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Endocrinology Flashcards

1
Q

Metabolic ketoacidosis with normal-low glucose is associated with what?

A

Alcoholic ketoacidosis

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2
Q

Which thyroid cells form the colloid?

A

Follicular cells

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3
Q

What mineral is associated with the thyroid colloid?

A

Iodine

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4
Q

What is the function of para-follicular cells (C-cells)?

A

Produce Calcitonin

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5
Q

What is the function of follicular cells?

A

Synthesise T4 and T3

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6
Q

What is the bioactive thyroid hormone?

A

T3

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7
Q

What is the main thyroid hormone produced by the thyroid gland?

A

T4

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8
Q

How is T4 transported int he blood?

A

Thyroid-binding globulin

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9
Q

What are the symptoms of hyperthyroidism?

A 
Tremor
Anxiety
Palpitations
Heat intolerance
Diarrhoea
Oligomenorrhoea
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10
Q

What are the symptoms associated with hypothyroidism?

A 
Lethargy
Cold intolerance
Weight gain
Constipation
Menorrhagia
Decreased deep tendon reflexes
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11
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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12
Q

What are the causes of hyperthyroidism?

A

Grave’s disease
Toxic multi-nodular goitre
Thyroiditis
Drugs (Amiodarone)

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13
Q

Which antibodies are associated with Grave’s disease?

A

Anti-TSH receptor antibodies

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14
Q

Which drug is associated with inducing hyperthyroidism?

A

Amiodarone

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15
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s thyroidits

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16
Q

Which auto-antibody is associated with Hashimoto’s thyroiditis?

A

Anti-TPO antibodies

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17
Q

What are the causes of hypothyroidism?

A

Hashimoto’s thyroiditis
Subacute thyroiditis
Drugs
Iodine deficiency -Common cause in the developing world

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18
Q

Which drugs can induce hypothyroidism (2)?

A

Lithium

Amiodarone

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19
Q

What is the most common cause of hypothyroidism in the developing world?

A

Iodine deficiency

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20
Q

What is the level of TSH in primary hyperthyroidism?

A

Low TSH

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21
Q

What is the level of TSH in primary hypothyroidism?

A

Raised

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22
Q

What is revealed in radio-scintigraphy in Grave’s disease?

A

Homogeneous increased iodine uptake

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23
Q

What is revealed in radio-scintigraphy in a toxic adenoma?

A

Hot nodule - increased iodine uptake in solitary nodule and suppressed uptake in other parts

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24
Q

What is revealed in radio-scintigraphy in a toxic multi-nodular adenoma?

