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Year 4 Additional Notes > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Features of acromegaly

A

Excess GH secondary to pituitary adenoma

Coarse features, spade like hands, increased shoe size
Large tongue, interdental spaces
Excessive sweating
Features of a pituitary tumour- hypopituitarusm, headache, bitenporal hemianopia
Raised prolactin
MEN-1

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2
Q

Complications of acromegaly

A

HTN
Diabetes
Cardiomyopathy
CRC

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3
Q

Investigations for acromegaly

A

Serum IGF-1 level/serial GH measurements (1st line)
OGTT- hyperglycaemia should suppress GH (not in acromegaly)- OGTT used to confirm diagnosis
MRI head- tumour

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4
Q

Management of acromegaly

A

Trans sphenoidal surgery
Or a somatostatin analogue eg. Octereotide (inhibits release of GH) for GH secreting tumours if surgery not possible/fails

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5
Q

Hypomagnesia and hypocalcaemia

A

Hypomagnesia can cause hypocalcaemia and render treatment such as vitamin D and calcium ineffective- need to treat the hypomagnesia first

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6
Q

Side effects of glucocorticoids

A

Endocrine- impaired glucose regulation, increased appetite, weight gain, hirsutism, hyperlipidaemia

Cushing’s syndrome- moon face, buffalo hump, striae

MSK- osteoporosis, proximal myopathy, a vascular necrosis of femoral head

Immunosuppression

Psych- mania, depression, psychosis

GI- peptic ulceration, acute pancreatitis

Ophthalmic- glaucoma, cataracts

Growth suppression, neutorphilia, intracranial HTN

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7
Q

Mineralcorticoid side effects

A

Fluid retention
HTN

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8
Q

Long term steroid use

A

Double corticosteroid dose (not fludrocortisone- mineralocorticoid) during inter current illness
Gradual withdrawal of systemic corticosteroids if patients have had more than 40mg daily for more than a week, or received more than 3 weeks treatment

NB- don’t stop for any reason. Always discuss with doctor!!

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9
Q

Causes of hypercalcaemia

A

2 conditions account for 90%- primary hyperparathyroidism (most common in community- solitary parathyroid adenomas). Malignancy is most common in hospitalised patients

Sarcoidosis
Vitamin D excess
Acromegaly
Thyrotoxicosis
Thiazide drugs
Dehydration
Addison’s disease
Pagers disease of bone (usually normal but can see an increase if immobilised due to condition)

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10
Q

Primary hypoparathyroidism

A

Decreased PTH secretion (eg. Due to thyroid surgery)
Low calcium, high phosphate
Treated with alfacalcidol
Main symptoms are of hypocalcaemia (inc. prolonged QT)

NB- main symptoms are due to hypoparathyroidism

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11
Q

Klienfelters syndrome

A

Karyotype 47, XXY

Features
Taller than average, lack of secondary sexual characteristics, small firm testes, infertile, gynaecomastia, elevated gonadotropin levels (FSH and LH) but low testosterone, obese

Diagnosis is karyotype (chromosomal analysis)

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12
Q

Multiple endocrine neoplasia (MEN)

A

MEN1- hyperparathyroidism (hypercalcaemia), pituitary, pancreas (insulinoma, gastrinoma, recurrent peptic ulceration)

MEN2a- medullary thyroid cancer, parathyroid, phaeochromocytoma

MEN2b- medullary thyroid cancer, phaeochromocytoma, neuromas, Marfinoid body habitus

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13
Q

Neuroblastoma

A

Childhood malignancy arising from adrenal medulla and sympathetic nervous system

Abdominal mass, pallor, weight loss, bone pain, hepatomegaly, paraplegia, proptosis

Raised urinary VMA and HVA

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14
Q

Primary hyperparathyroidism

A

PTH elevated
Calcium elevated
Phosphate low

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15
Q

Secondary hyperparathyroidism

A

PTH elevated
Calcium low or normal
Phosphate elevated
Vitamin D low

NB- parathyroid hyperplasias

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16
Q

Phaeochromocytoma

A

HTN
Headaches
Sweating
Palpitations
Anxiety

Test- 24 hour urinary collection of metanephrines

Surgery is the definitive management. The patient must first however be stabilized with medical management:
alpha-blocker (e.g. phenoxybenzamine), given before
beta-blocker (e.g. propranolol)

17
Q

Treatment for hyperparathyroidism

A

Total parathyroidectomy
Cinacalet if surgery not appropriate (mimics action of calcium)

18
Q

Dopamine and prolactin

A

Dopamine inhibits prolactin secretion from the anterior pituitary (dopamine agonists can be used to control prolactinomas eg. Bromocriptine, cabergoline)

19
Q

Causes of a raised prolactin

A

Secretory pituitary adenoma
Pregnancy
Oestrogens
Stress, exercise, sleep
Acromegaly
PCOS
Drugs- metoclopramide, haloperidol, rarely- SSRI, opioids

20
Q

Bone protection and steroids

A

Bone protection for patients who are going to take long-term steroids (ie. GCA) should start immediately (alendronic acid, vitamin D and calcium supplements)

21
Q

X ray of primary hyperparathyroidism

A

Generalised osteopenia, erosion of the terminal phalyngeal tufts (acro-osteolysis) and sub-periosteal resorption of bone particularly the radial aspects of the 2nd and 3rd middle phalanges, pepper pot skull (p for p- Pepper for Parathyroid)

In terms of history;

Generalised aches and pain, polydipsia and lethargy are also common symptoms of having a raised calcium level.

22
Q

Insulinoma features

A

Whipple’s triad of symptoms of 1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms is hallmark for an insulinoma

23
Q

What hormones are decreased during surgery

A

Insulin
Oestrogen
Testosterone

24
Q

What hormones are increased during surgery

A

GH
Cortisol
Renin
ACTH
Prolactin
ADH
Glucagon

25
Q

What hormones don’t change during surgery

A

TSH
LH
FSH

26
Q

Kallman syndrome

A

Hypogonadotropic hypogonadism

‘delayed puberty’
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above average height
Infertile

Cleft lip/palate and visual/hearing defects are also seen in some patients

27
Q

Differentiate Klinefelters from Kallmans

A

Kline every mountain;

gonadotrophins (LH/FSH), stature are all increased/high

NB- testosterone low in both

27
Q

Tertiary Hyperparathyroidism

A

Due to prolonged CKD/secondary hyperparathyroidism
High PTH
High/normal calcium (secondary- low/normal)

28
Q

Cushing’s disease

A

Due to an ACTH producing pituitary tumour (cortisol suppressed by dexamethasone but plasma ACTH is high)

The tumour is often too small to see on an MRI so a normal scan does not exclude it

29
Q

Acromegaly and prolactinomas

A

Prolactinomas- treat medically, then surgically

Acromegaly- treat surgically, then medically

30
Q

Causes of a raised prolactin

A

Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

31
Q

Severe hyponatraemia (<120)

A

Treat with hypertonic saline eg. 3%

Year 4 Additional Notes (17 decks)

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