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phase2a medicine > endocrine diseases > Flashcards

endocrine diseases Flashcards

Risk factors, pathology, signs, complications, diagnosis, and treatment for all endocrine conditions on the phase 2a list.

1
Q

diabetes mellitus

A

metabolic disorder of chronic hyperglycaemia due to insulin resistance or deficiency

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2
Q

T1DM risk factors

A

hypothyroidism
Addison’s
Coeliac disease

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3
Q

T2DM risk factors

A

HLA DR3 mutation
family history
lifestyle

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4
Q

secondary diabetes due to

A

haemochromatosis, cancer, CF

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5
Q

signs of diabetes

A 
polyuria
polydipsia
tiredness
blurred vision
weight loss (due to water loss and gluconeogenesis)
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6
Q

signs of diabetic ketoacidosis

A

chronic hyperglycaemia
raised plasma ketones
metabolic acidosis (low bicarbonate)
kussmaal breathing

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7
Q

How does diabetic ketoacidosis occur?

A

reduced insulin –> reduced fat breakdown and formation of glycerol and free fatty acids –> impair glucose uptake and are transported to liver –> oxidised to ketone bodies

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8
Q

complications of diabetes mellitus

A 
microvascular disease:
stroke and CVD
retinopathy due to leakage and occlusion of blood vessels (protein, fat, and glial cells grow down blood vessels)
neuropathy
nephropathy 
peripheral vascular disease
foot ulceration
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9
Q

fasting glucose diabetes mellitus diagnosis

A

> 7 mmol/L

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10
Q

random glucose diabetes mellitus diagnosis

A

> 11.1 mmol/L

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11
Q

HbA1c diabetes mellitus diagnosis

A

> 6.5%

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12
Q

test urine to diagnose diabetes

A

moderate to large urinary ketones

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13
Q

T1DM treatment

A

insulin

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14
Q

T2DM treatment

A

lifestyle modifications
statins and bp lowering drugs
metformin
sulfonylureas (e.g. gliclazide)

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15
Q

how does metformin work?

A

it reduces gluconeogenesis and increases glucose sensitivity

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16
Q

treatment of DKA

A

rehydration
insulin
electrolyte replacement
treat underlying cause

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17
Q

risk factors for hyperthyroidism

A 
hyperiodinism
too much synthetic thyroxine
Graves' disease
thyroiditis
amiodarone
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18
Q

primary hyperthyroidism

A

high T3 and T4

low TSH

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19
Q

secondary hyperthyroidism

A

high T3 and T4

high TSH

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20
Q

signs of hyperthyroidism

A

prefers cold weather, bad tempered

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21
Q

symptoms of hyperthyroidism

A 
pretibial myxoedema (rare)
sweaty
diarrhoea
oligomenorrhoea
weight loss
tremor
palpitations
visual problems
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22
Q

complications of hyperthyroidism

A

osteoporosis

thyroid storm

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23
Q

treatment of hyperthyroidism

A 
radioiodine therapy
thyroid surgery 
beta-blockers
carbimazole
thionamide
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24
Q

risk factors for hypothyroidism

A

low dietary iodine
Hashimoto’s thyroiditis (autoimmune)
surgery
post-partum thyroiditis (affects 1 in 20 women)
other autoimmune conditions: T1DM, Addison’s, vitiligo, alopecia

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25
Q

primary hypothyroidism

A

high TSH

low T3 and T4

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26
Q

secondary hypothyroidism

A

pituitary dysfunction

low T3, T4, and TSH

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27
Q

tertiary hypothyroidism

A

hypothalamus problem

low T3, T4, and TSH

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28
Q

signs of hypothyroidism

A

prefers warm weather

goitre

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29
Q

symptoms of hypothyroidism

A 
depressed
slow
tired
thin hair
croaky voice
heavy periods
constipation
dry skin 
puffy face
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30
Q

diagnosis of hyperthyroidism

A

thyroid function test - raised T4, low TSH

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31
Q

diagnosis of hypothyroidism

A

thyroid function test - low T4, TSH varies throughout the day (higher when dark)
check for thyroid autoantibodies

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32
Q

treatment of primary hypothyroidism

A

levothyroxine

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33
Q

thyroxine dose for patient with hypothyroidism

A

1.6mg per kg of body weight

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34
Q

autoimmune hypothyroidism

A

inflammatory infiltrate replaces follicles
thyroglobulin and thyroid peroxidase antibodies
thyroid cell destruction is mediated by CD8 T cells

