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GRACE Phase 2a Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is phaeochromocytoma?

A

Rare tumour that secretes catecholamines

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2
Q

Clinical presentation of phaeochromocytoma?

A

headache, profuse sweating, palpitations, tremor

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3
Q

Ix for phaeochromocytoma?

A

24hr urinary total catecholamines, CT

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4
Q

Carcinoid tumours

A

slow growing type of neuroendocrine tumour (arising from the cells in the endocrine and NS), commonly occur in the intestines, but are also found in the pancreas and lungs

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5
Q

Carcinoid syndrome

A

Group of symptoms due to the release of serotonin and other vasoactive peptides into the systemic circulation due to a carcinoid tumour

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6
Q

Presentation of carcinoid syndrome

A

Diarrhoea, abdominal cramps, palpitations, signs of R heart failure, bronchospasm

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7
Q

Ix for carcinoid syndrome?

A

high volume of 5-hydroxyindoleacetic acid (breakdown product of serotonin), LFTs

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8
Q

When does ketogenesis occur?

A

When the body is starved of glucose and glucagon stores are used, phenomenon also occurs in diabetes

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9
Q

What happens in ketogenesis?

A

Liver takes fatty acids –> ketones (from acetyl CoA - ketones = water soluble fatty acids). Ketones can cross the BBB

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10
Q

What is the problem with ketogenesis in diabetics?

A

Ketones = acidic, normally buffered, in T1DM –> metabolic acidosis

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11
Q

Cardinal symptoms of T1DM?

A

weight loss, polyuria, polydysia

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12
Q

Why do you get polyuria in T1DM?

A

More glucose than normal in nephron - therefore less water reabsorbed –> more urine

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13
Q

Normal glucose range /mmol/L?

A

4-6mmol/L

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14
Q

Fasting glucose levels for diabetics? Random?

A

Fasting - >7 mmol/L

Random - >11 mmol/L

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15
Q

GS test for DM?

A

HbA1c - glycated Hb >48mmol/L

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16
Q

Mx of T1DM

A

SC insulin, long acting once daily, short acting before meals

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17
Q

Fasting glucose levels for pre-diabetics? Random?

A

Fasting - 6.1-6.9 mmol/L

Random - 7.8-11.0 mmol/L

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18
Q

Px of T2DM

A

asymptomatic

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19
Q

Mx of T2DM

A
  1. lifestyle advice

2. Metformin (+sulfonylurea)

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20
Q

Signs of hypoglycaemia

A

Sweating, pallor, tachycardia, confusion

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21
Q

Respiration typical of DKA?

A

Kussmauls - deep and rapid, reduce acidosis

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22
Q

Complications of diabetes

A

hypoglycaemia, DKA

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23
Q

What is hepatomegaly?

A

Excessive release of GH, most often due to pituitary adenoma

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24
Q

Presentation of acromegaly?

A

Large extremities, coarsening of facial features, bitemporal hemianopia, large protruding jaw

