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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
Q

Management of hypothyroid?

A

Levothyroxine 50–1250–200 mcg/day

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26
Q

Why is T4 low in sick euthryoid?

A

Illnesses causes thyroid to shut down to reduce metabolic rate. Low T4, normal or high TSH

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27
Q

Treatment of Hyperthyroid?

A 
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
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28
Q

What investigation would be useful in high Thyroxine?

A

Technitium Scan (high uptake causes and low uptake causes)

29
Q

Other symptoms of Graves?

A
  • Thyroid acropachy
  • Pretibial Myxodema
  • Exophthalmos (because TSH receptors on back of eyes)
30
Q

What causes high thyroixine in Graves?

A

TSH Receptor antibodies stimulate TSH release

31
Q

What is thyroxine bound to in blood?

A

TBG (thyroid binding globulin)

Albumin

32
Q

Side effect of Propylthiouracil (PTU)?

A

Aplastic Anaemia

33
Q

What is the most common cause of hypothyroidism worldwide?

A

Iodine deficiency

34
Q

What treatment is used for DeQuervains Viral Thyroiditis?

A

Beta Blockers and NSAIDs

35
Q

2 markers for medullary thyroid carcinoma?

A

CEA and calcitonin

36
Q

3 types of thyroid cancer?

A

Papillary - Most common
Follicular
Medullary - Least common (MEN2 Ass.)

37
Q

Cells that medullary thyroid carcinoma originates in?

A

Parafollicular Cells

38
Q

Generic tumour marker for thyroid cancer?

A

Thyroglobulin

39
Q

Biochem of Conn’s?

A

Primary Hyperaldosteronism so HIGH Na and Low K

40
Q

Where does the ACTH come from if it is Cushing’s DISEASE?

A

From BRAIN i.e. pituitary adenoma

41
Q

Most common cause of Cushing’s Syndrome?

A

Steroid use (iatrogenic)

42
Q

4 causes of Cushing’s Syndrome?

A

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
Q

What is Low dose Dexamethasone Suppression test used for? How much do you give?

A

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
Q

What test distinguishes cushings disease and other causes?

A

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
Q

What might interfere with Dexamethasone Suppression test, leading to false positives?

A

Oestrogen

Phenytoin/Phenobarbitone - these drugs induce CYP3A4 which increases hepatic clearance of dexamethasone

46
Q

What investigation do you do for Conn’s?

A

Aldosterone: Renin Ratio. Will be high because high Aldosterone suppresses Renin.

47
Q

Management for Conn’s?

A

K sparing diuretics (spironolactone, amiloride)

48
Q

What is Addison’s?

A

Primary adrenal insufficiency - adrenals do not make enough cortisol

49
Q

Symptoms of Addison’s?

A

Skin pigmentation (due to high cleavage of POMC to make ACTH)
Hypotension (due to low cortisol)
Lethargy
Depression (cortisol is happy hormone)

50
Q

Investigation for Addison’s?

A

SynthACTHen test. If Cortisol rises = you’re normal. If cortisol does not rise = Addison’s.

51
Q

Management of Addison’s?

A

Hormone replacement therapy - corticosteroid replacement. Hydrocortisone/fludrocortisone

52
Q

What is pheochromacytoma (caused by)

A

Adrenal medulla tumour secreting catecholamines i.e. adrenaline

53
Q

Investigation for pheochromacytoma?

A

24 hour urinary catecholamine measurements and VMA and metanephrines

54
Q

Treatment of pheochromacytoma?

A

Alpha Blockade THEN Beta Blockade THEN surgery to remove the tumour

55
Q

Symptoms of Pheochromacytoma ?

A

Hypotension
Arrhythmias
Death

56
Q

Why can you not give B blockers in Pheochromacytoma before A blockers?

A

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
Q

which 3 tests are done fir diabetes?

A

OGTT
Fasting Plasma Glucose
HBA1c

58
Q

What is HbA1c in Diabetes mellitus?

A

HbA1c > 48

59
Q

What is OGTT in T2DM?

A

> 11.1

60
Q

What is Fasting Glucose in T2DM?

A

> 7.8

61
Q

What levels show impaired glucose tolerance?

A

OGTT >78 but less than 11.1

62
Q

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.

A

Acarbose leaving undigested sugar in the bowel giving wind as a side effect

63
Q

Acarbose leaving undigested sugar in the bowel giving wind as a side effect

A

Gliptins e.g. alogliptin

64
Q

What is C-peptide?

A

It is cleaved from Pro-insulin. Pro insulin is cleaved into c-peptide and insulin

65
Q

What does high levels of c-peptide in the blood indicate?

A

That endogenous insulin is being made

66
Q

What are endogenous causes of high insulin?

A

Insulinoma (rare)

Islet cell hyperplasia

67
Q

What do sulphonureas do?

A

Increase insulin from beta cells in pancreas

68
Q

If glucose is low, insulin is low and c-peptide is low. What could be the cause?

A 
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
Q

What are the expected blood results in a non-islet cell tumour ?

A 
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

AANIYA PATH (35 decks)

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