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Random Revision Note Questions > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What’s the difference between an endocrine and an exocrine gland?

A

An endocrine gland secretes directly into the bloodstream, whereas an exocrine gland secretes into a duct first.

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2
Q

Give 4 causes of primary adrenal insufficiency.

A

Addison’s disease, surgical removal, ACTH resistance/antibodies, invasion from tumour

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3
Q

Give 4 causes of secondary adrenal insufficiency.

A

Steroids, ACTH deficiency, basal skull fracture, radiotherapy

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4
Q

What are the 3 first line tests for Cushing syndrome?

A

Late night salivary cortisol
24 hour free cortisol
Dexamethasone suppression test (followed by serum cortisol level)

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5
Q

How does hyperglycaemia lead to insulin secretion?

A

Increased uptake of glucose into cells
Glucose is metabolised, increasing ATP
ATP causes K+ channels to close
K+ channels closing depolarises the cell membrane
Ca2+ channels open
Ca2+ enters the cells
Ca2+ entering causes exocytosis of insulin containing vesicles
Insulin is released by the pancreatic beta cells

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6
Q

Which blood values are diagnostic of diabetes?

A

Random plasma glucose >11mmol/mol
Fasting plasma glucose >7mmol/mol
HbA1c > 48mmol/mol

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7
Q

Give 3 microvascular complications of diabetes.

A

Nephropathy, neuropathy, retinopathy.

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8
Q

Give 3 macrovascular complications of diabetes.

A

Cerebrovascular disease, ischaemic heart disease, peripheral vascular disease

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9
Q

Which antibodies are most prominent in graves disease?

A

Anti-TSH receptor antibodies

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10
Q

What other antibody may be present in patients with Graves’ disease?

A

Anti thyroid peroxidase antibodies

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11
Q

Give 3 features specific to Graves’ disease.

A

Pretibial myxoedema
Thyroid acropachy
Eye disease

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12
Q

What is thyroid acropachy?

A

Finger clubbing, soft tissue swelling, periosteal new bone formation

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13
Q

What are signs of thyroid eye disease?

A

Exophthalmos (bulging of the eyeballs), ophthalmoplegia (paralysis of extraocular muscles)

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14
Q

How do women with post-partum thyroiditis present?

A

Initially present with hyperthyroidism after birth, but thyroid levels return to normal or even low.

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15
Q

What is the first line treatment of Grave’s disease?

A

Radioactive iodine treatment

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16
Q

What other management options are there for Grave’s disease?

A

Carbimazole, beta blockers, thyroidectomy

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17
Q

Why are beta blockers used in Grave’s disease?

A

Symptom management

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18
Q

Give 7 signs of Hashimoto’s thyroiditis.

A 
Bradycardia
Slow reflexes
Moon face
Ascites
Cold hands
Dry/thin skin/hair 
Drowsiness
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19
Q

What is the first line treatment of hypothyroidism?

A

Synthetic levothyroxine

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20
Q

What are the two main symptoms of diabetes insipidus?

A

Polyuria

Polydipsia

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21
Q

What is the gold standard investigation for diabetes insipidus?

A

Water deprivation test

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22
Q

Which class of diabetes drug can cause hypoglycaemia?

A

Sulfonylureas

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23
Q

Give an example of a sulfonylurea.

A

Gliclazide

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24
Q

How do sulfonylureas work?

A

Increase the pancreatic output of insulin

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25
Q

What is the gold standard investigation for acromegaly?

A

Oral glucose tolerance test

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26
Q

What findings are seen in secondary hyperparathryoidism?

A

PTH - high
Calcium - low
Phosphate - high

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27
Q

What findings are seen in primary hyperparathyroidism?

A

PTH - high
Calcium - high
Phosphate - low

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28
Q

What are the symptoms of hypercalcaemia?

A

Bones (bone pain), stones (kidney stones/urinary symptoms), moans (depression), groans (constipation, abdominal pain)

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29
Q

What tests are needed for the diagnosis of diabetes?

