Block 3 Endocrine Flashcards
1
Q
How to test if someone has a hormone producing tumour?
A
Try to suppress the produced hormone as they fail to show negative feedback
2
Q
How to diagnose conditions associated with hormone deficiencies
A
Stimulation tests
3
Q
When are cortisol levels highest?
A
In the morning
4
Q
Where is IGF made?
A
In the Liver
5
Q
What hormone normally suppresses prolactin release?
A
Dopamine as it has an inhibitory effect on prolactin release from the anterior pituitary
6
Q
Three major conditions caused by secretions from pituitary adenomas?
A
Growth hormone excess
Prolactin excess
Excess ACTH - CUSHING’S DISEASE
7
Q
Imaging of suspectied pituitary mass?
A
MRI
8
Q
What is Kallmann’s syndrome?
A
Congenital deficiency of GnRH
Associated with anosmia
9
Q
What two hormones are needed for life if hypothyroid
A
Hydrocortisone and levothyroxine
10
Q
What level of prolactin imply a prolactin-secreting tumour?
A
500mU/L
11
Q
What hormone does prolactin inhibit?
A
GnRH -so can cause oligo or amenorrhoea and erectile dysfunction
12
Q
In hyperprolactinaemia what should you exclude?
A
Macroprolactinaemia - prolactin bound to IgG which is inactive
13
Q
What common endocrine disorder can cause hyperprolactinaemia?
A
Hypothyroidism
14
Q
Cause of acromegaly?
A
Benign pituitary GH-producing adenoma
15
Q
Diagnostic test for acromegaly and gigantism
A
Glucose tolerance test: serum GH will be above 1mU/L
16
Q
What hormone represses GH secretion?
A
somatosatin
17
Q
Two common conditions that increase the total amount of TBG and free T4 in the blood?
A
Oestrogen so pregnancy and OCP
18
Q
Thyroid levels in thyrotoxicosis
A
TSH low,T4 high, T3 high
19
Q
Thyroid levels in primary hypothyroidism
A
TSH hight, T4 and T3 low or normal
20
Q
Thyroid levels in TSH deficiency
A
TSH low, T4 low, T3 low
21
Q
T3 toxicosis thyroid levels
A
TSH low, T4 normal, T3 high
22
Q
Borderline hypothyroidism thyroid levels
A
TSH slightly high, T4 and T3 normal
23
Q
Hypothyroidism is more common in which sex?
A
Women
24
Q
Autoimmune thyroiditis with goitre
A
Hashimoto’s thyroiditis
25
Four drugs that cause hypothyroidism
carbimazole, lithium, amiodarone and interferon
26
In which medical conditions do you need to rule out hypothyroidism?
oligomenorrhoea/amenorrhoea, menorrhagia, infertility and hyperprolactinaemia
27
Aim of hypothyroid treatment with levothyroxine
TSH to normal level (T4 not as important)
28
Myxoedema coma effect on E and U
Hypoglycaemia and hyponatraemia
29
Three commonest intrinsic thyroid disorders leading to hyperthyroidism
Grave's disease, toxic adenoma and toxic multinodualr goitre
30
Gave's disease antibody
IgG to TSH receptor
31
Three features of thyroid acropachy
Clubbing, swollen fingers and periosteal new bone formation
32
Anti-thyroid drug used in the UK
Carbimazole
33
How long does Carbimazole take to work, and what does this mean?
It takes 10-20 days to work, so propranolol can be used for symptomatic relief
34
Side effect of carbaminazole
agranulocytosis so if unexplained fever or sore throat most go to gp
35
When is radioactive iodine treatment for hyperthyroidism contra indicated?
Pregnancy and while breast feeding
36
Pre thyroid surgery drug
potassium iodide
37
Treatment for thyroid storm
Carbamazole, propranolol, potassium iodide and hyrocortisone
38
What eye conditions happen in which thyroid diseases?
Lid lag happens in all hyperthyroidism. Exophthalmos and ophthalmoplegia only occur in patients with ophthalmic grave's disease
39
What system is used to grade eye involvement in Grave's disease?
NOSPECS
| Look up and test
40
A goitre with a... suggests malignant
associated lymphadenopathy
41
How to test goitre
Blood test for thyroid function
| Imaging ultrasound and FNA
42
Commonest type of thyroid cancer
Papillary, which often effects young people
43
What cells in testis make testosterone
Cells of Leydig under LH from anterior pituitary
44
Enzyme deficiency in hypogonadism
5alpha-riductase
45
Ejaculation innervation
Lumbar sympathetics
46
Erection innervation
Pelvic parasympathetic
47
First choice therapy for erectile dysfunction
Phosphodiesterase type-5 inhibitors e.g sildenafil, tadafil, vardenafil.
48
Two drugs that cause gynaecomastia
Spironolactone and digoxin
49
Serious causes of gynaecomastia
Bronchial carcinoma and testicular tumours
50
What hormone stimulates ovarian androgen secretions?
LH and FSH under aromatase
51
What does HRT increase the risk of?
Breast cancer, coronary heart disease, stroke and Venous thromboembolism
52
Name a selective oestrogen receptor modulator used to treat osteoporosis
Raloxifene
53
What is primary and secondary amenorrhoea?
Primary amenorrhoea is when periods don’t start before the age of 15.
Secondary amenorrhoea is when they stop for three months in someone that normally has them
54
What is oligomenorrhoea?
Less than 9 periods a year ( common presentation of female hypogonadism)
55
Most common cause of amenorrhoea and hypogonadism in females?
