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FINALS > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What hormones are released by the anterior pituitary?

A 
LH/FSH 
GH
TSH
Prolactin
ACTH
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2
Q

What hormones are released by the posterior pituitary?

A

Vasopressin

Oxytocin

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3
Q

Where do paracrine, autocrine and endocrine hormones act?

A

Paracrine - nearby cells
Autocrine - cells of origin
Endocrine - distant site

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4
Q

What are the microvascular and macrovascular complications of DM?

A

Micro - retinopathy, nephropathy, neuropathy

Macro - stroke, MI, renovascular disease, limb ischaemia

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5
Q

What are some atypical causes of DM?

A

Steroids, anti-HIV drugs, antipsychotics
Pancreatitis, trauma, CF, cancer
Cushing’s - acromegaly, phaechromocytoma, hyperthyroidism, pregnancy

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6
Q

What are the criteria for impaired glucose tolerance?

A

OGTT >7.8mmol/L

DM = >11.1mmol/L

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7
Q

What are the criteria for impaired fasting glucose?

A 
Impaired = >6.1mmol/L 
DM = >7mmol/L
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8
Q

What is metabolic syndrome?

A

2 of:

  1. BP >130/85
  2. Triglycerides >1.7mmol/L
  3. Fasting glucose >5.6mmol/L or T2DM
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9
Q

What are the features of metformin?

A

Biguanide drug, increases insulin sensitivity
Helps with weight loss
SE: nausea, diarrhoea, abdo pain

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10
Q

What are some features of DPP4 inhibitors?

A

Inhibit enzymes that breakdown incretin (hormone that decreases blood glucose)
e.g. Sitagliptin

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11
Q

What are some features of glitazone?

A

Increases insulin sensitivity

SE: hypoglycaemia, fractures, fluid retention, abnormal LFTs

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12
Q

What are some features of sulphonyureas?

A

Increase insulin secretion
e.g. gliclazide
SE: hypoglycaemia, weight gain

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13
Q

What are some features of SGLT inhibitors?

A

Blocks reabsorption of glucose in the kidneys

e.g. empagliflozin

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14
Q

What are the stages of diabetic retinopathy?

A
  1. Background - micro aneurysms, haemorrhages, exudates
  2. Pre-proliferative - cotton wool spots, haemorrhages
  3. Proliferative - new vessel formation
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15
Q

What are the different types of diabetic neuropathy?

A

Symmetrical sensory polyneuropathy
Mononeuritis multiplex
Amyotrophy - painful wasting of quads and pelvic muscles
Autonomic neuropathy - postural BP drop, gastroparesis, urine retention, ED, diarrhoea

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16
Q

What is the triad of diabetic ketoacidosis?

A

Acidaemia
Hyperglycaemia >11
Ketonaemia or ketonuria

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17
Q

What is the management of DKA?

A
  1. ABCDE
  2. Cannulae and fluid bolus
  3. VBG, glucose, ketones, UEs, FBC, CRP
  4. 50 units insuline in 50ml saline
  5. Check glucose and ketones hourly
  6. Find and treat cause
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18
Q

What are non-DM causes of hypoglycaemia?

A 
EXogenous drugs
Pituitary insufficiency 
Liver failure
Addison's 
Islet cell tumours 
Non-pancreatic neoplasms
19
Q

What are some signs of hyperthyroidism?

A

Tachycardia, AF, tremor, palmar erythema
Thin hair, lid lag
Goitre, nodule, bruit

Graves - exophthalmos, ophthalmoplegia, pre-tibial myxoedema, clubbing

20
Q

What are some causes of hyperthyroidism?

A 
Graves
Toxic multi nodular goitre 
Toxic adenoma 
Ectopic thyroid tissue - ovarian teratoma 
Idoine excess 
De-Quervian's thyroiditis 
Amiodarone, lithium 
Post-partum
21
Q

What are the signs of hypothyroidism?

A

Ascites, weight gain
Pallor, puffy lids, coarse hair
Ataxia, hyporeflexia

22
Q

What are some causes of hypothyroidism?

A

Hashimoto’s thyroiditis
Iodine deficiency
Post-thyroidectomy
Amiodarone, lithium

23
Q

What is the action of PTH?

