6. Endocrine Flashcards
Common conditions of the endocrine system (9)
- Antidiuretic hormone disorders
- Corticosteroid responsive conditions
- Diabetes mellitus and hypoglycaemia
- Bone metabolism disorders
- Dopamine responsive conditions
- Gonadotrophin responsive conditions
- Hypothalamic and anterior pituitary hormone related disorders
- Sex hormone responsive conditions
- Thyroid disorders
The endocrine system (10)
- Hypothalamus
- Pituitary
- Pineal gland
- Thymus
- Ovaries/ testicles
- Pancreas
- Adrenal glands
- Parathyroid
- Thyroid
Common antidiuretic hormone disorders (2)
- Diabetes insipidus
2. SIADH
Common corticosteroid responsive conditions (1)
Cushing’s disease
Common gonadotrophin responsive conditions
- Hereditary angioedma
Common hypothalamic and anterior pituitary hormone disorders (4)
- Adrenocortical function testing
- Assessment of pituitary function
- Gonadotrophin replacement therapy
- Growth hormone disorders
Common sex hormone responsive conditions (2)
- Female sex hormone responsive conditions (Antioestrogens)
2. Male sex hormone responsive conditions (Male sex hormone antagonism)
Common thyroid disorders (2)
- Hyperthyroidism
2. Hypothyroidism
Commonly used drugs prescribed for endocrine conditions (18)
- Vasopressin and analogues
- Systemic corticosteroids
- Enzyme inhibitors
- Insulins
- Non-insulin diabetic drugs
- Glucagon
- Anabolic steroids
- Bisphosphonates
- Monoclonal antibodies
- Gonadotrophin releasing hormones
- Corticotropins
- Human growth hormones
- HRT
- Ovulation stimulation
- Androgens
- Sulfur containing imidazoles
- Thiouracils
- Thyroid hormones
Types of insulin (3)
- Short acting
- Intermediate acting
- Long acting
Types of non-insulin diabetic drug (6)
- Biguanides
- Gliptins
- GLP-1 receptor agonists
- Sulfonylureas
- Pioglitazone
- SGLT-2 inhibitors
Antidiuretic hormone
Vasopressin
Hormone produced by hypothalamus, stored in pituitary in response to increased osmolality. Works at distal convoluted tubule. Causes aquaporin-2s to increase water (and salt) reuptake.
What is diabetes insipidus?
Decreased production of/ response to ADH.
2 types: cranial where insufficient production (e.g. by trauma) and nephrogenic where insufficient response at kidney (e.g. by lithium)
Signs and symptoms of diabetes insipidus (2)
- Polyuria
2. Polydipsia
Polyuria
Increased urination
Polydipsia
Increased thirst
Management of diabetes insipidus (3)
- For cranial: vasopressin analogue: desmopressin (more potent and longer action than ADH, no vasoconstrictor effect)
- For nephrogenic: thiazide diuretics (paradoxically!)
- For nephrogenic: carbamazepine (unlicensed)
Desmopressin for differential diagnosis of diabetes insipidus
If there’s a response, it is cranial. If no response, nephrogenic (as the issue isn’t release, it’s inability to respond).
What is syndrome of inappropriate ADH secretion?
Lack of negative feedback system. Continual ADH production, independent of serum osmolality. Causes hyponatremia as salt diluted in greater volume of water.
May be caused by brain injury, drugs, infection, hypothyroidism and malignancy.
Signs and symptoms of ADH (1)
Not really anything. 1. Hyponatremia symptoms if any. These include nausea, vomiting, headache, anorexia and lethargy, muscle cramps, weakness, ataxia, drowsiness, seizures and coma.
Management of SIADH
- Remove underlying cause
- Fluid restriction
- Demeclocycline - acts by directly blocking renal tubular effect of ADH
- Tolvaptan - a vasopresin V2 receptor antagonist (make sure this isn’t too rapid, need to measure serm concentration)
Examples of vasopressin and analogues (2)
- Desmopressin
2. Vasopressin
