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Year 3 Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Embryologically, where does the Thyroid originate from?

A

Back of the tongue, then descends down the midline to sit anteriorly to the Thyroid Cartilage in the neck

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2
Q

Anatomically, what does the Thryoid gland consist of?

A

Right and Left lobes connected by a central Isthmus

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3
Q

Which nerves lie in close proximity to the Thyroid Gland?

A

Recurrent Laryngeal nerves

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4
Q

What relation do the Parathyroid glands have to the Thyroid?

A

4, located on the posterior aspect

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5
Q

Where does the blood supply of the Thyroid come from?

A

Superior and Inferior Thyroid arteries

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6
Q

What is Thyroid tissue made of?

A

Colloid which contains iodinated thyroglobulin

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7
Q

Where is Iodinated Thyroglobulin synthesised?

A

Follicular cells

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8
Q

Which neuroendocrine cells does the Thryoid contain, and what do they secrete?

A

C cells, which secrete Calcitonin

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9
Q

Simply, what do Thyroid hormones do?

A

Increase Basal metabolic rate
Influence growth in children
Act on CV, CNS and Reproductive systems

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10
Q

Which hormone does the Hypothalamus release for thyroid function?

A

Thyrotropin Releasing Hormone (TRH)

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11
Q

Which gland does TRH influence, and which hormone does this gland release?

A

Anterior Pituitary, which releases Thyroid Stimulating Hormone (TSH)

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12
Q

What is another name for Hyperthyroidism?

A

Thyrotoxicosis

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13
Q

What are some causes of Hyperthyroidism?

A

Graves Disease (Autoimmune)
Nodular Thyroid disease
Thyroiditis

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14
Q

What is Graves’ Disease?

A

An autoimmune hyperthyroid condition due to the presence of TSH receptor stimulating antibodies

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15
Q

How does Graves’ Disease present?

A

Lid Retraction
Proptosis
Thyroid eye disease
Skin Changes

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16
Q

What Is Nodular Thryoid disease?

A

A condition due to 1/many toxic nodules on the Thyroid. Leads to autonomous secretion of T3/T4

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17
Q

What is Thyroiditis?

A

Inflammation of the Thyroid leading to a thyroxine release. Can be viral, medication related or following childbirth

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18
Q

What are some generalised symptoms of Hyperthyroidism?

A 
Weight loss and increased appetite
Insomnia
Irritability
Anxiety
Heat intolerance
Palpitations
Tremor
Pruritis
Altered Bowel habits
Menstrual distubances
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19
Q

What are some clinical signs of Hyperthyroidism?

A 
Resting Tachycardia
Warm peripheries
Resting tremor
Hyper-reflexia
Lid Lag
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20
Q

How does Hyperthyroidism present in thyroid function tests?

A

Raised T3/T4

Reduced/Absent TSH

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21
Q

What treatment options are there for Hyperthyroidism?

A

Medical
Radioactive Iodine
Surgical

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22
Q

What medical treatments are available for Hyperthyroidism?

A

Thionamides (Carbimazole), which reduce T3/T4 synthesis

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23
Q

How is Radioactive Iodine used to treat Hyperthyroidism?

A

Iodine 131 damages Thyroid tissue, leading to Hypothyroidism

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24
Q

What surgical options are available for Hyperthyroidism?

