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Endocrine Flashcards

1
Q

What are the 6 hormones produced by the anterior pituitary

A
  • FLATPIG
  • FSH
  • LH
  • Adrenocorticotrophic hormone
  • TSH
  • Prolactin
  • Ignore
  • GH
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2
Q

What controls FSH and LH secretion and what are their function

A
  • GnRH

- Stimulate menstrual cycle and oestrogen in women, testosterone and sperm production in women

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3
Q

What controls ACTH secretion and what is its function

A
  • Corticotropin releasing hormone (CRH)

- Stimulate cortisol and androgen release from adrenal glands

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4
Q

What controls TSH secretion and what is its function

A
  • Thyrotropin releasing hormone

- Stimulates thyroid to produce TH (T4/T3)

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5
Q

What controls prolactin secretion and what is its function

A
  • Dopamine inhibits secretion

- Stimulates breast growth and lactation

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6
Q

What controls GH secretion and what is its function

A
  • GHRH and somatostatin (decreases)

- Increases protein synthesis and growth

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7
Q

What is the function of cortisol (4)

A
  • Increases carbohydrate and protein metabolism
  • Increases fat deposition
  • Part of bodies response to stress
  • Anti-inflammatory (hence suppresses immune system)
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8
Q

What is the function of Thyroid hormone (4)

A
  • Increases metabolism (fat/carb.)
  • Increases protein synthesis
  • Increases HR/CO
  • Increases resp. rate
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9
Q

What are the two hormones secreted by the posterior pituitary

A
  • ADH

- Oxytocin

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10
Q

What is the epidemiology of hyperthyroidism (2)

A
  • 2-5% of women get it in lifetime

- Most common 20-40

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11
Q

What can cause hyperthyroidism (5)

A
  • Graves disease
  • Toxic multinodular goitre
  • Adenoma
  • De Quervains thyroiditis
  • Drug induced
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12
Q

Describe the pathophysiology of Graves disease

A
  • TSH receptor stimulating antibodies bind to TSH receptor on thyroid
  • This stimulates TH production
  • Also leads to hyperplasia and hence goitre
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13
Q

How might hyperthyroidism present (7)

A
  • Weight loss and increased appetite
  • Warm and sweaty
  • Oligomenorrhea
  • Tremor
  • Palpitations
  • Goitre
  • Children
    • Excessive height and learning difficulties
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14
Q

How do you diagnose hyperthyroidism (2)

A
  • Thyroid function tests
    • TSH low due to negative feedback
    • T3/4 raised
  • TSHR antibodies in Graves
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15
Q

How do you treat hyperthyroidism (4)

A
  • B blockers to control symptoms (propanolol)
  • Anti-thyroid drugs
    • Propylthiouracil (stops T3 - T4 conversion)
    • Carbimazole (Lowers T3/T4 production)
  • Radioactive iodine
  • Surgery (thyroidectomy)
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16
Q

What is the epidemiology of hypothyroidism (3)

A
  • More common in females
  • Autoimmune/atrophic is most common cause
  • Increases with age
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17
Q

What are the causes of primary hypothyroidism (5)

A
  • Autoimmune/atrophic
  • Iatrogenic
  • Hashimotos thyroiditis (autoimmune + goitre)
  • Iodine defficiency
  • Drug induced
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18
Q

How might hypothyroidism present (5)

A
  • Weight gain/decreased appetite
  • Cold
  • Low mood/tired
  • Goitre
  • Myalgia/weakness
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19
Q

What are the signs of hypothyroidism

A
  • BRADYCARDIC
  • Bradycardia
  • Reflexes relax slowly
  • Ascites
  • Dry
  • Yawning/drowsy
  • Cold hands
  • Ataxia
  • Round puffy face
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20
Q

How do you diagnose hypothyroidism (2)

A
  • Thyroid function tests
    • High TSH (unless secondary)
    • Low T3/T4
  • Thyroid antibodies
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21
Q

How do you treat hypothyroidism

A
  • Levothyroxine (T4 replacement)
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22
Q

What is the epidemiology of thyroid carcinoma (3)

