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3a > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the most common cause of primary hypothyroidism worldwide?

A

Iodine deficiency

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2
Q

What is the autoimmune cause of hypothyroidism?

A

Hashimoto’s thyroiditis

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3
Q

Which drugs can induce hypothyroidism?

A

Amiodarone

Lithium

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4
Q

Which antibodies are produced in Hashimoto’s thyroiditis?

A

Antithyroid (TPO) autoantibodies

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5
Q

What surgical causes lead to hypothyroidism?

A

Thyroidectomy

Radio-iodine treatment

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6
Q

What are the risk factors for hypothyroidism?

A
  • Autoimmune disease e.g. Addison’s
  • Turner’s syndrome
  • Down’s syndrome
  • Cystic fibrosis
  • Primary biliary cirrhosis
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7
Q

A myxoedema coma is induced by severe hypothyroidism. What are the symptoms of this?

A

Hypothermia
Cardiac failure
Hypoglycaemia
Death

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8
Q

How would you treat a myxoedema coma?

A

IV T3
Glucose infusion
Rewarm patient

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9
Q

What are the symptoms of hypothyroidism?

A 
Menorrhagia
Fatigue
Cold intolerance
Low mood
Weight gain
Constipation
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10
Q

What are the signs of hypothyroidism? (hint: BRADYCARDIC)

A 
Bradycardia
Reflexes slow
Ataxia
Dry thin hair/skin
Yawning
Cold hands
Ascites
Round puffy face
Defeated demeanour
Immobile
Congestive heart failure
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11
Q

How would primary hypothyroidism present on thyroid function tests?

A

Low T3/T4

High TSH

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12
Q

How would secondary hypothyroidism present on thyroid function tests?

A

Low T3/T4

Low TSH

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13
Q

How would FBC, sodium and cholesterol present in hypothyroidism?

A

Macrocytic anaemia
Hyponatraemia
Hypercholesterolaemia

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14
Q

Which drug do you give to treat hypothyroidism?

A

Levothyroxine (T4)

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15
Q

Which level of vertebrae is the thyroid gland located?

A

C5-T1

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16
Q

Which hormone stimulates the release of TSH from the pituitary?

A

TRH = Thyrotropin-releasing hormone from the hypothalamus

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17
Q

Which autoimmune condition causes hyperthyroidism and thyrotoxicosis?

A

Graves’ disease

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18
Q

Which autoantibodies are produced in Graves’ disease?

A

Anti-TSH-receptor

They bind to TSH receptors and stimulate production of T3 and T4

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19
Q

Which conditions are associated with Graves’ disease?

A

T1DM
Addisons
Vitiligo

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20
Q

Apart from Graves’ disease, what are the other causes of hyperthyroidism?

A
  • Toxic multinodular goitre
  • Toxic thyroid adenoma
  • Iodine excess
  • Amiodarone
  • Viral infection
  • Postpartum thyroiditis
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21
Q

What are the symptoms of hyperthyroidism?

A
  • Tremor
  • Diarrhoea
  • Weight loss
  • Increased appetite
  • Sweating
  • Heat intolerance
  • Palpitations
  • Restlessness
  • Oligomenorrhoea
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22
Q

What are signs of hyperthyroidism?

A
  • Thin and brittle hair
  • Loss of outer third of eyebrow
  • Warm and moist skin
  • Tachycardia
  • Fine tremor
  • Brisk reflexes
  • Palmar erythema
  • Lid lag and retraction
  • Goitre
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23
Q

What are signs of Graves’ disease?

A
  • Diplopia
  • Exophthalmos
  • Chemosis
  • Clubbing
  • Pretibial myxoedema
  • Onycholysis
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24
Q

What is the thyroid function test result for primary hyperthyroidism?

A

High T3/T4

Low TSH

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25
Q

What is the thyroid function test result for secondary hyperthyroidism?

A

High T3/T4

High TSH

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26
Q

Which thyroid autoantibodies can you test for?

