Endocine Missed Points Flashcards
What drug may cause hypokalaemia
Salbutamol is associated with hypokalaemia
What drug is associated with Hyperkalaemia
ACEi - ramapril
What can inhibit GH in normal physiology
Dopamine
Hyperglycaemia
Cause of primary hyperaldosteronism
(Unilateral) Adrenal adenoma - 1/3 = conns syndrome
Bilateral adrenal hyperplasia - 2/3
Main cause of secondary hypertension
Conns syndrome
1st line investigation for conns syndrome
Aldosterone: renin ratio
Investigations for conns syndrome / hyperaldosteronism
Aldosterone : renin ratio
AVS (adrenal venous sampling)
What does AVS show
AVS = adrenal venous sampling
Shows if excessive hormones are being secreted from the adrenal glands
How do you differentiate from conns syndrome & bilateral adrenal hyperplasia
HRCT (high-resolution CT) abdomen + AVS
Primary hyperparathyroidism results..?
Calcium = high —> should trigger -ve feedback so PTH should be low, if Normal/high = primary hyperparathyroidism
Secondary hyperparathyroidism results..?
Ca2+ low (Vit d deficiency / renal impairment)
High PTH
In pheochromocytoma surgical treatment what else is done
Give alpha blocker prior surgery - phenylbenzamine
1st line treatment for T2DM
LIFESTYLE ADVICE
Then meds: 1st line medication = metformin
Gold standard investigation / Dx for pheochromocytoma
Elevated plasma free metanephrine
Then…
After G.S. Do MRI of adrenal
If Px previously Dx with autoimmune condition remember….
If Px has Sx of another autoimmune condition then its probably the new Dx
E.g. Px previous Dx with T1DM and presents with new symptoms like… hypotensive, salt craving, tanned, weight loss/anorexia = Addisons
Signs / symptoms for Addisons
Hyperpigmentation
Salt craving (decrease aldosterone —> increased Na+ excretion // increased K+ absorption)
Anorexia / weight loss
Hypoglycaemic
Vitiligo + change in body hair
Which thyroid cancer is most abundant
Papillary
Follicular
Medullary + anaplastic
Give a corticotropin independant cause of Cushing’s
Iatrogenic (steroid use) - most common overall cause
Adrenal adenoma
Give corticotopin dependant causes of Cushing’s
Cushings disease - most common ACTH dependant cause
Ectopic ACTH (SCLC)
What causes pseudo Cushing’s
Alcohol use
Resolves in 1-3 weeks
When is IgE seen
In allergic diseases
When is IgG seen
IgG is most common immunoglobulin
Seen in graves
Which immunoglobulin is seen in graves
IgG
Signs / symptoms for Hypercalcaemia
Stones - renal / biliary
Bones - bone pain / fractures
Psychiatric moans - depression
Abdominal groans - abdominal pain, constipation, pancreatitis
Polyuria + polydipsia
Hyperkalaemia ecg changes
GO ; absent p waves
GO LONG ; pronged PR interval
GO TALL ; tall tented T waves
GO UNDER ; wide QRS
Type of oedema seen in Graves and in Low serum albumin
Graves - NON-PITTING oedema
Low serum albumin - PITTING oedema
(Leakage of water in tissue)
Results of primary hypothyroidism..?
Low T3/4
High TSH
Results of secondary hypothyroidism?
Low T3/4
Low TSH (pituitary adenoma compresses TSH secreting cells
Common Sx of PCOS
Hirsutism
Acne
Oligoamenorrhoea
ADH synthesis..?
Supraoptic nuclei of hypothalamus
Stored in posterior pituitary
Where is glucagon secreted from
Alpha pancreatic cells
When is glucagon secreted
In response to hypoglycaemia
Role of glucagon
Acts on liver to convert glycogen —> glucose
Increases lipolysis + proteolysis
Difference in insulin and glucagon structure
Glucagon —> single polypeptide (29 amino-acids)
Insulin —> 2 polypeptides (51 amino acids)
How’s Vit D activated…
PTH increases activity of 1alpha-hydroxylase enzyme
Increased conversion of 25-hydroxycholecaleciferol —> 1, 25-dihydroxycholecaliciferol (active form of Vit D)
Helps Ca2+ absorption in small intestine
The role of PTH in osteoclast activity
Indirect stimulation of osteoclasts to increase bone resorption
OPG (secreted by osteoblasts) binds to block RANK-L : RANK complexes which are used to help mature osteoclasts for reduced bone resorption
so… PTH inhibits OPG… theres more complexes formed so more osteoclasts activity
Role of PTH…
Vit D activation….
Increases Ca2+ absorption in kidneys
Increased Ca2+ gut reabsorption
Increased osteoclast activity for bone resorption
Decreased phosphate reabsorption
Role of round ligament
Maintains anteverted position of uterus
Role of ovarian ligament
Connects ovaries to uterus
Role of cardinal ligament
Connects cervix —> later pelvic wall (supports vagina + cervix)
Contains uterine artery + vein
Role of broad ligament
Connect uterus —> pelvic wall
Splits pelvic cavity into uteri rectal pouch & uterovesicle pouch
Where does uterine arteries + vaginal arteries branch from
Internal pudendal arteries
What branch is the ovarian arteries come from
Abdominal aorta
Function of laydig cells
Produce testosterone
What stimulates wolffian duct to differentiate and into what
Testosterone
Into… epididymis, ejaculatory ducts, vas deferens, seminal vesicles
More potent version of testosterone and what does that form
Dihydrotestosterone
Later leads to penis, scrotum, prostate formation
Type of epithelium of vas deferens
Pseudostratified squamous with stereocilia lined by smooth muscle
Time frame of fertilisation after ovulation
Within 24-48 hrs
Where does fertilisation of egg take place
Ampulla of the fallopian tube
Stages of zygote development
Day What happens..?
