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Endocrine 2 Flashcards

1
Q

side effects of metaformin

A 
rash
GI - subside 
can interfere with b12 and folate defic
lactic acidosis - rare
discontinue if liver failure or cirrhosis 
renal failure stop if gfr <30 or creat >150
half if EGFR 30-45
temp withhold if IV contrast
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2
Q

SU SEs

A 
hypos in elderly, alcohol abuse, liver disease
weight gain 
GI upset, headaches
h/s
avoid in renal and liver failure
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3
Q

TZDs

A

weight gain
heart failure
fractures

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4
Q

DPP-IV inhibitors

A

pancreatitis

pancreatic cancer

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5
Q

SGLT inhibitors

A

thrush

UTIs

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6
Q

GnRH synthesised where
released how
simulates synthesis and release of what

A

by neurones in hypothalamus
pulsatile release
low pulses for FSH and high for LH

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7
Q

FSH secreted by what

does what

A

ant pit

stimulates follicular development and thickens endometrium

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8
Q

LH secreted by what

does what

A

ant pit
peak stimulates ovulation
stimulates CL development
thickens endometrium

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9
Q

what peaks before ovulation

A

oestrogen

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10
Q

what peaks following ovulation

A

progesterone

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11
Q

oestrogen secreted by what
stimulates what
blocks what and stimulates what

A

secreted by ovaries (follicles), adrenal cortex and placenta in pregnancy
stimulates thickening of endometrium
responsible for fertile cervical mucus
high oestrogen concentration inhibits prolactin and FSH and stimulates secretion of LH

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12
Q

progesterone does what

A

decorated by CL to maintain pregnancy
inhibits LH
responsible for thick cervical infertile mucus
maintains thickness of endometrium
has thermogenic effect (increased basal temp)
relaxes smooth muscles

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13
Q

hypothalamic hormones

A

GnRH
PRH
TRH
CRH
Somatostain - inhibits release of GH from a ant pit
Dopamine - inhibits prolactin release from ant pit

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14
Q

Ant pit hormones

A 
LH
FSH
PRL
TSH
ACTH
GH - stimulates IGF-1 from liver
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15
Q

post pit hormones

A

oxytocin - stimulates milk secretion/utrine contraction

ADH

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16
Q 
addisons is what 
ABs
signs
ix
rx
A

AI primary adrenal insufficiency - decreased cortisol and/or aldosterone

ABs produced against adrenal cortex or an enzyme called 21 hydroxylase

hyper pigmentation. hypotension

ACTH synacthin test - cortisol doesn’t rise in addisons

hydrocortisone and fludrocortisone

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17
Q

addiosns crisis treatment

A

0.9% saline
IV/IM hydrocortisone
glucose if hypoglycaemic

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18
Q

cushings is what
causes
test
rx

A 
increased cortisol 
pit (cushings dx) - adenoma 
adrenal (cushings syndrome) - adenoma/hyperplasia 
ectopic - SCLC
prolonged exposure to steroids

dexa supression test

if cause not found - bilateral adenectomy to prevent nelsons syndrome - lifelong hydro

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19
Q

pseudocushings

A

fails to be suppressed by dexa

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20
Q

conns is what
test
rx

A

increased aldosterone
saline suppression test
adrenelectomy - definitive. spironolactone/amiloride

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21
Q 
phaemocromocytoma is a what 
secretes what 
signs/symp 
what disease can be linked to them 
treatment
A

adrenal medullary tumour
catecholamines
headache, tremor, hypertension, fever, palpitations
MEN2
alpha blocker phenoxybenzine
BBs - propanolol, atenolol, metoprolol. surgical

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22
Q

10% tumour

A

extra renal
biologically malignant
bilateral
not assoc with hypertension

25% familial (bilateral, young)

