Endocrine

Question 1

What is Conn’s syndrome?

Answer 1

Primary Hyperaldosteronism due to an aldosterone producing adenoma.

Question 2

Which system does Conn’s syndrome bypass and what effect does this have on the body?

Answer 2

Bypasses RAAS system leading to high sodium and water retention, Increased renal potassium. excretion and low renin release

Question 3

Give 3 Signs/ Symptoms of Conn’s syndrome:

Answer 3

ANY 3 OF : Hypertension, Hypokalaemia, Nocturia, Polyuria, Mood disturbance, Difficulty concentrating, Lethargy

Question 4

What investigations would you order for Conn’s syndrome and what would you expect the results to be?

Answer 4

Aldosterone to renin ratio (increased), Plasma potassium (decreased),

Question 5

What drug + drug class is the first line treatment for Conn’s syndrome?

Answer 5

Spironolactone - Aldosterone antagonist

Question 6

What is the gold standard treatment for Conn’s syndrome?

Answer 6

Laparoscopic Adrenalectomy

Question 7

What is Cranial Diabetes insipidus (aka AVP defficiency)?

Answer 7

A disease characterised by a defficiency in vasopressin

Question 8

What is Nephrogenic Diabetes insipidus (aka AVP resistance)?

Answer 8

A disease characterised by a resistance to the action of vasopressin

Question 9

What is type 1 diabetes mellitus?

Answer 9

Hyperglycaemia due to absolute insulin defficiency

Question 10

What is type 2 diabetes mellitus?

Answer 10

Progressive disorder defined by deficits in insulin secretion and increased insulin resistance leading to abnormal glucose metabolism

Question 11

Give 3 signs/ symptoms of T1DM:

Answer 11

Weight loss, polyuria, polydypsia, hyperglycaemia, blurred vision, nausea/vomiting (DKA), abdo pain

Question 12

Give 3 signs/ symptoms of T2DM:

Answer 12

Polyuria, polydipsia, opportunistic infections, fatigue, blurred vision

Question 13

Which type of DM more commonly occurs at a young age?

Answer 13

T1 DM

Question 14

Give 3 Risk factors for T2DM:

Answer 14

Older age, Obesity, gestational diabetes, Family history of T2DM, HTN, Stress, non-white ancestry

Question 15

Outline the Hypothalamus, Pituitary, Thyroid axis if increased thyroid function is needed

Answer 15

1. Low T4 + T3 in blood so more needs to be released
2. Hypothalamus releases more TRH which stimulates Pituitary to release more TSH
3. This leads to the thyroid secreting more T3 and T4
4. If levels too high negative feedback occurs so less TRH released

Question 16

Whats the difference between primary and secondary hypothyroidism?

Answer 16

Primary indicates thyroid dysfunction - low T3,T4 but elevated TSH
Secondary indicates pituitary dysfunction - low TSH

Question 17

Give 3 causes of Primary hypothyroidism:

Answer 17

Autoimmune Thyroiditis (Hashimotos), Thyroidectomy, Radioactive iodine therapy, Radiotherapy for head/neck cancer, drugs - lithium, amiodarone

Question 18

Give 3 causes of Secondary Hypothyroidism:

Answer 18

Pituitary adenoma, Cyst, Meningioma, Other valid brain tumour, Infections that affect pituitary, Head trauma, surgery

Question 19

Give 3 causes of Secondary Hypothyroidism:

Answer 19

Pituitary adenoma, Cyst, Meningioma, Other valid brain tumour, Infections that affect pituitary, Head trauma, surgery

Question 20

Give 3 causes of Hyperthyroidism:

Answer 20

Graves disease, Toxic multinodular goitre, toxic adenoma, drugs (iodine), Pituitary adenoma secreting TSH, Congenital hyperthyroidism

Question 21

Give 3 signs/symptoms of Hypothyroidism

Answer 21

• Fatigue
  
  • Weight gain
  • Cold intolerance
  • Constipation
  • Menstrual disturbance
  • Muscle cramps
  • Slow cerebration
  • Bradycardia
  • Hypertension
  • Delayed reflexes
  • Periorbital oedema
  • Carotenaemia
  • Oedema

Question 22

Give 3 signs/symptoms of Hyperthyroidism

Answer 22

• Weight loss
  
  • Tachycardia
  • Hyperphagia
  • Anxiety
  • Tremor
  • Heat intolerance
  • Diarrhoea
  • Lid lag + stare
  • Menstrual disturbance

Question 23

Give 3 signs/symptoms specific to graves disease

Answer 23

• Diffuse goitre
  
  • Thyroid eye disease
  • Pretibial Myxoedema
  • Acropachy

Question 24

What investigation would you do for hypo/hyperthyroidism?

Answer 24

Thyroid function tests

Question 25

What result would you expect when investigating hypothyroidism and how would you differentiate primary and secondary?

Answer 25

Low T3/T4

High TSH in primary

Low TSH in secondary

Question 26

What result would you expect when investigating hyerthyroidism and how would you differentiate primary and secondary?

Answer 26

High T3/T4

Low TSH in primary

High TSH in secondary

Question 27

What is the treatment for hypothyroidism?

Answer 27

Synthetic L-Thyroxine (T4)

Question 28

Give the 3 treatments for Hyperthyroidism:

Answer 28

• Antithyroid drugs - e.g. carbamizole/ Propothiouracil ( examples of Thionamides).These decrease thyroid hormone synthesis. PTU also inhibits conversion of T3-T4
• Surgery - Partial/ subtotal thyroidectomy
• Radioiodine

Question 29

What is the most important diagnostic test for Thyroid cancer?

Answer 29

Fine needle aspiration

Question 30

What are the four types of thyroid cancer that account for 98% of all cases?

Answer 30

Papillary
Anaplastic
Follicular
Medullary

Question 31

What is the typical treatment for Thyroid cancer?

Answer 31

Treatment is usually total thyroidectomy followed by radioactive iodine ablation and TSH suppression (papillary or follicular).

Question 32

What is the typical presenation of thyroid cancer?

Answer 32

Typically young adult female with asymptomatic palpable thyroid nodule