endocrine Flashcards
1
Q
when do pregnant hypothyroid women need to change their their thyroxine and by how much
A
increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy
2
Q
Acromegaly CFs
A
large tongue, hands, face
XS sweating
signs of hypopituitarism- headache, bitemporal hemianopia
3
Q
which clinical problems assiciated with acromegaly
A
HTN, Cardiomyopathy, diabetes
4
Q
what is acromegaly caused by
A
XS GH secreted
95% caused by pit adenoma
MEN1
5
Q
Investigations acromegaly
A
GOLD STANDARD;
Serum IGF-1 levels
If IGF-1 raised- OGTT
6
Q
what would show on Ix for acromegaly
A
acromegaly: no supression of GH in hyperglycaemia
MRI brain - check for pit adenoma
7
Q
first line management acromegaly and what adjunct
A
trans sphenoid surgery
ocreotide= adjunct when awaiting surgery a somatostatin analogue which is often used as an adjunct to surgery resulting in reduced growth hormone levels and reduction in tumour size.
(bromocriptide DO agonist is only for medical management alone_
8
Q
management acromegaly:
A
- trans sphenoid surgery
- somatostatin analogue eg octreotide, directly inhibits the release of growth hormone
- pegvisomant——GH receptor antagonist
- dopamine agonists——bromocriptine (now last line)
9
Q
what is addisons disease and what does it cause
how does it affect electrolytes
and CFs
what causes addisons
A
primary hypoadrenalism
causes reduced cortisol and reduced aldosterone
low Na
high K
loss of pubic hair
CFs
axillary hair thinning
pubic hair thinning
vitiligo
salt craving
hypotension
hypoglycaemia
addisonian crisis
caused by autoimmune destruction of adrenal glands
10
Q
primary hypoadrenalism =????
A
addisons disease
11
Q
eg biguanide
A
metformin
12
Q
what type of meds are DPP4 inhibitors and their MOA
A
gliptins eg sitagliptin
DECREASE GLP 1 breakdown
13
Q
pros of biguanides and MOA
A
eg metformin-
no risk of hypoglycaemia
works by DECREASE hepatic glucose production
and
INCREASE peripheral insulin sensitivity
14
Q
how do gliptins work
A
DPP4 inhibitor
increase post prandial insulin
15
Q
eg sulpohonylurea
A
glicazide, glibenclamide
work by:
increase pancreatic insulin secretion
ATPk CLOSES CHANNEL
16
Q
which type of diabetes medicine causes weight gain
A
sulphonylurea== AVOID IN OBESE PATIENTS
17
Q
WHAT Type of diabetes medicine can cause hypoglycaemia
A
sulphonylureas- eg gliclazide
18
Q
eg thiazolidinediones
and MOA
A
eg pioglitazone
moa= PARRY gamma
19
Q
TRIAD symptoms of DKA
A
- blood glucose>11
- capillary ketones >3 or >2+ in urine
- pH<7.35
20
Q
initial DKA TX
A
IV FLUIDS- and Fixed rate insulin infusion
5OU actrapid in 50ml 0.9%NaCl
21
Q
HHS presentation and cause
CFS
Tx
A
characteristic of T2DM, severe hyperglycaemia in absense of ketosis causing hyperosmolar state
22
Q
Tx HHS
A
agressive iV fluids
consider potassium replacement if hypokalemc
23
Q
Treatment thyrotoxicosis
A
propylthiouracil
Propanolol
high dose steroids- dex 4mg iv
iodine
supportive measuresd
24
Q
which medication can cause thyroidtoxicosis
A
amiodarone
25
TRAb antibody sensitive and specific for which thyroid problem?
