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MRCP > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Describe endocrine effects of hypothalamus

A

ADH and oxytocin to posterior pituitary
Release hormones to anterior pituitary

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2
Q

Describe endocrine effects of posterior pituitary

A

ADH to kidneys
Oxytocin to Breast and uterus

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3
Q

Describe endocrine effects of anterior pituitary

A

ACTH to adrenals
Oxytocin to breast
FH and LSH to ovaries/testes
GH to bones/tissues
TSH to thyroid

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4
Q

Describe endocrine axis of adrenals

A

Hypothalamus releases CRH to ant. pituitary which release ACTH to adrenals

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5
Q

Describe layers and products of adrenals

A

cortex
- zona glomerular: mineralocorticoids
- zona fasciular: glucocorticoids
- zona reticular: androgens
medulla
- adrenaline/noradrenaline

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6
Q

What is acromegaly and what are the causes

A

increase in GH
pituitary adenoma
cancer releasing GH or GHRH

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7
Q

Visible symptoms of acromegaly

A

Frontal bossing, protruding jaw
large nose, large tongue
galactorrhoea

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8
Q

Organ dysfunction with acromegaly

A

HTN
cardiomegaly
diabetes
colorectal cancer

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9
Q

Symptoms of acromegaly caused by pituitary tumour

A

headaches
bitemporal hemianopia (pressing on optic chiasm)

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10
Q

Diagnosis of aromegaly

A

Raised IGF-1
OGTT
If GH >1 following glucose +ve

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11
Q

Management of acromegaly

A

1) transphenoidal surgery to remove
2) Medical management
- somatostatin analogue to inhibit GH release (octreotide)
- GH receptor antagonist (pegvisomant)
- dopamine agonist (bromocriptine)

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12
Q

What is Addisons

A

primary hypoaldosteronism due to autoimmune dysfunction of adrenals
other causes inc TB, metastatic carcinoma

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13
Q

Describe the RAA pathway

A

dehydration/low Na causes low blood volume and BP
Reduced renal perfusion causes release of renin by juxtaglomerular cells
Combined with angiotensinogen (liver) produces angiotensin I, combined with ACE (lungs) produces angiotensin II
Causes adrenals to produce aldosterone which increased Na and H20 reabsorption and increases blood volume/BP

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14
Q

Physiological cortisol response to stress

A

stress causes increased cortisol which causes increased gluconeogenesis in liver
- breakdown of muscle to produce amino acids
- breakdown of adipose tissue to produce free fatty acids

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15
Q

Describe presentation of Addisons where zona glomerular is affected

A

less aldosterone
- increased K+ and decreased Na
- salt cravings
- N&V
- dizziness
- fatigue

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16
Q

How do you manage an Addisonian crisis

A

IV hydrocortisone
IV NaCl ± dex

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16
Q

Describe presentation of Addisons where zona fascicular is affected

A

less cortisol therefore less glucose
- fatigue
- overactive pituitary releases proopiomelanocortin -> melanocyte stimulating hormone->hyperpigmentation

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16
Q

Describe presentation of Addisons where zona reticular is affected

A

less androgens
- mainly affects females because males also get testosterone from testes
- loss of pubic hair
- decreased sex drive

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16
Q

How do you interpret a 9am cortisol

A

> 500 addisons unlikely
100-500 do SST
<100 abnormal

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16
Q

How/why does Addisonian crises occur

A

Major stress creates sudden need for cortisol/aldosterone that cannot be met
- D&V
- pain in back/legs/abdomen
- hypotension
-LOC

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17
Q

How do you diagnose Addisons?

A

short synacthen test
Given synthetic ACTH, measure cortisol and aldosterone produced, if doesn’t rise then +Ve for adrenal insufficiency

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18
Q

What is Cushings syndrome?

A

Increased cortisol

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19
Q

Physiological effects of cortisol

A

1) gluconeogenesis
2) increased sensitivity of peripheral blood vessels to adrenaline
3) decreased immune response

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20
Q

Causes of Cushing Syndrome

A

Exogenous: steroids
Endogenous: pituitary adendoma (Cushings disease), SCLC, adrenal adenoma/carinoma

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21
Q

Symptoms of Cushings syndrome

A

excess muscle/bone breakdown
-muscle wasting, thin skin, bruising, fractures
Increased glucose, increased insulin, increased adipose tissues
- buffalo hump, moon face, central obesity
- Diabetes
Increased periperal sensitivity to adrenaline
- HTN
- infections

22
Q

Imagining in Cushings

A

MRI pituitary
CT adrenal
CT TAP (malignancy)

23
Q

Management of Cushings

A

Exogenous: gradually reduce steroids
Pituitary adenoma: surgery
Adrenal steroid inhibitors e.g. ketoconazole

