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Finals > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What causes a primary adrenal insufficiency? (5)

A 
Adrenal gland affected:
Addison's disease
Malignancy e.g. adrenal mets, lymphoma
Infection e.g. TB, HIV
Adrenal haemorrhage 
Congenital adrenal hyperplasia
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2
Q

What causes a secondary adrenal insufficiency?

A

Pituitary gland dysfunction e.g. radiation, Sheehan syndrome

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3
Q

What causes a tertiary adrenal insufficiency?

A

Hypothalamus gland dysfunction e.g. long-term steroids suppresses activity

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4
Q

What signs are present in Addison’s disease? (2)

A

Hyperpigmentation

Postural hypotension

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5
Q

What special test do you use to diagnose Addison’s disease?

A

Short Synacthen test (ACTH stimulation test)

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6
Q

What blood tests are required to investigate Addison’s (apart from FBC, LFTs, U&Es)? (6)

A 
Cortisol
ACTH (differentiates between primary and secondary)
Renin (high) and aldosterone (low)
Adrenal autoantibodies
Glucose
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7
Q

What electrolyte abnormalities would you expect in Addison’s? (5)

A

Low sodium and raised potassium

Other: low calcium and glucose, raised urea

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8
Q

What is the management of an Addisonian crisis?

A

Hydrocortisone 100mg STAT then every 6h
Monitor fluid balance
Monitor U&Es, glucose and ECG

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9
Q

What are the main pituitary dependent causes of Cushing’s? (2)

A

Cushing’s disease (pituitary adenoma)
Ectopic production e.g. SCLC producing ACTH

In these cases, the rise in cortisol is due to increase in ACTH; therefore will have raised ACTH in bloods

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10
Q

What are the main pituitary independent causes of Cushing’s?

A

Iatrogenic i.e. taking steroids - ACTH will be decreased due to negative feedback
Adrenal adenoma - cortisol production no longer listens to ACTH

In these cases, the ACTH will be low due to negative feedback; therefore will have low ACTH in bloods

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11
Q

What special test diagnoses Cushing’s syndrome?

A

Dexamethasone suppression test

If suppressed on 1mg dexamethasone, rules out dexamethasone
Then give 8mg

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12
Q

What is a probable diagnosis?

  1. High dose dexamethasone - cortisol suppressed, ACTH raised
  2. High dose dexamethasone - cortisol, not suppressed, ACTH raised
  3. High dose dexamethasone - cortisol, not suppressed, ACTH low
A
  1. Pituitary adenoma (Cushing’s disease)
  2. Ectopic ACTH
  3. Adrenal adenoma
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13
Q

What would you expect to see on an ABG for Cushing’s syndrome?

A

Hypokalaemic metabolic alkalosis

This is because an excess of mineralcorticoids causes sodium to be retained (causing hypertension) and potassium and hydrogen to be lost (K+ and H+ have same transporter)

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14
Q

So you’ve successfully diagnosed Cushing’s syndrome, now how would you find the culprit?

  1. Suspecting pituitary adenoma
  2. Suspecting ectopic or adrenal adenoma
A
  1. MRI of pituitary and bilateral inferior petrosal sinus sampling (IPSS)
  2. CT TAP
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15
Q

What are the causes of primary hyperaldosteronism?

A

Conn’s syndrome (adenoma), bilateral adrenal hyperplasia

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16
Q

What are the causes of secondary hyperaldosteronism?

A

Anything that raises renin e.g. renal artery stenosis, renin-secreting tumour, fibromuscular dysplasia, coarctation of aorta, diuretics

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17
Q

What is hyperaldosteronism most likely to present with?

A

Hypertension

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18
Q

What would you likely see on an ABG in hyperaldosteronism?

A

Hypokalaemic metabolic alkalosis

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19
Q

What special test is used in hyperaldosteronism?

A

Aldosterone-renin ratio

20
Q

What is the medical management of hyperaldosteronism?

A

K+ sparing diuretics e.g. spironolactone, eplerenone

21
Q

What are some secondary causes of diabetes?

A

Pancreatic disease e.g. chronic pancreatitis, cystic fibrosis, haemochromatosis
Endocrine e.g. Cushing’s, thyrotoxicosis, acromegaly
Medication e.g. steroids, atypical antipsychotics, thiazide diuretics

22
Q

What is the diagnostic criteria for diabetes, assuming they have symptoms? (3)

A

Random blood glucose >11.1
Fasting glucose >7.0
HbA1c >48 (not suitable for type 1 or secondary cause)

If no symptoms, need 2 tests on different days to diagnose

23
Q

What is the diagnostic criteria for impaired glucose tolerance?

A

Fasting glucose 6.1-6.9 AND 2h post glucose >7.8, <11.1

HbA1c 42-47

24
Q

What initial bloods would you get when investigating diabetes (apart from glucose)?