A

Anti thyroid peroxidase (anti-TPO)
Anti thyroglobulin
TSH receptor

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27
Q

How would you treat hyperthyroidism?

A
  • Beta blockers
  • Block and replace: carbimazole + levothyroxine
  • Radioiodine (cannot give in pregnancy or malignancy)
  • Thyroidectomy - indicated in malignancy
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28
Q

What are the clinical features of a thyroid storm?

A
  • Palpitations
  • Tachycardia
  • Tremor
  • Nausea and vomiting
  • Abdominal pain
  • Reduced consciousness
  • Confusion
  • Seizures
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29
Q

How do you manage. thyroid storm?

A
  • Carbizamole
  • Beta blockers
  • Potassium iodide
  • IV hydrocortisone
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30
Q

What are the complications of thyrotoxicosis?

A
  • AF
  • Heart failure
  • Angina
  • Deterioration of visual acuity
31
Q

What is Cushing’s syndrome?

A

Clinical state of excessive cortisol

32
Q

What is Cushing’s disease?

A

Cushing’s syndrome caused by a pituitary adenoma secreting inappropriate ACTH

33
Q

What are the causes of Cushing’s syndrome?

A
  • Oral steroid use
  • Adrenal adenoma
  • Pituitary adenoma
  • Paraneoplastic - small cell lung cancer secreting ACTH
34
Q

Corticotropin-releasing hormone is secreted from the hypothalamus. CRCh binds to pituitary which then releases ACTH. ACTH stimulates the adrenal cortex to release cortisol. What are the functions of cortisol?

A
  • Increases carbohydrate and protein catabolism
  • Increases deposition of fat and glycogen
  • Sodium retention
  • Increased renal potassium loss
  • Gluconeogenesis
  • Diminishes host response to infection
  • Reduces bone formation
35
Q

What are the symptoms of Cushing’s syndrome?

A
  • Weakness
  • Facial fullness
  • Weight gain
  • Low mood
  • Decreased libido
  • Polydipsia
  • Polyuria
  • Acne
  • Hirsutism
36
Q

What are the signs of Cushing’s syndrome?

A 
CUSHING
Cataracts
Ulcers
Skin striae
Hyperglycaemia + hypertension
Increased infection
Necrosis
Glucosuria

Moon facies
Buffalo hump
Truncal obesity
Oedema

37
Q

What is pseudo-Cushing’s syndrome caused by?

A

Excess alcohol

38
Q

Which investigations can diagnose Cushing’s syndrome?

A
  1. 24 hour urinary free cortisol
  2. Dexamethasone suppression test - failure of dexamethasone to suppress cortisol indicates Cushing’s
  3. Late night salivary cortisol. Cortisol has diurnal variation, however this is absent in Cushing’s
39
Q

How do you treat Cushing’s syndrome?

A
  • Reduce steroids
  • Resection of tumour
  • Mitotane to inhibit glucocorticoid synthesis
40
Q

What are the complications of Cushing’s syndrome?

A
  • Hypertension
  • Diabetes
  • Obesity
  • Metabolic syndrome
  • Osteoporosis
41
Q

What is acromegaly?

A

Increased production of growth hormone after the fusion of epiphyseal plates

42
Q

What are the causes of acromegaly?

A
  • Pituitary adenoma

- Multiple endocrine neoplasia

43
Q

What does growth hormone stimulate the release of in the liver?

A

IGF-1

44
Q

What are the symptoms of acromegaly?

A
  • Sweating
  • Headache
  • Decreased libido
  • Athralgia
  • Visual deterioration
  • Paraesthesia
45
Q

What are the signs of acromegaly?

A
  • Skin darkening
  • Puffy lips and eyelids
  • Big tongue
  • Deep voice
  • Massive growth of hands, feet and jaw
46
Q

What investigations would you to do determine acromegaly?

