endo key points Flashcards
Grave’s thyroiditis
an autoimmune disease with antibodies to the thyroid stimulating hormone (TSH) receptor prolonging stimulation
Exophthalmos occurs in Graves due to?
- Exophthalmos is due to the TSH receptor antibodies binding to TSH receptors
- at the back of the eye
- resulting in inflammation
- and an increase in glycosaminoglycans.
- This causes swelling of the eye muscles and connective tissue.
Role of PTH
PTH increases the activity of 1-α-hydroxylase enzyme, which converts 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol, the active form of vitamin D.
Osteoclasts do not have a PTH receptor and effects are mediated via osteoblasts.
This patient presented with a one-month history of the signs and symptoms the most consistent with a clinical diagnosis of hypothyroidism. She had low mood, weight gain, round puffy face and a low heart rate and blood pressure.
The most common cause of clinical hypothyroidism in the developed world is Hashimoto’s thyroiditis
What are brown tumours?
Brown tumors are tumors of bone that arise in settings of excess osteoclast activity, such as hyperparathyroidism, and consist of fibrous tissue, woven bone and supporting vasculature, but no matrix.
They are radiolucent on x-ray. The osteoclasts consume the trabecular bone that osteoblasts lay down and this front of reparative bone deposition followed by additional resorption can expand beyond the usual shape of the bone, involving the periosteum thus causing bone pain. They appear brown because haemosiderin is deposited at the site.
what is diagnostic sign is present in 90% of Hashimoto’s thyroiditis cases?
Anti-thyroid peroxidase (anti-TPO) antibodies are present in 90% of Hashimoto’s thyroiditis cases
DKA caused by
DKA is caused by uncontrolled lipolysis (not proteolysis)
which results in an excess of free fatty acids that are ultimately converted to ketone bodies
acromegaly caused by…
what may be used to treat it…
Acromegaly is caused by excessive growth hormone.
Somatostatin directly inhibits the release of growth hormone, and hence somatostatin analogues are used to treat acromegaly
Mrs Roylance, a 37-year-old patient with type 1 diabetes, attends for annual diabetes review. When discussing injection technique, she admits she only uses her abdomen for insulin injections as it is the least painful site. The nurse checks the injection sites and finds a ‘pouch’ of fat on each side of the lower abdomen.
A common and easily identified complication of insulin therapy is lipodystrophy
which can cause erratic insulin absorption
The staff at a maternity unit struggle to identify the gender of a newborn child due to the presence of ambiguous external genitalia. The suspected diagnosis is associated with mineralocorticoid deficiency and androgen excess. What is the pathophysiology?
congenital adrenal hyperplasia!
It results from a deficiency of the enzyme 21-alphahydroxylase
Thus, XX females may appear as apparent males at birth.
This is known as virilisation of genitalia.
When present insulin drive potassium into cells, however, in a ketoacidotic state there is no insulin to preform this function. SOoooo?
Thus potassium leaks out of cells.
In addition the high glucose levels in the blood results in a glycosuria in the urine and subsequently an osmotic diuresis.
This results in potassium loss through the kidneys.
insulin drives what into cells
potassium, resulting in a hypokalaemia state.
