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FINALS medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Too much growth hormone=?

A

acromegaly (adults) gigantism (paeds)

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2
Q

Not enough GH

A

pituitary dwarfism

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3
Q

Too much cortisol

A

Cushing’s disease if pituitary

Cushing’s syndrome if due to steroids/adrenal adenoma/paraneoplastic

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4
Q

What paraneoplastic tumour is often linked to cushing’s syndrome

A

Small Cell lung ca

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5
Q

Not enough cortisol

A

Adrenal insufficiency (primary/sec/tert)

Or congenital adrenal hyperplasia

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6
Q

Test for cushing’s?

A

Dexamethasone suppression test

Urinary free cortisol (3 times)

Late night cortisol

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7
Q

What are the causes of adrenal insuff?

A

primary- Addison’s (autoimmune), TB/fungal/HIV

Secondary- pituitary damage e.g. non-functioning adenoma

Tertiary- stopped LT steroids

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8
Q

Test for secondary adrenal insufficiency?

A

Insulin stress test/glucon stimulation

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9
Q

Test for acromegaly?

A

OGTT

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10
Q

Test for GH deficiency?

A

Insulin stress test

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11
Q

Too much adrenaline?

A

Phaeochromocytoma

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12
Q

Test for phaeochromocytoma?

A

plasma free metanephrins/24h urine catecholamines

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13
Q

Too much aldosterone?

A

Conn’s or secondary hyperaldosteronism

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14
Q

Causes of Conn’s

A

Adrenal adenoma/carcinoma

Bilat adrenal hyperplasia

Familial

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15
Q

Causes of secondary hyperaldosteronism?

A

Low renal BP- so RA stenosis/obstruction or heart failure

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16
Q

What would happen to renin in secondary hyperaldosteronism?

A

high

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17
Q

Do you get low adrenaline in adrenal insufficiency?

A

No- medullary sparing

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18
Q

What type of adrenal insufficiency does not effect aldosterone?

A

Secondary as it is under renin control, not pituitary

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19
Q

What electrolyte derangement do you get in primary adrenal insuff?

A

Low sodium, high potassium (as less aldosterone to retain sodium, and it is a K/Na pump so K not pumped out)

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20
Q

What electrolyte derangement do you get in secondary adrenal insuff?

A

Low sodium, normal potassium (aldosterone not involved, but cortisol has some action on sodium)

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21
Q

What is the effect of congenital adrenal hyperplasia on hormones?

A

Low cortisol

High testosterone

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22
Q

What is the pathophysiology of congenital adrenal hyperplasia?

A

Deficiency of 21-hydroxylase enzyme which catalyses the conversion of progesterone into aldosterone and cortisol, but is not involved in the conversion of progesterone to testosterone. So ALL of the progesterone becomes testosterone so high testosterone, low cortisol and aldosterone.

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23
Q

Inheritance of congenital adrenal hyperplasia

A

Autosomal recessive

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24
Q

Low ADH

A

SIADH

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25
Q

High ADH

A

diabetes insipidus

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26
Q

Test for diabetes insipidus

A

Water deprivation test

Desmopressin stimulation test

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27
Q

Pathophys of primary hyperparathyroid?

A

Parathyroid tumour

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28
Q

How do PTH and calcium change in primary hyperparathyroid

A

Both high

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29
Q

Pathophys of secondary hyperparathyroid?

A

Low vitamin D or CKD results in low calcium so high PTH to try and stimualte

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30
Q

Pathophys of tertiary hyperparathyroid?

A

Long term secondary leads to gland hyperplasia. When secondary is resolved then excess PTH and also calcium

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31
Q

What drug can you give in hyperparathyroid if surgery is inappropriate?

A

Cinacalcet to reduce PTH

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32
Q

How can you test to see if hyperparathyroid might cause kidney damage?

A

24h urine calcium

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33
Q

Causes of hypoparathyroid

A

Surgery, genetic, autoimmune, RT, tumour

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34
Q

What happens to calcium, phosphate and PTH in hypoparathyroid?

A

Calcium and PTH low

Phosphate high

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35
Q

What is the action of PTH on phosphate?

A

Makes the kidneys excrete it in the urine.

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36
Q

In general in endocrinology, if you think there is too much of a hormone being made what type of test do you do?

A

Suppression test

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37
Q

In general in endocrinology, if you think there is not enough of a hormone being made what type of test do you do?

A

Stimulation test

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38
Q

Test for primary adrenal insufficiency?

A

Short synacthen test

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39
Q

What is synacthen?

A

ACTH analogue

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40
Q

What visual field defect can you get in pituitary tumours?

A

Bitemporal hemianopia

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41
Q

What type of pituitary tumour might you treat medically? How?

A

Prolactinoma- give a dopamine agonist

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42
Q

Which cases of hyperthyroid should be referred to endo?

A

All

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43
Q

What order are hormones lost in in pituitary tumours?

