Endocrine Flashcards
Glicozide action
binds to ATP dependent pottasium channel on membranes of pancreatic beta cells
hypokaleamia with high BP
Cushing’s
Conn’s
Liddle’s
11-beta hydoxylase def
hypokaleamia without hypertension
Dieuretics
GI loss
Renal tubular acidosis
Barttres
Gitelmans
Bartters syndrome
defect in NKCC2 channel defect in ascending limb of loop of Henle
failure to thrive
salt wasting
metabolic alkalosis
urinary calcium elevated
polyhdramniosis
high bicarb - compromised cl reabsorption interfere withcl/bi carb exchange
increased renin, aldesterone
Gitlman’s syndrome
defect in in NaCl transporter in DCT
less severe than Bartters
metabolic alcolosis,** low urinary calcium,** hypocaleasema,, low magnesium
latent Autoimmune Diabetes of Adulthood
- Presence of islet antibodies of slow progression
- Clinical features: Adult-onset diabetes, + Type 1 diabetes-associated autoantibodies (such as GAD65, IA-2, and ZnT8)
3 criteria for the diagnosis of LADA
- Age greater than 30 years
- Positive autoantibodies to islet β cells
- Insulin independence for at least the initial 6 months after initial diagnosis
Maturity-onset diabetes of the young (MODY)
Early onset (before age 30), autosomal dominant inheritance, and impaired insulin production
asymptomatic and young slim individuals
Maturity-onset diabetes of the young (MODY)
- HNF1A 30% to 60% of MODY.
- HNF4A 5% to 10% of MODY
- GCK 30% to 60% of MODY.
- HNF1B less than 5% of MODY.
lack of islet autoantibodies - characteristic
MODY Genes Associated Syndromes
- Wolfram Syndrome/ DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness)
- Thiamine-responsive megaloblastic anemia syndrome
- Maternity-inherited diabetes with deafness
SGLT 2 inhibitors action
Reversibly Inhibit SGLT 2 in PCT
SGLT 2 inhibitors adverse effects
- increase urine output
- weight loss
- UTI & genital infections
- Normoglycemic ketoacidosis
- lower limb aputation risk
- Founeirs Gangrene
Adverse effects of sulphanurea
hypoglycemic epicodes
hyponatremia
bone marrow suppression
pheriperal nuropathy
Type 1 RTA associations
Distal convuluting Tubules
- Low K+
- hight Ca
- PH>5.5
- renal calculai
- Associatd with SS & RA
Kallmann syndrome traid
- Delayed or absent puberty,
- Anosmia or hyposmia
- Infertility
deficiency in gonadotropin-releasing hormone (GnRH
Lupus pernio (Besnier-Tenneson syndrome)
- Blue red to violet smooth shiny nodules and plaques on the head and neck, predominantly on the nose, ears, lips, and cheeks
- Pathognomonic of sarcoidosis
Systemic glucocorticoid achne features
monomorphic papular rash without comedons or cysts
Cervical cancer risk factors
HIPS C
HPV types 16, 18, and 31; high risk exposure
Immunocompromised individuals: long term steroids, HIV, transplant patients
Promiscuity: multiple partners
Smoking
COCP
- features of addison’s disease
2.
high K+
low Na+
low sugar
loss of pubic hair, nor bolding
2. adrenocorticotrophic hormone stimulation (Synacthen®) test
Hashimoto’s thyroiditis associated cancers
thyroid MALT lymphoma
(Extranodal marginal zone B-cell lymphoma)
The Rotterdam criteria
2 ot of 3 of the followings
- oligo- or anovulation,
- hyperandrogenism (clinical or biochemical)
- polycystic ovarian morphology (PCOM) on ultrasound.