A

2 positive tests from the following:

  • Random plasma glucose >11
  • Fasting plasma glucose >7
  • HbA1c > 48

Fasting plasma glucose and HbA1c are preferred

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30
Q

What test is used to monitor diabetes?

A

HbA1c

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31
Q

What is the first line management of type 2 diabetes?

A

Lifestyle management

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32
Q

What is the first line medical management of type 2 diabetes?

A

Metformin

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33
Q

How does metformin work?

A

Increases sensitivity of cells to insulin

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34
Q

How do sulfonylureas work?

A

They increase the amount of insulin that the body produces

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35
Q

Give a side effect of sulfonylureas.

A

Hypoglycaemia

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36
Q

What are the two most common complications of diabetes?

A

Retinopathy, peripheral neuropathy

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37
Q

What is the first line management of diabetic ketoacidosis?

A

IV fluids

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38
Q

What is the second line management of diabetic ketoacidosis?

A

Insulin

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39
Q

What type of tumour is a carcinoid tumour?

A

Neuroendocrine tumour

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40
Q

What is the triad of symptoms seen in a carcinoid tumour?

A

Flushing, diarrhoea, palpitations

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41
Q

When do symptoms appear with a carcinoid tumour?

A

Once it has metastasised to the liver

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42
Q

What is the first line/gold standard investigation for a carcinoid tumour?

A

Urinary 5-hydroxyindoleacetic acid

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43
Q

What is the first line investigation for acromegaly?

A

IGF-1

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44
Q

What is the gold standard investigation for acromegaly?

A

Oral glucose tolerance test

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45
Q

What can be tested for in phaeochromocytoma?

A

Plasma free metanephrines

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46
Q

What molecule causes hyperpigmentation in Addison’s disease?

A

POMC - propriomelanocortin

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47
Q

What symptoms does Conn’s syndrome present with?

A

Weakness, muscle cramps, hyporeflexia, polyuria/polydipsia

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48
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism

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49
Q

Which diabetes medication promotes weight loss, and which can cause weight gain?

A

Metformin promotes weight loss

Sulfonylureas can cause weight gain

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50
Q

What lab results are indicative of diabetic ketoacidosis?

A

Ketones > 3
Glucose > 11
pH < 7.3

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51
Q

What is the first line treatment of acromegaly?

A

Transphenoidal surgery

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52
Q

What is the second line treatment of acromegaly?

A

Somatastatin analogue (ocreotide or lanreotide)

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53
Q

What is the third line treatment of acromegaly?

A

GH receptor agonist

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54
Q

Give 4 signs of hypothyroidism.

A

Cold intolerance
Weight gain
Carpal tunnel
Lethargy

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55
Q

Give 5 signs of hyperthryoidism.

A 
Heat intolerance
Weight loss
Palpitations 
Tremor
Anxiety
56
Q

What is the most common cause of hypothryoidism in the developed world?

A

Hashimoto’s

57
Q

What is the most common cause of hypothryoidism in the developing world?

A

Iodine deficiency

58
Q

What does a basal cell carcinoma look like?

A

Pink, waxy and flat

59
Q

What does a squamous cell carcinoma look like?

A

Firm, red and scaly

60
Q

Give a side effect of coming off long term steroids.

A

Adrenal insufficiency due to atrophy whilst on steroids

61
Q

Give 3 types of cancer that can cause SIADH.

A

Small cell lung carcinoma
Prostate cancer
Pancreatic cancer

62
Q

What ECG changes take place in hyperkalaemia?

A

Tall tented T waves
Flattened P waves
Wide QRS

63
Q

Give 5 signs seen in hyperkalaemia.

A 
Muscle weakness or cramping 
Palpitations 
Hyperreflexia 
Irritability
Dyspnoea
64
Q

Give 4 complications of acromegaly.

A

Type 2 diabetes
Hypertension
Sleep apnoea
Bitemporal hemianopia

65
Q

What is the first line investigation for acromegaly?

A

Serum IGF-1 (raised)

66
Q

What is the gold standard investigation for acromegaly?

A

Oral glucose tolerance test

67
Q

What is the first line treatment of acromegaly?

