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Phase 3 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is it called when there is a tumour that produces hormones?

A

Paraneoplastic syndrome

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2
Q

How is congenital adrenal hyperplasia inherited? and what enzyme is defected?

A

Autosomal recessive

21 alpha hydroxylase

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3
Q

What drugs can cause adrenal insufficiency?

A

Ketoconazole

Rifampicin

Barbiturates

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4
Q

Outline clinical findings of Addisons?

A

Hyponatraemic

Hyperkalaemia

Increased Urea

Creatinine levels increase

Increased renin

Reduced androgens
- DHEA

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5
Q

How is the adrenal insufficiency test done?

A

Short SynACTHen test
- 250mg given IV.

30mins later if <450nmol/L cortisol then positive

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6
Q

Management of adrenal insufficiency:

A

hydrocortisone

FLudrocortisone

  • sick day rules
  • treatment of TB if present
  • insulin titration
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7
Q

What are the definitions for hypoglycemia:

A

Diabetic: <4mmol/L

Non Diabetic <3mmol/L

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8
Q

List some causes of hypoglycemia out with diabetes:

A

Inappropriate insulin release:

  • insulinomas
  • MEN -1

Insulin Mimicking pathologies:

  • Lymphomas
  • Tumours secrete IFG-2

Drug induced:

  • sulfonlureas
  • repaglinide

Impaired gluconeogenesis

  • organ failure
  • alcohol
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9
Q

What is the symptoms of hypoglycaemia?

A

Whipples Triad

  • Neuroglycopenic
  • autonomic
  • Measured glucose level
  • improvement with glucose
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10
Q

At what level of blood glucose is there EEG changes?

A

<2mmol/L

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11
Q

What level of blood glucose is there come and convulsions?

A

<1.5mmol/L

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12
Q

What the common causes of primary aldosteronism?

A

Adrenal adenoma - 40%

Adrenal hyperplasia - 60%

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13
Q

What are the symptoms of primary aldosteronism?

A
  • hypertension
  • hypokalemia
  • alkalosis
  • mildly hypernatremic
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14
Q

What are some important tests in primary aldosteronism?

A

Renin: aldosterone ratio

Suppression test
- 2L of saline

4 hours later if aldosterone >27pmol/L= positive

Plasma renin/ aldosterone ratio
- >35>300 diagnostic

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15
Q

What are the managements for primary aldosterone?

A

Surgical:

  • only if unilateral
  • laparoscopic

Medication:
- spironolactone

  • eplerenone
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16
Q

What investigations should be done on pituitary tumour?

A
  • MRI
  • visual field testing
  • prolactin levels
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17
Q

What are the symptoms of a prolactinoma?

A

Galactorrhoea

menstrual disturbance

reduced libido

headaches

disturbed vision

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18
Q

what investigations should be done for a suspected prolactinoma?

A

Serum prolactin

FSH and LH levels (since these are supressed)

MRI

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19
Q

What is the treatment options for prolactinoma?

A

Cabergoline
- dopamine agonist

Surgery

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20
Q

What are the symptoms of acromegaly?

A

Coarse facial appearance

enlarged tongue

increased iner-dental space

sweats

headaches

joint pains

hypertension

diabetes

bowel cancer

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21
Q

What is considered a macroadenoma?

A

> 1cm

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22
Q

Name some causes of hypopituitrism:

A 
Tumours 
infarction 
infiltrations 
trauma 
congenital
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23
Q

What tests are done for cushing’s syndrome?

A

24 hour cortisol test

Late night salivary cortisol sample

Dexamethasone suppression test

CRH test
- to see if ACTH is increased

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24
Q

What drugs can be used to treat cushings?

A

Ketoconazole

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25
Q

symptoms of Pheochromocytoma?

A

Hypertension

Episodes of:

  • Headaches
  • palpitations
  • sweating
  • abdominal pain
  • anxiety
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26
Q

What are the etiologies of pheochromocytomas?

A

75% sporadic mutations

25% associated with conditions making them more vulnerable to developing the tumour:
- MEN2

  • Neurofibromatosis
  • Von Hippel Lindau disease
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27
Q

Investigations into pheochromocytoma?

A
  • Blood pressure
  • Thyroid function
  • Urinary catecholamines
  • noradrenaline
  • adrenaline
  • metadrenalines
  • Normetadrenalines

*CT

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28
Q

Treatment for Pheochromocytoma?

A

Alpha blocker
- doxazosin

Beta blockers

Adrenalectomy
**medication given before surgery

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29
Q

What investigations need to be done for a male with hypogonadism?

