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4th Year Finals > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the most common cause of Acromegaly?

A

Pituitary Adenoma

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2
Q

Name all three causes of Acromegaly?

A

Pituitary Adenoma
Excess GHRH eg Lung Cancer or Pancreatic Cancer

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3
Q

When Acromegaly occurs alongside a GHRH Ectopic cancer like Lung or Pancreatic what is this called?

A

Paraneoplastic Syndrome

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4
Q

Growth hormone is released by what cells within what structure in response to GHRH?

A

Somatotropic Cells within Anterior Pituitary

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5
Q

GHRH is released from what structure?

A

Hypothalamus

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6
Q

GHRH stimulates what cells to release Growth Hormones?

A

Somatotropic

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7
Q

What is bitemporal hemianopia?

A

Loss of outer half of vision in both eyes due to pressure on optic chiasm

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8
Q

Which orthopaedic condition can be seen in Acromegaly?

A

Carpal Tunnel Syndrome

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9
Q

Name 12 common symptoms/signs of Acromegaly?

A

Coarse Facial Apperance
Spade Like Hands
Increase in Shoe Size
Macroglossia
Macrogathia
Interdental Spaces
Excessive Sweating
Headaches
Bitemporal Hemianopia
Galactorrhoea
Carpal Tunnel
Amenorrhoea

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10
Q

How to diagnose Acromegaly?

A

Serum IgF1 Levels increased

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11
Q

IgF1 is released/produced by what organ?

A

Liver

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12
Q

IgF1 + Growth Hormone release does what to GHRH?

A

Inhibits GHRH and Stimulates Somatostatin Release

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13
Q

How to confirm Acromegaly diagnosis?

A

OGTT

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14
Q

What will OGTT find in Acromegaly?

A

GH Suppressed

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15
Q

Raised prolactin can lead to what symptom?

A

Galatorrhoea

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16
Q

What type of surgery for Pituitary Adenoma in Acromegaly?

A

Transphenoidal

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17
Q

What medication is first line in Acromegaly and it’s actions?

A

Somatostatin Analogue eg Octerotide or Sandostatin

  • Directly inhibits release of Growth Hormone
  • Induces tumour shrinkage
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18
Q

Name common side effects of Somatostatin analogues eg Octerotide or Sandostatin?

A

Nausea, Diarrhoea, Cramp, Cholesterol Gallstones, Constipations, Hair Loss, Gallbladder Disease, Bradycardia

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19
Q

Second line medication in Acromegaly?

A

GH Receptor Antagonist eg Pegvisomant

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20
Q

What dopamine agonist can be used third line in Acromegaly?

A

Bromocriptine

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21
Q

If someone is unwell in Acromegaly and getting an infection what steroid should they take with an infection?

A

Hydrocortisone double or triple dose for 3-5 days

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22
Q

Name the common complications of Acromegaly? (7)

A

Hypertension
Diabetes
Cardiomyopathy
Colorectal Cancer/Polyps
Sleep Apnoea
Cardiomyopathy
Accelerated Osteoarthritis

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23
Q

Most common cause of Addisons Disease

A

Autoimmune Destruction of Adrenal Gland which reduces cortisol and aldosterone

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24
Q

Name Primary causes of Hypoadrenalism? (6)

A

Tuberculosis
Mets in Lung, Adrenal, Breast, Melanoma
Congenital Adrenal Hyperplasia
Menigoccal Septicemia (Waterhouse Frederichsen Syndrome)
HIV
Antiphospholid Syndrome

