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Endocrine Flashcards

1
Q

Treatment for hypothyroidism?

A

Levothyroxine (T4) – review at 12 weeks, adjust 6 weekly

NB: give smaller doses if elderly as risk of angina or MII

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2
Q

What is Hashimoto’s thyroiditis? What can it causE?

A

anti-TSH, anti-TPO, anti-TG. can cause hypothyroidism

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3
Q

what is Grave’s disease?

A

IgG autoantibodies bind to and stimulate TSH receptors (triggers = infection, stress, childbirth)
Eye disease, pretibial myxoedema, thyroid acropachy
Autoimmune (vitiligo, type 1 DM, Addison’s)
Causes Hyperthyroidism

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4
Q

What else causes hyperthyroidism/

A

TOXIC MULTINODULAR GOITRE

  1. TOXIC ADENOMA
  2. ECTOPIC THYROID TISSUE (mets / struma ovarii)
  3. EXOGENOUS (Iodine / T4 excess)
  4. DE QUERVAIN’S THYROIDITIS (post-viral)
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5
Q

What causes hypothyroidism?

A

PRIMARY HYPOTHYROIDISM (↓T4)
Primary atrophic hypothyroidism
Hashimoto’s thyroiditis (anti-TSHR, anti-Tg, anti-TPO)
Iodine deficiency
Post-thyroidectomy / radioiodine / antithyroid drugs
Lithium / amiodarone

SECONDARY HYPOTHYROIDISM (↓TSH)
Hypopituitarism
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6
Q

Signs and symptoms of hypothyroidism?

A 
Bradycardic
Reflexes relax slowly
Ataxia (cerebellar)
Dry, thin hair / skin
Yawning / drowsy / coma
Cold hands +/- ↓T°C
Ascites
Round puffy face
Defeated demeanour
Immobile +/- Ileus
CCF
CVS: -
RS: Hoarse voice
GI: Constipation
Int: Cold intolerance
Endo: Weight gain
UG: Menorrhagia
MSK: Myalgia, weakness
Neuro / Psych: Tired, low mood, dementia
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7
Q

What investigations do you do for hypothyroidism?

A

INVESTIGATIONS:

TFT (thyroid function tests)

Lipids/cholesterol (should be increased)

(c) FBC (macrocytosis)

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8
Q

what are the SX for hyperthyroidism?

A 
CVS: Palpitations
RS: -
GI: Diarrhoea 
Int: Heat intolerance
Endo: ↓Weight, ↑appetite
UG: Oligomenorrhoea +/- infertility
MSK: -
Neuro / Psych: Tremor, irritability, labile emotions

and

HANDS:
- Palmar erythema; warm, moist skin; fine tremor

PULSE:
- Tachycardia; SVT; AF

FACE:
Thin hair; lid lag / retraction

NECK:
Goitre; nodules; bruit

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9
Q

What Ix do yu do for hyperthyroidism?

A

INVESTIGATIONS:

(a) TFT
(b) FBC (normocytic anaemia)
(c) ESR (↑)
(d) Calcium (↑)
(e) LFT (↑)
(f) Thyroid autoantibodies
(g) Visual fields, acuity, eye movements

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10
Q

How do you treat hyperthyroidism?

A

(i) β-blockers:
- Propanolol (rapid control of symptoms)

(ii) Antithyroid medication:
Titration (carbimazole: SE = AGRANULOCYTOSIS)
Block and replace (carbimazole + thyroxine)
these inhibit the action of TPOy

(iii) Radioiodine (131I)
(iv) Thyroidectomy

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11
Q

What is thyroid eye diseasE?

A

bulging of eyes (pushed forward) due the eye muscles and fatty tissue binding to the eye and causing inflammation. can lead to double vision, proptosis, exophthlamos, opthalmoplegia. grittiness in the eyes, eye discomfort and diplopia.

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12
Q

How can TED be treated?

