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SJ Phase 2a > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the function of insulin?

A
  1. Suppress hepatic glucose output
  2. Increase glucose uptake into insulin sensitive tissues
  3. Suppress lipolysis and breakdown of muscle
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2
Q

What is the function of glucagon?

A
  1. Increase hepatic glucose output
  2. Reduce peripheral glucose uptake
  3. Stimulate peripheral release of gluconeogenic precursors
  4. Gluconeogenic precursors = glycerol and AA’s which cause lipolysis and muscle glyconeolysis and breakdown
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3
Q

Define Type I DM

A

Autoimmune destruction of pancreatic beta cells leading to complete insulin deficiency

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4
Q

Epidemiology of Type I DM

A
  1. Presents age 5-15
  2. Accounts for 10% of all diabetes
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5
Q

Risk factors of Type I DM

A
  1. HLA DR3-DQ2 or HLA DR4-DQ8
  2. Northern European
  3. Autoimmune disease - 90%
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6
Q

Pathophysiology of Type I DM

A
  1. Autoantibodies attack Beta cells in Islets of Langerhans
  2. Creates insulin deficiency
  3. Leads to hyperglycaemia
  4. Continuous breakdown of glycogen from liver (gluconeogenesis)
  5. Leads to glycosuria
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7
Q

Signs and symptoms of Type I DM

A
  1. Classic triad = polydipsia, polyuria, weight loss (BMI<25)
  2. Possible ketosis
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8
Q

Diagnosis of Type I DM

A

Random plasma glucose > 11mmol/L
Fasting plasma glucose > 7 mmol/L

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9
Q

Treatment of Type I DM

A
  1. Insulin
  2. Short acting insulin (4-6h)
  3. Longer acting insulin (12-24h)
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10
Q

Aetiology of Type II DM

A
  1. gradual insulin resistance/pancreatic beta cells fail to secrete enough insulin OR BOTH
  2. Cushing’s
  3. Chronic pancreatitis
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11
Q

Risk factors of Type II DM

A
  1. Lifestyle - obesity, exercise, excess calorie/alcohol
  2. Asian men
  3. > 40 yrs
  4. Hypertension
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12
Q

Signs and symptoms of Type II DM

A
  1. Polydipsia
  2. Polyuria
  3. Glycosuria
  4. Central obesity
  5. Slow onset
  6. Blurred vision
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13
Q

Diagnosis of Type II DM

A
  1. Fasting plasma glucose > 7 mmol/L
  2. Random plasma glucose > 11 mmol/L
  3. HbA1c > 48 mmol/L
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14
Q

Treatment of type II DM

A

1st line = lifestyle changes
2nd line = Medications
-Metformin
- If HbA1c remains high; dual therapy of Metformin AND:
-DPP4 inhibitor
-Sulphonylurea
-Pioglitiazone
-If still high triple therapy = above + insulin

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15
Q

Define Diabetic Ketoacidosis (DKA)

A

Complete lack of insulin -> high ketone production

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16
Q

Aetiology of DKA

A
  1. Untreated/undiagnosed T1DM
  2. Infection/illness
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17
Q

Pathophysiology of DKA

A
  1. Absence of insulin -> uncontrolled catabolism -> unrestrained gluconeogenesis and decreased peripheral glucose uptake -> hyperglycaemia
  2. Hyperglycaemia -> osmotic diuresis -> dehydration
  3. Peripheral lipolysis for energy -> FFAs in circulation increase -> FFAs turned to Acetyl CoA -> ketone bodies -> acidosis
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18
Q

Signs of DKA

A
  1. Kussmaul’s breathing
  2. Pear drop breath
  3. Hypotension
  4. Tachycardia
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19
Q

Symptoms of DKA

A
  1. N&V
  2. Weight loss
  3. Reduced mental state
  4. Lethargy
  5. Abdominal pain
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20
Q

Diagnosis of DKA

A
  1. Random plasma glucose > 11 mmol/L
  2. Plasma ketones > 3 mmol/L
  3. Blood pH < 7.35 / bicarb < 15 mmol/L
  4. Urine dipstick: glycosuria & ketonuria
  5. Serum U&E: Raised urea and creatinine
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21
Q

Treatment of DKA

A
  1. ABC management
  2. 0.9% saline IV
  3. IV insulin
  4. Restore electrolytes
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22
Q

Define Hyperosmolar hyperglycaemic state (HHS)

A
  1. Marked hyperglycaemia
  2. Hyperosmolality
  3. Mild/no ketosis
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23
Q

Aetiology of HHS

A
  1. Untreated/undiagnosed T2DM
  2. Infection/illness
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24
Q

