endocrine Flashcards
1
Q
what is Cushing’s disease?
A
Cushings disease is caused by a pituitary gland tumour that over-secretes the hormone ACTH, thus overstimulating the adrenal glands’ cortisol production.
2
Q
what are the signs and symptoms of Cushing’s disease?
A
- signs- moon face, central obesity, hypertension
- symptoms- mood change and weight gain
3
Q
how is Cushing’s disease diagnosed?
A
- MRI to locate adenoma
- overnight dexamethasone suppression test
4
Q
what is Cushing’s syndrome?
A
Refers to the signs and symptoms associated with excess cortisol in the body, regardless of the cause
5
Q
what can cause Cushing’s syndrome?
A
- exogenous administration of steroids
- Cushing’s disease
- adrenal nodular hyperplasia
6
Q
what can cause hyperthyroidism?
A
- Graves disease
- Toxic multinodular disease
- Toxic adenoma
- Ectopic thyroid tissue
- Exogenous- iodine excess
7
Q
how does hyperthyroidism present?
A
- symptoms- diarrhoea, weight loss, increased appetite
signs- warm skin, palmar erythema, irregular pulse
8
Q
how is hyperthyroidism diagnosed?
A
- low TSH
- T4 and T3 raised
9
Q
how is hyperthyroidism treated?
A
- beta blockers
- carbimazole- anti-thyroid medication
- radioiodine
thyroidectomy
10
Q
what can cause hypothyroidism?
A
- Iodine deficiency
- Post-thyroidectomy
- Drug-induced- e.g. antithyroid
- primary hypothyroidism- disease of the thyroid gland
- secondary- hypothalamic or pituitary disease
11
Q
clinically how does hypothyroidism present?
A
- symptoms- tired, lethargic, weight increase, constipation
- signs- bradycardia, dry hair, ascites, goitre
12
Q
how is hypothyroidism treated?
A
levothyroxine (T4)
13
Q
what is Grave’s disease?
A
circulating IgG autoantibodies bid to and activate G coupled thyrotropin receptors, resulting in hyperplasia and hypertrophy of the thyroid gland- producing excess thyroid hormones
14
Q
how does Grave’s disease present clinically?
A
- pretibial myxoedema, thyroid acropachy
- signs of hyperthyroidism- e.g. weight loss and diarrhoea
15
Q
how is Grave’s disease treated?
A
carbimazole and thyrozine
16
Q
what is Hashimoto’s thyroiditis?
A
an autoimmune condition where a low colloid content in the cells results in hypothyroidism
17
Q
what are the 5 types of thyroid carcinoma?
A
- papillary
- follicular
- anaplastic
- lymphoma
- medullary cell
18
Q
how is a thyroid carcinoma treated?
A
- radioactive iodine
- levothyroxine
- chemotherapy
- thyroidectomy
19
Q
what is Conn’s syndrome?
A
Conns syndrome is the autonomous secretion of excess aldosterone
20
Q
what zone of the adrenal gland is aldosterone produced in?
A
zona glomerulosa
21
Q
clinically how does Conn’s syndrome present?
A
hypokalaemia and hypertension!
22
Q
on an ECG how is Conn’s syndrome diagnosed?
A
- flat T waves
- ST depression
- long QT interval
23
Q
apart from an ECG, how else can Conn’s be diagnosed?
A
plasma aldosterone must be raised while renin is low
24
Q
how is Conn’s syndrome treated?
A
- laparoscopic adrenalectomy
- spironolactone
25
what is the aetiology of hypocalcaemia?
- osteomalacia
- high phosphate levels due to hypoparathyrodism
- chronic kidney disease
26
how does hypocalcaemia present?
```
SPASMODIC
Spasms
Perioral paraesthesiae
Anixous
Siezures
Muscle tone increased in smooth muscle
Orientation impaired
Dermatitis
Impetigo herpetiformis
Chovstek’s sign
```
27
what is the etiological basis of hypercalcaemia of malignancy?
- Commonly of squamous cell tumours of the lung and breast
- Bone metastases common
- Lytic bone metastases
- Myeloma
- Production of osteoclast activating factor or PTH- like hormones by the tumour
28
what are the symptoms of a patient with hypercalcaemia of malignancy?
lethargy, anorexia, nausea, polydipsia, polyuria, dehydration, confusion
29
what can cause primary hyperparathyroidism?
- solitary adenoma
- hyperplasia
- parathyroid cancer
30
what are the clinical manifestations of primary hyperparathyroidism?
