Endo part 1 Flashcards
typical biochemical pattern for primary hyperparathyroidism
- excessive autonomous secretion of PTH
- from parathyroid gland
- results in usually mild hypercalcaemia
- and low serum phosphate
74 y/o lady, 6 month history of
- worsening confusion
- unintentional weigh tloss
- low back pain
PMH
- hypothyroidism managed with levothyroxine
blood results show
- raised calcium
- raised urea
- normocytic anaemia
most likely cause of hypercalcaemia?
Multiple myeloma
- combo of hypercalcaemia, normocytic anaemia and renal failure seen more so in MM situation
why does hypercalcaemia arise in patients with mulitiple myeloma?
- aar of tumour induced osteoclastic bone destruction
which type of diuretics are shown to worsen hypercalcaemia?
- indapamide
- thiazide
carpal spasm on inflation of BP cuff to pressure above systolic is known as
trousseau’s sign
phalens sign seen in
carpal tunnel syndrome
chvosteks sign indicates
hypocalcaemia
tap over parotid cn7
causes facial muscles to twitch
froments sign is seen in
ulnar nerve palsy
describe primary hypoparathyroidism
- decrease in PTH secretion
- e.g. secondary to thyroid surgery
- leads to low calcium
- leads to high phosphate
how may primary hypothyroidism be treated?
- with alfacalcidol (vit d)
summarise main symptoms of hypoparathyroidism secondary to hypocalcaemia
- tetany (muscle twitching, cramping and spasm)
- perioral paraesthesia
- trousseaus sign
- chvosteks sign
- if chronic: depression, cataracts
- prolonged QT interval on ECG
hypocalcaemia as seen on ECG
- prolonged QT interval on ECG
how does psuedohypoparathyroidism come about?
- target cells being insensitive to PTH
- due to abnormality in a G protein
- low calcium, high phosphate , high PTH
pseudohypoparathyroidism associated with what three clinical features
- low IQ
- short stature
- shortened 4th and 5th metacarpals
how is diagnosis of psuedohypoparathyroidism made?
- measuring urinary cAMP and phosphate following infusion of PTH
In pseudohypoparathyroidism type I neither cAMP nor phosphate levels are increased whilst in pseudohypoparathyroidism type II only cAMP rises.
Pseudopseudohypoparathyroidism
similar phenotype to pseudohypoparathyroidism but normal biochemistry
which medication may result in galactorrhoea and why?
- metoclopramide
- its a dopamine receptor antagonist (migraines)
- dopamine normally inhibits prolactin
spironolactone is
- aldosterone antagonist
- known to cause gynaecomastia
what is Kallman’s syndrome
- delayed puberty secondary to hypogonadotrophic hypogonadism
- LH and FSH are low or normal
- sex hormone levels are low
- often have lack of smell
21-hydroxylase deficiency occurs due to
- congenital adrenal hyperplasia
- characterised by virilisation of female genitalia and precocious puberty in males
what is klinefelter syndrome?
47, XXY
- infertility
- small poorly functioning testicles
- characterised by low testosterone
- increased levels of FSH and LH
what is androgen insensitivity syndorme?
- x-linked recessive
- due to end organ resistance to testosterone
- genotypically male children 46 XY will tend to have female phenotype
key features of kallman’s syndrome
- delayed puberty
- hypogonadism, cryptorchidism
- anosmia (lack of smell)
- sex hormone slow
- LH, FSH inappropriately low
- patients often normal or above average height
what is a characteristic x-ray finding of hyperparathyoidism in the head?
pepperpot skull
- excess PTH
- excess osteoclastic acitivity
- osteolytic lesions on skull
pregnant women with hypothyroidism may need to have what management done?
- increase in their thyroid hormone replacement dose by up to 50%
- woman’s need for levothyroxine will increase during pregnancy
what is firstline investigation in suspected primary hyperaldosteronism?
- plasma aldosterone / renin ratio
which test is used to diagnose cushings syndrome?
- dexamethasone suppression test
patients with cushings typically present with?
- central obesity
- abdominal striae
- hypertension
- hyperglycaemia
which test used to diagnose Addison’s disease?
- short synacthen test
addisons disease characterised by
- hypoaldosteronism
- patients presenting with weakness, anorexia, weight loss, hyperpigmentation, hyponatraemia and hyperkalaemia
primary hyperalodsteronism thought to be caused by :
- commonly by adrenal adenoma known as Conns syndrome
what is hashimoto’s thyroiditis?