A

Thyroidectomy

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25
How can Hypothyroidism be sub-classified?
Primary Hypothyroidism - Thyroid issue | Secondary Hypothyroidism - HPA issue
26
What are some causes of Primary Hypothyroidism?
``` Autoimmune - Hashimoto's Thyroiditis Pregnancy Iodine deficiency Drugs - Amiodarone, Lithium Iatrogenic - Surgery, Radioactive Iodine ```
27
What are some causes of Secondary Hypothyroidism?
TSH deficiency due to HPA disease
28
How does Secondary Hypothyroisim present?
Reduced T4 | Normal TSH
29
What are some symptoms of Hypothyroidism?
``` Weight Gain Cold Intolerance Fatigue Constipation Bradycardia Myxoedema - Thickening of Skin, Puffy eyes ```
30
What other condition can present very similarly to Hypothyroidism?
Depression
31
How does Hypothyroidism present in Thyroid Function Tests?
Reduced T4 Raised TSH +ve Thyroid Peroxidase antibodies in Hashimoto's
32
What is the recommended treatment for Hypothyroidism?
50-100microgram/day Thyroxine | If elderly/IHD - 25microgram/day
33
Following treatment for hypothyroidism, what does a persistently elevated TSH suggest?
Under-replacement
34
Following treatment for hypothyroidism, what does an undetectable TSH suggest?
Over-replacement - HPA suppression
35
How can sub-clinical hypothyroidism present?
Normal T4 Elevated TSH Only treat if symptomatic
36
How is Diabetes Mellitus characterised?
Chronically elevated glucose
37
What levels of plasma glucose are seen in Diabetes Mellitus?
Fasting Glucose =>7.0mmol/L | Random Glucose =>11.1mmol/L
38
What value of HbA1c indicates diabetes in a symtomatic patient?
>6.5%
39
What is the cause of Type 1 Diabetes Mellitus?
Pancreatic Islet Beta Cell Deficiency
40
How does Type 1 Diabetes Mellitus present?
Rare Presents in younger patients (<30) Absolute insulin deficiency due to autoimmune Beta cell destruction Patient requires insulin
41
What is the cause of Type 2 Diabetes Mellitus?
Defective insulin action or secretion
42
How does Type 2 Diabetes present?
Common, particularly in middle-aged/older patients | Primarily due to an increased peripheral resistance to insulin
43
What are some rarer causes of diabetes?
``` Exocrine pancreas failure Endocrine disease Gestational diabetes Malnutrition-related diabetes Maturity Onset Diabetes in Young (MODY) - Genetic ```
44
What are some symptoms of Type 1 Diabetes?
``` Rapid onset weight loss, polyuria and polydypsia Ketoacidosis is possible Age <30 Elevated venous plasma glucose Presence of Ketones due to Lipolysis ```
45
What is the generalised treatment for Type 1 Diabetes?
Subcut Insulin
46
What are some symptoms of Type 2 Diabetes?
Overweight | Insidious polyuria and polydypsia
47
What are some complications of Type 2 Diabetes?
``` Ischaemic Heart Disease Cerebrovascular disease Renal failure Foot ulcers Visual impairment ```
48
What is the generalised treatment for Type 2 Diabetes?
Oral hypoglycaemic agents
49
What are some generalised symptoms of diabetes?
Tiredness Weakness Lethargy Weight loss
50
How can complications of diabetes be subclassified?
Microvascular | Macrovascular
51
Why does diabetes have macrovascular complications?
Increases risk of atherosclerosis
52
What conditions do diabetics have an increased risk of?
Stroke - 2x MI - 3-5x Amputation of a foot due to Gangrene - 50x
53
How are the macrovascular risks of diabetes best managed?
Risk stratification of: Hypertension Smoking Lipid Abnormalities
54
What are some microvascular complications of diabetes?
``` Diabetic Retinopathy Diabetic Nephropathy Diabetic Neuropathy Diabetic Foot Infections ```
55
What is Diabetic Retinopathy?
Metabolic consequences of poorly controlled diabetes leads to thickening of basement membrane of small blood vessels of the eye. These then occlude causing retinopathy