thyrotoxic storm treatment in the background of DKA
Betablockers
PTU
hydrocortisol
hashimoto’s thyroiditis
hypothyroidism
Goiter
Anti TPO, anti thiroglobulin
Liddle’s syndrome
Hypertension
Hypokalemia
Metabolic Alkalosis
Autosomal dominant
epithelial sodium channel
Primary Hyperparathyroidism
common - parathyroid adenoma,
PTH high / normal
Ca High
Causes Causes of SIADH
SIADH Cannot Void
S: SSRIs (Sertaline)
I: Indomethacin (Analgesics)
A: Antidepressants (Tricyclics)
D: Diuretics (Thiazides)
H: Haloperidol
Cannot: Cyclophosphamide, Carbamazepine
Void: Vincristine
Lithium Diabetic Incepides
ibcrease urine outout
low urine osmolality
raised plasma osmolality
hypernatremia
SIADH
low urine output
low sodium
Low plasma osmolality
High urine osmolality
Addisons diesese and cortisol level
- <100 = Addisons or hypoadresalism likely
- 100<Cortisol < 500 = inconclusive - Short Synacthon test
- > 500 = Addisons unlikely
electrolyte abnormalities in Addisons
Hypercalemia
hyponatremia
hypoglicemia
metabolic acidosis
Metabolic syndrome
central obesity
insulin resistance
hypertension, and dyslipidemia
poses a significant risk for the development of atherosclerotic cardiovascular diseases
type II diabetes mellitus
other conditions - raised Uric acid levels, Polysisctic ovarian syndrome, fatty liver disease
Diagnosis of DKA
Glucose >11
pH<7.3
Bicarbonate <15
Blood ketones >3 or urine ketones 2+
Urge incontinence 1st line for elderly
Mirabegron - Mirabegron is a selective beta-3 adrenergic receptor agonist.
oxybutinin can cause confusion in elderly
Multiple Endocrine Neoplasia type 2B (MEN2B)
Marfanoid habitus, edullary thyroid cancer, pheochromocytoma, and mucosal neuromas
RET proto onco gene present
MEN type 1
3 P’s
Parathyroid gland
Pancreas
Pituitary gland
MEN type 2A
medullary thyroid cancer >70%
2Ps
Pheochromocytoma - Adrenal
Parathyroid
RET proto onco gene present
Acromigaly Management
1st line - Transphenoidal surgery
if unsuccessfull medications
1. somatosatin analogue
2. pegvisoman
3. dopamine agonists
colorectal cancer risk increased
Actopic ACTH
- same clinical presentation as Cushings, but with severe hypokalemia and very high ACTH
- doesnt respond to high dose dexa suppression
Cushings disease
8- cushings syndrome + elevated 9 am cortisol and high ACTH
- respond to high dose Dexa (2mg 6hr for 48hr)
-dexa respond to pituirary only, CRH - increasse cortisol (0nly in piturory )
Primary hyperparathyroidism
80% Solitory Adenoma
10% Hyperplasia
1% cancer
80% symptomatic
- polydipsia, polyurea, depression, constipation, peptic ulcers, pancreatitis, bone pain fractures, kidney stones, hypertension
- high Ca+, low Ph+, PTH could be normal
- Scan - Techniciam Mibi substraction
- X ray - paper pot skull, ostiitis, fibrosa cystica
- Management - parathiroidectomy, non - surgical = cinacalcet
Complications of pregnancy related to thirotoxicosis
Fetal loss
maternal heart failure
premature labor
If triple therapy with metformin and 2 other oral drugs (gliplazin + Sulphunilurea) failed (BMI >35)
Replace GLP-1 mimetic instead of gliclazide
GLP-1 side effects
- Ketoacidosis
- Severe gastro-intestinal disease (not
for liraglutide and semaglutide) - Liraglutide: diabetic gastroparesis,
inflammatory bowel disease
DPP-4
inhibitor
(‘gliptins’)
Ketoacidosis
No Hypoglycaemia
risk
Acromegaly Diagnosis
IGF 1 level followed by OGTT + serial GH measurements
hypoglycemia due to insulin
1. Symptoms
2. Hormonal response
- Shakiness, sweating, dizziness, or lightheadedness.
- Hunger, confusion, or difficulty concentrating.
- Rapid heartbeat, blurred vision, or headache.
