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Clinical 4th Year > Chapter-5 Endocrinology > Flashcards

Chapter-5 Endocrinology Flashcards

1
Q

Name three thyroid hormones

A

Thyroxine (T4)
Triiodothyronine (T3)
Calcitonin

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2
Q

How are the thyroid hormones released (T4 & T3)

A

Hypothalamus secretes thyroid releasing hormone which stimulates the release of thyroid stimulating hormone from the anterior pituitary which obviously stimulates the release of T3 and T4 from the thyroid

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3
Q

What’s the problem with non-functioning pituitary tumours?

A

Cause problems but don’t produce hormones to detect it

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4
Q

Do functioning pituitary tumours produce hormones to detect it?

A

Yeh

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5
Q

When May pituitary infarction occur and why is it rare?

A

Someone’s post pregnancy, rare because it has a good blood supply

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6
Q

How can pituitary tumours cause visual problems

A

Where they press is where the retinal nerves cross, this causes visual field loss

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7
Q

What is the treatment for non-functional tumours

A

There is no pharmacological treatment just surgery: aim is to protect eyesight and restore pituitary function

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8
Q

What’s the most common functioning pituitary tumour

A

Prolactinomas

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9
Q

What is a prolactinoma?

A

Prolactin secreting tumours

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10
Q

What’s the role of prolactin

A

Acts as a contraceptive and post pregnancy

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11
Q

Symptoms of prolactinoma in women

A

Pressure effects (headache, vision)
Absent periods
Infertility
Galactorrhoea

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12
Q

Symptoms of prolactinoma in men

A 
Pressure effects (headache, vision) 
Erectile dysfunction 
Hypogonadotrophic 
Hypogonadism
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13
Q

What’s the rationale for using dopamine receptor agonists in prolactinomas

A

Prolactin is inhibited by release of dopamine from the hypothalamus

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14
Q

Name two ergot derived dopamine agonists used in prolactinomas

A

Cabergoline

Bromocriptine

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15
Q

Name a non-ergot derived dopamine agonist used in prolactinomas

A

Quinagolide

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16
Q

What are the problems with using dopamine agonists in prolactinomas

A

Concerns over valvular and retroperitoneal fibrosis (require baseline then annual echo)

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17
Q

When treating a woman with prolactinoma who wants to get pregnant which dopamine agonist is used and why

A

Bromocriptine is preferred because cabergoline has a long half life

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18
Q

What is acromegaly?

A

Growth hormone secreting pituitary tumours–> teeth separating, jaw growing, large lips, nose, hands

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19
Q

What is used to treat acromegaly

A

First line surgery

Somatostatin analogues may achieve control of growth hormone secretion

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20
Q

Name two somatostatin analogues used to treat acromegaly and what is their half life?

A

Octreotide
Lanreotide

Half life: 2hrs

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21
Q

What is somatostatin and what is it’s half life

A

Growth hormone inhibitory hormone

2 minutes!

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22
Q

To monitor patients with acromegaly response to somatostatin analogues what should you measure and why not GH?

A

Measure IGF-1

Because GH goes up and down throughout the day

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23
Q

What’s the only available growth hormone receptor antagonist

A

Pegvisomont

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24
Q

How do you monitor pegvisomont effects

A

IGF-1

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25
Q

Symptoms of cushings

A 
Moon face
Buffalo hump
Bruising and thin skin 
Lemon in match stick 
Hypertension 
Diabetes 
Low potassium 
Gastric ulcers
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26
Q

How do you treat cushings

A

Surgery

Metyrapone: cortisol synthesis inhibitor before surgery

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27
Q

Which bit of pituitary is more robust?

A

Posterior

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28
Q

What age do you reach peak bone mass

A

25

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29
Q

Who qualifies for growth hormone?

A

Must have proven underlying pathology- stimulation test must prove GH deficiency, low QoL AGDA score
3-9month trial with definite improvement in QoL AGDA

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30
Q

Patient has active malignancy should you give growth hormone replacement

A

NO - contraindicated

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31
Q

List side effects of growth hormone replacement

A 
Peripheral oedema 
Arthralgia 
Carpal tunnel syndrome 
Globular tolerance 
Benign intracranial hypertension
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32
Q

What is polycythaemia

A

Testosterone stimulates RBC production in bone marrow, raised hematocrit and Hb can cause strokes

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33
Q

Is hydrocortisone long acting and how often is it given and why

A

No it’s short acting, given TDS to mimic natural diurnal rhythm

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34
Q

When is cortisol highest?

A

Morning

35
Q

Why do you double dose of hydrocortisone in hospital?

A

Stressed - need to mimic this - cortisol is stress hormone

36
Q

A drop in hydrocortisone for at least 6 hrs can lead to what?

A

Adrenal crisis: drop BP

37
Q

What are the hydrocortisone sick day rules

A

Double dose if:

  • febrile illness
  • fractured limb
  • severe shock
  • long haul flight
  • surgery: IV then double dose
  • gastroenteritis: IM double dose
  • dental extraction 20mg
38
Q

How does desmopressin work

A

Acts on kidney collecting ducts and tubules (ADH) to allow water reabsorption into the bloodstream

39
Q

What two hormones does the posterior pituitary gland release

A

ADH

Oxytocin

40
Q

Name 6 hormones the anterior pituitary releases

A 
ACTH 
GH
MSH
TSH
Gonadotropins (FSH,LH)
41
Q

If someone has impaired thyroid hormones levels what do you need to determine

A

Cause:
Primary- thyroid
Secondary- pituitary
Tertiary- hypothalamus

42
Q

What’s the role of the thyroid hormones?

