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BDS 2 BAMS > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what is the difference between primary and secondary disease

A

primary - problem with the actual gland, graves disease

secondary - a problem in another gland is having an effect on the secretions of another gland

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2
Q

what stimulates release of hormones from pituitary gland

A

hormones or nerve activation from hypothalamis

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3
Q

what hormones are released from pituitary gland

A

anterior - acth, growth hormone, fsh, lh, tsh

posterior - adh, prolactin

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4
Q

what are the types of tumour in the pituitary gland

A

functional - can still release hormones but levels may be skewered,
non-functional - no release of hormones

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5
Q

what is the change of hormones released in functional tumours at different ages

A

younger than 40 - increase in ACTH, stimulates release of cortisol, result in cushings disease
older than 40 - growth hormone, results in acromegaly

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6
Q

what is acromegaly

A

increase in GH but bones have fused so growing bones cannot grow any longer. instead, get increase of bulk in bones in mandible, skull, nose, fingers, feet, and increase in thickness of soft tissue

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7
Q

how can acromegaly be tested for

A

GH test isnt stable, instead measure insulin like growth factor - might have increased spacing or loose fitting denture

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8
Q

what can cause hyperthroidism

A

graves disease - antibody fitting into TSH receptor, stimulating production of thyroid hormone
tumour - more likely to be primary than secondary

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9
Q

what are the symptoms of hyperthyroidism

A

symptoms - sweating, fast heart rate, anxious, ophthalamopy

signs - tachycardia, warm skin, atrial fibrillation, higher BP, goitre

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10
Q

how can hyperthyroidism be treated

A

carbimazole, blocks action of T4, beta blockers to reduce effect, surgery to reduce size

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11
Q

what can cause hypothyroidism

A

hashimoto’s disease - antigens stimulating production of antibodies against thyroid gland
secondary - non-functioning adenoma in pituitary

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12
Q

what are the symptoms of hypothyroidism

A

symptoms - weight gain, constipation, tiredness

signs - bradycardia, hyperlipidaemia, dry coarse skin

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13
Q

how can hypothyroidism be treated

A

by giving thyroxin

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14
Q

how would blood test help to define the cause of hyperthyroidism

A

all causes will have high T3
low TSH - primary cause - graves disease
high TSH - secondary cause - pituitary

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15
Q

how would blood test help to define cause of hypothyroidism

A

all causes will have low T3
low TSH - secondary cause - pituitary tumour
high TSH - primary cause - hashimotos disease

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16
Q

what is the difference between diabetes mellitus and insipidus

A

mellitus - to do with glucose levels in the blood, hyperglycaemia
insipidus - lack of ADH so unable to concentrate urine

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17
Q

how can diabetes mellitus be diagnosed

A

random glucose test - not always accurate, glucose levels may be high if just ate carbohydrates
fasting test - levels of glucose normally
glucose tolerance test - measure levels before eating then 2 hours after, if above 11.1 - diabetes

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18
Q

what causes type 1 diabetes

A

autoimmune disease against insulin, unable to get glucose into cells, antibodies may be - islet cell autoantibody, insulin auto antibodies, glutamic acid decarboxylase

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19
Q

what symptoms are present in type 1

A

diabetes symptoms - polyuria, polydipsia and tiredness

also hyperglycaemia and ketoacidosis

20
Q

what is ketoacidosis

A

diabetics are unable to get glucose into cells so instead use ketones for energy production. acid is produced as a by product, this increases acid in body - can be dangerous or fatal

21
Q

how is type 2 diabetes diagnosed

A

normally from non-type 1

22
Q

why are type 2 diabetics less likely to go into ketoacidosis

A

they have a low level of insulin to prevent it, normally present before it gets to this stage, however, if left long enough they will

23
Q

what causes type 2 diabetes

A

poor diet and lack of exercise, constantly releasing insulin, cells become desensitised, also eventually run out of insulin

