ENDOCRINE SYSTEM Flashcards
what percentage of all diabetes sufferers have diabetes type 1?
a) 5%
b) 10%
c) 50%
d) 100%
b) 10%
which immune complexes is diabetes type 1 associated with?
HLA
what occurs to the pancreas in type one diabetes?
beta cell destruction
absolute insulin deficiency
what enzyme is used in diagnostic antibody testing for DMT1?
Glutamate acid dehydrogenase
give 2 risk factors for diabetes type 1
family history
other autoimmune conditions
what 2 substances will be present in the urine of a patient with DMT1?
ketones
glucose
how do DMT1 patients normally first present?
Diabetic ketoacidosis
give 2 physiological features of a DKA
ketones used for gluconeogenesis
hyperglycaemia
metabolic acidosis
what will be present to smell on the breath of someone with DMT1?
ketones on breath
what causes polydipsia/polyuria in DMT1?
osmotic diuresis
what diagnostic test would you use to test for DMT1?
HBA1C
what would be first line treatment for a DKA and DMT1 in general?
insulin
why would you give potassium in treatment for a DKA?
to prevent rebound hypokalaemia in response to hyperkalemia in DKA
why don’t DMT1 patients get AKI as soon as expected in a DKA?
polyuria is a protective factor for the kidney
why does caution have to be exercised in giving fluids in a DKA?
to avoid cerebral overload as brain hydration is maintained
in relation to insulin, what two things can cause DMT2?
increased resistance
decreased secretion
name 2 drugs that are associated with DMT2
glucocorticoids
thyroxine
olanzepine (antipsychotic can increase weight)
Diazoxide
give 4 symptoms of DMT2
polydipsia polyuria weight loss blurred vision/visual disturbances fatigue
name 2 diagnostic tests used for DMT2
fasting glucose
random glucose
HBA1C
Glucose tolerence test
what is first line treatment for DMT2?
metformin
what time of drug is metformin?
biguanide
how does metformin work?
increases insulin sensitivity
give 2 side effects of metformin
anorexia (can be good thing in obese patients)
D&V
reduced B12 absorption
what is second line treatment for DMT2?
sulfonylureas
how do sulphonylureas work?
increase insulin secretion from beta cells
give 2 examples of sulphonylureas
gliclazide
glibenclamide
tolbutamide
give a side effect of sulfonylureas
weight gain and hypoglycaemia
what is third line treatment for diabetes?
thiazolidinedione (glitazone)
what does glitazone do?
increases insulin sensitivity
who does cushion’s syndrome most commonly affect?
a) middle aged women
b) middle aged men
c) old women
d) old men
a) middle aged women
what causes cushing’s syndrome?
hyperadrenocorticolism over production of glucocorticoids long term corticosteroid treatment e.g. autoimmune/inflamm adrenal carcinoma/adenoma Carney Complex Cushings disease
what causes 90% of cushings cases?
ACTH over production from pituitary gland & adrenal hyperplasia
where in the body except the pituitary can ACTH be produced?
Ectopic ACTH production due to tumour formation ( benign and malignant) Thyroid Lung= small cell lung cancer Pancreas Thymus glands
what 5 things make up Carney Complex ?
Multiple Endocrine Neoplasia (men)
adrenal hyperplasia pituitary adenoma myopia schwannoma testicular tumour
what is the point of an overnight dexamethasone suppression test in the diagnosis of Cushing’s?
giving body steroids should cause serum levels to decrease in a normal patient. If don’t can be cushings
why might you suggest a CT/MRI in the diagnosis of Cushing’s?
of adrenal glands to check for hyperplasia
give 2 types of weight gain that are characteristic of Cushing’s
central obesity
moon face
give 2 skin symptoms of Cushing’s
purple abdominal striae
thin bruising skin
poor wound healing
give two genitor-reproductive symptoms of Cushing’s
amenorrhoea
impotence
libido loss
give 2 bone symptoms of Cushing’s
osteoporosis
fractures
what is hirtuism? (symptom of Cushing’s)
hair growth on face
give 2 drugs that can be given in treatment of Cushing’s by decreasing plasma cortisol
aminoglutethimide
ketoconazole
metyrapone
excess of what can cause pseudo-cushings?
alcohol
which gender is thyroid problems most common in?
females
what causes 2/3 of hyperthyroidism?
grave’s disease
what causes Grave’s disease?