A

U&Es, eGFR, urine ACR
Full lipid profile, HbA1c
TFTs, coeliac screen

25
Q

What tests can you order if you are not sure if it is type 1 or type 2 diabetes? (2)

A

C-peptide and autoantibodies (e.g. anti-GAD, IAA)

26
Q

Can you name the type of diabetic drug and the common side effects?

  1. Metformin
  2. Sitagliptin
  3. Exanetide
  4. Gliclazide
  5. Dapagliflozin
  6. Pioglitazone
A
  1. Biguanide - diarrhoea, nausea, lactic acidosis
  2. DDP-4 inhibitor - GI upset, pancreatitis
  3. GLP-1 mimetic - GI upset, asthenia, NB women must be on effective contraception
  4. Sulfonylurea - weight gain, hypoglycaemia
  5. SGLT-2 inhibitors - UTIs, weight loss
  6. Thiazolidinediones - weight gain, fluid retention, bladder cancer, osteoporosis, heart failure
27
Q

Which of the type 2 medications is not used for dual therapy and when is it used?

A

Exanetide - only used if BMI >35 and insulin contraindicated

28
Q

What is the management for hypoglycaemia?

A

If alert, can give glucose orally e.g. glucogel, sugar lumps, Lucozade and cola
If cannot take orally, give IV glucose 20% in a large vein or IM glucagon

29
Q

What is the management for DKA? (7)

A

F - fluids
I - rapid acting insulin, fixed rate 0.1U/kg/h
G - closely monitor, give 10% dextrose after if falls below 14
P - monitor potassium
I - infection and other triggers (look for them)
C - chart fluid balance
K - ketones (monitor hourly)

When in doubt, follow the local DKA protocol!

30
Q

What are the stages of diabetic retinopathy? (3)

A
  1. Background - microaneurysms and hard exudates
  2. Pre-proliferative - cotton wool spots, dot and blot haemorrhages
  3. Proliferative - symptomatic e.g. floaters or sudden vision loss; at risk of vitreous haemorrhage
31
Q

What are the driving rules for type 1 diabetes? (4)

A

Must notify the DVLA
Carry glucose with you
Check BM before driving and every 2h - must be at least 5mmol
If BM low, stop, eat something sugary and wait 45 minutes

32
Q

What special test is used for SIADH and what results would confirm it?

A

Urine and serum osmolality (and urine and serum Na+)

urine osmolality and sodium - high
serum osmolality and sodium - low

33
Q

What are some causes of SIADH?

A 
Small cell lung cancer
Infection e.g. atypical pneumonia 
Abscess
Drugse.g. lithium, carbemazepine, NSAIDs, antipsychotics
Head injury

Hypothyroidism
Postoperative

34
Q

What other blood tests would you order when investigating SIADH?

A

TFTs (exclude hypothyroidism)

K+ and possibly short Synacthen test (exclude Addison’s)

35
Q

What is the special test for diabetes insipidus?

A

Fluid deprivation test

36
Q

What do these results from the water deprivation test suggest?

  1. Before <300, after DDVAP >800
  2. Before <300, after <300
  3. Before >800, after >800
A

Cranial (as back to normal after giving ADH)
Nephrogenic (not due to lack of ADH)
Psychogenic or primary polydipsia

37
Q

What are some causes of diabetes insipidus?

A

Cranial - tumour, infection, haemorrhage, Wolfram’s

Nephrogenic - hypokalaemia, hypercalcaemia, CKD, RTA, pregnancy, medication e.g. orlistat, lithium, congenital

38
Q

What is the management for SIADH?

A

Consult a specialist before commencing treatment
Consider cause
Usually fluid restrict or give tolvaptan

39
Q

What autoantibody is used to test for:

  1. Hashimoto’s?
  2. Grave’s?
A
  1. Thyroid peroxidase antibody (TPOAb)

2. Thyroid stimulating hormone receptor antibody (TRAb)

40
Q

What are some causes of hyperthyroidism? (4)

A

Grave’s disease
Toxic multinodular goitre
Solitary nodule
De Quervain’s thyroiditis

41
Q

What scans can you get to investigate a thyroid nodule? (2)

A

Thyroid USS

Thyroid uptake scan (high uptake in hyperthyroidism, low in cancer)

42
Q

What are the most important side effects of carbimazole and propythiouracil? (2)

A

Agranulocytosis

Foetal abnormalities

43
Q

What are the management options for hyperthyroidism? (3)

A

Medication e.g. beta blocker for symptoms, PTU, carbimazole
Surgery
Radioiodine

44
Q

What are some causes of hypothyroidism? (5)

A 
Hashimoto's
Iodine deficiency
Infiltration e.g. sarcoidosis, amyloidosis, haemochromatosis 
Medication e.g. amiodarone, lithium
Pituitary failure e.g. Sheehan
45
Q

What is the most common type of thyroid cancer?

A

Papillary thyroid carcinoma

46
Q

What type of thyroid cancer arises from the C-cells?

A

Medullary thyroid carcinoma

Finals (23 decks)

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