A

eyelid surrgeyr, corticosteroids - methylprednisolone, stop smoking, sunglasses, surgical decompression.

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13
Q

What happens when a cell gets insufficient insulin?

A

the insulin receptor in the cell is not activiated, the glucose channel isnt opened so the glucose in the blood builds. lack of insulin stimulates glycogen. Cell releases Cortisol, adrenaline and GH to produce energy.

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14
Q

What does GH do?

A

reduces insulin activity and glucose utilisation so increases blood glucose

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15
Q

What does adrenaline do in DM?

A

increases hydrolyiss of fatty acids and increases ketones. this can lead to diabetic ketoacidosis.

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16
Q

What does cortisol do?

A

increases proteolysis which produces more glucose

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17
Q

How does DKA cause hyperkalaemia?

A

High acidity causes inreas in H+. these are transported into cells and exchanges for K+. The transporter which pumped K+ into the cell and Na+ outside is controlled by insulin. Because of the lack of insulin this channel no longer functions. this leads to excess K+ in the blood

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18
Q

First line Tx for DM2?

A

Metformin

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19
Q

What does Metformin do?

A

Increases insulin sensitivity in GLUT4 receptors in liver,
increases gluces uptake
decreases gylocogenolysis

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20
Q

Metformin CI?

A

liver and renal impairment

21
Q

Metformin side effects?

A

anorexia, nausea/discomfot/GI upset/ lactic acidosis

22
Q

What do DPP inhibitors do?

A

Prevent breakdown of GLP-1 so inreases insuline production. Effective early on while insulin function is stable. treament for DM2

23
Q

Name some DPP inhibitors?

A

Alogliptin
limagliptin
saxogliptin
sitagliptin

24
Q

Side effects of DPP inhibitors?

A

headache and muscle weakness. Do not give to DM1 paitients or DKA patients.

25
Q

What does Sulfonylurea do?

A

Tx for DM2, opens B cell channels and increased insulin production. can cause weight gain, liver disease
DO NOT GIVE IN PREGNANCY

26
Q

NAME some sulfonylurea drugs?

A

glibenclamide
gliclazide
toblutamide

27
Q

What is the last line of treatment for DM2?

A

Insulin injections.

28
Q

What is cushing’s disease?

A

bilateraly adrenal hyperplasia from an adenoma in the anterior pituitary gland. causes ACTH realse excess

29
Q

What is Cushing’s syndrome caused by? (factors that increase ACTH)

A 
-ECTOPIC CRH PRODUCTION
Thyroid medullary and prostate cancers
-ECTOPIC ACTH PRODUCTION
Small cell lung Ca and carcinoid tumours
-CUSHING’S DISEASE 
Bilateral adrenal hyperplasia from ACTH-secreting pituitary adenoma
30
Q

Cushing’s syndrome causes? (factors that have decreased ACTH due to negative feedback)

A

Adrenal adenoma/carcinome,
adrenal nodular hyperplasia
Iatragenic (steroid usages)

31
Q

Symptoms of Cushings?

A

Round face, central obesity, abdominal striae, bruises, muscle weakness, osteoporesis, skin and muscle atrophy, moonface, buffalo neck lump, acne, increase inweight, mood changes, gonadal dysfunction,

32
Q

Treatment of acromegaly?

A

Trans-sphenoidal surgery to remove tumour

Somatostatin analogue (SSA) – e.g. IM octreotide or lanreotide (NB GI side effects)

Radiotherapy

Pegvisomant (recombinant GH analogue)

33
Q

Complications of acromegaly?

A

Impaired glucose tolerance (40%) and Diabetes Mellitus (15%)

Vascular: HTN; LVH; cardiomyopathy; arrhythmias; IHD; stroke

Colon cancer

34
Q

Signs of acromegaly?

