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MS3 - Clinical biochem > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Causes of Secondary HTN

A

Renal

Endocrine

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2
Q

Endocrine causes of Secondary HTN

A
  1. Cushing
  2. Conn syndrome
  3. Hyperthyroidism / Hyperparathyroidism
  4. Acromegaly
  5. Phaeochromocytoma
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3
Q

Phaeochromocytoma

A

Catecholamine producing tumour of adrenal medulla

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4
Q

Symptoms of phaeochromocytoma

A

Sweating
Palpitation
Weight loss
HTN

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5
Q

Ix for Phaeochromocytoma

A

I. 24 hour urine

  • catecholamine levels or their metabolites (metanephrine)
  • affected by drugs: eg. paracetamol, cough syrup, tricyclic antidepressant, beta blockers)
  • sample needs to be collected in acid

II. Plasma metanephrine

  • low specificity
  • pts must be rested for 15-30 min
  • affected by caffeine, alcohol, smoking
  • only used as a secondary test
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6
Q

Conn’s syndrome definition

A

Excess aldosterone production

Leads to alkalosis / hypokalaemia

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7
Q

Causes of Conn’s syndrome

A

Primary - adrenal adenoma

Secondary - increased renin secretion

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8
Q

Ix for Conn’s syndrome

A

Plasma aldosterone:renin ratio
Pt must be rested > 30 mins
Primary = High aldosterone + Low renin

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9
Q

Secretions of anterior pituitary

A 
TSH
ACTH
FSH
LH
GH
Prolactin
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10
Q

Acromegaly

A

Excess GH secretion

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11
Q

Sx of Acromegaly

A 
Sleep apnoea
Protuding jaw
HTN - Na retention
Polyps
Glucose intolerance
Hypercalcaemia - increased Vit D
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12
Q

Ix for acromegaly

A

Basal IGF-1 (and GH)

Glucose tolerance test - GH should be suppressed < 1

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13
Q

Serum thyroid hormone forms

A

Bound > 99%

Free - active form

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14
Q

Sx of hypothyroidism

A
  • Lethargy, tiredness
  • Weight gain
  • Cold intolerance
  • Coarsening of hair + skin
  • Slow reflexes, hoarseness
  • Constipation
  • Menstrual abnormalities
  • Bradycardia
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15
Q

Mx of hypothyroidism

A

Thyroxin

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16
Q

Hyperthyroidism symptoms

A
  • Weight loss
  • Heat inttolerance
  • Palpitations
  • Agitation, tremor
  • Muscle weakness
  • Diarrhoea
  • Thyroid eye disease
  • Menstrual abnormalities
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17
Q

Hormones produced in adrenal gland

A

Adrenal cortex:
Aldosterone
Cortisol
Androgens

Adrenal medulla:
Catecholamines

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18
Q

Layers of adrenal gland

A

Zona glomerulosa - aldosterone

Zona fasiculatis and reticularis - cortisol + androgens

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19
Q

Daily cortisol production

A

25 mg/day

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20
Q

Functions of cortisol

A

Insulin antagonist
Glucogenesis
Protein catabolism
Immunosuppressant

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21
Q

Hypothalamo pituitary axis for cortisol release

A

CRH - Hypothalamus
ACTH - Anterior pituitary
Cortisol - Adrenal cortex

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22
Q

Addison’s disease definition

A

Primary adrenal insufficiency

Reduced cortisol and aldosterone

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23
Q

Sx of Addison’s disease

A

Hypoglycaemia
Hypotension
Hyperkalaemia
Skin hyperpigmentation

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24
Q

Ix for Addison’s disease

A

High ACTH + Low Cortisol
Short Synacthen test
Electrolytes

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25
Q

Short Synacthen test

A

250 micrograms synthetic ACTH IM

Normal people - cortisol rises > 420

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26
Q

Most common cause of Congenital Adrenal Hyperplasia (CAH)

