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Endocrinology Flashcards

1
Q

What are the two main causes of hypercalcaemia?

A

Primary Hyperparathyroidism

Malignancy e.g. multiple myeloma, bone metastasis

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2
Q

How does hypercalcaemia present?

A

Bones, stones, moans, groans

Bone pain/fracture
Renal calculi / renal colic
Depression

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3
Q

How does hypercalcaemia show on an ECG?

A

Short QT interval

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4
Q

How is hypercalcaemia treated?

A

Rehydration with normal saline

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5
Q

What are the causes of hypocalcaemia?

A

Vitamin D deficiency
Chronic kidney disease
Primary hypoparathyroidism
Pseudohypoparathyroidism

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6
Q

How does hypocalcaemia present?

A

Tetany - muscle twitching/cramping
Parasthaesia

Trousseau’s sign
Chvostek’s sign

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7
Q

How does hypocalcaemia show on an ECG?

A

Prolonged QT interval

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8
Q

How is hypocalcaemia managed?

A

IV Calcium Gluconate

10ml of 10% over 10 minutes

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9
Q

What is Cushing’s Syndrome?

A

The signs and symptoms due to prolonged cortisol excess

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10
Q

What is Cushing’s Disease?

A

Increased cortisol due to a pituitary adenoma secreting ACTH

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11
Q

How does Cushing’s Syndrome present?

A

Moon face
Central obesity
Proximal limb wasting
Buffalo hump

Hyperglycaemia
Hypertension
Osteoporosis
Depression

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12
Q

What are ACTH dependent causes of Cushing’s?

A

Cushing’s Disease

Ectopic ACTH secreted from small cell lung cancer

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13
Q

What are ACTH independent causes of Cushing’s?

A

Steroids
Adrenal adenoma
Adrenal carcinoma

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14
Q

How is Cushing’s Syndrome investigated?

A

Overnight Dexamethasone suppression test

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15
Q

What is seen on 8mg Dexamethasone suppression test for Cushing’s Disease?

A

Suppressed ACTH, suppressed cortisol

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16
Q

What does it mean if the 8mg Dexamethasone suppression test suppresses ACTH but not cortisol?

A

ACTH independent Cushing’s - adrenal adenoma, adrenal carcinoma

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17
Q

What does it mean if both ACTH and cortisol are still high after 8mg Dexamethasone suppression test?

A

Ectopic ACTH production e.g. from small cell lung cancer

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18
Q

What is the main cause of primary hypoadrenalism?

A

Addison’s disease

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19
Q

What are causes of secondary adrenal insufficiency?

A

Due to the pituitary not producing enough ACTH - may be due to surgery/trauma/radiotherapy

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20
Q

What is tertiary hypoadrenalism?

A

Hypothalamus not producing enough corticotrophin releasing hormone - usually due to long term steroid use

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21
Q

How does adrenal insufficiency present?

A

Lethargy, weakness

Weight loss

Salt-craving

Hypoglycaemia

Hyponatraemia

Hyperkalaemia

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22
Q

How is adrenal insufficiency investigated?

A

Short synacthen test - Synacthen given and cortisol levels measured before and after (Synacthen is synthetic ACTH and stimulates adrenal hormone release)

Can also measure 9am cortisol

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23
Q

How is hypoaldrenalism managed?

A

Hydrocortisone + fludrocortisone

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24
Q

How does an Addisonian crisis present?

