Endocrine Flashcards
1
Q
The anterior pituitary gland releases(6):
A
Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Follicle-stimulating hormone (FSH)
luteinising hormone (LH)
Growth hormone (GH)
Prolactin
2
Q
The posterior pituitary releases (2):
A
Oxytocin
Antidiuretic hormone (ADH)
Both created in hypothalamus
3
Q
When the hypothalamus detects low thyroid hormone levels- what is released?
A
Thyrotropin-Releasing Hormone (TRH)
4
Q
Pituitary Gland: It responds to TRH to release what?
A
Thyroid-Stimulating Hormone (TSH)
5
Q
Thyroid Gland: XXX signals the thyroid gland, which is located in your neck, to produce and release thyroid hormones - YY and ZZ
A
XXX = TSH
YY= T3 (triiodothyronine)
ZZ= T4 (thyroxine).
6
Q
When the end hormone (e.g., T3 and T4) suppresses the release of the controlling hormones (e.g., TRH and TSH), this is called what?
A
negative feedback.
7
Q
which part of the brain releases Growth Hormone-Releasing Hormone (GHRH) ?
A
Hypothalamus
8
Q
GHRH signals the pituitary gland to release what?
A
Growth Hormone (GH)
9
Q
What stimulates the production of Insulin-Like Growth Factor 1 (IGF-1)
A
GH
10
Q
in response to low levels of calcium in the blood- what is released?
A
Parathyroid Hormone (PTH)
11
Q
PrimaryHyperthyroidism:
Raised or lowered what?
A
Lowered TSH, Raised T3 and T4 levels.
12
Q
Primary Hypothyroidism:
Raised or lowered what?
A
High TSH, Low T3 and T4 levels.
Hashimoto’s thyroiditis
13
Q
Secondary Hyperthyroidism
A
Abnormal pituitary; high TSH, T3, and T4.
14
Q
Secondary Hyporthyroidism TSH, T3 T4
A
Low TSH
Low T3
Low T4
15
Q
Relevant antibody in autoimmune thyroid disease Hashimoto’s
A
Anti-TPO antibodies
16
Q
Which antibodies raised in:
Graves’, Hashimoto’s, and thyroid cancer
A
Anti-Tg antibodies
17
Q
Which antibodies Cause Graves’ disease;
A
TSH receptor antibodies
TRAb
18
Q
Radioisotope scans are used to investigate what?
A
hyperthyroidism and thyroid cancers
19
Q
Ultrasound of the thyroid gland helps diagnose what?
A
thyroid nodules and
distinguish between cystic (less bad) and solid nodules
anantomy
20
Q
Radioisotope scans in Grave’s Disease show?
A
Diffuse high uptake is found in Grave’s
21
Q
Radioisotope Toxic Multinodular Goitre and Adenomas show?
A
Focal High Uptake of Iodine
22
Q
Thyroid Cancer on Radioisotope shows?
A
“Cold” Areas (Abnormally Low Uptake)
23
Q
eyeballs sticking out (exophthalmos)- Woman 30 - 50 age
Which disease?
TSH- low or high?
T3+T4 low or high?
TSH recepter antibodies? +Ve or -Ve
A
Grave’s disease
TSH- low
T3+T4 high
TSH receptor antibodies +Ve (TRAb)
24
Q
3 clinical features of Graves’
A
exophthalmos
Diffuse Goitre (no nodules)
Pretibial Myxedema
25
"What are three conditions, aside from Graves' disease, (HYPER)
that can cause an elevation in both T3 and T4 thyroid hormone levels?"
1) Toxic Multinodular goitre
2) solitary toxic thyroid nodule
3) thyroiditis (de quervain's)
26
Symptomatic treatment Graves 1st line
Propanolol
27
treatment for Graves(4)
Carbimazole (agranular cytosis)
Propylthiouracil (**PTU preferred 1st trimester- then carbimazole**)
Radioactive Iodine
Surgery
28
45 YO Woman. Tired, Fat, low mood, dry skin and constipation ,cold - diagnosis?
Hashimoto's Thyroiditis (causes hypothyroidism)
29
Hashimoto's Thyroiditis- antibodies (2)
Antithyroid peroxidase (Anti-TPO) antibodies
Antithyroglobulin antibodies (Anti-TG)
30
Hashimoto's Thyroiditis- expected T3, T4 and TSH?