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25
Name a secondary cause of Hypoadrenalism?
Pituitary Disorders
26
Name common symptoms in Addisons? (6)
Lethargy Anorexia Nausea/Vomit Salt Crave Skin Pigmentation Vitiligo
27
Name 5 common electrolyte abnormalities in Addisons?
Hypotension Hypoglycemia Hyponatraemia Hyperkalaemia Metabolic Acidosis
28
How to Diagnose Addisons?
ACTH Stimulation Test (Short Synacthen Test)
29
What happens to bloods in Addisons? (4)
Reduced Na+ due to low aldosterone Increased K+ due to low aldosterone Decreased Glucose High Urea
30
If Cortisol is High on ACTH Stimulation test what does that diagnose?
Addisons
31
How to Treat Addisons? (2)
Hydrocortisone and Fludrocortisone
32
Management of Intercurrent illness in Addisons?
Double Hydrocortisone Fludracortisone dose stays same
33
What can cause an Addisonian Crisis?
Infection/Surgery Adrenal Haemorrhage eg Waterhouse Frederichsen Syndrome Steroid Withdrawal
34
Treatment of Addisonian Crisis?
Hydrocortisone 100mg IM or IV
35
What does the Adrenal Cortex produce? (5)
Aldosterone Cortisol Testosterone Progesterone Oestrogen
36
What does the Adrenal Medulla produce?
Adrenaline Noradrenaline
37
What is Barter's Syndrome?
Inherited cause of Severe Hypokalaemia due to defective chloride absorption at ascending loop of henle
38
Symptoms of Barter's Syndrome? (5)
Fail to Thrive Polyuria/Dypsia Hypokalaemia Normotension Weak
39
What mode of inheritance is Congenital Adrenal Insufficiency?
Autosomal Recessive
40
What happens to the anterior pituitary when low cortisol is produced?
High levels of ACTH secreted which can stimulate production of adrenal androgens
41
Most common cause of Congenital Adrenal Insufficiency?
21 Hydroxylase Deficiency
42
How does 21 Hydroxylase Deficiency present? (3)
Virilisation of Female Genitals Precocious Puberty in Males Salt Losing Crisis
43
How does 11 Beta Hydroxylase Deficiency present?
Virilisation of Female Genitals Precocious Puberty in Males Hypertension/Hypokalaemia
44
Diagnosis of Congenital Adrenal Insufficiency?
ACTH Stimulation
45
What happens if Congenital Hypothyrodism is not treated within first four weeks of life?
Irreversible Cognitive Impairment
46
How is congenital hypothyrodism diagnosed?
Heel Prick Test
47
Symptoms of Congenital Hypothyrodism? (5)
Prolonged Neonatal Jaundice Delayed Milestones Short and Puffy Face Macroglossia Hypotension
48
Cushings Syndrome Pathophysiology?
Excess Corticosteroids and Glucocorticoids
49
Most common cause of Cushings Syndrome/Disease?
ACTH Dependent: Pituitary Tumour secreting ACTH
50
Causes of Cushings Syndrome? (4)
Pituitary Tumour ACTH Independent eg Steroids for Asthma, IBD Adrenal Adenoma/Carcinoma Severe Alcohol/Depression
51
Symptoms of Cushings? (8)
Central Obesity Purple Striae Oedema Plethoric Faces Buffalo Hump Moon Face Proximal Muscle Atrophy Poor Wound Healing
52
Signs of Cushings? (5)
Hypokalaemia Metabolic Acidosis Hypertension Often Osteoporosis/Osteopenia Impaired Glucose Tolerance Very Low Potassium with Ectopic ACTH Secretion
53
Diagnosis of Cushings Disease (with cause of Pituitary Adenoma)
Overnight Dexamethasone Suppression Test (Suppressed Cortisol and ACTH)
54
Diagnosis of Cushings Syndrome?
Overnight Dexamethasone Suppression Test (Not suppressed cortisol and suppressed ACTH)
55
Test to diagnose location of Cushings?
Plasma ACTH - Suppressed: ACTH Indep Cause - High ACTH: Dependent Cause
56
Treatment of Cushings? (5)
Surgery to remove Tumour Steroid Replacement Therapy Adrenal Hormone Synthesis inhibitors: Ketoconazole, Etomidate, Metyrapone Destroy Adrenocortical Cells: Mitotone Radiotherapy
57
Cushings increases the risk of what 4 conditions?
Increased Risk of Infection Hypertension Heart Failure Diabetes
58
What is Carbimazole used for?
Thyrotoxicosis
59
Mechanism of Carbmiazole?
Blocks thyroid peroxidase = reduces thyroid hormone production
60
Carbmiazole adverse effects? (2)
Agranulocytosis Crosses placenta but may be used in low doses in pregnancy
61
Side effects of Fludrocortisone? (2)
Fluid Retention Hypertension
62
Side effects of Prednisolone? - Psychiatry (4)
Insomnia Mania Depression Psychosis
63
Side Effects of Prednisilone (skin) - 7
Impaired Glucose Regulation Increased Appetite Hyperlipidemia Moon Face Buffalo Hump Striae Proximal Myopathy
64
Side effects of Prednisilone - Rheumatology/MSK (2)
