Endocrine Flashcards
Which hormones are produced by the posterior pituitary
Oxytocin
ADH
What does CRH stimulate?
ACTH release to adrenals
What does TRH stimulate?
TSH to stimulate thyroid hormone release
What does GRH stimulate?
GH to stimulate IGF-1 release to fat, muscle and liver
What does PRF do?
Stimulates prolactin to increase milk production at breasts
What does GnRH do?
Stimulates LH (sex steroid production) and FSH (ovary/sperm development)
What hormones are released from the 3 layers of the cortex and the medulla?
Glomerulosa: Aldosterone (increases Na retention)
Fasiculata: Cortisol (increases blood glucose, BP, bone breakdown)
Reticularis: Androgens ( produce testosterone so secondary sex characteristics)
Medulla: Catecholamines
Hypertension
HYPOkalaemia (muscle weakness)
alkalotic
Primary hyperaldosteronism
Ix: 1st: Increased Aldosterone: Renin ratio
Saline suppression test
CT for finding growth
Management:
Primary: Adrenalectomy
BAH: Spironolactone
Moon face Purple striae Fat around waist Hypertension Increased bone breakdown
Cushing’s
(Increased cortisol)
Investigation:
Dexamethasone suppression (low if exogenous)
Syacthen test ( low if adrenal)
High dose dexamethasone (raised if pituitary)
Treatment: Surgery
Metyrapone (reduce production pre-op)
Skinny
Hyperpigmented
HYPOtension ( Low Na
Addison’s (HLA DR3) (low aldosterone and cortisol)
Confirm by: synacthen test
Can also do APS 1/2
Treatment: Hydrocortisone (corticosteroid)
Fludrocortisone (mineralosteroid)
Sexual ambiguity
HYPOtension
Tachycardia
Congenital adrenal hyperplasia (21-OHase and increased testosterone)
Investigate with:
Increased 17-OH progesterone
Hyponatremia/Hyperkalaemia
Management:
Steroid replacement
Aldosterone replacement
Surgery
Episodic
Hypertension, headaches and sweating
Phaeochromocytoma
Investigate: 24hr metanephrins
Management:
a blocker (tamsulosin
B-blocker (propanolol)
Cure with surgery
Sweating Palpitations Weight loss Heat intolerance Pretibial myxoma Thyroid acropachy Diarrhoea Oligomenorrhea
Hyperthyroidism (caused by graves disease usually)
Investigate:
Raised T3/4
TSH: Low if primary, high if secondary
Anti-TSH receptor antibodies
Management:
B blocker
Carbimazole/PTU
Thyroidectomy
Dry brittle skin Weight gain Lethargy Cold intolerance Constipation Menorrhagia Decreased reflexes
Hypothyroidism (usually hashimotos)
Investigate with TFTs
Low T3/4
TSH: High if 1, low if 2
Treatment: Levothyroxine
painful goitre and raised ESR indicates?
De Quervains
Big head, hands and feet
Cardiomyopathy
Diabetes
Acromegaly (increased IGF-1)
Investigate: glucose tolerance test
Management:
Octreotide/cabergoline
Pegvisomant (GH antagonist)
TS surgery to cure
Galactorrhea
Reduced ‘sex’ physiology
Prolactinoma
Investigate: prolactin assay
MRI
Treatment: cabergoline
TS surgery to cure
Infertility
hair growth
Irregular periods
PCOS
Increased LH and testosterone but NORMAL OESTROGEN
Investigate:
US
serum androgens
Management:
Weight reduction
COC pill
Metformin if insulin resistant
Infertility
Amenorrhea
Night sweats
Vaginal dryness
POF ( Reduced oestrogen)
Investigate:
reduced oestrogens
US
Karyotyping for turners and klinefelters
Treatment: Oestrogen replacement
Bone pain
Renal stones
Abdo pains
confusion
Hypoparathyroidism
Investigate:
Increased Ca and reduced PO4
Increased PTH
Increased calcium in urine
Treatment:
Surgery
Cincacelet if not suitable
Distinguish primary, secondary and tertiary hyperparathyroidism
Primary: Raised Ca2+ raised/normal PTH
Secondary: normal Ca2+ raised PTH (usually due to kidney)
Tertiary: Raised PTH raised Ca2+ (bascialy PTH insensitvity)
Cramps
Altered mood
peripheral tingling
Trousseaus sign
Hypoparathyroidism
(usually due to removal of glands)
Investigate:
Reduced PTH and Ca
Treatment:
Calcium supplements
Vitamin D
shortened 4th and 5th metacarpal is
pseudohyperparathyroidism
everything is also raised
Reduced bone density (>2.5 SDs)
Ca2+ and PO4 normal
Osteoporosis
Management:
- vit D analogues
- Desonumab
- Strontium
- Zolendroic acid
Increased bone turnover with poor mineralisation leading to thickened cortices
Raised ALP only
Pagets
Increased fractures
Muscle pain
Reduced 25-OH
Increased PTH
Vit D deficiency
Calciferol/ 1a calcidiol
Most common thyroid tumour Finger-like appearance 'annie-eye' nucleus' psammoma bodies LYMPHATIC spread Iodine rich areas
Papillary
Management: Thyroidectomy
Low iodine diet
Broken capsules
HAEMATOGENOUS SPREAD
Follicular
Raised calcitonin
Diarrhoea and flushing
Amyloid
MEN II
Medullary
Spindle shaped cells
Pleomorphic
Anaplastic
Debulk chemo and raiotherapy
How to investigate for thyroid tumours?
US
FNA
Involvement of the following indicates what?
Parathyroid (hyper)
Pituitary
Pancreas ( insulinomas etc)
MEN I
2/3: parathyroidectomy
Parathyroid and Phaeochromocytoma +/-
a) HPT
b) marfanoid mucosal neuromas
RET GENE
MEN II
Reduced cortisol with normal aldosterone
Sheehans syndrome
Thin Thirsty Tired Increased toilet use HbA1c: >48mmol/mol
Diabetes mellitus
Investigate: FG > 7mmol/mol Random >11mmol/mol T1: low C-peptide + +ve antibodies (anti-GAD) T2: increased C-peptide -ve antibodies
Treatment: insulin or diabetic drugs
Management of type 2 DM
- Metformin
- gliptin/SU/pioglitazone/ SLT2i
- another
- not effective + BMI > 35 give metformin + SU + glp-1
Diabetic out drinking with mates
Heavy breathing
Fruity breath
Fatigued
DKA
Investigate:
->3mmol ketones
(B-HB in blood, ACA in urine)
-ABGs: acidosis
Treatment: 0.9% saline Insulin (0.1 units/kg/hr) K+ if <5.5 after 1l saline ECG LMWH
Diabetic
severely dehydrated
Hypotensive
HHS
Investigate:
-hyperglycemic (> 30) without >3 ketones
- increased blood osmolarity (320)
Management: SLOW IV fluids Electrolytes LMWH Insulin
Normal insulin levels
Impaired fasting glucose
Normal response
GAD -ve
MODY
(HNF1a or glucokinase)
Management:
Insulin: first 3 months of life
Sulfonylureas after
