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CP1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Hormones in calcium homeostasis

A

PTH released by parathyroid in response to low CA, aids with absorption and releases Ca from bone

D3 vital for the absorption of Ca

Calcitonin released by thyroid in response to high Ca

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2
Q

Causes of hypercalcaemia

A 
Excessive PTH secretion 
Malignancy (PTH independent)
Excessive action of D3
Excessing dietary intake 
Drugs - thiazide diuretics, lithium, vit D, vit A
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3
Q

Symptoms of hypercalcaemia

A

General - fatigue, dehydration, confusion, depression, irritability

Renal - renal stones, polyuria

MSK - bone pain, calcifications in hyaline cartilage

GI - Abdo pain, constipation, nausea and vomiting

“Bones, Stones, Groans, Moans”

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4
Q

Causes of hypocalcaemia

A

Raised phosphate (CKD, phosphate based treatment)
Hypoparathyroidism
Low vitamin D (e.g. short gut, cirrhosis, CKD, resistance)
Acute pancreatitis
Acute rhabdomyolysis
Calcium chelators
Tumour lysis post chemo

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5
Q

Symptoms of hypocalcaemia

A

CNS - irritation, confusion, seizures, cognitive change

PNS - Spasms and cramping (tetany), periorbital and peripheral parathesia

Cardio - bradycardia, arrhythmia, hypotension, long QT

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6
Q

Investigating Hypocalcaemia

A

Calcium levels adjusted for albumin + albumin levels

PTH levels - best in morning, low in hypoparathyroidism, raised in via D deficiency, renal disease, malignancy with bony involvement

Vitamin D levels

ALP - raised in bony mets independent of other liver markers

Phosphate - raised phosphate in context of no renal failure or tissue points to hypoparathyroidism or pseudohypoparathyroidism

Magnesium - hypomagnesaemia and severe hypermagnesaemia causes hypocalcaemia

Renal function to rule in/out renal failure

Creatinine Kinase to rule in/out rhabdomyolysis

Amylase/Lipase to rule out pancreatitis

ECG to check for arrhythmia

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7
Q

Investigating Hypercalcaemia

A

PTH levels - hyperparathyroidism accounts for 90% of cases, very low PTH could point to malignancy

Vitamin D for vit D intoxication
Renal function
CXR for sarcoidosis if pulmonary symptoms

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8
Q

Typical labs in Adrenal Crisis

A

Hyponatraemia

Hyperkalaemia (primary)

Low aldosterone and high renin (primary)

Raised creatinine due to hypovolaemia

May have Hypoglycaemia

May have raised lymphocytes and eosinophils

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9
Q

Symptoms of Adrenal Crisis

A

Hypotension, postal hypotension, dizziness

Abdominal pain, nausea, vomiting, weight loss

Confusion, lethargy, delirium, coma

Cramps in back and legs

Hypovolaemic shock

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10
Q

Tumour locations in Multiple Endocrine Neoplasms Type 1 (MEN I)

A

Parathyroid glands
Endocrine GI tract
Anterior pituitary

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11
Q

Pituitary Adenoma Size Classifications

A

Microadenoma < 10mm

Macroadenoma > 10mm

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12
Q

Pituitary Adenoma Histology Classifications

A

Chromophobe - most common, secrete prolactin or are non functioning

Acidophil - secrete GH or prolactin

Basophil - secrete ACTH and rarely cause pressure

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13
Q

Symptoms due to compression of pituitary adenoma

A

Headache due to pressure

Bitemporal hemianopia due to option chiasm pressure

Diplopia from pressure on CN III, IV and VI

Haemorrhage or infarct of pituitary (apoplexy) leading to severe headache, visual disturbance and lack of essential hormones causing adrenal crisis

Hypogonadism - soft and small testes, ED, gynaecomastia, amenorrhoea, infertility, low libido, breast atrophy, hot flushes

Hypothyroidism - weight gain, fatigue, low mood

Adrenal insufficiency - nausea, vomiting, anorexia, weakness, adrenal crisis

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14
Q

Symptoms due to hormonal changes of pituitary adenoma

A

Hyperprolactinaemia leading to galactorrhoea, amenorrhoea and hypogonadism

Excessive growth hormone leading to acromegaly

Excess ACTH leading to Cushing’s

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15
Q

Hormones secreted by outer adrenal cortex

A

Steroid Hormones - Aldosterone, Cortisol, Sex Hormones

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16
Q

Hormones secreted by inner adrenal medulla

A

Catecholamines - adrenaline and noradrenaline

17
Q

Symptoms of Cushing’s (raised cortisol)

A 
Truncal obesity
Moon face 
Buffalo hump 
Thinning hair
Bruising and striae
Hypertension 
Osteoporosis and fractures
18
Q