- In severe cases, seizures, loss of consciousness, or coma
- Shakiness, sweating, dizziness, or lightheadedness.
- Glucagan increase
- adrenalin, cortisol increase
Schematic representation of glucose metabolism
1: Hexokinase/glucokinase,
2: Glycogen synthase,
3: Phosphorylase,
4: Phosphofructokinase,
5: Pyruvate kinase,
6: Pyruvate carboxylase,
7: Phosphoenolpyruvate carboxykinase,
8: Fructose-1,6-biphosphatase,
9: Glucose-6-phosphatase.
Thyroid bining globilin in pregnancy
eastrogen - Liver TBG increases
and bind to FT3 & FT4
rerduce free T3, T4
Secondary Increase increase in TSH
klinefelter syndrome
Male phenotype, Karyotype (47, XXY),
Long/tall,
Infertile, gyenicomastia
Nondisjunction,
Eunuchoid body proportions,
FSH elevated, High LH (Elevated Gonadotropins)
Minimal facial & axillary hair,
Estradiol/testosterone ratio elevation
Hyperthyroidism clinical manifestations
Pretibial Myxedema (Thyroid Dermopathy)
Hyperpigmentation
Vitiligo
Galactosemia
Diagnosis - Neontal screening - elevated levels of galactose-1-phosphate
Classic Galactosemia: Mutation in enzyme galactose-1-phosphate uridyltransferase (GALT).
Variant Galactosemia: GALK1 and GALE.
clinical manifestations - oor feeding, jaundice, liver damage, and cataracts, Sepsis
if not treated - failure to thrive and interlectual difficulties
Pioglitazone
1. mech action
2. contraindications
- The thiazolidinedione, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration. PPAR Gamma
- History of heart failure, previous or
active bladder cancer, uninvestigated
macroscopic haematuria, causes weight gain, liver imparement
carbimazole mechanism of action
Blocks thyroid hormonogenesis by inhibiting the action of thyroid peroxidase, organification of iodide and their uptake by tyrosyl radicals as well as the coupling of iodotyrosines with iodothyronine residues (T3 and T4) which in turn suppress the synthesis of thyroid hormones
Causes of drug induced hyponatraemia
Anticancer agents - Vinca alkaloids (e.g. Vincristine), platinum compounds (e.g. Cisplatin), Alkylating
agents (e.g. Cyclophosphamide)
Anti-depressants - Tricyclic antidepressants, SSRIs, MAOI
Anti-epileptic medications - Carbamazepine, Sodium Valproate
Anti-hypertensives - ACEi, ARB, Amlodipine
Anti-pyschotic medications - henothiazines, Butyrophenones
Diuretics - Thiazides, Indapamide, Amiloride, loop
diuretics
Proton pump inhibitors - Omeprazole
Cause of hyponatraemia
- Medications (most commonly thiazide diuretics).
- Syndrome of inappropriate antidiuresis.
- Underlying medical conditions (such as heart failure, kidney disease, and liver disease).
The severity of hyponatraemia can be classified as:
Mild — serum sodium concentration 130–135 mmol/L.
Moderate — serum sodium concentration 125–129 mmol/L.
Severe — serum sodium concentration less than 125/120 mmol/L.
Pseudo-hyponatraemia
false low serum Na+ concentration due to hyperproteinaemia - multiple myeloma or hypertriglyceridaemia
Hypertonic (or hyperosmolar) hyponatraemia
- Severe hyperglycaemia (the high levels of glucose draw intracellular water into the extracellular space)
- Administration of an active osmolyte (such as mannitol)
Hypovolemic (volume depletion) hyponatraemia causes
- Medications, especially thiazide diuretics.
- Endocrine disorders (primary adrenal insufficiency).
- Cerebral salt-wasting (a rare cause of hyponatraemia resulting from a central nervous system insult such as aneurysmal subarachnoid haemorrhage).
- Severe diarrhoea and/or vomiting (gastrointestinal sodium loss).
- Sweating (for example during exercise) and extensive skin burns (transdermal sodium loss).
