Endocrine Flashcards
Does Eplerenone or Spironolactone have less chance of causing gynaecomastia?
Eplerenone
What is the most important modifiable risk factor for the development of thyroid eye disease?
Smoking
T/F Hashimoto thyroiditis is associated with he development of MALT?
True
Water deprivation test - Nephrogenic DI.
Urine osmolality after water deprivation?
Urine osmolality after desmopressin?
Low + Low
Water Deprivation test - Cranial DI.
Urine Osmolality after water deprivation?
Urine osmolality after desmopressin?
Low + High
16M reviewed in clinic due to concerns around development. Short stature, no facial hair, sparse pubic hair, testicular volume 3mls. Cleft palate. Anosmia. LH, FSH, Testosterone all low.
Kallman Syndrome
16M presents with delayed puberty. TSH and FSH high. Testosterone low.
Klinefelter Syndrome
Mechanism of Carbimazole?
Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin
What gene is Medullary Thyroid Cancer associated with?
RET Oncogene
Karyotype of Klinefelters?
47, XXY
defective NKCC2 channel in the ascending loop of Henle
Bartters sybdrome
Mutated NCL sympoter in the distal convoluted tubule
Gitelman syndrome
How do solfonylureas exert there effect?
(e.g. Gliclazide)
Inhibiting ATP-sensitive potassium channels on the membrane of pancreatic beta cells. This causes depolarisation of the beta cells, resulting in the opening of voltage-gated calcium channels. The subsequent calcium influx leads to exocytosis of vesicles containing insulin.
Why do Iron tablets need to be taken at least four hours after regular medication?
Iron/calcium carbonate can reduce the absorption of levothyroxine
How does octeritide work as a treatment for Acromegally?
Somatostatin directly inhibits the release of growth hormone
Autosomal dominant condition where there is continuous activation of epithelial sodium channels (ENaC) in the collecting duct. Leads to hypokalaemia and metabolic alkalosis but in the setting of hypertension and low renin + aldosterone. Tx involves medication which blocks ENaC (e.g. amiloride)
Liddle Syndrome
What are the muscarinic antagonists which are used in urge incontinence?
Tolterodine, Oxybutynin, Solifenacin
Triad of recurrent renal stones, Hypokalaemia, nephrocalcinosis. Presents with hyperchloremic metabolic acidosis with a normal anion gas.
RTA 1
Fanconi syndrome and Wilsons disease is associated with what type of RTA?
2
What medications can cause false renin:aldosterone ratio results?
ACEi + ARB + Direct renin inhibitors + Aldosterone antagonists
works by inhibiting the PCSK9 protein, which normally binds to LDL receptors on the liver. By blocking PCSK9, evolocumab allows more LDL receptors to remain available on liver cells, where they can remove LDL-C from the blood more effectively, leading to lower blood LDL-C levels. Primarily used in heterozygous familial hypercholesterolemia, homozygous familial hypercholesterolemia, and atherosclerotic cardiovascular disease (ASCVD)
Evolocumab
Graves Disease
3 associated antibodies?
1) TSH Immunoglobulin
2) Thyroid Peroxidase (Autoimmune)
3) Thyroglobulin
What antibodies are associated seronegative generalised Myasthenia Gravis?
Anti-MUSK antibodies
What antibodies are associated with Myasthenia Gravis?
Anti-acetylcholine receptor antibodies
What antibodies is associated with 75% of Grave disease patients?
Anti-thyroid peroxidase (TPO) antibodies
Typical VBG abnormality pattern in Cushing syndrome?
Hypokalaemia metabolic alkalosis
Thyroid cancer types:
(1) 70%, often young females, excellent prognosis
(2) 20%
(3) 5%, cancer of parafollicular (c) cells, secrete calcitonin, Part of MEN-2
(4) 1%, not responsive to treatment, cause premature symptoms
(5) Rare, associated with Hashimotos thyroiditis
(1) Papillary
(2) Follicular
(3) Medullary
(4) Anaplastic
(5) Lymphoma
Medication for stress incontinence?
Duloxetine
Medication for urge incontinence (when anti-muscarinic are CI e.g. Alzheimer’s or closed angle glaucoma
Mirabegron (Beta-3 agonist)
MEN 1. 3 Ps?
HyperParathyroidism + Pituitary Tumours + Pancreatic Tumours
MEN 2A - 1 ‘M’ + 2 ‘Ps’
Medullary Thyroid Cancer + Hyperparathyroidism + Phaeochromocytoma
MEN 2B - 2 ‘M’s + 1 ‘P’
Medullary Thyroid Cancer, Marfans + Phaeochromocytoma
Four conditions which cause Hypokalaemia and Hypertension?
Cushing Syndrome / Conns Syndrome / Liddles Syndrome / 11 beta hydroxylase deficiency
Five conditions with cause hypokalaemia without hypertension?
Diuretics / GI loses / Renal tubular acidosis / Bartters syndrome / Gitelman syndrome
What will nuclear scintigraphy reveal in toxic multinodular goitre?
Patchy Uptake
What cancer do patients with Acromegally have an increased risk of?
Colorectal
What hormone triggers Ovulation?
LH
At what point in the menstrual cycle do Progesterone levels peak?
Luteal Phase (Progesterone is produced by the corpus Luteum)
A diagnosis of Impaired Fasting Glycaemia has a blood glucose level between?
6.1mmol/L to 6.9mmol/L
Diagnosis of diabetes requires a fasting plasma glucose level above?
7 mmol/L
What blood sugar level do you need for diagnosis of impaired glucose tolerance after oral glucose test?
7.8-11.1 mmol/L
What type of renal tubular acidosis is linked with Sjogrens syndrome?
Type 1
Peptic Ulceration, galactorrhoea, hypercalcaemia? Triad for..
Multiple Endocrine Neoplasia Type 1
What pattern of uptake would you expect in subacute thyroiditis on the technetium scan?
Globally reduced
In pregnancy Raised total T3 and T4 but normal fT3 and fT4 can be seen. Why?
high concentrations of thyroid binding globulin, which can be seen during pregnancy
Women with hypothyroidism taking levothyroixne need to increase there thyroxine by upto how much during pregnancy?
50%
Which hormone is under continuous inhibitory control?
Prolactin
What regime is preferred in pregnancy for management of hyperthyroidism?
Titration regime with low dose of anti-thyroid medication
What part of the renal syndrome is compromised in Barters Syndrome?
Sodium, potassium and Chloride pumps
22F presents with secondary amenorrhoea, pregnancy test negative. FSH, TSH, Prolactin normal. Oestrogen and free androgen index low. Diagnosis?
Hypothalamic Hypogonadism
Alcoholic excess patient presents with hypoglycaemia. 1st line management.Glucagon or IV 20% Dextrose 100mls (+Thaimine replacement)
IV Dextrose + Thaimine replacement
How do you calculate serum osmolality?
2(Na+) + Glucose + Urea
Diagnostic criteria for HHS? (Hyperosmolar Hyperglycaemic state)
1) Hypovolaemic (2) Hyperglycaemic (Glu > 30) (3) Raised serum osmolality (>320) (4)Ketones < 3 (5)No Acidosis
Typical findings of SIADH:
-Serum Osmolality
-Urinary Sodium
-Urine Osmolality
-Low )<280)
-High >20
-Normal/high (around 500)
Formula for estimating serum osmolality?
(2 X Na) + (2 X K+) + Glucose + Urea
