Endocrine 2 medicine

Question 1

endocrine glands

Answer 1

ductless glanads

release directly into the blodostream

Question 2

hormones

Answer 2

chemical signals produced by an endocrine glands that act some distance from the gland

Question 3

what does the thyroid glands pridce

Answer 3

thyroxine t4
tri-iodotyronine T3
(T4 usually converted to T3 which is the main hormone which has an effect on tissues)
calcitonin

Question 4

what does calcitonin do

Answer 4

regulate blood calcium levels

Question 5

cascade of hormone release from thryodi

Answer 5

hypothalamus secretes TRH
TSH secreted by pituitary
thyroid secretes T3/4

Question 6

measurement of the thyroid hormones

Answer 6

T4
T3
TSH (stimulating hormone)

Question 7

hypothyroidism

Answer 7

T4/3 insufficient

suspected if TSH higher the normal

Question 8

primary hypothyroidism and secondary

Answer 8

1) primary hypothyroidism
- Thyroid not producing enough T4/T3
- pituitary produces more TSH to compensate
can see a goitire
2) secondary hypothyroidism
- Pituitary not producing enough TSH
- therefore lack of T3/T4

Question 9

symptoms and signs of hypothyroidism

Answer 9

symptoms
weight gain
lethargy
cold intolerance
menorrhagia

signs
- facial puffiness
bradycardia
hoarsness
periorbital oedema

Question 10

causes of primary/secondayr/teritiary hypothyroidism

Answer 10

primary 
- dyshormogenesis
iodine deficiency 
autoimmunity 
post radioactivity iodine

secondya
pituitary tumour/granuloma

Tertiary
isolated TRH deficiency

Question 11

indicatons for screening hypothyroidism

Answer 11

1) Congenital hypothyroidism
2) Treatment of hyperthyroidism
3) Neck Irradiation
4) Pituitary Surgery or Irradiation
5) Patients on lithium and amiodarone

Question 12

treament of hypothyroidism

Answer 12

levothyroxine

Question 13

graves diseas

Answer 13

increase T3/4
decreased TSH
goitre
abnormal thyroid stimulating IgG

Question 14

causes of hyperthyroidism

Answer 14

autoimmune thyroid disease eg graves
nodular goitre
toxic adenoma

Question 15

symtoms and signs of hyperthyroidisim

Answer 15

symptoms
weight loss
heat intolerance
increased sweating, appetite

signs
goitre
tremor
tachyarida
warm skin

Question 16

graves disease clinical features

Answer 16

diffuse goitre
eye signs (bulging, dry eyes)

hyperthyroidism

Question 17

treatment of hyperthyroidism

Answer 17

oral antithyroid drugs

surgical

Question 18

primary diagnostic tool for thyroid issues

Answer 18

FNA

Question 19

hypothalamus

Answer 19

produces hormones which influences the pituitary to release hormones

Question 20

pituitary dysfunction can lead to 3 options..

Answer 20

1) tumour mass effects
- can cause headaches and visual defects
2) hormone excess
- signs of excess hormone
3) hormone deficiency
- peripherally in the body

Question 21

causes of hypopituitarism

Answer 21

pituitary tumours
radiotherapy 
trama
infarction
infiltration

Question 22

acromegaly and features

Answer 22

excess growth hormone therefore high IGF 1

Clinical features 
Head related
-	Coarse facial features
-	Enlargement of supraorbital ridges
-	Separation of teeth
-	Prognathism
-	Macroglossia

Question 23

adrenal gland cortisol - how is it stimulated for production

Answer 23

hypothalamus produces CRH
drives production of ACTH from pituitary
cortisol released from adrenal gland

• disruption to this can be a disorder e.g. cushings

Question 24

Cushing syndrome and cuases

Answer 24

excess glucocorticods
causes
pituitary/adrenal tumour

Question 25

pituitary tumour/adrenal tumour causes

Answer 25

Pituitary tumour – ACTH dependant hypocortisolism (cushings)

• producing too much ACTH
• stimulates adrenal to produce too much cortisol

Adrenal tumour – ACTH independent hypocortisolism

• excess cortisol
• ACTH levels will go low

Question 26

adrenal insufficiente

Answer 26

primary - lack of cortisol in adrenal gland, moree ACTH to compensat

Secondary , lack of cortisol production, lack of ACTH can indicate problem from pituitary

Question 27

causes of adrenal insufficiency

Answer 27

autoimmune
tuberulosis

secondary
after treatment of cushings
after exogenous glucocorticoids

Question 28

glucocorticoid cover for dental procedure

Answer 28

patients may be on glucocorticoids, steroids
for procedures should up the dose to prevent adrenal crisis

Simple
- double dose 1 hr before surgery, double dose for 24hrs after
major
hydrocortisone 100mg im at induction; 50mg im 6 hourly until well and then double dose oral steroids for 24 – 48hours