IgG antibodies bind to TRH receptors and cause excess hormone and thyroid hyperplaseia
give 3 triggers of grave’s
infection
stress
childbirth
what other conditions is Grave’s associated with?
Addisons, DMT1 and Vitiligo
give 4 other causes of hyperthyroidism
toxic multi nodular goitre
toxic adenoma of thyroid gland
follicular carcinoma
sub acute (de-quervain’s) thyroiditis (self limiting)
choriocarcinoma (ocarina teratoma w thyroid tissue)
Out of these 3 hormone,TSH/T3/T4 which would be low and which would be high in hyperthyroidism?
low TSH
high T3, T4
give 3 symptoms characteristic of Grave’s disease
exophthalmus pretibial myxoedema thyroid acropatchy thyroid bruis Clubbing
what is a risk of thyroidectomy surgery?
recurrent laryngeal nerve damage
give 5 complications of hyperthyroidism
HF Atrial fibrillation thyroid eye disease osteoporosis gynaecomastia
what is hashimoto’s thyroiditis?
autoimmune destruction of thyroid gland
give 2 drugs which can cause hypothyroidism
amiodarone
lithium
iodine
carbimazole
Name 2 genetic syndromes that can cause hypothyroidism
Pended’s
Turner’s
what is pendred’s syndrome?
thyroid problems & bilateral sensorineural deafness
what is Turner’s syndrome?
female missing one sex chromosome (45X)
what is the cause of secondary hypothyroidism?
pituitary failure
which of these indicates thyroid failure and which indicates pituitary failure?
a) high TSH, low T3/4
b) low TSH, low T3/4
a) thyroid failure
b) pituitary failure
Give 5 limb-related symptoms of hypothyroidism
myxoedema myalgia arthralgia paraesthesia in hands neuropathy (carpal tunnel) Slow reflexes due to cerebellar ataxia
give 2 facial symptoms of hypothyroidism
face swelling
hair loss outer 1/3 of eyebrow
give 2 complications of hypothyroidism in pregnancy
pre-eclampsia
low birth weight
premature birth
What are the causes of thyroid nodules?
cyst thyroiditis tumour overgrowth of normal tissue Iodine deficiency
how many of the population have palpable goitres?
a) 1%
b) 9%
c) 30%
d) 70%
b) 9%
how can smoking cause a goitre
thiocyanate in cigarettes interferes with body’s use of iodine
how many goitres are thyroid cancer?
a) 1 in 10
b) 1 in 20
c) 1 in 100
d) 1 in 200
b) 1 in 20
give 5 differential diagnoses for goitre
pharyngeal pouch tumour cyst submandibular stones carotid aneurysm/tortuous (pulsatile)
What are the ranges of HB1ac for DMT1?
Normal, pre diabetic and diabetic?
<42mmol/ml = normal 42-47mmol/ml = pre diabetic >48mmol/ml = diabetic
How can you diagnose diabetes other than using the HB1ac?
2 out of 3 on 2 separate occasions
Fasting glucose >7
Random glucose >11
Glucose tolerance test
What does the HB1ac test look at?
The average amount of glucose in your blood in the last 2 to three months
What is DKA?
When you body lacks insulin it breaks down fat to produce and high level of glucose also causes hyperglycemia. Can be fatal
What are the physical symptoms a DMT1 patient might get?
Blurred vision Fatigue Weight loss Feel very thirsty Increase urine output especially at night Takes longer for cuts and grazes to heal Itchiness around the genital area
Differential diagnosis of DMT1?
Type 2
Maturity onset diabetes of the young
What is MODY?
It is caused by single gene passing through family
Diabetes under 25 with parents having diabetes
What lifestyle factors should you consider with DMT1?
Reduce weight Healthy eat No smoking Exercise Reduce BP
What are risk factors of DMT2?
Age Obesity Diabetes or pre diabetes while pregnant 5 * more common if South asian or African Carribean (over 25) First degree relative with DMT2
Before you have medical treatment what should you advice patients to do who have DMT2?
Reduce weight
More exercise
Eat healthier= less sugar and fat. More fibre
What should you monitor regularly in a patient with DMT?
Eyes and feet
What treatment do you give if the first 3 lines of treatment for DMT2 don’t work?