Polycystic ovarian syndrome
56
Endocrine causes of amenorrhoea
Hypothyroidism, hyperprolaxtinaemia
57
Name and causes of general increase in body hair
Hypertrichosis.
Can be racial e.g Mediterranean, drugs e.g cyclosporin, minoxidil and phenytoin. Anorexia nervosa.
58
Name for male pattern body hair growth in females
Hirutism
59
Most common cause of hirsutism in females
PCOS
60
What other hormonal disturbances is PCOS associated with?
Hyper insulin anemia and insulin resistance
61
Typical presentation of PCOS
Amenorrhoea and oligomenorrhoea, hirsutism and acne, also obesity
62
What are the three criteria that you need two of to diagnose PCOS
Menstrual irregularity
Clinical or biochemical evidence of hyperandrogenism
Polycystic ovaries on ultrasounds
63
Commonest cause of hirsutism?
PCOS
64
Clinical diagnosis of PCOS?
```
Menstraul irregularity (Amenorrhoea, oligomenorrhoea)
Hyperandrogenism e.g hirsutism, acne, frontal balding and polycystic ovaries on ultrasound scan
```
65
How to test for PCOS biochemically?
Raised free androgen index. Total testosterone level could stay the same
66
Treatment for PCOS
Oestrogens such as the COP, or antiandrogens suchas cyproterone and spironolactone
67
What is used to replace natural aldosterone in patients with primary adrenal insufficiency?
Fludrocortisone, is a mineralocorticoid
68
Which hormone inhibits CRH and ACTH?
Cortisol
69
Effect of cortisol on U And E
Increased secretion of potassium and increased retention of sodium
70
What type of steroid is fludrocortisone?
A potent mineralocorticoid
71
What is a name for primary hypoadrenalism?
Addison’s disease
72
What sort of disease is Addison’s?
It is a autoimmune disease
73
Clinical features of Addison’s
Lethargy, depression, anorexia and weight loss. Postural hypotension.
Hyperpigmentation from stimulation of melanocytes by ACTH
Can present as Addisonian crisis
74
Presentation of addisonian crisis
Vomiting, abdominal pain, profound weakness, hypoglycaemia and hypovolaemic shock
75
How to diagnose Addison’s
Short ACTH test - would show no rise in cortisol - use tetracosatide to test.
ACTH level taken, if high confirms Addison’s
Blood test show hyponatraemia and hyperkalaemia and raised urea.
If CXR shows evidence of TB think calcified Kidneys, to Addison’s
76
Two drugs given for Addison’s
Hydrocortisone 15-25mg daily
| Fludrocortisone 50-300mg daily
77
Treatment for Addisonian crisis
Hydrocortisone 100mg I.V once cortisol and ACTH measured
78
Key clinical key between primary and secondary hypoadrenalism
In secondary (e.g steroid use causing pituitary suppression’s) there is no ACTH so no hyperpigmentation
79
Main cause of spontaneous Cushing’s syndrome
Pituitary ACTH production leading to cushings disease
80
What actually causes Cushing’s syndrome
Over production of glucocorticoids
81
Clinically what mimics Cushing’s syndrome very closely, and so is probably a good differential
Alcohol excess causing pseudo-Cushing’s syndrome
82
Clinical features of Cushing’s
```
Lemon on legs
Moon face
Buffalo hump
Hypertension, hypokalaemia
Pigmentation if ACTH dependent cause
```
83
How to investigate Cushing’s syndrome
Confirm raised cortisol level by doing a 48-hour low-dose dexamethasone test, in Cushing’s, raised about 50nmol/l after.
84
How to treat Cushing’s
Remove cause, e.g adrenalectomy or removal of pituitary gland.
85
How to diagnose phaeochromocytoma
24 hour urine catecholamine test
86
Diagnosis of acromegaly
OGTT - GH remains higher than 2 in hyperglycaemia
87
Medical treatment for acromegaly (you would do surgery)
Somatostain analogous e.g octreotide
| GH receptor antagonist - Pegvisomant
88
autoimmune destruction of the adrenal glands
addisons disease
89
Treatment for addisonian crisis and explination
high hydrocortisone 100mg i.v. Fludrocortison not needed as hydrocortisone has a weak mineralocorticoid effect
90
Syndrome that leads to low potassium, polydipsia and failure to thrive
bartter's syndrome - No potassium reabsorption at the loop of henlee, like taking chronic furosemide
91
Mechanism of action and adverse effect of carbimazole
blocks thyroid peroxidase. Agranulocytosis
92
A 34-year-old female presents with a thyroid nodule. She has a family history of thyroid disease and both her sisters have undergone total thyroidectomies. Her past medical history includes hypertension which has been difficult to manage.
his is a typical scenario for medullary carcinoma in which a phaeochromocytoma may also be present. It may be inherited in an autosomal dominant fashion and affected family members may be offered prophylactic thyroidectomy.
93
A 52-year-old woman presents with a neck swelling. Her GP reports that her TSH value is low at 0.01 mu/l. A scintigraphy demonstrates a hot nodule.
This lady has thyrotoxicosis (low TSH) and a hot solitary nodule indicating a toxic adenoma. Thyroid cancer rarely causes thyrotoxicosis or hot nodules.
94
An 18-year-old female presents with 3 nodules in the right lobe of the thyroid. Clinically she is euthyroid and there is associated cervical lymphadenopathy. She has no family history of thyroid disease.
Papillary carcinoma
95
MEN-2 thyroid disease
Medullary thyroid cancer