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35
Q

risk factors for Grave’s disease

A 
genetic
environmental 
female
smoking
having another autoimmune disorder
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36
Q

pathology of Grave’s disease

A

thyroid stimulating immunoglobulin causes excess production of thyroid hormones

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37
Q

signs of Grave’s disease

A 
poor heat tolerance
sleeping problems
tachycardia
acropachy (finger clubbing)
proptosis (eye bulging)
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38
Q

symptoms of Grave’s disease

A 
pretibial myxoedema
eye bulging
unintentional weight loss
muscle weakness
goitre
oligomenorrhoea
hand tremor
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39
Q

complications of Grave’s disease

A

Grave’s ophthalmopathy

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40
Q

treatment of Grave’s disease

A

radioiodine uptake therapy
thyroid surgery
beta blockers
carbimazole

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41
Q

action of carbimazole

A

acts on thyroid peroxidase enzyme

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42
Q

risk factors for Hashimoto’s thyroiditis

A

female
over 60
HLA-DR5

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43
Q

Hashimoto’s thyroiditis

A

gradual autoimmune destruction of the thyroid gland

goitre due to lymphocyte and plasma cell infiltration

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44
Q

signs of Hashimoto’s thyroiditis

A

panic disorder
heavy periods
enlarged and lobulated thyroid

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45
Q

symptoms of Hashimoto’s thyroiditis

A 
goitre
weight gain
feeling tired
constipation 
depression
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46
Q

complications of Hashimoto’s thyroiditis

A

thyroid lymphoma (non-Hodgkin)

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47
Q

diagnosis of Hashimoto’s thyroiditis

A

antithyroid peroxidase antibodies (TPOAb)

anti-thyroglobulin antibodies

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48
Q

treatment of Hashimoto’s thyroiditis

A

levothyroxine

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49
Q

cause of Cushing’s disease

A

pituitary adenoma

or ectopic tumour producing ACTH

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50
Q

pathology of Cushing’s disease

A

adrenal gland produces more cortisol due to excess ACTH

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51
Q

signs of Cushing’s disease

A 
hypertension
weak muscles
acne
fragile skin which heals poorly
central obesity
osteoporosis
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52
Q

symptoms of Cushing’s disease

A 
central obesity with thin arms and legs
hump 
women have more hair
irregular menstruation 
chronic tiredness
proximal myopathy
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53
Q

symptoms of Cushing’s disease

A 
central obesity with thin arms and legs
hump 
women have more hair
irregular menstruation 
chronic tiredness
proximal myopathy 
purple abdominal striae
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54
Q

diagnosis of Cushing’s disease and Cushing’s syndrome

A

Dexamethasone suppression test

  1. check medication
  2. check levels of cortisol after taking dexamethasone
  3. if cortisol remains high, do a blood test for ACTH - ACTH will be high if patient has Cushing’s
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55
Q

treatment of Cushing’s disease and Cushing’s syndrome

A

treat underlying cause

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56
Q

risk factors for prolactinoma

A

female

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57
Q

prolactinoma pathology

A

lactotroph cell pituitary tumour

or may be tumour in pituitary fossa that interrupts stalk and stops dopamine

58
Q

signs of prolactinoma

A 
visual field defect
CSF leak 
infertility
galactorrhoea
amenorrhoea
low testosterone
59
Q

symptoms of prolactinoma

A

headache
changes in menstrual cycle
low libido

60
Q

diagnosis of prolactinoma

A

blood test - check prolactin levels
medical imaging
drug history

61
Q

treatment of prolactinoma

A

dopamine agonists - cause tumour to shrink

microadenoma responds to small doses of cabergoline

62
Q

mean age at diagnosis for acromegaly

A

44

63
Q

pathology of acromegaly

A

pituitary tumour releasing growth hormone –> IGF-1 released from liver –> growth of hands and tongue

64
Q

signs of acromegaly

A 
arthralgias (joint pain)
acral enlargement (hands)
maxillofacial changes
excessive sweating
hypogonadal symptoms
macroglossa
prognathism
frontal bossing
65
Q

symptoms of acromegaly

A 
increased size of extremities
snoring
deep voice
decreased libido
headache
arthralgia
66
Q

complications of acromegaly

A 
osteoarthritis
T2DM
sleep apnoea
hypertension
CAD
stroke
headache
life expectancy decreased by 10 years
67
Q

diagnosis of acromegaly

A

glucose tolerance test

can exclude by finding low serum GH
MRI scan
IGF-1

68
Q

treatment of acromegaly

A

surgery
somatostatin analogues (octreotide)
pegvisomant growth hormone analogue
radiotherapy (takes about 5 years - eventually turns tumour to scar tissue)

