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AANIYA PATH > Aani CP: Endocrine > Flashcards

Aani CP: Endocrine Flashcards

1
Q

Which test do you do for pituitary function?

A

Triple test

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2
Q

What are the components of the triple test for pituitary function?

A
  • IV insulin 0.15 Units/kg
  • GnRH (100mg)
  • TRH (200mcg)
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3
Q

Contraindications to the triple test?

A
  • Ischaemic heart disease (hypo will cause MI)
  • Epilepsy (hypoglycaemia will cause fit)
  • Untreated hypothryoid
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4
Q

At what level does glucose stimulate pituitary?

A

<2.2

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5
Q

What happens in the triple test?

A

Insulin causes glucose to drop and then adrenaline is released

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6
Q

Side effects of triple test?

A

Aggressive, palps, sweaty, convulsions

TRH - metallic taste, nausea

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7
Q

What happens if glucose goes too low in triple test?

A

Rescue them with 50ml 20% dextrose - wide bore green cannula already in place

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8
Q

What should happen in order to raise glucose levels in triple test?

A

ACTH and GH should rise –> cortisol and GH increase glucose release to normalise glucose levels.
Cortisol shouldl get to 170-500nmol/l
GH should get to 6mcg/l

These rise in response to insulin lowering blood glucose

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9
Q

How high should a normal person’s cortisol get in response to the triple test?

A

Over 500nmol/l

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10
Q

In response to the triple test, if someone’s TSH remains low, what is the underlying diagnosis?

A

Hyperthryroidism because it is suppressing the TSH despite the action of TRH

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11
Q

If someone has 6000 prolactin, what do they have?

A

Prolactinoma

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12
Q

Which hormones are raised in acromegaly?

A

GH and prolactin

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13
Q

How to test if someone has acromegaly (test with hormones)?

A

GTT. Giving glucose should lower GH to 0 or undetectable e.g <0.3mcg.
If it does not = GH excess

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14
Q

What does TRH do?

A

Increases TSH and prolactin

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15
Q

What does prolactin do?

A 
Secretion of milk 
Inhibits GnRH (causing amenorrhoea)
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16
Q

Treatment of pituitary adenoma?

A

Depends if it is secreting hormones.
Prolactin secreting? Give dopamine agonists e.g. Bromocriptine/Cabergoline
GH secreting? Give octreotide (mimics somatostatin) /surgery/radiotherapy

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17
Q

Side effects of dopamine agonists?

A

Excess dopamine = think manic. Super powers, gambling etc.

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18
Q

What does the prolactin level need to be to diagnose a functioning pituitary adenoma?

A

> 5000

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19
Q

If large pituitary tumour does not have high prolactin, what is it?

A

Non-functioning pituitary adenoma

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20
Q

Why are the prolactin levels still high in a non-functioning pituitary adenoma?

A

Because it is pressing on the pituitary stalk so dopamine cannot be released and so dopamine cannot suppress prolactin. = Secondary Hyperprolactinaemia

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21
Q

Which antibodies are in Hashimotos?

A

Anto Thyroid Peroxidase (Anti-TPO)

Hypothyroid - Low T4, high TSH

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22
Q

Which antibodies are in Graves?

A

TRAbs - Thyrotropin Receptor Antibodies

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23
Q

What is the T4 and TSH of subclincial Hypothyroid?

A

Normal T4
High TSH
May also have TPO Abs (susceptible to getting Hashimotos)

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24
Q

Why might a pregnant lady have low TSH?

A

hCG acts like TSH and stimulates T4 release (especially if high HCG). This feeds back and reduces TSH release