A 
Hypotension
Hypoglycaemia
Reduced consciousness
Hyponatraemia
Hyperkalaemia
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25
How is an Addisonian crisis managed?
100mg stat hydrocortisone
26
What are the two main causes of hyperaldosteronism?
``` Adrenal adenoma (conn’s syndrome) Bilateral idiopathic adrenal hyperplasia ```
27
How does hyperaldosteronism present?
Hypertension | Hypokalaemia- may present as muscle weakness
28
How is bilateral adrenal hyperplasia managed?
Aldosterone antagonist (Spironolactone)
29
How does type 1 diabetes present?
Polyuria Polydipsia Weight loss
30
What blood glucose is needed to diagnose type 1 diabetes?
Fasting >7 | Random >11.1
31
What autoantibodies can be seen in T1DM?
Anti-GAD Insulin autoantibodies Islet cell antibodies
32
How is type 1 diabetes managed?
Insulin therapy
33
How does DKA present?
``` Polyuria Polydipsia Dehydration Abdominal pain Kussmaul breathing Acetone smelling breath ```
34
What lab results are seen in DKA?
Raised ketones Raised blood pH (metabolic acidosis with raised anion gap) Raised glucose Low bicarbonate
35
How is DKA managed?
1) fluid resus with 0.9% sodium chloride 2) IV Insulin at 0.1 units/kg/hour 3) potassium replacement
36
What are modifiable risk factors for T2DM?
Obesity Sedentary lifestyle High carb diet
37
What are non-modifiable risk factors for T2DM?
Ethnicity Family history Old age
38
How is T2DM investigated?
Fasting glucose >7 Random glucose >11.1 HbA1c >48
39
How is T2DM managed?
1) Metformin 2) add: Sulfonylurea/gliptin/pioglitazone/SGLT-2 inhibitor 3) add another 4) insulin Add another if HbA1c is above 58
40
What are side effects of Metformin?
Diarrhoea Abdominal pain Lactic acidosis
41
When is Metformin contraindicated?
Chronic kidney disease Recent MI Alcohol abuse Note: stop Metformin in acidosis
42
Which diabetic drug can cause hypoglycaemia?
Sulfonylurea (keep HbA1c at 53)
43
What are side effects of sulfonylurea?
Weight gain | Hypoglycaemia
44
Which diabetic drug is CI in pregnancy and breastfeeding?
Sulfonylurea
45
What are side effects of a gliptin (DPP4 inhibitor)?
Symptoms of URTI GI tract upset Pancreatitis NOT THAT EFFECTIVE
46
What are side effects of a pioglitazone e.g. Thiazolidinedione?
Weight gain Increased risk of bladder cancer (CI in bladder cancer) Fluid retention Increased risk of fractures
47
How does hypoglycaemia present?
``` Sweating Shaking Anxiety Hunger Nausea ```
48
What is the most common cause of hypothyroidism?
Hashimoto’s thyroiditis
49
How does hypothyroidism present?
``` Weight gain Menorrhagia Cold intolerance Constipation Dry skin ```
50
What autoantibodies are seen in Hashimoto’s?
Anti-thyroglobulin antibodies | Anti-TPO antibodies
51
How is hypothyroidism managed?
Levothyroxine
52
What are side effects of levothyroxine?
Hyperthyroidism Reduced bone mineral density (osteoporosis) Worsening of angina AF
53
What medications interact with levothyroxine?
Iron tablets and calcium carbonate Allow 4 hours gap
54
What TFTs are seen in hypothyroidism?
High TSH | Low T3/T4
55
What is the most common cause of hyperthyroidism?
Graves’ disease
56
How does hyperthyroidism present?
``` Weight loss Mania Heat intolerance Excessive sweating Oligomenorrhea Pretibial myxoedema Diarrhoea ```
57
What autoantibody is seen in Graves’ disease?
Anti-TSH antibodies
58
What extra symptoms are seen in Graves’ disease?
Exophthalmos | Pretibial myxoedema
59
What are other causes of hyperthyroidism?
Toxic multinodular goitre Solitary toxic thyroid nodule Subacute thyroiditis
60
What is the presentation of subacute thyroiditis?
Hyperthyroidism after a viral infection Self-limiting TENDER goitre
61
How is hyperthyroidism managed?
1) symptomatic relief with propranolol 2) anti-thyroid drug: Carbimazole 3) radioactive iodine 4) thyroidectomy
62
What is a thyroid storm?
Life threatening complication of hyperthyroidism | Precipitated by illness/surgery/trauma
63
How does thyroid storm present?
High-grade fever Confusion/agitation Hypotension Tachycardia Nausea and vomiting Treated with = Propranolol + Steroid (e.g. Hydrocortisone) + Anti-thyroid drug (Carbimazole/Propylthiouracil)
64
How is thyroid storm managed ?
Propranolol + Steroid (e.g. Hydrocortisone) + Anti-thyroid drug (Carbimazole/Propylthiouracil)
65
What is the role of parathyroid hormone?
Increased calcium by: Increasing calcium reabsorption Inhibiting osteoclasts Stimulating kidneys to convert vitamin D3 to calcitriol
66
