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Med Finals - Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What hormones are produced by the anterior pituitary

A

TSH
ACTH
FSH
LH
GH
Prolactin

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2
Q

What hormones are produced by the posterior pituitary

A

Oxytocin
ADH

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3
Q

Describe hypothalamic pituitary thyroid axis

A

Hypothalamus - thyrotropin-releasing hormone
Pituitary - Thyroid stimulating hormone
Thyroid - T3 + T4
Negative feed back

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4
Q

Actions of cotrisol

A

Inhibit immune system
Inhibit bone formation
Raises blood glucose
Increases metabolism
Increases alertness

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5
Q

Actions of growth hormone

A

Stimulate muscle growth
Increases bone density and strength
Stimulates cell regeneration and reproduction
Stimulates growth of internal organs

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6
Q

Actions of PTH

A

Increases serum calcium
Increases the activity and number of osteoclasts - causing bone reabsorption
Increases calcium reabsorption in kidneys
Activeates vitamin D in the kidneys - promotes calcium absorption from the small intestine.

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7
Q

Actions of aldosterone

A

Increases intravascular volume
Increase sodium reabsorption from the distal tubule
Increases potassium secretion from distal
Increase hydrogen secretion from collecting

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8
Q

Define Cushing’s Syndrome

A

Refers to the signs and aymptoms that develop after prolonged abnormal elevation of cortisol

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9
Q

Define Cushing’s Disease

A

Refers to specific pituitary adenoma that secretes excess ACTH.

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10
Q

Features of Cushing’s syndrome

A

Round moon face
Central obesity
Abdominal striae
Buffalo hump
Proximal limb muscle wasting

Hypertension
Cardiac hypertrophy
Hyperglycaemia
Depression
Insomnia

Osteoporosis
East bruising

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11
Q

Common causes of Cushing’s syndrome

A

Exogenous steroids
Cushing’s disease
Adrenal adenoma
Paraneoplastic - SCLC

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12
Q

Investigations in Cushing’s Syndrome

A

Overnight dexamethasone suppression test

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13
Q

Define adrenal insufficiency

A

Where the adrenal glands do not produce enough steroid hormones, particularly cortisol and aldosterone.

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14
Q

Define Addison’s disease

A

Primary adrenal insufficiency
Autoimmune condition resulting in damage to the adrenal gland.

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15
Q

Define secondary adrenal insufficiency

A

Inadequate ACTH stimulating the adrenal gland
Pituitary dysfunction removal, infection, loss of blood supply in radiotherapy.
Sheehan’s - Blood loss in child birth causes pituitary necrosis

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16
Q

Define tertiary adrenal insufficiency

A

Inadequate CRH release by hypothalamus
Long term oral steroids

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17
Q

History of adrenal insufficiency

A

Fatigue
Nausea
Cramps
Abdominal pain
Reduced libido

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18
Q

Clinical signs of adrenal insufficiency

A

Bronze hyperpigmentation - ACT stimulates melanocytes, particularly in skin creases
Hypotension - particularly postural

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19
Q

Investigations in adrenal insufficiency

A

Short synacthen test!
UE - hyponatraemia, hyperkalaemia
Early morning cortisol
ACTH leve
Auto antibodies
CT/MRI
MRI pituitary

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20
Q

Management of adrenal insufficiency

A

Steroid replacement
Hydrocortisone - glucocorticoid replacing cortisol
Fludrocortisone - mineralocorticoid replacing aldosterone

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21
Q

Define Addisonian crisis

A

Term used to describe the acute presentation of severe addisons, absence of steroid hormones leads to life threatening presentation

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22
Q

History of Addisonian crisis

A

Reduced conscious
Hypotension
Hypoglycaemia, hyponatraemia, hyperkalaemia
Very sick
First presentation of Addison’s, or infection, trauma.