Grave's disease
26
which thyroid antibody is tested in Grave's disease
TSH receptor antibody (TRAb)
27
MOA carbimazole and propylthiouracil
TPO
28
What does adrenal gland secrete
adrenaline, aldosterone, cortisol
29
electrolyte disturbance caused by addisons?
hyponatremia
hyperkalemia
30
Another name for sub acute thyroiditis =
de quervain
31
sick euthyroid is common in which patient demographic
hopsital inpatients
32
treatment for sick euthyroid syndrome
no treatment- Changes are reversible upon recovery from the systemic illness and no treatment is usually needed
33
TSH and free T3 in sick euthyroid syndrome
low TSH low T3
34
Sub clinical hypothyroidism TSH and T3 levels
High TSH,
normal T3
35
Poor compliance with thyroxinE patients: TSH and T3 levels
Hight TSH
normal t3
36
Polydipsia ivestigation test
water deprivation test
37
water deprivation test: positive for primary POLYDIPSIA:
starting plasma osmolality
urine osmolality after fluid deprivation
-urine osmolality after desmopressin
starting plasma osmolality LOW
urine osmolality after fluid deprivation: HIGH
urine osmolality after desmopressin: HIGH
38
Water deprivation test: nephrogenic DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: low
39
where is ADH secreted
hypothalumus
40
cranial DI water deprivation test
starting plasma osmolality:High
urine osmolality after fluid deprivation:low
urine osmolality after desmopressin: high
41
which medication deiabetes med can cause DKA
Dapagliflozin/SGLT2 inhibitors
42
Klinefelter's syndrome chromosome abnormality
CFs
47XXY
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels but low testosterone HIGH LH, HIGH FHS
43
HYPOCALCAEMIA ECG
LONG QTC
44
Which syndrome causes LH & FSH low-normal and testosterone is low
Kallmans syndrome
Also, cleft palate, small testes, X LINKED recessive INHERITED
45
Sjogrens syndrome can cause ?type of renal tubular acidosis
type 1- distal
46
treatment for severe hyponatremia
3% nacl
47
Familial hypercholesterolaemia (FH) - inheritance
is an autosomal dominant c
48
bilateral adrenal hyperplasia causes hyper????????
HYPERALDOSTEROINISM
49
most common cause primary hyperparathyroidism
Primary hyperparathyroidism: solitary adenoma
50
in pregnancy- increase in which thyroid antibody
TBG- thyroxine binding globulin
51
Exenatide = MOA
Exenatide = Glucagon-like peptide-1 (GLP-1) mimetic
52
Deafness and hypothyroidism== what condition
pendred disease
53
MODY inheritance patter
auto dominant
54
is urinary sodium high or low in SIADH
high
55
which diabetes med can cause pancreatitis and severe renal impairment
exenatide
56
long term corticosteroid use can cause
avascular necrosis
57
acromegaly patients high risk for which type of cancer
colorectal
58
Meglitinides - moa
bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells
59
MEN 1, 2a and 2b associated conditions
see screenshot
MEN 1
PPP
Parathyroid, pituitary, pancreas
MEN 2a
PP
Parathyroid
Phaechromocytoma
MEN 2b
P
Phaeochromocytoma
Marfanoid body
medullary throid
60
hypercalcaemia is most common in which MEN type
MEN 1
61
acetozolamide - electrolyte hypo or hyperkalemia
hypokalemia
62
thiazide- electrolyte hypo or hyperkalemia
hypokalemia
63
sick euthyroid syndrome- TSH and T4 level
BOTH LOW
64
VBG of (all) renal tubular acidosis
hyperchloraemic metabolic acidosis
(normal anion gap)
65
carbimazole MOA
Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin --> reducing thyroid hormone production + no action on 5'-deiodinase
carbimazole
== NO ACTION ON 5 deiodinase
66
propylthiouracil moa
Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin --> reducing thyroid hormone production + inhibits 5'-deiodinase which reduces peripheral conversion of T4 to T3
67
incontinence in elderly---give?
give mirabegron
NOT oxybutynin (bc elderly == confusion)
68
MOA mirabegron
mirabegron- beta3 agonist
69
definitive mangement hyperparathyroidism
total parathyroidectomy
70
anti thyroid medications in pregnancy
1st trimester
2nd trimester
1st trimester- propylthiouracil
2nd trimester onwards- switch back to carbimazole
71
primary hyperparathyroidism symptoms
bones groans stones psychic moans
MEN 1 and 2
72
electrolyes in primary hyperparathyroidism
high calcium
low phosphate
normal-high PTH
73
In a patient with T2DM (poorly controlled) and CVD:
add metformin first
if still not helping:
add ???