A
  • Rare
  • More common in females
  • Minimally active hormonally
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23
Q

What are the types of thyroid carcinoma (3)

A
  • Papillary (70%)
    • Well differentiated, good prognosis
  • Follicular (20%)
    • Well differentiated, good prognosis
  • Anaplastic (5%)
    • Poorly differentiated, poor prognosis
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24
Q

How might thyroid carcinoma present (2)

A
  • Hard, enlarged, irregular thyroid

- May be hoarseness of voice and dysphagia due to pressing on local structures

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25
How do you diagnose thyroid carcinoma (3)
- Needle aspiration biopsy - Ultrasound - TFTs
26
How do you treat thyroid carcinoma (3)
- Radioactive iodine - Levothyroxine to supress TSH (stimulates growth) - Thyroidectomy
27
What are the causes of cushings syndrome (4)
- Iatrogenic - oral steroids (most common) - Cushings disease - ACTH secreting pituitary adenoma - Ectopic ACTH secreting adenoma - Adrenal adenoma
28
How might cushings syndrome present (8)
- Central obesity - Round, ruddy face - Mood change - Muscle wasting/weakness - Infection - Thick skin, easily bruises - Acne - Raised B.P
29
How do you diagnose cushings syndrome (4)
- Random cortisol test (raised) - Dexamethasone suppression test - In normal causes dec. cortisol, in cushings cortisol still high - Serum ACTH (raised = ectopic/cushings disease, normal = adrenal adenoma) - Cortictrophic releasing hormone test - If it causes further increase in cortisol then cushings disease - If not then ectopic adenoma
30
How do you treat cushings syndrome (4)
- Iatrogenic - stop steroids - Cushings disease - Remove pituitary adenoma - Adrenalectomy - Adrenal adenoma - Adrenalectomy - Ectopic - removal
31
What is gigantism
- Acromegaly in children
32
What is the epidemiology of acromegaly (3)
- Rare - Most commonly caused by benign GH secreting pituitary tumour - Usually presents in middle age
33
How might acromegaly present (6)
- Headache (very common) - Large hands and feet - Visual deterioration - Excess sweating - Increased weight - Arthralgia and backache
34
What are the signs of acromegaly (5)
- Wide nose - Pertruding jaw - Deep voice - Large tongue - Carpal tunnel syndrome
35
How do you diagnose acromegaly (2)
- Serum GH (not diagnostic as pulsatile) | - Insulin like growth factor 1 (IGF-1) raised (diagnostic)
36
How do you treat acromegaly (3)
- Remove pituitary tumour - Somatostatin analogues - GH receptor agonists
37
What is the epidemiology of hyperprolactinaemia (2)
- More common in females | - Most common pituitary hormonal disturbance
38
What are the causes of hyperprolactinaemia (4)
- Prolactinoma - Pituitary stalk damage - Drugs (most common cause) - Pregnancy/breast feeding
39
How might hyperprolactinaemia present (4)
- Amenorrhea - Galactorrhoea - E.D/facial hair loss in males - Infertility
40
How do you diagnose hyperprolactinaemia
- Serum prolactin raised
41
How do you treat hyperprolactinaemia
- Dopamine agonists (cabergoline)
42
What is Conns syndrome
- Primary excess production of aldosterone independent of RA system, leading to increased Na and water retention and increased K secretion
43
What are the causes of Conns syndrome (2)
- Adrenal adenoma | - Adrenal hyperplasia
44
How might Conns syndrome present (2)
- Hypertension | - Hypokalaemia (cramp/spams, paraesthesiae)
45
How do you diagnose Conns syndrome
- Serum renin (low) : aldosterone (high)
46
How do you treat Conns syndrome (2)
- Laproscopic adrenalectomy | - Spiralactone (aldosterone agonist)
47
What is addisons disease
- Destruction of the entire adrenal cortex leading to lack of cortisol, aldosterone and androgens
48
What is the epidemiology of addisons disease (2)