Pathophysiology of HHS

A
  1. Low insulin -> increased gluconeogenesis -> hyperglycaemia but enough insulin to inhibit ketogenesis
  2. Hyperglycaemia -> osmotic diuresis -> dehydration
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25
Signs and symptoms of HHS
1. Reduced mental state 2. Lethargy 3. Severe dehydration
26
Diagnosis of HHS
1. Random BLOOD glucose > 30 mmol/L 2. Urine dipstick: glucosuria 3. Plasma osmolality: high 4. U+E: low total body K+, high serum K+
27
Treatment of HHS
1. 0.9% saline IV 2. Insulin at low rate of infusion 3. Restore electrolytes 4. Low Molecular Weight Heparin (LMWH)
28
Define hyperthyroidism
1. Clinical effect of excess thyroid hormone 2. Primary - abnormally high thyroid function 3. Secondary - abnormally high Thyroid Stimulating Hormone (TSH) production
29
Aetiology of hyperthyroidism
1. Graves Disease - 65-75%, autoimmune, F>M 9:1 2. Toxic multinodular goitre 3. Toxic adenoma 4. Metastatic follicular thyroid cancer
30
Epidemiology of hyperthyroidism
1. Young women 20-40 yrs 2. Grave's disease 0.5%
31
Risk factors of hyperthyroidism
1. Smoking 2. Stress 3. HLA-DR3 4. Other autoimmune disease
32
Pathophysiology of hyperthyroidism
Increase in T3 hormone leads to: -> increased metabolic rate -> cardiac output -> bone resorption -> activates sympathetic nervous system
33
Signs and symptoms of hyperthyroidism
1. Hot & sweaty 2. Diarrhoea 3. Hyperphagia (excessive eating) 4. Weight loss 5. Palpitations
34
Diagnosis of hyperthyroidism
1. Thyroid function test (TFT) - elevated T4/T3 2. Primary hyperthyroidism = decreased TSH 3. Secondary hyperthyroidism = increased TSH 4. Thyroid autoantibodies (anti-TSHR) 5. Ultrasound + CT head
35
Treatment of hyperthyroidism
1. Drug management a. Beta-blockers - rapid symptom relief b. 1st line Carbimazole - blocks synthesis of T4 c. 2nd line Propylthiouracil - prevents T4->T3 conversion 2. Radioiodine 3. Thyroidectomy
36
Pathophysiology of Grave's Disease
1. IgG autoantibodies bind to TSH receptors 2. Increase T4/T3 production 3. React with orbital autoantigens
37
What are some additional symptoms of Grave's (except hyperthyroidism onoes)
1. Thyroid eye disease - Eyelid retraction - Periorbital swelling - Proptosis (bulging eyes) 2. Pretibial myxoedema 3. Thyroid acropachy (nail clubbing,digit swelling)
38
Epidemiology of hypothyroidism
1. 4/1000 per year 2. >40yrs 3. F>M 6:1
39
Pathophysiology of hypothyroidism
Inadequate T3 to increase metabolic rate for normal body functions
40
Aetiology of hypothyroidism
1. Autoimmune causes - Hashimotos (inflammation -> goitre) - primary atrophic hypothyroidism 2. Iodine deficiency 3. Hypopituitarism
41
Signs and symptoms of hypothyroidism
1. Fatigue + lethargy 2. Weight gain + loss of appetite 3. Cold 4. Constipation 5. Goitre
42
Diagnosis of hypothyroidism
1. TFTs - decreased T4 and T3 2. Primary hypo = increased TSH 3. Secondary hypo = decreased TSH 4. Autoantibodies
43
Treatment of hypothyroidism
Levothyroxine (T4)
44
Define Cushing's syndrome
1. Long term exposure 2. Excessive cortisol hormone 3. Released by adrenal glands
45
Pathophysiology of Cushing's
1. Adrenocorticotropic hormone (ACTH) dependent - ACTH secreting from pituitary adenoma - Ectopic ACTH production from small cell lung cancer 2. ACTH independent - Steroid use -Adrenal adenoma
46
Signs and symptoms of Cushing's
1. Moon face 2. Central obesity 3. Buffalo hump 4. Acne 5. Striae
47
Diagnosis of Cushing's
1. Random plasma cortisol - raised 2. Overnight dexamethasone suppression test - cortisol won't be suppressed in Cushing's 3. Urinary free cortisol 4. Plasms ACTH
48
Treatment of Cushing's
1. If due to steroid - stop use 2. Removal of pituitary adenoma 3. Adrenalectomy 4. Cortisol synthesis inhibition - Metryapone - Ketoconazole
49
Define Acromegaly
Excess GH -> overgrowth of all systems
50
Aetiology of Acromegaly
1. Pituitary adenoma = most common 2. Secondary product of a malignancy that secretes ectopic GH (e.g. Lung cancer)