A

Involved in metabolism

Growth and development

43
Q

List the signs of hypothyroid

A 
Facial swelling 
Hair loss
Dry skin 
Reduced heart rate 
Husky voice 
Hypothermia 
Goitre
44
Q

Give signs of hyperthyroid

A 
Tremor 
Warm skin 
Agitation 
Goitre 
Exophthalmos 
Atrial fibrillation
45
Q

Can hyperthyroidism cause atrial fibrillation?

A

Yeh!

46
Q

What’s the half life of T4

A

5-7 days

47
Q

What’s the half life of T3

A

1day

48
Q

True or false: primary hypothyroidism is diagnosed using thyroid hormone levels (low) and TSH (high)

A

True

49
Q

What is exophthalmos and what is it a sign of

A

Bulging of the eye - hyperthyroid

50
Q

What is Graves’ disease and what does it cause

A

Autoimmune condition causing hyperthyroid (thyrotoxicosis)

51
Q

True/false: secondary hypothyroidism TSH would be high

A

False it would be low

52
Q

Give four causes of primary hypothyroid

A

Hashimoto’s thyroiditis (autoimmune)
Anti-thyroid meds
Thyroidectomy
ADR to amiodarone

53
Q

List symptoms of hypothyroid

A 
Fatigue
Constipation 
Weight gain 
Depression 
Menorrhagia 
Psychosis 
Hearing loss
54
Q

Give symptoms of hyperthyroid

A 
Palpitations 
Diarrhoea 
Weight loss 
Sweating 
Heat intolerance 
Hunger and thirst 
Anorexia
55
Q

Which thyroid hormone is active in stimulating cells

A

T3

56
Q

How do organs in the body that require thyroid hormones obtain it?

A

They have the ability to generate T3 by converting T4 by enzymes called deiodinases

57
Q

Levothyroxine is a synthetic form of what?

A

Thyroxine (T4)

58
Q

What are the main treatments for hyperthyroidism

A

1) medication to stop it producing too much thyroid hormone
2) radioiodine treatment
3) surgery

59
Q

Name two thionamides used to treat hyperthyroid

A

Carbimazole

Propylthiouracil

60
Q

When taking thionamides do you see the benefit immediately?

A

No after 1 or 2 months

61
Q

What is used to relieve symptoms of hyperthyroid whilst waiting for thionamides to work

A

Beta-blocker

62
Q

How does carbimazole work

A

Inhibits the organification of iodide and hence the synthesis of thyroid hormones. Also has mild immunosuppressive activity that reduces serum level of TSH receptor antibody

63
Q

Two drugs that can cause drug induced thyroid disease

A

Amiodarone

Lithium

64
Q

How can amiodarone cause drug induced thyroid disease

A

It inhibits the conversion of T4 to T3 and also it contains 40% iodine which can directly inhibit thyroid function (hypo) alternatively it can cause hyper via an inflammatory process

65
Q

True/false: cholestyramine can reduce the absorption of thyroxine

A

True

66
Q

True or false: ferrous sulphate can increase the absorption of thyroxine

A

False it reduces it

67
Q

Do glucocorticoids decrease TSH secretion?

A

Yeh

68
Q

Does amiodarone have a long half life? How should you manage hyper and hypo thyroid on amiodarone?

A

Hypo- start levothyroxine

Hyper- stop amiodarone because carbimazole won’t work for some reason

69
Q

How does lithium cause hypothyroidism

A

1) increases intrathyroidal iodine content
2) inhibits coupling of iodotyrosine residues to form T3 and T4
3) inhibits release of T4 and T3

70
Q

List patients which you should screen for thyroid condition

A 
Amiodarone/lithium 
Diabetes
AF 
Hyperlipidaemia
Down's syndrome 
Turners syndrome 
Addison's disease
71
Q

What does the adrenal medulla produce

A

noradrenaline

Adrenaline

72
Q

What is Cushing’s syndrome

A 
Cushings disease (tumour)
Exogenous steroid intake
73
Q

What is Addison’s disease

A

Lack of cortisol or mineralocorticoid

74
Q

What is conns syndrome

A

Hyperaldosteronism

75
Q

What is phaeocromocytoma

A

Tumour that causes excess release of adrenaline and noradrenaline

76
Q

What does the adrenal cortex produce

A

Steroids:
Corticosteroids
Mineralocorticoids
Sex hormones

77
Q

Symptoms of addisons

A 
Anorexia 
Weight loss
Weakness
DiZzy and low BP
Arthralgia 
Low Na high K 
No fight or flight
78
Q

In Addison’s- to replace mineralocorticoid what should you give

A

Fludrocortisone

79
Q

In Addison’s what should you give for glucocorticoid replacement

A

Hydrocortisone

80
Q

How to diagnose cushings

A

PMH
Dexamethasone test
Symptoms

81
Q

In primary hypothyroidism why are TSH levels often high?

A

Cos low levels of T3 and T4 feed back to hypothalamus

82
Q

Advantages and disadvantages of block and replace for hyperthyroid treatment

A

Negative: more tablets
Positive: quicker onset

83
Q

What monitoring is required for carbimazole

A 
Fever 
Sore throat
Bruising bleeding 
WCC 
Signs of infection
84
Q

If hyperthyroid in pregnancy can you use block and replace?

A

NO just carbimazole

Clinical 4th Year (9 decks)

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