69
Q

pathology of Conn’s syndrome

A

primary hyperaldosteronism resulting in low renin

often due to adrenal gland enlargement or an adrenal gland adenoma

70
Q

signs of Conn’s syndrome

A 
hypertension
muscular weakness
excessive micturition 
poor vision 
signs of hypokalaemia (e.g. muscle problems)
71
Q

symptoms of Conn’s syndrome

A

headaches
muscle spasms
tingling sensations

72
Q

complications of Conn’s syndrome

A

cardiovascular disease

73
Q

diagnosis of Conn’s syndrome

A

U&E - low renin, high aldosterone
adrenal vein sampling
medical imaging

74
Q

treatment of Conn’s syndrome

A

surgery
aldosterone antagonists (spironolactone)
low salt diet
dexamethasone (for familial disease)

75
Q

risk factors for Addison’s disease

A 
primary adrenal insufficiency
past history of TB
post-partum bleed
cancer
steroids
76
Q

pathology of Addison’s disease

A

autoimmune adrenal destruction

decrease in adrenal function causes increase in ACTH

77
Q

signs of Addison’s disease

A

skin colour changes
decrease in aldosterone –> decrease in Na+ and increase in K+
alopecia

78
Q

symptoms of Addison’s disease

A 
lean 
tired
anorexia
weakness
fever
confusion 
depression
79
Q

complications of Addison’s disease

A

adrenal crisis and death under physiological stress

80
Q

diagnosis of Addison’s disease

A

imaging

ACTH stimulation test - cortisol remains low

81
Q

primary Addison’s disease diagnosis

A

high ACTH

high renin

82
Q

secondary Addison’s disease diagnosis

A

low ACTH

83
Q

treatment of Addison’s disease

A

hydrocortisone for cortisol

fludrocortisone for mineralocorticoids

84
Q

why does Addison’s disease cause pigmented skin?

A

ACTH acts on melanocortin receptor on adrenal glands and on skin

85
Q

risk factors for hyperkalaemia

A 
low aldosterone
WNK1 and WNK4 mutations
low sodium delivery to DCT
low serum potassium level 
kidney injury
Addison's disease
drugs - ACEi, spironolactone
86
Q

pathology of hyperkalaemia

A

excessive intake, decreased secretion, or a shift of potassium from the intracellular to the extracellular space

87
Q

signs of hyperkalaemia on ECG

A

tall tented T waves
small P waves
wide QRS complex
ventricular fibrillation

88
Q

symptoms of hyperkalaemia

A 
frank muscle paralysis
dyspnoea
palpitations
chest pain 
nausea
vomiting
paresthesias
89
Q

complications of hyperkalaemia

A

cardiac arrest

90
Q

diagnosis of hyperkalaemia

A

ECG
urine potassium, sodium, and osmolality
FBC
metabolic profile

91
Q

treatment of hyperkalaemia

A

polystyrene-sulfonate resin
furosemide
haemodialysis
insulin with glucose

92
Q

hypokalaemia risk factors

A

poverty

poor diet

93
Q

causes of hypokalaemia

A 
diuretics
vomiting and diarrhoea
pyloric stenosis
rectal villous adenoma
intestinal fistula
Cushing's syndrome
steroids
ACTH
Conn's syndrome
alkalosis
renal tubular failure
94
Q

signs of hypokalaemia

A 
muscle weakness
hypotonia
hyporeflexia
cramps
tetany
palpitations
light-headedness
constipation
95
Q

complications of hypokalaemia

A

cardiac arrest following bradycardia

96
Q

diagnosis of hypokalaemia

A

bloods - U&Es

ECG

97
Q

treatment of hypokalaemia

A

tentative supplementation of potassium

98
Q

risk factors for syndrome of inappropriate secretion of ADH (SIADH)

A 
cancer
CNS disorders
chest disease
hypothyroidism
drugs
99
Q

which cancers can cause SIADH?

A

lung small cell
pancreatic cancer
thymus cancer
lymphoma

100
Q

which CNS disorders can cause SIADH?

A 
meningoencephalitis
abscess
stroke
subarachnoid haemorrhage 
subdural haemorrhage 
trauma
neurosurgery 
Guillain-Barré
vasculitis
SLE
101
Q

which chest diseases can cause SIADH?

A

TB
pneumonia
abscess
aspergillosis

102
Q

which drugs can cause SIADH?