A

21-hydroxylase deficiency

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27
Q

2 main types of CAH

A

Simple viralising

Salt wasting

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28
Q

Simple viralising CAH

A

Androgen affected

Male like symptoms

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29
Q

Salt wasting CAH

A

Aldosterone affected

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30
Q

Sx of Newborn CAH

A
  • Ambiguous external genitalia
  • Pigmented scrotum
  • Salt wasting
  • Sudden unexplained death (males)
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31
Q

Sx of Adult CAH

A
  • Hirsutism
  • Menstrual cycle disorder
  • Subfertility
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32
Q

Ix for CAH

A

1) Blood:
17α hydroxy progesterone
Electrolytes
Glucose

2) Urine
- Electrolytes
- Steroid profile

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33
Q

Sx of Cushing’s syndrome

A 
Mental disturbances
Truncal obesity
Striae
Hyperandrogenism - hirsutism, amenorrhoea
Glucose tolerance
Sodium retention
HTN
Osteoporosis
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34
Q

Ix for Cushing’s

A

Dexamethasone suppression test

Low serum/salivary cortisol - false negatives

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35
Q

Dexamethasone suppression test

A

1) 1 mg overnight
9 am cortisal should be < 50 mmol/L

2) Low dose dexamethasone 6 hourly for 48 hrs
Cushing’s shows no suppression

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36
Q

Cushing’s disease

A

Pituitary dependent Cushing’s syndrome

ACTH is raised

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37
Q

Differentiating between primary and secondary Cushing’s syndrome

A

High dose dexamethasone
Primary - no suppression
Secondary - some suppression

38
Q

Causes of Diabetes Insipidus

A

Cranial

Nephrogenic

39
Q

Causes of Cranial Diabetes Insipidus

A

Idiopathic:

  • Familial (autosomal dominant)
  • Sporadic

Secondary:

  • Trauma
  • Tumours (craniopharyngioma, pituitary adenoma)
  • Infections
  • Autoimmune
40
Q

Causes of Nephrogenic Diabetes Insipidus

A

Idiopathic

Secondary - drugs, metabolic, vascular

41
Q

Drug causing Nephrogenic Diabetes Insipidus

42
Q

Vascular cause of Nephrogenic Diabetes Insipidus

A

Sickle cell disease

43
Q

Metabolic cause of Nephrogenic Diabetes Insipidus

A

Hypercalcaemia

Hypokalaemia

44
Q

How does Hypercalcaemia lead to Hypernatraemia

A

calcium interfers with vasopressin action, if high can be the cause of water depletion/dehydration

45
Q

Water deprivation test

A

Diagnoses Diabetes insipidus if urine osmolarity does not increase

46
Q

Differentiating test for cranial vs nephrogenic diabetes insipidus

A

Desmopressin

47
Q

Action of loop diuretics

A

Block Na reabsorption in proximal tubule

Can cause hypokalaemia

48
Q

Effect on acidosis on [K]

A

Acidosis leads to Hyperkalaemia

49
Q

Actions of PTH

A

Bone resorption
Increases Ca reabsorption in kidney
Decreases PO4 reabsorption in kidney