A

Transphenoidal resection of pituitary adenoma

68
Q

What are the second line pharmacological managements of acromegaly?

A

Dopamine agonists - cabergoline

Somatostatin analogues - ocreotide

69
Q

Give 4 differentials of polyuria and polydipsia.

A

Diabetes mellitus, diabetes insipidus, Conn’s, hypercalcaemia

70
Q

What is the first line investigation of SIADH?

A

Serum sodium, serum osmolality, serum urea

71
Q

What is the first line management of SIADH?

A

IV saline and fluid restriction

72
Q

What is the most common cause of primary hyperparathyroidism?

A

A solitary adenoma

73
Q

What are the symptoms of hypercalcaemia?

A

Bones, stones, groans, moans, thrones

  • Bone pain/fracture
  • Renal/biliary stones
  • Constipation
  • Abdominal pain
  • Depression
74
Q

What is the definitive treatment of primary hyperparathyroidism?

A

Total parathyroidectomy

75
Q

What condition can classically cause the symptoms of hypercalcaemia?

A

Primary hyperparathyroidism (or any other condition where calcium is high really)

76
Q

What is the first line investigation of Cushing’s syndrome?

A

Overnight dexamethasone suppression test

77
Q

What is the most common cause of Cushing’s?

A

Exogenous causes e.g excessive corticosteroid use

78
Q

What is the main electrolyte abnormality in Conn’s syndrome?

A

Hypokalaemia

79
Q

What is the first line investigation of Conn’s syndrome?

A

Aldosterone/renin ratio

80
Q

What is the aldosterone/renin ratio in primary aldosteronism?

A

High

81
Q

What is the aldosterone/renin ratio in secondary aldosteronism?

A

Low

82
Q

What is seen on ECG in hypercalcaemia?

A

Short QT interval

Tall T waves

83
Q

What two tests/signs are positive in hypercalcaemia?

A

Chvostek’s sign

Trosseau’s sign

84
Q

What is the pathophysiology of hypercalcaemia of malignancy?

A

Excess PTHrP secretion from tumour

85
Q

Give 4 actions of PTH.

A

Increased renal absorption of calcium
Renal excretion of phosphate
Increased intestinal absorption of calcium
Increases bone turnover to release calcium

86
Q

What is carcinoid syndrome?

A

Excess release of serotonin from a tumour

87
Q

What are the two most common features of carcinoid syndrome?

A

Diarrhoea and flushing

88
Q

What is the action of carbimazole?

A

Blocks thyroid peroxidase from iodinating tyrosine residues

89
Q

Give 6 signs/symptoms of DKA.

A 
Fruity breath
Reduced consciousness
Polyuria/polydipsia
Tachycardia
Kussmauls breathing 
Abdominal pain
90
Q

Give 4 symptoms of hypoglycaemia.

A

Sweating
Palpitations
Shaking
Poor concentration

91
Q

What is the most common electrolyte disturbance found in Addison’s disease?

A

Hyponatramie (hyperkalaemia also seen, but not as commonly)

92
Q

What is the first line pharmacological management of Graves’ disease?

A

Carbimazole

93
Q

What is the urine osmolality in diabetes insipidus?

A

Low urine osmolality

94
Q

What happens to urine osmolality after desmopressin is given in cranial diabetes insipidus?

A

Urine osmolality will increase

95
Q

What happens to urine osmolality after desmopressin is given in nephrogenic diabetes insipidus?

A

Urine osmolality remains low

96
Q

What is the first line treatment of an addisonian crisis?

A

100mg IV hydrocortisone

97
Q

Which hormone inhibits GH secretion from the anterior pituitary?

A

Somatostatin

98
Q

What cells synthesise T3 and T4?

A

Thyroid follicular cells

99
Q

Give 5 signs of Cushing’s disease?

A 
Moon face
Buffalo hump
Osteoporosis
Skin thinning 
Mood change
100
Q

What are the TFT results seen in primary hypothyroidism?

A

Low T3/T4, High TSH

101
Q

What are the TFT results seen in secondary hypothyroidism?