- Asymptomatic
- Raised calcium
- Weak, tired, depressed, renal stones, abdo pain
- Bone pain, fractures, osteopenia/ osteoporosis
- Raised blood pressure
31
what is the aetiology of secondary hyperparathyroidism?
- low vitamin D intake
- hypertrophy of parathyroid resulting in excess PTH
- chronic renal failure
32
how does tertiary hyperparathyroidism occur?
Occurs after prolonged secondary hyperparathyroidism- glands act autonomously having undergone hyperplastic or adenomatous change
33
what is SiADH?
Continued secretion of ADH despite plasma being very dilute leading to retention of water and excess blood volume- results in hyponatraemia (Na+ becomes less concentrated)
34
what can cause SiADH?
- Malignancy- small cell carcinoma of the lung
- Drugs
- CNS disorder- meningoencephalitis, abscess, stroke
- Pneumonia
- Meningitis
35
how would a patient with SiADH present clinically?
- Confusion
- Anorexia
- Nausea
- Concentrated urine
36
what values of concentrated urine and osmolality must be present to diagnose SiADH?
Concentrated urine- Na+ > 20mmol/L and osmolality >100mOsmol/kg in the presence of hyponatraemia and low plasma osmolality
37
What can cause acromegaly?
- Increased secretion of GH from pituitary tumour
| - Hyperplasia
38
clinical manifestations of acromegaly
- Symptoms- acroparaesthesia, amenorrhoea, low libido, headache, increased sweating, arthralgia, backache
- Signs- massive growth of hands, feet and jaw, wide nose, macroglossia, widely spaced teeth, sclap folds, skin darkening, acanthosis nigricans, laryngeal dyspnoea, obstructive sleep apnoea, goitre
39
what diagnostic test can be done to confirm an initial diagnosis of acromegaly?
oral glucose 24 hour test
40
what is a prolactinoma?
a benign tumour of lactotroph cells of the anterior pituitary gland which causes excess production of prolactin
41
what is the clinical presentation of males and females who have a prolactinoma?
- Symptoms in both genders- vision problems, headaches, decreased libido, infertility, galactorrhoea
- Female symptoms- amenorrhoea, vaginal dryness, brittle bones in old age
- Male symptoms- gynecomastia, erectile dysfunction
42
what are carcinoid tumours?
a diverse group of tumours of enterochromaffin cell origin, capable of producing serotonin
43
where can carcinoid tumours commonly occur?
Appendix
Ileum
Rectum
Elsewhere in GI tract, ovary, testis, bronchi
44
what are the signs and symptoms of carcinoid syndrome?
Bronchoconstriction
Paroxysmal flushing of upper body
Diarrhoea
CCF (congestive cardiac failure)
45
what is diabetes inspidus?
passage of large volumes (over 3L a day) of dilute urine due to impaired water reabsorption of the kidney
46
what are the causes of diabetes insipidus?
- cranial- defects in ADH gene, posterior pituitary tumour
| - nephrogenic- impaired response of the kidney to ADH due to hypokalaemia, hypercalcaemia or sickle cell
47
how does diabetes insipidus present clinically?
- Polyuria
- Polydipsia
- Dehydration
- Symptoms of hypernatraemia- lethargy, thirst, weakness, irritability, confusion, coma, fits
48
what is the pharmacological treatment of diabetes insipidus?
- cranial- desmopressin
| - nephrogenic- benzoflumethiazide
49
what is Addison's disease?
destruction of the adrenal cortex leads to glucocorticoid (cortisol) and mineralocorticoid (aldosterone) deficiency
50
what is the aetiology of Addison's disease?
- Autoimmune
- TB
- Adrenal metastases
- Lymphoma
- Opportunistic infection- HIV
- Adrenal haemorrhage
- Congenital
51
what is the commonest cause of secondary adrenal insufficiency?
iatrogenic due to Lon term steroid therapy surpressing the pituitary
52
what are the symptoms of hyperglycaemia?
```
polyuria
polydipsia
unexplained weight loss
visual blurring
lethargy
```
53
what are the stages of diabetic retinopathy?
- background- micro-aneurysms
- pre-proliferative- occluded vessels, venous loops
- proliferative- ischaemia, new blood vessels form
54
what are the microvascular complications of hyperglycaemia?
retinopathy
nephropathy
neuropathy
55
why does diabetic ketoacidosis occur?
glucose is not taken up by cells due to lack of insulin, therefore ketoacidosis must occur to produce energy, however this produces acetone as a by-product
56
what are the fasted and random glucose levels used to diagnose diabetes?
fasting greater than 7mmol/L
| random greater than 11 mol/L
57
what can cause type 1 diabetes?
insulin deficiency from autoimmune destruction of insulin secreting pancreatic beta cells
58
how is hypoglycaemia diagnosed?
plasma glucose less than 3 mol/L
59
```
how would you treat:
-vascular disease
- nephropathy
- diabetic retinopathy
in diabetes?