Osteoporosis Avascular Necrosis of Femoral Head
65
Side effects of Prednisilone - Infection/GI (5)
Susceptibility to Severe Infection Reactivation of TB Peptic Ulcers Acute Pancreatitis Neutrophilia
66
Side effects of Prednisilone - Neuro (2)
Growth Suppression Intracranial Hypertension
67
Androgen Insensitivity Syndrome, 5a Reductase Deficiency, and Male Pseudohermatophoriditism carry what karotype?
46 XY
68
Androgen Insensitivity Syndrome inheritance?
X Linked Recessive
69
Androgen Insensitivity Syndrome physiology?
Results in end organ resistance to testosterone causing genotypically male children to have female phenotype
70
Presentation of Androgen Insensitivity Syndrome? (2)
Vagina and Testes No Uterus
71
Diagnosis of Androgen Insensitivity Syndrome (2)
Elevated Testosterone, Oestrogen and LH
72
5a Reductase Deficiency Syndrome inheritance?
Autosomal Recessive
73
5a Reductase Deficiency Syndrome physiology
Inability of males to convert testosterone to dihydrotestosterone
74
5a Reductase Deficiency Syndrome presentation (3)
Ambigious Genitalia in Newborn Period Hypospadias common Virilization at Puberty
75
21 Hydroxylase Deficiency presentation? (4)
Simple Virilising Salt Wasting Late Onset/Non Classical Turns little girls into little boys and little boys into little men
76
21 Hydroxylase Deficiency - Which would be most effective at suppressing adrenal androgen production in classical CAH?
Hydrocortisone
77
Carbimimazole is used to manage what condition?
Thyrotoxicosis
78
Mechanism of Carbimazole
Blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin
79
Adverse effects of Carbimimazole?
Agranulocytosis
80
Most common cause of Thyrotoxicosis
Graves Disease
81
Features specific to Graves Disease
Exopthalmos Opthalmoplegia Pretibial Myxoedema Digital Clubbing Soft tissue swelling of hands and feet periosteal new bone formation
82
Thyroid acropachy in Graves is a triad of?
Digital clubbing Soft tissue swelling of hands and feet Periosteal new bone formation
83
Which antibodies are specific to graves?
TSH Receptor Stimulating and Anti Thyroid Peroxidase antibodies
84
What does Thyroid sctinigraphy show in Graves
diffuse, homogenous increased uptake of radioactive iodine
85
How to treat Graves disease?
Propranolol for Symptoms Carbimiazole Radioiodine treatment
86
After radioiodine treatment how long should pregnancy be avoided?
4-6 months following treatment
87
Hashimoto Thyroditis is typically associated with?
Hypothyrodism
88
Features of Hashimoto Thyroditis
Goitre
89
Hashimoto Thyroditis is associated with the development of?
MALT Lymphoma
90
Causes of Primary Hypothyrodism
Hashimoto Thyroditis Subacute Thyroditis (De Quervain) Riedal Thyroditis After Thyroidectomy/Radioiodine Lithium/Amidarone/Carbmiazole Iodine Deficiency
91
Hashimoto Thyroditis is an autoimmune disease associated with what three conditions?
IDDM Addisons Pernicious Anaemia
92
Features of Hypothyrodism?
Weight Gain Lethargy Cold Intolerance Dry Skin and Hair Non Pitting Oedema Constipation Menorrhagia Decreased Deep Tendon Reflexes Carpal Tunnel
93
Treating Hypothyrodism?
Levothyroxine
94
What happens in pregnancy to Thyroxine Binding Globylin?
Increases but Free Thyroxine uneffected
95
How to treat Thyroxicosis in Pregnancy?
Propylthiouracil in FIrst Trimester Carbmiazole outside of this
96
Is thyroxine safe during pregnancy?
Yes and will need increased dose
97
How to recognise subclinical hyperthyrodism?
Normal T4 and Low TSH
98
Causes of Subclinical Hyperthyrodism?
Multinodular Goitre
99
How to recognise subclinical hypothyrodism?
TSH raised but T3/T4 Normal
100
Best prognosis thyroid cancer?
Papillary
101
Which is cancer is of parafollicular cells and secretes calcitonin?
Medullary Thyroid Cancer
102
Which thyroid cancer has to the worst prognosis?
Anaplastic
103
Management of Papillary and Foillcular thyroid cancer?
Total Thyroidectomy Radioiodine
104
Subacute Thyroiditis (De Quervain) associated with?
Painful Goitre and Raised ESR
105
Precipitating events of Thyroid Storm?
Thyroid or Non Thyroidal Surgery Trauma Infection CT Contrast
106
How to treat Thyroid Storm?
IV Propranolol Propylthiouracil
107
On Thyroid Nuclear Sctinigraphy reveals patchy uptake what is this?
Toxic Multinodular Goitre
108
How to treat Toxic Multinodular Goitre
Radioiodine Therapy

4th Year Finals (37 decks)

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