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4 MBCHB > ENDOCRINE 1 > Flashcards

ENDOCRINE 1 Flashcards

1
Q

adrenal insufficiency is what primary causes

secondary causes

A

primary AI Addisons
TB, mets, HIV, anti phosphorus
Pit disease tumours, irradiation, infiltration

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2
Q

who does adrenal insufficiency occur in and what is it

A

20-50s

decreased production of cortisol plus minus aldosterone

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3
Q

symptoms/signs of adrenal insufficiency

A

anorexia, weight loss, fatigue, lethargy, weakness, nausea and vomiting, pigmentation especially of the palmer creases, postural hypotension, hypoglycaemia, vitiligo, loss of pubic hair in females

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4
Q 
ix results for adrenal insufficiency 
glucose
sodium
potassium 
cortisol 
calcium 
what ABs
what test is done
A 
decreased glucose 
decreased Na
increased K
decreased cort
increased calcium 
21 hydroxyls ABs
ACTH synacthin test: cortisol measured before and 30 mins after giving synacthin 200mcg IM. doesn't rise in Addisons
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5
Q

treatment of adrenal insufficiency

A

hydrocortisone 3 doses

fludrocortisone - minerocorticiod replacement for postural hypotension

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6
Q

addisons crisis is what

causes

A

acute deficiency of adrenal hormones

undiagnosed addisons, not adhering to treatment, infection, injury, pregnancy

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7
Q

symptoms of addisons crisis
ix
treatment

A

hypotension, severe abdominal pain, severe vommiting and diarrhoea, confusion, hypovalaemic shock, LOC, coma and death

decreased sodium or normal. increased potassium or normal. increased calcium. decreased cortisol

1L 0.9% saline, hydrocortisone 100mg IV/IM, glucose if hypoglycaemic

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8
Q 
what is cushings 
high mortality if what 
pituitary causes 
adrenal causes 
ectopic causes
iatrogenic is what
A

high levels of cortisol

left untreated

benign pit adenoma leading to increased ACTH

adrenal adenoma, hyperplasia, carcinoma

outside of adrenal axis - SCLC

steroids - commonest cause

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9
Q

what is pseudocushings
causes
ix

A

signs and symptoms present - not related to hypothalamic adrenal pit axis

idiopathic, alcohol, stress, depression, eating disorder

fails to be suppressed by dexa , false positive insulin stress test

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10
Q

symptoms of cushings

A

central obesity, mood face, buffalo hump, thinning of skin, dry skin, telengectasia, excessive sweating stretch marks, proximal muscle weakness, hirsutism, oligo/amen

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11
Q

investigations for cushings screening

A

1mg overnight dexa suppression test measured at 8sm <50 is normal
24 hour urine free cortisol <200 normal
diurnal cortisol variation midnight/am
late night salivary cortisol

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12
Q

diagnostic test for cushings

A

2mg/day suppression test <50 over 16 hours is normal

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13
Q

in what type of cushings will cortisol be suppressed

A

pituitary - cushings disease

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14
Q

treatment of cushings

A

reduce dose of steroids
adenoma - transphenoidecomy or adrenelectomy
bilateral adecetomy if cause unknown to prevent Nelsons - lifelong hydrocortisone
metyoprone, ketocondzone, pasicreotide

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15
Q

causes of hyperaldosteronism

A

idiopathic hyperplasia
adrenal adenoma - Conns
carcinoma - rare

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16
Q

symptoms of hyperaldosteronism

A

decreased K, aldosterone:rennin ratio if raised do a 2L saline suppression test pr a fludrocortisone suppression test
HRCT abd. adrenal vein sampling

17
Q

treatment of hyperaldosteronism

A

spironolactone/amiloride for hyperplasia

adrenlectomy for adenoma

18
Q

what is a phae
derived from what
life threatening what
assoc with what

A

adrenal medullary tumour
chromatic cells - secretes catecholamines
hypertension or arrhythmias
MEN2, NF1, VHL syndrome

