Endocrine Disorders

Question 1

What does Hashimotos cause antibodies against?

Answer 1

Thyroid Peroxiase

Question 2

What would you expect to see in a staining of Hashimotos thyroud tissue?

Answer 2

Lymphocyte infiltration - lots of blue

Question 3

What is connective like in Hashimotos?

Answer 3

Fibrotic

Question 4

What is the second most common cause of hypertension accounting for the most common cause of secondary hypertension?

Answer 4

Primary Aldosteronism - excessive release of aldosterone indepentant of the RAS system

Question 5

What is Euvolemic?

Answer 5

Where the patient doesn’t appear to fluid overloaded. The total amount of Na2+ is normal but there is too much water retention and thus it is diluted - hypotonic.

Question 6

In patients with SIADH, why does the brain swell and what is an important management of this?

Answer 6

As the fluid becomes hypotonic, fluid moves into the brain cells causing swelling.

In response the cells will pump out Na2+, K+, Cl- and glutamate in an effort to reduce the osmotic drive. If then treated too quickly with a hypertonic solution the fluid will be pulled out the cell too quickly and cause osmotic demylination

Question 7

What are the most common causes of hypercalcaemia?

Answer 7

Primary hyperparthyroidism: where the negative feedback isn’t adjusted and the cheif cells continue to release PTH which continues to break down bone and reabsorb Ca2+
- usually due to a small adenoma

Malignancy: Releasing PTH- related peptide.

Question 8

How do you differentiate between primary hyperparathyroidism and malignancy?

Answer 8

In primary the levels of PTH should be high.

If PTH is low then suggestive of malignancy as the high levels of Ca2+ are regulating the PTH levels normally.

Question 9

Whats the treatment for hypercalcaemia?

Answer 9

Bisphosphonates

parathyroidectoma

Question 10

What are the stages in Cushing’s diagnosis?

Answer 10

1. assess levels of high cortisol. Midnight salivary test.
2. Dexamethason suppression test - to assess whether there is actual high levels of cortisone
3. Source the cause. Measure ACTH levels.
   - if low then adrenals is cause

• if high establish source of ACTH
  Give CRH and see if the levels of ACTH increase. If they don’t it is an ectpoic source.

Question 11

In Addison’s disease what would you expect the U&Es to be like and why?

Answer 11

Low Na2+ - lack of aldosterone production reabsorbing Na2+ and water

High K+ - lack of aldosterone excreted K+

High Urea - dehydration

Low Glucose is possible as well as there is lack of regulation for gluconeogenesis

Question 12

What test can be done to establish the source of adrenal insufficiency?

Answer 12

Short SYNACTH test. If primary it will have no effect and levels of ACTH should already be high.

If secondary then increased cortisol production

Question 13

What drug is given for replacement of aldosterone?

Answer 13

Fludrocortisone

Question 14

What are the antibodies of Grave’s disease? and what are they known as?

Answer 14

IgG antibodies that bind to the TSH receptor.

Long acting thyroid stimulators

Question 15

What infections are associated prior to Grave’s disease?

Answer 15

Yersinia Enterocolitica

E. Coli

Question 16

In type II diabetes, what are the collective pathologies associated with development of insulin intolerance? and what are they termed?

Answer 16

• central obesity
• hypertension
• dyslipidaemia
• Fasting glucose is high

Metabolic syndrome

Question 17

There is associated insulin receptor gene dysfunction in diabetes type II, what other things may be seen with this?

Answer 17

Acanthosis Nigricans - under armpit dark spots

Hyperandrogenism - excessive androgen production

Question 18

What are the broad stages of DM Type II pathologenesis?

Answer 18

Insulin resistance leading to increased insulin secretion.

• increased fatty deposits in muscles and liver
• adipocytokines release - inducing low inflammation
• hyperplasia and hypertrophy of beta cells

Beta cells fail

• build up of Amylin in cells
• reduction in insulin production

Question 19

Outline processes of diabetic nephropathy:

Answer 19

thickened of basement membrane and hyaline arteriosclerosis of the efferent vessels

buldging of the basement membrane causing the gaps between podocytes to increase

*this all leads to intial hyperfiltrations

Mesengial cells respond by increasing collagen production to support excessive forces - lowering GFR

Question 20

What are some symptoms of Grave’s disease?

Answer 20

Graves opthalmopathy

• Proptosis
• diploia

Pretibial Myxoedema

Finger clubbing

Question 21

What are the common causes of hyperthyroidism? and what tests can be useful for differentiation?

Answer 21

Graves

Toxic multinodular goitre

Toxic Adenoma

TSH: to assess whether it is primary or secondary

Antibodies:

• TSH Receptor Antibodies
• thyroperioxidase Antibodies

Radioisotope - distinguish between mutlinodular and adenoma

Question 22

When would someone have high T3 but low T4?

Answer 22

When been treated with synthetic T3

Question 23

What technique can be used to assess the thyroid?

Answer 23

Fine needle aspiration

Question 24

What is the drug that can be given for the treatment of acromegaly?

Answer 24

Somatostatin

Question 25

What test can be done to confirm amcromegaly?

Answer 25

Glucose tolerance test - increase in glucose should feedback to stop GH release

Question 26

What other affects can prolactoma have on the body other than milk production?

Answer 26

Menstrual disruption

In males reduced labido

Question 27

If an adenoma is suspected of the pituitary gland what should be done?

Answer 27

check hormones

size of pituitary

Vision

Question 28

What cancers are assoicated with acromegally?

Answer 28

Colon Cancer

Question 29

What is Sick Euthyroid?

Answer 29

Low levels of TSH and T3, T4 due to the patients being systemically ill.

the thyrod gland still functions though

Question 30

What are the diagnostic criteria for diabetes type II? and name some tests

Answer 30

Diagnosis is based on two different lab findings:

• HbA1c >48mmol/mol (6.5%)
• fasting plasma glucose >6.9mmol/L
• random plasma glucose test >11.1mmol/L

this is conjunction with clinical findings - polydipsia etc.

Question 31

What anti bodies are most commonly seen with type I diabetes?

Answer 31

Anti - glutamic acid decarboxylase (GAD)

Islet Cell anti bodies

Insulin auto-antibodies

Question 32

What is a common finding in the urine of type I diabetics at time of diagnosis?

Answer 32

Ketones

Question 33

What are the main causes of adrenal insufficiency disease?

Answer 33

Auto immune - addisons

tuberculous spread

malignancy

Question 34

in the setting of adrenal insufficiency what is the first line of treatment?

Answer 34

Intravenous hydro cortisone

Question 35

What must one think when a patient presents with known Addisons and is cortisol crisis?

Answer 35

Are they acutely unwell and not increased their dosage in response to this - leading to the cortisol being used elsewhere

Question 36

How does ADH reach the pituitary?

Answer 36

Via nerves

Question 37

What affect does cortisol have on bones and why?

Answer 37

makes them more fragile. Increases bone resorption

Question 38

What is the result of taking exogenous steroids?

Answer 38

Negative feedback to hypothalamus and pituitary.
reduced CRH and ACTH and cortisol

atrophy of adrenal glands.

• dangerous if they come off them quickly