1. Fertilisation
2-3. Cleavage (increasing cell no. For cell differentiation )
4. Compaction (flattening of cells)
5. Cavitation and differentiation
21. Implantation
Contents of spermatic duct..?
Remember rule of 3…
3 arteries
3 nerves
3 fascia’s
3 others….
Inguinal nerve runs outside spermatic duct outside inguinal canal
If Px is being treated with long-term steroids + they stop…. Think of what…
Suppression of adrenal glands
Secondary’s adrenal insufficiency
What cancers can cause SIADH
Think ectopic ADH…
SCLC
Pancreatic
Prostate
Lymphomas
Most commonly caused by renal impairment
Hyperkalaemia
Causes of renal impairment….
Hyperkalaemia
Trauma
Addisons
DKA
Sx for Hyperkalaemia
Palpitations
Dyspnoea
Hyperreflexia
Paraesthesia
Abdominal pain + diarrhoea
Complications of acromegaly
T2DM
Sleep apnoea
Cardiomyopathy
Colorectal cancers
1st line investigation for acromegaly and why
GH is pulsatile so IGF-1 is 1st line investigation
1st line treatment for acromegaly
Trans-sphenoidal resection … or …
Medication:
Dopamine agonists (Cabergoline / Bromocriptine)
SST analogue (octreotide)
GH antagonist (pegvisomant)
Differential; diagnosis for polyuria and polydipsia
DM
DI
Primary polydipsia
Hypercalcaemia
Hyperparathyroidism
Most likely cause of primary hyperparathyroidism
Solitary adenoma (80%)
Definitive treatment hyperparathyroidism
Total parathyroidectomy
Differential Dx for T2DM
Acromegaly
Cushing
Hypothyroidism
1st line investigation for Cushing’s
Overnight dexamethasone
Most common cause Cushing’s syndrome
Exogenous steroids
Differential Dx for conns
Primary hyperparathyroidism
DM
Renal artery stenosis
SIADH
Hypercalcaemia ECG changes
Short QT interval
Sx / sign of hypocalcaemia
CATs go numb
Convulsion
Arrythmias
Tetany
Numbness
Chvostek
Troussoea
When do you see…
Chvostek
Troussoea
Hypocalcaemia
Where does superior thyroid artery branch off from
External carotid artery
Where does inferior thyroid artery branch off from
3rd branch of subclavian
(Thyrocervical branch)
Define Hypercalcaemia of malignancy
Caused by excessive secretion of PTHrP (parathyroid hormone peptide)
Generalised Sx of pituitary adenoma
Headaches
Visual disturbance
N&V
Fatigue
Unexplained weight loss/gain
Signs / symptoms of carcinoid tumour /// syndrome
Flushing
Diarrhoea
Asthma-like wheeze // SoB
Tricuspid incompetence (murmur)
Define carcinoid syndrome
Poorly malignant tumour of enterochromaffin cells that secrete serotonin
What drug decreases thyroid hormone production
Carbimazole
Mechanism of action of carbimazole for decreased thyroid hormone production
Blocks thyroid peroxidase from coupling & iodinating the tyrosine residues on thyroglobulin
Decreasing thyroid hormone production
Signs / Sx of DKA
Reduced consciousness
Fruity breath
Kausmauls breathing
Tachycardia + hypotensive
Tx of Hyperkalaemia
Calcium gluconate (if showing ecg changes / Arrythmias)
Insulin + dextrose
First line treatment type 2
ALWAYS CONSERVATIVE ;
Dietary and lifestyle changes
Then if asks about medication; metformin
ECG changes seen in hypokalaemia
U waves
Prolonged QT
Inverted t waves
What Sx does carcinoid syndrome come with
Diarrhoea
Itching
SOB
Facial flushing
Complications of hyperthyroidism
Hyperthyroid crisis
Atrial fibrillation
Side effect of carbimazole
Used for hyperthyroidism Tx
Agranulocytosis
Pancytopenia; bone marrow suppression
Most common cause of hypothyroidism
Autoimmune condition; Hashimoto’s
Complication of Addison’s
Addisonian crisis
+
Osteoporosis
Tx for Addisonian crisis
Aggressive IV fluids and iv steroids
+
Glucose if hypoglycaemic
Side effect of Amiodarone
Hypothyroidism
Can also cause hyperthyroidism
What’s a byproduct of insulin
Serum-C peptide protein is a product of insulin PRODUCTION
How do you tell the difference between exogenous and endogenous insulin effects
If serum-C peptide is raised it means the insulin is excessive endogenous production
Most common cause of Addison’s
Autoimmune adrenalitis
Give a severe complication of DKA
Cerebral oedema
Which DI does lithium toxicity cause
Nephrogenic diabetes insipidus
Which condition is linked to meningitis that decreases glucose
Waterhouse - friderichson syndrome
What is the Tx of diabetic neuropathy
Pregabalin
Target blood pressure for under 80s
<140/90
Target blood pressure for over 80s
<150/90
Which diabetes medication can give weight gain as a side effect
Sulfonylurea
Symptomatic relief for hyperthyroidism
Propranolol
Commonest cause of hypopituitarism
Pituitary adenoma
A non-GI side effects of metformin
B12 deficiency
Lactic acidosis
3 complications of HHS
MI
Stroke
Cerebral oedema
What Sx is described as darkening of the skin folds and which disease can it be seen in
Acyanthosis nigracans
Sx of T2DM; seen under armpits, back of neck and groin
Which diabetic medication can cause pulmonary oedema
Pioglitazone
Which diabetic medication is related to UTIs
Dopagliflozin