A
  • history
  • weight distribution
  • sexual activity
  • Examination
  • orchidometer
  • Basal levels of testosterone
  • highest in morning
  • LH and FSh
  • semen analysis
  • chromosomes
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30
Q

What are some etiologies of hypogonadism in men?

A

Hypogonadotropic hypogonadism

  • pituitary tumour
  • prolacitnoma
  • head trauma

Primary gonadal failure

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31
Q

What’s the most common cause of hypogonadotropic hypogonadism?

A

Kallmann’s syndrome

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32
Q

What genes are associated with Kallmann’s syndrome:

A

X- linked - KAL1 gene

Autosomal Dominant KAL2 gene

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33
Q

What is the pathophysiology of Kallmann’s syndrome?

A

Failure of the GnRH cells to migrate from the olfactory placode to the hypothalamus

develop lack of sense of smell as well

34
Q

What are the clincal features of Klamman’s syndrome?

A

Lack of FSH and LH

Cryptochidism

Micro-penis

small growth

35
Q

What is the pathology in primary gonadal disease?

A

Direct problem with the Leydig cells.
- dysfunctional testosterone

  • trauma,
  • chemo
  • radiotherapy
  • multisystemic disorders
36
Q

Why do men with Klinefelter’s syndrome have low testosterone?

A

Seminferous tubules regress and do not function correctly

37
Q

List some symptoms of hypercalcaemia

A
  • confusion, tiredness
  • Bone pain
  • shortening of QT interval
  • dehydration
  • renal stones
38
Q

What are the PTH related causes of hypercalcemia?

A

adenoma of parathyroid

diffuse hyperplasia of parathyroid

Familial hypocalcuric hypercalcaemia

39
Q

What is the pathogenesis of familial hypocalcuric hypercalcaem?

A

Lack of CaSR receptors on parathyroid and kidneys
- defect in chromosome 3

thus PTH doesn’t switch off.

Kidneys it continues to reabsorb

40
Q

What is a significant clinical finding in FHH that differentiates it from other hypercalcemia?

A

Urine calcium: Plasma calcium ratio

41
Q

What are some non- PTH related causes of hypercalcaemia?

A

Carcinoma

Malignancy
- PTH -related peptide

Granulomatous disorders
- produce 1 alpha hydroxylase

Drugs

  • thiazides
  • lithium

Paget’s disease

Hyperthyroidism

42
Q

Investigations carried out for hypercalcaemia?

A

Corrected calcium for albumin levels

  • x-ray
  • for lung cancer
  • FBC
  • thyroid function tests
  • urine/ plasma ration
  • end organ damage
  • DEXA scan
  • alkaline phosphatase
43
Q

Treatment of hypercalcaemia:

A

*stop causitive agent

  • IV fluids
  • flush calcium out
  • loop diuretics
  • bisphosphonates
  • steroids
  • thyroidectomy
44
Q

What must be present to carry out a thyroidectomy?

A

Only on those who can survive, usually <50 years old

intractable symptoms
renal stones
hypercalciuria

45
Q

What drug can be associated with hyperthyroidism?

A

Amiodarone

  • has a high content of iodine which may trigger increased thyroxine in already hyperthyroid patients.

May lead to an acute hypersecretion of T4, T3 due to an immediate thyrotoxicosis
followed by hypothyroidism
- seen in previously healthy thyroids

46
Q

What chemical marker may be seen with amiodarone hyperthyroidism and why is this?

A

high T4>T3 levels.

because amiodarone prevents the break down of T4 into T3

47
Q

How is hyperthyroidism and thyrotoxicosis different?

A

Hyperthyroidism refers to the thyroid directly being over active.

Thyrotoxicosis is a syndrome that refers to the over amount of free T4 and T3 regardless of cause.
- doesn’t have to strictly come about through hyperthyroidism i.e a damaged gland releasing T4 and T3

48
Q

What are some primary causes of thyrotoxicosis

A

Graves

toxic multinodular goitre

toxic adenoma

49
Q

What are some secondary causes for thyotoxicosis?

A

TSHoma - of pituitary

Gestational thyrotoxicosis

thyroid hormone resistance syndrome

50
Q

What are the drugs used for hyperthyroidism?

which is used for pregnancy or if pregnancy is planned?

A

Carbimazole

Propylthiouracil

Propylthiouracil is used for pregnancy

51
Q

What are the two regimens used for the drug dosages in hyperthyroidism?

A

Reducing regimen

Block and replace

52
Q

What risk factors increase the likely hood of opthalmopathy in Graves disease?

A

Smoking
male sex
age
radioactive iodine treatment

53
Q

What would prompt immediate referral to an ophthalmologist in Grave’s disease?

A

Poor vision
blurred vision
rapid change in vision
poor colour vision

54
Q

What are some causes of hypothyroidism?