A

Heterogeneous uptake

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25
What is the management of hyperthyroidism?
Propranolol - Non cardioselective beta-blocker for symptomatic management Carbimazole (TPO inhibitor) Propylthiouracil Radio-iodine
26
What are the side effects of carbimazole?
Agranulocytosis (No neutrophils)
27
What is the definitive management for hypothyroidism?
Levothyroxine
28
How common is thyroid eye disease in Grave's patients?
25-50%
29
What is the most common form of thyroid eye disease in Grave's?
Bilateral exophthalmos
30
What is the pathophysiology of exophthalmos in Grave's?
Anti-TSH receptor antibodies binding to TSH receptors in the eyes - stimulates growth of tissue
31
What are the features of Bilateral exophthalmos in Grave's?
``` Diplopia Conjunctival oedema (chemosis) Opthalamlgia Exposure keratopathy Optic neuropathy (Blurred vision) ```
32
Due to increased sympathetic tone in Grave's disease what features are seen in the eye?
Lid lag and retraction
33
What are the three specific features in Grave's disease?
Bilateral exophthalmos - lid lag and retraction Pretibial myxoedema Thyroid acropachy (Thickening of the extremities)
34
What are the classic features of thyroid cancer?
Non-functional (Euthyroid), painless, rapidly growing Solitary - Irregular (Nodular shape Palpable nodule, hard and fixed Hoarse voice - Tumour compression on the recurrent laryngeal nerves Dysphagia Haemopotysis Airway obstruction
35
Why does a hoarse voice occur in thyroid cancer?
Tumour compression on the recurrent laryngeal nerve
36
What is the most common subtype of thyroid cancer?
Papillary carcinoma (70%) - associated with cervical lymphadenopathy
37
What is the epidemiology of papillary carcinoma?
35-year old female with childhood radiation exposure
38
A circular concentric laminations in papillary carcinoma is known as what?
Psammoma body
39
What thyroid cancer is associated with a Psammoma body?
Papillary carcinoma
40
What is the second most common thyroid cancer?
Follicular carcinoma (20%) - associated with low dietary iodine intake
41
What is a rare variant of follicular carcinoma?
Hurthle cell carcinoma
42
Which MEN types are associated with medullary carcinoma?
MEN2a and MEN2B
43
What are the most aggressive thyroid cancers?
Anaplastic carcinomas
44
What is the definitive investigation for thyroid cancer?
Fine needle aspirate biopsy with ultrasound +TFTs - to exclude functional nodules
45
What neoplasms are associated with MEN type 1?
``` 3Ps Pituitary tumours (Prolactinoma) ``` Pancreatic tumours (Insulinoma, glucagonoma, gastrinomas) Parathyroid adenomas (Raised Ca, and HyperPTH)
46
What are the common pancreatic tumours are associated with MEN1?
Insulinoma Glucagonoma Gastrinoma
47
What are the symptoms of hypercalcaemia?
``` Renal colic Abdominal pain Constipation Psychological depression Bone pain, osteoporosis ```
48
What is the onset of symptoms for MEN1?
MEN1 mutation has high penetrance and therefore develops early in life.
49
What investigations are performed for MEN1?
CT/MRI (whole-body), genetic testing
50
What is Zollinger-Ellison syndrome compared with MEN1 gastrinoma?
Non-MEN1 gastrinoma
51
MEN2A and MEN2B is associated with which type of thyroid cancer?
Medullary thyroid cancer
52
Medullary thyroid cancer is associated with which type of cell?
Parafollicular C-cell - produce calcitonin
53
Which tumours are associated with MEN2A?
Phaeochromocytoma Parathyroid adenoma Medullary thyroid cancer
54
Which tumours are associated with MEN2B?
Phaeochromocytoma Medullary thyroid cancer Neuromas (Mucosal) - Associated with Marfanoid habitus
55
What is Marfanoid habitus?
Including long limbs, with an arm span that is at least 1.03 of the height of the individual, and a crowded oral maxilla, sometimes with a high arch in the palate, arachnodactyly, and hyperlaxity. Pectus excavatum
56
A Marfanoid habitus is associated with which type of MEN syndrome?
MEN2B
57
What gene is associated with MEN2A and 2B in genetic testing?
RET oncogene
58
What blood investigation is performed in suspected medullary thyroid carcinoma?
Calcitonin
59
What type of tumour is carcinoid syndrome?
Neuroendocrine cell
60
How does carcinoid syndrome arise to produce a symptomatic presentation?
The carcinoid tumour metastasises to the liver
61
What does serotonin get metabolised into by the liver?
5-HIAA (excreted via the urine)
62
What hormone is raised in carcinoid syndrome?
