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Year 3 > Block 3 Endocrine > Flashcards

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

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2
Q

How to diagnose conditions associated with hormone deficiencies

A

Stimulation tests

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3
Q

When are cortisol levels highest?

A

In the morning

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4
Q

Where is IGF made?

A

In the Liver

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5
Q

What hormone normally suppresses prolactin release?

A

Dopamine as it has an inhibitory effect on prolactin release from the anterior pituitary

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6
Q

Three major conditions caused by secretions from pituitary adenomas?

A

Growth hormone excess
Prolactin excess
Excess ACTH - CUSHING’S DISEASE

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7
Q

Imaging of suspectied pituitary mass?

A

MRI

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8
Q

What is Kallmann’s syndrome?

A

Congenital deficiency of GnRH

Associated with anosmia

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9
Q

What two hormones are needed for life if hypothyroid

A

Hydrocortisone and levothyroxine

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10
Q

What level of prolactin imply a prolactin-secreting tumour?

A

500mU/L

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11
Q

What hormone does prolactin inhibit?

A

GnRH -so can cause oligo or amenorrhoea and erectile dysfunction

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12
Q

In hyperprolactinaemia what should you exclude?

A

Macroprolactinaemia - prolactin bound to IgG which is inactive

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13
Q

What common endocrine disorder can cause hyperprolactinaemia?

A

Hypothyroidism

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14
Q

Cause of acromegaly?

A

Benign pituitary GH-producing adenoma

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15
Q

Diagnostic test for acromegaly and gigantism

A

Glucose tolerance test: serum GH will be above 1mU/L

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16
Q

What hormone represses GH secretion?

A

somatosatin

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17
Q

Two common conditions that increase the total amount of TBG and free T4 in the blood?

A

Oestrogen so pregnancy and OCP

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18
Q

Thyroid levels in thyrotoxicosis

A

TSH low,T4 high, T3 high

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19
Q

Thyroid levels in primary hypothyroidism

A

TSH hight, T4 and T3 low or normal

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20
Q

Thyroid levels in TSH deficiency

A

TSH low, T4 low, T3 low

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21
Q

T3 toxicosis thyroid levels

A

TSH low, T4 normal, T3 high

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22
Q

Borderline hypothyroidism thyroid levels

A

TSH slightly high, T4 and T3 normal

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23
Q

Hypothyroidism is more common in which sex?

A

Women

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24
Q

Autoimmune thyroiditis with goitre

A

Hashimoto’s thyroiditis

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25
Q

Four drugs that cause hypothyroidism

A

carbimazole, lithium, amiodarone and interferon

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26
Q

In which medical conditions do you need to rule out hypothyroidism?

A

oligomenorrhoea/amenorrhoea, menorrhagia, infertility and hyperprolactinaemia

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27
Q

Aim of hypothyroid treatment with levothyroxine

A

TSH to normal level (T4 not as important)

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28
Q

Myxoedema coma effect on E and U

A

Hypoglycaemia and hyponatraemia

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29
Q

Three commonest intrinsic thyroid disorders leading to hyperthyroidism

A

Grave’s disease, toxic adenoma and toxic multinodualr goitre

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30
Q

Gave’s disease antibody

A

IgG to TSH receptor

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31
Q

Three features of thyroid acropachy

A

Clubbing, swollen fingers and periosteal new bone formation

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32
Q

Anti-thyroid drug used in the UK

A

Carbimazole

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33
Q

How long does Carbimazole take to work, and what does this mean?

A

It takes 10-20 days to work, so propranolol can be used for symptomatic relief

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34
Q

Side effect of carbaminazole

A

agranulocytosis so if unexplained fever or sore throat most go to gp

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35
Q

When is radioactive iodine treatment for hyperthyroidism contra indicated?

A

Pregnancy and while breast feeding

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36
Q

Pre thyroid surgery drug

A

potassium iodide

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37
Q

Treatment for thyroid storm

A

Carbamazole, propranolol, potassium iodide and hyrocortisone

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38
Q

What eye conditions happen in which thyroid diseases?

A

Lid lag happens in all hyperthyroidism. Exophthalmos and ophthalmoplegia only occur in patients with ophthalmic grave’s disease

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39
Q

What system is used to grade eye involvement in Grave’s disease?

A

NOSPECS

Look up and test

40
Q

A goitre with a… suggests malignant

A

associated lymphadenopathy

41
Q

How to test goitre

A

Blood test for thyroid function

Imaging ultrasound and FNA

42
Q

Commonest type of thyroid cancer

A

Papillary, which often effects young people

43
Q

What cells in testis make testosterone

A

Cells of Leydig under LH from anterior pituitary

44
Q

Enzyme deficiency in hypogonadism

A

5alpha-riductase

45
Q

Ejaculation innervation

A

Lumbar sympathetics

46
Q

Erection innervation

A

Pelvic parasympathetic

47
Q

First choice therapy for erectile dysfunction

A

Phosphodiesterase type-5 inhibitors e.g sildenafil, tadafil, vardenafil.

48
Q

Two drugs that cause gynaecomastia

A

Spironolactone and digoxin

49
Q

Serious causes of gynaecomastia

A

Bronchial carcinoma and testicular tumours

50
Q

What hormone stimulates ovarian androgen secretions?

A

LH and FSH under aromatase

51
Q

What does HRT increase the risk of?