- More common in females | - Very rare
49
What are the causes of addisons disease (3)
- Autoimmune adrenitis (most common) - Long term steroids (atrophy due to low ACTH) - TB
50
How might addisons disease present (8)
- Low mood, lethargy, depression - Tanned - Weight loss/anorexia - Hypotension - Amenorrhea/ E.D - Dehydration - Nausea, vomiting and abdo. pain - Loss of body hair
51
How do you diagnose addisons disease
- Bloods | - ACTH stimulation test (in addisons no/poor response of cortisol secretion to ACTH)
52
How do you treat addisons disease (2)
- Acute - IV hydrocortisone, fluids, glucose - Oral prednisolone and fludrocortisone - Advise patient on when to increase dose
53
What is diabetes insipidus
- Passage of large volumes of dilute urine due to impaired water retention by the kidneys (related to ADH)
54
What are the two causes of diabetes insipidus
- Cranial - Decreased ADH secretion by posterior pituitary - Nephrogenic - Decreased response of kidneys to ADH
55
How might diabetes insipidus present (4)
- Polyuria - Polydipsia - Dehydration - Hypernatraemia (weakness, confusion, lethargy)
56
How do you diagnose diabetes insipidus (3)
- Measure urine volume - Water deprivation test - Urine dipstick to check for glycosuria (DM)
57
How do you treat diabetes insipidus (2)
- Cranial - Desmopressin (ADH analogue) - Nephrogenic - Treat cause - Thiazide diuretic
58
What is syndrome of inappropriate ADH secretion
- Continued secretion of ADH despite low plasma osmolality leading to hypervolaemia and hyponatraemia
59
How might syndrome of inappropriate ADH secretion present (4)
- Malaise/nausea - Confusion - Weakness and aches - Anorexia
60
How do you diagnose syndrome of inappropriate ADH secretion
- Bloods - Low Na - Low osmolality
61
How do you treat syndrome of inappropriate ADH secretion (4)
- Loop diuretics (furosemide) - Treat underlying cause - Restrict fluid intake - Hypertonic saline (high salt)
62
What is the function of parathyroid hormone (PTH) (4)
- Increases bone resorption - Increases Ca absorption in intestines - Increases Calcitriol production - Increases Ca retention and Phosphate excretion
63
What is the function of Calcitriol (4)
- Inhibits PTH release (negative feedback) - Increases bone resorption - Increases Ca and phosphate absorption - Increases Ca and phosphate retention
64
Describe the epidemiology of hypercalcaemia (2)
- Most seen in old women | - Mostly caused by hyperparathyroidism and malignancy
65
What are the causes of hypercalcaemia (3)
- Primary hyperparathyroidism (Adenoma/hyperplasia) | - Malignancy secreting PTH like substance
66
How might hypercalcaemia present (4)
- Bones (pain, fracture, osteoporosis) - Stones (renal and gall) - Groans (abdominal pain, malaise, nausea, polyuria and polydipsia - dehydration) - Psychiatric moans (depression, anxiety, confusion)
67
How do you diagnose hypercalcaemia
- Bloods - Primary (inc. Ca, PTH, dec. phosphate) - Malignancy (inc. Ca, phosphate, dec. PTH)
68
How do you treat hypercalcaemia (4)
- Acute (iv. saline/fluids, biphosphonates) - Hyperparathyroidism - Adenoma - Surgical resection - Hyperplasia - PTectomy - Calcimimetic - increases PT sensitivity to Ca
69
What is the epidemiology of hypocalcaemia (2)
- All ages + sexes | - Common in hospital, correlates with severity of illness
70
What are the causes of hypocalcaemia (4)
- CKD (dec. Calcitriol production) - most common - Hypoparathyroidism - Pseudohypoparathyroidism (dec. sensitivity of PTH recptors) - Vitamin D deficiency
71
How might hypocalcaemia present (5)
- SPASM - Spasm - Paraesthesiae - Anxious - Seizure/convulsions - Muscle tone increased
72
How do you diagnose hypocalcaemia (2)
- Clinical history and Low Ca | - PTH low in hypoparathyroidism, raised in other causes
73
How do you treat hypocalcaemia (3)
