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The Holy Grail (Treatments) > Endo > Flashcards

Endo Flashcards

1
Q

Prolactinoma

A benign pituitary adenoma that produces prolactin.

  • Galactorrhea
  • Menstrual irregularity
  • Impotence (males)
  • Headache, visual field abnormalities
A

Dopamine agonists to shrink tumour:

  • Bromocriptine
  • Quinagolide
  • Cabergoline
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2
Q

Acromegaly

GH excess

A 
1. Pituitary surgery + radiotherapy
Dopamine agonist (cabergoline)
Somatostatin analogue (octreotide)
GH antagonist (pegvisomant)
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3
Q

Hypothyroidism

  • Decreased thyroid hormone (T3/T4), apart from in subclinical.
  • Decreased basal metabolic rate, decreased HR, fatigue, weight gain, lethargy, cold intolerance, amenorrhoea, menorrhagia
Primary: 
Overt: Inreased TSH, Decreased T4, Decreased/normal T3
Subclinical: Increased TSH, normal T3/T4
- Hashimoto's Thyroiditis 
- Iodine deficiency
- Drug induced (Amiodarone/ lithium)
Secondary: 
Decreased/normal TSH, Decreased T3/T4
- Pituitary/ Hypothalamus problem
A

Levothyroxine

  • check TSH 4 weeks after starting then
  • check TSH every 2 months
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4
Q

Hyperthyroidism

  • Excess thyroid hormone (T3/ T4)
  • Increased basal metabolic rate, increased HR, AF, anxiety, nervousness, weight loss, heat intolerance, tremor, diahorrhea, exopthalmos, thin hair, oligomenorrhea
  • Graves Disease
  • Nodular thyroid disease
A

Carbimazole (oral)
Propylthiouracil (If pregnant in 1st trimester)
Betablockers: Propranolol, for tremors
If relapsed/ presence of thyroid nodules: Radioactive iodine
Surgical excision

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5
Q

Graves Disease

Increased T3/T4, decreased TSH

A type of hyperthyroidism.
Autoimmune destruction of TSH receptors.
- smokers
- high iodine intake
- TSH receptor antibodies
- lid lag
- smooth symetrical goitre with homogenous iodine uptake

A

Carbimazole (oral)
Propylthiouracil (If pregnant in 1st trimester)
Betablockers: Propranolol, for tremors
If relapsed: Radioactive iodine

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6
Q

Nodular thyroid disease

Increased T3/T4, decreased TSH

Single nodule: toxic thyroid adenoma
Multiple nodules: toxic multinodular goitre

A

Carbimazole (oral)
Propylthiouracil (If pregnant in 1st trimester)
Betablockers: Propranolol, for tremors
If relapsed/ presence of thyroid nodules: Radioactive iodine
Surgical excision

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7
Q

De Quevrain’s (subacute) thyroiditis
T4: increases, then decreases, then normal
TSH: decreases, then increases, then normal

Expresses symptoms of thyrotoxicosis

  • Viral trigger (previous sore throat)
  • Tender goitre
A

Self limiting
NSAIDS
Beta blockers: propranolol
Aspirin

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8
Q

Hypercalcaemia

Excess of Calcium
- Usually due to hyperparathyroidism/ cancer

“Stones, bones, groans, and phychic moans”

  • Thirst, dehydration, confusion, polyuria
  • Osteopenia, fractures, depression
  • Abdominal pain, pancreatitis, ulcers, renal stones
A 
Fluids: 0.9% saline 4-6L in 24h
Loop diuretics (if rehydrated)
Biphosphonates (lower Ca2+)
Calcitronin salmon 
If myeloma: Chemotherapy
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9
Q

Primary Hyperparathyroidism : overproduction of PTH (eg: adenoma)
Increased PTH and Ca2+

A

Surgery to remove adenoma

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10
Q

Secondary Hyperparathyroidism : Physiological response to low Ca2+
Increased PTH, decreased Ca2+

A

Treat underlying cause (renal failure etc)

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11
Q

Tertiary Hyperparathyroidism : Excessive PTH production after years of secondary. PT is autonomous.
Increased PTH and Ca2+

A

Cinacalcet

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12
Q

Hypocalcaemia

Due to: hypoparathyroidism, Vit D deficiency, chronic renal failure

A

Calcium supplements
Vit D tablets
6 monthly injection of cholecalcifol

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13
Q

Osteoporosis

A 
Calcium and Vit D supplements 
Biphosphonates 
Denosumab
Teriparatide 
HRT
Selective Oestrogen Receptor Modulator
Testosterone
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14
Q

Type 1 Diabetes Mellitus

Immune system destorys beta cells in the pancreas. The body can sense sugar levels, however cannot produce insulin.