19
Q

symptoms of phao
investigations
10%
rx§

A

headaches, sweating, palpitations, nausea, weakness, anxiety, hypertension, epigastric pain, constipation, decreased weight, pallor, fever, postural hypotension, hypertensive retinopathy

increased BG, increased Ca, increased Hb
24 hour urinary metanephrines. MRI to locate tumour

10% extra adrenal, 10% malignant, 10% bilateral, 10% not assoc with hypertension, 25% familial (young and bilateral)

alpha blocker - phenoxybenzamine
BB - propanol, atenolol, metoprol
surgery

20
Q 
congenital adrenal hyperplasia genetic 
lack of what 
testosterone 
aldosterone 
cortisol 
symptoms 
treatment
A

AR
21 hydroxyls in 90%
increased
decreased
decreased
civilisation of female genitilia, precious puberty in males, salt losing crisp at age 1-3w
glucocorticoid and mineralocorticoid replacement

21
Q

acromegaly is what caused by what
symptoms
complication of what

A

excuses secretion of GH. pit tumour
thickened soft tissue - skin, large jaw, large hands, sweaty, headache, bi temp semi, OSA/snoring, early CV death, htn
colorectal cancer +/- colonic polyps

22
Q

ix of acromegaly

A

IGF1 - age and sex matched
GTT should suppress GH to <0.4, in acromegaly no change or paradoxical rise. remains >1
visual fields, Ct/MRI of pit, pit function tests

23
Q

treatment of acromegaly

A

transphenoidal surgery 90% success if micro 50 macro
if GTT still >1 bromocrtiptine/cabergoline
or octeotride somatostatin analogie
or pegvisoment GH antagonist

24
Q

follow up ofacromegaly

A

IGF1, GH<1, other pit hormone, colon cancer surveillance, CV risk factors, sleep apnoea

25
Q

proloactinoma normal causes and other causes

female presentation

male presentation

A

pregnancy, BF, stress, sleep
dopamine antagonist, anti psychotics, anti dep, hypothyroid, stalk lesions (iatrogenic, RTA), proloactinoma

early presentation, galactorrhea, menstrual irregularity, inferility

late presentation, impotance, visual disturbance, headache, ant pit malfunction

26
Q

investigations for prolactinoma

treatment

effect of treatment on prolactin, menstruation, pregnancy rate, tumour

A

PRL concentration, MRI of pit: micro <1cm, pit stalk, optic chasm
visual fileds. pit function tests

DA: cabergoline 2xwkly, bromacrptine TDS, quinagolide OD

prolactin normalised in 96%
menstruation regained in 94%
preg rate 91%
tumour shrinkage §

27
Q

hypopituarism caused by what

A

can’t produce or insufficiency supply pf hypothalamic releasing hormones
pit tumours, mets, local brain tumours, granulomatous disease, iatrogenic, AI, infection, meningitis

28
Q

symptoms of hypopit

GH, TSH, ACTH, LH/FSH

A

menstrual irregularities, infertility, impotance, gynacamastia, loss of facial hair in men, loss of axillary and pubic hair, dry skin and hair, hypothyroid, growth retardation in children

growth failure, hypothyroid, hypo adrenal, hypogonadism

29
Q

ix of hypopit

A

ACTH cortisol
TSH thyroxin
LH/FSH testosterone/oestriadol
GH - IGF1

30
Q

treatment for hypopit

A 
thyroxine 
hydrocortisone 10-25mg/daily
ADH desmospray or tablets
GH nightly SC injection 
oestorgen/progesterone F
testosterone replace in men
31
Q

testosterone types and risks

A

IM every 3-4w/prolonged 10-14w
gel
oral - restaridol

prostate enlargement
expands already present prostate cancer
polycythaemia
hepatitis in oral tablets

4 MBCHB (80 decks)

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