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PACES > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Ant/Post pituitary hormones

A

Ant: LH, FSH, GH, TSH, Prolactin, ACTH
Post: ADH, Oxytocin

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2
Q

WHO diabetes criteria

A
  • Fasting plasma glucose >7
  • Random/post OGTT >11.1
  • HbA1c >48
    Repeat test if no symptoms
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3
Q

4 commonest T1DM Abs

A
  • Glutamic acide decarboxylase (GAD65)
  • Islet cell (ICA),
  • Insulin
  • IA-2
    All fade as disease progresses
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4
Q

C-peptide role

A

By-product of insulin production

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5
Q

Diabetes non medical management

A
  • Eye screening service
  • Annual foot check
  • Annual urine A:Cr
  • HbA1c 3-6/12ly
  • Annual BP
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6
Q

Risks of diabetes in pregnancy

A

Macrosomia
-> Shoulder dystocia
Miscarriage
Preterm labour
Pre-eclampsia
Worsening diabetes complications (retina/foot etc)

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7
Q

Hyperthyroidism presenting features

A

Weight loss
Anxiety
Cardiac:
- Palpitations
- AF
- SVT
Neurological:
- Essential tremor
- Proximal muscle weakness
- Eye protrusion (Graves’ only)
GI:
- Increased appetite
- Diarrhoea
Oligomenorrhoea/irregularity/loss of libido

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8
Q

Hyperthyroidism investigations

A
  • TFTs - High fT4/3 (3 more sensitive), likely low TSH (secondary rare)
  • TSH receptor antibodies
  • Thyroid US/Radioiodine if unclear cause, Abs negative to identify e.g. nodule/adenoma
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9
Q

Graves’ examination findings

A

Hands/arms:
- Tremor
- AF
- Vasodilation, clammy
- Palmar erythema
- Thyroid acropachy, onycholysis
Arms:
- Proximal myopathy
- Hypertension
Face:
- Exophthalmos
- Lid lag
- Reduced colour vision
Neck:
- Goitre
- With bruit
Legs:
- Pretibial myxoedema
- Brisk reflexes

Associations:
- Myasthenia gravis
- Vitiligo
- Rarely splenomegaly
- Osteoporosis

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10
Q

Hyperthyroidism causes

A
  • Graves’ most common
  • Toxic nodular goitre
  • Thyroid adenoma
  • Postnatal thyroiditis
  • Initial phase of subacute/de Quervain thyroiditis
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11
Q

Graves’ management

A

Lifestyle:
- Stop smoking!!

Medical:
- Symptomatic - propranolol
- Carbimazole (propylthiouracil if storm) - block/replace or titration according to TFTs. Trial 18/12 then withdraw - 50% relapse
- Radioiodine - usually first line (using anti thyroid drugs before and after Rx). Avoid if: pregnancy, orbitopathy (consider + steroid). Often leads to lifelong hypoT

Surgical:
- Thyroidectomy - make euT first with carbimazole etc. Total preferred as lower risk recurrent hyperT. LevoT afterwards

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12
Q

Antithyroid drug SEs

A

Carbimazole:
- Agranulocytosis - report fever/sore throat, rash
- Rash
Propylthiouracil
- ANCA+ small vessel vasculitis

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13
Q

Radioiodine advice

A
  • Frequent handwashing
  • Double flush toilet
  • Avoid close contact, esp women & children
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14
Q

Thyroid storm precipitants

A
  • Post thyroidectomy
  • Radioiodine
  • Infection
  • MI
  • Trauma
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15
Q

Thyroid storm management

A

Fever, agitation, hyperthermia, tachy

  • A-E & resus
  • Propranolol or shorter acting BBs. Consider non-DHP CCBs
  • Carbimazole & later iodine
  • Steroids to prevent peripheral T4-3 conversion
  • Endocrine advice, consider thyroidectomy (if not done and failing to improve)
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16
Q

Hypothyroidism signs

A

Hands:
- Bradycardia
- Dry, thin skin
- Cool
- Possible ataxia
- Phalen’s/Tinel’s

Face:
- Anaemia and carotenaemia
- Loss of eyebrows
- Xanthelasma
- Peri-orbital oedema

Neck
- Goitre (hashimotos) or thyroidectomy scar
- JVP in CCF

Legs:
- Slow-relaxing reflexes
- Proximal myopathy

17
Q

Causes primary hypothyroidism

A
  • Hashimoto’s thyroiditis most common in UK
  • Iodine def most common globally
  • Hyper T treatment - post thyroidectomy/radio I, carbimazole etc
  • Drug SEs: Amiodarone, Lithium
  • Infiltrative (sarcoid/haemochromatosis)
  • Subacute (de Quervain’s)
18
Q

Hashimoto’s associations

A

Other autoimmune:
- T1DM
- Addison’s
- Pernicious anaemia
- Vitiligo
- Sjogren’s
Other:
- Turner’s, Down’s
- CF
- PBC
- Hypercholesterolaemia
- POEMS (polyneuropathy, organomegaly, endocrinopathy, m-protein band (plasma cytoma), skin pigmentation)

19
Q

Hypothyroidism investigations

A
  • TFTs
  • Anti TPO, thyroglobulin (hashimotos)
  • FBC - mild normocytic anaemia
  • Glucose
  • Cholesterol (raised)
20
Q

Hypothyroidism management

A

Levothyroxine
- Monitor 6/52ly after starting/changing (Half life 1/52)
- Then annually

Risks of angina with rx
Risks of CAD without, even if subclinical
Can unmask Addison’s -> crisis

21
Q

Parathyroid axis

A

PTH secreted in response to low Ca
Leads to increase osteoclast activity, increase vit D activation, increase Ca reabsorption/PO4 secretion in kidney

22
Q

Primary hyperparathyroidism causes

A
  • Mostly solitary adenoma
  • 20% gland hyperplasia
  • Parathyroid cancer very rare
23
Q

Parathyroidectomy complications

A
  • Hypoparathyroidism
  • Recurrent laryngeal nerve damage (-> hoarse)
24
Q

Causes secondary hyperparathyroidism

A
  • Low vit D (diet, low sunlight, malabsorption)
  • CKD (low vit D activation)
25
Q

Secondary hyperparathyroidism bone profile results

A

Low Ca
High PTH (appropriately)

26
Q

Secondary hyperparathyroidism presentation

A

Hypocalcaemia
- Cramps
- Bone pain & fractures
- Perioral tingling
- Chvostek’s
- Trousseau’s

27
Q

Management 2ry hyperparathyroidism in CKD

A
  • Phosphate restriction +/- binders
  • Vit D/calcium supplementation
  • +/- parathyroidectomy
28
Q

MEN genes

A

MEN 1 - MEN1
MEN 2 - RET proto-oncogene

29
Q

MEN 1

A

The Ps
- Parathyroid adenoma/hyperplasia in 90%
- Pancreas endocrine tumours (gastrinoma, insulinoma, somatostatinoma)
- Pituitary (prolactinoma/GH-secreting tumour)

30
Q

MEN2a

A

MAP
- Medullary thyroid carcinoma in almost all
- Adrenal - phaeochromocytoma, often bilateral
- Parathyroid hyperplasia

31
Q

MEN2b

A
  • Medullary thyroid carcinoma
  • Adrenal - phaeo
  • Marfanoid appearance
  • Mucosal neuromas (lips, eyelids, cheeks, tongue)

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