Serotonin Bradykinin Histamine
63
What are the common features of carcinoid syndrome?
Flushing (Vasodilation due to bradykinin and histamine) Diarrhoea (Serotonin induced effect on gut motility) Shortness of breath Pulmonary stenosis Abdominal pain (Serotonin activated fibroblasts) Itching (Histamine)
64
What hormone inhibits serotonin release?
Somatostatin
65
What investigations are performed on suspected carcinoid syndrome?
Urinary 5-HIAA CT Scan Octreotide scan - specific
66
What is octreotide?
A somatostatin analogue
67
What specific scan is performed in carcinoid syndrome?
Octreotide scan - binds to neuroendocrine cells
68
What hormone released by the hypothalamus directly controls LH/FSH secretion?
GnRH
69
Which cells respond to LH in males?
Leydig cells
70
What is the function of Leydig cells?
Release testosterone
71
What is the function of Sertoli cells?
Spermatogenesis
72
Sertoli cells respond to which hormone?
FSH
73
Which hormone is secreted by theca cells?
Progesterone
74
Which hormone is secreted by granulosa cells?
Oestrogen
75
Which gonadotrophin acts on theca cells?
LH
76
What is physiological hypogonadism?
Pregnancy
77
What is primary hypogonadism (Female)?
Gonadal dysfunction -Reduced oestrogen and progesterone production - Turner's syndrome (Gonadal Dysgenesis) - Gonadal damage - Primary ovarian failure - PCOS
78
What is the karyotype of Turner's syndrome?
45X0
79
What are the causes of secondary hypogonadism?
Kallman syndrome Pituitary/hypothalamic tumour (Non-functioning or prolactinoma) Hyperprolactinaemia Functional - Hypothalamic amenorrhoea -Low BMI, Excess exercise, stress Contraceptive pill use - Negative feedback signal to reduce FSH and LH
80
What symptom is typically associated with Kallman syndrome?
Anosmia- Failed development migration of olfactory bundles
81
What are functional causes of hypothalamic amenorrhoea?
Low BMI Excess exercise Stress
82
What are the main causes of primary hypogonadism in Males?
Gonadal dysgenesis (Klinefelter's syndrome, cryptochrodism) Gonadal damage Post-orchitis (Mumps)
83
What is the karyotype for Klinefelter's syndrome?
47XXY
84
What are the secondary causes of hypogonadism in Males?
Kallman Syndrome Pituitary/hypothalamic tumour Hyperprolactinaemia
85
What are the features of hypogonadism?
Delayed puberty - Primary amenorrhoea, absent sexual characteristics (absent pubic hair, delayed thelarche, micropenis, high-pitched voice, small undescended testes) Infertility Low libido Female specific - Night sweats/hot flushes -Amenorrhoea Erectile dysfunction
86
What is the first-line investigation in females presenting with symptoms of hypogonadism?
Pregnancy test
87
What investigations are performed in hypogonadism?
``` Pregnancy test LH/FSH Prolactin Testosterone/Oestradiol TFTs Karyotyping Pituitary MRI ```
88
What is the hormone profile in primary hypogonadism?
Hypergonadotrophic hypogonadism - Raised LH/FSH/GnRH Low tesosterone/oestrogen
89
What is the hormone profile in secondary hypogonadism?
Hypogonadotropic hypogonadism
90
What are the effects of growth hormone?
Increased blood glucose Increased insulin resistance Increased muscle growth Increased bone thickness
91
What organs does GH have an effect on?
Bone Muscle Liver Kidney Releases IGF-1
92
Growth hormone causes the release of what?
Insulin-like growth factor-1 (Somatomedin)
93
What is the most common cause of acromegaly?
Pituitary adenoma of somatotrophs
94
What are the features of Acromegaly?
``` Coarse facial features Prognathism and large tongue Spade-like hands and large feet Excessive sweating Organomegaly Headache Visual disturbances Possible: Hyperprolactinaemia, hypopituitarism ```
95
Why is gigantism?
Growth of long bones (Epiphyseal growth plates have no fused)
96
Why is there hyperprolactinaemia in acromegaly?
Pituitary adenoma compression of the pituitary stalk reduces dopamine secretion -Reduces negative regulation of prolactin release from lactotrophs
97
What visual defect is associated with pituitary adenomas?
Bitemporal hemianopia
98
What are the common complications of acromegaly?
``` Diabetes mellitus Hypertension Carpal tunnel syndrome Cardiomyopathy Colorectal cancer ```
99
What is seen in an OGTT in acromegaly?
Paradoxical rise in Growth hormone
100
What is the first-line investigation in acromegaly?
Serum IGF-1
101
What is the diagnostic investigation in confirming acromegaly?
OGTT
102