56
What is Diabetic Nephropathy?
Diabetes increases GFR due to poor glycaemic control. This gives renal hypertrophy and eventual glomerular sclerosis. This gives Proteinuria and can lead to end-stage renal disease
57
What types of Diabetic Neuropathy are there?
Symmetrical mainly distal polyneuropathy Acute painful neuropathy Mononeuropathy Autonomic neuropathy
58
What are the gross anatomical areas of the adrenal glands?
Outer Cortex | Inner Medulla
59
What are the zones of the adrenal cortex called and what do they produce?
Zona Glomerulosa - Aldosterone Zona Fasciculata - Cortisol Zona Reticularis - Androgens
60
How can the hormones produced by the adrenal glands be classified?
Glucocorticoids Mineralocorticoids Androgens
61
What is the primary role of Glucocorticoids?
Primarily affect Carbohydrate metabolism
62
What is the primary role of Mineralocorticoids?
Effect extracellular balance of Sodium and Potassium in the DCT of the kidney
63
What is the primary role of Androgens?
Important role in adult females and developing humans
64
What actions do Glucocorticoids increase/stimulate?
``` Gluconeogenesis Glycogen deposition Protein catabolism Fat deposition Sodium retention Potassium loss Free water clearance Uric acid production Circulating neutrophils ```
65
What actions do Glucocorticoids decrease/inhibit?
``` Protein synthesis Host response to infection Lymphocyte transformation Delayed hypersensitivity Circulating lymphocytes Circulating eosinophils ```
66
What is the Adrenal Medulla made of?
Tissue of the SNS
67
What is the Adrenal Medulla responsible for releasing?
Adrenaline Noradrenaline Dopamine
68
What is Primary Adrenal insufficiency also known as?
Addison's Disease
69
What causes Addison's Disease?
Destruction of the entire adrenal cortex leads to reduced hormone production
70
What are some causes of Addison's disease?
Autoimmune disease TB Surgical removal of adrenals Haemorrhage/infarct
71
What are some symptoms of Addison's disease?
``` Weight loss + Anorexia Malaise + Weakness Fever Depression Impotence/Amenorrhoea Nausea + Vomiting Diarrhoea Confusion Postural Hypotension Abdo Pain ```
72
What are some clinical signs of Addison's disease?
``` Hyperpigmentation Buccal pigmentation Loss of weight General wasting Dehydration Loss of body hair ```
73
What will investigations demonstrate in Addison's disease?
``` Hyponatraemia Hyperkalaemia Raised urea Hypoglycaemia Mild anaemia Reduced 9am Cortisol Raised ACTH ```
74
What is the management for Addison's disease?
Glucocorticoid replacement - Hydrocortisone/Fludrocortisone
75
Which hormone is released by the Hypothalamus in response to stress/circadian stimuli?
Corticotrophin Releasing Hormone (CRH)
76
What does the anterior pituitary release in response to raised CRH?
Adrenocorticotrophin Hormone (ACTH)
77
What does ACTH make the adrenal glands release?
Cortisol
78
What effects does Cortisol have on the Anterior Pituitary + Hypothalamus?
-ve Feedback
79
When does circadian release of ACTH/Cortisol peak?
Between 8-9am
80
What is an Addisonian Crisis?
A medical emergency due to an acute deficiency of Cortisol
81
What are some symptoms of an Addisonian crisis?
``` Abdo pain Confusion, LOC or Coma Dehydration Dizziness Fatigue Headache Fever Loss of Appetite ```
82
What will biochemistry demonstrate in an Addisonian crisis?
``` Hypotension Hyponatraemia Hyperkalaemia Hypoglycaemia Dehydration ```
83
What is the recommended immediate management of an Addisonian crisis?
1 litre of 0.9% Saline over 30-60 minutes with 100mg IV Hydrocortisone
84
What can cause secondary hypoadrenalism?
Hypothalamic-Pituitary Disease - Inadequate ACTH | Long term steroid therapy leading to hypothalamic-pituitary-adrenal suppression
85
