Endocrine Flashcards
sweating, palpitations, tachycardia and acute confusion.
On examination she is warm to touch, has an irregular pulse, a heaving apex, evidence of pulmonary oedema and a smooth symmetrical swelling of the anterior neck.
thryoid storm
Mx of thyroid storm
IV propanolol (control symptoms)
propylthiouracil (control thyroid)
IV hydrocortisone (prevent thyroid inflammation)
DKA Mx
fluids
insulin infusion 0.1
hypotension, hyponatremia, hyperkalaemia, fatigue, nausea
hyperpigmentation
addisons disease
large hands, feet, macroglossia, sweating, fatigue
acromegaly
pathophis of acromegaly
increased growth hormone = increased insulin-like growth factor IGF1
Mx for acromegaly
trans sphenoidal surgery
follow up for cardiac (echo) and colon cancer issues
mx of diabetes insipidus
desmopressin
mx for cushings
surgically remove the tuour
hypertension resistant to treatment. metabolic alkalosis, hypokalaemia
conns syndrome (hyperaldosteronism)
primary and 2ndary hyperaldosteronism
1: adrenal hyperplasia producing excess aldosterone
2: renal artery stenosis
Mx of conns
spironolactone (aldosterone antagonist, potassium sparing diuretic)
hashimotos antibodies
anti-tpo, anti-thyroglobulin
mx of hypothyroidism
levothyroxine
mx of hyperthyroidism
- carbimazole
- propylthiouracil
Dx of acromegaly
insulin like growth factor
IGF1
diagnosis of type 2 diabetes (HbA1c and fasting glucose values)
HbA1c > 48 mmol
fasting glucose >7.1
most common thyroid cancer
papillary
what thyroid cancer is associated with MEN
medullary thyroid cancer
4 types of thyroid cancer
medullary
anaplastic
follicular
papillary
primary hypothyroidism results
high tsh
low t4
secondary hypothyroidism results
low tsh
low t4
if they only take their hypothyroid medication a day before their appt? results
high TSH
normal t4
what is sick euthyroid syndrpme
happens when pt is ill
TSH, T4 and t3 are all low
graves
autoimmune hyperthyroidism
hashimotos
autoimmune hypothyroidism
MEN 2a
medullary thyroid cancer
hyperparathyroidism
phaeochromocytoma
MEN type 1
pancreas
pituitary
parathyroid
how do the paratyroid glands work (3 effects)
- low serum calcium
- PTH is released from the chief cells of the parathyroid gland
- This causes
- increased osteoclast activity → break down of bone to release calcium into blood
- causes kidneys to reabsorb waste calcium from the urine back into the blood
- causes kidneys to release calcitriol
- causes gut to reabsorb calcium from digesting food
- Increased calcium!!
primary hyperparathyroidism
Causes
blood results
Mx
parathyroid adenoma
raised Ca, low Phosphate, raised ALP, raised PTH
Mx: remove the tumour
2ndary hyperparathyroidism
Causes
blood results
Mx
any condition that causes hypocalcemia, and therefore stimulates release of PTH (CKD, vit deficiency)
low Ca, low PO4, high PTH, high ALP
Mx: calcium and vit d supplementation
tertiary hyperparathyroidism
Causes
blood results
Mx
prolonged secondary hyperparathyroidism
hyperplasia of the parathyroid glands
high Ca, normal PO4, high PTH, high ALP
Mx: surgical resection. cinaclet + alendronate
how does CKD relate to parathyroid disease
mention all the compound
causes secondary hyperparathyroidism
reduced 25-hydroxycholecalciferol
reduced calcitriol
reduced Ca reabsorption
increased PTH
Signs of hyperparathyroidism in the absence of high PTH?
malignancy induced release of PTHrP (parathyroid related protein, mimics the action of PTH)
hypoparathyroidism
cause
px
blood results
Mx
Causes: iatrogenic, Digeorge syndrome
Px: hypocalcemia, muscle twitching,
low Ca, high PO4, low ALP, low PTH
Mx: iv calcium gluconate if severe hypocalcemia. Ca and vit d supplementation
special sign in hypoparathyroidism
Chovstek sign (facial twitches when the cheek is tapped)
cause of acromegaly
pituitary tumour secreting excess growth hormone
OR
ectopic secretion of GH from a carcinoid tumour
psammoma bodies indicate
papillary thyroid cancer
they are the remnants of dead papillary cells
SIADH should not be diagnosed in the presence of…
hypovolemia
hypotension
addisons
fluid overload
hypothyroidism
de quervains thyroiditis diagnosis
low radio iodine uptake test
difference between graves + de quervains on radio iodine uptake test
graves = high
de quervains = low
what class of drug is metformin
MOA
Side effects
biguanides
reduces gluconeogenesis in the liver
increases insulin sensitivty
SE: diarrhoea, lactic acidosis
what class of drug is gliclazide
MOA
Side effects
sulphonylurea
stimulated insulin secretion from the pancreas
SE: weight gain,
what class of drug is dapagliflozin
MOA
Side effects
SGLT-2 inhibitor
increases renal excretion of glucose
SE: increased risk of UTI, polyuria
what class of drug is sitagliptin
MOA
Side effects
DPP-4 inhibitor
increases insulin release from pancreas
SE: constipation
what class of drug is sulaglutide
MOA
Side effects
Trulicity
GLP - analogue
increases insulin secretion
SE: nausea, weight loss
what class of drug pioglitazone
MOA
Side effect
thiazolidinediones
reduced circulating free fatty acids = glucose uptake by muscle cells
SE: weight gain, peripheral oedema
Conns syndrome renin and aldosterone results
Low renin
High aldosterone
Secondary hyperaldosteronism renin and aldosterone
High and high
Pseudohypoparathyroidism results
Low calcium
High phosphate
Low PTH
Most important mechanism of immunosuppression in prolonged hypoglycemia
Impaired neutrophil and macrophage chemotaxis
what is waterhouse-fridreichsen syndrome
bilateral adrenal haemorrhage
associated with severe bacterial infection e.g. neisseria meningitis
SIADH vs primary polydipsia vs diabetes insipidus
euvolemia hyponatremia high urine osmolality
polydipsia: hypervolemia, low urine osmolality (very diluted)
diabetes insipidus: hypernatremia
diabetic ketoacidosis vs diabetic hyperosmolar coma
DKA seen in Type 1 diabetics, poorly controlled
diabetic hyperosmolar coma seen in older patients with T2DM
adrenal crisis px
result of ACTH test
caused by abrupt withdrawal of steroids
symptoms of adrenal hypo function (hyponatremia, hyperkalaemia, dizziness)
postural hypotension
no cortisol response to ACTH test
urgent Mx of DKA
normal saline infusion
what medication can cause nephrogenic diabetes insipidus
lithium
what medications can cause SIADH
carbamazepine
chlorpromazine
what medication could be used to treat SIADH and why
demclocycline
tetracycline-like antibiotic, promotes water diuresis
link between cortisol and calcium
hypercortisolism leads to reduced serum calcium
leads to secondary hyperparathyroidism
familial hypercholesterolaemia pathophysiology
deficiency of apo B 100
what is the inheritance pattern of MEN
autosomal dominant
Mx of HHS
iv fluids and thromboprophylaxis
klinefelters
karyotype + symptoms
hypogonadism
47XXY
high FSH low testosterone
2 drugs that cause gynacomastia
digoxin
spironolacton
what drug causes galactorrhea
chlorpromazine
standard HbA1c target in T2DM
48 mmol/mol
