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Phase 2a Resits > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

T1DM - what is it? Epidemiology?

A
  • autoimmune destruction of pancreatic beta cells → complete insulin deficiency
  • usually presents aged 5-15
  • 10% of all diabetes
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2
Q

Risk Factors of T1DM

A
  • family history of HLA DR3-DQ2 or HLA DR4-DQ8
  • Northern European
  • other autoimmune diseases eg autoimmune thyroid, coeliac, Addison’s
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3
Q

Pathophysiology of T1DM

A
  • autoantibodies attack beta cells in the islets of Langerhans
  • causes insulin deficiency → hyperglycaemia
  • continuous breakdown of glycogen from liver (glucogenesis) → glycosuria
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4
Q

Signs and Symptoms of T1DM

A
  • classic triad = polydipsia, polyuria, weight loss (BMI <25)
  • usually short history of severe symptoms
  • may present with ketosis
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5
Q

Diagnostic Criteria of T1DM

A

random plasma glucose >11

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6
Q

Treatment of T1DM

A
  • insulin
  • short-acting insulin/insulin analogues → 4-6hrs
  • longer-acting insulin → 12-24hrs
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7
Q

What is T2DM?

A
  • non-insulin dependent
  • patients gradually become insulin resistant AND/OR
  • pancreatic beta cells fail to secrete enough insulin
  • progresses from impaired glucose tolerance
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8
Q

Causes of T2DM

A
  • gestational diabetes
  • steroids
  • Cushing’s
  • chronic pancreatitis
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9
Q

Risk Factors of T2DM

A
  • lifestyle factors
  • Asian men
  • > 40yrs
  • HTN
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10
Q

Signs and Symptoms of T2DM

A
  • polydipsia
  • polyuria
  • glycosuria
  • central obesity
  • blurred vision
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11
Q

Investigations for T2DM

A
  • fasting plasma glucose >7
  • random plasma glucose >11
  • HbA1c >48
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12
Q

1st Line Management for T2DM

A

LIFESTYLE

  • dietary advice
  • smoking cessation
  • decrease alcohol intake
  • encourage exercise
  • regular blood glucose and HbA1c monitoring
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13
Q

2nd Line Management for T2DM

A

MEDICATIONS
1. metformin → increased insulin sensitivity → 1st choice if overweight
2. add either DPP4 inhibitor, sulphonylurea (increased insulin secretion) or pioglitazone
3. triple therapy
4. then add insulin
use HbA1c levels to monitor

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14
Q

What is DKA

A
  • diabetes ketoacidosis
  • complete lack of insulin → high ketone production
  • medical emergency
  • serious complication of T1DM
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15
Q

Causes of DKA

A
  • untreated/undiagnosed T1DM
  • infection
  • illness
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16
Q

Pathophysiology of DKA

A
  • absence of insulin → hyperglycaemia
  • hyperglycaemia → osmotic diuresis → dehydration
  • peripheral lipolysis for energy → increased circulating free fatty acids → oxidised to acetyl CoA → ketone bodies (acidic) → acidosis
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17
Q

Symptoms of DKA

A
  • extreme diabetes symptoms plus
  • N&V
  • weight loss
  • confusion and reduced mental state
  • lethargy
  • abdominal pain
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18
Q

Signs of DKA

A
  • Kussmaul’s breathing
  • ‘pear drop’ breath
  • hypotension
  • tachycardia
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19
Q

Investigations of DKA

A
  • random plasma glucose >11
  • plasma ketones >3
  • blood pH <7.35
  • bicarb >15
  • urine dipstick → glycosuria, ketonuria
  • raised urea and creatinine
  • decreased total K+ and increased serum K+
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20
Q

Treatment of DKA

A
  • ABCDE management
  • replace fluid → 0.9% saline IV
  • IV insulin
  • restore electrolytes → K+
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21
Q

What is ABCDE management?

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
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22
Q

What is HHS?

