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5th year countdown > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What 3 hormones do the adrenals produce

A

Glucocorticoids cortisol
Mineralcorticoids aldosterone
Sex hormones

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2
Q

Where does aldosterone work

A

Distal convoluted table → reabsorb Na through Na/K pump.

Stimulates loss of protons and reabsorb Bicarb

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3
Q

Therefore in addisonian rises what abnormalities would you see on ABG

A 
metabolic acidosis (can't get rid of acid and reabsorb bicarb)
↓Na, ↑K
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4
Q

Lack of cortisol causes what serum abnormality

A

↓glucose

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5
Q

Why do you get mucosal skin pigmentation

A

ACTH and MTH made from same precursor (refer to osmosis video)

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6
Q

Mgmt of addisonian crisis

A
  1. Measure cortisol
  2. IM hydro 100mg
  3. 1L 0.9 NaCL over 1 hour
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7
Q

Most common cause of adrenal insufficiency

A

autoimmune destruction (80%)

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8
Q

What is the defining test for addisons?

A

Synacthen Test - give

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9
Q

What is Waterhouse Freidrichsen Sybdrome

A

Actue haemorrhage of adrenal glands → secondary to meningococcal septicaemia

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10
Q

What is Sheehans syndrome

A

Hypopitutarism cause by ischchaemic necrosis after blood loss in childbirth

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11
Q

Signs of hypokalaemia on ECG

A

T wave inversion

U waves → looks wavy google it

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12
Q

To types of adrenal ↑

A
  1. Cushing syndrome

2. Primary hyperaldostonism

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13
Q

Cushing signs

A

Muscle wasting + thin extremities, DM, easy bruising …..

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14
Q

Causes of cushings syndrome

A
  1. ACTH dependant
    • Cushings disease (80%) - pituitary tumour secreting ACTH
    • ectopic ACTH production - small cell lung cancer

ACTH Indépendant causes

1) Iatrogenic: steroid
2) adrenal adenoma (5-10%)

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15
Q

Primary hyperaldosteronism 2 causes?

A

1) Adrenal adenoma (conns syndrome) → cut it out or spironolactone
2) bilateral idiopathic adrenal hyperplasia

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16
Q

Long term steroid mgmt.

1) what to do in infections
2) D+V

A

1) ↑ during infection - double dose

2) IV or IM dose

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17
Q 
Why give 
fludrocortisone 
Hydrocortison
prednisolone 
Dexamethasone
A

1) ↓ glucocortisone, ↑ mineral corticoid

4) ↑ glucocorticoid, ↓ mineralcorticoid

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18
Q

What is a pheochromocytoma?

A

Catecholamine secreting tumour

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19
Q

Investigations for pheochromocytoma

A

24 hours collection of urinary metanephrines

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20
Q

Tx for pheochromocytoma? What medication must you give before?

A

Surgery give alpha blocker before

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21
Q

Main causes of hypercalcaemia

A

1) Primary hyperparathyroidism

2) Malignancy

22
Q

How can malignancy cause hypercalcaemia

A

bone mets
myeloma
PTHrP from squamous cell lung cancer

23
Q

Mgmt of hypercalcaemia

A
  • Fluids resus

* Bisphosphanates → take 2-4 days to work.

24
Q

What is trousseaus?

A

BP cuff sign

25
Q

What can you see in ECG on hypocalcaemia

A

prolonged QT interval

26
Q

Signs of hypocalaemia

A

CATs go Numb

confusion
arrhythmia
tetany
numbness

27
Q

Causes of hypocalcaemia

A
  1. vit D deficiency (osteomalcai)
  2. Chronic renal failure
  3. hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
28
Q

What is the relationship between Ca and phospahte

A

PTH

1) ↑ osteoclasts - ↑Ca ↑phos
2) Kidney → activates vit D
3) At nephron PTH causes >Ca and < phosphate → net ↑CA ↓phosphate

29
Q

What 4 markers help you differentiate causes of hypocalcaemia

A

Calcium
Phosphate
ALP
PTH

go through table lifted form pass medicine

30
Q

Refeeding Syndrome → what causes it, what electrolytes deplete

Who can it effect

A

↓ phos, Ca, Mg - all low in cells but normal in serum

People who have not been eating - e.g bowel surgery, anorexia

31
Q

Why does hypercalcaemia cause polyuria

A

Nephrogenic diabetes inscipidous - stops nephron reacting to ADH

32
Q

ADH - where produced and why?

A

Produced posterior pit
release in response to
↓ plasma volume,

33
Q

ADH - where produced and why?

A

Produced posterior pit
release in response to
↓ plasma volume, ↑drum osmolarity

34
Q

Why thirsty when hungover

A

Prevents pituitary releasing ADH - central diabetes incipidous

35
Q

What is nephrogenic DI

A

insensitivity to ADH

lithitum, hypercalcaemia, Demeclomyclin

36
Q

Central DI

A

Deficiency of ADH

head injury

37
Q

Inv of diabetes insipidus

A

• High plasma osmolality, low • urine osmolality
Water deprivation test - deprive of water and measure conc of urine → unable to concentrate urine then give synthetic ADN (vasoopressin) - >

38
Q

How to test of central of nephrogenic

A 
synthetic ADN (vasoopressin) - > if central will concentrate urine 
→ nephro will stay the same
39
Q

What is nephrogenic DI

A

insensitivity to ADH
lithitum, hypercalcaemia, Demeclomyclin

→ polyuria and extreme thirst

40
Q

Causes

A

Small cell lung cancer
Any neuro injury
SSRI, tricyclic

41
Q

Mgmt

A

Fluid restriction → 1 L a day

Demeclomcycline

42
Q

Hyponatraemia symtoms

A

Muscle weakness
spasms/cramps
Seizures
+ feeling crap

43
Q

How to work out cause

A

1) Fluid balance examination

2) urine osmolarity

44
Q

If hypovolaemia and urine osmorlity < 20

A

D+V, sweating, burn

45
Q

If hypervolaemia and urine osmorlity < 20

A

HF, cirrhosis, IV dex

46
Q

If hypovolaemia and urine osmorlity > 20

A

Diuretics, addisons,

47
Q

If euvolaemic and urine osmorlity > 20

A

SIADH

48
Q

If correct hyponatraemia too quickly what happens, how quickly should you fix it

A

central pontine myelinolysis

10mmol/day - 0.9% NaCl - 8 hourly

49
Q

What do you give for prolactinoma

A

Dompaine agnoist - bromocriptine

↑ dopamine ↓ prolactin

50
Q

Test for acromegaly

A

glucose tolerance test → high glucose, suppresses pituitary

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