A

Breast cancer, coronary heart disease, stroke and Venous thromboembolism

52
Q

Name a selective oestrogen receptor modulator used to treat osteoporosis

A

Raloxifene

53
Q

What is primary and secondary amenorrhoea?

A

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
Q

What is oligomenorrhoea?

A

Less than 9 periods a year ( common presentation of female hypogonadism)

55
Q

Most common cause of amenorrhoea and hypogonadism in females?

A

Polycystic ovarian syndrome

56
Q

Endocrine causes of amenorrhoea

A

Hypothyroidism, hyperprolaxtinaemia

57
Q

Name and causes of general increase in body hair

A

Hypertrichosis.

Can be racial e.g Mediterranean, drugs e.g cyclosporin, minoxidil and phenytoin. Anorexia nervosa.

58
Q

Name for male pattern body hair growth in females

A

Hirutism

59
Q

Most common cause of hirsutism in females

A

PCOS

60
Q

What other hormonal disturbances is PCOS associated with?

A

Hyper insulin anemia and insulin resistance

61
Q

Typical presentation of PCOS

A

Amenorrhoea and oligomenorrhoea, hirsutism and acne, also obesity

62
Q

What are the three criteria that you need two of to diagnose PCOS

A

Menstrual irregularity
Clinical or biochemical evidence of hyperandrogenism
Polycystic ovaries on ultrasounds

63
Q

Commonest cause of hirsutism?

A

PCOS

64
Q

Clinical diagnosis of PCOS?

A 
Menstraul irregularity (Amenorrhoea, oligomenorrhoea)
Hyperandrogenism e.g  hirsutism, acne, frontal balding and polycystic ovaries on ultrasound scan
65
Q

How to test for PCOS biochemically?

A

Raised free androgen index. Total testosterone level could stay the same

66
Q

Treatment for PCOS

A

Oestrogens such as the COP, or antiandrogens suchas cyproterone and spironolactone

67
Q

What is used to replace natural aldosterone in patients with primary adrenal insufficiency?

A

Fludrocortisone, is a mineralocorticoid

68
Q

Which hormone inhibits CRH and ACTH?

A

Cortisol

69
Q

Effect of cortisol on U And E

A

Increased secretion of potassium and increased retention of sodium

70
Q

What type of steroid is fludrocortisone?

A

A potent mineralocorticoid

71
Q

What is a name for primary hypoadrenalism?

A

Addison’s disease

72
Q

What sort of disease is Addison’s?

A

It is a autoimmune disease

73
Q

Clinical features of Addison’s

A

Lethargy, depression, anorexia and weight loss. Postural hypotension.

Hyperpigmentation from stimulation of melanocytes by ACTH

Can present as Addisonian crisis

74
Q

Presentation of addisonian crisis

A

Vomiting, abdominal pain, profound weakness, hypoglycaemia and hypovolaemic shock

75
Q

How to diagnose Addison’s

A

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
Q

Two drugs given for Addison’s

A

Hydrocortisone 15-25mg daily

Fludrocortisone 50-300mg daily

77
Q

Treatment for Addisonian crisis

A

Hydrocortisone 100mg I.V once cortisol and ACTH measured

78
Q

Key clinical key between primary and secondary hypoadrenalism

A

In secondary (e.g steroid use causing pituitary suppression’s) there is no ACTH so no hyperpigmentation

79
Q

Main cause of spontaneous Cushing’s syndrome

A

Pituitary ACTH production leading to cushings disease

80
Q

What actually causes Cushing’s syndrome

A

Over production of glucocorticoids

81
Q

Clinically what mimics Cushing’s syndrome very closely, and so is probably a good differential

A

Alcohol excess causing pseudo-Cushing’s syndrome

82
Q

Clinical features of Cushing’s

A 
Lemon on legs 
Moon face 
Buffalo hump 
Hypertension, hypokalaemia 
Pigmentation if ACTH dependent cause
83
Q

How to investigate Cushing’s syndrome

A

Confirm raised cortisol level by doing a 48-hour low-dose dexamethasone test, in Cushing’s, raised about 50nmol/l after.

84
Q

How to treat Cushing’s

A

Remove cause, e.g adrenalectomy or removal of pituitary gland.

85
Q

How to diagnose phaeochromocytoma

A

24 hour urine catecholamine test

86
Q

Diagnosis of acromegaly

A

OGTT - GH remains higher than 2 in hyperglycaemia

87
Q

Medical treatment for acromegaly (you would do surgery)

A

Somatostain analogous e.g octreotide

GH receptor antagonist - Pegvisomant

88
Q

autoimmune destruction of the adrenal glands

A

addisons disease

89
Q

Treatment for addisonian crisis and explination

A

high hydrocortisone 100mg i.v. Fludrocortison not needed as hydrocortisone has a weak mineralocorticoid effect

90
Q

Syndrome that leads to low potassium, polydipsia and failure to thrive

A

bartter’s syndrome - No potassium reabsorption at the loop of henlee, like taking chronic furosemide

91
Q

Mechanism of action and adverse effect of carbimazole

A

blocks thyroid peroxidase. Agranulocytosis

92
Q

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.

A

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
Q

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.

A

This lady has thyrotoxicosis (low TSH) and a hot solitary nodule indicating a toxic adenoma. Thyroid cancer rarely causes thyrotoxicosis or hot nodules.

94
Q

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.

A

Papillary carcinoma

95
Q

MEN-2 thyroid disease

A

Medullary thyroid cancer

Year 3 (26 decks)

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