A
  • hyperosmolar hyperglycaemic state
  • marked hyperglycaemia, hyperosmolality, mild/no ketosis
  • medical emergency
  • serious complication of T2DM
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23
Q

Pathophysiology of HHS

A
  • low insulin → increased glucogenesis
  • hyperglycaemia but enough insulin to inhibit ketogenesis
  • hyperglycaemia → dehydration
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24
Q

Signs and Symptoms of HHS

A
  • extreme diabetes symptoms plus
  • confusion and reduced mental state
  • lethargy
  • severe dehydration
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25
Investigations for HHS
- random plasma glucose >11 - urine dipstick = glycosuria - plasma osmolality = high - decreased total K+ and increased serum K+
26
Treatment of HHS
- replace fluids → 0.9% saline IV - low rate infusion of insulin - restore electrolytes → K+ - LMW heparin
27
What is Hyperthyroidism
- clinical effect of thyroid hormone - primary = abnormal increased thyroid function - secondary = abnormal increased TSH production
28
Causes of Hyperthyroidism
- Graves disease - toxic multinodular goitre - toxic adenoma - metastatic follicular thyroid cancer - iodine excess eg IV contrast - secondary causes = TSH secreting pituitary tumour
29
Epidemiology of Hyperthyroidism
- mainly young women → 20-40yrs | - Graves disease
30
Risk Factors of Hyperthyroidism
- smoking - stress - HLA-DR3 - other autoimmune diseases eg T1DM, Addison's, vitiligo
31
Pathophysiology of Hyperthyroidism
- increased T3 - increased metabolic rate, CO, bone resorption - also activates sympathetic NS
32
Signs and Symptoms of Hyperthyroidism (9)
- hot and sweaty - diarrhoea - hyperphagia - weight loss - palpitations - tremor - irritability/anxiety/restlessness - oligomenorrhoea - goitre
33
Investigations for Hyperthyroidism
- TFTs → increased T4/T3 - primary = decreased TSH - secondary = increased TSH - thyroid autoantibodies → anti-TSHR - US/CT head
34
Treatment for Hyperthyroidism
1. carbimazole → blocks synthesis of T4 2. propylthiouracil → prevents conversion of T4 to T3 - beta-blockers for symptom relief - radioiodine - thyroidectomy
35
Pathophysiology of Graves
- IgG autoantibodies (anti-TSHR-Ab) bind to TSH receptors - increased T3/T4 production - also react with orbital autoantigens
36
Symptoms of Graves
- hyperthyroid symptoms - thyroid eye disease → eyelid retraction, periorbital swelling, proptosis - pretibial myxoedema - thyroid acropachy → clubbing, painful finger and toe swelling
37
What is Hypothyroidism
- clinical effect of lack of thyroid hormone - primary = abnormal decreased thyroid function - secondary = abnormal decreased TSH production - not enough T3 to increase metabolic rate for normal body functions
38
Epidemiology of Hypothyroidism
- mainly >40yrs | - female > male
39
Causes of Hypothyroidism
- autoimmune diseases eg hashimotos, primary atrophic hypothyroidism - primary iodine deficiency - drugs eg antithyroid, lithium - secondary cause = hypopituitarism
40
Signs and Symptoms of Hypothyroidism (9)
- fatigue - weight gain - loss of appetite - cold - lethargy - constipation - low mood - menorrhagia - goitre
41
Investigations for Hypothyroidism
- TFTs → decreased T3 and T4 - primary = increased TSH - secondary = decreased TSH - autoantibodies → anti-TPO
42
Treatment for Hypothyroidism
levothyroxine T4
43
What is Hashimoto's thyroiditis
- most common cause of hypothyroidism - cause = autoimmune inflammation of thyroid gland - associated with anti-TPO and antithyroglobulin antibodies - goitre then atrophy of gland
44
What is Cushing's
long term exposure cortisol → released by adrenal glands
45