T3 and T4 low
TSH High
31
Other causes of Low T3/T4 & High TSH i.e. hypothryoidism (not Hashimoto's Thyroiditis) (3)
**TIM**
1. Treatmentfor Hyperthryoidism.
2. Iron Deficiency
3. Meds (Lithium)
32
Treatment for Hashimoto's Thyroiditis?
Levothyroxine
33
What does disease Parathyroid Tumour cause?
Primary Hyperparathyroidism
34
how does PTH increase serum calcium (3)
Increase osteoclast activity in bones
Increase Calcium absorption in kidneys
Increase Vit D activity which Increases gut absorption.
35
how does hypercalcemia present (2)
1. Renal Stones lead to abdo groans.
2. Painful bones lead to psychiatric moans.
36
Cause of primary hyperparathyroidism? Calcium and Phospate up or down?
Tumour , Calcium Up, Phosphate Down
37
Cause of Secondary hyperparathyroidism(2)? and Calcium up or down?
decrease Vit D and CKD.
Calcium down or same.
38
Cause of tertiary hyperparathyroidism? and Calcium up or down?
prolonged secondary hyperparathyroidism -eg, renal failure causes tertiary, Hyperplasia, Calcium Up
39
Woman, Age 30-50, 2 months fatigue, cramps, abdo pain, vomiting, sleepy, hypotensive. Unusual Tan skin. TB/Autoimmunity / WFS issue DIAGNOSIS?
ADDISON'S
40
Acute diagnosis of Addison's
Adrenal Crisis
41
bronzing of skin in Addison's, why is this?
excessive ACTH stimulates melanocytes
42
Primary Addison's Disease- damage to what?
What is decreased?
Which syndrome can it lead to?
damage to the adrenal glands.
Decrease Cortisol and Aldosterone
Waterhouse-Friderichsen syndrome
43
Secondary Addison's Disease-how does it happen
Decrease ATCH from pituitary
44
Tertiary Addison's Disease-how?
Decrease CRH from hypothalamus
45
Key biological findings in Addison's(3)
Hyponatraemia, low cortisol, hyperkalemia
46
Diagnostic test Addison's
Short Synacthen Test (ACTH)
47
Treatment for Addison's
Hydrocortisone replace Cortisol
Fludrocortisone replace Aldosterone
**H**orny **C**owboys **F**uck **A**lot
48
Great Khali, what disease
Acromegaly
49
which hormone raised in Acromegaly
GH
50
Cause of Acromegaly
Pituitary Adenoma
51
Initial blood test for acromegaly
IGF-1
52
Definitive Treatment Acromegaly
transsphenoidal removal
53
Options for blocking the raised GH
Somatostatin (Ocreotide)1st line
GH Antagonist (Pegvisomant)
Dopamine Agonist (Bromocriptine)
54
Acromegaly = Increased risk of which cancer?
Colorectal
55
Old, fat man- sedentary lifestyle- polyuria- numbness in fingers and toes - what does he have?
T2D
56
Diagnostic test for T2D
HbA1c
57
Criteria for:
Prediabetes HBA1C
Diabetes
58
HbA1c treatment target for T2D for new diagnosis?
48 mmol/mol
59
HbA1c treatment target for T2D for moving beyond metformin?
53 mmol/mol
60
1st line medication T2D
Metformin
61
drug options T2D (6)
Sulfonylurea (Gliclazide)
Pioglitazone (TDZ)
DPP-4 Inhibitor (Sitagliptin)
SGL-2 inhibitor (Empagliflozin)
GLP-1 Mimetics (Extenatide)
Insulin
62
Too much aldosterone - which disease?
Conn's Syndrome (Primary Hyperaldosteronism)
63
2 Primary causes of Conn's
Adrenal Adenoma
Bilateral Adrenal Hyperplasia
64
2 Secondary causes of Conn's
Renal issues
Heart Failure
65
How can renin levels be used to differentiate between primary and secondary forms of Conn's syndrome?
Primary= Decrease Renin( adrenal gland issue)
Secondary = Increase Renin ( kidney issue)
66
Conn's BP exam findings
Hypertension
67
Conn's electrolyte findings (3)
Hypokalaemia
Hypernatremia
High bicarbonate
68
Conn's BG finding
Alkalosis
69
Aldosterone antagonists for Conn's
Eplerenone and spironolactone
70
man ages 30-55 ,
anxiety, headaches, palpitations, and diaphoresis
What does he have
Pheochromocytoma
71
Pheochromocytoma affects which part of adrenal glands
chromaffin cells in the adrenal medulla
72
Associated genetic condition for Pheochromocytoma?