- Acute - IV calcium gluconate - Hypoparathyroidism - Calcitriol and Ca supplements - Vitamin D deficiency - Oral adcal (vit. D and Ca)
74
What are the important values for hyperkalaemia (2)
- K > 5.5mmol/L = hyperkalaemia | - K > 6.5mmol/L = EMERGENCY
75
What can cause hyperkalaemia (3)
- AKI/ renal failure - Drugs (NSAIDs, K sparing diuretic, ACE inhibitors) - Addisons (dec. aldosterone)
76
How might hyperkalaemia present (5)
- Fast irregular pulse - Light headed/ dizzy - Palpitations - Chest pain - Weakness/ fatigue
77
How do you diagnose hyperkalaemia (2)
- U&Es (K > 5.5, > 6.5 = EMERGENCY) | - ECG
78
How do you treat hyperkalaemia (4)
- Acute - Calcium gluconate (stabilises cardiac myocytes) - Insulin (+glucose) to drive K into cells - Nebulised salbutamol to drive K into cells - Non-acute - Treat cause/ diet restriction
79
What are the important values for hypokalaemia (2)
- K <3.5 = hypokalaemia | - K <2.5 = EMERGENCY
80
What can cause hypokalaemia (4)
- Thaizide and loop diuretics - Renal failure - Increased aldosterone (Cushings, Conns) - GI loss (vomiting/diarrhoea)
81
How might hypokalaemia present (5)
- Weakness/ fatigue - Palpitations - Cramps - Light headed - Hypertonia/hypereflexia
82
How would you diagnose hypokalaemia (2)
- U&Es Low K > 3.5, >2.5 = EMERGENCY | - ECG
83
How do you treat hypokalaemia (4)
- Acute - IV K (carefully) - Non-acute - Medication review/treat cause - K sparing diuretic (spironolactone) - K supplements
84
What is Diabetes mellitus (2)
- A syndrome of hyperglycaemia due to insulin deficiency/resistance or both - Results in serious micro/macrovascular complications
85
What is type 1 diabetes
- Disease of insulin deficiency due to autoimmune destruction of Beta cells on the islets of langerhans
86
What is the epidemiology of type 1 diabetes (2)
- Usually presents in younger people | - Patients usually leaner
87
Describe the pathophysiology of type 1 diabetes
- Autoimmune destruction of Beta cells on islets of langerhans - Leads to insulin deficiency causing increased liver glucose production and decreased uptake by cells - This causes glycosuria which causes polyuria and polydipsia due to increased urine osmolality due to increased glucose in the urine - Also decreased uptake of glucose by cells leads to ketogenesis which can lead to muscle wasting and ketoacidosis
88
What is type 2 diabetes
- Hyperglycaemia resulting from a combination of decreased insulin secretion and resistance
89
What is the epidemiology of type 2 diabetes (2)
- Usually presents in older people | - Fatter patients
90
What are the risk factors for type 2 diabetes (4)
- Obesity - Lack of exercise - Family history - Increasing age
91
How might diabetes mellitus present (5)
- Triad of - Polyuria - Polydipsia - Weight loss - More rapid onset in type 1 - Complications may be presenting complaint - Neuropathy - Retinopathy - Erectile dysfunction - Skin infection
92
How do you diagnose diabetes mellitus (2)
- In symptomatic 1 in asymptomatic both - Random plasma glucose > 11.1 mmol/L - Fasting plasma glucose > 7 mmol/L
93
How do you treat type 1 diabetes (5)
- Educate patients on self adjusting dose - Finger prick before (short acting)/after (long acting) meals - 3 Types of insulin - Short acting insulin (4-6 hours) before meal - Short acting insulin analogue (4-6 hours) before meal eg. insulin aspart - Long acting insulin (12-24+ hours) after meal, mixed with retarding agents eg. isophane insulin
94
How do you treat type 2 diabetes (5)
- Lifestyle change (weight loss/diet/exercise) - B.P and cholesterol management - 1st line oral metformin (decreases liver glucogenesis and increases cell senstivity to insulin) - Add oral gliclazide (promotes insulin secretion) - Add insulin eg. isophane insulin
95
What are the risk factors for diabetic ketoacidosis (4)