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25
Management of hypothyroid?
Levothyroxine 50--1250--200 mcg/day
26
Why is T4 low in sick euthryoid?
Illnesses causes thyroid to shut down to reduce metabolic rate. Low T4, normal or high TSH
27
Treatment of Hyperthyroid?
``` Depends on cause. Always give Beta Blockers. In low uptake hyper - treat symptoms In high uptake - give Radioactive Iodine. OR drugs OR surgery Thionamines: - Carbimazole - Propylthiouracil (PTU) - not used often because of aplastic anaemia risk ```
28
What investigation would be useful in high Thyroxine?
Technitium Scan (high uptake causes and low uptake causes)
29
Other symptoms of Graves?
- Thyroid acropachy - Pretibial Myxodema - Exophthalmos (because TSH receptors on back of eyes)
30
What causes high thyroixine in Graves?
TSH Receptor antibodies stimulate TSH release
31
What is thyroxine bound to in blood?
TBG (thyroid binding globulin) | Albumin
32
Side effect of Propylthiouracil (PTU)?
Aplastic Anaemia
33
What is the most common cause of hypothyroidism worldwide?
Iodine deficiency
34
What treatment is used for DeQuervains Viral Thyroiditis?
Beta Blockers and NSAIDs
35
2 markers for medullary thyroid carcinoma?
CEA and calcitonin
36
3 types of thyroid cancer?
Papillary - Most common Follicular Medullary - Least common (MEN2 Ass.)
37
Cells that medullary thyroid carcinoma originates in?
Parafollicular Cells
38
Generic tumour marker for thyroid cancer?
Thyroglobulin
39
Biochem of Conn's?
Primary Hyperaldosteronism so HIGH Na and Low K
40
Where does the ACTH come from if it is Cushing's DISEASE?
From BRAIN i.e. pituitary adenoma
41
Most common cause of Cushing's Syndrome?
Steroid use (iatrogenic)
42
4 causes of Cushing's Syndrome?
Endogenous (overproduction of cortisol) : 1. Pituitary adenoma (Cushing's Disease) 2. Adrenal Adenoma (will have low ACTH) 3. Ectopic ACTH secretion from another tumour e.g. Lung Exogenous: 1. Steroid use
43
What is Low dose Dexamethasone Suppression test used for? How much do you give?
To see if someone has Cushings Syndrome. Give 0.5mg Dex every 6 hours for 48 hours. If cortisol is suppressed, you are NORMAL yey. If not, you have CUSHINGS SYNDROME do high dose Dex to determine cause.
44
What test distinguishes cushings disease and other causes?
High dose dexamethasone suppression test. 2mg every 6 hours for 48 hours. If cortisol falls by 50% you have pituitary dependent cushings disease. If cortisol is not supressed then it is an adrenal adenoma or ectopic ACTH from another source.
45
What might interfere with Dexamethasone Suppression test, leading to false positives?
Oestrogen | Phenytoin/Phenobarbitone - these drugs induce CYP3A4 which increases hepatic clearance of dexamethasone
46
What investigation do you do for Conn's?
Aldosterone: Renin Ratio. Will be high because high Aldosterone suppresses Renin.
47
Management for Conn's?
K sparing diuretics (spironolactone, amiloride)
48
What is Addison's?
Primary adrenal insufficiency - adrenals do not make enough cortisol
49
Symptoms of Addison's?
Skin pigmentation (due to high cleavage of POMC to make ACTH) Hypotension (due to low cortisol) Lethargy Depression (cortisol is happy hormone)
50
Investigation for Addison's?
SynthACTHen test. If Cortisol rises = you're normal. If cortisol does not rise = Addison's.
51
Management of Addison's?
Hormone replacement therapy - corticosteroid replacement. Hydrocortisone/fludrocortisone
52
What is pheochromacytoma (caused by)
Adrenal medulla tumour secreting catecholamines i.e. adrenaline
53
Investigation for pheochromacytoma?
24 hour urinary catecholamine measurements and VMA and metanephrines
54
Treatment of pheochromacytoma?
Alpha Blockade THEN Beta Blockade THEN surgery to remove the tumour
55
Symptoms of Pheochromacytoma ?
Hypotension Arrhythmias Death
56
Why can you not give B blockers in Pheochromacytoma before A blockers?
If you give B blockers first, the heart contractility will reduce (good). But then in response, the vessels will constrict (alpha mediated) and you could get a hypertensive crisis. You don't get vasodilation because the B mediated dilation is blocked by the beta blockers.
57
which 3 tests are done fir diabetes?
OGTT Fasting Plasma Glucose HBA1c
58
What is HbA1c in Diabetes mellitus?
HbA1c > 48
59
What is OGTT in T2DM?
> 11.1
60
What is Fasting Glucose in T2DM?
>7.8
61
What levels show impaired glucose tolerance?
OGTT >78 but less than 11.1
62
Name the drug used for patients with type 2 diabetes which inhibits the enzyme alpha glucosidase in the brush border membrane of the small bowel.
Acarbose leaving undigested sugar in the bowel giving wind as a side effect
63
Acarbose leaving undigested sugar in the bowel giving wind as a side effect
Gliptins e.g. alogliptin
64
What is C-peptide?
It is cleaved from Pro-insulin. Pro insulin is cleaved into c-peptide and insulin
65
What does high levels of c-peptide in the blood indicate?
That endogenous insulin is being made
66
What are endogenous causes of high insulin?
Insulinoma (rare) | Islet cell hyperplasia
67
What do sulphonureas do?
Increase insulin from beta cells in pancreas
68
If glucose is low, insulin is low and c-peptide is low. What could be the cause?
``` When glucose is low. Body turns off insulin production so low C-peptide is normal. This could be caused by: fasting exercise illness anorexia hypo-pituitaty disorder ```
69
What are the expected blood results in a non-islet cell tumour ?
``` Low glucose Low insulin Low c-peptide Low ketones Low FFA (free fatty acids) The Big IGF-2 binds to IGF-1 receptors and insulin receptors acting like insulin ```

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