  • Weight loss, polyuria, polydipsia, fatigue, blurred vision
  • Candida infetion
  • DKA presentation
A

Insulin
Blood sugar monitoring
Education: Carb estimations etc

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15
Q

Type 2 Diabetes Mellitus

Hyperinsulinaemia, insulin resistance and relative insulin deficiency

A
  1. Diet and exercise
  2. Metformin
  3. Metformin + Sulphonylurea
    Metformin + TZD
    Metformin + DDP IV
  4. Metformin + Sulphonylurea + TZD
    Metformin + GLP-1
    Metformin + Sulphonylurea + GLP-1
  5. Metformin + Sulphonylurea + Insulin (basal isophane, humulin/ insulatard)
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16
Q

Diabetic Ketoacidosis
Ketonaemia> 3mmol/l / >2++ on urinalysis
Blood glucose > 11mol/l
Bicarbonate <15mmol/l / venous pH <7.3

  • Vomiting, abdominal pain, kussells’ breaths, weakness, confusion

A decrease in insulin, leads to an increase in glucagon which increases glucose (released from the liver). High glucose in the urine leads to ometic diuresis.
The absence of insulin leads to lipolysis which leads to fatty acids being converted through beta oxidation into ketone bodies that make the body more acidic.

A

0.9% saline 500ml stat
replace missing electrolytes
insulin (0.1 units/kg/per)

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17
Q

Hyperosmolar hyperglycaemic State (HSS)

High glucose in blood, absence of ketones/ acidosis

  • due to thiazides, steroids, fizzy drinks
  • Common in elderly
  • Blood glucose > 60mmol/l
  • dehydration, weakness/cramps, confusion
A

0.45% saline
insulin
LMWH prophylaxis

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18
Q

Hypoglycaemia
Glucose level: <3.9 mmol/l

  • Shakiness, anxiety, tachycardia, sweating, cold, clammy, dilated pupils, nausea, fatigue, confusion
A

Acute: glucose tablet/ gel
Afterwards: biscuits/snack if still a while till next meal
Severe: glucagon injection

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19
Q

Primary Adrenal Insufficency

Inadequate adrenocorticoid function due to:

  • Addison’s disease
  • Congenital adrenal hyperplasia
  • Adrenal TB, malignancy
  • Weight loss, fatigue, low BP, abdominal pain, vomiting, skin pigmentation
A

Hydrocortisone (mimics diurnal cortisone rhythm)
Fludricortisone (replaces aldosterone)
Education

20
Q

Secondary Adrenal Insufficency

Inadequate adrenocorticoid function due to:

  • Lack of ACTH stimulation
  • Iatrogenic (excess exogenes steroid)
  • Hypothalamic/ pituitary disorders
  • Weight loss, fatigue, low BP, abdominal pain, vomiting
A

Hydrocortisone

21
Q

Addison’s disease

Immunological destruction of the adrenal cortex

  • Weight loss, fatigue, low BP, abdominal pain, vomiting, skin pigmentation
A

Hydrocortisone (mimics diurnal cortisone rhythm)
Fludricortisone (replaces aldosterone)
Education

22
Q

Addisonian Crisis

Medical emergency caused by insufficient levels of cortisol

Penetrating pain in the legs, severe vomiting and diahorrea, low BP, fever, confusion, syncope, convulsions, lethargy

  • Hyperkalaemia
  • Hypercalcaemia
  • Hyponatraemia
A 
Injected hydrocotrisone (long-term)
If stopping- wean off
23
Q

Cushing’s Syndrome

Excess cortisol secretion

  • Women 20s-40s
  • Moonface with red plethoric cheeks
  • Cataracts, buffalo lump, abdominal fat
  • Easily bruised, poor wound healing
  • Muscle wasting (thin legs)
  • Striae, HTN, myopathy
ACTH dependent: 
- pituitary adenoma
- ectopic ACTH production (carcinoma)
ACTH independent: 
- adrenal adenoma, carcinoma, hyperplasia
A

Adrenalectomy
Metyrapone
Ketoconazole
Pasireotide

24
Q

Cushing’s Disease

A pituitary problem leading to over production of ACTH

A

Hypophysectomy (surgical removal of the hypophysis (pituitary gland))
Radiotherapy
Bilateral adrenalectomy

25
Q

Primary Aldosteronism

Autonomous production of aldosterone independant of its regulators (Angiotensin II/ K+). Due to:

  • Bilateral adrenal hyperplasia
  • Conn’s syndrome
  • Severe HTN, hypokalaemia, alkalosis
A

Spironolactone, epleronone (Mineralcorticoid receptor agonists)
Laparoscopic adrenalectomy

26
Q

Pheochromocytoma

Adrenaline secreting tumour of the adrenal glands
- associated with headaches, palpitations, sweating and HTN

The 10% tumour:

  • malignant
  • bilateral
  • hyperglycaemia
  • in children
  • familial
  • associated with MEN2
A 
Phenoxybenzamide (alpha-blocker)
Atenolol, propranolol, metoprolol (beta-blockers)
Fluid replacement
Remove laparoscopicaly 
Chemotherapy
27
Q

