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Progress test packs > Endocrine and Nephrology > Flashcards

Endocrine and Nephrology Flashcards

0
Q

aldosterone job

A

fluid and salt retention
K excretion

inhibited by spironalactone/ amiloride
deficient in addisons
- hypotention, low Na, high K

too much in conns
- htn, hypo K, alkalosis

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1
Q

secondary htn

A

RENAL 80%
gn, pyelo, cystic, stenosis

ENDOCRINE
cush (cortisol), 
conn (aldosterone), 
congen adren hyp, 
phaeo, acromeg
hyperparathyroid
PREGNANCY

VASCULAR

  • coarctation
  • renal artery stenosis

alcohol

rare: MAO-i (depression) with cheese

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2
Q

ADH job

A

fluid retention

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3
Q

cushing syndorme vs disease

A

sydrome

  • HTN,
  • hirsuit, acne, thin hair
  • ihd, infection
  • central obesity, striae, thin/bruised skin
  • osteoporosis, proximal myopathy
  • impotence/dysmenorrh

= can be

1) iatrogenic
2) adrenal tumour/hyperplasia
3) ectopic acth producing tumour
4) pituitary tumour

disease = pituitary tumour
- produce acth -> casue adrenal hyperplasia

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4
Q

cushings test

A

48 hr low dose DEXOMETHASONE test

24hr urinary cortisol
also renin increased

ACTH helps diagnosis

  • inc in ectopic/pituitary tumour
  • dec in adrenal tumour/hyperplasia

do CT

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5
Q

cushings treatment

A

pre-surgery

  • metyrapone
  • ketoconazole

surgery

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6
Q

conns

A

primary hyperaldosteronism
- ademona or hyperplasia on adrenal

HTN HYPOKAL ALKALOSIS
weakness, polyuria/dipsia

low renin
high aldosterone
CT scan

T
(spironalactone/amiloride)
–> surgery

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7
Q

phaeo

A

adrenal tumour producing adrenaline/noradrenaline

SWEAT, PALP, TACHY, ANXIETY
HTN, HEADACHE,

othostatic hypo
cafe au lait

inc urinary adrenaline

T:
alpha blocker
b blocker
–> surgery

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8
Q

addisons

tired tanned tearful
GI

A

adrenocorticol insufficiency
low cortisol and aldost

= autoimmune
= or after stopping steroids

hypotension
GI upset
fatigue, depress
hypopigmentation

low Na, high K, acidosis,
hyperpigment, dehydration

synACTHhen test (short acth)
autoantibodies

T: hydrocort and fludrocort

also in crisis –> fluid

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9
Q

acromegaly

A

pit tumour –> GH
DIAG: ogtt w GH meas
- IGF1 will also be raised

htn sweating heaaches
visual field (temporal)

spade hands, big jaw/brow, coarse skin, sweaty
big lips, tongue, goitre, organomegaly, low voice
OA/arthropathy, carpal tunnel, pseudogout
prox myopthy, mononeuropathy

cv disease
htn, dm
polyps, crc

T:
somatostatin analogue (octreotide)
GH receptor antag
- sugery + radio

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10
Q

congenital adrenal hyperplasia

A

HTN
high acth
female virilisation at birth

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11
Q

renal cell carcinoma (adenocarcinoma)

A 
renal cell adenocarcinoma
-HAEMAT
-LOIN PAIN
-ABDO MASS
may have fever, varicocoele

paraneoplastic:
hypercalcaemia, polycythaemia, htn

US, IV pyelogram

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12
Q

bladder cancer

A

painless frank haematuria

risk: smoking, industrial toxins (dyes), age>50

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13
Q

Hyperthyroid

A

60% graves

  • autantibodies
  • 30% have eyes (proptosis, exop, lid lag)
  • painless goitre
  • 50% cured by 18m carbimazole
toxic multinod (Painless G)
toxic adenoma (no G)
- these two may require surgery or radioiodine rather than carbimazole
subacute thyrotoxicosis (de Q)
-PAINFUL GOITRE
-low isotope uptake
-self limiting
-raised esr (often post viral)
treat w nsaids

drugs amiodarone, lithium

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14
Q

hypothyroid types/causes

A

primary atrophic
- no goitre

hashimotos

  • can be initially hyperth
  • GOITRE
  • autoantibodies

in subacute (dq) get hyperthyroid, then hypothyroid

  • self limiting post viral
  • painful goitre, low isotope uptake, high ESR

also amiod, lithium, iodine defic (G)

