Endocrinology Flashcards

1
Q

What antibodies are associated with Graves disease?

A

TSH receptor antibodies

Also, to a lesser extent
Anti-thyroid peroxidase antibodies

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2
Q

Symptoms of hyperthyroidism

A
Anxiety and irritability 
Sweating and heat intolerance 
Tachycardia 
Weight loss
Fatigue
Diarrhoea 
Sexual dysfunction
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3
Q

Management of hyperthyroidism

A
Carbimazole 
Propylthiouracil
Radioactive iodine 
Beta blockers 
Surgery
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4
Q

Subacute (de quervains) thyroiditis presentation and management

A

Typically follows a viral infection
Typically causes hyperthyroidism

  • painful goitre
  • raised ESR

Usually self-limited

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5
Q

Presentation of hypothyroidism

A
Tiredness, lethargic 
Low mood 
Cold-disliking 
Weight gain 
Constipation 
Menorrhagia 
Decreased cognition and memory 
Dry skin 
Fluid retention
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6
Q

Presentation of hyperparathyroidism

A

Bones - painful
Stones - kidney
Abdominal moans - constipation, nausea and vomiting
Psychiatric groans - fatigue, depression and psychosis

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7
Q

a low dexamethasone test indicates no suppression of cortisol, what does this mean?

A

Cushing’s syndrome

  • dexmeth exerts negative feedback (hypothalamus) reduces CRH and pituitary reduces ACTH in normal response.
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8
Q

Patient has cushings syndrome, on a high dose dex test, cortisol is suppressed, ACTH is suppressed to

A

Cushings disease

Some negative feedback

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9
Q

Patient has cushings syndrome, on a high dose dex test, ACTH suppressed but cortisol isn’t. What does this mean?

A

Shows an adrenal adenoma

Cortisol is independent of the pituitary

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10
Q

Patient has cushings syndrome, high dose dex test reveals that cortisol is not suppressed and neither is ACTH

A

Reveals ectopic ACTH production (SCLC), as production of both is independent of pituitary and adrenal glands

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11
Q

What type of ABG disturbance might be seen in cushings syndrome

A

Hypokalaemic metabolic alkalosis

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12
Q

Management of cushings

A

Trans-sphenoid removal of pituitary adenoma
Surgical removal of adrenal tumour
Surgical removal of tumour producing ectopic ACTH

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13
Q

What is primary adrenal insufficiency

A

Where adrenal glands have been damaged and don’t produce cortisol and mineralcorticoid
- commonly autoimmune

  • Addisons
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14
Q

What is secondary adrenal insufficiency?

A

Result of a loss of ACTH and so cortisol is release from adrenals is less
- pituitary damage

Also chronic steroids - if withdrawn, hypothalamus does not wake up quick enough to release CRH

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15
Q

Electrolyte disturbance in addisons

A

Hyponatraemia and Hyperkalaemia

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16
Q

Is ACTH high or low in primary adrenal insufficiency?

A

High

  • trying to compensate for lack of negative feedback on cortisol
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17
Q

Is ACTH high or low in secondary adrenal insufficiency?

A

Low

  • reason arsenal glands are not producing cortisol is due to lack of ACTH
18
Q

Causes of primary aldosteronism

A

Solitary aldosterone-producing adenoma - CONNS syndrome
Bilaterally adrenal hyperplasia
Rare - adrenal cancer

19
Q

Features of hyperaldosteronism

A
HTN 
Hypokalaemia
- muscle weakness, cramps, palpitations 
Alkalosis
Polyuria 
Polydypsia
20
Q

Is renin high or low in primary hyperaldosteronism

A

Low - suppressed by high BP

21
Q

Is renin high or low in secondary hyperaldosteronism

A

High - high renin is the cause

22
Q

Causes of secondary hyperaldosteronism

A

Where excessive renin stimulates the adrenal gland produces more aldosterone.

Causes of high renin:

  • renal artery stenosis
  • renal artery obstruction
  • heart failure
23
Q

Does acidosis or alkalosis occur in hyperaldosteronism

A

Alkalosis (excretion of potassium)

24
Q

Features of insulinoma

A

Fasting hypoglycaemia with whipple’s triad:

  • symptoms with fasting or exercise
  • recorded hypoglycaemia with symptoms
  • symptoms relieved with glucose
25
Tests for insulinoma
Glucose (fasting) Suppressive test - IV insulin and measure C-peptide production - C-peptide suppressed by insulin normally, does not occur in insulinoma CT / MRI - pancreas
26
What should be prescribed in patients awaiting surgery for phaeocytochroma?
Phenoxybenzamine (Alpha blocker) Then a beta blocker
27
Painful goitre, hyperthyroidism following an infection and raised ESR and increased iodine uptake on scan would indicate what?
Subacute thyroiditis
28
Hypertension and muscle weakness, alkalosis should point towards what?
Hyperaldosteronism Muscle weakness = hypokalaemia
29
What diabetic medication causes fluid retention?
Pioglitazone
30
First line test in acromegaly
IGF-1 levels raised Then OGTT and GH measurement (no suppression of GH) also impaired glucose tolerance associated with acromegaly
31
What is diabetes insipidus?
Lack of ADH production (cranial) or | Lack of response to ADH (nephrogenic)
32
Causes of diabetes insipidus
Nephrogenic: - drugs - lithium - mutations in the X chromosome - intrinsic kidney disease Cranial: - idiopathic - brain infections or surgery or radiotherapy - head injury
33
Test for diabetes insipidus
Water deprivation test
34
What is the osmolality of serum and urine in diabetes insipidus?
Low urine osmolality | High serum osmolality
35
After 8 hour water deprivation, someone's urine osmolality is low, then after desmopressin the urine osmolality is high. What does this mean?
Cranial diabetes insipidus Can still respond to ADH (but don't produce any)
36
After 8 hour water deprivation, someone's urine osmolality is low, then after desmopressin the urine osmolality is low still. What does this mean?
Nephrogenic diabetes insipidus Kidneys do not respond to ADH
37
After 8 hour water deprivation, someone's urine osmolality is high, what does this mean?
Normal
38
Electrolyte and osmolality abnormalities in syndrome of inappropriate ADH
Hyponatraemia (excessive fluid retention) | High urine osmolality
39
Peptic ulceration, galactorrhoea, hypercalcaemja should make you think of what?
Multiple endocrine neoplasia type 1
40
Features of MEN1
Parathyroid - hypercalcaemia Pituitary- prolactinoma Pancreas- insulinoma or gastronoma (peptic ulceration)
41
Features of MEN2a
Parathyroid- hypercalcaemia | Phaeochromocytoma