5. Endocrinology Flashcards
Pituitary tumours
Types (2) and features (2) of each
Effects of too much (2) and too little (2) GH
Definition and signs/symptoms (8) of acromegaly
Functional - well differentiated, hormone producing
Non-functional - space-occupying, non-hormone producing (visual field defects)
Too much GH - acromegaly, gigantism. Too little - growth failure, metabolic changes
Appositional bone growth. Coarse features, enlarged supra-orbital ridges, broad nose, big hands, big tongue, reverse overbite IHD, visual field defects
Thyroid dysfunctions
Types (2)
Investigations (2)
Hormone levels in primary hyperthyroidism (2)
Hormone levels in secondary hyperthyroidism (2)
Hormone levels in primary hypothyroidism (2)
Hormone levels in secondary hypothyroidism (2)
Goitre is due to
Hyperthyroidism, hypothyroidism
Blood test, FNA/FNB
Reduced TSH, raised T3
Raised TSH and T3
Raised TSH, reduced T4
Reduced TSH and T4
Iodine deficiency
Hyperthyroidism and hypothyroidism
Causes (2)
Signs and symptoms (7)
Treatment and drug treatment (2)
Definition of Graves disease
Signs and symptoms
Hypothyroidism
Causes (2)
Signs and symptoms (4)
Treatment
Graves disease (primary), pituitary tumour (secondary)
Hot, excess sweating, weight loss, palpitations, increased BP, eyelid retraction, lid lag
Surgery, beta-blockers
Auto-antibody stimulation of TSH receptors
Opthalmopathy
Hashimotos (primary), pituitary tumour (secondary)
Cold intolerance, tired, delayed reflexes, goitre
Thyroxine tablets
Diabetes Mellitus
Definition
Diagnosis involves
Definition of glucose tolerance test, including values (4)
Cause of type 1 Features of type 1 (2) Unusual type of type 1 Signs and symptoms (4) Management
Cause of type 2 (5) Diagnosis Signs and symptoms Management (2) Complications (5)
Hypoglycaemia signs and symptoms (4)
Management (2)
Ketoacidosis signs and symptoms (4)
Management (3)
Types of oral hypoglycaemic agents (2)
Oral side effects (5)
Abnormality of glucose regulation
Two random plasma glucose tests, results > 11.1
Normal < impaired glucose tolerance < diabetic diagnosis
GTT - 8 hour fast - normal < 6.1, IGT 6.1-7.0, diabetes > 7.0
75g glucose load, wait 2 hours - normal < 7.8, IGT 7.8-11.1, diabetes > 11.1
Immune-mediated destruction of pancreatic B cells by auto-antibodies
Ketoacidosis, hypoglycaemia
LADA - latent autoimmune diabetes in adults
Polydipsia, polyuria, tiredness, weight loss (maintained appetite)
Insulin
Obesity, sedentary, diet, genetics, environmental
Rule out type 1 diabetes
Often none - present with complications
Weight loss, diet changes
Poor wound healing, unusual infections, diabetic retinopathy, neuropathy, nephropathy
Warm, sweaty, pale, palpitations
Glucose, glucagon
Sweet breath, dehydration, polyuria, increased HR
Insulin, potassium, IV hydration
Insulin secretagogues, insulin sensitisers
Dry mouth, soreness, ulcers, increased risk of decay, lichenoid reactions
Hormones and therapeutic steroids
Function of aldosterone
Function of cortisol (2)
Function of therapeutic steroids
Side effects of therapeutic steroids (8)
Salt and water retention (Na uptake, K loss)
Maintains BP (prevents hypotension), reduces bone synthesis
Increase glucocorticoid and mineralocorticoid effects
Hypertension, type 2 diabetes, osteoporosis, increased infection risk, peptic ulceration, easy bruising, hyperlipidaemia, psychiatric disturbances
Adrenal dysfunction
Types of hyper function diseases and associated hormones (2)
Types of hypo function and associated diseases (2)
Cushing’s syndrome (cortisol), Conn’s syndrome (aldosterone)
Primary (Addison’s disease), secondary (Sheehan’s disease)
Cushing’s syndrome
Effect Main cause Signs and symptoms (4) Investigations (2) Diagnosis/results Treatment is based on whether primary/secondary cause - treatment types (2)
Raised steroid hormones (ACTH and cortisol, etc.)
Cushing’s disease
Diabetes features, HTN, purport/thin skin, muscle weakness
24hr urine sample, CRH test
Increased ACTH and cortisol
Tumour removal, enzyme inhibitors
Addison’s disease and acute adrenal crisis
Effect Cause Signs and symptoms (4) Investigations Positive synACTHen result when cortisol is not produced - gland destruction. Results of primary (2)/secondary hypo function Complications Management (2)
Reduced steroid hormones (ACTH and cortisol, etc.)
TB - autoimmune adrenalitis
Postural hypotension, weight loss, weakness, loss of body hair
24hr urine sample, CRH test
Reduced ACTH, raised cortisol (-synACTHen) - gland adenoma
Reduced ACTH and cortisol (+synACTHen) - pituitary failure)
Raised ACTH, reduced cortisol (-synACTHen) - gland failure
Hormone replacement
Acute adrenal crisis/Addisonian crisis
Hormone replacement (treat problem), fluid resuscitation
Causes of oral pigmentation (6)
Race, smoking, drugs (contraceptive pill), pregnancy, melanoma, chronic trauma
Cushing’s syndrome
Effect Main cause Signs and symptoms (4) Investigations (2) Diagnosis/results Treatment is based on whether primary/secondary cause - treatment types (2)
Raised steroid hormones (ACTH and cortisol, etc.)
Cushing’s disease
Diabetes features, HTN, purport/thin skin, muscle weakness
24hr urine sample, CRH test
Increased ACTH and cortisol
Tumour removal, enzyme inhibitors
Addison’s disease and acute adrenal crisis
Effect Cause Signs and symptoms (4) Investigations Positive synACTHen result when cortisol is not produced - gland destruction. Results of primary (2)/secondary hypo function Complications Management (2)
Reduced steroid hormones (ACTH and cortisol, etc.)
TB - autoimmune adrenalitis
Postural hypotension, weight loss, weakness, loss of body hair
24hr urine sample, CRH test
Reduced ACTH, raised cortisol (-synACTHen) - gland adenoma
Reduced ACTH and cortisol (+synACTHen) - pituitary failure)
Raised ACTH, reduced cortisol (-synACTHen) - gland failure
Hormone replacement
Acute adrenal crisis/Addisonian crisis
Hormone replacement (treat problem), fluid resuscitation
Causes of oral pigmentation (6)
Race, smoking, drugs (contraceptive pill), pregnancy, melanoma, chronic trauma
