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Clinical 4th Year > Chapter-5 Endocrinology > Flashcards

Chapter-5 Endocrinology Flashcards

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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
Symptoms of cushings
``` Moon face Buffalo hump Bruising and thin skin Lemon in match stick Hypertension Diabetes Low potassium Gastric ulcers ```
26
How do you treat cushings
Surgery | Metyrapone: cortisol synthesis inhibitor before surgery
27
Which bit of pituitary is more robust?
Posterior
28
What age do you reach peak bone mass
25
29
Who qualifies for growth hormone?
Must have proven underlying pathology- stimulation test must prove GH deficiency, low QoL AGDA score 3-9month trial with definite improvement in QoL AGDA
30
Patient has active malignancy should you give growth hormone replacement
NO - contraindicated
31
List side effects of growth hormone replacement
``` Peripheral oedema Arthralgia Carpal tunnel syndrome Globular tolerance Benign intracranial hypertension ```
32
What is polycythaemia
Testosterone stimulates RBC production in bone marrow, raised hematocrit and Hb can cause strokes
33
Is hydrocortisone long acting and how often is it given and why
No it's short acting, given TDS to mimic natural diurnal rhythm
34
When is cortisol highest?
Morning
35
Why do you double dose of hydrocortisone in hospital?
Stressed - need to mimic this - cortisol is stress hormone
36
A drop in hydrocortisone for at least 6 hrs can lead to what?
Adrenal crisis: drop BP
37
What are the hydrocortisone sick day rules
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
How does desmopressin work
Acts on kidney collecting ducts and tubules (ADH) to allow water reabsorption into the bloodstream
39
What two hormones does the posterior pituitary gland release
ADH | Oxytocin
40
Name 6 hormones the anterior pituitary releases
``` ACTH GH MSH TSH Gonadotropins (FSH,LH) ```
41
If someone has impaired thyroid hormones levels what do you need to determine
Cause: Primary- thyroid Secondary- pituitary Tertiary- hypothalamus
42
What's the role of the thyroid hormones?
Involved in metabolism | Growth and development
43
List the signs of hypothyroid
``` Facial swelling Hair loss Dry skin Reduced heart rate Husky voice Hypothermia Goitre ```
44
Give signs of hyperthyroid
``` Tremor Warm skin Agitation Goitre Exophthalmos Atrial fibrillation ```
45
Can hyperthyroidism cause atrial fibrillation?
Yeh!
46
What's the half life of T4
5-7 days
47
What's the half life of T3
1day
48
True or false: primary hypothyroidism is diagnosed using thyroid hormone levels (low) and TSH (high)
True
49
What is exophthalmos and what is it a sign of
Bulging of the eye - hyperthyroid
50
What is Graves' disease and what does it cause
Autoimmune condition causing hyperthyroid (thyrotoxicosis)
51
True/false: secondary hypothyroidism TSH would be high
False it would be low
52
Give four causes of primary hypothyroid
Hashimoto's thyroiditis (autoimmune) Anti-thyroid meds Thyroidectomy ADR to amiodarone
53
List symptoms of hypothyroid
``` Fatigue Constipation Weight gain Depression Menorrhagia Psychosis Hearing loss ```
54
Give symptoms of hyperthyroid
``` Palpitations Diarrhoea Weight loss Sweating Heat intolerance Hunger and thirst Anorexia ```
55
Which thyroid hormone is active in stimulating cells
T3
56
How do organs in the body that require thyroid hormones obtain it?
They have the ability to generate T3 by converting T4 by enzymes called deiodinases
57
Levothyroxine is a synthetic form of what?
Thyroxine (T4)
58
What are the main treatments for hyperthyroidism
1) medication to stop it producing too much thyroid hormone 2) radioiodine treatment 3) surgery
59
Name two thionamides used to treat hyperthyroid
Carbimazole | Propylthiouracil
60
When taking thionamides do you see the benefit immediately?
No after 1 or 2 months
61
What is used to relieve symptoms of hyperthyroid whilst waiting for thionamides to work
Beta-blocker
62
How does carbimazole work
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
Two drugs that can cause drug induced thyroid disease
Amiodarone | Lithium
64
How can amiodarone cause drug induced thyroid disease
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
True/false: cholestyramine can reduce the absorption of thyroxine
True
66
True or false: ferrous sulphate can increase the absorption of thyroxine
False it reduces it
67
Do glucocorticoids decrease TSH secretion?
Yeh
68
Does amiodarone have a long half life? How should you manage hyper and hypo thyroid on amiodarone?
Hypo- start levothyroxine | Hyper- stop amiodarone because carbimazole won't work for some reason
69
How does lithium cause hypothyroidism
1) increases intrathyroidal iodine content 2) inhibits coupling of iodotyrosine residues to form T3 and T4 3) inhibits release of T4 and T3
70
List patients which you should screen for thyroid condition
``` Amiodarone/lithium Diabetes AF Hyperlipidaemia Down's syndrome Turners syndrome Addison's disease ```
71
What does the adrenal medulla produce
noradrenaline | Adrenaline
72
What is Cushing's syndrome
``` Cushings disease (tumour) Exogenous steroid intake ```
73
What is Addison's disease
Lack of cortisol or mineralocorticoid
74
What is conns syndrome
Hyperaldosteronism
75
What is phaeocromocytoma
Tumour that causes excess release of adrenaline and noradrenaline
76
What does the adrenal cortex produce
Steroids: Corticosteroids Mineralocorticoids Sex hormones
77
Symptoms of addisons
``` Anorexia Weight loss Weakness DiZzy and low BP Arthralgia Low Na high K No fight or flight ```
78
In Addison's- to replace mineralocorticoid what should you give
Fludrocortisone
79
In Addison's what should you give for glucocorticoid replacement
Hydrocortisone
80
How to diagnose cushings
PMH Dexamethasone test Symptoms
81
In primary hypothyroidism why are TSH levels often high?
Cos low levels of T3 and T4 feed back to hypothalamus
82
Advantages and disadvantages of block and replace for hyperthyroid treatment
Negative: more tablets Positive: quicker onset
83
What monitoring is required for carbimazole
``` Fever Sore throat Bruising bleeding WCC Signs of infection ```
84
If hyperthyroid in pregnancy can you use block and replace?
NO just carbimazole

Clinical 4th Year (9 decks)

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