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Year 3 - Medical Block Workbooks > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Thyroid embryology

- Remnants

A

Thyroid remnants

  1. Thyroglossal cysts
  2. Lingual thyroid
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2
Q

Thyroid

  1. Tissue
  2. Cell types
A

Thyroid tissue

  1. Colloid
    - Iodinated thryoglobulin

2 Follicular cells
- Produce thyroglobulin

2 C-cells
- Secrete calcitonin

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3
Q

Thyroid hormones

- Metabolism

A

Thyroid hormones

  1. Thyroxine
    - Made from thyroglobulin
    - Main circulating hormone
  2. Tri-iodothyronine
    - Potent
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4
Q

Hypo-thyroidism

- Primary vs Secondary

A

Hypothyroidism

  1. Primary
    - High TSH, low T4
  2. Secondary
    - Low/norm TSH, low T4
    - Pituitary disease
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5
Q

Hyperthyroidism serology

  1. Primary
  2. Secondary
A

Hyperthyroidism

  1. Primary
    - Increased T3,T4
    - Suppressed TSH
  2. Secondary
    - Low/normal TSH
    - TSHoma/TH resistance/interference
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6
Q

Hyperthyroidism

- Causes

A

Hyperthyroidism causes

  1. Graves’ (commonest)
    - Young women
    - Relapsing-remitting
  2. Nodular thyroid disease
    - Autonomous secretion
  3. Thyroiditis
    - Inflammation
    - Viral/medication/post-partum
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7
Q

Hyperthyroidism

- Presentation

A

Hyperthyroidism HPx

  1. Sympathetic action
    - Resting tachycardia/HTN
    - Warm peripheries
    - Weight loss
    - Insomnia
    - Irritability/anxiety
    - Resting tremor
  2. Other symptoms
    - Lid-lag (upper lid tone)
    - Hyperreflexia
    - Pruritus
    - Bowel frequency
    - Menstrual disturbance/reduced fertility
  3. Elderly
    - Reduced energy
  4. Children
    - Accelerated growth
    - Behaviour disturbances
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8
Q

Graves’ Disease

- Pathognomonic signs

A

Graves’ Pathognomonics

  1. Lid retraction and proptosis
  2. Tibial myxoedema
    (and skin changes)
  3. Thyroid acropachy (nail changes)
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9
Q

Hyperthyroid

- Management

A

Hyperthyroid Mx

  1. Thionamides
    (Reduce T3/4 synthesis, ADR agranulocytosis)
    - Carbimazole
    - Propylthiouracil
  2. Beta-blockers
  3. Definitive
    - Radiactive iodine
    - Thyroidectomy and replacement
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10
Q

Hypothyroid

- Primary Causes

A

Primary Hypothyroidism

  1. Autoimmune
    - Enlargement is called Hashimoto’s
  2. Post-partum
  3. Iodine deficiency
  4. Drugs
    - Amiodarone
    - Lithium
  5. Iatrogenic
    - Surgical
    - Radiation
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11
Q

Hypothyroid

- Secondary causes

A

Secondary hypothyroidism

  • TSH deficiency
    1. Rare
    2. Investigate hypothalmic-pituitary disease
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12
Q

Hypothyroidism

- Presentation

A

Hypothyroid HPC

Often incidental blood result

  1. Weight gain
  2. Cold intolerance
  3. Fatigue
  4. Constipation
  5. Bradycardia
  6. Myxoedema
    - Skin thickening
    - Eye puffiness
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13
Q

Autoimmune hypothyroidism

- Ix

A

Hypothyroidism Ix

  1. Thyroid antibodies
  2. Hashimoto’s
    - TPO antibodies
    (Thyroid peroxidase)
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14
Q

Hypothyroidism

- Tx

A

Hypothyroidism Tx

1. Thyroxine replacement
50-100 MCG OD

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15
Q

Cortisol

- Transport

A

Cortisol transport

  1. 80-90% CBG
    - Cortisol binding globulin
  2. 5-10% albumin
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16
Q

Addison’s

- Pathology

A

Addison’s Pathology

  1. Destruction of adrenal (autoimmune)
  2. Genetic defects in steroid synthesis
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17
Q

Addison’s Disease (primary)

- S&S

A

Addison’s S&S
(Primary)