- Salt-wasting nephropathies, for example tubulopathy after chemotherapy.
- Third space losses — bowel obstruction, pancreatitis, severe hypoalbuminaemia, sepsis, or muscle trauma
Hypervolemic (volume overload) hyponatraemia causes
- Congestive heart failure.
- Liver disease (cirrhosis with ascites).
- Kidney disease (acute kidney injury, chronic kidney disease, nephrotic syndrome).
Euvolemic (normal volume status) hyponatraemia
- Drugs (for example selective serotonin-reuptake inhibitors and thiazide diuretics).
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
- Endocrine disorders (secondary adrenal insufficiency and hypothyroidism [very rare cause]).
- High water low solute intake — primary polydipsia, anorexia nervosa, and beer potomania (excess beer consumption with a low solute diet).
Gestational diabetic criteria
OGTT test
fasting >5.6
2 Hour >7.8
Gestational Diabetic management
Metformin (fasting Glucose <7, not controlled by diet/ fasting)
Insulin (if not treated with insulin)
Treated with short acting (no long acting)
Gestational Diabetic complications
Macrosmia
polyhydro amnio
Hypocalcemia, ECG
QT Interval Prolongation:
rare : Peaked T waves, Torsades de pointes, Atrial Fib
Anaplastic thyroid cancer (ATC)
Rare, aggressive, spreads rapidly, often leading to a poor prognosis
>60 years
Papillary thyroid carcinoma
- Slow-growing, palpable lump, Asymptomatic
- Risk Factors: Radiation Exposure, Genetic Factors, Family History
- young females
- ## treatable
Familial hypercholesterolemia
- autosomal dominant
- high LDL
**Simon Broome Criteria **
1. adult - total chol- 7.5, LDL- 4.9
Child- total - 6.7, LDL - 4
2. tendon xanthoma,
3. Family histiory
tretatment - high dose statin
Gynecomastia causing drugs
Renal artery Stenosis vs primary hyperaldesteronism
PH - high Bp, Low K+, high Na+, low Renin (diagnosed from treatment resistent hypertension with low K+), aldesterone renin ratio high
RTS - kow k+, high Aldesterone, High Na+, High Renin
secondary hyperparathioridism
in renal failure, low vit D, low Ca, raised PTH, raised ALP due to bone resoption
tertiry Hyperparathiroidism
long standing secodnary hyperpara result in hyperplasia of parathiroid gland.
raised Ca, raised PTH, high Ph
Thyroid eye disease (TED)
changes in color vision - urgent decompression surgery
insulinoma
pancreatic tumors that produce excess insulin
lead to hypoglycemina
diagnosis- supervised fasting (72 hrs)
nuroendocrine tumor in pancreartic beta cells in langhanns
MEN 1 associated
primary treatment for insulinoma is surgical removal of the tumor.
hypoglycemia, including sweating, tremors, palpitations, confusion, and in severe cases, seizures or loss of consciousness
A diagnosis of insulinoma is often suspected when a patient presents with Whipple’s triad, which includes:
Symptoms of hypoglycemia
Documented low blood sugar (glucose) at the time of symptoms
Improvement of symptoms after glucose administration
Prolactinoma
causes of raised prolactin
pregnancy
prolactinoma’
PCOS
primary hyporthiroidism
metacropanide
domperidone
phenothiozene
features of excess prolactin
men - loss of libido, impotence,galactoria
female- amenohria, galactoria
clomofin action
Anti eastrogen
heavy smokers with high BP and altered mental status, polyurea, weight gain
metabolic alcolosis with hypocalemia
small cell lung cancer - Ectopic ACTH
Complete Andregen Insensitvity Syndrome
XY along with inability of body cells to responds to andregens, rudimentory testes
Bi lateral groin swelling
Diabetic neuropathy
amitriptiline, deuloxitine, gaba pentin
poorly controlled diabetic normal vision, funduscopy neovascularization
risk of vitriuos haemorrage
treatment- lasor photocoagulation
pitutory adenoma
secretory - prolactinoma
nonsecretory -