Why are adrenal medullary tumours concerning?
They are Catecholamine (Adrenaline/Noradrenaline) secreting
86
Where are the majority of Phaeochromocytomas found?
90% are from the Adrenal Medulla
87
Where else can catecholamine secreting tumours be found?
Elsewhere in the chain | 10 % - called Paraganglioma
88
What are some symptoms of a Phaeochromocytoma?
``` Anxiety Palpitations Tremor Sweating Headache Flushing Nausea and Vomiting Weight loss Chest Pain Polyuria ```
89
What are some clinical signs of a Phaeochromocytoma?
``` Hypertension Tachycardia/arrhythmias Bradycardia Orthostatic hypotension Pallor Glycosuria Fever ```
90
What investigations are appropriate for a suspected Phaeochromocytoma?
Raised Catecholamines on biochemistry | CT/MRI/PET
91
What is the recommended treatment for Phaeochromocytoma?
Surgical excision
92
What medication should be started once Phaeochromocytoma is confirmed?
Alpha Blocker - Hypertension | Beta Blocker - Arrhythmias
93
What value of serum sodium is considered the lower limit of normal?
135mmol/L
94
In terms of blood volume, how can hyponatraemia be classified?
Hypovolaemic Euvolaemic Hypervolaemic
95
How can causes of hyponatraemia be generally classified?
Renal | Extra-renal
96
What are some early signs of Hyponatraemia?
Headache Nausea Vomiting General malaise
97
What are some late signs of Hyponatraemia?
Confusion Agitation Drowsiness
98
What can acute severe hyponatraemia lead to?
Seizures Respiratory depression Coma Death
99
If a patient is confirmed to have hypotonic hyponatraemia, what should be checked next?
Urine Osmolality
100
In hyponatraemia, what does a Urine Osmolality of <100mOsmol/kg suggest?
Primary polydypsia Inappropriate IV fluid prescription Inadequate intake
101
In hyponatraemia, what does a Urine Osmolality of >100mOsmol/kg suggest?
Cause unknown, check urine sodium
102
In hyponatraemia, what does a Urine Sodium value of <30mmol/L suggest?
Low effective arterial volume (Dehydration, CCF, Nephrotic syndrome)
103
In hyponatraemia, what does a Urine Sodium value of >30mmol/L suggest?
?SIADH ?Addison's ?Hypothyroidism
104
What is SIADH?
A condition characterised by excessive/inappropriate secretion of ADH
105
Which tumours can cause SIADH?
``` SCC of Lung Prostate Thymus Pancreas Lymphomas ```
106
Which Pulmonary Lesions can cause SIADH?
Pneumonia TB Lung Abscesses
107
What are some CNS causes of SIADH?
``` Meningitis Tumours Head injury SLE Vasculitis ```
108
What are some metabolic causes of SIADH?
Alcohol withdrawal | Porphyria
109
What are some common symptoms of SIADH?
Dilutional hyponatraemia Euvolaemia Low plasma osmolality with inappropriate urine osmolality Continued urinary sodium excretion >30mmol/L Absence of Hypokalaemia Normal renal and thyroid function
110
What is the generalised treatment for Hyponatraemia?
Identify and Correct cause | Consider fluid restriction if dilutional hyponatraemia
111
What controls most peripheral hormone systems?
The Hypothalamus and Pituitary
112
Where is the Pituitary gland located?
The pituitary fossa at the base of the brain
113
What lies in close anatomical relation to the Pituitary gland?
Optic Chiasm superiorly | Cavernous sinuses laterally
114
What is the anterior pituitary formed from?
Upgrowth of Rathke's Pouch
115
What is the posterior pituitary formed from?
The floor of the third ventricle
116
Which hormones are released from the posterior pituitary?
ADH | Oxytocin
117
Which hormones act upon the anterior pituitary?
``` Gonadotrophin Releasing Hormone (GnRH) Growth Hormone Releasing Hormone (GHRH) Dopamine Thyrotrophin Releasing Hormone (TRH) Corticotrophin Releasing Hormone (CRH) ```
118
Which hormones are synthesised by the anterior pituitary, and which hormone triggers their release?