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15
Q

hyperthyroid sx

A

anxiety, hot, sweaty

```
palpitation, tachycardia, af
cardiomyopathy
tremor
diarrhoea
menstrual
proximal myopathy
pretibial myxoedema
~~~

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16
Q

Hyperthyroid treat

A

b block vs Sx

Anti-thyroid: carbimazole
?block and replace
!!! risk of agranulocytosis —> neutropenia
(watch for sore throat/fever)

radioiodine
surgery

leaves pt hypothyroid - levothyroxine

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17
Q

thyroid storm

A

can complicate hyperthyroidism

+++ anxiety, tremor, tachy, fever, sweat, confusion

fluid
steroid
b block
carbimazole

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18
Q

Hypothyroid symptoms

A

Sx

  • depress, loss of energy, cold
  • hairloss (frontal), loss of eyebrows
  • puffy dry skin, complexion
  • hoarse voice
  • cardiomyopathy, bradycardia
  • wg, constip, menorrhagia
  • carpal tunnel
  • myalgia, cramps, weakness, slow reflexes
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19
Q

hypothyroid association

A

turners, downs, CF
pbc

treatment - levothyroxine

  • titrate dose vs symptoms and blood levels
  • high dose may trigger angina

NB AMIODARONE CAUSES THYROID PROBLEMS - both hypo and hyper

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20
Q

acute kidney injury definition

A

creat rise by 26 micromols/l in 48hrs

creat rise by 50% of baseline in a week (baseline from 3m)

oliguria (less than 0.5ml/kg/hr)

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21
Q

Acute renal failure causes and approach

A

Pre-renal
- hypovol, sepsis,

Renal

  • T.I.D (tubulointerstitial disease)
    • from nsaids, gentamycin, ace, ciclosporin
    • from ischaemia
  • from gn
  • also haemolytic uraemic syndrome

Post renal (us shows hydronephrosis)

  • stones
  • prostate
  • retroperitoneal fibrosis

—> Manage pulm oedema and hyperkalaemia

If pulm oed, hyperkal, acidosis, encephalop, pericarditis
—> dialysis

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22
Q

acute renal failure

prerenal (50%) vs atn (30%)

A

prerenal
- hypoperfusion (hypovol, sepsis)
- tubules still working so Na is resorbed
(low urine Na, high serum Na) and urine is concentrated (high osmol)

atn (tin)

  • ischaemia
  • nephrotoxins (nsaid, abx)
  • hepatorenal syndrome
  • GN, vasculitis, myeloma, HUS
  • –> high Na in urine and dilute
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23
Q

nephrotoxic drugs

A

gentamycin, streptamycin (aminoglycosides)
radiocontrast

nsaids
ace/arb

immunosuppress (cyclosporin, methotrexate)
chemotherapy

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24
Q

serious comps of acute renal fail

A

hyperkalaemia (tall t, small p, wide qrs, pr)

  • give ca gluconate
  • give insulin glucose
  • give calcium resonium/salbutamol
pulmonary oedema
- sit up, high flow o2
- furosemide 120mg IV over 1 hr
- morphine 2.5 IV (cause venous dilation)
(+metoclopramide)
-- HAEMODIALYSIS
-- CPAP
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25
Q

acute renal failure management

A

often occurs w illness, sepsis, nephrotoxic drugs
- is cause pre, intra, or post renal?

oliguria
raised urea (7) and creat (120)

nausea/vom
bleeding, htn

  • –> risk high K and met acidosis
  • –> risk vol overload - pulm oedema

Mx:

  • o2 sats, listen to chest - ?pulm oedema
  • ?give fluid, catheterise
  • test urine (pre vs atn)
  • stop nephrotoxins
  • watch bloods - hyperkalaemia?
  • US abdo/kidney - obstruction?

