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Endocrine Flashcards

1
Q

Px of Cushing’s disease?

A
  • Moon face
  • Central obesity
  • Abdominal striae
  • Buffalo hump
  • Proximal muscle wasting
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2
Q

Px of Acromegaly?

A

Bitemporal hemianopia +

  • Large nose & tongue
  • Thick, soft tissue
  • Prominent forehead
  • Profuse sweat
  • Skin-tags
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3
Q

Px of Prolactinoma?

A
  • Galactorrhoea
  • Menstrual irregularity
  • Infertility
  • Impotence
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4
Q

Causes of cushing’s syndrome pneomnonic?

A

CAPE

C - Cushing’s disease (pituitary adenoma)
A - Adrenal adenoma
P - Paraneoplastic syndrome
E - Exogenous steroids

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5
Q

Most common cause of paraneoplastic syndrome causing cushing’s?

A

Small cell lung cancer -> ectopic ACTH

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6
Q

Ix for cushing’s syndrome?

A

Dexamethasone suppression test
- Low dose overnight
- Low dose 48hr
- High dose 48hr

24hr urinary free cortisol

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7
Q

What do the results of a high dose 48hr dexamethasone suppression test indicate in sus[ected Cushing’s syndrome?

A

Cortisol will be suppressed in a pituitary adenoma (cushing’s disease)

Cortisol will not be suppressed in an adrenal adenoma or ectopic ACTH

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8
Q

What is Nelson’s syndrome?

A

The development of an ACTH-producing pituitary tumour after the surgical removal of both adrenal glands due to a lack of cortisol and negative feedback

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9
Q

What drug can be used to reduce the production of cortisol?

A

Metyrapone

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10
Q

Ix for acromegaly?

A

Serum IGF1 elevated
Glucose tolerance test - normally would suppress GH
MRI pituitary

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11
Q

Drugs used in acromegaly when surgery not suitable?

A
  • GH antagonist (Pegvisomant)
  • Somatostatin analogue (Sandostatin LAR)
  • Dopamine agonist (cabergoline)
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12
Q

What are prolactinomas associated with?

A

Multiple endocrine neoplasia (MEN) type 1 (AD)

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13
Q

Drug Mx of prolactinomas?

A

Dopamine agonists - bromocriptine, cabergoline

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14
Q

The surgical management of pituitary adenoma?

A

Trans-sphenoidal removal of pituitary adenoma

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15
Q

Causes of nephrogenic diabetes inspidus?

A

Medications - lithium
Genetic
Kidney disease
Hypercalcaemia
Hypokalaemia

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16
Q

Urine and serum osmolality in diabetes insipidus?

A

Low urine osmolality (lots of water diluting the urine)

High/normal serum osmolality (water loss may be balanced by increased intake)

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17
Q

Urine osmolality after water deprivation and after desmopressin in diabetes insipidus types?

A

After : Water deprivation Desmopressin

Cranial Low High

Nephrogenic Low Low

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18
Q

Drug Mx of cranial diabetes inspidus?

A

Desmopressin

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19
Q

What is SIADH?

A

Excessive ADH -> Excessive water reabsorption in collecting ducts -> hyponatraemia + more concentrated urine

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20
Q

What is Cushing’s disease and Addison’s?

A

Cushing’s disease is due to a pituitary adenoma -> excess cortisol

Addison’s is autoimmune destruction of adrenal glands -> reduced cortisol + reduced aldosterone

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21
Q

What is Sheehan syndrome?

A

Major post-partum haemorrhage causes avascular necrosis of the pituitary gland -> adrenal insufficiency

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22
Q

What is and causes tertiary adrenal insufficiency?

A

Hypothalamus decreases CRH output, often due to long-term exogenous steroid use

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23
Q

Causes of SIADH?

A

Increased secretion by posterior pituitary
Ectopic ADH (from small cell lung cancer)
Trauma - head injury or post-op surgery
Pulmonary - atypical pneumonia, abscess, TB

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24
Q

Urine and serum osmolality in SIADH?