A

GH, LH, FSH, TSH, ACTH, Prolactin

good luck for the annual paper

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44
Q

Can you give antithyroid drugs in toxic nodule/ multinodular goitre?

A

No- radioiodine or surgery

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45
Q

Why can you get increased alk phosph and calcium in Graves?

A

High bone turnover as everything is sped up in hyperthyroid

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46
Q

Most likely cause of high TSH

A

pituitary TSHoma

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47
Q

Name two antithyroid drugs

A

carbimazole

propylthiouracil

48
Q

Can you do a block and replace regime for hyperthyroid in pregnancy?

A

No as foetus relies on maternal thyroxine- titrate instead

49
Q

Carbimazole SE

A

Agranulocytosis

50
Q

If multiple hormone deficiencies, which is replaced first?

A

Cortisol

51
Q

T4 AKA

A

thyroxine

52
Q

Intracellularly which thyroid hormone is converted to which?

A

T4 to T3

53
Q

What are the two mechanisms for thyrotoxicosis?

A
  1. increased synthesis of TH (hyperthyroid)

2. increased release of TH from a damaged thyroid gland

54
Q

Rx of thyroiditis?

A

Supportive, can give beta blockers and NSAIDs for Sx

55
Q

What are the two mechanisms by which amiodarone induces thyrotoxicosis

A

Type 1 - high iodine content of the drug provides a substrate for excessive TH synthesis in patients with a previously silent MNG

Type 2- toxic effect of the drug on the thyroid gland- destructive thyroiditis - release of preformed TH

56
Q

What cause of thyrotoxicosis has a tender goitre?

A

De Quervains/subacute thyroiditis

57
Q

What are the causes of a diffuse goitre?

A

Graves

De Quervains

Post partum

Secondary/TSHoma

58
Q

How do you differentiate between true cushings and pseudo cushings? (test)

A

insulin stress test

59
Q

Electrolyte and acid-base imbalance in cushings?

A

Hypokalaemic metabolic alkalosis

60
Q

Calcitonin is a tumour marker for what sort of thyroid cancer?

A

Medullary (originates from the parafollicular cells which produce calcitonin)

61
Q

MEN1 has which cancers

A

parathyroid (hyperPTH, hypercalc)

pituitary

pancrease

62
Q

MEN IIa has what cancers

A

Parathyroid

Phaeochromocytoma

Medullary thyroid

63
Q

What gene MEN II?

A

RET oncogene for both types

64
Q

MEN IIb has what cancers?

A

Phaeochromocytoma

Medullary thyroid ca

Plus marfanoid body habitus and mucosal neuromas

65
Q

What gene for MEN type 1?

A

MEN1

66
Q

T1DM blood glucose targets at waking and at other times in the day

A

5-7 mmol/l on waking

4-7 mmol/l before meals at other times of the day

67
Q

Impaired fasting glucose represents what type of insulin resistance?

A

Hepatic

68
Q

Impaired glucose tolerance represents what type of insulin resistance?

A

Muscle

69
Q

Is impaired glucose tolerance or impaired fasting glucose more likely to progress to T2DM and heart disease?

A

Impaired glucose tolerance

70
Q

Someone has impaired fasting glucose what is next step?

A

Offer OGTT

71
Q

The first-line treatment for a phaeochromocytoma is?

A

Non-selective alpha blocker- phenoxybenzamine.

72
Q

Why do you give alpha blockers before beta blockers in Rx phaeochromocytoma?

A

Otherwise can get hypertensive crisis

73
Q

Antibodies in Graves

A

TSH receptor antibodies

74
Q

Which babies get hyperthyroid?

A

Mother has Grave’s

75
Q

Long term complications of untreated hyperthyroid?

A

Congestive HF

Osteoporosis

76
Q

Which congenital abnormalities have an increased incidence of Hashimoto’s?

A

Down’s and Turner’s

77
Q

5 drugs that cause hypothyroid

A

Antithyroid drugs (carbimazole, propylthiouracil)

Amiodarone (can cause hyper and hypo)

Lithium

alpha interferon

IL2

78
Q

When can someone who’s had a total thyroidectomy expect to be hypothyroid?

A

2-4w

79
Q

When can someone who’s had a SUB total thyroidectomy expect to be hypothyroid?

A

Majority within the first year. If euthyroid at one year then annual chance of hypo is 0.5-1%

May become transiently hypo at 4-8w but then recover

80
Q

When can someone who’s had radioiodine therapy for Grave’s expect to be hypothyroid?

A

Majority within the first year. If euthyroid at one year then annual chance of hypo is 0.5-2%

81
Q

If RT to neck causes hypothyroid how long does it take?

A

years, often preceded by subclinical

82
Q

Does iodine deficiency or excess cause hypothyroid?

A

Both

83
Q

Random diseases that can cause hypothyroid

A

Haemochromatosis

Sarcoid

Amyloidosis

Leukaemia

84
Q

What is a paraneoplastic cause of hypothyroid?