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23
Q

Management of Addisonian crisis

A

Parenteral steroids
IV fluid resuscitation
Correct electrolytes and glucose

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24
Q

Thyroid function test in hyperthyroidis,

A

TSH - Low
T3+4 - High

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25
Thyroid function test in hypothyroidism
Primary TSH - High T3+4 - Low Secondary TSH - Low T3+4 - Low
26
What antibodies are present in Grave's disease
anti-TPO Antibodies Antithyroid perocidase
27
Define hyperthyroidism
Where there is overproduction of thyroid hormone
28
Define thyrotoxicosis
Refers to abnormal and excessive quantity of thyroid hormone in the body
29
Define primary hyperthyroidism
Hyperthyroidism due to thyroid pathology
30
Define secondary hyperthyroidism
Thyroid producing too much hormone as a result of overstimulation Pathology in the hypothalamus or pituitary
31
Most common cause of hyperthyroidism
Graves disease
32
Define graves disease
Autoimmune condition where TSH receptor antibodies cause primary hyperthyroidism.
33
Clinical signs of Grave's disease
Exophthalmos - bulging eyes Pretibial myxoedema Grave's eye disease Diffuse goitre - not nodular
34
History of hyperthyroidism
Anxiety and irritability Sweating and heat intolerance Tachycardia Weight loss increased appetite Fatigue Frequent loose stool Sexual dysfunction
35
Unique features of toxic multinodular goitre
Goitre with firm nodules Over 50 Not graves
36
Define De Quervain's thyroiditis
Describes the presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism Hyperthyroid followed by hypo due to negative feed back.
37
Management of De Quervain's thyroiditis
Self limiting NSAIDs and beta blockers
38
Presentation fo thyrotoxicosis
Pyrexia Tachycardia Deliriu,
39
Management of thyrotoxicosis
As hyperthyroidism Fluid resuscitation Anti-arrhythmics and beta blockers
40
Management of hyperthyroidism
Carbimazole carful titration to normal levels or to block and replace Radioactive iodine - taken up by thyroid and radiation destroys it Levothyroxine replacement Propranolol for symptoms Surgery - remove nodules
41
Common causes of hypothyroidism
Hashimoto's thyroiditis - anti-TPO antibodies Iodine deficiency Iatrogenic Medication - lithium, amiodarone Hypopituitarism - tumours, infection, vascular, radiation
42
Features of hypothyroidism
Weight gain Appetite reduction Fatigue Dry skin Coarse hair and hair loss Fluid retention Heavy or irregular periods Constipation
43
Investigations in hypothyroidism
TSH and T3+4 CT
44
Management of hypothyroidism
Levothyroxine
45
Define type 1 diabetes mellitus
A disease where the pancreas stops being able to produce insulin. May be genetic, linked to Viruses (coxsackie B + enterovirus). As a result of no insulin being produced there is a constant state of hyperglycaemia.
46
Define diabetic ketoacidosis
A state of hyperglycaemia with ketosis and acidosis. As cells have no fuel they undergo ketogenesis, this leads to acidosis. So hyperglycaemic that glucoses is excreted in urine, taking with it a lot of water resulting in dehydration. Insulin drives potassium into cells - common complication of starting treatment
47
History of DKA
Polyuria Polydipsia Nausea and vomiting Acetone breath - pear drops Dehydration Altered consciousness
48
Diagnosis of DKA
Hyperglycaemia - >11 Ketosis - Blood >3 Acidosis - pH <7.3
49
Management of DKA
FIG-PICK Fluids!!! Insulin Glucose - monitor and add when below roughly 14 Potassium - monitor and replace Infection - treat underlying cause Chart - fluid balance Ketones
50
Management of T1DM
Sub cu insulin Monitoring glucose intake and BMs
51
History of hypoglycaemia
Tremor Sweating Irritable Dizziness Pallor Reduced consciousness
52
Management of hypoglycaemia
100ml of 20% glucose over 5 minutes
53
Macrovascular complications of T1DM
Coronary artery disease Peripheral ischaemia - ulcers Stroke HTN
54
Microvascular complications of T1DM
Peripheral neuropathy Retinopathy Kidney disease - glomerulosclerosis
55
Define type two diabetes mellitus
Repeat exposure to glucose and insulin leads to resistance, requiring progressively more insulin putting strain on the pancreas. This leads to chronic hyperglycaemia
56
Risk factors for TIIDM
Age Black, Chinese, south Asian FH Obesity Sedentary lifestyle High carbohydrate
57
History of TIIDM
Fatigue Polydipsia and polyuria Unintentional weight loss Opportunistic infection Slow healing Glucose in urine
58
Investigations in TIIDM
OGTT HbA1c Random glucose Fasting glucose
59
Numbers for diabetes diagnosis on OGTT, HbA1c, Random and fasting glucose
OGTT >11 Random glucose >11 Fasting glucose >7 HbA1c >48 (>42 for prediabetes)
60
Management of TIIDM
Lifestyle - exercise and weightless Metformin Then pioglitazone
61
Define acromegaly
Clinical manifestation of excessive growth hormone, most often caused by pituitary adenoma.
62
What visual defect is often seen in acromegaly
Bitemporal hemianopia
63
History of acromegaly
