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2MB: disease summaries > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Which hormones are produced by the posterior pituitary

A

Oxytocin

ADH

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2
Q

What does CRH stimulate?

A

ACTH release to adrenals

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3
Q

What does TRH stimulate?

A

TSH to stimulate thyroid hormone release

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4
Q

What does GRH stimulate?

A

GH to stimulate IGF-1 release to fat, muscle and liver

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5
Q

What does PRF do?

A

Stimulates prolactin to increase milk production at breasts

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6
Q

What does GnRH do?

A

Stimulates LH (sex steroid production) and FSH (ovary/sperm development)

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7
Q

What hormones are released from the 3 layers of the cortex and the medulla?

A

Glomerulosa: Aldosterone (increases Na retention)

Fasiculata: Cortisol (increases blood glucose, BP, bone breakdown)

Reticularis: Androgens ( produce testosterone so secondary sex characteristics)

Medulla: Catecholamines

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8
Q

Hypertension
HYPOkalaemia (muscle weakness)
alkalotic

A

Primary hyperaldosteronism
Ix: 1st: Increased Aldosterone: Renin ratio
Saline suppression test
CT for finding growth

Management:
Primary: Adrenalectomy
BAH: Spironolactone

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9
Q 
Moon face
Purple striae
Fat around waist
Hypertension
Increased bone breakdown
A

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)

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10
Q

Skinny
Hyperpigmented
HYPOtension ( Low Na

A

Addison’s (HLA DR3) (low aldosterone and cortisol)
Confirm by: synacthen test
Can also do APS 1/2

Treatment: Hydrocortisone (corticosteroid)
Fludrocortisone (mineralosteroid)

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11
Q

Sexual ambiguity
HYPOtension
Tachycardia

A

Congenital adrenal hyperplasia (21-OHase and increased testosterone)

Investigate with:
Increased 17-OH progesterone
Hyponatremia/Hyperkalaemia

Management:
Steroid replacement
Aldosterone replacement
Surgery

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12
Q

Episodic

Hypertension, headaches and sweating

A

Phaeochromocytoma

Investigate: 24hr metanephrins

Management:
a blocker (tamsulosin
B-blocker (propanolol)
Cure with surgery

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13
Q 
Sweating 
Palpitations
Weight loss
Heat intolerance
Pretibial myxoma
Thyroid acropachy
Diarrhoea
Oligomenorrhea
A

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

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14
Q 
Dry brittle skin
Weight gain
Lethargy
Cold intolerance
Constipation
Menorrhagia
Decreased reflexes
A

Hypothyroidism (usually hashimotos)

Investigate with TFTs
Low T3/4
TSH: High if 1, low if 2

Treatment: Levothyroxine

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15
Q

painful goitre and raised ESR indicates?

A

De Quervains

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16
Q

Big head, hands and feet
Cardiomyopathy
Diabetes

A

Acromegaly (increased IGF-1)

Investigate: glucose tolerance test

Management:
Octreotide/cabergoline
Pegvisomant (GH antagonist)
TS surgery to cure

17
Q

Galactorrhea

Reduced ‘sex’ physiology

A

Prolactinoma

Investigate: prolactin assay
MRI

Treatment: cabergoline
TS surgery to cure

18
Q

Infertility
hair growth
Irregular periods

A

PCOS
Increased LH and testosterone but NORMAL OESTROGEN

Investigate:
US
serum androgens

Management:
Weight reduction
COC pill
Metformin if insulin resistant

19
Q

Infertility
Amenorrhea
Night sweats
Vaginal dryness

A

POF ( Reduced oestrogen)

Investigate:
reduced oestrogens
US
Karyotyping for turners and klinefelters

Treatment: Oestrogen replacement

20
Q

Bone pain
Renal stones
Abdo pains
confusion

A

Hypoparathyroidism

Investigate:
Increased Ca and reduced PO4
Increased PTH
Increased calcium in urine

Treatment:
Surgery
Cincacelet if not suitable

21
Q

Distinguish primary, secondary and tertiary hyperparathyroidism

A

Primary: Raised Ca2+ raised/normal PTH
Secondary: normal Ca2+ raised PTH (usually due to kidney)
Tertiary: Raised PTH raised Ca2+ (bascialy PTH insensitvity)

22
Q

Cramps
Altered mood
peripheral tingling
Trousseaus sign

A

Hypoparathyroidism
(usually due to removal of glands)

Investigate:
Reduced PTH and Ca

Treatment:
Calcium supplements
Vitamin D

23
Q

shortened 4th and 5th metacarpal is

A

pseudohyperparathyroidism

everything is also raised

24
Q

Reduced bone density (>2.5 SDs)

Ca2+ and PO4 normal

A

Osteoporosis

Management:

  1. vit D analogues
  2. Desonumab
  3. Strontium
  4. Zolendroic acid
25
Q

Increased bone turnover with poor mineralisation leading to thickened cortices
Raised ALP only

A

Pagets

26
Q

Increased fractures
Muscle pain
Reduced 25-OH
Increased PTH

A

Vit D deficiency

Calciferol/ 1a calcidiol

27
Q 
Most common thyroid tumour
Finger-like appearance
'annie-eye' nucleus'
psammoma bodies
LYMPHATIC spread
Iodine rich areas
A

Papillary

Management: Thyroidectomy

28
Q

Low iodine diet
Broken capsules
HAEMATOGENOUS SPREAD

A

Follicular

29
Q

Raised calcitonin
Diarrhoea and flushing
Amyloid
MEN II

A

Medullary

30
Q

Spindle shaped cells

Pleomorphic

A

Anaplastic

Debulk chemo and raiotherapy

31
Q

How to investigate for thyroid tumours?

A

US

FNA

32
Q

Involvement of the following indicates what?
Parathyroid (hyper)
Pituitary
Pancreas ( insulinomas etc)

A

MEN I

2/3: parathyroidectomy

33
Q

Parathyroid and Phaeochromocytoma +/-
a) HPT
b) marfanoid mucosal neuromas
RET GENE

A

MEN II

34
Q

Reduced cortisol with normal aldosterone

A

Sheehans syndrome

35
Q 
Thin
Thirsty
Tired 
Increased toilet use
HbA1c: >48mmol/mol
A

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

36
Q

Management of type 2 DM

A
  1. Metformin
    • gliptin/SU/pioglitazone/ SLT2i
    • another
  4. not effective + BMI > 35 give metformin + SU + glp-1
37
Q

Diabetic out drinking with mates
Heavy breathing
Fruity breath
Fatigued

A

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
38
Q

Diabetic
severely dehydrated
Hypotensive

A

HHS
Investigate:
-hyperglycemic (> 30) without >3 ketones
- increased blood osmolarity (320)

Management: 
SLOW 
IV fluids
Electrolytes
LMWH
Insulin
39
Q

Normal insulin levels
Impaired fasting glucose
Normal response
GAD -ve

A

MODY
(HNF1a or glucokinase)

Management:
Insulin: first 3 months of life
Sulfonylureas after

2MB: disease summaries (10 decks)

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