A

Serum has no sodium and lots of water – low serum osmolality, low serum Na+

Urine has lots of sodium and no water – high urine osmolality, high urine Na+

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25
Px of SIADH?
Headache Fatigue Muscle aches and cramps Confusion Severe hyponatraemia -> seizures + reduced conciousness
26
Causes of SIADH?
Post-operative Drugs - SSRIs, Carbamazepine Small cell lung cancer
27
Ix / Mx of SIADH?
Exclude malignancy + pulmonary cause Fluid restriction Vasopressin receptor antagonists (tolvaptan)
28
What are the two phases of central pontine myelinolysis?
o Phase 1 – confusion, headache, N&V o Phase 2 – spastic quadriparesis, pseudobulbar palsy, cognitive changes due to pontine demyelination
29
Antibodies associated with Graves?
TSH receptor antibodies (TRAB)
30
Antibodies associated with Hashimoto's?
Anti-thyroid peroxidase (anti-TPO) antibodies Anti-thyroglobulin (anti-Tg) antibodies
31
Specific px of Grave's?
Diffuse goitre Bilateral exophthalmos (bulging eyes) Peripheral myxoedema (shin becomes discoloured and waxy) Thyroid acropachy (hand swelling and finger clubbing)
32
Specific Px of toxic multi-nodular goitre?
Goitre with firm nodules Age >50
33
Hyper-thyroidism drug mx?
1. Carbimazole 2. Propylthiouracil 3. Radioactive iodine Symptomatic -> b-blockers Definitive -> surgery
34
TSH levels in thyroidism?
- TSH T3&T4 1 hyper L H 2 hyper H/N H 1 hypo H L 2 hypo L/N L
35
Cause of hypothyroidism?
Iodine deficiency Hashimoto's thyroiditis Drugs - Lithium, amiodarone Secondary causes - tumours, surgery, trauma, radiotherapy
36
Mx of hypothyroidism?
Levothyroxine
37
What is Conn's syndrome?
Adrenal adenoma -> too much aldosterone
38
What does aldosterone do?
Increase sodium reabsorption from the distal tubule Increase potassium secretion from the distal tubule Increase hydrogen secretion from the collecting ducts
39
Causes of primary and secondary hyperaldosteronism?
Primary: - Bilateral adrenal hyperplasia (most common) - An adrenal adenoma secreting aldosterone (known as Conn’s syndrome) - Familial hyperaldosteronism (rare) Secondary (due to low BP in kidneys): - Renal artery stenosis - Heart failure - Liver cirrhosis and ascites
40
Hyperaldosteronism px?
Hypertension (resistant) Non-specific - headaches, muscle weakness, fatigue Low potassium (can be normal)
41
Ix for hyperaldosteronism?
Aldosterone-to-renin ratio (ARR) - High aldosterone and low renin indicate primary hyperaldosteronism - High aldosterone and high renin indicate secondary hyperaldosteronism
42
Mx of high aldosterone?
Aldosterone antagonists - Eplerenone, spironolactone Underlying cause - remove adenoma or angioplasty renal artery stenosis
43
Px of adrenal insufficiency?
Bronze hyperpigmentation (excessive ACTH) Hypotension Fatigue, muscle weakness, weight loss, abdo pain, depression
44
Biochemicals of adrenal insufficiency?
Low sodium High potassium High calcium
45
Ix for adrenal insuficciency?
Short synacthen test (synthetic ACTH) - This causes cortisol to increase, failure of this indicates Addison's disease or secondary adrenal atrophy
46
Antibodies px in autoimmune adrenal insufficiency?
Adrenal cortex antibodies 21-hydroxylase antibodies
47
Mx of adrenal insufficiency?
Hydrocortisone (replace cortisol) Fludrocortisone (replace aldosterone)
48
Px of adrenal crisis?
Reduced consciousness Hypotension Hypoglycaemia Hyponatraemia and hyperkalaemia
49
Mx of adrenal crisis?
ABCDE IM / IV hydrocortisone IV fluids Correct hypoglycaemia (IV dextrose) Monitor electrolytes and fluid balance
