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5th Year > Endocrine Stuff > Flashcards

Endocrine Stuff Flashcards

1
Q

What will U+Es show in Addison’s?

A

Lowered Na+

Raised K+

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2
Q

Why is potassium raised in Addison’s?

A

Lack of aldosterone

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3
Q

Will glucose be raised or lowered in Addison’s?

A

Lowered

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4
Q

In a GP, what are the cortisol level cutoffs when investigating Addison’s?

A 
<100 = likely Addison's
100-500 = synachten test
>500 = unlikely Addison's
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5
Q

What is the synachten test?

A

ACTH stimulation test - give ACTH and measure cortisol 30mins later
Addison’s = no cortisol peak

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6
Q

What other investigations are required if investigating Addison’s? (2)

A

CXR - TB and lung cancer

Anti-21-hydroxylase Ab - indicates immune destruction, +ve in 80%

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7
Q

What is the management of Addison’s?

A

Steroid replacements
Hydrocortisone = glucocorticoid
Fludrocortisone = mineralcorticoid

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8
Q

What is the sick rule for Addison’s?

A

Double hydrocortisone, no change to fludrocortisone

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9
Q

What is the management of an Addisonian crisis?

A

IV Hydrocortisone 100mg

IV fluids

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10
Q

What malignancy may cause Cushing’s syndrome?

A

Small cell lung cancer

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11
Q

What ABG picture will Cushing’s syndrome give?

A

Metabolic alkalosis with hypokalaemia

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12
Q

Why do you get hypokalaemia in Cushing’s syndrome?

A

Overload of cortisol can have some knock-on aldosterone effects

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13
Q

How are Cushing’s causes categorised?

A

ACTH-dependent and ACTH-independent

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14
Q

What are the ACTH-dependent causes of Cushing’s? (2)

A

Cushing’s disease (80%)

Ectopic ACTH production (eg. SCLC)

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15
Q

What is Cushing’s disease?

A

Pituitary tumour secreting ACTH -> adrenal hyperplasia

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16
Q

What are the ACTH-independent causes of Cushing’s? (2)

A

Iatrogenic/steroids

Adrenal adenoma/carcinoma

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17
Q

What 3 investigations will help in the diagnosis of Cushing’s?

A

Overnight dexamethasone suppression test
24hr urinary cortisol
Insulin stress test

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18
Q

How is the dexamethasone suppression test conducted?

A

Give dex at 10pm, measure cortisol at 9am

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19
Q

Why may an insulin stress test be performed?

A

Allows differentiation between Cushing’s and pseudo-Cushing’s

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20
Q

What are the two stages to the overnight dex suppression test?

A

Low-dose (1mg)

High-dose (8mg)

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21
Q

What does the low-dose ODST indicate?

A

Whether someone has Cushing’s syndrome
Low cortisol = NORMAL person
Normal/high cortisol = Cushing’s syndrome

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22
Q

What does the high-dose ODST indicate?

A

The cause of the Cushing’s syndrome
Low cortisol = Cushing’s disease
Normal/high cortisol = Adrenal/ectopic cushing’s

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23
Q

How do you differentiate between adrenal and ectopic Cushing’s on laboratory tests?

A

Low ACTH after high-dose ODST = adrenal cushing’s

High ACTH after high-dose ODST = ectopic ACTH production

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24
Q

What is the management of Cushing’s?

A 
Iatrogenic = stop steroids
Mifepristone = decreases steroid secretion
Tumours = surgical removal
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25
Q

What are the symptoms of diabetes insipidus?

A

Polyuria
Polydipsia
Dilute urine

26
Q

What laboratory test will indicate diabetes insipidus?

A

Low urine osmolality

High serum osmolality

27
Q

How is diabetes insipidus classified?

A 
Cranial = not producing ADH
Nephrogenic = not responding to ADH
28
Q

What 3 investigations should be performed if suspect diabetes insipidus?

A

Rule out DM - BGL/HbA1c
Rule out CKD - U+E
Water deprivation test - deprive fluids for 8hrs then check osmolality

29
Q

What is the management of CRANIAL diabetes insipidus?

A

Desmopressin

30
Q

What is the management of NEPHROGENIC diabetes insipidus?

A

Bendroflumethiazide

31
Q

In practice, what is often done to distinguish between cranial and nephrogenic diabetes insipidus?