What is primary hyperparathyroidism? What is the most common cause?
Usually due to an adenoma of the parathyroid gland
67
What lab results are seen in primary hyperparathyroidism?
High parathyroid hormone High calcium Low phosphate
68
What is secondary hyperparathyroidism?
High parathyroid hormone due to: Reduced dietary intake of vitamin d Chronic kidney disease High PTH normal calcium
69
What is tertiary hyperparathyroidism?
After there has been secondary hyperparathyroidism for a long time. Causes hyperplasia of the parathyroid. Once underlying cause is treated, still increased PTH High PTH, high calcium
70
What are the symptoms of hyperparathyroidism?
``` Same symptoms of hypercalcaemia Bones, groans, stones, moans Bone pain/fractures Renal stones Depression ```
71
What is the main cause of hypoparathyroidism?
Usually secondary to thyroid surgery
72
How does hypoparathyroidism present?
Presents with hypocalcaemia Tetany - muscle twitching/cramping Parasthesia Chvostek's sign – twitching of facial muscles in response to tapping over facial nerve Trousseau’s sign - carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes
73
What is pseudohypoparathyroidism?
Target cells are not sensitive to PTH High PTH Low calcium
74
What is Acromegaly?
Excess growth hormone
75
What is the main cause of acromegaly?
Pituitary adenoma
76
What are features of acromegaly?
Large tongue Large nose Large hands and feet Protruding jaw Prominent forehead Skin tags Excess sweating Symptoms of tumour - headaches, bitemporal hemianopia
77
What is the initial investigation conducted in acromegaly?
Insulin-like growth factor
78
What next test is conducted for acromegaly if ILGF-1 is positive?
Oral glucose tolerance test
79
How is acromegaly managed?
Trans-sphenoidal removal of pituitary tumour If surgery not suitable - somatostatin analogue e.g. octreotide
80
What is a pituitary adenoma?
A benign pituitary tumour
81
How does a pituitary adenoma present?
Symptoms of excess hormone being produced (prolactin, growth hormone or ACTH to cortisol) Symptoms of pituitary tumour (hypopituitarism, bitemporal hemianopia, headaches)
82
What is a prolactinoma?
A prolactin secreting pituitary adenoma
83
How does a prolactinoma present?
In women - amenorrhoea, galactorrhoea, infertility In men - impotence, lack of libido, galactorrhoea
84
How is a prolactinoma managed?
Dopamine agonists - bromocriptine or cabergoline If this fails - trans sphenoidal removal
85
What is diabetes insipidus?
Low ADH
86
What are the two types of diabetes insipidus?
Nephrogenic and cranial
87
Which drug most commonly causes nephrogenic diabetes insipidus?
Lithium
88
How does diabetes insipidus present?
Polyuria and polydipsia
89
Does diabetes insipidus have high or low urine osmolality?
Low urine osmolality
90
How is diabetes insipidus investigated?
Fluid deprivation test No fluid for 8 hours - test urine osmolality Then give desmopressin and Check again in 8 hours Cranial DI - urine osmolality high after giving desmopression Nephrogenic DI - urine osmolality still low
91
How is diabetes insipidus treated?
Cranial - desmopressin Nephrogenic - thiazide diuretics
92
What is SIADH?
Excess ADH
93
What electrolyte imbalance is seen in SIADH?
Hyponatraemia
94
What do you have to be careful of when treating severe hyponatraemia?
Central pontine myelinosis
95
How is SIADH treated?
Tolvaptan
96
What is the most common type of thyroid cancer?
Papillary
97
Which thyroid cancer has the best prognosis?
Papillary
98
What is a phaeochromocytoma?
Adrenal tumour secreting catecholamines (adrenaline and noradrenaline)
99
How is phaeochromocytoma treated?
Definitive management - surgery 1) stabilise patient with alpha blocker - Phenoxybenzamime 2) then beta blocker - propranolol
100
Which type of thyroid cancer is associated with increased calcitonin?
Medullary
101
Why do you have to be careful with fluid resus in DKA in children and young adults?
Can cause cerebral oedema
102
How does cerebral oedema present?
Headache, irritability, visual disturbances, confusion
103
Which diabetes drug is associated with weight loss?
SGLT-2 inhibitor ( -gliflozin)
104
What is the main side effect of carbimazole?
Agranulocytosis
105
What does HbA1c need to be to add another diabetic drug to someone who has T2DM?
58 or over
106
What are macro vascular complications of diabetes?
Coronary artery disease Peripheral ischaemia Stroke HTN
107
What are micro vascular complications of diabetes?