A

Secreted in response in decreased Ca levels
Increases osteoclast activity
Ca and phosphate released from bones
Increased Ca and decreased phosphate reabsorption in the kidney

Net = increased calcium, decreased phosphate

24
Q

What are the causes and features of primary hyperparathyroidism?

A

80% caused by solitary adenoma
All gland hyperplasia

  1. Hypercalcaemia - weak, tired, depressed, thirsty, renal stones
  2. Bone reabsorption - pain, fractures, osteoporosis
  3. Hypertension
25
Q

What are the causes of secondary hyperparathyroidism?

A

Low vitamin D, chronic renal failure - low calcium

26
Q

What is the cause of tertiary hyperparathyroidism?

A

Occurs after prolonged secondary due to gland hyperplasia

High calcium, high PTH - no negative feedback

27
Q

What are the causes and signs of primary hypoparathyroidism?

A

Autoimmune, Di George

Spasms
Paraesthesia
Anxiety 
Seizures
Muscle tone increased
Orientation impairment 
Dermatitis
Impetigo
Cardiomyopathy
28
Q

What are the causes of secondary hypoparathyroidism?

A

Radiation, surgery, hypomagnesaemia

29
Q

What is multiple endocrine neoplasia?

A

Functioning hormone-producing tumours in multiple organs
Autosomal dominant
Includes: MEN 1 and 2, neurofibromatosis, Von-hippel Lindau and Peutz Jegher

30
Q

What is the tumour pattern in MEN1?

A

Parathyroid adenoma
Pancreas insulinoma or gastronoma
Pituitary prolactinoma

MEN1 = tumour suppressor gene

31
Q

What is the tumour pattern in MEN2?

A

A - Thyroid medullary carcinoma, phaeochromocytoma, parathyroid hyperplasia

B - similar to A, + mucosal neuromas and Marfinoid appearance, - hyperparathyroidism

MEN2 = oncogene

32
Q

What does the adrenal cortex produce?

A
  1. Glucocorticoids e.g. cortisol
  2. Mineralocorticoids e.g. aldosterone
  3. Androgens
33
Q

What are some ACTH dependent causes of Cushing’s syndrome?

A

Cushing’s disease i.e. pituitary adenoma

Ectopic ACTH production e.g. SC lung cancer, carcinoid tumours

34
Q

What are some ACTH independent causes of Cushing’s syndrome?

A

Iatrogenic - taking steroids
Adrenal adenoma/carcinoma
Adrenal hyperplasia
McCune-Albright syndrome

35
Q

What are some symptoms of Cushing’s syndrome?

A

Weight gain, acne, proximal weakness
Depression, irritability, lethargy, psychosis
Irregular menses, hirtuism, erectile dysfunction

36
Q

What are some signs of Cushing’s syndrome?

A

Central obesity
Bruises, purple abdominal striae
Osteoporosis, hypertension, hyperglycaemia, frequent infections

37
Q

What initial investigation should be done for Cushing’s syndrome?

A
  1. Overnight dexamethasone suppression test
    - 1mg dex at midnight
    - Measure cortisol at 8am
    - Normally suppresses to <50nmol/L
38
Q

What are the next line tests for Cushing’s syndrome?

A
  1. 48 hour dexamethasone suppression test
  2. Plasma ACTH
    - If undetectable think adrenal tumour - CT
    - If detectable do high dose suppression test
  3. MRI pituitary
  4. Bilateral inferior petrosal sinus blood sampling
39
Q

What are the causes of primary adrenal insufficiency (Addison’s)?

A

Autoimmune

TB, lymphoma, APS, SLE

40
Q

What is Waterhouse-Freiderichsen syndrome?

A

Bilateral adrenal cortex haemorrhage in meningococcal sepsis

41
Q

What causes secondary adrenal insufficiency?

A

Suppression of the pituitary adrenal axis from chronic steroid use

42
Q

What are the signs and symptoms of Addison’s?

A

Lean, tanned, tired, tearful, weak, anorexia, faints, dizziness
Depression, psychosis
Nausea and vomiting, abdominal pain, diarrhoea or constipation
Pigmented palmar creases and buccal mucosa
Postural hypotension

43
Q

What investigations should be done for Addison’s?

A

U and Es

Low sodium, high potassium

FINALS (19 decks)

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