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Phase 4 > Endocrine 2 > Flashcards

Endocrine 2 Flashcards

1
Q

Broadly outline the causes of hypopituitarism:

A

Hypothalamus:

  • infection
  • Kallmann’s syndrome
  • Infection

Pituitary stalk:

  • trauma
  • Craniopharyngioma
  • Carotid artery aneurysm

Pituitary:

  • Macroadenoma (1cm)
  • Pituitary apoplexy
  • Infiltrative - sarcoidosis
  • Sheenhan syndrome
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2
Q

What are the causes of adrenal insufficiency, broadly?

A

Addison’s - autoimmune

TB infection in the adrenals

Secondary adrenal insufficiency

  • exogenous steroid use
  • Macroadenoma

Metastatic cancer

  • Lung
  • Breast

21 alpha hydroxylase

Waterhouse- friderichsen syndrome

Drugs:
- ketoconazole

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3
Q

Outwith ACTH, what other test can be done to determine between primary and secondary insufficiency?

A

Renin- aldosterone levels

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4
Q

When should the Short synACThen test be done?

A

Early morning

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5
Q

When investigating for Addison’s disease what is a very important thing to remember:

A

To treat first

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6
Q

How does someone with an addisonian crisis present and what is the treatment?

A

• Shock

- Vasoconstricted 
- Oliguria
- Comatose 

* Confused  
* Hypoglycaemic 

• Postural drop 
- Collapse

Causes:

• Infection 
- Always remember to do an infection screen 

* Trauma 
* Missed taking steroids 
* Surgery

Investigations:

*remember to treat if high suspicion

Bloods: 
	• FBC 
	• U&Es 
	• CRP 
	• Blood glucose 
\+/- 
	• Blood cultures if suspect infection

Orifices:
• Urine sample
- Infection

X-ray:
• CXR
- Infection

ECG:
• High K+ so must be ready to manage

Special tests:
• ACTH

Management:

* IV fluids 
* IV hydrocortisone 
* IV glucose

+/- Hyperkalaemia management

+/- Sepsis management

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7
Q

What are some of the complications of obesity?

A

Metabolic Syndrome

  • T2DM
  • Hypertension
  • Hyperlipidaemia

Coronary heart disease

Strokes

NAFLD

Restricted ventilation
- Obstructive sleep apnea

Cancers:
- Breast, uterus (hormone dependent)

PCOS

OA

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8
Q

What tests should be done to assess causes for obesity and diagnosis?

A

Bloods:

- TFTs 
- Cortisol and Dexamethasone suppression test

BMI testing:
• Weight kg/ height (m)2
- Kg/m2

Waist circumference

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9
Q

What investigations should be done when someone has obesity?

A 
Bloods: 
	• FBC 
	• LFTS - NAFLD (raised transaminases) 
	• Lipids studies 
	• CRP levels 
	• Blood glucose (DM)

X-rays:
• Abdominal ultrasound
- Assess the liver

ECG:
- Assessment of cardiovascular function is essential

Special tests:
• Sleep Polysomnography

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10
Q

What are the therapies for obesity?

A

1st: Life style changes:
- exercise
- diet

2nd:
- Low calorie diet >100kj drop a day
or
- Very low calorie diet - done by professionals

3rd:
Medication
- Orlistat

4th:
Surgery 
- Gastric band 
- Gastric sleeve 
- Roux - en - Y - gastric bypass
- Duodenal switch
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11
Q

What is a defining feature of De quervain’s syndrome that separates it from Graves disease clinically?

A

Tender goitre

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12
Q

What are the symptoms of Grave’s ophthalmopathy?

A

• Prominence of the eyes

• Painful watering of the eyes 
- Excessive lacrimation 

* Gritty feeling in eyes 
* Photophobia 
* Lid retraction 

• Corneal damage 
- This can occur as there is an inability to close the lid 

• Optic nerve compression 

- Reduced visual acuity 
- Reduced colour vision 

• Extraocular palsy involvement This is seen with diplopia   - also seen with upward gaze abnormality
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13
Q

What is the investigations into Grave’s ophthalmopathy?

A

Visual assessment/ Visual acuity

MRI

TFTs

Ophthalmology review

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14
Q

What is the treatment for Grave’s ophthalmopathy?

A

Stop smoking

Hypromellose eye drops

Prednisolone
- for acute flares

Taping eyes shuts / wearing dark sunglasses

Sleeping up right

Surgical intervention:

  • Surgical decompression
  • Lid retraction
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15
Q

Outwith Grave’s disease name some other causes of hyperthyroidism:

A

Toxic multinodular Goitre

Solitary Adenoma

Drugs

  • Amiodarone
  • Iodine contrast media

Thyrotoxic phase of thyroiditis

  • Hashimotos
  • De Quervain’s syndrome
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16
Q

What are the side effects of Propylthiouracil and when is it used?

A

Hepatotoxicity

Used during pregnancy and breast feeding instead of carbimazole

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17
Q

When is thyroid surgery indicated in patients?

A

Large goitre
Poor drug compliance
Continual thyrotoxicosis despite medical management

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18
Q

What is the surgery done in Grave’s?