—> DIALYSIS
(acidotic, hyperkal, p.oed, pericard, enceph)

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26
Q

indication for dialysis in acute renal fail

A 
pulmonary oedema
persistant hyperkal
severe met acidosis
uraemic encephalopathy
uraemic pericarditis
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26
Q

Nephritic syndrome

A

type of acute kidney diysfunction

HAEMATURIA w RED CASTS
mild proteinuria
HTN (fluid retention)

urea and creat, low gfr

may be seen 2/3 weeks post strep pyog

mx:
ace vs htn and prot
diuretic if oedema
?dialysis if ureamic
? biopsy
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27
Q

Chronic renal failure features

A

tiredness
anaemia (take EPO)
bone probs: low Ca, high PO4, high PTH
lose sex drive

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28
Q

renal bone disease

A

2dry hyperparathyroid

see high PTH but low/norm Ca

due to failure of vit D metab by kidneys

  • > low Ca abs
  • -> inc PTH release
  • also phosphate retention by kidneys

= causes bone disease (demin) - ALP+

T: vit D, phosphate binders

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29
Q

Systemic renal probs

A 
DM
myeloma
renovascular disease
goodpasture 
vasculitides (weg, mp, pan, HSch)
SLE, SSc

amyloid

haemolytic uraemic syndrome (diar, haemolysis, thrombocyto, renal)

cryoglobinaemia (cold, renal, urticaria)

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30
Q

Polycystic Kidney

A 
autosomal dominant (95% type 1 chrom 16, 5% chrom 4)
25% cases are spontaneous

screening if FH by US
-need more cysts if older
ie 2 30, 4 bilat>60

prog growth of cysts
- haemat, pain, renal imp, htn

associated with berry aneurysm (SAH in 10%)

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31
Q

renovascular disease

A

mainly due to atheroma

see htn resistant to treatment
US - asymmet kidneys
angiography

risk - smoking, cholest etc
tx: stenting/plasty

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32
Q

Reflux nephropathy

A

Kidneys can become scarred and shrunken due to chronic tubulo interstitial disease/nephritis

Assoc w recurrent UTI’s (pyelonephritis)

Ix:
IV urogram
DMSA (radio scan of kidney tissue - shows scarring)
Micturating cystogram (uses xray)

Treat uti, htn, ?steroids, dialysis

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33
Q

SLE

A

kidney impairment - GN

also facial rash

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33
Q

Tubulo interstital disease

Interstitial nephritis

A

Intrinsic renal failure
Accounts for 20% of dialysis

Can present w proteinuria, haematuria or in renal failure
- do UE’s, urine protein and mc+s, us and ?biopsy

May be acute -renal fail (?+ fever, rash, eosinophilia)

  • often due to drugs
  • -abx (gentamycin), nsaids
  • also infection, sjogrens

Chronic

  • presents with crap renal function, htn, polyuria
  • small kidneys on us
  • often due to REFLUX - rec pyelonephritis
  • also long term analgesia, gn, ischaemia, metabolic (uric acid, myeloma, high ca), toxins (heavy metals), sarcoid

T: identify and correct cause

  • corticosteroids
  • dialysis
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34
Q

renal vein thrombosis treat

A

warfarin 3-6months (inr 2-3)

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35
Q

eGFR

A

variables:CAGE
creatinine, age, gender, ethnicity

if over 60 need other evidence of kidney disease
under 15 is end stage renal failure

36
Q

need for dialysis

A 
30% GN
20% TIN (tubulo-interstitial nephritis)
10% PKD
10% DM
10% HTN/RV
37
Q

Glomerulonephritis

A

type of intrinsic renal injury

  • may be chronic or rapid deter
  • can present w nephrotic, nephritic, AKI,
  • or just solitary protein/haemat
  • nephritic/acute renal fail - IgA, post infec, vasculit, goodpast
  • nephrotic synd - minimal ch, membranous, fsgs, mesangio

may be multisystem illness

diag by biopsy
ANCA (weg), C3/4, ANF (sle), antiBM (goodpast)

tx: steroid and immuno supp
ace vs bp
diuretic vs oedema
statin, anticoag
30% of dialysis patients
38
Q

Types of glomerularnephritis

A

Non proliferative (generally nephrotic)

  • minimal change
  • FSGS
  • membranous (can also be nephritic)
  • thin basement (just micro haemat)

Proliferative

  • IgA
  • post infectious
  • rapid progressive
  • membranoprolif / mesangiocapil (can be nephrotic)
39
Q

comps of diabetes

A 
vascular eg cvd, pvd
nephropathy
-microalbuminaemia indicates early disease
-ace or arb good
retinopathy
neuropathy
40
Q

diabetic retinopathy

aspirin good

A
  • cap changes
  • microaneurysm (dots)
  • occlusion (cotton wool spots)
  • ischaemia

neoproliferation of vessels - bleeding and fibrosis

  • hemorrahge (blots)
  • risk of detachment
41
Q

Nephrotic Syndrome

A

TRIADS
proteinuria
hypoalbumin
oedema (due to low protein and high sodium)