``` LH + FSH - GnRH Growth Hormone - GHRH Prolactin - Dopamine TSH - TRH ACTH - CRH ```
119
Which hormonal axes is the pituitary gland a key member of?
``` Growth Axis Adrenal Axis Gonadal Axis Thyroid Axis Prolactin ```
120
What is the physiological process in the growth axis?
Growth hormone is secreted in a pulsatile manner. It acts on the liver to produce insulin-growth factor 1. GH is important in MSK growth in children, and has a role in adults
121
Which hormone increases activity of the growth axis?
GHRH
122
Which hormone decreases activity of the growth axis?
Somatostatin
123
Which hormone increases activity of the adrenal axis?
CRH
124
Which hormone decreases activity of the adrenal axis?
Cortisol
125
What is FSH reponsible for?
Ovarian follicle development in women | Sperm production in men
126
What is LH responsible for?
Ovulation in women | Testosterone secretion from Leydig cells in men
127
Which hormone increases activity of the gonadal axis?
GNRH
128
Which hormones decrease activity of the gonadal axis?
Testosterone Oestrogen Prolactin
129
Which hormone increases activity of the Thyroid axis?
TRH
130
Which hormone decreases activity of the Thyroid axis?
Thyroxine
131
What does Prolactin do?
Causes lactation | Has a direct inhibitory effect on LH and FSH
132
Which hormone increases Prolactin activity?
TRH
133
Which hormone decreases Prolactin activity?
Dopamine
134
How can Pituitary tumours present?
Due to the mass defect | Due to hormonal excess
135
What may functional pituitary tumours present with?
Acromegaly (GH) Cushings (ACTH) Prolactinoma (Prolactin) TSHoma (TSH)
136
How do non-functional pituitary tumours present?
Hypopituitarism | Compression of Local structures
137
How are hormone levels affected in hypopituitarism?
All hormones except prolactin decrease
138
What other effect can a pituitary tumour lead to?
Alteration of visual fields
139
When can Prolactin and TSH levels be measured?
Any time
140
When should LH and FSH be measured in women?
Within the first 5 days of the menstrual cycle
141
When should LH and FSH be measured in men?
At 9am with the patient in a fasting state
142
When should Cortisol be measured?
9am
143
What does the Synacthen test measure?
Adrenal failure
144
How does the Synacthen test work?
After 2 weeks of ACTH deficiency, the adrenal cortex atrophies. It therefore doesn't respond well to synthetic ACTH
145
How does the Insulin Tolerance Test work?
Insulin-induced hypoglycaemia is a physiological stress that should lead to ACTH and GH risis. If it doesn't, it suggests a Pituitary axis problem
146
What imaging modalities are appropriate for a suspected pituitary lesion?
MRI/Functional MRI PET CT if unable to have MRI
147
When does physiological hyperprolactinaemia occur?
``` Pregnancy Lactation Severe stress Sleep Coitus ```
148
What is considered a mild elevation of Prolactin?
400-600mU/L
149
What do Prolactin levels of 5000mU/L or above suggest?
Prolactin-secreting Pituitary tumour
150
What are some causes of Hyperprolactinaemia?
``` Prolactinoma Co-secretion of Prolactin in Acromegalous tumours Stalk compression by pituitary adenomas PCOS Primary Hypothyroidism Dopamine antagonists ```
151
How does Hyperprolactinaemia present clinically?
Galactorrhoea Oligomenorrhoea/Amenorrhoea Decreased libido Subfertility
152
What is the recommended treatment for Hyperprolactinaemia?
Dopamine (D2) Agonist, Cabergoline/Bromocriptine
153
What are Non-Functioning Pituitary Adenomas?
Biologically inactive pituitary tumours that can present with visual field defects, headaches or hypopituitarism
154
When is surgical intervention recommended with non-functioning pituitary adenomas?
If visual loss is a risk
155
How can common causes of hypopituitarism be classified?
Congenital | Acquired
156