A

Hashimotos thyroiditis

destructive thyroiditis

secondary hypothalamic

iodine deficiency

treatment of hyperthyroidism

idiopathic

55
Q

What is the treatment for hypothyroidism?

A

50 -100mcg levothyroxine

25mcg for ischemic heart disease

56
Q

What is the term giving to the build up of mucopolysaccharides in the skin?

A

myxedema

57
Q

What’s a serious complication of hypothyroidism that can result in death?

A

Myexdema coma

  • bradycardia - heart failure
  • bradyypnea
  • hypothermia
58
Q

What drugs are given for hyperthyroidism, how do they work and what are some major side effects?

A

Carbimazole
Propylthiouracil

reduced activity of peroxidase
reduced conversion of T4 to T3

Agranulocytosis
- much watch patients for infection

59
Q

Which of the thyroid diseases would cause periods to stop?

A

Hyperthyroidism

60
Q

What Antibodies are associated with Hashimoto’s

A

Anti-thyroglobulin

Anti-thyroid peroxidase

61
Q

What is a modifiable risk factor towards Graves disease?

A

Smoking - showing to make it much more likely

62
Q

What are the drugs used in Graves disease?

A

Carbimazole

Propylthiouracil

63
Q

What immune modulators may be used for Grave’s disease?

A

Interferon

Alemtuzemab - CD52

64
Q

Why might a lady on contraception or a pregnant women, present with an increase in total T4 levels?

A

Contraception and pregnancy increase Thyroglobulin binding hormone. thus the thyroid has to increase output to maintain the free amount.

the free amount will be normal

65
Q

What is it called when an injection of iodine is given to someone with hyperthyroidism, which results in suppression of thyroid hormone?

A

Wolff Chaikoff effect

66
Q

What is it called when relatively small amount of iodine is given to someone with hyperthyroidism, and causes a massive increase in thyroid hormone? and name a drug that this is an example off:

A

Jod - Basedow Phenomenon
- given a relatively small amount of iodine which triggers thyroid hormone release from a hyperthyroid gland. normal glands will counter regulate.

it is the opposite of Wolff Chaikoff effect.

Amiodarone is an exmaple.

67
Q

whats it called when a neonate has hypothyroidism and symptoms associated?

A

Cretinism

Mental retardation
Course facial features
short stature

68
Q

What effect does testosterone have on RBCs?

A

Increases erythropoiesis

69
Q

What is a level of diagnostic prolactin?

A

> 6000

70
Q

Following what infection may lead to hyperthyroidism?

A

Yersina Infection

E.Coli infection

71
Q

Name some causes of Secondary hyperthyroidism:

A

Pituitary adenoma TSHoma

Gestational Thyrotoxicosis

72
Q

List some causes of primary gonald insufficiency:

A

Chemotherapy

Trauma

radiotherapy

73
Q

What is it called where there is a congenital reduction in hypothyroidism - and what are some symptoms and what are some of the major causes:

A

Cretinism

Coarse facial features
Glossis hypoplasia
Development delay
Myexdema

Thyroid dysgenesis
TSH receptor dysgensis
Dysmorphogenesis in thyroperioxidase

May also be caused by maternal reduction in thyroid hormone

74
Q

What are the main antibodies associated with Graves:

What gene is it most associated with?

A

TSH Antibodies

Thyroperioxidase antibodies

HLA DR3

75
Q

What is the main antibody implicated in Hashimotos disease:

A

Thyroperioxidase

76
Q

There are two thyroid disease caused by amiodarone, what are they and how are they treated?

A

Type 1: Autoimmune thyrotoxicosis
- Carbimazole

Type 2: Destructive Thyroiditis
- Corticosteroids

77
Q

What do the test results look like for sub-clinical hypothyroidism?

A

High TSH

Normal T4

78
Q

What kind of tumour is Thyroid C Cancer?

A

Medullary cancer

derives from the parafollicular C Cells

Calcitonin producing

79
Q

Which gene is associated with Familial Medullary thyroid Cancer?

A

RET gene

Associated with MEN2
- autosomal dominant

Protoncogene that is passed on. one of the few that is.

80
Q

List the other types of thyroid cancer:

A

Follicular Carcinoma
- metastasis to bone

papillary adenocarcinoma

81
Q

How do you treat hyperkalemia? and give an example in an emergency situation that it may be raised (outwith DKA as there is different management for that) and name an important investigation to monitor the effects of the high K+ and what would you expect to see?

A

Calcium Resonium

Insulin - actrapid
+/- Glucose

Calcium Gluconate

**if they become acidotic then treat with bicarb

Example would be:
AKI
due infective secretion of the K+ ions

*ECG = talk peaked T waves

Phase 3 (50 decks)

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