A
  • Oral glucose test - glucose should suppress GH, in acromegaly, this will not occur
  • IGF-1 levels
  • MRI of pituitary
47
Q

How would you manage acromegaly?

A
  • Tumour resection
  • Somatostatin analogues to inhibit GH
  • GH antagonist e.g. pegvisomant
48
Q

What are the complications of acromegaly?

A
  • Diabetes
  • Sleep apnoea
  • Hypertension
  • IHD
  • Arthritis
49
Q

Which cells are destroyed in T1DM?

A

Beta cells

50
Q

What are the risk factors for T1DM?

A

Enteroviruses
Vitamin D deficiency
Autoimmune disease

51
Q

What are the symptoms of T1DM?

A 
Thirst 
Polyuria - glucose draws water into urine by osmosis. Kidneys cannot reabsorb any more glucose as they have reached maximum absorptive capacity
Weight loss 
Fatigue
Infections e.g. thrush
52
Q

What are the signs of DKA?

A 
Tachycardia
Hyperventilation
Sweating 
Hypotension
Confusion
Collapse
Vomiting
53
Q

Which specific investigations can you do for T1DM?

A
  • Autoantibodies against beta cells

- Serum C peptide - absent due to beta cell destruction

54
Q

What are glucose values for someone with diabetes?

A

Random venous plasma glucose >11.1 mmol/L

Fasting plasma glucose >7 mmol/L

55
Q

What is the HbA1c value for someone with diabetes?

A

HbA1c >48 mmol/mol

56
Q

What is the treatment for T1DM?

A

Insulin

57
Q

What are plasma and urinary ketone levels for someone with DKA?

A

Plasma ketones >3

Urinary ketones >2

58
Q

How would you manage DKA?

A

Fluids
Insulin
Replacement of electrolytes, K+

59
Q

What are the risk factors for T2DM?

A 
Obesity
Alcohol excess
High cholesterol
Smoking
FH 
CVS disease
Hypertension
Age
60
Q

In T2DM, there is insulin resistance. What are the symptoms of this?

A 
Asymptomatic
Thirst
Polyuria
Fatigue
Increased hunger
61
Q

What is the conservative management for someone with T2DM?

A 
Stop smoking
Lose weight 
Exercise 
Ramipril
Statin
62
Q

Outline the step wise approach to medically treating T2DM.

A
  1. Metformin - increases cell sensitivity to insulin
  2. Sulfonylurea e.g. gliclazide
  3. DDP4 inhibitor e.g. gliptin
  4. Isophane insulin
  5. GLP1-mimetic - incretin analogue
63
Q

What are the side effects of metformin?

A

Diarrhoea
Nausea
Weight loss

64
Q

What are the side effects of gliclazide?

A

Hypoglycaemia

Weight gain

65
Q

What are the macrovascular complications of T2DM?

A

Atherosclerosis
Stroke
MI
Peripheral vascular disease

66
Q

What are the microvascular complications of T2DM?

A

Retinopathy
Nephropathy
Neuropathy

67
Q

What are the features of diabetic retinopathy?

A

Haemorrhages
Lipid deposits
Macula oedema

68
Q

What are the features of diabetic nephropathy?

A

Albumin:creatinine ratio >3
Raised ESR
Normochromic normocytic anaemia

69
Q

How would you manage diabetic nephropathy?

A

ACEi
ARB
Dialysis

70
Q

What are the symptoms of diabetic neuropathy?

A 
Pain
Paraesthesia
Burning 
Diarrhoea/constipation
Incontinence
Erectile dysfunction
71
Q

What are the signs of diabetic neuropathy?

A

Ulceration
Infection
Postural hypotension

72
Q

How would you test for diabetic neuropathy?

A
  • Test sensation using microfilament 10g
  • Test vibration perception using tuning fork
  • Test ankle reflexes
  • Doppler ultrasound
73
Q

How would you treat diabetic neuropathy?

A

Avoid weight bearing

Capsaicin

3a (13 decks)

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