HYPERLIPID (check cholesterol)
INFECTION (IgG loss)
CLOTTING (lose antithrombin iii, protein c and protein s)
- sudden deterio in renal func, pain, haemat - think renal ven thrombosis

cause: GN 75%
- also DM, amyloid,

42
Q

proteinuria

A

shown by dipstick
can be raised in exercise, fever etc

follow up

  • 24 hr urine collection
  • Bence Jones test if rel
  • biopsy if heavy

microalbunaemia: early DM nephro
RBC casts: GN –> biopsy
ANF, ANCA: wegen, SLE

43
Q

Nephritic syndrome

A

triad of

  • haematuria, casts
  • oliguria
  • htn

often overlapping w acute renal failure

associated w proliferative types of GN
- IgA, post-infec, rapid Prog

44
Q

Minimal Change GN

A

Nephrotic synd in kids/young adults

Minimal change on biopsy, immunology
(foot processes fused)

Doesn’t progress

45
Q

Membranous GN

A

Mainly nephrotic but can be nephritic

diffuse thickening w IgG C3

2/3 autoimmune

Otherwise

  • malignancy
  • penicillamine
  • malaria
  • hep b
  • sle

1/3 remit
1/3 stable CKD
1/3 progress to ESRF

46
Q

focal segment glomerulosclerosis

A

scarring

generally progresses to ESFR

secondary to

  • alports
  • heroin
  • HIV
  • sickle
  • reflux
47
Q

Alports

A

x linked dominant
20% spontaneous

childhood GN (due to abn BM)
- haemat, failure

DEAFNESS and eye probs
renal transplant failure

need dialysis by 20’s

48
Q

Thin basement GN

A

Genetic - autosomal dominant

Often no nephritic or nephrotic
- just microscopic haematuria

Benign course - good prognosis

49
Q

Nephrotic syndrome treatments

A

low Na intake (vs oedema)
diuretic vs oedema
ACE vs proteinuria

statin vs hyperlipid
anticoag if immobile

steroid + immunosupp

50
Q

IgA nephropathy

aka BERGERS

A

Most common type of GN
Proliferative, w IgA deposits
Nephritic

Self resolving, benign course
Young adults within days of resp infection

Can devel Henoch Schonlein in kids
- see purpuric rash

51
Q

Henoch Schonlein (IgA)

A

purp rash
polyarthritis
abdo pain
nephropathy

52
Q

Post-infectious

A

1-4 weeks post infection
- classical strep pyog throat

‘Smoky brown urine’

Good prognosis in kids
In adults can progress

53
Q

Mesangiocap GN (aka membranoproliferative)

A

Unlike most proliferative gn this is more nephrotic

Tramline, large glomerular membrane

Causes include SLE and hepatitis

54
Q

Rapid progressive GN

A

Also called crescenteric

Poor prognosis - devel quickly to ESRF

Can devel from

  • IgA, post infectious
  • goodpastures
  • sle
  • wegeners
55
Q

Goodpastures

= anti BM disease

A

renal failure and pulmonary hemorrhage (haemoptysis)
system unwell

antiBM antibodies

t: plasmaphoresis (remove ab’s)
pred, cyclophosph

56
Q

Vasculitides

A

wegeners (small vessel)

  • lungs and kidneys
  • haemop and nosebleeds
  • GN/ renal fail
  • ANCA (cANCA)

microscopic polyangitis (small vessel)

  • kidneys, skin, neuro (myalgia)
  • ANCA (pANCA)
  • t: pred and cyclophosph

pan (medium vessel)

  • non specific - wl, fever, malaise
  • then skin, heart, kidney, neuro
  • pANCA
  • t: immunosupp

churg-strauss doesnt affect kidney
- asthma

henoch scholein

  • ?post infection
  • malaise, arthralg, abdo pain
  • purpuric rash on extensors
  • some renal involve
57
Q