50
What is a pheochromocytoma?
Adrenal gland tumour -> excessive catecholamines (adrenaline)
51
Initial Ix of pheochromocytoma?
Plasma free metanephrines 24hr urine catecholamines
52
Mx of pheochromocytoma?
Alpha blockers - phenoxybenzamine or doxazosin Beta blockers (after alpha blockers established) Surgical removal of tumour
53
Px of pheochromocytoma?
Anxiety Sweating Hypertension Tremor Headache Palpitation Tachycardia (Increased adrenaline)
54
Severity of hypercalcaemia?
Mild 2.6 - 3.0 Moderate 3.01 - 3.40 Severe >3.4
55
Px of hypercalcaemia
Bone pain Fatigue, lethargy, muscle weakness N&V Rena colic Constipation, abdo pain Hypertension
56
Most common 2 causes of hypercalcaemia?
Primary hyperparathyroidism Malignancy
57
What is primary hyperparathyroidism?
Due to a parathyroid tumour
58
What is secondary hyperparathyroidism due to?
Low Vitamin D or CKD -> Insufficient calcium absorption -> High PTH
59
What is tertiary hyperparathyroidism due to?
Parathyroid gland hyperplasia due to chronic secondary hyperparathyroidism
60
First line diabetes management?
Metformin
61
When should a Sulphonylureas be prescribed in diabetes?
Second or third line after metformin First-line if metformin is not tolerated
62
What is Sulphonylurea therapy is associated with?
Hypoglycaemia (caution should be taken in the elderly) Weight gain
63
How do sulphonylureas act?
Sulphonylureas increase endogenous release of insulin from pancreatic β-cells
64
How does metformin act?
Complex There is reduced production of glucose by the liver, weight loss or stabilisation, and improved insulin sensitivity
65
What kind of drugs are gliclazide and glimepiride
Sulphonylureas
66
What kind of drug is Pioglitazone?
Thiazolidinediones
67
Risks of Pioglitazone? (5)
Peripheral oedema Heart failure Weight gain Bladder cancer Fractures.
68
When can pioglitazone (Thiazolidinediones) be prescribed?
Pioglitazone should be considered, usually as dual or triple therapy, for lowering HbA1c
69
When can DDP4 inhibitors be prescribed?
DPP-4 inhibitors should be considered, usually as dual or triple therapy, for lowering HbA1c.
70
What are some DDP4 inhibitors?
-gliptins Alogliptin, linagliptin, saxagliptin, sitagliptin and vildagliptin
71
How do DDP4 inhitors work?
They inhibit the activity of the enzyme DPP-4 and hence prolong the actions of endogenous GLP-1
72
How do SGLT2 inhibitors work?
They reduce renal glucose re-absorption resulting in increased glucose excretion equivalent to a net loss of 200–300 kcal/day
73
What drugs can be prescribed as an add-on in T2DM patients with CVD?
SGLT2 inhibitors - empagliflozin and canagliflozin GLP-1 receptor agonist - liraglutide
74
When should GLP-1 agonists be considered?
BMI ≥30 in combination with oral glucose-lowering drugs or basal insulin (or both) as third- or fourth-line treatment Alternative to insulin in people for whom treatment with combinations of oral glucose-lowering drugs has been inadequate.
75
When should GLP-1 agonists be considered?
BMI ≥30 in combination with oral glucose-lowering drugs or basal insulin (or both) as third- or fourth-line treatment Alternative to insulin in people for whom treatment with combinations of oral glucose-lowering drugs has been inadequate.
76
How do GLP-1 agonists work?
Augments secretion of insulin from pancreatic β-cells and inhibit inappropriate glucagon secretion. Half-life of 2 minutes due to breakdown by DDP4
77
How are GLP-1 receptor agonists administered?
Subcutaenous

Finals HH (21 decks)

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