Insulin
What are thyroid nodules?
Solid/fluid filled lumps in thyroid gland
What are the risk factors for thyroid nodules?
Smocking
FHx
Amiodarone and lithium side effects
What are the symptoms of thyroid nodules
Often asymptomatic
Release thyroxine which is a causes by hyperthyriodism
What are the signs of thyroid nodules?
On swallowing see movement of nodules
Enlarged thyroid
How can you diagnose thyroid nodules and goitre?
Often incidental Physical examination US TFT's and autoantibodies Fine needle aspiration Radioactive iodine scan
What is red flag symptom of thyroid nodule?
Stridor with thyroid mass
What developments of thyroid would indicate urgent referral?
Child with thyroid nodule
Painless thyroid mass that has enlarged rapidly
Hoarseness or change in voice with goitre
Palpable cervical lymphadenopathy
What is treatment for thyroid nodule?
Treat underline cause
Excision if malignant
Treat hyperthyroidism
What are the two type of goitre?
Diffuse smooth goitre
Nodular goitre
What are the causes of diffuse smooth goitre?
Iodine deficiency
Graves disease
What is a goitre?
Abnormal swelling of thyroid gland
What are the causes of goitre?
Pregnancy Menopause Hypo/hyperthyriodism thyroid cancer (1 in20 of goitres) smoking Iodine deficiency Drugs: lithium and immunosuppressors
What can be a serious side effect of goitre?
Can compress trachea or esophagus
What is cushings syndrome?
When the body produces to much cortisol
What type of hormone is cortisol and what is its main aim?
It’s the stress hormone and maintains homeostasis
What is cushings disease and how does it cause cushings syndrome?
It is hyperplasia and tumour growth on the pituitary gland causing excess production of ACTH which leads to excess production of cortisol
How does Corticotroponin releasing hormone from the hypothalamus cause Cushing’s?
While rare it can cause excessive production of ACTH by the pituitrary gland
What does ACTH stand for?
Adrenocorticotropic hormone
What are non ACTH causes of cushings syndrome?
Excessive glucocorticoid
Adrenal adenoma and carcinoma
Long term corticosteroids use
What is the ratio of female to male in cushings?
5:1
What group of people have high incidence of cushings?
Diabetics
Osteoporsis group
Hypertension
Obese people
How long free does the urine have to be of cortisol to not have cushings?
24hours
What happens to your mood in cushings?
Depression and fatigue
What happens to your BP and glucose levels in cushings?
Hypertension
Hyperglycaemia
What is sub acute (de-quervain’s) thyroiditis (self limiting)?
Self limiting painful goitre
Causes rise in erythrocyte sedimentation rate and no radio iodine uptake
What are the risk factors of hyperthyriodism?
Fhx Pregnancy Female High iodine uptake HAART Child birth Trauma and surgery to thyroid smoking
Why does high uptake of iodine increase chance of hyperthyriodism?
Increases production of thyroxine
What are the physical signs and symptoms of hyperthyroidism?
Weight loss Heat intolerance Hair loss Goitre Sweaty Over active Diarrohea Labile emotions
What happens sexually in hyperthyroidism?
Oligomenorrhoea
Infertility
What heart related symptoms do you get in hyperthyroidism?
Palpitations (AF, SVT) and tremor
What rare signs and symptoms do you get in hyperthyroidism?
Alopecia
Uriticaria
Physiocosis
itch
What drugs would you give to prevent thyroid production?
Propanolol
Carbimaazole
What are common side effects of hypothyriodism?
Weight gain Constipation Lethargy Cold intolerance Amenorrhoea Hair loss in outer 1/3rd of eyebrow
How mentally does hypothyriodism effect a patient?
Depression
Lipid loss
Difficulty concentrating
What heart complications can you get in hypothyriodism?
Pericardial effusion
What is the treatment of hypothyriodism?
Levothyroxine
What drugs does Levothyroxine interact with?
Carbamexapine
Phenytoin
Rifampicin
Iron tablet
What complication of hypothyriodism increases chance of CVD?
High cholesterol levels
What is the role of TSH and what organ is it released from?
It is released from the anterior pituitary gland and it controls the production of T3 and T4 from the thyroid gland
What is TRH and what organ is it released from?