Polycystic ovarian syndrome (PCOS)

Elevated endrogens in females

  • oligomenorrhea, menorhaggia, amenorhea
  • excess hair, pelvic pain, darker thickened skin
  • infertility
A

Folic acid, rubella vaccination,
Weight loss
Metformin
Contraceptive pill

Ovulation induction:

  • Clomiphene citrate
  • Gonadotrophic injections
28
Q

Maturity onset diabetes of the young (MODY)

  • defective glucose sensing in pancreas
  • loss of insulin secretion
  • strong family history
  • C-peptides positive
A

Gibenclamide

29
Q

Donohue Syndrome

  • Look like an elf/ leprechaun
  • Autosomal recessive
  • Growth retardation
  • Severe insulin resistance due to insulin receptor signalling
A

Support
Carb meals + large insulin bolus
Life expectancy <2 years

30
Q

Rabson Mendenhall Syndrome

  • autosomal recessive
  • severe insulin resistance
  • hyperglycaemia, compensating hyperinsulaemia
  • acanthosis nigricans
  • DKA
  • fasting hypoglycaemia
A

Support
Carb meals + large insulin bolus
Life expectancy <2 years

31
Q

Wolfram Syndrome / DIDMOAD

  • Diabetes insipidus
  • Diabetes mellitus
  • Optic atrophy
  • Deafness
A

Treat symptoms systematically

32
Q

Bordet-Biedl Syndrome

-obesity, retinitis pigmentosa, polydactyly, hypogonadism, and renal failure

A

Treat symptoms systematically

33
Q

Diabetic Nephropathy

  • Kimmelsteil-wilson syndrome/ Nodular glomerulosclerosis
  • microvascular changes that lead to angiopathy of capillaries in the kidneys
  • HTN
  • Decreased GFR
  • Increased Vascular disease
A

ACE inhibitors
ARBs

Decrease blood pressure to <130/80 if

34
Q

Neuropathy

A 
Amytriptyline 
Duloxetine
Gabapentin 
Pregabalin
Topical capsaicin cream
35
Q

Obesity

A

Orlistat

Bariatric Surgery

36
Q

Thyroid Storm

  • severe hyperthyroidism
  • resp + cardio failure
  • medical emergency
A 
Lugol's iodine
Glucocorticosteroids
Propylthiouracil
Beta-blockers
Fluids + monitoring
37
Q

Diabetes Insipidus

  • lack of ADH
  • life-threatening dehydration
A

Desmospray
Desmopressin oral tablets
Desmopressin injection

38
Q

Syndrome of inappropriate ADH secretion (SIADH)

  • ectopic production of ADH
A

Treat underlying cause
Demeclocycline
Conivaptan
Tolvaptan

39
Q

Craniopharyngioma

rare type of brain tumor derived from pituitary gland embryonic tissue that occurs most commonly in children
- Headaches and visual disturbances

A

Radiotherapy

40
Q

Panhypopituitarism

A decrease in production of anterior pituitary hormones

  • GH insufficiency
  • Hypothyroidism
  • Hypogonadism
  • Adrenal insufficiency

Due to: tumours, granulomas, trauma

A 
Thyroxine
Hydrocortisone
ADH
GH
HRT/oestrogen/progesterone (female)
Testosterone (male)
41
Q

Congenital Adrenal Hyperplasia

Excessive/ deficient production of sex steroids
- autosomal recessive
Males: adrenal insufficiency, weight gain
Females: Genital ambiguity

A

Glucocorticoid replacement
Surgical correction
Restore fertility

42
Q

Hypothalamic ovulatory disorder Type 1

Due to: stress, excessive exercise, Kallman’s syndrome, decreased FSH, decreased oestrogen

A

Stabilise weight
Hormone therapy:
- GnRH
- FSH and LH

43
Q

Hyperprolactinaemia

  • Galactorea
  • Amenorrhea
    Normal FSH/LH, decreased oestrogen, increased prolactin
A 
Dopamine agonist (cabergoline)
Bromocriptine
44
Q

Premature Ovarian Failure

Menopause <40 years old
Increased FSH, decreased oestrogen
- Amenorrhoea
- Associated with Turner’s, Fragile X, Addison’s

A

HRT

egg donation

45
Q

Hypogonadism (male)

Primary: Congenital
- Decreased testosterone, increased LH/FSH

Secondary: Pituitary/hypothalamic
- Decreased testosterone and LH/FSH

A

Testosterone

46
Q

Turner syndrome

  • one women (one X chromosome)
  • short stature
  • failure to pass through puberty
    webbed neck, spaced nipples, shield chest
  • coarctation of the aorta
  • lymphoma, scoliosis
A

Treat symptoms

47
Q

Gestational diabetes

A woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section

A

Lifestyle
Metformin
Insulin

The Holy Grail (Treatments) (13 decks)

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