51
Pathophysiology of acromegaly
GH acts directly on tissue
52
Signs and symptoms acromegaly
1. Prominent forehead and brow 2. Increased jaw size 3. Large facial features and extremities 4. Bitemporal hemianopia 5. Profuse sweating
53
Diagnosis of acromegaly
1st line - insulin like growth factor 1 test = raised Gold standard - oral glucose tolerance test
54
Treatment of acromegaly
1. Transsphenoidal resection surgery 2. Somatostain analogue 3. GH receptor antagonist 4. Dopamine agonist
55
Define prolactinoma
Benign adenoma of pituitary gland producing excess Prolactin
56
Pathophysiology of prolactinoma
1. 2 types of prolactinoma - Micro: tumour < 10mm diameter on MRI - Macro: tumour > 10mm on MRI 2. Increased release of prolactin -> galactorrhoea - milk production stimulated - inhibit FSH anf LH
57
Signs and symptoms prolactinoma
1. Visual field defect 2. Headache 3. Oligomenorrhoea 4. Infertility 5. Galactorrhoea
58
Diagnosis of prolactinoma
1. Serum prolactin levels 2. MRI head
59
Treatment of prolactinoma
1. 1st line - dopamine agonists: Bromocriptine 2. Gold standard - transsphenoidal resection surgery of pituitary gland
60
Define Conn's syndrome
Primary hyperaldosteronism due to aldosterone producing adenoma
61
Pathophysiology of Conn's
Excess production of aldosterone; independent of renin-angiotensin system -> High Na+ and water retention -> Increased K+ excretion in kidneys -> Low renin release
62
Signs and symptoms of Conn's
1.Hypertension 2. Hypokalaemia 3. Nocturia 4. Polyuria 5. Mood disturbance
63
Diagnosis of Conn's
1. Aldosterone:Renin ratio blood test = increased 2. Plasma potassium = reduced 3. U+E
64
Treatment of Conn's
1. 1st line - Spironolactone if hyperplasia 2. Gold standard - Laparoscopic adrenalectomy if adenoma MAIN AIM - lower BP - decrease aldosterone levels - resolve electrolyte imbalance
65
Define Addison's
Primary adrenal insufficiency
66
Aetiology of Addison's
1. Autoimmune destruction 2. TB 3. Adrenal metastases
67
Pathophysiology of Addison's
Destruction of adrenal cortex -> decreased production of glucocorticoid (cortisol) and mineralocorticoid (aldosterone)
68
Signs and symptoms of Addison's
1. Tanned 2. Lean 3. Fatigue 4. Pigmented palmar creases 5. Postural hypotension
69
Diagnosis of Addison's
1. 1st line - U+E = hyponatraemia, hyperkalaemia, hypoglycaemia 2. Gold standard - Short SynACTHen test - Presents with low cortisol, high ACTH - Plasma renin and aldosterone: high renin, low aldosterone
70
Treatment of Addison's
1. Hydrocortisone - replaces cortisol 2. Fludrocortisone - replaces aldosterone
71
Define SIADH
1. Syndrome of Inappropriate ADH 2. Excess ADH secretion causing water reabsorption in collecting ducts
72
Aetiology of SIADH
1. Post-op major surgery 2. Infection 3. Head injury 4. Medication (thiazide diuretics)
73
Signs and symptoms of SIADH
1. Headache 2. Nausea 3. Fatigue 4. Muscle cramps 5. Confusion
74
Diagnosis of SIADH
U+E = hyponatraemia Urine Na+ = high Urine osmolality = high NEED to exclude hyponatraemia - -ve short SynACTHen Test - exclude adrenal insufficiency - No D+V - No history of diuretic use - No AKI/CKD
75
Treatment of SIADH
1. Stop causative medication 2. Fluid restriction 3. Tolvaptan (ADH receptor blocker)
76
Define hyperkalaemia
> 5.5 mmol/L
77
Aetiology of hyperkalaemia
1. Impaired excretion - AKI/CKD - Drug affect (ACEi, NSAIDS, beta blockers) - Renal tubular acidosis - Addison's 2. Increased intake - IV K+ therapy - Increased dietary intake 3. Shift to extracellular - Metabolic acidosis - Decreased insulin
78
Symptoms of hyperkalaemia
1. Fatigue 2. Weakness 3. Chest pain 4. Palpitations
79
Signs of hyperkalaemia
1. Arrhythmia 2. Reduced power + reflexes 3. Flaccid paralysis
80
Diagnosis of hyperkalaemia
1. ECG - small/absent P wave - Prolonged PR interval (>200ms) - Wide QRS interval (>120ms) 2. Bloods - FBC U+E 3. Urine osmolality and electrolytes