50
Q

Actions of 1,25dihydroxycholecalciferol

Vit D

A

increased Ca and PO4 absorption from GI and Kidney

51
Q

Actions of Calcitonin

A

Bone mineralisation

Reduced Ca and PO4 reabsorption

52
Q

Clinical use of calcitonin

A

Tumour marker

Therapeutic Rx of hypercalcaemia and Paget’s

53
Q

Presentation of Hypercalcaemia

A

Bones, stones, abdo groans and psychic moans

Bone pain
Renal calculi
Constipation
Abdo pain
Confusion
54
Q

ECG changes in hypercalcaemia

A

Shortened QT

Bradycardia

55
Q

Funky causes of hypercalcaemia

A

Prolonged tourniquet
Sarcoidosis
Thiazide diuretics - increased Ca reabsorption

56
Q

Rx of hypercalcaemia

A

Rehydration
Bisphosphonates
Steroids - for malignant disease

57
Q

Hypocalcaemia presentation

A 
Lethargy
Tetany
Cramps
Cataracts
Brittle nails/hair
58
Q

ECG changes in hypocalcaemia

A

Prolonged QT

Arrhythmias

59
Q

Hypocalcaemia treatment

A

Diet
Oral calcium supplementation
Oral vit D
IV calcium gluconate

60
Q

Vit D deficiency in childern

61
Q

Vit D deficiency in adults

A

Osteomalacia

62
Q

Causes of hypoparathyroidism

A

Surgery
Congenital - Di George syndrome

Mg deficiency - PTH resistance

63
Q

Extracellular Ca distribution

A

50% free (ionised)
40% bound
10% complexed

64
Q

Ovarian failure

A

Low oestradiol

65
Q

Causes of primary ovarian failure

A
  • Premature ovarian insufficiency
  • Post menopausal
  • Autoimmune damage
  • Surgery
  • Turners syndrome
66
Q

Causes of secondary ovarian failure

A

LHRH deficiency - Kallman syndrome

Prolactinoma

67
Q

Physiological causes of hyperprolactinaemia

A

Pregnancy

Drugs - dopamine antagonists

68
Q

Role of dopamine on prolactin

A

Dopamine inhibits prolactin secretion

69
Q

Pathological causes of hyperprolactinaemia

A

Prolactinoma
Acromegaly
Pituitary stalk lesions
Chronic renal failure

70
Q

Presentation of Polycystic Ovarian syndrome (PCOS)

A 
Oligo / Amenorrhoea
Obesity
Insulin resistance
Hirsutism
Oestrogenisation
Increased CVS risk
71
Q

Endocrine levels in PCOS

A

High LH

Normal FSH

72
Q

Lab test changes during pregnancy

A

Increased:

  • ALP
  • GFR

Decreased:

  • Albumin
  • Creatinine
  • Fasting BG
73
Q

Hormone changes in pregnancy

A

Increased:

  • Oestrogen
  • Progesterone
  • Prolactin
  • hCG

Decreased:

  • LH
  • FSH
74
Q

Complications of pregnancy

A

Gestational diabetes
HTN / Pre-eclampsia
Obstetric cholestasis

75
Q

Pregnancy related liver diseases

A 
Pre-eclampsia
HELLP
Hyperemesis Gravidarum
Acute Fatty Liver of pregnancy
Obstetric cholestasis
76
Q

HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelets

77
Q

Obstetric cholestasis

A

Usually 3rd trimester

Generalised pruritis

78
Q

Biochemistry findings of obstetric cholestasis

A

Serum bile acids
Raised ALT and AST
ALP and Bilirubin usually normal

79
Q

Site of LH action

A

theca and

mature granulosa cells

80
Q

Site of FSH action

A

follicular

granulosa cells

81
Q

Phases of menstrual cycle

A

Follicular phase

Luteal phase

82
Q

Follicular phase of menstrual cycle

A
  • Follicles recruited
  • FSH makes it grow
  • Oestrogen production
  • Rise in oestrogen causes LH release
  • LH ruptures follicle
83
Q

Luteal phase of menstrual cycle

A

Corpus luteum carries on producing progesterone

84
Q

Ix for infertility

A 
LH/FSH
Prolactin
TFT
Testosterone
Oestradiol
85
Q

Ovulation day in menstrual cycle

86
Q

Assessment of ovulation

A

Progesterone level:

1) > 30 - normal ovulation
2) < 30 - reduced conception rate
3) low level, repeat next cycle

87
Q

Role of FSH in males

A

stimulates sertoli cells to produce spermatozoa

88
Q

Role of LH in males

A

stimulates Laydig cells to produce testosterone

89
Q

Causes of male infertility

A

Hypergonadotrophic hypogonadism
Hypogonadotrophic hypogonadism
Obstructive azoospermia

90
Q

Early signs of pre-eclampsia

A

HTN

Raised urate

91
Q

Late signs of pre-eclampsia

A

Raised urea and creatinine
Low GFR
Proteinuria
Oedema

MS3 - Clinical biochem (11 decks)

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