Thyrotropin-releasing hormone (TRH) from the hypothalamus causes the release of TSH
In response to TSH how much T3/T4 is produced by the thyroid gland?
More T4 to T3
Where is T4 activated to T3?
Peripherals in the kidney and liver
Is all of the T4 and T3 in a active state?
No only the hormones that are free are in the active state. Most of T4 and T3 are bounded to proteins (thyroglobulin)
What is the effect of circulating T4 and T3 on the TSH and TRH?
Circulating T4/3 depresses the release of TRH and TSH from hypothalamus and anterior pituitary respectively
What is the function of the parathyroid gland?
4 tiny glands that sit behind the neck and controls the level of calcium by releasing parathyroid hormone (PTH)
How does the release of PTH increase the levels of calcium in the body?
Breaks down bone and releases the body
Increases the ability to absorb calcium from food
Increase the kidney’s ability to hold onto calcium instead of it being excreted via urine
What in parathyroid adenoma?
What does it cause
Benign tumour of the parathyroid gland
Increase release of Calcium from the bones causing hypercalcaemia
What are the symptoms of parathyroid adenoma?
Primary hyperparathyroid symptoms Kidney stones Depression due to hormone imbalance Constipation Fatigue
What is the diagnosis of Pt adenoma?
Blood: PTH and calcium levels
What is the treatment of PT adenoma and how effective is it?
Surgery for removal of affected gland and 95% successful
What is hyperparathyroidism?
Inappropriate activity of the parathyroid gland causing ^^PTH
What is primary hyperparathyroidism and what is the cause?
PTH levels is not determined by calcium serum levels. hypercalcaemia is the outcome
Caused by PT adenoma or dysfunction of the PT
What is secondary hyperparathyroidism and what is the cause?
It is when calcium levels do not respond to changes in PTH, causing hypocalcaemia
Parathyroid try to respond by increase the production of PTH
Caused by vitamin D3 deficiency
What causes Vitamin D3 deficiency?
CKD
Lack of sunshine
Dietary
Inability to convert from cholesterol
What is tertiary hyperparathyroidism?
It is long term secondary that leads to hyperplasisa and lowered response
What are symptoms of primary hyperparathyroidism?
Osteoporosis Bone deformity Bone fracture Bone, muscle and abdo pain Kidney stones Urinary calculi Cognitive impairment
What are symptoms of secondary hyperparathyroidism?
Rickets
Osteomalacia–> soften bone
Renal osteodystrophy
what is renal osteodystrophy?
It is weekend bones due to kidney inability to maintain normal calcium and phosphate levels
What is the diagnosis of a blood test if their is either :
a) high PTH and Calcium
b) high PTH but low Calcium
a) priamry
b) secondary
What is the treatment for
a) primary
b) secondary
a) surgery
b) treat the Vitamin D3 deficiency
What is addisons?
Adrenal gland insufficiency
Do not produce enough cortisol or aldosterone
What are the causes of addisons disease?
Developed world = autoimmune disease
Developing = TB
Sepsis and bleeding into the gland
What are the 4 main functions of cortisol?
Help to regulate BP, immune system
Help to balance insulin regulatory effects on blood glucose level
Help to control bodies response to stress
What is the function of aldosterone?
Helps to regulate salt levels in blood and control BP
What are the signs and symptoms of addisons disease?
Weight loss and loss of apeptite Weakness Light headness Low blood pressure Skin hyperpigmintation Abdo pain and fatigue Anxiety and low mood changes the need to urinate frequently increased thirst craving for salty foods Dehydration
What is adrenal crisis?
Low BP and syncope
Low back pain
Hyponatremia, hypokalaemia, hypercalcaemia, hypoglycaemia
Triggered by stress (injury, surgery, infection etc.)
What do you see in ABG for addisons patients?
Metabolic acidosis
What is treatment for addisons disease?
Hormone replacement e.g. hydrocortisone, prednisolone, fludrocortisone
o Normally oral
o Can have injection & dextrose in crisis
High salt diet
What are normal glucose levels in the
a) urine
b) blood?
A) 0-0.8mmol/L
b) 3.9-5.5 mmol/L
What is diabetes insipidus?
When you produce large amounts of urine and are very thirsty. Not linked to DM
When is oral glucose tolerance test normally used?
Diabetes in pregnancy