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25
Ix for acromegaly?
1. IGF-1 blood test 2. Oral glucose tolerance (high glucose --> suppresses GH normallu) 3. MRI scan 4. Visual field test
26
Mx for acromegaly?
1. Trans-sphenoidal surgical removal of adenoma 2. GH antagonist - pegvisomant 3. Somatostatin analogue (inhibits GH release) - ocretide
27
Highest point of cortisol release?
Morning
28
Functions of cortisol
Stress hormone, increased energy source by carbohydrate breakdown and protein, diminished host response, vasoconstriction
29
Causes of Cushings
Iatrogenic - oral steroids Cushings (too much ACTH) Pituitary adenomas
30
Px of Cushings?
Central obesity, moon face, stretch marks, poor healing, proximal muscle wasting, depression, HTN
31
Ix of Cushings?
Overnight dexamethasone suppression test, 24hr urinary cortisol
32
Mx of Cushings?
Stop steroids | tumour removal
33
Addisons/Primary adrenal insufficiency
Disorder causing reduced production of adrenocortical hormones, most commonly due to autoimmune destruction of the adrenal gland (Addisons)
34
mnemonic for cardinal symptoms of Addisons?
Tanned, toned, tired, tearful
35
Ix for Addisons?
1. Short ACTH stimulation test (Synacthen) - doesn't lead to cortisol production 2. Urinary/serum electrolytes (hyponatraemia, hyperkalaemia)
36
Mx of Addisons?
Oral hydrocortisone - cortisol | Fludrocortisone - aldosterone
37
Common cause of secondary hyperaldosteronism?
Renal artery stenosis (increased production of renin due to decreased perfusion in the kidneys)
38
Conn's syndrome/ hyperaldosteronism?
Hypersecretion of aldosterone due a pituitary adenoma or bilateral adrenal hyperplasia most commonly
39
Hallmarks of Conn's syndrome
1. HTN | 2. Hypokalaemia (weakness, irritability, polyuria/nocturia)
40
Ix for Conn's?
1. U+E's - decreased renin and increased aldosterone | 2. Hypokalaemic ECG
41
Mx for Conns?
1. Laparascopic adrenalectomy | 2. Aldosterone anatagonist - spironolactone
42
Which cells secrete calcitonin? When is this release?
Parafollicular C cells, low serum calcium
43
TRH
thyrotropin releasing hormone is secreted from the paraventricular nucleus fo the hypothalamus, causing the release of TSH from the anterior pituitary
44
Building blocks of thyroid hormone
Tyrosine (amino acid) and iodine are assembled onto the glycoprotein thyroglobulin, synthesis occurs in the colloid of the follicle
45
Thyroid autoantibodies
Antithyroid peroxidase antibodies, anti-thyroglobulin antibodies
46
2 types of autoimmune thyroid disease
1. Graves - hyper | 2. Hashimotos - hypo
47
Thyroid function test
1. Levels of TSH, levels of free T3 and T4 2. Thyroid autoantibodies 3. TSH receptor antibody (Graves) 4. US 5. Radioactive iodine isotope scan
48
Causes of hyperthyroidism?
1. Graves disease (60-80%) 2. Toxic multinodular goitre 3. Thyroid adenoma 4. Pituitary adenoma (secondary)
49
Clinical px of hyperthyroidism
Goitre, weight loss and increased appetite, heat intolerance and sweating, tremor, palpitations, anxiety/irritability
50
Clinical px specific to Graves (IgG TSH antibodies)
Buldging eyes (exopthalmos), pretibial myoxedema
51
Graves disease
Autoimmune cause of hyperthyroidism due to production of excessive IgG antibodies stimulation TSH receptors
52
Thyrotoxicosis
excessive amounts of TH, hospital admission - beta-blockers, anti-arrhythmatic medication
53
Mx for hyperthyroidism
1. Anti-thyroid drugs - carbimazole 2. Radioactive iodine 3. Surgery
54
Types of thyroid autoantibodies
Antithyroglobulin, antithyroid peroxidase, TSH receptor antibody (Graves)
55
Commonest cause of hypothyroidism - developing and then Western world?
Iodine deficiency, autoimmune disease
56
Hashimotos thyroiditis
Form of autoimmune hypothyroidism - anti-thyroid peroxidase, anti-thyroglobulin antibodies --> goitre
57
Px of hypothyroidism?
``` Weight gain, moon face Cold intolerance, dry skin Depressed, irritable, fatigue Constipated Goitre Fluid retention - oedema ```
58
Drug that interferes with TH synthesis, can cause both hypo- and hyperthyroidism (mainly hypo)?
Amiodarone (anti-arrhythmic), iodine rich, structurally like T4, 2% of px will get thyroid issues from it
59
Tx for hypothyroidism?
Replace thyroid hormone - levothyroxine (CI in px with IHD)
60
Myxoedema coma?
Complication of hypothyroidism - hypothermic, hypotensive, bradycardic - IV levothyroxine
61
Levothyroxine
Synthetic T4
62
4 cardinal symptoms of thyroid cancer?
1. Hard, irregular thyroid nodules 2. Hoarseness of voice 3. Dysphagia (difficulty swallowing) 4. Enlarged lymph nodes
63
Dx of thyroid cancer
1. US | 2. Fine needle aspiration and biopsy
64
Tx for thyroid cancer
Radioactive iodine
65
Px of hyperparathyroidism/ hypercalcaemia?
Stones, bones, groans and psychiatric moans
66
PTH acts to ?
Raise serum calcium by: 1. Increasing bone resorption 2. Increasing Ca2+ renal reabsorption 3. Forming active vit D --> intestinal uptake of Ca2+ increased
67
Causes of primary hyperparathyroidism?
Parathyroid adenoma
68
Tx for primary hyperparathyroidism?
Increased Ca2+ and PTH
69
Hypoparathyroidism causes
Autoimmune, Vit D deficiency
70
SIADH
syndrome of inappropriate ADH secretion, excessive ADH --> increased water retention --> hyponatraemia
71
Causes of SIADH
Infection, problem with posterior pituitary, SCLC
72
px of SIADH
Headache, fatigue, muscle aches and cramps, confusion
73
Mx of SIADH
Treat underlying cause, restrict fluid intake,
74
Hypercalcaemia sx
Bones, stones, groans, psychiatric moans
75
hypocalcaemia sx (SPAS)
spasms paraesthesia anxiety seizures
76
Causes of hypercalcaemia?
Primary hyperparathyroidism, malignancy
77
Causes of hypocalcaemia?
Vit D deficiency, hypoparathyroidism, CKD
78
ECG presentation of hypercalcaemia/hypo?
Short QT interval - hyper | Long Qt interval - hypo
79
1st line mx for px with DKA?
IV fluids (not insulin)

GRACE Phase 2a Medicine (20 decks)

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