A

Give Desmopressin and see if it works

32
Q

What is the management of acute hypercalcaemia?

A

0.9% saline 1L 4hrly 24hrs, then 1L 6hrly 48-72hrs
Furosemide if overloaded
IV Pamidronate

33
Q

What are Chvostiks and Trousseau signs indicative of?

A

Hypercalcaemia

34
Q

What is the management of secondary hyperparathyroidism?

A

Alfacalcidol (active vitD)

35
Q

What are the criteria for familial hyperlipidaemia?

A

Total cholesterol >7.5 AND FHx of premature CHD

OR Total cholesterol >9.0

36
Q

What are the features of a pituitary adenoma?

A

Excess GH -> acromegaly
Bitemporal hemianopia
Raised prolactin (1/3) -> galactorrhoea

37
Q

What syndrome are pituitary adenomas associated with?

A

MEN-1 (6% of pituitary adenomas)

38
Q

What is the management of a pituitary adenoma?

A

Transphenoidal surgery to remove

Octreotride to decrease GH

39
Q

What is Addison’s disease?

A

Autoimmune destruction of adrenal glands
Resulting in decreased cortisol and aldosterone
Most common primary hypoadrenalism in UK (80%)

40
Q

What are the symptoms of Addison’s disease?

A 
Lethargy, weakness, anorexia, weight loss
Nausea and vomiting
Salt craving
Hyperpigmentation esp. palmar creases
Vitiligo
Loss of pubic hair in females
41
Q

What are the physiological features of Addison’s disease?

A

Hypotension
Hypoglycaemia
Hyponatraemia
Hypokalaemia

42
Q

What are the features of an Addisonian crisis?

A

Shock
Collapse
Pyrexia

43
Q

What are the non-Addison’s causes of primary hypoadrenalism? (5)

A 
TB
Metastatic cancer (eg. bronchial)
Meningococcal sepsis = Waterhouse-Friderichson syndrome
HIV
Anti-phospholipid syndrome
44
Q

What are the causes of secondary hypoadrenalism? (2)

A

Pituitary disorders

Exogenous glucocorticoids

45
Q

From inside to out, name the parts of the adrenal gland?

A

Medulla
Zona reticularis
Zona fasciculata
Zona glomerulosa

46
Q

What percentage of the adrenals is medulla?

A

20%

47
Q

What is secreted from the adrenal medulla?

A

Catecholamines

48
Q

What percentage of the adrenals is cortex?

A

80%

49
Q

What percentage of cortex is zona reticularis, and what does it secrete?

A

7%

Androgens ie. oestrogen and testosterone

50
Q

What percentage of cortex is zona fasciculate, and what does it secrete?

A

78%

Glucocorticoids ie. cortisol

51
Q

What percentage of the cortex is zona glomerulosa, and what does it secrete?

A

15%

Mineralcorticoids ie. aldosterone

52
Q

Which hormone stimulates the adrenal cortex?

A

ACTH

53
Q

What stimulates the adrenal medulla?

A

Nerve fibres

54
Q

What is the function of mineralocorticoids?

A

Na+ and water retention in kidneys -> increase BP and blood volume

55
Q

What is the function of glucocorticoids?

A

Increased protein and fat breakdown to glucose -> increase BGL
Immune system suppression

56
Q

What are the causes of primary HYPERaldosteroniam? (3)

A 
Idiopathic adrenal hyperplasia (70%)
Adrenal adenoma = Conn's syndrome
Adrenal carcinoma (rare)
57
Q

What are the features of HYPERaldosteronism?

A

Hypertension
Hypokalaemia -> muscle weakness (10-40% in practice)
Alkalosis

58
Q

What is the 1st line investigation for HYPERaldosteronism?

A

Aldosterone/Renin Ratio

59
Q

What will the ARR show for HYPERaldosteronism?

A

High aldosterone with low renin - due to -ve feedback from Na+ retention -> decreased renin

60
Q

What investigations should be performed if you get a high ARR?

A

High-resolution CT - identifies bilateral vs unilateral causes
Adrenal venous sampling - identifies the gland secreting the excess hormone

61
Q

What is the management of an adrenal adenoma (Conn’s syndrome)?

A

Surgical removal

62
Q

What is the management of bilateral adrenal hyperplasia?

A

Spironalactone (aldosterone antagonist)

5th Year (8 decks)

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