What is the first-line definitive management of acromegaly?
Trans-sphenoidal surgery - Radiotherapy - Somatostatin analogues - Dopamine receptor agonists (Cabergoline and bromocriptine) - GH receptor antagonists
103
What is type 1 diabetes?
Pancreatic islet B-cell autoimmune destruction - Absolute deficiency in insulin - Lipolysis and ketogenesis
104
Which gene is associated with type 1 diabetes mellitus?
HLA DR3-4
105
What is type 2 diabetes mellitus?
Reduced peripheral sensitivity to insulin , reduced insulin production over time
106
What is the characteristic presentation of T1DM?
<20 years Polyuria, and polydipsia (osmotic diuresis) Weight loss and fatigue DKA signs FH of autoimmune disease
107
What are DKA signs?
Nausea and vomiting Abdominal pain Kussmaul breathing (deep hyperventilation) Sweet-smelling breath (ketonaemia)
108
What is the characteristic features of T2DM?
>40 YEARS asymptomatic Polyuria, polydipsia Examination findings -acanthosis nigricans
109
What are the main risk factors for T2DM?
Obesity Hypertension South Asian/Afro-Caribbean ethnicity
110
What is the normal random glucose range?
<11.1
111
What is the cut-off for fasting glucose in diabetes?
>7.0
112
What is the cut-off for a 2-hour post-prandial glucose?
>11.1
113
What is the cut-off for HbA1c diabetes diagnosis?
>48 (6.5%)
114
What is the pre-diabetes range for fasting glucose?
5.5-6.9
115
What confirms the diagnosis of diabetes Mellitus?
symptomatic + 1 test | Asymptomatic + 2 different tests on 2 different days
116
What are the specific antibodies involved in type 1 diabetes mellitus?
Anti-GA and islet cell antibodies
117
What does a urine dip reveal in T1DM?
Urinary Ketones
118
What is the first-line management for T1DM?
Basal-bolus Long-acting and short-acting (Before meals)
119
Example of long-acting insulin
Insulin glargine (Subcutaneous injection OD)
120
Example of short-acting insulin
Insulin lispro
121
What is basal-bolus insulin?
Short-acting and long-acting insulin prior to meals/
122
How is T1DM measured
Monitored daily using capillary glucose | Over time using HbA1c
123
What is the first-line management for T2DM?
Lifestyle modifications - diet, exercise and education
124
What is step 1 of glycaemic control in T2DM?
Metformin if HbA1c >48 despite lifestyle advice
125
What is step 2 in glycaemic control?
Add another drug (DPP4i, Pioglitazone, SU, SGLT-2i)
126
What are the indications for starting atorvastatin in lipid management for T2DM?
If QRISK >10% | -Atorvastatin 20mg
127
What are the indictions for 80mg OD atorvastatin in T2DM?
IHD, CVD and PAD
128
What is the BP management in T2DM?
ACEi or ARB (In Afro-Caribbean Origin)
129
What is step 2 in BP management?
Add CCB or thiazide
130
What step 3 in BP management in T2DM?
ACEi/ARB + CCB + Thiazide
131
What are the acute metabolic disturbances associated with DM?
Hypoglycaemia DKA HHS
132
What glucose parameter is associated with hypoglycaemia?
Low plasma glucose <3.6 mmol/L
133
What are the common causes of hypoglycaemia in T2DM?
Inappropriate insulin regime Missed meals Drugs - SUs
134
What are the signs of Hypoglycaemia?
``` Palpitations Tremor Sweating Pallor anxiety Drowsiness Confusion altered behaviour COMA ```
135
What is the management for hypoglycaemia in a conscious patient?
Oral glucose and complex carbohydrate | Short-acting - glucogel
136
What is the management of hypoglycaemia in impaired consciousness?
1mg IM glucagon
137
What is the triad of DKA?
Hyperglycaemia Ketonaemia Metabolic acidosis
138
What is the main effect of glucose in DKA?
Osmotic diuresis (Polyuria) - dehydration
139
What is the main effect of ketones in DKA?
Acid induced enzyme dysfunction - coma and death
140
What is the main aim of DKA?
IV fluids and insulin
141
What sign is not seen in HHS?
Abdominal pain
142
What ketone parameter is indicative of DKA?
>3 mmol/L | pH < 7.3
143
What pH value is associated with DKA?
pH <7.3
144
What is the pH value in HHS?
Normal (7.35-7.45) and normal ketones <3 mmol/L
145
What is the initial management for HHS and DKS?
Fluids (normal saline) and potassium chloride (If K<5.5) IV insulin after fluids and only when Potassium is not <3.5
146
When is IV insulin administered in HHS?
After fluids and when K is not <3.5
147
What is the effect of insulin on potassium?
Increase potassium cellular intake- risk of hypokalaemia
148
What type of insulin is given in HHS and DKA?
Fixed-rate insulin infusion
149