Add SGLT2 inhibitor
eg piglitazone
74
what type of anti diabetic med good for CVD
SGLT 2 inhibitor eg dapagliflozin
75
how often check hba1c in t2dm
every 3-6 months until stable , then 6 monthly
76
HBA1C targets in T2DM
lifestyle only
lifestyle + metformin
lifestyle +drug can cause hypos
lifestyle only 48
lifestyle + metformin 48
lifestyle +drug can cause hypos 52
77
Causes of HTN and hypokalemia (plus mneumonic)
Liddle Cushing Conned 11 people
Liddle's syndrome
Cushing's syndrome
Conn's syndrome (primary hyperaldosteronism)
11-beta hydroxylase deficiency
78
Causes of hypokalemia WITHOUT HTN
diuretics
GI loss (e.g. Diarrhoea, vomiting)
renal tubular acidosis (type 1 and 2**)
Bartter's syndrome (furosemide ascLOH)
Gitelman syndrome
79
which antidiabetic med causes glycosria
dapagliflozin
80
which antidiabetic med CI in heart failure
Thiazolidinediones- eg pioglitazone
81
cinacalcet==? and when to give
in primary hyperparathyroidism
= calcium mimetic
82
familial hypercholesterolaemia inheritance
aut dom (exception to rule)
83
addisons disease investigation
ACTH stimulation test- synacthen test
Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM
if this not possible:
9am cortisol
84
electrolytes in addisons
addisons- primary hypoaldosteronism
hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis
85
investigations cushing disease
confirm and localise
confirm:
overnight dexamethasone suppression test
IF positive for cushings disease:
NO suppression of morning cortisol
Localise:
high-dose dexamethasone suppression test
86
VBG in cushings sydnrome
met alk and kypokalemic
87
interpretation of high dose dexamethasone suppression test to localise cushings
Cushings syndrome (eg adrenal adenoma)
Cortisol- NOT supp
ACTH : +SUPpressed
Cushing disease (pit adenoma)
Cortisol: suppressed
ACTH: suppressed
Ectopic ACTH syndrome:
Cortisol: not suppressed
ACTH: not suppressed
88
how does osteomalacia affect calcium and phosphate
LOW CALCIUM
and LOW PHOSPHATE
89
impaired fasting glucose range
6.1-7.0
90
impaired glucose tolerance rang
fasting <7.0
AND
OGTT 2 hr 7.8-11.0
91
gitelmans syndrome
cause
how it affects electrolytes
Gitelman's syndrome is due to a defect in the thiazide-sensitive Na+ Cl- transporter in the distal convoluted tubule.
Features
normotension
hypokalaemia
hypocalciuria
hypomagnesaemia
metabolic alkalosis
92
what type of cancer ass'd with MODY
HCC
93
what type of med is dapagliflozin, canagliflozin, GLIFLOZINS and their
MOA
gliflozins
MOA: SGLT2 inhibitor
Increase urinary glucose
excretion
reduce glucose reabsorption`
gliflozins can cause forniers gangrene
94
in toxic multinodular goitre-- nuclear scintigraphy == ?
patchy uptake-
95
Second-line treatments T2DM:
Sulphonylureas e.g. gliclazide.
Gliptin's e.g. sitagliptin.
Thiazolidinedione e.g. pioglitazone
Sodium/glucose cotransporter 2 (SGLT-2) inhibitors e.g. canagliflozin
Second-line treatments for type 2 diabetes range from:
Sulphonylureas e.g. gliclazide. Side effects include weight gain and hypoglycaemia.
Gliptin's e.g. sitagliptin. Side effects include headaches, but are generally well tolerated.
Thiazolidinedione e.g. pioglitazone. Side effects include fluid retention and weight gain.
Sodium/glucose cotransporter 2 (SGLT-2) inhibitors e.g. canagliflozin. Side effects include urinary tract infections and increased risk of foot amputations (mainly with canagliflozin, but no evidence of a link with empagliflozin and dapagliflozin).