- Stopping insulin therapy - Infection - Surgery - Undiagnosed type 1
96
What is the pathophysiology of diabetic ketoacidosis
- Low insulin leads to low glucose uptake by cells causing increased ketone body formation - Also glycosuria leads to increased fluid and electrolyte loss - This results in a raised concentration of acidic ketones in the blood - Leads to acidosis, attempted respiratory compensation and impaired kidney excretion of H+ and ketones due to dehydration
97
How might diabetic ketoacidosis present (6)
- Severe dehydration - decreased consciousness/ drowsiness - Hyperventilation - Vomiting - Pear drop breath - Low body temperature - May be severe abdominal pain
98
How do you diagnose diabetic ketoacidosis (2)
- Bloods - Acidaemia Ph <7.35 - Rasied ketones >3 mmol/L - Lowered bicarb. <15 mmol/L - Hyperglycaemia >11 mmol/L - Heavy keto/glycosuria
99
How do you treat diabetic ketoacidosis (4)
- IV. fluids - Replace electrolytes - Restore acid-base balance - Insulin + glucose (to avoid hypoglycaemia)
100
What is a hyperosmolar hyperglycaemic state
- A life-threatening emergency with marked hyperglycaemia and hyperosmolality
101
Describe the pathophysiology hyperosmolar hyperglycaemic state
- Usually caused by infection - Insulin deficiency leads to hepatic glucogenesis but insulin levels still high enough to suppress ketogenesis - Leads to severe dehydration
102
How might hyperosmolar hyperglycaemic state present (2)
- Severe dehydration | - Decreased consciousness, confusion, drowsiness
103
How would you diagnose hyperosmolar hyperglycaemic state (2)
- Bloods - Hyperglycaemia - Very high serum osmolality - Heavy glycosuria
104
How do you treat hyperosmolar hyperglycaemic state (4)
- Iv fluids - Replace electrolyte loss - Insulin - LMW heparin as predisposed to thrombus due to hyperosmolality
105
What are the main reasons for diabetic complications (4)
- Poor glycaemic control - Poor B.P control - Long duration of diabetes - Pregnancy
106
What is diabetic macrovascular disease (2)
- Diabetes predisposes to atherosclerosis and hence embolus leading to increased chance of stroke/MI/preipheral ischaemia - Treat with B.P control and statins
107
What is diabetic retinopathy (2)
- Microaneurysm and haemorrhage leads to progressive retinal damage and hence progressive visual loss - Treat with laser surgery (stops progression, cannot reverse)
108
What is diabetic nephropathy (2)
- Basement membrane damage and glomerular damage due to poor glycaemic and B.P control - Treat by improving glycaemic control and B.P control
109
What is diabetic neuropathy (2)
- Paraesthesiae, numbness, burning of limbs and erectile dysfunction - Treat with paracetamol/opioids (codeine) anticonvulsants
110
What is diabetic foot ulcer (2)
- Trauma unnoticed due to numbness of foot leads to ulceration - Treat by patients checking foot, keeping good hygiene and wearing lose shoes
111
What are the causes of hypoglycaemia (7)
- Diabetics - Insulin - Non diabetics - Explain - Exogenous drugs - Pituitary insufficiency - Liver failure - Addisons - Islets tumour - Neoplasm
112
How might hypoglycaemia present (5)
- Hunger - Anxiety/sweating - Dizziness - Palpitations - Confusion/drowsiness
113
How do you diagnose hypoglycaemia (2)
- Finger prick glucose test (<3 mmol/L) | - Look for cause
114
What is the treatment for hypoglycaemia
- Oral sugar/ iv glucose
115
What ECG changes would you expect to see in hypercalcaemia
- Short QT interval
116
What ECG changes would you expect to see in hypocalcaemia
- Long QT interval
117
What ECG changes would you expect to see in hyperkalaemia
- Tall tented T waves | - Rapid QRS
118
What ECG changes would you expect to see in hypokalaemia
- Small T waves | - U waves

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