Endocrine Flashcards
What is the cause of excessive sweating and oily skin in acromegaly?
caused by sweat gland hypertrophy
4 Complications of acromegaly
- HTN
- DM
- CARDIOMYOPATHY
- COLORECTAL CANCER
What is the confirmatory test of acromegaly if IGF-1 LEVEL is raised ?
Oral glucose tolerance test
In Oral glucose tolerance test
in normal patients GH is suppressed to < …….. mu/L with hyperglycaemia
< 2
Acromegaly: management
Trans-sphenoidal surgery is the first-line treatment for acromegalyin the majority of patients.
If a pituitary tumour is inoperable or surgery unsuccessful then medication may be indicated:
- somatostatin analogue : octreotide
- pegvisomant
- dopamine agonists : bromocriptine
External irradiation is sometimes used for older patients or following failed surgical/medical treatment
somatostatin analogue directly inhibits ……
the release of growth hormone
GH receptor antagonist ( pegvisomant ) - prevents ….
dimerization of the GH receptor
10 Acute phase proteins
- CRP
- procalcitonin
- ferritin
- fibrinogen
- alpha-1 antitrypsin
- caeruloplasmin
- serum amyloid A
- serum amyloid P component**
- haptoglobin
- complement
During the acute phase response the liver decreases the production of other proteins ( negative acute phase proteins)
(5)
albumin
transthyretin (formerly known as prealbumin)
transferrin
retinol binding protein
cortisol binding protein
causes of hypoadrenalism
Primary causes
1. tuberculosis
2. metastases(e.g. bronchial carcinoma)
3. meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
4. HIV
5. antiphospholipid syndrome
Secondary causes
- pituitary disorders (e.g. tumours, irradiation, infiltration)
Exogenous glucocorticoid therapy
Management of addisonian crisis
- hydrocortisone 100 mg im or iv continue 6 hourly until the patient is stable.
- oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
Causes of raised alkaline phosphatase (ALP)
liver: cholestasis, hepatitis, fatty liver, neoplasia
Paget’s
osteomalacia
bone metastases
hyperparathyroidism
renal failure
physiological:pregnancy, growing children, healing fractures
2 Causes of Raised ALP and raised calcium
Bone metastases
Hyperparathyroidism
Children are screened for Congenital hypothyroidism at …. days using …….. test
Children are screened at 5-7 days using the heel prick test
In Toxic multinodular goitre
The treatment of choice is …..
radioiodine therapy.
painful goitre and raised ESR
Subacute thyroiditis (de Quervain’s)
Management of Thyroid eye disease
smoking cessation
topical lubricants may be needed to help prevent corneal inflammation caused by exposure
steroids
radiotherapy
surgery
4 phases of Subacute thyroiditis
phase 1 (lasts 3-6 weeks): hyperthyroidism,painful goitre,raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal
thyroid scintigraphy:globally reduced uptake of iodine-131
In which condition?
Subacute thyroiditis
Riedel’s thyroiditis is associated with ……..
retroperitoneal fibrosis.
SGLT-2 inhibitors reversibly inhibit ……..
sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
Side effects of SGLT2
urinary and genital infection (secondary to glycosuria).Fournier’s gangrene has also been reported
normoglycaemic ketoacidosis
increased risk of lower-limb amputation: feet should be closely monitored
women with established hypothyroidism who become pregnant should have their dose increased ‘by
At least 25 - 50 mcg levothyroxine
Mechanism of action of Carbimazole
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production