24
Q

Risk factors for endometrial cancer

A

Increased oestrogen
- nulliparity
- early menache
- late menopause
- unopposed oestrogen

metabolic
-obesity
- PCOS
- Diabetes

25
Q

Protective factors for endometrial cancer

A

multiparity
COCP
smoking

26
Q

Presentation of endometrial cancer

A

PMB

27
Q

Investigation and management of endometrial cancer

A

TV US
Hysteroscopy + biopsy

Surgery

28
Q

Symptoms of uterine fibroids

A

menorrhagia
abdo pain, bloating, LUTS
subfertility

29
Q

Diagnosis and management of uterine fibroids

A

TVUS

Medical: GnRH antagonists
Surgical: myomectomy, endometrial ablation, hysterectomy

30
Q

Types of urinary incontinence

A

1) urge: detrusor overactivity
2) stess: when laughing/coughing
3) Overflow
4) Functional
5) mixed: urge/stress

31
Q

Management of urge incontinence

A

bladder retraining 6/52
antimuscarinics (oxybutynin)
mirabegron (elderly)

32
Q

Management of stress incontinence

A

Pelvic floor exercises 3/12
surgery
duloxetine

33
Q

Features of PCOS

A

subfertility, infertility
menstrual disturbance
hirsutism, acne
obesity
acanthosis nigricans

34
Q

Diagnosis of PCOS

A

requires 2 out of the following 3
1) infrequent or no mestration
2) signs of increased androgens e.g hirsutism, acne, increased testosterone
3) polycystic ovaries on USS

35
Q

Causes of hypothyrodism

A

primary
- hashimotos thyroiditis
-de Quervains
- Riedel
- thyroidecomy
- lithium, amiodarone
Secondary
- pituiarty failure

36
Q

Conditions associated with hypothyroidism

A

Downs
Turners
Coeliac

37
Q

Symptoms of hypothyroid

A

Hair loss, dry skin
weight gain, fluid gain
fatigue
constipation
cold sensitive

38
Q

Investigations of hypothryoidism

A

primary: low T3/T4 high TSH
Secondary: Low T3/T4 low TSH

39
Q

Management of hypothyroidism

A

levothyroxine - titrate until normal TSH
Increase in pregnancy

40
Q

SE of levothyroxine

A

AF, worsening angina, reduced bone mineral density

41
Q

What is de Quervains

A

Sub acute thyroiditis following viral infection

42
Q

How does de Quervains present

A

Phase 1: 3-6 weeks
-hyperthyroid, goitre, raised ESR
Phase 2 1-3 weeks: euthyroid
Phase 3 weeks/months Hypothyroid
Phase 4: normal

43
Q

How do you diagnose de Quervains

A

thyroid scintigraphy - decreased iodine 131 uptake

44
Q

How do you manage de Quervains

A

self limiting, steroids if severe

45
Q

What is subclinical hypothyroidism

A

High TSH, normal T3/T4 with no symptoms

46
Q

How do you manage subclinical hypothyroidism

A

If TSH >10 on 2 occasions more than 3 months apart - give levo

If TSH 5.5-10 on 2 occasions more than 3 months apart and symptomatic - give levo

if TSH 5.5-10 and >65 repeat in 6 months

47
Q

What causes thyroid eye disease

A

Graves
inflam of muscles behind eye

48
Q

How do you prevent/manage thyroid eye disease

A

Prevent: stop smoking
Treat: steroids, topical lubricants, radiotherapy, surgery

49
Q

Causes of hyperthyroidism

A

Graves
Toxic multinodular goitre
Pituitary/hypothalamic pathology

50
Q

Symptoms of hyperthyroidism

A

Heat intolerance, sweating
weight loss
tachycardia
loose stools

51
Q

How does Graves present?

A

hyperthyroid symptoms
+ diffuse goitre, eye disease, pretibial myxoedema

52
Q

What is a thyroid storm

A

triggered by trauma. infection, contrast
-pyrexia
- N&V
- tachycardia
- Hypertension
-Delerium

53
Q

Thyroid storm management

A

fluids, b blockers, steroids, anti-arrhythmics

53
Q

Management of hyperthyroidism

A

1) carbimazole
2) propylthiouracil - less used because risk of hepatic injury
3) radioactive iodine, surgery + levo

54
Q

Causes and management of subclinical hyperthyroidism

A

multinodular goitre
excessive thyroxine
m:: low dose anti thyroid agent 6 months

54
Q

How do you diagnose and treat toxic multinodular goitre

A

patchy update on nuclear scintigraphy
mx: radioiodine therapy

MRCP (19 decks)

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