```
- vascular disease- address risk factors, statins
- nephropathy- renal dialysis, control hypertension vi ACE/ ARB
- diabetic retinopathy- laser photo coagulation
60
what value must Hb1Ac be above to diagnose diabetes?
greater than 48mmol/L (6.5%)
61
what value must the oral glucose tolerance test be above to diagnose diabetes?
2 hour value greater than 11.1mmol/L
62
how would you treat diabetic ketoacidosis?
fluids, IV insulin and potassium replacement
63
what are the marcovascular problems associated with hyperglycaemia?
```
stroke
MI
renovascular disease
limb ischaemia
heart disease
```
64
what are the clinical features of type 1 diabetes?
weight loss
persistent hyperglycaemia despite diet and medication
islet cell antibodies
ketonuria on dipstick
anti-glutamic acid decarboxylase antibodies
65
what are some common insulin regimens used in type 1 diabetes?
- disposable pens
- vary injection site
BD biphasic regimen- twice daily pre mixed
QDS- ultra fast before meals and bed time long acting analogue
66
complications of diabetic ketoacidosis
```
cerebral oedema
aspiration pneumonia
hypokalaemia
hypomagnesaemia
hypophosphataemia
thromboembolism
```
67
how would you treat a patient with type 2 diabetes?
```
metformin
then add sulfonylurea
then add glitazone
add sulfonylurea receptor binders
glucagon-like peptide analogues
alpha glucosidase inhibitors
```
68
what different types of sub-cutaneous insulin injections can be offered to a patient?
- ultra-fasting acting (nororapid)- 30 mins before meal
- isophate insulin- peaks at 4-12 hours
- pre-mixed insulins
- long term recombinant human insulin analogues to use before bed
69
what can cause hypokalaemia?
- Diuretics
- Vomiting and diarrhoea
- Pyloric stenosis
- Rectal villous adenoma
- Intestinal fistula
- Cushings
- Conns
- Alkalosis
- Liquorice abuse
- Renal tubular failure
70
clinically how does hypokalaemia present?
```
muscle weakness
hypotonia
hyporeflexia
cramps
tetany
constipation
```
71
what appearance would hypokalaemia give on an ECG?
small/ inverted T waves
prominent U waves
long PR interval
ST depression
72
what can cause hyperkalaemia?
- Drug interference with potassium excretion
- Combination of ACE inhibitors with NSAIDS
- Oliguric renal failure
- K+-sparing diuretics
- Rhabdomyolysis – due to crush injury
- Metabolic acidosis
- Excess K+ therapy
- Addison’s disease
- Massive blood transfusion
- Burns
73
how does hyperkalaemia present?
fast irregular pulse
chest pain
weakness
palpitations
74
how does hyperkalaemia present on an ECG?
tall T waves
small P waves
wide QRS complex
75
how can hyperkalaemia be diagnosed?
serum potassium greater than 5.5mmol/L
76
how would you treat a patient with hyperkalaemia?
- treat underlying cause
| - IV calcium gluconate and IV actrapid
77
what is the hyperosmolar hyperglycaemic state?
Complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis
78
what clinical features would suggest a diagnosis of type 1 diabetes?
- weight loss
- persistent hyperglycaemia despite diet
- autoantibodies
- islet cell antibodies
- anti-glutamic acid decarboxylase (GAD) antibodies
- ketonuria on dipstick
79
what can cause diabetes mellitus?
- drugs- anti-HIV, thiazides, steroids
- pancreatic- surgery, trauma, haemochromatosis, cancer
- Cushing's disease
- acromegaly
- phaemochromocytoma
- hyperthyroidism
80
what is the typical type 2 DM patient?
asian background, male, over 40
81
how does diabetic ketoacidosis present clinically?
- drowsiness, vomiting and dehydration
- pear drop smell on breath
- triggers- infection, surgery, MI, chemotherapy, pancreatitis
82
how is diabetic ketoacidosis diagnosed?
- acidaemia
- hyperglycaemia
- ketonaemia
83
how is Addison's disease diagnosed?
Na+ decreased, K+ increased due to reduced aldosterone
- hypoglycaemia- low cortisol
- short ACTH stimulation test
84
how is Addison's disease treated?
replace steroids with oral hydrocortisone