Wegeners

A

GN - renal failure
saddle nose
haemoptysis, nosebleeds

ANCA (esp cANCA)

t: steroid, cyclophosphamide

58
Q

T1DM

A

juvenile onset generally
insulin defic due to autoimmune destruc of panc

Polyuria/dispia, infections, weight loss
Prone to ketoacidosis and wl

DISH

59
Q

T2DM mgmt

A

lifestyle
statin, bp control

metformin (GI upset)
glicazide - sulfonyl (hypo, wg, siadh)

?insulin

?glitazone (fluid retention, liver, bone)
?exenatide GOOD FOR WEIGHT LOSS

60
Q

t2dm

A 
older onset
asian men
obesity etc
strong genetic component
- dec insulin secretion
61
Q

comps of diabetes

A 
vascular eg cvd, pvd
nephropathy
-microalbumin aemia indicates early disease
-ace or arb good
retinopathy
neuropathy
62
Q

HONK

A 
hyperglycaemic crisis (may be >50)
- sodium will aslo be raised (>160)
  • do not see acidosis

precip by infection, mi etc

  • > thirst, polurai
  • -> hyperviscosity - thrombosis (ha, visual)

high mortality

T as per dka

  • fluid + K
  • insulin
63
Q

MODY

A

type 2 under 25 years
autosomal dominant
dont see ketosis

64
Q

diabetic retinopathy

aspirin good

A
  • cap changes
  • microaneurysm (dots)
  • occlusion (cotton wool spots)
  • ishcaemia

neoproliferation of vessels - bleeding and fibrosis

  • hemorrahge (blots)
  • risk of detachment
65
Q

diabetic foot

A 
NEUROPATHY
low sensation in stocking distrib
absent knee jerks
deformity
- charcot

ISCHAEMIA
?pulse
ulcers - painless and punched out

treat fungal infec

66
Q

diab neuropathy

A

numbness pain tingle
glove and stocking
worse at night

duloxetine first line
amitriptyline
pregabalin

67
Q

diabetes target blood pressure

A

no organ damage 140,80
end organ damge 130,80

ACE inhib

68
Q

SIADH - retaining to much fluid

A

hyponatraemia
concentrated urine

drugs - ssri, tca, carbamez, cyclophosph
malig, pnaeumonia, tb, neuro

68
Q

UTI

A

urethritis, prostatitis, cystitis
(frequency, dysuria, smelly, fever, ?abdo pain)
- may get haematuria in cystitis
-may get back ache, flu in prostatitis

–> pyelonephritis (see fever+, rigors, pain+, ?oliguria)

obstruction is big risk factor
are there voiding probs? retention?
test renal function, consider US
recurrent: do cystoscopy

70
Q

preventing UTI

A

fluid intake
cranberry juice
urinate often
wiping, voiding post sex

72
Q

preventing renal stones

A

good fluid intake

protein diet and thiazides increase Ca - so avoid

allopurinol if prone to urate stones

rhubbarb, spinach increase oxalate
vit B6 reduces oxalate

cystein - alkalinize urine
phosphate - acidify urine

72
Q

secondary htn

A

RENAL 80%
gn, pyelo, cystic, stenosis

ENDOCRINE
cush (cortisol), 
conn (aldosterone), 
congen adren hyp, 
phaeo, acromeg
hyperparathyroid
PREGNANCY

VASCULAR

  • coarctation
  • renal artery stenosis

alcohol

rare: MAO-i (depression) with cheese

73
Q

renal stones

A

pain +++ loin to groin
haematuria

inc risk with

  • low fluid intake high ca intake
  • hyperparathyroid
  • recurrent UTI’s (struvite)
Ix:
abdo xray/ KUB xray
IVU
24hr urine (for chemistry of stone)
fbc and urine (UTI?) 
renal US and UE's

mx: analgesia (opioid) and fluid
? alpha blocker can help pass stone
?Abx
if >5mm need lithotripsy (ECWL or PCNL)

74
Q

respiratory acid and alkalosis

A

Resp Acid
- hypoventilation
copd, nm, sedation

Resp Alk
- hyperventilation
panic, PE

75
Q

types of renal stone

A

80% ca oxalate
15% struvite (infection, esp protease) - staghorn
10% uric acid (LUCENT)

rarer: cystein (semi-lucent), xanthine (lucent or semi)

76
Q

Hypokalaemia <3.5

A 
diuretic
aldost excess (conns and cushings)
vom, diarr
insulin
salbutamol

ecg: U (wave after T), flat T, tall P, long PR
tx: KCl (w/ or w/out fluid)