A

opiates
psychotropics
SSRIs
cytotoxics

103
Q

signs of SIADH

A

anorexia

lethargy

104
Q

symptoms of SIADH

A

chronic pain

105
Q

diagnosis of SIADH

A

U&Es

diagnosis of exclusion

106
Q

treatment of SIADH

A

treat the cause
restrict fluid (only 1L/day) - measure input and output
salt ± loop diuretic (furosemide)
demeclocycline if fluid restriction not working
vasopressin receptor antagonists (tolvaptan)

107
Q

risk factors for diabetes insipidus

A

disease of kidney or pituitary

108
Q

pathology of diabetes insipidus

A

the passage of large volumes of dilute urine (more than 3L/day) due to impaired water resorption by the kidney

109
Q

cranial diabetes insipidus

A

reduced ADH secretion from the posterior pituitary

110
Q

nephrogrenic diabetes insipidus

A

impaired response of the kidney to ADH

111
Q

symptoms of diabetes insipidus

A 
polyuria
polydipsia
dehydration 
symptoms of hypernatraemia
no glucosuria
112
Q

diagnosis of diabetes insipidus

A

water deprivation test - osmolarity won’t rise

more than 3L urine a day

113
Q

differentiating cranial from nephrogenic diabetes insipidus

A

osmolarity will increase following desmopressin in cranial, but not in nephrogenic

114
Q

treatment of cranial diabetes insipidus

A

desmopressin

115
Q

treatment of nephrogenic diabetes insipidus

A

treat the cause
try bendroflumethiazide if it persists
NSAIDs

116
Q

why do NSAIDs lower urine volume and plasma Na+?

A

they inhibit prostaglandin synthase (prostaglandins locally inhibit the action of ADH)

117
Q

pathology of hypercalcaemia of malignancy

A

PTH-RP released from cancer cells, or breakdown of bone

118
Q

symptoms fo hypercalcaemia of malignancy

A 
bone pain
abdominal pain 
kidney stones
nausea
constipation 
polyuria
lethargy 
depression

bones, stones, groans, and moans

119
Q

complications of hyperacalcaemia of malignancy

A

QT gets shorter

120
Q

treatment of hypercalcaemia of malignancy

A

bisphosphonates
calcitonin
fluids

121
Q

what can cause a false reading of hypercalcaemia?

A

tourniquet on for too long

sample old and haemolysed

122
Q

hypocalcaemia risk factors

A

low serum albumin
low magnesium
vitamin D deficiency

123
Q

signs of hypocalcaemia

A 
SPASMODIC
Spasms (Chvostek's sign on face and Trousseau's sign on hand)
Paraesthesia
Anxiety
Seizures
Muscle tone increase
Orientation difficulties
Dermatitis
Impetigo herpetiformis
Cataracts
124
Q

complications of hypocalcaemia

A

QT gets longer

125
Q

treatment of hypocalcaemia

A

calcium gluconate

cardiac monitoring

126
Q

pathology of primary hyperparathyroidism

A

autonomous PTH secretion

parathyroid gland adenoma

127
Q

complications of hyperparathyroidism

A

pepper pot skull

128
Q

diagnosis of hyperparathyroidism

A

DEXA scan for osteopenia/osteoporotic risk

high calcium with tertiary

129
Q

treatment of primary and secondary hyperparathyroidism

A

surgery to remove tumour

130
Q

treatment of tertiary hyperparathyroidism

A

surgery to remove parathyroid gland

131
Q

pathology of secondary hyperparathyroidism

A

increased PTH secretion to compensate for prolonged hypocalcaemia

132
Q

pathology of tertiary hyperparathyroidism

A

development of parathyroid hyperplasia after long-standing hyperparathyroidism
loss of negative feedback

133
Q

cause of hypoparathyroidism

A

autoimmune

134
Q

signs of hypoparathyroidism

A

hypocalcaemia
Trousseau’s sign
Chvostek’s sign

135
Q

symptoms of hypoparathyroidism

A

tetany

136
Q

diagnosis of hypoparathyroidism

A

serum calcium (low)
serum albumin
PTH

137
Q

treatment of hypoparathyroidism

A

calcium gluconate

calcitriol

138
Q

treatment of serotonin producing neuroendocrine tumour

A

octreotide (somatostatin analogue)

139
Q

risk factors for thyroid cancer

A

radiation exposure at young age (causes DNA damage)
enlarged thyroid
family history
female

140
Q

signs of thyroid cancer

A 
neck pain and voice change (due to compression of recurrent laryngeal nerve)
symptoms of hyper/hypothyroidism
thyroid nodules (worrying if patient is under 20 as benign tumour unlikely)
141
Q

diagnosis of thyroid cancer

A

USS
fine needle aspiration
measure TSH

142
Q

treatment of thyroid cancer

A 
radiation therapy (radioactive iodine)
chemotherapy
thyroid hormone therapy
targeted therapy
surgical removal followed by hormone replacement therapy

phase2a medicine (53 decks)

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