Endo Flashcards
Most aggressive subtype of thyroid ca which is often diagnosed late?
Anaplastic
Type of thyroid ca: typically upper lobe ca, typically facial flushing and diarrhoea
- what syndrome is is associated with?
Medullary thyroid ca
- flushing and diarrhoea due to calcitonin secretion
- MEN2!
Most common type of thyroid ca?
Common iatrogenic cause
Papillary (popullary haha)
- caused by radiation to head and neck often, seen in children ++
Top 3 causes of high prolactin
Prolactinoma
Hypothyroidism (TRF stimulates both TSH and prolactin)
Drugs - dopamine antagonists
HbA1c targets in T2DM
For lifestyle only or + drug which doesn’t cause hypoglycaemia - aim 48
If on sulfonylurea/other hypoglycaemic drug - aim 53
State the indications for commencing SGLT2 inhibitors in T2DM at time of diagnosis
1st establish metformin therapy.
Then add sglt2 if:
Established CVD
Heart failure
QRISK >10%
TFT levels in sick euthyroid syndrome?
Low T4/T3
Normal TSH
- no sx of clinical hypothyroidism
TFT levels in sick euthyroid syndrome?
Low T4/T3
Normal TSH
- no sx of clinical hypothyroidism
Cause of primary haemochromatosis
HFE gene mutation (auto recessive)
Diabetes mellitus
Skin pigmentation
Liver cirrhosis
Diagnosis?
Haemochromatosis
Diabetes mellitus
Skin pigmentation
Liver cirrhosis
Diagnosis?
Haemochromatosis
Liver disease
+ psychiatric disorder
Diagnosis?
Wilson’s disease
What is cushings disease
Pituitary ACTH secreting tumour
Most common cause of Cushing’s syndrome?
Pituitary Adenoma (Cushings disease)
Dexamethasone suppression test
- if low dose is given, what is the result in:
- adrenal adenoma
- ectopic ACTH secreting tumour
- pituitary tumour
No suppression of cortisol in any of them
High dose dexamethasone suppression test - what is the cortisol level in each scenario
- adrenal adenoma
- ectopic ACTH (aka secreting tumour)
- pituitary adenoma
A high dose of Dex would ordinarily exert negative feedback on PITUITARY ACTH production, and subsequent cortisol release would decrease
- adrenal adenoma: no suppression
- ectopic ACTH: no suppression
- pituitary adenoma: suppression of cortisol release
Biochemistry abnormality in Wilson’s disease
Low caeruloplasmin
What is pseudohypoparathyroidism
Low Ca and high PTH
Caused by an inherited resistance to PTH
impaired fasting glucose
6-7
impaired glucose tollerance
7.8 - 11 for 2 hour OGTT
best blood test in suspected acromegaly?
IGF1
best blood test in suspected addisons?
short synacthen test
Cushings disease vs syndrome?
disease = pituitary tumour secreting ACTH
1st line test in suspected cushings syndrome
overnight dexamethasone suppression
- Cortisol will be high the following morning in Cushings
Fibrosis of the thyroid - rock hard neck lump
Riedels thyroiditis
most common type of thyroid malignancy?
Papillary
2 drugs which can cause DM
steroids
thiazides
milk alkali syndrome
- triad of features
hypercalcemia
metabolic alkalosis
renal failure
secondary hyperparathyroidism
Ca, phosphate, PTH levels?
CKD –> low calcitriol + kidneys unable to excrete phosphate
- low Ca
- high phosphate (and this binds to Ca and uses it all up!!)
- high PTH
ECG changes in hyper and hypocalcemia
hypercalcemia - osborn wave
hypocalcemia - QT prolongation
vitamin D deficiency
Ca, phosphate, PTH levels?
unable to synthesise calcitriol
- low Ca
- low PTH
- high PTH
secondary vs tertiary hyperparathyroidism
secondary is due to CKD –> lowcalcitriol and low Ca–> high PTH in response
tertiary is due to prolonged secondary hyper PTH –> autonomous PTH secretion . therefore high ca and low PO4
what is pseudohypoparathyroidism
resistance to PTH hormone.
how to calculate anion gap
(Na+K)-bicarb - chloride
most common cause worldwide of non toxic goitre
iodine deficiency
3 top causes of high prolactin
- prolactinoma
- hypothyroidism
- dopamine antagonist = domperidone, metoclopramide
De Quervains thyroiditis
what is it
Hyperthyroidism and fever
followed by hypothyroidism (TSH suppressed and T4 supplies run out)
Most common neurological manifestation of diabetes?
Most serious neuro manifestation ?
Gustatory sweating
most serious - postural hypotension
pt is tired
TSH high, T4 normal. has no thyroid autoantibodies. what do you do next?
i.e. subclinical hypothyroidism
- repeat tests in 3 months
congenital adrenal hyperplasia
-how does it present in girls vs boys
- key blood tests x2
girls: typically with ambiguous genitalia at birth
boys: normal genitalia therefore present at 1 week old with salt losing crisis
17 hydroxyprogesterone - high if 21-a-hydroxylase deficiency
short synACTHen test - will result in low cortisol if the non-salt losing form
adrenocortical insufficiency in pt with meningitis - diagnosis
Waterhouse Friederichsen
Features of MEN1
3Ps
- PTH high
- Pituitary tumour
- Pancreatic islet cell tumour
Features of MEN2a vs 2b
Both MEN2s have:
- Medullary THYROID ca
- Phaeochromocytoma
2a) - high PTH
2b) - Marfanoid
