5. BAMS Endocrinology Flashcards
Where is aldosterone produced and what does it do
What is cortisol, where is it produced and what does it do
Explain the negative feedback loop involved in cortisol secretion
Explain the differences between the two types of pituitary tumours
Zona glomerulosa - increases salt and water retention and indirectly affects BP
Glucocorticoid, zona fasicularis and raises BP (normal maintenance), inhibits bone synthesis and lowers immune reactilivity
When there are low cortisol levels, the hypothalamus releases CRH, stimulating the anterior pituitary gland release ACTH. This acts on the adrenal gland stimulating cortisol secretion. When cortisol secretion is sufficient, it acts (negative feedback) to inhibit the secretion of CRH and ACTH
Functional adenoma - well-differentiated, hormone-producing
Non-functional adenoma - space-occupying, non-hormone-producing
What is caused by unregulated levels of growth hormone
What is acromegaly and list 4 clinical features of how it presents
Too high –> gigantism/acromegaly
Too low –> slow growth/metabolic changes
Appositional bone growth - enlarged hands, type 2 diabetes, reverse overbite, coarse features
Hyperthyroidism and Hypothyroidism
What is the main cause of hyperthyroidism and what is this caused by
List 5 common symptoms of hyperthyroidism
Describe hormone levels in primary and secondary hyperthyroidism
What is the main cause of hypothyroidism and what is this caused by
List 5 common symptoms of hypothyroidism
Describe hormone levels in primary and secondary hypothyroidism
List 3 thyroid disease investigations
How is a thyroid disease treated
Graves disease - autoimmune disease (auto-antibodies stimulate TSH receptors)
Heat intolerance, hypertension, weight loss, diarrhoea, increased HR, palpitations, lid lag, eyelid retraction
Primary - low TSH, high T3; secondary - high TSH and T3
Hashimoto’s thyroiditis - autoimmune disease
Cold intolerance, weight gain, tired, constipation, slow HR, delayed reflexes
Primary - high TSH, low T4; secondary - low TSH and T4
Blood tests, ultrasound, tissue sample
Hyper - radioiodine, medications (B-blockers), surgery
Hypo - thyroxine tablets
Type 1 Diabetes Mellitus
How is diabetes diagnosed
What is type 1 diabetes
How can ketoacidosis and hypoglycaemia develop
List 5 symptoms of type 1 diabetes
What are 2 main causes of type 1 diabetes
2 RPG results > 11.1mmol/l glucose in blood. RPG involves GTT - 8hr fast, measure (6.1 < 6.1-70 > 7.0), 75g glucose load, measure 2hr later (7.8 < 7.8-11.1 > 11.1)
Autoimmune disease involving immune-mediated destruction of pancreatic B cells by auto-antibodies
Cells cannot metabolise glucose correctly, so fat is used –> build-up of acidic ketones (ketoacidosis) –> insulin treatment –> hypoglycaemia –> glucose required
Polydipsia, polyuria, tiredness, weight loss, increased appetite
Genetic (familial clustering) and environmental triggers
Type 2 Diabetes Mellitus
What is type 2 diabetes
List 3 features associated with type 2 diabetes
What are 3 main causes of type 2 diabetes
How is it diagnosed
List 6 diabetic complications patients may present with
List main treatments for type 2 diabetes
Describe 2 types of oral hypoglycaemic agents
Insulin-resistant - metabolic disorders –> metabolic syndromes
HTN, early accelerated atherosclerosis, obesity with abdominal distribution
Poor diet, obesity, sedentary/lack of exercise
By excluding type 1
Diabetic foot ulcer, retinopathy, neuropathy, nephropathy, poor wound healing, unusual infections
Weight loss, exercise, diet restriction
Insulin secretagogues - cause cells to release insulin
Insulin sensitisers - increase insulin cell sensitivity
Considering dentistry, what 5 side effects can diabetes have
Xerostomia, burning mouth syndrome, increased caries risk, ulcers, increased infection risk
Adrenal Hyperfunction and Hypofunction
What is Conn’s syndrome
What is Cushing’s syndrome and list 3 main causes
List 8 symptoms of Cushing’s syndrome
Describe hormone levels in primary and secondary adrenal hyper function
What is Addison’s disease and list 2 main causes
List 5 symptoms of Addison’s disease
Describe hormone levels in primary and secondary adrenal hypo function
Excess aldosterone levels
Excess cortisol levels - adrenal adenoma, Cushing’s disease and ectopic ACTH production
Muscle weakness, obesity with abdominal distribution, moonface, buffalo hump, diabetes features, thin skin, purpura, fractures, hypertension
Primary - low ACTH, high cortisol; secondary - high ACTH and cortisol
Destruction/dysfunction of adrenal gland - autoimmune and TB
Postural hypotension, weight loss, tired, weakness, loss of body hair (males), anorexia
Primary - high ACTH, low cortisol; secondary - low ACTH and cortisol
Therapeutic Steroids
What effect do they have on adrenal gland
List 6 adverse effects of therapeutic steroids
Cause adrenal gland suppression - enhance effects of glucocorticoids and mineralocorticoids
Hypertension, type 2 diabetes, osteoporosis, increased infection risk, peptic ulceration, thinning of skin
Steroid Prophylaxis
When is this used
List 3 features of therapeutic steroids
List 3 features of steroid use for Addison’s
When increased physiological requirement anticipated
Hypertension tendency, supra physiological, all steroids exogenous
Hypotension tendency, physiological replacement, all steroids exogenous
Acute Adrenal Crisis
How does this develop
List 3 symptoms/signs
How is it managed
From Addison’s disease due to insufficient cortisol levels
Vomiting, hypotension, coma
Treat problem, fluid resuscitation
List 6 causes of oral pigmentation
Race, drugs (contraceptive pill, antimalarials), melanoma, melanotic macule, smoking, pregnancy, chronic trauma, pigmented naevus
