Endo Flashcards
what is the name given to a syndrome which has abnormal findings on thyroid function tests yet there is no-thyroidal illness:
euthyroid sick syndrome
- deficiency of thyroid hormones
- catabolic states
- —-> body breaks down proteins
MEN 1 syndrome is characterised by presence of two of which three tumour types:
Pituitary adenoma
pancreatic islet cell tumours
parathyroid
MEN 2 syndrome characterised by:
Thryoid
- medullary thyroid carcinoma
Phaeochromocytoma
Parathyroid
Describe how chronic renal failure may affect levels of calcium and phosphate in the body?
Chronic renal failure
- 1a-hydroxylation of 25-hydroxycholecalciferol to form calcitrol IMPAIRED
- REDUCES Ca2+
- REDUCED phosphate excretion due to renal impairement
- Low plasma Ca2+ causes PTH to INCREASE
- Secondary hyperparathyroidism
In chronic renal failure, as the disease progresses how might it lead to tertiary hyperparathyroidism:
- glands act autonomously
- due to hyperplastic or adenomatous change
- INCREASED PTH secretion
- so elevated Ca2+§
what are the levels of PTH and Calcium in primary hyperparathyroidim:
PTH high
- high calcium
- low phosphate
Features of hypocalcaemia:
TAP CT
TAP CT
T-tetany
A-abdominal cramps
P-perioral parasthesiae
C-chovsteks sign
T- trousseaus (carpal spasm after occlusion)
this is decreased production of PTH due to suppression by hypercalcaemia:
secondary hypoparathyroidism
pseudohypoparathyroidism occurs as a result of:
target cell failure to respond to PTH appropriately
PTH elevated
Ca2+ low
Phosphate HIGH
37 M
pc: 2 episodes pancreatitis , calcium was raised at the time
now patient has reduced urinary calcium.
patient likely has:
hypocalciuric hypercalcaemia
54 M
pc: confused, digital clubbing and RHS pleural effusion.
patient has significant hyponatraemia and is euvolaemic.
urine osmolality raised.
likely diagnosis:
HYPONATRAEMIA
- confusion
Urine osmolality - RAISED
- -> continued ADH secretion
- —> SIADH
associated with small cell lung cancer
which is given to patients before removal of an adrenal phaeochromocytoma:
alpha-adrenergic receptor blockers
- phenoxybenzamine or doxazosin
The following signs are associated with:
- exopthalmos
- diffuse goitre
- pre-tibial myoedema
GRAVES DISEASE
- autoimmune
- TSH receptor antibodies
- hyperthyroidism
this describes presence of viral infection with
- fever
- neck pain
- tenderness
- dysphagia
- hyperthyroidism features
De-Quervains thyroiditis
tx
- NSAIDS + BB
35 y/o F
pc: lethargy, decreased appetite, weight gain
bloods:
- Low T3, T4
- Low TSH even after TRH injection
secondary hypothyroidism
- failure in pituitary gland to produce enough TSH
e. g.
- tumours
- infection
- Sheehan syndrome
- radiation
patient has the following blood results:
ELEVATED PTH
Low Calcium
ELEVATED phosphate
indicative of:
PTH is high: we would except calcium to be high and low phosphate.
BUT
we’ve got high PTH and low calcium and high phosphate.
indicating their is failure of target cell response
–> PSUEDOHYPOPARATHYROIDISM
patient:
lethargy, weight loss, fainting episodes.
postural drop in BP.
low sodium:
patients condition:
Addison’s disease
- decreased cortisol
- decreased aldosterone
primary adrenal failure
autoimmune destruction of adrenal cortex, reduction in cortisol and aldosterone levels.
deficiency of cortisol + aldosterone
- hypotension
- hyponatraemia
- hyperkalaemia
- skin and mucosal hyperpigmentation
somatostatin action:
inhibits the release of GH
what three things are increased after a glucagon stimulationtest:
- C-peptide
- cortisol
- growth hormone
glucagon stimulates both insulin and C-peptide.
C-peptide is cleaved of what during insulin production:
C-peptide cleaved from proinsulin
during insulin production.
which signalling pathway does growth hormone use?
tyrosine kinase receptor that uses the
JAK/STAT pathway
other tyrosine kinase receptor hormone :
- platelet derived growth factor
- fibroblast growth factor
- insulin like growth factor 1
22M
- > 7 fasting glucose
- brother diabetic
- FH hepatocellular carcinoma
likely diagnosis:
MODY
MODY-3
- most common
- mutation HNF-1A gene
- strong FH diabetes
- hepatocellular carcinoma
why does goitre arise in Hashimoto’s thyroiditis:
- lymphocytic and plasma cell infiltration
patient with a thyroid storm should be treated with:
propylthiouracil
iodine
propranolol
hydrocortisone
how do propylthiouracil and iodine work?
block the synthesis of new thyroid hormone
prevent further deterioration of the condition.
in addition hydrocortisone works through inhibiting the less potent form of thyroid hormone T4 to more potent R3
72 F
acute agitation, fever, nausea and vomiting
disorientated, pyrexic, tachycardic, irregular pulse.
congestive cardiac failure.
pmh: Graves disease
likely diagnosis?
thyroid storm
- high temperature
- tachycardia
- agitation
pmh: graves disease
patient presents with addisonian crisis, why is her past medical history of having a joint disorder important?
patient may have RA
- controlled with oral prednisolone
- may suppress natural cortisol production over long periods
this is a syndrome caused by adrenal haemorrhage causing addison’s disease, as a result of severe bacterial infection :
waterhouse-friderichsen syndrome