Multiple endocrine neoplasia type 2 (MEN2)
73
"10% rule" in the context of pheochromocytoma
10% Rule:
10% of pheochromocytomas are extra-adrenal
10% Bilateral
10% Cancerous
74
Initial test options for pheochromocytoma (2)
24-Hour Urine Catecholamines
Plasma Free Metanephrines
75
Management of pheochromocytoma(3)
Alpha Blockers (Phenoxybenzamine)
Beta Blockers (After Alpha blockers)
Adrenalectomy
76
Where is ADH normally secreted FROM?
Posterior pituitary
PP
77
Eptopic ADH from SCLC leads to what disease?
SIADH
78
Treatment SIADH
Fluid restriction
ADH receptor blockers (Tolvaptan)
79
Concern with rapid changes in blood Na (SAIDH)
Central Pontine Myelinolysis
80
Other endocrine causes of Hyponatraemia?
Adrenal insufficiency
81
Common meds that cause Hyponatraemia (2)
Diurectics
SSRIS
82
4 causes of a low blood and urinary sodium? I.e fluid loss
Sweating
Diarrhoea
Vomitting
Burns
83
young person, weight loss, polyuria, polydipsia vomitting and drowsiness- diagnosis?
Diabetic Ketoacidosis
84
Underlying diagnosis for DKA?
T1D
85
Criteria for Acute Diag for DKA in bloods? (3)
Acidosis
Hyperglycaemia
Ketosis
86
Initial Mgt DKA
FIG PICK
F- Fluids
I- Insulin
G- Glucose
P- Potassium
I- Infection
C- Chart fluid balance
K- Ketone Monitoring
87
Long term treatment DKA
Subcutaneous Insulin Regiment
88
Methods for monitoring DKA(3)
HbA1c (3-6 months)
Capillary blood glucose
Flash glucose monitoring
89
Woman 20-50 , central obesity (truncal adiposity), moon facies, buffalo hump (dorsocervical fat pad), purple striae (due to skin atrophy and easy bruising), and proximal muscle weakness.
Dx?
Cushing's Syndrome
90
Pathology of Cushing's Syndrome
Excessive Cortisol
91
Causes of Cushing's syndrome (4)
Exogenous Steroids
Pituitary Adenoma (increased ACTH)
Adrenal Adenoma
Paraneoplastic (Eg SCLC)
92
Resulting conditions of Cushing's Syndrome (4)
Hypertension
T2D
Depression
Osteoporosis
93
Diagnostic test for Cushing's Syndrome
Dexamethasone Suppression test
94
Tx for Cushing's Sydnrome
Treat the cause (tumour removal)
95
Polydipsia and Polyuria- Dx?
Diabetes Insipidus
96
Two Types of DI?
Cranial (lack of ADH)
Nephrogenic (Lack of response to ADH)
97
How do serum and urine osmolality values differ in the diagnosis of Diabetes Insipidus (DI)?
Serum Osmolality: High, because the body loses water through excessive urination, increasing the concentration of solutes in the blood.
Urine Osmolality: Low, indicating the urine is very diluted due to the kidneys' failure to reabsorb water, resulting in a low concentration of solutes in the urine.
98
Test of choice for DI?
Water Deprivation Test
99
DI-
Interp of results from Water Depr. Test
Cranial DI: The brain doesn't make enough ADH, but if we give a synthetic version, the kidneys start working better.
Nephrogenic DI: The kidneys don't respond well to ADH, so even with the synthetic version, they don't do much to concentrate the urine.
100
Medical treatment for DI
Desmopressin
101
Fasting Blood Glucose:
Normal:
Pre-Diabetets
**
Diabetes:
Normal: Less than 100 mg/dL (5.6 mmol/L)
Pre-diabetes (impaired fasting glucose): 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
**Diabetes: 126 mg/dL (7.0 mmol/L) or higher**
102
Oral Glucose Tolerance Test (2-hour plasma glucose):
Normal:
**Impaired Glucose Tolerance (IGT):
**
Diabetes:
**Normal: Less than 140 mg/dL (7.8 mmol/L)**
Impaired Glucose Tolerance (IGT): 140 to 199 mg/dL (7.8 to 11.0 mmol/L)
Diabetes: 200 mg/dL (11.1 mmol/L) or higher
103
Hemoglobin A1c (HbA1c):
Normal:
**Pre-diabetes (increased risk):
**
Diabetes:
Hemoglobin A1c (HbA1c):
Normal: Less than 5.7%// less than 41 mmol/mol.