A

Skin darkening
Acanthosis nigricans

Big supraorbital ridge
Interdental separation
Macroglossia
Prognathism
Laryngeal dyspnoea
OSA

Spade-like hands and feet
Tight rings
Carpal tunnel syndrome

35
Q

Symptoms of acromegaly?

A 
RS: Snoring
GI: “Wonky bite” (malocclusion)
Int: ↑Sweating
Endo: ↑Weight
UG: ↓libido; amenorrhoea
MSK: Arthralgia; backache
Neuro: Acroparaesthesia;  headache
36
Q

What is Addison’s disease?

A

primary adrenal insufficiency. 21- hydroxylase antibodies attack adrenal cortex and stop the release of adrenal hormones

37
Q

How would you replace glucocorticoids with in Addision’s Tx?

A

Fludrocortisone

38
Q

What investigations would you do for Addision’s diseas?

A
  1. Bloods:
    - FBC (anaemia, eosinophilia)
    - U&E (↓Na+, ↑K+, ↑Ca2+, ↑Urea)
    - BM (↓)
  2. Short ACTH Stimulation Test:
    Measure plasma cortisol before and 30mins after IM Tetracosactide (SynACTHen)
    Addison’s excluded if 30min cortisol >550nmol/L
  3. 9AM ACTH levels: inappropriately high in Addison’s
  4. 21-hydroxylase adrenal autoantibodies
39
Q

Investigations for cushings disease?

A
  1. Bloods (↑plasma cortisol)
  2. Overnight dexamethasone suppression test
    Dexamethasone 1mg PO at 00:00
    Measure serum cortisol at 08:00
    Normal <50nmol/L (no suppression in Cushing’s)
  3. 48h dexamethasone suppression test
    - Dexamethasone given qds for 2 days
    Measure cortisol at 0h and 48h
    No suppression in Cushing’s
40
Q

What is the overnight/48hr dexamethasone supporession test used for?

A

test for cushing’s disease, the cortisol should be suppressed when measured. but in Cushing’s there is no suppression.

41
Q

What is Nelson’s syndrome?

A

Nelson’s syndrome – increased skin pigmentation due to raised ACTH from an enlarging pituitary tumour as adrenalectomy removes negative feedback; responds to pituitary radiation.

42
Q

What is a complication of a bilateral adrenolectomy?

A

This removed the adrenal gland as a treatment for Cushing’s syndrome. But causes the enlargment of the pituitary

43
Q

Causes of hypoparathrydoidism?

A

Surgical the big one

Autoimmune

DiGeorge (and other, rarer causes of Parathyroid absence)

Haemochromatosis

Familial forms

44
Q

Symptoms of hypoparathyroidism?

A

LOW CALCIUM — Parasthaesia (especially around mouth and lips)
— Tetany (Chvostek’s sign & Trousseau’s sign)
— Increased reflexes
— QT elongation as well as reduced rate and contractility
and
Convulsions
Arrhythmia
Tetany

Go numb

45
Q

What conditions can cause a low calcium?

A

Kidney failure, pancreatitis, tumor lysis syndrome, CCB overdose, Rhabdomyolysis, Bisphosphonates
Kidney disease, vit D malabsorption or deficiency, drugs (including steroids and diuretics)

46
Q

Treatment for hypokalaemia?

A 
If mild (>2.5mmol/L, no symptoms), give oral K supplements (>=80mmol/24h e.g. Sando-K 2 tabs / 8h). Review K after 3 days. If taking a thiazide diuretic and K >3mmol/L, consider repeating and/or K+ sparing diuretic. 
If severe (<2.5mmol/L and/or dangerous symptoms) give IV K+ cautiously, not more than 20mmol/h and not more concentrated than 40mmol/L. Do NOT give K+ if oliguric. NEVER give K+ as a fast stat bolus dose
47
Q

No more than how much in IV K?

48
Q

Causes of Hypokalaemia?

A

Diuretics; V/D; Cushing’s; Conn’s; Pyloric stenosis; Alkalosis

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