A

Consumptive hypothyroidism - ectopic production of type 3 deiodinase from vascular/fibrotic tumours. This essentially inactivates T3/4 peripherally

85
Q

What other serology changes might someone with hypothyroid have (other than TFT changes)

A

hyperlipidaemia

hyponatraemia

86
Q

How do you start someone under 50 on levothyroxine?

A

Initially: 50-100mcg OD

Titrate: change by 25-50mcg 3-4weekly

Maintenance: 100-200mcg OD

87
Q

How do you start someone over 50 on levothyroxine?

A

Initially: 25mcg OD

Titrate: change by 25mcg 3-4weekly

Maintenance: 50-100mcg OD

88
Q

Why is levothyroxine prescribing different in >50

A

They might have IHD- levothyroxine increases myocardial O2 demand

89
Q

Information for pts on levothyroxine- how to take

A

30 min before breakfast/caffeine/other meds

90
Q

How often should TFTs be monitored on levothyroxine?

A

6 weekly until stable then annually

91
Q

What are severely hypothyroid patients who get an infection/cold exposure/trauma/take opioids at risk of

A

Myxoedema coma

92
Q

Presentation myxoedema coma

A

Coma

Hypothermia

Hypercapnia

Hyponatraemia

Bradycardia

93
Q

Rx myxoedema coma

A

IV liothyronine

Fluids

+IV hydrocort until r/o concurrent adrenal insuff

ICU- ?ventilator

Correct hypothermia

Treat cause

94
Q

Can you give levothyroxine as normal in a suspected adrenal insufficiency patient?

A

Do a short synacthen test as may precipitate addisonian crisis- if confirmed to have then give hydrocort as well

95
Q

Do you replace thyroid hormones in subclinical hypothyroid?

A

Only if:

Pregnant

Serum TSH >10

Goitre

Symptomatic

High serum antiTPO antibodies

96
Q

If you don’t initially treat a subclinical hypothyroid do they require follow up?

A

Yes keep monitoring to see if become overt

97
Q

Affect of oestrogen therapy on levothyroxine?

A

Can increase need for levo

98
Q

If someone is fasted for surgery should they still have levothyroxine replacement?

A

Only if they need to be fasted for >5-7days- then you give it IV at 80% the oral dose.

99
Q

In transient hypothyroid following thyroiditis do you treat?

A

only if symptomatic

100
Q

what is metabolic syndrome?

A

Clustering of CVD risk factors, underlying pathology

may be related to insulin resistance

101
Q

Can metabolic syndrome affect lean individuals?

A

Yes

102
Q

What things are used in diagnosing metabolic synd in adults?

A

at least 3 of:

Waist circ

Triglycerides

HDL

BP

Fasting glucose

103
Q

What percentage of thyroid nodules are malignant and in whom is the risk increased?

A

5%

<20/>70yo

104
Q

Thyroid nodule with what other signs should prompt a 2ww?

A

Regional lymphadenopathy

Child

Voice changes

RT Hx

Persistent pain

FHx endocrine cancer

105
Q

What could sudden pain in a thyroid nodule indicate?

A

Sudden bleed into cyst

106
Q

is the diurnal variation of cortisol maintained in cushings?

A

No

107
Q

Cushing’s disease is what?

A

Pituitary adenoma secreting excess ACTH

108
Q

Once a patient has abnormal urinary cortisol/dex suppression/late night cortisol tests, what needs to be done?

A

Test to determine cause:

-Plasma ACTH (high=ACTH dependent i.e. pituitary or paraneoplastic ACTH production)

Plus MRI pituitary etc as indicated

Most reliable test of cause is inferior petrosal sinus sampling

109
Q

what electrolyte metabolic imbalance in cushing’s

A

hypokalaemic metabolic alkalosis

110
Q

6 causes of cushings syndrom

A

ACTH dependent: 1. pituitary adenoma, 2. ectopic ACTH from a tumour eg lung ca

Non-ACTH dependent: 3. adrenal adenoma, 4. adrenal carcinoma, 5. excess glucocorticoid medication, 6. rare- micro/macronodular adrenal hyperplasia

111
Q

Rx cushing’s caused by ectopic ACTH from tumour

A

Excise tumour

If no remission after this - ketoconazole/metyrapone

112
Q

Rx cushing’s caused by pituitary adenoma

A
  1. transphenoid surgery ±stabilisation beforehand with ketoconazile/metyrapone ±adjuvant RT
  2. if refractory- bilateral adrenalectomy or medical adrenalectomy with mitotane
113
Q

Rx cushing’s caused by adrenal adenoma

A

unilat adrenalectomy

114
Q

Rx cushing’s caused by adrenal carcinoma

A

unilat adrenalectomy + mitotane

115
Q

What do ketoconazole/metyrapone do?

A

Stop cortisol synthesis

116
Q

How do you treat diabetes/HTN caused by cushings?

A

As normal

FINALS medicine (8 decks)

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