  1. Fatigue and weakness
  2. Anorexia and weight loss
  3. Abdo-pain and nausea
  4. Dizziness and postural hypotension
  5. Increased pigmentation
    - ACTH excess from negative feedback
  6. Female low libido and hair
    - androgens
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18
Q

Addison’s

- Ix

A

Addison’s Ix

Bedside
1. Hypoglycaemia

Bloods

  1. Hyperkalaemia
  2. Hyponatraemia.
  3. Uraemia
  4. Mild anaemia

Screening
- SynthACTHen

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19
Q

Addison’s

- Mx

A

Addison’s Mx

  1. Steroid emergency card
  2. Lifelong replacement
    - Hydrocortisone for gluco (prednisolone)
    - Fludrocortisone for mineral
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20
Q

ACTH deficiency

- Management

A

ACTH deficiency Mx

  1. Hydrocortisone
  2. No need for fludrocortisone
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21
Q

Phaeochromocytoma

- Complications

A

Phaochromocytoma complications

  1. HTN crisis
  2. Arrhythmias
  3. Death
  4. Encephalopathy
  5. Hyperglycaemia
  6. Pulmonary oedema
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22
Q

Phaeochromocytoma

  1. Tests
  2. Imaging
A

Phaeochromocytoma

  1. 24hr Urinary catecholamines
    Plasma metanephrines
  2. Ct Abdo
    MRI Abdo or body
    PET scans
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23
Q

Phaeochromocytoma

-	Management
A

Phaeochromocytoma Mx

  1. Surgery
    - Open or lap
  2. Alpha block (HTN crisis)
    - Phenoxybenzamine (or doxazosin)
    - Beta blockade
24
Q

Pituitary

-	Five Axes

- Stimulatory
- Resultant
A

Pituitary Axes

  1. Growth - GH
    Hyp: GHRH and somatastatin Liver: IGF-1
  2. Adrenal - ACTH
    Hyp: CRH
    Adrenal: cortisol
  3. Gonadal - FSH & LH
    Hyp: GnRH
    Ovulation & Corpus luteum
    Leydig Testosterone
  4. Thyroid - TSH
    Hyp: TRH
    T3&T4