Lab findings in Cushing’s

A

Raised cortisol - random or evening salivary

Positive dexamethasone tests

May be hyperglycaemic

19
Q

Causes of Cushing’s

A

ACTH secreting pituitary adenomas

ACTH secreting tumour elsewhere such as lungs

Adrenal hyperplasia/adenoma leading to excess cortisol

Adrenal carcinoma

Iatrogenic from prolonged use of steroids

20
Q

Addison’s causes a reduction in these hormones

A

Cortisol

Aldosterone

21
Q

Symptoms of Addison’s

A 
Fatigue 
Anorexia and weight loss
Nausea, vomiting and diarrhoea 
Hyperpigmentation 
Depression and irritability 
Hypotension
Arthralgia and myalgia
22
Q

Lab findings in Addison’s

A

Low morning cortisol (<100 nanomol/L highly likely to be adrenal crisis)

Hyponatraemia (not always)

Hyperkalaemia (not always)

Hypoglycaemic (not always)

ACTH will be high in Addisons but low in secondary insufficiency

Synacthen test (ACTH) will not increase cortisol

High renin and low aldosterone

Autoantibodies positive in 80% of cases and tend to be IgG class

23
Q

Causes of Addison’s

A

Presence of autoantibodies against adrenal gland

Congenital adrenal hyperplasia

Infections such as TB, HIV and CMV

Adrenal mets

Haemochromotosis

Amyloidosis

Iatrogenic causes such as adrenalectomy, adrenal haemorrhage from anticoagulation

24
Q

Treatment for Addison’s and Adrenal Crisis

A

Glucocorticoid replacement - usually hydrocortisone

Mineralcorticoid replacement - usually fludrocortisone

ADRENAL CRISIS

High dose intramuscular hydrocortisone ASAP

IV fluids to stabilise and prevent renal failure

25
Q

Symptoms of primary hyperaldosteronism (Conn’s)

A 
Hypertension which can be severe
Headache
Hypokalaemia 
Hypernatraemia 
Metabolic Alkalosis 
Polyuria
Muscle Cramps
26
Q

Causes of secondary hyperaldosteronism

A

Over activation of the RAAS system by renal artery stenosis or juxtaglomerular cell tumours

27
Q

Causes of primary hyperaldosteronism

A

Tumour or hyperplasia of adrenal glands leading to excess aldosterone

28
Q

Lab findings in primary hyperaldosteronism

A 
Hypokalaemia 
Hypernatraemia
High aldosterone and low renin 
Raised WCC
Raised urine metadrenaline
29
Q

What is phaechromocytoma

A

Rare tumour of the chromaffin cells

Can occur in the adrenal medulla OR extra-medullary e.g. abdomen or aortic bifurcation

Produce catecholamines (e.g. adrenaline and noradrenaline)

10% Rule – 10% malignant, 10% extra-medullary, 10% bilateral, 10% familial

30
Q

Symptoms of phaechromocytoma

A

Classic triad of:
Episodic headache
Diaphoresis
Tachycardia

May also have:
Episodic or postural hypertension
Anxiety
Palpitations 
Hyperglycaemia (stimulated gluconeogenesis)
31
Q

Causes of hyperthyroidism

A

Autoimmune - TSH-rAB thyroid receptor antibodies attach to receptors in the thyroid and stimulate T3 and T4 production

Single Toxic Nodule/Adenoma

Toxic Multinodular Goitre

De-Quervain’s Thyroiditis - transient and associated with inflammatory processes

32
Q

Causes of hypothyroidism

A

Autoimmune lymphocytic with anti-thyroid autoantibodies causing inflammation

Hashimoto’s - autoimmune, thyroid peroxidase antibodies, may be thyroglobulin antibodies

33
Q

Hyperthyroid Treatment

A

Carbimazole or other antithyroid drugs

Beta Blockers

Radioiodine Therapy

Surgery

34
Q

Thyroid tumour types

A

Papillary - most common, 30-50 years, good prognosis

Follicular - 20% cases, 40-60 years, good prognosis

Medullary - 5%, NET, often familial, poor prognosis but slow

Anaplastic - aggressive

Lymphoma - variable

35
Q

Diagnostic criteria for diabetes

A

Fasting plasma glucose > 7.00 mmol/L
OR
2 hour post-load plasma glucose > 11.00 mmol/L
OR
Random glucose > 11.1 mmol/L
OR
HbA1c > 48 mmol/mol (normal is < 42, 42-47 is considered pre-diabetes)

36
Q

Secondary causes of diabetes

A 
Pancreatic disease 
Cystic Fibrosis 
Haemochromotosis 
Acromegaly 
Cushing's 
Drug induced 
Rubella
Mumps 
CMV
Pregnancy
37
Q

Lab finings in Hyperosmolar Hyperglycaemic State

A 
Hyperglycaemia 
Hypovolaemia 
Serum osmolality > 320 mol/kg
No ketones
Mild acidosis may be present 
Leukocytosis

CP1 (13 decks)

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