What signs are seen in background retinopathy on fundoscopy?
Blot and dot haemorrhages/hard exudates
150
What is the management of background retionopathy?
Improve glycaemic control
151
What is the management of pre-proliferative retionopathy?
Pan-retinal laster photocoagulation
152
What fundoscopic signs are seen in pre-proliferative retionopathy?
Background + cotton wool spots
153
What is seen in proliferative retinopathy?
Neovascularisation
154
What is the management for maculopathy?
Intravitreal VEGF inhibitors
155
What are the risks associated with neovascularisation in retinopathy?
Associated with retinal detachment and vitreous haemorrhage - visual loss
156
What fundoscopic signs are seen in maculopathy?
Hard exudates need the macula
157
What are the signs of diabetic nephropathy?
Oedema, polyuria, lethargy and hypertension
158
What is the first-line investigations for diabetic nephropathy?
Urinalysis | Albumin:creatinine ratio (Raised) - Microalbuminuria
159
What is the gold standard investigation for diabetic nephropahty?
Renal biopsy - revealing Kimmelstiel-Wilson nodules
160
What nodules are seen in a renal biopsy for diabetic nephropathy?
Kimmelstiel-wilson nodules
161
What is the definitive management for diabetic nephropathy?
ACEi/ARB (renoprotective)
162
What is the aetiology of diabetic neuropathy?
Blockage of the vasa nervosum
163
What is the characteristic presentation of peripheral neuropathy?
Glove and stocking distribution - Loss of sensation - Inspect feet Monofilament on LL exam Loss of ankle jerk/vibration/sense/fractures (Charcot's joint)
164
What is mononeuropathy?
Motor loss | -wrist drop, foot drop, 3rd nerve palsy
165
What is autonomic neuropathy?
GI tract: Difficulty swallowing, delayed gastric emptying, bladder dysfunction Postural hypotension Cardiac autonomic supply
166
Which neuropathic pain agents are used in DN?
Duloxetine Pregabalin Gabapentin
167
What is the main symptom of diabetes insipidus?
Production of dilute urine (Hypotonic polyuria)
168
What are the two types of diabetes insipidus?
Lack of vasopressin release from the posterior pituitary gland Nephrogenic - Collecting ducts insensitive to vasopressin
169
What are the causes of cranial DI?
Pituitary tumour/surgery, TBI, infection (meningitis) Sarcoidosis/TB SAH
170
What are the nephrogenic causes of DI?
``` Lithium therapy Electrolyte imbalance (HyperCal, hypokal) ``` Ureteric obstruction Inherited (AVPV2 gene)
171
What is the presentation of DI?
Polyuria, nocturia Polydipsia Dehydration: Tachycardia/reduced tissue turgor/dry mucous membranes Signs of the cause
172
What is the diagnostic test for DI?
Water deprivation test
173
How long is a water deprivation test carried out for?
8 hours or more than 3% body weight lost
174
After a water deprivation test what drug is adminsitered?
Desmopressin
175
What is the urine osmolality in diabetes insipidus during a water deprivation test?
Dilute - low
176
What happens to urine osmolality after desmopressin administration in cranial diabetes insipidus?
Increases
177
Management for cranial DI?
Intranasal desmopressin
178
Management for nephrogenic DI?
Thiazide diuretic
179
What is SIADH?
Excess ADH - Serum sodium decreases - Urine osmolality increases - Urine sodium increases
180
What are the main CNS causes?
SAH, stroke, tumour, TB Pulmonary: Pneumonia, bronchiectasis Malignancy - small cell lung cancer Drugs - Carbamazepine, SSRI Idiopathic
181
What is the management of SIADH?
Treat the underlying cause Immediate fluid restriction (Hyponatremia) If ineffective- consider oral demeclocycline (Makes collecting ducts less repsonsive to ADH)
182
What are the three main causes of hypovolaemic hyponatremia?
Diarrhoea, vomiting, diuretics Management is IV fluids, there is low urinary sodium (<20)
183
What is the cause of euvolaemic hyponatremia?
SIADH Hypothyroidism Adrenal insufficiency Management is fluid restriction
184
What is the presentation of severe hypervolaemia?
Seizures, decreased consciousness
185
What is the complication of administering hypertonic saline in hyponatremia (too fast)?
Central pontine myelionlylsis
186
What are the main acquired causes of hypothyroidism?
Hashimoto's thyroidits Iatrogenic (Post-surgery, radioiodine, medication for hypertyroidism) Severe iodine deficiency or iodine excess (Wolff-Chaikoff effect)
187
What is the presentation of hypothyroidism?