**Pre-diabetes (increased risk): 5.7% to 6.4% // 42 to 47 mmol/mol.**
Diabetes: 6.5% or higher// 48 mmol/mol or higher.
104
Thiazolidinediones (TZDs) - Example: Pioglitazone
Contraindications (1)
Heart failure
105
Thiazolidinediones (TZDs) - Example: Pioglitazone
Side Effects (1)
Fluid retention leading to edema
106
Sulfonylureas - Example: Gliclazide
Contraindications:
Severe kidney or liver disease
107
Sulfonylureas - Example: Gliclazide
Side Effect:
Weight gain
108
SGLT2 Inhibitors - Example: Empagliflozin
Contraindications(2)
Type 1 diabetes
Diabetic ketoacidosis
109
SGLT2 Inhibitors - Example: Empagliflozin
Side Effects:
Side Effects:
Genital yeast infections
Urinary tract infections
Increased urination
Dehydration
110
Metformin
Contraindications:
Severe kidney disease
111
Metformin:
Side Effects:
Metformin
Gastrointestinal upset (diarrhea, nausea)
112
Hypothyroidism is typically treated with thyroid hormone replacement therapy, name?
Levothyroxine (T4).
113
Exenatide mechanism
Mimic GLP-1, boost insulin, control sugar.
114
Sitagliptin mechanism
Inhibit DPP-4, boost GLP-1.
115
Cushings (too much cortisol) is what ref. Salt and Potassium.
Cushings = fat = weight gain from the sodium which brings in water
Hypernatremia and Hypokalaemia
116
What is Addisons (too little cortisol) ref Salt and Potassium
Hyponatremia + Hyperkalaemia
Addisons = thin = weight loss from all the sodium lost so water lost too
117
Go -
find -
rex -
make -
good -
sex -
Go - glomerulosa
find - fasciculata
rex - reticularis
make - mineralocorticoid (Aldosterone)
good - glucocorticoid (Cortisol)
sex - sex hormones
118
Diabetes Melitus-
if **fasting glucose** is greater than or equal to x mmol/l
what is x?
7.0 mmol/l
119
Diabetes Melitus-
random glucose is greater than or equal to Y mmol/l
What is Y?
11.1 mmol/l
120
Nephrogenic DI, after Water Deprivation test and ADH
Low and Low
121
pituitary adenoma in the context of Cushing's 1 buzzword// vision
Bitemporal Hemianopsia
122
Hyperosmolar Hyperglycemic State (HHS) 3 buzzwords
Extreme Hyperglycemia (> 33 mmol/L)
Increased Serum Osmolality
Minimal or No Ketosis
123
Addison's
Conn's
Cushings
Excess/Too little WHAT?
Addisons= Too little cortisol
Conn's= Excess Aldosterone
Cushings= Excess Cortisol
124
Test for
Addison's
Conn's
Cushings
Addison's= Short Synthaen test
Conn's= Aldosterone:Renin
Cushings test= Dexamethasone suppression test
125
MEN 1 (two buzzwords)
Primary Hyperparathyroidism
Adenoma
126
MEN 2a (3 buzzwords)
Medullary Thyroid Carcinoma (MTC)
Pheochromocytoma
RET Gene
127
Myxoedema Coma (1 buzzwords)
severe hypothyroidism
128
PIGs
Thyroid Storm/Thyrotoxic crisis
Propranolol
Iodine
Glucorticoids
Prophylthiouracil
129
Men2b (3 buzzwords)
Marfanoid hands
Mucosal Neuroma
RET
130
Cushing Syndrome (2)
excess cortisol in the body regardless of cause
High levels of urinary free cortisol can Cushing's syndrome
131
Cushing Disease
where the excess cortisol is due to an ACTH-producing pituitary adenoma
132
Low dose dexamethasone test
decrease cortisol, and acth
cushing SYNDROME
133
high dose dexamethasone test
cushing DISEASE
Significant suppression of cortisol
If cortisol levels do not suppress with the high dose= ectopic ACTH source / adrenal tumour
134
KEEP GOING DIVZ
YOU GOT THIS BRO