77
Q

hyperkalaemia >5.5

A 
low aldost - addison
spironalactone/amiloride
ace-i
haemolysis
acidosis

ecg: tall t, falt p, wide qrs
tx: ca gluconate, insulin glucose, calcium resonium

78
Q

hyponatraemia <135

A

what is the volume status?

hypervolaemic
- hf, liver, kidney fail

normovol
- SIADH - fluid reten (high urinary Na)
(SqLC, pneumonia etc, CNS trauma/infec)

hypovol

  • dehydr, vom, diarr, burns (low urinary Na)
    • these can also cause hypernat
  • fluid lost from diuretics, addisons (high urinary Na)
79
Q

hypernatraemia >145

give dextrose fluid

A

hypervol
- aldost excess (cushings, conns)
(give diuretics)

normovol
- diabetes insipidus - fluid loss, dilute urine
(adh defic or nephrogenic - Ca, Li)

hypovol

  • burns, sweat, vom, diarr
  • diuretics
  • hyperglycaemia
80
Q

Hypercalcaemia >2.6

A

bones moans (depres) groans (constip) stones
peptic ulcers
—> nephrogenic diabetes insipidus

80% primary hyperparathyroidism
- PTH may be normal/rasied w Ca high
- polyuria, polydip, weakness, vom
- low phosphate
= adnoma or hyperplasia of gland
= can also be due to LITHIUM

20& malig
- consider if Ca high but PTH low
= myeloma of bone 2dry
= squam cell lc producing PTH-like protein

81
Q

diabetes insipidus - pissing too much fluid

A

inappropriately dilute urine, large vol

cranial = ADH deficiency

nephrogenic
= hypercalcaemia
= lithium

T: desmopressin (also used in von willebrands, haemophilia)

82
Q

Hypocalcaemia <2.1

A

tetany, seizures, qt elong

chvosteck (tap on facial nerve)

trousseau (bp cuff -> carpopedal spasm)

83
Q

Urge incontinence

A

Overactive bladder

Anticholinergic tablet
Bladder retraining

84
Q

tuberous sclerosis

A

rare auto dom

  • intellect, epilepsy
  • facial angiofibroma
  • renal angiomyolipoma, malig
  • harmartoma
85
Q

VON HIPPEL LINDAU

A

autosomal dominant renal disorder

renal tumours
brain tumour - haemangioblastoma
adrenal tumou
- phaeo (htn, ha/sweat/tachy, trem,anxiety)

86
Q

bph

A

v common over 60
smooth enlarged prostate
psa normal <4 ideally
do msu to rule out UTI

complications

  • retention - may need self catheterisation
  • infection
  • stones

treatment

  • ? self catheterise
    1) alpha blocker - tamsulosin
    2) 5alpha red inh - finasteride (anti androgen - causes erectile/libido probs)
    2) surgery - resection or stenting/dilate
87
Q

hyperprolactinaemia

A

galactorrhoea
bitemporal hemianopia
w: menstual prob, infertility
m: erectile dys

C: prolactinoma
- also stress, renal fail, PCOS

T of prolactinoma

1) dopamine agonists (shrink)
2) surgery and radio

88
Q

prostatism history

A

voiding probs
- hesitancy/strian, poor flow, terminal dribble, pis en deux

storage probs
- urgency, frequency, nocturia, incontinence

any red flags - weight loss, bone pain, blood in urine

family history
medications

cause

  • bph
  • prostate cancer
89
Q

bph

A

v common over 60
smooth enlarged prostate
psa normal <4 ideally

complications

  • retention - may need self catheterisation
  • infection
  • stones
treatment
1) alpha blocker - tamsulosin
2) 5alpha red inh - finasteride (anti androgen - causes erectile/libido probs)
Catheteristion
Surgery - turp
90
Q

prostate cancer

A

psa raised - over 10 is suspicious

  • do TR US
  • do TR punch biopsies

gives gleason score “3+4” means mainly stage 3 some 4 (5 is worst)

also use tnm staging - do ct

do cxr, bonescan and renal us to look for mets

treatment

  • wait
  • surgery - turp of total prostatectomy
  • radio - external beam or brachytherapy
  • gnrh analogue - goserelin - “zolidex 3m injections”
  • newer anti androgen drugs

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