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Endocrinology > Disease > Flashcards

Disease Flashcards

1
Q

What is the main cause of acromegaly?

A

90% = benign pituitary adenoma

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2
Q

What is prognanthism?

A

Protusion of the mandible, seen in acromegaly

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3
Q

What is Cushing’s syndrome?

A

A disease state caused by excess cortisol

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4
Q

What is the most common cause of Cushing’s syndrome?

A

Exogenous steroids

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5
Q

What is the most common endogenous cause of Cushing’s syndrome?

A

Pituitary adenoma

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6
Q

What is Cushing’s disease?

A

Pituitary adenoma resulting excess cortisol production

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7
Q

What are the causes of Cushing’s syndrome?

A

Exogenous steroids
Ectopic ACTH production
Adrenal adenoma/carcinoma
Pituitary adenoma

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8
Q

Which causes of Cushing’s syndrome are due to excess ACTH?

A

Pituitary adenoma, ectopic ACTH secreting tumour

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9
Q

Which causes of Cushing’s syndrome are due to corticosteroid excess and are not ACTH dependent?

A

Exogenous steroids, adrenal adenoma/carcinoma

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10
Q

What is the role of low dose (1mg) dexamethasone suppression test?

A

Test for Cushing’s syndrome - if you administer dexamethasone and the morning cortisol is normal or high then Cushing’s syndrome is present

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11
Q

What does it mean if a patient has low cortisol after a low dose dexamethasone suppression test?

A

They do not have Cushing’s syndrome

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12
Q

What does it mean if a patient has normal cortisol after a low dose dexamethasone suppression test?

A

They have Cushing’s syndrome

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13
Q

What does it mean if a patient has high cortisol after a low dose dexamethasone suppression test?

A

They have Cushing’s syndrome

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14
Q

Why might you perform a 24 urinary cortisol?

A

To assess for Cushing’s syndrome

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15
Q

What are the tests for Cushing Syndrome?

A

24 hour urinary cortisol, low dose dexamethasone suppression test, late night salivary cortisol

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16
Q

What are the doses for the low and high dose dexamethasone tests?

A 
Low = 1mg
High = 8mg
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17
Q

What is the role of the high dose dexamethasone suppression test?

A

To differentiate causes of Cushing’s syndrome

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18
Q

What does it mean if a patient has low cortisol after a high dose dexamethasone suppression test?

A

Pituitary adenoma - Cushing’s disease i.e. dexamethasone is sufficient to suppress the ACTH production

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19
Q

What does it mean if a patient has high cortisol after a high dose dexamethasone suppression test?

A

The patient either has an ectopic ACTH producing tumour or an adrenal tumour or exogenous steroids

20
Q

How is ACTH level useful in differentiating between different causes of Cushing’s syndrome?

A

ACTH will be high in an ectopic tumour but low in an adrenal tumour

21
Q

What is Addison’s disease?

A

Adrenal insufficiency i.e. low cortisol

22
Q

What are the biochemical features of Addison’s disease?

A

Low sodium, Low sugar, Low BP

High Potassium, High Calcium, Metabolic acidosis

23
Q

Why do you see hyperpigmentation in Addison’s disease?

A

Increased ACTH production

24
Q

How commonly is hypertension caused by phaeochromocytoma?

A

0.1% of HTN cases are caused by phaeochromocytoma

25
Q

How does Conn’s syndrome effect BP, potassium and sodium levels?

A

Low potassium
Low BP
High Sodium

26
Q

How does Addison’s disease effect BP potassium and sodium levels?

A

High potassium
High BP
Low sodium

27
Q

How does Conn’s syndrome effect BP?

A

Hypertension

28
Q

How does Addison’s disease effect BP?

A

Hypotension

29
Q

What is the most common cause of primary hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia

30
Q

What is conn’s syndrome?

A

Primary hyperaldosteronism caused by an adrenal adenoma

31
Q

What causes secondary hyperaldosteronism?

A

Caused by excess secretion of renin due to either renal artery stenosis or a renin secreting tumour

32
Q

Describe the biochemical features of addisons disease

A

Low mineralcorticoid = potassium retention and sodium and water loss, leading to high H+ ions and hypercalcaemia I.e high K+, low Na+, low BP, Metabolic acidosis, high Ca2+
Low glucocorticoid - low gluconeogenesis = hypoglycaemia

33
Q

What is the most common cause of Addison’s disease?

A

Autoimmune adrenalitis leading to low production of glucocorticosteroid and mineralcorticosteroid

34
Q

What are the signs and symptoms of Addison’s disease?

A

Muscle and joint pain, anxiety/personality change, hypotension, weight loss, hyperpigmentation

35
Q

Which types of adrenal insufficiency don’t cause hyperpigmentation?

A

Secondary - low ACTH production from hypothalamus

Tertiary - low CRH production from hypothalamus

36
Q

Why is hyperpigmentation associated with Addison’s disease?

A

Primary adrenal insufficiency leads to decrease in both mineralcorticosteroid and glucocorticosteroid production causing increased production of ACTH which causes hyperpigmentation

37
Q

What is the cause of congenital adrenal hyperplasia?

A

Deficiency in alpha 21-hydroxylase (in 90% of cases)

38
Q

What is the aetiology for congenital adrenal hyperplasia?

A

Autosomal recessive condition

39
Q

Which hormones are affected in congenital adrenal hyperplasia?

A

Deficiency in cortisol and aldosterone
Excess androgen
Excess ACTH

40
Q

What are the consequences of the hormone changes in congenital adrenal hyperplasia?

A

Deficiency in cortisol = increase in ACTH and hypoglycaemia
Deficiency in aldosterone = low sodium, high potassium, hypotension
Excess androgens in females result in virilisation, ambiguous genitalia
Excess ACTH = adrenal hyperplasia

41
Q

What are the serum markers of congenital adrenal hyperplasia?

A 
Hyperkalaemia
Hyponatraemia
Hypoglycaemia
Raised 17-hydroxyprogesterone
Raised androgens
Reduced SHBG
Reduced cortisol and aldosterone
42
Q

What are the clinical features of congenital adrenal hyperplasia?

A 
Female virilisation (Irregular menses, ambiguous genitalia, short stature, acne, hirsutism)
Hypotension
43
Q

Conns syndrome- what happens to the serum potassium

A

It is low (hypokalaemia)

44
Q

Congenital adrenal hyperplasia- what happens to serum potassium?

A

It increases (hyperkalaemia)

45
Q

Addison’s disease- what happens to the serum potassium?

A

It increases- hyperkalaemia

46
Q

Where do MEN type 1 tumours arise?

A

Pituitary gland, hyperparathyroidism, pancreas

47
Q

Where do MEN type 2 tumours arise?

A

Phaeochromocytoma, parathyroid hyperplasia, medullary cell carcinoma

Endocrinology (16 decks)

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