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23
Q

hyperthyroidism TFTS

rx

A

decreased TSH increased T4T3

carbimazole BBs for symptoms

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24
Q

graves antibodies
goitre
scintogrophy
treatment

A 
anti TPO, TSH receptor ABs
smooth symm goitre 
high uptake 
@18m 50% will relapse and 50% will resolve
carb decrease dose over 12-18m then stop
25
primary hyperparathyroidism
increased Ca, increased PTH, low phosphate | adenoma
26
secondary hyperparathyroidism
increased PTH, decreased Ca increased phosphate in renal disease decreased in vit D deficiency
27
tertiary hyperparathyroidism
increased PTH, increased calcium, increased phosphate
28
parathyrectomy indications
<50 end organ damage present increased calcium GFR <60
29
``` De Quiuervincs presentation TFTs scintogrophy treatment ```
``` painful following viral infection hyper first then become hypo low uptake self limiting ```
30
hypothyroidimg goitrous non goitrous treatment
increased TSH, low T4T3 goitrous - hashimotos, drug induced non goitrous - congenital, atrophic, post radio/ablastive thyroxine (increase during pregnancy)
31
hasimotos goitre | antibodies
painless with rubber consistency and irregular surface | Anti tPO and anti thyroglobin ABs
32
hypoparathyroidism signs rx
low calcium increased phosphate decreased/normal PTH chovesteks - tapping the facial nerve causes facial muscles to contact trousu - occluding the arm circulation for 3m causes carpopedal spasm calcium and vit D supplement IV calcium if severe
33
subclinical hypothyroidism
increased TSH normal T4/T3
34
secondary hypothyroidism
normal TSH decreased T3/T4
35
subclinical hyperthyroidism
low TSH normal T3T4
36
transcription factor MODY
adolescent/young adult progressive hyperglycaemia 1/3 diet 1/3 OHD 1/3 insulin cx frequent
37
glucokinase MODY
onset at birth stable hyper glycaemia diet control cx rare
38
DKA biochem dx | DKA cx
ketonuria >3 or >2 on dip BG >11 or known DM bicarb <15 or ph<7.3 children - cerebral oedema adults get - aspiration pneumonia, ARDS, hypokalaemia
39
treatment for DKA
0.9 NaCl when glucose falls to 15 switch to dextrose insulin potassium
40
HHS who
``` type 2 DM elderly osmolarity 400 high glucose 60 increased sodium ```
41
peripheral neuropathy treatment
analgesia | amitriptyline, gabapentin, prcegablin
42
neuropathy treatment
ACEI/ARB
43
retinopathy stages and treatment
mild non prolif - haemorrhages and microaneurysms mod non porlfi - haem, MA, hard exudates severe non prolif - haem, venous beading prolif - new vessel formation laser, vitrectomy, anti VEGF
44
Diabetes insipidus types symp ix rx
``` cranial - decreased secretion of ADH nephrogenic - renal resistance to ADH polyuria, polydipsia, nocturia water deprivation test desmopressin ```
45
``` hypogonadotrophic hypogonadism causes symp ix rx ```
stress, eating disorders, trauma, kallmasn, drugs amen decreased FSH/LH, oestrogen defic stabilise weight, pulsatile GnRH, injections (USS monitoring of response)
46
PCOS symp dx treatment
10-20% amen 80% oligo 50-80% have insulin resistance oligo/amen polycystic ovaries acne/hirsutism ``` clomifene citrate (+ metaformin) injections laparoscopic ovarian diathermy ```
47
complications of ovulation induction
hyprsitmualtion multiple preg ovarian cancer
48
what is linked to ovulation induction
hyperprolactinoma | treatment dopamine agonist
49
what test confirm normal regular cycles
mid luteal day 21 progesterone test | >30 on 2 samples confirms regular cycles
50
hirsutism causes
PCOS, familial, idiopathic, CAH | adrenal or ovarian tumour - high testosterone and signs of vitalisation
51
treatment for hirsutism
PCOS - OCP, anti androgens | Late onset CAH - low dose glucocorticoid to suppress ACTH drive
52
pseudohypoparathyroidism
decreased calcium | increased PTH
53
psedopseduohypoparathyroidim
normal calcium and PTH
54
acute hypocalcaemia
IV calcium gluconate 10ml 10% over 10 mins in 50mls saline or dextrose
55
acute hypercalcaemia
0.9% saline 46L in 12 hours loop diuretics once rehydrated bisphosphonates
56
osteoporosis common fractures
neck of femur vertebral body distal radius humeral neck
57
osteopenia osteoporosis severe osteoporosis
>1 SD below >=2.5 below >= 2.5 and a fragility fracture
58
pagets treatment
analgesia | if still in pain then bisphosphonates

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