low** likely to be **adrenal cause,** do CT adrenals - **If high** likely to be **ectopic ACTH or pituitary tumour (Cushing's disease)** **_CRH_** - Inject CRH if ACTH high. In Cushing's disease will cause a rise in ACTH and cortisol but if ectopic will not **_Pituitary MRI_** - If suspect pituitary cause - Can do Inferior Petrosal Sinus Sampling **(IPSS)** if MRI shows nothing - If suspect ectopic do whole body CT or PET
74
How is Cushing's syndrome managed?
DEPENDS ON CAUSE * **Steroids:** stop if possible * **Cushing's Disease:** *transphenoidal surgery* to remove pituitary adenoma or *bilateral adrenalectomy* if cannot find source * **Adrenal adenoma/carcinoma**: *laparoscopic adrenalectomy* * **Ectopic ACTH:** treat underlying malignancy * Can give *metyrapone and ketoconazole* to lower cortisol pre-op or whilst waiting for radiation to take effect
75
The mainstay of treatment for Cushing's is surgery, what medical treatments can be given?
**- Metyrapone and Ketoconazole** to lower cortisol ## Footnote **- Radiotherapy**
76
What are some of the complications with Cushing's disease?
- Risk of CVD - Hypertension - Osteoporosis - DM
77
What is hyperparathyroidism and what are some causes of this?
Raised PTH hormone which can cause hypercalcaemia (Ca\>2.6) **- Primary Hyperparathyroidism:** parathyroid adenoma, hyperplasia of all glands, parathyroid cancer **- Secondary Hyperparathyroidism**: anything that causes low Ca (vit D deficiency, chronic renal failure) **- Tertiary Hyperparathyroidism:** long term secondary hyperPTH **- Malignant Hyperthyroidism:** PTHrP from SCC lung cancers, breast, renal cell carcinoma
78
What are some causes of hypercalcaemia with a low/normal PTH level?
- **Malignancy** (always always rule this out first) due to PTHrP **- Benign granulomatous disease** e.g TB, sarcoidosis
79
What are some of the causes of hypercalcaemia with raised PTH?
**Primary Hyperparathyroidism** - Parathyroid adenoma - Multiple endocrine neoplasia - If very high Ca or jaw tumours then likely parathyroid cancer
80
What is the presentation of hyperparathyroidism?
**- Often asymptomatic** and found incidentally on test with raised Ca **- Hypercalcaemia:** tiredness, generalised aches, abdominal pains, constipation, polyuria and polydipsia due to nephrogenic DI, renal stones **- Bone resorption due to raised PTH:** pain, fractures, osteopenia, Brown Tumours
81
What investigations should you do to diagnose primary hyperparathyroidism and what will they show?
**- Ca:** high **- Phosphate:** low **- PTH:** raised or normal **- ALP:** raised due to increased bone turnover **- ECG** **- X-rays**: decreased bone density (especially distal radius), subperiosteal erosions of phalanges, osteitis fibrosa cystica/brown tumour, salt pepper skull **- Renal US:** nephrocalcinosis
82
How is primary hyperparathyroidism managed?
- If due to **adenoma surgical excision** using US or MIBI scan to localise pre-op and intraoperative PTH sampling to confirm removal - If symptoms are severe and serum Ca\>2.85 then **parathyroidectomy** - If not suitable for surgery give **calcimimetic drugs** (e.g cinacalcet) to lower Ca
83
What are some complications of a parathyroidectomy?
- Hypoparathyroidism - Symptomatic hypocalcaemia - Recurrent laryngeal nerve damage so hoarse voice
84
How are secondaryhyperparathyroidism managed?
- Correct causes - Give phosphate binders - Vit D - Cinacalcet
85
How does acute severe hypercalcaemia present and how is it treated?
- May be severely dehydrated and renal impairment. May have short QT, muscle weakness, cognitive disturbance - Needs urgent treatment to **prevent arrhythmias and coma** **- IV fluids** **- IV bisphosphonates**
86
What is familial hypocalciuric hypercalcaemia?
**Autosomal dominant** genetic **defect in calcium sensing receptor** Distinguish from hyperPTH by **low urine calcium/creatinine ratio** Often have family history of mild hypercalcaemia
87
What is the definition of hypocalcaemia and what are some causes of this?
Symptomatic when Ca\<1.9 - Primary hypoparathyroidism - Post surgical hypoparathyroidism following thyroidectomy - Vit D deficiency - Mg deficiency
88
What happens to PTH, Phosphate and Ca levels in hypoparathyroidism?
- PTH low - Phosphate raised - Ca low
89
Why may a thyroidectomy cause hypoparathyroidism?
Accidental removal or damage of the parathyroid glands during thyroid removal Mat be permanenet but often temporary
90
What happens to PTH, Phosphate and Calcium during VitD deficiency?
- PTH high - Ca low - Phosphate low (due to high PTH)
91
How does hypomagnesiumaemia occur and why does it causes hypocalcaemia?
**- Causes:** GI loss, alcohol, drugs like PPIs - Mg is needed for PTH secretion so causes functional hypoparathyroidism
92
How does hypocalcaemia present and why is acute severe hypocalcaemia dangerous?
- Muscle cramps - Carpo-pedal spasm - Perioral and peripheral paraesthesia - Chvostek's and Troussaeu's sign **Acute severe:** laryngospasm, prolonged QT interval, seizures
93
What is pseudohypoparathyroidism?
Failure of target cell response to PTH so PTH resistance - Hypocalcaemia - Hyperphosphataemia - High PTH - Normal Vitamin D
94
What is the typical appearance of someone with pseudohypoparathyroidism?
- Short stature - Round face - Short 4th and 5th metacarpals
95
How is pseudohypoparathyroidism treated?
Same as normal pseudohypoparathyroidism - Ca supplements (Sandocal) - Calcitriol or just Adcal
96
How are the following causes of hypocalcaemia managed to restore Ca back to normal: - Acute - Vit D deficiency - Hypoparathyroidism - Mg Deficiency
**- Acute:** IV calcium gluconate 10mls 10% over 10 mins as life threatening **- Vit D deficiency:** Loading dose cholecalciferol 20,000 IU per week for 7 weeks then maintenance of 2000IU a week **- Hypoparathyroidism:** Synthetic PTH s/c OR Calcitriol + Sandocal OR Adcal D3 **- Mg deficiency:** Stop precipitating drugs, IV Mg Sulfate 24mmol/24 hours. If alcohol is the issue or chronic GI loss seek specialist advice
97
How is acute severe hypercalcaemia managed?
**Step 1:** IV fluids **Step 2:** Once hydrated give bisphosphonates **Step 3:** check Ca blood levels daily, bisphosphonates can take 48h
98
What are some drugs that can lower calcium levels in hypercalcaemia?
- Calcitonin (Miacalcin) - Bisphosphonates - Calcimimmetics - Prednisolone

Y3 Medicine (24 decks)

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