Headaches + visual field defects - space occupying Arthritis Largeness Sweating
64
Clinical signs of acromegaly
Frontal bossing - forehead and brow Large nose Macroglossia - tongue Large hands and fee Prognathism- protruding jaw Hypertrophic heart Hypertension TIIDM Colorectal cancer Skin tags
65
Investigations in acromegaly
Insulin-like growth factor Oral glucose tollerance test MRI head Opthamology
66
Management of acromegaly
Trans-sphenoidal removal of pituitary tumour Somatostatin analogues to block GH release,
67
Define hyperparathyridism
Overproduction of parathyroid hormone.
68
Actions of parathyroid hormone
Raise blood calcium Increase osteoclast activity - broken down and reabsorbed Increase absorption in gut Increase reabsorption Activate vit D
69
Presentation of hypercalcaemia
Renal stones, painful bone, abdominal groans and psychiatric moans. Nausea and vomiting Fatigue Depression Psychosis
70
Causes of primary hyperparathyroidism
Tumour of the parathyroid gland.
71
Causes of secondary hyperparathyroidism
Insufficient vit D Chronic renal failure Something causing hypocalcaemia - more parathyroid created in feed back
72
Define Conn's syndrome
Adrenal adenoma secreting aldosterone
73
Define primary hyperaldosteronism
Adrenal glands secrete too much aldosterone, also causing low renin
74
Causes of primary hyperaldosteronism
Bilateral adrenal hyperplasia Conn's syndrome Familial - type 1 and 2 Adrenal carcinoma
75
Define secondary hyperaldosteronism
Excessive renin stimulates the adrenal glands to produce more aldosterone
76
Causes of secondary hyperaldosteronism
Renal artery stenosis Renal artery obstruction Heart failure
77
Investigations in hyperaldosteronism
Renin aldosterone ration Blood pressure UEs - hypokalaemia Gas - alkalosis CT/MRI - tumour Renal doppler
78
Management of hyperaldosteronism
Aldosterone antagonists = eplerenone, spironolactone Remove tumour Renal artery angioplasty
79
Define syndrome of inappropriate Anti-Diuretic hormone
A condition where the is inappropriately high amounts of ADH
80
Action of ADH
Secreted by the posterior pituitary glad and cause reabsorption of water in the collecting ducts - causing increase in blood volume and pressure
81
History of SIADH
Headache Fatigue Muscle aches and cramps Confusion` ?seizures and reduced consciousness
82
Causes of SIADH
Posterior pituitary secretes too much Post operative Infection - lung abscess and atypical pneumonia Head injury Medication - thiazides, carbamazepine, vincristine, cyclophosphamide, antipsychotics, SSRIs, NSAIDs Malignancy - Small cell lung cancer Meningitis
83
Investigations of SIADH
Diagnosis of exclusion Euvolemic with hyponatraemia Urine osmolality will be high - lots of salt very concentrated CXR CT TAP MRI head Negative short synacthen test - rule out adrenal insufficiency No diuretic use No diarrhoea No excessive water intake No kidney disease or AKI
84
Management of SIADH
Correct sodium slowly to prevent central pontine myelinolysis Less than 10mmol/L per 24hours
85
Define diabetes insipidus
Lack of ADH or response to ADH Prevents the kidneys from being able to concentrate urine, leading to polyuria and polydipsia.
86
Define nephrogenic diabetes insipidus
When the collecting ducts do not respond to ADH
87
Causes of nephrogenic diabetes insipidus
Drugs - lithium Mutations in AVPR2 gene - X linked Intrinsic kidney disease Electrolyte disturbance
88
Define cranial diabetes insipidus
When the hypothalamus does not produce ADH for the pituitary gland to secrete
89
Causes of cranial diabetes insipidus
Brain tumours Head injury Brain malformation Brain infections - meningitis, encephalitis, TB Brain surgery or radiotherapy
90
History of diabetes insipidus
Polyuria and polydipsia Dehydration Postural hypotension Hyponatraemia
91
Investigations in diabetes insipidus
Low urine osmolality - low salt concentration high water High serum osmolality - lots of salt Water deprivation test - desmopressin
92
Fluid deprivation test results
No fluids 8 hours urine osmolality, desmopressin then urine osmolality again in 8 hours Cranial - initialy low osmolality and then high Nephrogenic - low before and after Primary polydipsia - high initially
93
Management of diabetes insipidus
Treat causes Desmopressin if cranial
94
Define phaeochromocytoma
A tumour of the chromaffin cells (adrenalin producing cells), that secretes unregulated amounts of adrenaline. Adrenaline is a catecholamine that stimulates the sympathetic nervous system.
95
Causes of pheochromocytoma
25 % familial and associated with MEN 2 Patterns of tumour 10% bilateral 10% cancerous 10% outside adrenal gland.
96
Investigations of phaeochromacytoma
24 hour catecholamines Plasma free metanephrines (breakdown product of adrenaline - longer half life)
97
History of phaeochromocytoma
Anxiety Sweating Headache Hypertension Palpitations, tachycardias Paroxysmal AF
98
Management of pheochromocytoma
Alpha blockers - phenoxybenzamine Beta blockers Adrenalectomy

Med Finals - Medicine (10 decks)

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