A

Low T3/T4, Low TSH

102
Q

Give an example of an alpha blocker used in the treatment of pheochromocytoma.

A

Phenoxybenzamine

103
Q

Why is phenoxybenzamine given to pheochromocytoma patients before a removal of the tumour?

A

To avoid spikes of hypertension during the surgery

104
Q

What is seen on ECG in hypokalaemia?

A

Small T waves, ST depression, U waves, short QT

105
Q

What is the action of DPP-4 inhibitors?

A

Prevent insulin from being metabolised

106
Q

What is the action of sulfonylureas?

A

Stimulate insulin production

107
Q

What is the action of SGL-2 inhibitors?

A

Block reabsorption of glucose in the kidneys

108
Q

What is the action of GLP-1 analogues?

A

Increase insulin production by increasing the beta cell mass of the pancreas

109
Q

What is the first line investigation in diabetes insipidus?

A

Water deprivation test

110
Q

What is the investigation used to differentiate between cranial and nephrogenic diabetes insipidus?

A

IM desmopressin test

111
Q

What would the results be for a desmopressin test in cranial and nephrogenic diabetes insipidus?

A

The urine is concentrated in cranial DI, whereas it remains diluted in nephrogenic DI.

112
Q

What is the first line treatment of a prolactinoma?

A

Dopamine agonist - cabergoline

113
Q

What is the second line treatment of a prolactinoma?

A

Transphenoidal resection of tumour

114
Q

Give 4 causes of diabetic ketoacidosis.

A

Underlying infection
Disruption of insulin treatment
Binge drinking
New onset of diabetes

115
Q

What are the contraindications of metformin?

A

Renal disease
Liver failure
Heart failure

116
Q

Give 4 side effects of metformin.

A

Anorexia
Diarrhoea
Nausea
Abdominal pain

117
Q

What is the pathophysiology of graves disease?

A

TSH receptor autoantibodies cause thyroid hormone overproduction

118
Q

What is the first line investigation for graves disease?

A

Thyroid function tests

119
Q

What is the gold standard investigation for graves disease?

A

Anti-TSH antibodies

120
Q

Give 3 risk factors for Hashimoto’s thyroiditis.

A

Female
Other autoimmune disease
Down’s syndrome/Turner’s syndrome

121
Q

What antibodies are most prevalent in Hashimoto’s thyroiditis?

A

Thyroid peroxidase antibodies

122
Q

What is the first line management of hypothyroidism?

A

Levothyroxine

123
Q

What is De Quervian’s thyroiditis?

A

Hyperthyroidism usually following a viral illness

124
Q

What is the treatment of De Quervian’s thyroiditis?

A

Aspirin

125
Q

What is primary hypothyroidism?

A

Problem with the thyroid itself

126
Q

What TFTs will be seen in primary hypothyroidism?

A

Low T3/T4, high TSH

127
Q

What is secondary hypothyroidism?

A

Problem with the pituitary

128
Q

What TFTs will be seen in secondary hypothyroidism?

A

Low T3/T4, low TSH, high TRH

129
Q

What is tertiary hypothyroidism?

A

Problem with the hypothalamus

130
Q

What TFTs will be seen in tertiary hypothyroidism?

A

Low T3/T4, low TSH, low TRH

131
Q

What are the clinical effects of a pituitary tumour?

A

Pressing on other structures
Pressure damage to the normal pituitary leading to hypopituitarism
Effects of excess hormones from functional tumours

132
Q

What are the commonest biochemical abnormalities in Addison’s disease?

A

Hypernatraemia
Hypercalcaemia
Hypokalaemia
Decreased glucose

133
Q

What is the most common cause of an addisonian crisis?

A

Cessation of long term steroids

134
Q

What is the action of metformin?

A

Decreases hepatic glucose production
Decreases intestinal absorption of glucose
Increases peripheral glucose uptake and use

135
Q

What is the gold standard investigation for phaeochromocytoma?

A

Serum metanephrines

Random Revision Note Questions (10 decks)

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