``` Cold intolerance Lethargy Weight gain Constipation Dry skin Hair loss Hoarse voice Mental slowness, depression, dementia, cramps, ataxia, paraesthesia ``` Menstural disturbances (irregular cycles menorrhagia) Myxoedema coma (severe hypothyroidism)
188
What are the examination findings consistent with hypothyroidism?
Bradycardia, cold hands Pale puffy face, goitre, hair loss, dry skin, vitiligo Pericardial or pleural effusions Ascites Slow relaxation of reflexes Signs of carpal tunnel syndrome
189
What is subclinical hypothyroidism?
Normal serum free-T4 and T3, and increased TSH
190
What is the management for hypothyroidism?
Levothyroxine
191
What is the management of myxoedema coma?
``` Oxygen Rewarming Rehydration IV T4/T3 IV hydrocortisone ```
192
What is thyrotoxicosis?
A syndrome resulting from an excess of circulating free thyroxine (T4) and/or free triiodothyronine (T3). -Due to increased thyroid hormone synthesis
193
What autoantibodies are associated with Hashimoto's thyroiditis?
Anti-thyroid peroxidase
194
What auto-antibodies are associated with Grave's disease?
TSH-receptor antibodies
195
What are the features of Grave's disease?
-eye signs (30% of patients) -exophthalmos -ophthalmoplegia -pretibial myxoedema -thyroid acropachy, a triad of: digital clubbing -soft tissue swelling of the -hands and feet periosteal new bone formation Symptoms of thyrotoxicosis - Heat intolerance - Sweating - Palpitations - Anxiety and irritability - Weight loss (Despite good appetite) - Diarrhoea, pruritus - Exertional dyspnoea - Menstural irregularities
196
What is Graves opthalmopathy?
Blurred vision, double vision, eye grittiness, eye protrusion (Exophtalmos)
197
What is the presentation of subacute thyroiditis?
neck pain radiating to the jaw or to the ear, inability to the swallow - Fever - Palpitations - Malaise - Tremor - Heat intolerance
198
What is the TFT picture in subacute thyroidits?
Low TSH | Raised T3 and T4 due to release of pre-formed thyroid hormone in the colloid.
199
What is the first-line management for subacute thyroiditis?
Corticosteroid | Analgesia - Ibuprofen
200
What is the first-line management for controlling symptoms of thyrotoxicosis?
Propanolol (Beta-blockers)
201
What are the symptoms of thyrotoxicosis?
General: Underweight, restless, irritable, sweating. • Signs of associated autoimmune conditions – vitiligo. • Hands: tremor, warm, moist, rapid, or irregular pulse, onycholysis, acropachy, palmar erythema. • BP: Wide pulse pressure • Eyes: Lid retraction and lid lag (due to increased catecholamine sensitivity of levator palpebrae superioris)
202
What does a radioisotope uptake scan reveal in Grave's disease?
Homogenous uptake
203
What does a radioisotope uptake scan reveal in Toxic multinodular goitre?
Heterogenous activity - multiple areas of increased activity with suppression of uptake of the gland
204
What is the first-line management of an acute thyroid crisis?
Beta-blockade - atenolol, propanolol
205
What is the pharmacological management for thyrotoxicosis?
Carbimazole | Propylthiouracil
206
What is a toxic multi-nodular goitre?
Excess production of thyroid hormones from a functionally autonomous thyroid nodules which do not require stimulation from TSH.
207
What is the management of a toxic multi-nodular goitre?
Radioiodine therapy
208
What is the presentation of thyroid storm?
* Medical emergency: 50% mortality untreated. * Hyperpyrexia > 41 oC * Accelerated tachycardia/arrhythmia * Cardiac failure * Delirium/frank psychosis * Hepatocellular dysfunction – jaundice
209
What is the management of a thyroid storm?
symptomatic treatment e.g. paracetamol treatment of underlying precipitating event beta-blockers: typically IV propranolol anti-thyroid drugs: e.g. methimazole or propylthiouracil Lugol's iodine dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
210
What is the surgical management of a thyroid storm?
Thyroidectomy | Radiodine
211
What are the side effects of thioamides?
Agranulocytosis (Reduction in neutrophil - neutropenia) - Increased sepsis risk - Rashes
212
What is the pre-operative preparation for thyroidectomy?
Potassium iodide
213
What effect is observed by the administration of iodine therapy in hyperthyroidism?
Wolff-Chaikoff effect - inhibition of thyroid hormone synthesis and secretion
214
What are the main causes of Addison's disease?