Peripheral neuropathy Retinopathy -proliferative Nephropathy - glomerulonephritis
108
What is gastroparesis? How is it managed?
Complication of diabetes Delayed gastric emptying - food held in stomach longer than usual Causes nausea/vomiting Abdominal pain Feeling of fullness/bloating Management = Domperidone/Metoclopramide
109
What is subclinical hypothyroidism? How is subclinical hypothyroidism managed?
Raised TSH but normal T3/T4 If TSH 4-10: If under 65 + symptomatic = Levothyroxine. Otherwise - watch and wait If TSH >10 Under 70 = Levothyroxine Older than 70 = watch and wait
110
What is the action of aldosterone?
Increases sodium+water absorption Increases potassium excretion Increases BP
111
How can diabetes be diagnosed in a patient with haemoglobinopthy?
Oral glucose tolerance testing Can't do HbA1c because of haemaglobin
112
Which drugs can cause gynaecomastia?
Spironolactone Digoxin Finasteride Goserelin
113
What are causes of gynaecomastia? (Non-drug)
``` Physiological – normal in puberty Kallman’s/Klinefelter’s Testicular failure Liver disease Testicular cancer Drugs ```
114
What happens to C-peptide levels in T1DM?
Low
115
What is bitemporal hemianopia and what can cause this?
Loss of vision in both eyes on temporal side Due to damage to the optic chiasm - due to tumours e.g. pituitary tumour
116
What is the role of ADH?
Increased water absorption at the DCT and collecting duct
117
What is the role of aldosterone?
Increased sodium reabsorption Increased potassium excretion Increases BP
118
Why does hypocalcaemia occur in CKD?
Decreased renal production of vitamin D --> Decreased calcium absorption
119
How is postpartum thyroiditis managed?
Watch and wait
120
What are the three types of multiple endocrine neoplasia?
MEN type I = 3 P's Hyperparathyroid, pituitary, pancreas (insulinoma, gastrinoma) Hypocalcaemia MEN type IIa 2 P's - parathyroid + phaeochromocytoma Medullary thyroid cancer MEN type IIb 1 P - Phaeochromocytoma Marfanoid body habits
121
What is pituitary apoplexy?
Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.
122
What are precipitating factors of a pituitary apoplexy?
HTN Pregnancy Trauma Anticoagulation
123
What are features of a pituitary apoplexy?
Sudden onset headache similar to that seen in subarachnoid haemorrhage Vomiting Neck stiffness Visual field defects: classically bitemporal superior quadrantic defect Extraocular nerve palsies Features of pituitary insufficiency e.g. hypotension/hyponatraemia secondary to hypoadrenalism
124
How is pituitary apoplexy diagnosed?
MRI Head
125
How is pituitary apoplexy managed?
Urgent steroid replacement Careful fluid balance Definitive = surgery
126
Which visual defect is seen in pituitary apoplexy?
Classically bitemporal superior quadrantic defect Bitemporal superior quadrantinopia
127
What is sick euthyroid syndrome? How is it managed?
Everything low - TSH, T3, T4 Or TSH inappropriately normal with low T3 and T4 No thyroid abnormality No treatment needed - usually recovers after recovery from systemic illness
128
What is carcinoid syndrome? How does it present?
A rare, slow growing malignant tumour that develops in the neuroendocrine system Usually from liver mets Abdominal pain Diarrhoea Flushing Bronchospasm
129
How is carcinoid syndrome diagnosed?
Raised urinary 5-HIAA
130
How is carcinoid syndrome managed?
Octreotide (somatostatin analogue)
131
How is pheochromocytoma diagnosed?
24 hour urinary collection of metanephrines
132
What is a myxoedema coma? How does it present?
Complication of untreated hypothyroidism ``` Confusion Hypothermia Bradycardia Hyporeflexia Seizures ```
133
How is myxoedema coma managed?
IV thyroid replacement + IV hydrocortisone (until co-existing adrenal insufficiency has been excluded)
134
How is hyperaldosteronism investigated/diagnosed?
First line investigation for hyperaldosteronism = Plasma aldosterone/renin ratio If abnormal --> CT Abdomen, adrenal venous sampling (To differentiate cause).
135
What is the diagnostic criteria for hyperosmolar hyperglycaemic state?
1. Hypovolaemia 2. Hyperglycaemia (No ketonaemia or acidosis) 3. High serum osmolality
136
How is hyperosmolar hyperglycaemic state managed?
Mainstay = 0.9% Sodium Chloride This will reduce hyperglycaemia and treat serum osmolality Check serum osmolality frequently Can add insulin but only once glucose is no longer dropping with just fluids

Medicine Finals (32 decks)

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