endocrine 3 Flashcards
diabetes insupidus overview and types of
increaced amounts of dilute urine
lack of ADH/ ADH action
3L of urine a day
cranial or nephrogenic
cranial- hypothalamus issue, neurosurgm trauma, tumours, sarcoidosis
nephrogenic disease- ADH receptor resistance
hypokalaemia (long term downregs )
hypercalcaemia
drugs
acidosis
can also get gestational and iatrogenic( alcohol)
signs and symptoms ,investigation and management of Diabates insipidus
S+S- polyuria + dipsia
dehydration
hypokalaemia, hyeprnatraemia
Ix:
water depravation test-
measure urine vol
urine + serum osmolality (urine low, plasma high)
MRI for pituitary tumour (vasopressin from post pituitary)
Rx:
emergency- lower sodium by no more than 12 per day.
use 0.9% saline initially.
lowering Na too fast can cause brain and perif oedema.
long term thiazide like diuretics, remove cause, replace fluids.
ddavp- and ADH analogue.
types of parathyroid disease
primary- uncontrolled PTH prod via tumour
- need to remove tumour- PTH + Ca high (PTH can be normal but thats still weird if ca high)
secondary- insufficient vit D- low Ca absorbtion–> hypocalcaemia–> inc levels of PTH –> hyperplase –> Ca2+ will be low high pth, Rx with vitamin D.
tertiary-
secondary happens for long time–> hyperplasia–> PTH baseline inc massively –> initial cause is treated but they become self governinig—> hypercalcaemia –> high PTH, high Ca. Rx with surgery- partial pth ectomy.
hypoparathydoidism but very rare- surgery (thyroid) idiopathic, autoimmune, absence of glands- hypomagnaesmia.
discuss hypercalcaemia- Risk facctors, causes and signs + symptoms.
increase in total plasma calcium above 2.6
RF: post menopausal women
50-60 years old.
fhx of hyperpth
hx current/ passt lithium use.
head/ neck radiation
Most common cause- hyper pth.
malignancy (most common in hospitalised)
S+S: moans bones stones, groans.
- moans- anorexia, nausea, vom, constipation, pancreatitis.
bones- weakness, pain #, porosis
stones- aki, ckd, kidney
groans- altered mental state, poor concentration.
shortened QT interval.
investigation and treatment of hypercalcaemia.
two or more measurements showing 2.6 or higher. - one should be corrected level.
get a PTH measurement
vitamin D levels
Ph meaurement
CXR- for lung cancer- check for bone mets
24 hour urinary calcium
mild is under 3
mod is under 3.4
severe is greater than 3.4 likely to be malignancy if greater than 3.25
Rx:
hydrate/dilute
loop diuretic + saline to remove + dilute
bisphosphonates- pamidronate - inhibit osteoclast activity.
calcitonin
pred maye be useful
discuss hypocalcaemia - definition, risk factor, s+s
hypocalcaemia if ionised ca <1.1mol
Risk factors:
vit D deficiency, PTH deficiency, hypomagnaesia/ albiminemia.
new born babies
s+S- tetany, peripferal parasthaesia, depression, cataracts, skin (dermatitis, eczema, hyperpigmentation psoriasis)
LONG QT, troussous signs, chvosteks sign.
investigations and managements of hypocalcaemia
serum total calcium concentration
albumin levls
mg levels + renal function
PTH lvel
ecg
exclude pancreatitis- very common cause
Rx:
rx underlying cause (remove offending drugs)
mild- calcium 5mmol/6h po
CKD- alfacalcidol
severe- 10ml 10% calcium gluconate IV (over 30 min)