5: Prolactin
Control: Dopamine & TRH

25
Pituitary tumours - Four functional syndromes
Pituitary syndromes 1. Acromegaly (GH) 2. Cushings (ACTH) 3. Hyper-prolactinaemia - Prolactinoma 4. TSHoma
26
Pituitary tumour - Visual field defect - Significance
Pituitary tumour - Visual field defect 1. Bi-temporal hemi-anopia 2. Indication for surgery in non-functional
27
ACTH Pituitary Reserve | - Severity Assessment
SynACTHen Test Failure to respond to ACTH - Two week ACTH deficiency - Atrophy of adrenal cortex
28
ACTH and GH reserve | - Gold standard test
ACTH and GH Reserve Test 1. Insulin Tolerance Test 2. Induce hypoglycaemia below 2.2mmol/l
29
Hyperprolactinaemia - 6 DDx
Hyperprolactinaemia 1. Pregnancy 2. PCOS 3. Prolactinoma 4. Dopamine antagonists - Anti-emetics - Anti-psychotics 5. Hypothyroidism 6. Renal failure
30
Micro-prolactinoma | - Presentation
Micro-prolacinoma 1. Menstral disturbance 2. Galactorrhoea 3. Infertilerty - Male hypogonadism
31
Macro-prolactinoma | - Presentation
Macro-prolactinoma 1. Men 2. Very high prolactin levels
32
Prolactinoma | - Mx
Prolactinoma Mx Dopamine agonists (D2) 1 Cabergoline 2 Bromocriptine
33
Prolactinoma Mx | - ADRs
Prolactinoma Mx ADRs 1. D2 agonists - Nausea - Postural hypertension - Psychiatric disturbance 2. Rapid reduction - Meningitis 3. Parkinsons doses - Valve abnormalities
34
Acromegaly | - Ix
Acromegaly Ix 1. OGTT - Failure to suppress GH 2. IGF-1 - High levels
35
Acromegaly | - Tx
Acromegaly Tx Medical 1. Monthly somatostatin analogues - Octreotide 2. Dopamine agonists 3. Definitive Surgery 4. Gamma knife (external beam/stereotactic radiotherapy)
36
Hypo-pituitarism - DDx
Hypo-pituatarism DDx 1. Pituitary tumour 2. Inflammatory/infiltrative disorders - Ass. with D. Insipidus 3. Braintrauma 4. Radiotherapy
37
Hypo-pituitarism | - Sx
Hypo-pituitarism Sx 1. Lethargy 2. Weight gain 3. Sexual dysfunction 4. Acute hypo-adrenal crisis 5. Short stature in children
38
Hypopituitarism | - Investigative aim
Hypopituitarism Investigations - Exclude adrenal insufficiency
39
Hypopituitary - Treatment pathways
Hypo-pituitary treatments 1. ACTH - Hydrocortisone 2. TSH - Thyroxin 3. Gonadotropin in men - Testosterone 4. Gonadotropin in women - Ostrogen and progesterone (COCP or HRT) 5. GH - Subcut GH
40
Cushing’s syndrome | - Presentation (six elements)
Cushing’s presentation 1. Central obesity 2. Dorso-cervical fat pad 3. Round, red face (plethora) 4. Thin skin and easy bruising 5. Proximal myopathy 6. Hypertension
41
Cushing’s syndrome | - Investigations
Cushing’s syndrome Ix 1. Pseudocushings - Alcoholism - Severe depression 2. 24hr UFC - Urine cortisol 3. LDDST - Low dose dexamethasone supression test 4. DST - Dexamethasone suppression test (overnight)
42
Cushings | - DDx
Cushing’s DDx 1. Pituitary - Very responsive to CRH 2. Adrenal - Hirsuitism - Low ACTH 3. Ectopic - Smoking Hx - Weight loss - Unresponsive to CRH
43
Cushing’s Management 1. Pit 2. Adr 3. Ect
Cushings Mx 1. Trans-sphenoidal removal — Pituitary adenoma - Metyrapone and Ketoconazole 2. Laparascopic adrenalectomy 3. Underlying ectopic malignancy
44
Hyponatraemia Sx 1. Early 2. Late
Hyponatraemia 1. Early Sx - Headache - N&V - Malaise 2. Late Sx - Confusion - Agitation - Drowsiness - Resp depress, coma, death
45
SIADH | - Three Exclusions
SIADH exclusions 1. Hypothyroidism 2. Salt depletion 3. ACTH deficiency
46
SIADH - 6 Causes
SIADH Causes 1. Idiopathic 2. CNS pathology 3. Lung cancer 4. Respiratory Pathology 5. Non-lung cancer 6. Drugs - Anticonvulsants
47
Hypervolaemic hyponatraemia - Mx
Hypervolaemic hyponatraemia Mx - Specialist 1. Cirrhosis 2. Nephrotic syndrome 3. CCF - Fluid restriction - Drug treatment 1. Demeclocycline 2. ADH antagonists
48
DI | - Two types
DI 1. Cranial DI - ADH insufficiency 2. Nephrogenic DI - Vasopressin resistance
49
DI | - Diagnostic criteria
DI criteria 1. Urine volume >3l/24 hours 2. High serum osmolality (>295mosmol/Kg) 3. Low urine osmolality (<300 mosmol/Kg)
50
DI | - Mx
DI Mx Cranial 1. Pituitary disease managmenet 2. DDAVP - Desmopressin Nephrogenic 1. Underlying cause
51
Hypercalcaemia | - Ix for Malignancy
Malignant hypercalcaemia Ix 1. PTH - Low in malignant 2. Normal/high in non-malignant
52
Hypercalcaemia with suppressed PTH | - DDx
Hypercalcaemia with suppressed PTH | - SCC until proven otherwise
53
Hypercalcaemia with non-suppressed PTH | - DDx
Hypercalcaemia with non-suppressed PTH 1. Primary PTH 2. MEN 3. HPT-Jaw tumour syndrome
54
Hypocalcaemia | - DDx
Hypo-calcaemia DDx 1. Postsurgical 2. Vitamin D - Neonate - High PTH, low phosphate 3. Hypomagnesaemia - Normal or low PTH - GI loss - Alcohol/drugs (PPIs)
55
Hypocalcaemia - Mx
Hypocalcaemia Mx 1. Vit D Deficiency - Cholecalciferol replacement 2. Hypoparathyroid replacement - Alfacalcidol - Calcitriol 3. Magnesium deficiency - Stop precipitating drugs (PPIs) - IV MgSO4

Year 3 - Medical Block Workbooks (7 decks)

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