24
Q

what complications are normally associated with type 2 diabetes

A

hyperlipidaemia, cardiovascular problems, more unusual infections

25
Q

what are symptoms of type 2 diabetes

A

obesity, hypertension, infections, hyperglycaemia

26
Q

compare type 1 and type 2

A

type 1 - hyperglycaemia with ketoacidosis, presents with diabetic symptoms (polyuria, polydipsia, tiredness), young and thin
type 2 - old and fat, more complications (infections and cardiovascular problems), less likely to go into ketoacidosis

27
Q

how is type 1 diabetes managed

A

insulin injections. can be done by themselves or nurse. doing it themselves - more control over it, can eat when they like, if a nurse - only get it twice a day so need to plan around insulin injections

28
Q

how is type 2 diabetes managed

A

changing lifestyle, diet and exercise, may be on drugs to improve insulin release and increase sensitivity to insulin (sulphonylureas and biguanides)

29
Q

what is hypoglycaemia

A

low blood sugar levels, when take insulin and dont eat, levels get too low, can cause dizzyness, increase in hR and confusion before unconsciousness

30
Q

what are some complications of diabetes

A

hypo, large vessel disease - increased risk of atherosclerosis, angina and hypertension
small vessel disease - poor wound healing, increased infection risk, neuropathy

31
Q

what might cause adrenal hyperfunction

A

primary tumour - adrenal adenoma

secondary - pituitary tumour, functioning

32
Q

what would be the consequence and symptoms of adrenal hyperfunction

A

excess cortisol and aldosterone. cushing’s syndrome symptoms - diabetes type 2 symptoms, weight gain, infections, back pain
signs - hypertension, obesity, thin skin

33
Q

how would the cause of adrenal hyperfunction be investigated

A

check blood levels of ACTH and cortisol
cortisol will always be high
if ACTH high - pituitary tumour, negative feedback not working. if ACTH low - primary tumour

34
Q

what might cause adrenal hypofunction

A

may be autoimmune attacking adrenal gland

or secondary - non-functioning pituitary tumour

35
Q

what are some symptoms of adrenal hypofunction

A

weight loss and lethargy
signs - hypotension, due to lack of aldosterone for fluid reabsorption
addisons disease

36
Q

how can addisons disease be investigated

A

blood test for cortisol and acth
cortisol is always low
if acth low - secondary, pituitary adenoma
if acth high - primary, autoimmune
can also use synthacth - if positive result - primary cause

37
Q

what is addisons crisis

A

hypovolemia, vomiting and fluid loss - need fluid in and iv steroid - lack of aldosterone and cortisol

38
Q

how is addisons disease treated

A

by giving fludrocortisone - replacement for aldosterone and hydrocortisone for cortisol, also fluid replacement

39
Q

what is the difference between patients with addisons disease and those on synthetic steroids

A

addisons disease only need replacement of physiological control, unable to reabsorb fluid so hypovolemia and hypotension, whereas steroids give supra-physiological control, more than they require, normally have hypertension

40
Q

what is the problem with patients on synthetic steroids for a long period of time

A

high levels of cortisol so switch of production of cortisol, can get adrenal atrophy. when they then come off medication, get an increase in ACTH but nothing to stimulate and unable to produce their own cortisol

41
Q

why can the dose of steroid given not fixed

A

because levels of cortisol released is dependant on environment and stimulus, if get an infection, get an increase in cortisol released, in response to stress

42
Q

what patients might require steroid prophylaxis

A

those with addisons disease, only getting enough for physiological normal. those on synthetic steroids already have more than they need so they should be fine for an infection

43
Q

what advice should be given to patients on prednisolone after dental treatment

A

if over 15mg - dont have to do anything, should have enough
if 1-15mg - should double their dose on the day of treatment and for 2 days after, increases just incase of stress they have enough cortisol to prevent adisonian crisis
those who have stopped taking steroids in the past 3 months - should be given just incase

44
Q

what dental treatment requires steroid prophylaxis

A

minor oral surgery or spreading dental infection

routine or restoration - not required

45
Q

what is also common in patients on steroids - dental aspects

A

candida infections, increased risk of diabetes - type 2, other complications also involved - e.g. cardiovascular disease, oral pigmentation

BDS 2 BAMS (12 decks)

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