What are some causes of hypopituitarism?
Pituitary tumour Inflammatory/Infiltrative disorders Traumatic brain injury Radiotherapy
157
What are some symptoms of hypopituitarism?
Lethargy Weight gain Sexual dysfunction
158
What is the recommended treatment for an ACTH deficiency?
Hydrocortisone
159
What is the recommended treatment for a TSH deficiency?
Thyroxine
160
What is the recommended treatment for a Gonadotropin deficiency in men?
Testosterone
161
What is the recommended treatment for a Gonadotropin deficiency in women?
Oestrogen and Progesterone
162
What is the recommended treatment for a Growth Hormone deficiency?
Daily Growth Hormone injections
163
What causes Acromegaly?
A growth-hormone secreting pituitary tumour
164
What is the equivalent of Acromegaly in children?
Gigantism
165
What are some symptoms of Acromegaly?
``` Increased size of hands and feet Headaches Excessive sweating Tiredness Weight gain Impotence/poor libido Goitre Deep voice Breathlessness ```
166
What are some physical signs of Acromegaly?
``` Prominent Supraorbital ridge Large tongue Hirsuitism Thick greasy skin Hypertension Heart Failure Arthropathy ```
167
What investigation is appropriate with suspected Acromegaly?
Oral Glucose Tolerance test
168
What is found with the Oral Glucose Tolerance test in Acromegaly?
Failure to suppress GH levels after OGTT, raised IGF-1
169
What will an MRI show in Acromegaly?
Pituitary tumour
170
What is the management steps of confirmed Acromegaly?
Surgery - Treatment of choice Somatostatin analogues may improve symptoms Radiotherapy
171
After treatment, what should be monitored regularly in acromegalous patients?
Sleep apnoea Diabetes CV Risk
172
What is Cushing's Syndrome?
Term used to describe the clinical state of increased circulating free glucocorticoid
173
How can the conditions causing Cushings be subdivided?
ACTH-Dependent Cushings | Non-ACTH Dependent Cushings
174
What are some ACTH dependant causes of Cushings syndrome?
Pituitary Dependent - Cushings Disease Ectopic ACTH-Producing tumours ACTH Administration
175
What are some Non-ACTH dependant causes of Cushings syndrome?
Adrenal adenomas/carcinomas Glucocorticoid administration Alcohol-induced pseudo-cushings
176
What are some common physical signs of Cushings Syndrome?
``` Plethoric, moon-shaped face Thin Skin Central obesity Bruising Poor wound healing Purple/Red striae Dorsal Fat Pad - "Buffalo Hump" ```
177
Which investigations are appropriate with suspected Cushings Syndrome, and what will they show if positive?
24h Urine Cortisol - Raised | Low Dose Dexamethasone Suppression Test - Fails to suppress to <50nmol/L
178
What are some differentials of causes of Cushings syndrome, and which symptoms suggest each cause?
Pituitary tumour Adrenal tumour - Hirsuitism Ectopic ACTH - Hypokalaemia, weight loss
179
What is the recommended management for confirmed Cushings syndrome?
Adrenal tumour - Laparoscopic removal Ectopic ACTH - Manage/Treat causative tumour Cushings Disease - Trans-sphenoidal pituitary removal
180
Which 2 things can both lead to Diabetes Insipidus?
Deficiencies of Vasopressin (ADH) | Insensitivity to the actions of ADH
181
What symptoms does Diabetes Insipidus present with?
Polyuria - 10-15L/day in some cases Nocturia Compensatory Polydypsia
182
What is a real risk in patients with Diabetes Insipidus?
Severe dehydration
183
What are the two broad classes of causes of Diabetes Insipidus?
Cranial | Nephrogenic
184
What are some Cranial causes of Diabetes Insipidus?
``` Familial Idiopathic Tumours - Hypothalamic/Pituitary Hypothalamo-Pituitary surgery Infections Trauma ```
185
What are some Nephrogenic causes of Diabetes Insipidus?
Renal Disease Hypokalaemia Hypercalcaemia Drugs
186
How does Diabetes Insipidus present biochemically?