96
What can lithium cause- cranial or nephrogenic DI
nephrogenic DI
97
Dapagliflozin MOA and where it acts
SGLT-2 inhibitors reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule
98
gestational diabetes diagnosis range
Diagnostic thresholds for gestational diabetes
gestational diabetes is diagnosed if either:
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
5678
99
what to give in gestational diabetes if metformin not tolerated
glibenclamide
or give if BM targets not met on metformin but pt declines insulin
100
management of pre existing diabetes in pregnancy
BMI <27
stop meds apart from metformin and start insulin
folic acid 5mg od
101
Targets for self monitoring of pregnant women (pre-existing and gestational diabetes)
537864
fasting 5.3
1 hr post meal 7.8
2 hr post meal 6.4`
102
what is hungry bone syndrome and how does it affect calcium levels
hungry bone syndrome = sudden drop in previously high parathyroid hormone levels
causes hypocalcaemia
103
Bartter's syndrome : where does it act
CFs
loop of henle , inhibits Na-K-2Cl
acts like furosemide
CFs
normotension
polyuria, polydipsia
hypokalemia
FTT in childhood
104
Liddles syndrome
inheritance
CFs
treatment
where does it act
aut dominant
HTN
hypokalemia
met alkalosis
Tx= amiloride or triamtrelene
acts in distal tubules
incr sodium absorption
105
graves disease- antibodies most common
anti TSH
106
GLP 1 mimetic - egs
MOA
major pro with GLP 1 mimetics
eg exenatide, liraglutide
MOA= increase insulin secretion
inhibit glucagon secretion
weight lose
107
Hashimotos thyroiditis associated with which type of cancer
thyroid lymphoma
108
orlistat MOA
lipase inhibitor
109
drug induced gynaecomastia
spironolactone
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
110
insulin and c peptide levels
sulfonylurea-induced hypoglycemia: Insulin and C-peptide Rise
Insulin - Induced Hypoglycemia: Insulin Rise but C-peptide Low
111
is MGUS associated with hyper or hypo calcaemia or normal calcium
NO HYPERCALCAEMIA
112
RET oncogene thyroid cancers (2)
papillary and medullary
113
what is monoclonal gammopathy of uncertain significance (MGUS)
the absence of complications such as immune paresis, hypercalcaemia and bone pain
114
gestational diabetes - patient previously had in prev pregnancy- when to do OGTT in next pregnancy?
ASAP
115
which antibody most likely to be found in hashimotos
anti tpo + goitre
116
Gitelman = Thiazide diuretic
Bartter = Loop diuretic
Gitelman = Thiazide diuretic in DCT
Bartter = Loop diuretic
GITELMAN WAS A Normal man (normotension)
117
tender goitre, hyperthyroidism and raised ESR. ==?
subacute thyroiditis
118
Sick euthyroid:
T4 + T3 low, TSH normal or low
Subclinical hyperthyroidism:
T4 + T3 normal, TSH low (high if subclinical hypo)
Sick euthyroid:
T4 + T3 low, TSH normal or low
Subclinical hyperthyroidism:
T4 + T3 normal, TSH low (high if subclinical hypo)
119
haemochromatosis
general population testing
genetic family testing
general population: transferrin saturation > ferritin
family members: HFE genetic testing
120
Mx urge incontinence
1. lifestyle
2. if still not improved- musicarinic antagonists eg oxybutynin
IF ELDERLY AND FRAIL
mirabegron (a beta-3 agonist)
121
androgen insensitivity syndrome
46XY
Features
'primary amenorrhoea'
little or no axillary and pubic hair
undescended testes causing groin swellings
breast development may occur as a result of the conversion of testosterone to oestradiol
Management
counselling - raise the child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy
122
conns anti HTN of choise
spironolactone
123
phaeochromoctyoma Tx anti htn
phenoxybenzamine = non selective alpha antagonist
presents as adrenal mass
124
which pit hormone is constantly under inhibition
prolactin
125
cushings electrolyte and VBD
hypokalemic met alk
126
causes of pseudohyponatremia
hyperlipidaemia
or taking blood from arm with IV in
127
hyper thyroid and hypo thyroid
which cause galatorrhoea and gynaecomastia
Hyperthyroidism - Gynaecomastia
Hypothyroidism - Galactorrhoea
low=cry=leak