* Primary - Autoimmune >70% * Infections: Tuberculosis, meningococcal septicaemia, CMV, histoplasmosis. * Infiltration: Metastasis (lung, breast, melanoma), lymphomas, amyloidosis. * Infarction: Secondary to thrombophilia. * Inherited: Adrenoleukodystrophy, ACTH receptor mutation. * Iatrogenic: Sudden cessation of long-term steroid therapy.
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What is the presentation of Addison's disease?
Dizziness, anorexia, weight loss, diarrhoea, vomiting, abdominal pain Lethargy, and weakness Depression Postural hypotension
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What are the examination findings associated with Addison's disease?
Increased pigmentation - palmar creases, buccal mucosa Loss of body hair in women
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What are the signs of an Addisonian crisis?
``` Hypotensive shock Tachycardia Pale Cold Clammy Oliguria ```
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What are the consequences of adrenocortical failure?
``` Hyponatremia Hyperkalaemia Hypotension Hypoglycaemia fatigue Hyperpigmentation Weight loss ```
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What is the first-line investigation for Addison's disease?
9 am cortisol - low (Diurnal rhythms exhibited by cortisol secretion) <100 High ACTH
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What is the diagnostic investigation to confirming primary adrenal insufficiency?
Short synacthen test - 250ug | -There is reduced cortisol secretion - unresponsive to ACTH stimulation
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What is Waterhouse-Friderichsen syndrome?
Meningococcal infection precipitating adrenal haemorrhage and Addisonian crisis
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What are the precipitating factors for an Addisonian crisis?
Steroid withdrawal Waterhouse-Fridericshen syndrome Sepsis/Acute exacerbation of chronic insufficiency
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What is the first-line management of an Addisonian crisis?
Rapid IV infusion rehydration (0.9% saline, 1L over 30-60 minutes, 2-4L) IV 200mg hydrocortisone bolus
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Which corticosteroid is administered first in Addison's
Hydrocortisone
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What is the definitive management for Addison's disease?
Hydrocortisone and fludrocortisone
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What is Cushing's syndrome?
Syndrome associated with chronic inappropriate elevation of free circulating cortisol
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What are the ACTH-dependent causes of Cushings?
Excess ACTH secretion from a pituitary adenoma (Cushing's disease)- Responds to High-dose dexamethasone suppression test
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What are the ACTH independent causes of Cushing's?
Benign adrenal adenoma Adrenal carcinoma Adrenal nodular hyperplasia Oral steroids - main cause
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Which lung is the associated?
Small cell lung cancer
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What is the presentation of Cushing's?
``` Weight gain Fatigue Muscle weakness- Proximal myopathy Myalgia Thin skin Easy bruising Poor wound healing Fractures Frontal balding Recurrent Achilles tendon rupture ```
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What are the examination findings are associating with Cushing's?
``` Moon face Facial plethora Interscapular fat pad- buffalo neck hump Supraclavicular fat distribution Thin skin Myopathy Bruises Central obesity Striae Kyphosis Hypertension, ankle oedema Pigmentation in ACTH dependent cases ```
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What is the first-line investigation for Cushing's?
24-hour urine collection of urinary free cortisol Late-night salivary cortisol
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What is the diagnostic investigation to differentiate between Cushing's disease and syndrome?
Low-dose dexamethasone test High-dose dexamethasone test
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What does a high-dose dexamethasone test reveal ACTH-independent Cushing's?
No suppression- indicates adrenal hyperplasia
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What investigations are performed in ACTH-independent Cushing's?
Low plasma ACTH | CT or MRI of adrenals

Phase1c Medicine (11 decks)

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