A

Subtotal Thyroidectomy

19
Q

What are the associations with Grave’s

A

type 1DM
Vitiligo
Addison’s

20
Q

What’s the symptoms of Hypothyroidism?

A 
MOMS SO TIRED 
Memory loss
Obesity 
Menorrhagia
Slowness 
Skin - brittle dry - hair 
Onest is slow 
Tiredness 
Intolerance to cold 
Raised BP  - yet has bradycardia
Energy levels low 
Delayed reflexes  / Depresion
21
Q

What is Whipple’s triad for hypoglycemia?

A

Low plasma glucose < 3 / < 3.5 (Diabetes)
Symptoms in keeping with hypoglycemia
Symptoms resolve after administration of glucose

22
Q

What advice should be given to people who have received radiotherapy for the thyroid?

A

Must stay away from:
- Pregnant
- Young children
for 3 weeks.

No breast feeding

23
Q

What are the complications of untreated hyperthyroidism?

A

Acutely:

  • AF
  • Thyrotoxic storm

Long term:

  • Heart failure - cardiomyopathy
  • Osteoporosis
24
Q

What are the symptoms of a thyrotoxic storm?

A

Tachycardia
Hyperthermia
Confusion
Coma

Triggered by:

  • infection
  • Trauma
  • M.I
  • Surgery
  • Radioiodine
25
Q

When is thyroid surgery indicated?

A

Failed medical therapy
- following the 12-18months

Patient preference
- cosmetic

Compression of goitre causing dyspnea

Intolerable side effects of medication

26
Q

What are the findings and Treatment of thyrotoxic storm?

A

Clinical findings:

  • Tachycardia / AF
  • Hyperthermia
  • Acute abdomen
  • thyroid bruit

Treatment:
- endocrine advice

  • IV fluid
  • Beta blockers (care taken as can cause Heart Block)
  • Antiarrhythmic drugs
    +
  • Rate control - digoxin
  • Carbimazole
  • Steroids - prevents peripheral break down

+/-
- antibiotics

27
Q

What important advice should be given to people with addison’s disease?

A

Know to increase dose of steroids for illness

Carry steroid card

Wear medic - alert bracelet

Keep supply of IV/ IM steroids incase oral route is not possible

28
Q

What important thing needs to be ruled out before treating someone with hyperparathyroidism?

A

Vitamin D

you can only have hyperparathyroidism with normal vitamin D

29
Q

What are the most important investigations into hypercalcemia?

A

PTH
Vitamin D
Serum electrophoresis
CXR

30
Q

What is the criteria for PCOS?

A

Rotterdam Criteria:

  • Clinical biochemical evidence
  • Lack of ovulation
  • Cysts on ovaries
31
Q

What must patient be prior to radioactive iodine therapy?

A

Euthyroid with medication withdrawal some 5-7 days prior.

32
Q

Which patients may have worsening of their symptoms with radioactive iodine?

A

Those with thyroid eye disease

33
Q

What are the acidophilic tumours of pituitary?

A

Somatotrophs - GH

Lactotrophs - prolactin

34
Q

What are the symptoms of Prolactinoma? and how is it investigated?

A 
Galactorrhea 
Amenorrhea 
Erectile dysfunction 
Hypogonadism 
Headaches 
Visual disturbance

Measurement of prolactin
MRI of brain
Visual field testing

35
Q

If someone suddenly develops severe headache and double vision with loss of pituitary hormones what is a likely cause and how is it treated?

A

Pituitary apoplexy

Conservatively with hormone replacement
or
Surgical decompression

36
Q

Why is there often prolactinoma in hypopituitarism disorders?

A

Loss of dopamine function to suppress it

37
Q

What are the causes of hyperprolactinemia?

A

Tumours:

  • Prolactinomas
  • Adenomas
  • suppresses the dopamine control
  • Growth hormone tumours

Drugs
- Anti-dopaminergic drugs - metoclopramide

CKD
- failure of clearance

Hypothyroidism

Chest surgery
- triggers the mammary nerve reflex

PCOS
- not understood pathology

38
Q

What are the symptoms of hyperprolactinemia?

A 
Discharge from nipples 
Ammenorrhea 
Erectile dysfunction 
Infertility 
Osteoporosis - especially in postmenopausal women
Delayed puberty in teen
Gynecomastia

Signs and symptoms of the underlying cause:

  • CKD
  • Hypothyroidism etc
39
Q

What investigations are warranted into hyperprolactinemia?

A

Repeats of prolactin level

Hypothyroidism analysis

Pituitary functioning

MRI of head

40
Q

Target blood sugar levels of diabetic?

A

4 - 7

below 4 you hit the floor above 7 you go to heaven

41
Q

Name some causes of primary gonadal- deficiency and what are the typical symptoms?

A 
Orchiectomy
Radiation 
Testicular torsion 
Klinefelter's syndrome 
CKD 
Cirrhosis

Reduced libido
Erectile dysfunction
Loss of secondary sexual characteristics - hair/ Muscle
Gynecomastia

42
Q

How can you differentiate between primary and secondary hypogonadism?

A

Measure LH and FSH

43
Q

What are the symptoms of thyrotoxic storm:

A 
Fever 
Tachycardia 
Hypertension 
Diarrhea
Heart failure 
Abnormal LFTs

Phase 4 (49 decks)

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