128
pegvisomant moa AND WHAT IS IT used ofr
pegvisomant for acromegaly
GH receptor antagonist - prevents dimerization of the GH receptor
129
hyponatremia--
urinary sodium <20 and >20 causes
Urinary sodium > 20 mmol/l
Sodium depletion, renal loss (patient often hypovolaemic)
diuretics: thiazides, loop diuretics
Addison's disease
diuretic stage of renal failure
Patient often euvolaemic
SIADH (urine osmolality > 500 mmol/kg)
hypothyroidism
------------------------------------------------------
Urinary sodium < 20 mmol/l
Sodium depletion, extra-renal loss
diarrhoea, vomiting, sweating
burns, adenoma of rectum
Water excess (patient often hypervolaemic and oedematous)
secondary hyperaldosteronism: heart failure, liver cirrhosis
nephrotic syndrome
IV dextrose
psychogenic polydipsia
130
Congenital adrenal hyperplasia
causes
cfs
tx
Congenital adrenal hyperplasia is most commonly due to 21-hydroxylase
autosomal recessive disorders
affect adrenal steroid biosynthesis
in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH
ACTH stimulates the production of adrenal androgens that may virilize a female infant
Cause
21-hydroxylase deficiency (90%)
11-beta hydroxylase deficiency (5%)
17-hydroxylase deficiency (very rare)
CFs
Early puberty irregular menses, acne, hirsutism, early breast and pubic hair development, clitoromegaly and male-pattern baldness.
131
which anti diabetic med causes incr flatulence
acarbose
132
heterozygous or homozyhous familial hypercholesterolaemia
The presence of tendon xanthomata and cholesterol levels meet the diagnostic criteria for familial hypercholesterolaemia. Homozygous familial hypercholesterolaemia is exceedingly rare - most patients die in their teenage years from a myocardial infarction.
133
liddlye syndrome inheritacne
aut dom
LIDL is dominant in the distant tubes
134
stress incontinence tx
1 pelvic floor exercises
2 . duloxetine
135
fibrate MOA
136
globally decreased uptake on thyroid scan
deceased uptake, painful goitre= subacute de quervain thyroiditis
137
sulphonylurea MOA
increase peripheral insulin secretion by CLOSING potassium-ATP channels on the beta cells
138
most common cause of tertiatry hyperparathyroidism
CKD renal disease
139
pendred syndrome
hypothyroid
painless goitre
deafness
140
what causes ketone production in DKA
lipolysis
141
what is fanconi syndrome
Fanconi syndrome describes a generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule resulting in:
type 2 (proximal) renal tubular acidosis
polyuria
aminoaciduria
glycosuria
phosphaturia
osteomalacia
142
insulinoma c peptide level
high c peptide level in insulinoma
143
siadh Dx urine osmolality
Euvolema + urine osmolality higher than serum osmolality= SIADH
144
which malignant cell secretes PTH related peptide?
SQUAMOUS-- secreted by lung SCC
145
what causes hypercalcium in sarcoidosis
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
146
addisons crisis mx
100mg hydrocortisone IV
IV 0.9 nacl
147
insulin lispro =?
fast rapid action
148
myxoedema coma CFs
very low fT3 T4 and high TSH
unconcious
HYPOTHERMIC
heart failure
149
which pit hormone is constantly under inhibition
prolactin
150
does wilsons or haemochromatosis cause chorea
WILSONS causes chorea
151
difference between pit adenoma and pit apoplexy
pit apoplexy =
Pituitary apoplexy is commonly seen in the presence of a pituitary tumour and is caused by bleeding into or impaired blood supply of the pituitary, This generally presents with sudden onset headache, followed by symptoms of non-functioning pituitary.
152
TYPES OF MODY and their gene mutations
most common = mody 325
MODY 3= HNF alpha
MODY 2= glucokinase
MODY 5 = HNF Beta
153
how does alcohol affect BMs
Alcohol causes increased insulin secretion
154
what type of mab is used in familial hypercholesterolaemia
evolucumab
155
what anti htn is used in marfans
losartan
156
Tx thyroid eye disease
RITUXIMAB
157
cushings initial investigation
24hr urinary free cortisol
(not suppressed if + cushings)
158
adrenal adenoma HTN treatment
spironolactone or eplenerone