High Serum Osmolality Low Urine Osmolality High Urine Volume
187
What are the diagnostic criteria for Diabetes Insipidus?
Urine Volume >3L in 24h with: Serum Osmolality >295mOsmol/Kg Urine Osmolality <300mOsmol/Kg
188
What can the Water Deprivation test be useful in diagnosing?
Suspected Diabetes Insipidus
189
How will patients with Diabetes Insipidus respond to the Water Deprivation test?
Unacceptable thirst | Weight loss
190
What is given during the water deprivation test?
WDT Synthetic Vasopressin (DDAVP)
191
How does Cranial DI respond to DDAVP during the water deprivation test?
Reduced urine output
192
How does Nephrogenic DI respond to DDAVP during the water deprivation test?
Unaffected urine output
193
What are the generalised management steps for confirmed Diabetes Insipidus?
Manage underlying/causative disease | DDAVP/Desmopressin administration
194
Ordinarily, how many Parathyroid glands are there, and where are they located?
4, posterior aspect of thyroid
195
Where can additional Parathyroid glands sometimes be found?
In the neck/mediastinum
196
Which cells of the Parathyroid secrete PTH?
Chief cells
197
When is PTH secreted by the Parathyroid glands?
When serum Ca falls
198
How does PTH increase serum calcium?
Increases osteoclastic resorption of bone Increases intestinal Ca2+ absorption Increased synthesis of 1,25-(OH)2D3 - Vit D Precursor Increase renal tubular resorption of Calcium Increased excretion of Phosphate
199
What is Hypercalcaemia?
Serum Ca >2.6mmol/L
200
What are the most common causes of Hypercalcaemia?
Primary Hyperparathyroidism | Malignancies
201
What does Hypercalcaemia + a reduced PTH suggest?
Malignancy until r/o
202
What does Hypercalcaemia + a normal PTH suggest?
Hyperparathyroidism until r/o
203
What are some non-specific symptoms of hypercalcaemia?
``` Tiredness Generalised aches and pains Polyuria + Polydypsia - Nephrogenic DI Abdo pain and constipation Kidney stones ```
204
What is a useful rhyme to remember hypercalcaemia symptoms?
Moans, Stones, Groans and Bones
205
What biochemical markers will be present in primary hyperparathyroidism?
Hypercalcaemia Raised/Normal PTH Reduced Phosphate Raised ALP
206
When is surgery recommended in Hypercalcaemia?
If Serum Ca >2.85mmol/L or symptoms are debilitating
207
What is Hypocalcaemia?
Serum Calcium <1.9mmol/L
208
What are some causes of Hypocalcaemia?
Post-surgical Hypoparathyroidism Vitamin D Deficiency Hypomagnesia
209
Why does Post-surgical Hypoparathyroidism occur?
Post thyroidectomy, can be temporary or can be due to removal of parathryoid glands
210
What are some clinical features of acute hypocalcaemia?
Laryngospasm Prolonged QT Seizures
211
What are some clinical features of sub-acute hypocalcaemia?
Muscle cramps Carpo-pedal spasm Peri-oral and peripheral paraesthesia Neuropsychiatric signs
212
What is Chvostek's Sign?
Facial spasm when the cheek is gently tapped with a finger. Seen in hypocalcaemia
213
What is Trousseau's Sign?
Carpo-pedal spasm induced after inflating a BP cuff. Seen in hypocalcaemia
214
What is the recommended treatment for Vit. D deficiency?
Cholecalciferol - 20 000 IU for 7 weeks loading | 1-2000 IU for maintenance
215
What is the recommended treatment for Hypoparathryoidism?
1-alphacalcidol | Calcitrol
216
What can be a risk with excessive treatment of hypocalcaemia?
Nephrocalcinosis
217
What is Pseudohypoparathyroidism?
Rare G-Protein mutation leading ot PTH resistance
218
How does Pseudohypoparathyroidism present?
Hypocalcaemia + Raised Phorphate High PTH Normal Vitamin D
219
What is the characteristic appearance suggestive of Pseudohypoparathyroidism?
Short stature Round Face Short 4th and 5th Metacarpals

Year 3 Medicine (8 decks)

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