81
Treatment of hyperkalaemia
1. ABC 2. Cardiac monitoring 3. Calcium gluconate - protect myocardium 4. Insulin+dextrose or nebulised salbutamol - drive K+ intracellularly
82
Define hypokalaemia
<3.5 mmol/L
83
Aetiology of hypokalaemia
1. Increased excretion - Renal disease - Drug effect - GI loss (D+V) - Conn's syndrome 2. Decreased intake - Dietary deficiency or fasting 3. Shift to intracellular - Metabolic alkalosis - Drug effect - Agonists - SABAs and LABAs
84
Signs of hypokalaemia
1. Arrhythmia 2. Hypotonia 3. Hyporeflexia 4. Muscle paralysis 5. Rhabdomyolysis
85
Symptoms of hypokalaemia
1. Fatigue 2. Weakness 3. Cramps 4. Palpitations 5. Constipation
86
Diagnosis of hypokalaemia
1. ECG - Prolonged PR interval - ST depression - Flat T waves - Prominent U waves 2. Bloods - FBC, U+E 3. Urine osmolality and electrolytes
87
Treatment of hypokalaemia
1. K+ - PO/IV 2. Other electrolytes required
88
What are the two types of diabetes insipidus
1. Cranial 2. Nephrogenic
89
Symptoms of diabetes insipidus
1. Polyuria 2. Polydipsia 3. Dehydration
90
Pathophysiology of diabetes insipidus
1. Impaired water resorption from kidneys -> large volumes of dilute urine because of reduced ADH -> Secretion from posterior pituitary (cranial) OR -> Impaired response of the kidney to ADH (nephrogenic)
91
Aetiology of cranial diabetes insipidus
1. Idiopathic 2. Congenital 3. Tumour 4. Trauma 5. Infection
92
Aetiology of nephrogenic diabetes insipidus
1. Inherited 2. Metabolic (low K+, high Na+) 3. Drugs 4. Chronic renal disease
93
Diagnosis of diabetes insipidus
1. Gold standard - 8h water deprivation test to diagnose 2. Desmopressin test = establish cranial (urine output decrease) or nephrogenic (little/no change) 3. Cranial MRI
94
Treatment of diabetes insipidus
1. Rehydration 2. Cranial - Desmopressin (synthetic ADH) 3. Nephrogenic - Bendroflumethiazide
95
Define hyperparathyroidism
1. Excessive secretion of parathyroid hormone (PTH) 2. Primary - parathyroid gland produces excess PTH 3. Secondary - increased secretion of PTH to compensate hypocalcaemia 4. Tertiary - Autonomous secretion of PTH even after correction of calcium deficiency due to CKD
96
Aetiology of hyperparathyroidism
1. Primary -Adenomas -Hyperplasia of all glands 2. Secondary - CKD/low Vit D 3. Tertiary - Develops from prolonged secondary hyperparathyroidism
97
Signs and symptoms of hyperparathyroidism
BONES - bone pain STONES - renal calculi MOANS - psychic moans GROANS - abdominal groans Hypercalcaemia
98
Diagnosis of hyperparathyroidism
1. PTH/bone profile: high PTH, high Ca2+, low phosphates 2. Primary - raised Ca2+ 3. Secondary - low serum Ca2+, high PTH 4. Tertiary - Raised Ca2+ + raised PTH 5. DEXA scan, x ray (Salt and pepper degradation of bone), ultrasound for stones
99
Treatment of hyperparathyroidism
1. Primary - surgical removal of adenoma - Give bisphosphonates 2. Secondary - Calcium correction 3. Tertiary - Cinacalcet (calcium mimetic) - Total/part parathyroidectomy
100
Define hypoparathyroidism
1. Reduced PTH production 2. Primary = gland failure -Autoimmune destruction - Congenital - DiGeorge syndrome (22q11 del) 3. Secondary - surgical removal - Mg depletion (Mg required for PTH secretion)
101
Pathophysiology of hypothyroidism
1. Hypocalcaemia 2. Hyperphosphatemia 3. Neurons become more excitable
102
Signs of hypoparathyroidism
1. Chvostek's sign - facial nerve tap induces spasm 2. Trousseau's sign - BP cuff causes wrist flexion and fingers pull together
103
Symptoms of hypoparathyroidism
1. Convulsion 2. Arrhythmias 3. Tetany (involuntary muscle contraction) 4. Spasm 5. Numbness
104
Diagnosis of hypoparathyroidism
1. Bloods-bone profile - Decreased Ca2+ - Elevated/normal phosphate - Decreased PTH 2. ECG - Prolonged QT + ST segments
105
Treatment of hypoparathyroidism
1. IV calcium 2. AdCal D3 - Calcitriol 3. Synthetic PTH

SJ Phase 2a (13 decks)

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