- autoimmune cause of hypothyroidism
- caused by autoantibodies attacking thyroid (anti-thyroid peroxidase, antithyroglobulin)
features of hashimoto’s thyroiditis
- weight gain
- tiredness
- cold intolerance
- pooor concentration
- nontender goitre on examination
where is calcitonin made?
- peptide hormone
- made and secreted by parafollicular cells
calcitonin role
- inhibit osteoclasts
- oppose PTH
papillary carcinoma notes
Usually contain a mixture of papillary and colloidal filled follicles
Histologically tumour has papillary projections and pale empty nuclei
Seldom encapsulated
Lymph node metastasis predominate
Haematogenous metastasis rare
Follicular adenoma notes
Usually present as a solitary thyroid nodule
Malignancy can only be excluded on formal histological assessment
Follicular carcinoma notes
May appear macroscopically encapsulated,
microscopically capsular invasion is seen.
Without this finding the lesion is a follicular adenoma.
Vascular invasion predominates
Multifocal disease raree
medullary carcinoma notes
C cells derived from neural crest and not thyroid tissue
Serum calcitonin levels often raised
Familial genetic disease accounts for up to 20% cases
Both lymphatic and haematogenous metastasis are recognised, nodal disease is associated with a very poor prognosis.
Anaplastic carcinoma notes
Most common in elderly females
Local invasion is a common feature
Treatment is by resection where possible, palliation may be achieved through isthmusectomy and radiotherapy. Chemotherapy is ineffective.
34 y/o female patient
- feeling thirsty all the time
- polyuria pale urine
- weakness in arms
- occassional palpitations
- low potassium
primary hyperaldosteronism suspected
describe subacute thyroiditis aka de quervains thydroiditis
- thought to occur post viral infection
features
- hyperthyroisim
- painful goitre
- raised ESR
- globally reduced uptake on iodine-131 scan
drug used to treat hyperthyroidism
carbimazole
worsening fatigue, thirst, anorexia, constipation, and general aches and pains are all indicative to
hypercalcaemia
tertiary hyperparathyroidism
- usually occurs after prolonged secondary hyperparathyroidism
- glands become autonomous
- produce excessive PTH even after initial cause of hypocalcaemia has been corrected
If there is clubbing with hyperthyroidism, think
Grave’s disease
In type 1 diabetics, a general HbA1c target of ……. should be used
48 mmol/mol
treatment of choice for toxic multinodular goitre
radioactive iodine
A 42-year-old man presents to the emergency department with a headache, sweating and palpitations. These symptoms have been ongoing for the last hour and he feels they are worsening.
On examination, his blood pressure is found to be 180/90 mmHg and a fine tremor is noted in both hands. His urine is sampled and shows raised levels of urinary metanephrines
Given this man’s presentation, what is the most appropriate first-line treatment?
Phaeochromocytoma
- raised BP
- raised urinary metanephrines
- palpitations, tremor and headache
what type of drug is amlodipine
calcium channel blocker
propranolol is a
beta blocker
action of metformin
- reduces peripheral insulin sensitivity
- reduces gluconeogenesis
myxoedema coma typically presents with
confusion and hypothermia
In type 1 diabetics, blood glucose targets:
on waking
before meals at other times of the day
5-7 mmol/l on waking
4-7 mmol/l before meals at other times of the day
The symptoms of polyuria, nocturia and chronic thirst, combined with a pre-existing diagnosis of chronic kidney disease (CKD) suggests
nephrogenic diabetes insipidus
how does nephrogenic diabetes insipidus result
- renal insensitivity to ADH
- preventing the concentration of urine
- water deprivation test should be done
how does the short synacthen test worth
- synacthen is a synthetic ACTH analogue
- should stimulate cortisol secretion from the adrenal glands
The primary mode of action of orlistat is to …
inhibit pancreatic lipases
in turn will decrease absorption of lipids from the intestine
A 19-year-old with type 1 diabetes presents to the Emergency Department feeling unwell. She states she has had vomiting and diarrhoea for 2 days and has not been taking her full insulin doses as she has been off her food. Her capillary glucose is 37 mmol/l and there are 4+ ketones on urinalysis.
classic presentation of
diabetic ketoacidosis
Whipple’s triad of symptoms are hallmark for an…
insulinoma
what is Whipple’s triad of symptoms?
- hypoglycaemia with fasting or exercise
- reversal of symptoms with glucose
- recorded low BMs at time of symptoms