Causes of Cushing's
- ACTH secreting from pituitary adenoma (Cushing's disease) - ectopic ACTH production from small cell lung cancer - iatrogenic → steroids - adrenal adenoma
46
Signs and Symptoms of Cushing's (8)
- moon face - central obesity - buffalo hump - acne - HTN - striae - hirsutism - weight gain
47
Investigations for Cushing's
- raised random plasma cortisol - overnight dexamethasone suppression test → cortisol will not be suppressed - urinary free cortisol - plasma ACTH
48
Treatment for Cushing's
- depends on underlying cause - Cushing's disease → remove pituitary adenoma → transsphenoidal surgery - adrenal adenoma → adrenalectomy - cortisol synthesis inhibition → metyrapone, ketoconazole
49
What is Acromegaly?
- release of excess GH causing overgrowth of all systems - GH acts directly on tissues eg liver, muscle, bone, fat - GH acts indirectly through induction of insulin-like GF
50
Causes of Acromegaly
- pituitary adenoma | - secondary to malignancy that secretes ectopic GH eg lung cancer
51
Complications of Acromegaly
- erectile dysfunction | - DM
52
Signs and Symptoms of Acromegaly (7)
- prominent forehead and brow - increased jaw size - large hands, nose, tongue, feet - visual field defect - profuse sweating - lower pitch of voice - obstructive sleep apnoea
53
Investigations for Acromegaly
1. insulin-like GF 1 test = raised GOLD STANDARD = oral glucose tolerance test - random serum GH = raised - MRI pituitary fossa
54
Treatment for Acromegaly
1. transshpenoidal resection surgery (for adenoma) 2. somatostatin analogue eg octreotide 3. GH receptor antagonist eg pegvisomant 4. dopamine agonist eg cabergoline
55
What is Prolactinoma?
- benign adenoma of pituitary gland producing excess prolactin - thought to have a genetic association
56
Causes of Hyperprolactinaemia
- non-functioning pituitary tumour → compresses pituitary stalk → no inhibition of prolactin release - prolactinoma - antidopaminergic/antipsychotic drugs
57
Pathophysiology of prolactinoma
- two types of tumour → micro and macro | - increased release of prolactin = galactorrhea (stimulates milk) and inhibits FSH and LH
58
Signs and Symptoms of Prolactinoma (6)
- visual field defect - headache - menstrual irregularity - infertility - galactorrhoea - secondary hypogonadism (rediced libido, sexual dysfunction)
59
Investigations for Prolactinoma
- prolactin levels | - CT head
60
Treatment for Prolactinoma
1. dopamine agonists → bromocriptine/cabergoline | GOLD STANDARD = transsphenoidal resection surgery of pituitary gland
61
What is Conn's?
primary hyperaldosteronism due to an aldosterone producing adenoma
62
Pathophysiology of Conn's
- excess production of aldosterone, independent of RAAS - high Na+ and H2O retention - increased K+ excretion in kidneys - low renin release
63
Signs and Symptoms of Conn's (5)
- HTN - hypokalaemia - nocturia, polyuria - mood disturbance - difficulty concentrating
64
Investigations for Conn's
- aldosterone-renin ratio blood test = increased - plasma K+ = reduced - U&E
65
Treatment for Conn's
1. spironolactone → if hyperplasia GOLD STANDARD = laporascopic adrenalectomy → if adenoma aim = lower BP, decrease aldosterone, resolve electrolyte imbalance
66
What is Addison's
- primary adrenal insufficiency | - destruction of adrenal cortex → decreased production of glucocorticoid (cortisol) and mineralocorticoid (aldosterone)
67
Causes of Addison's
- autoimmune destruction = most common in UK - TB → most common cause worldwide - adrenal metastases
68
Signs and symptoms of Addison's
Signs - 4T's = thin, teary, tired, tanned - pigmented palmar creases - postural hypotension Symptoms - diarrhoea - dizziness - nausea - lethargy
69
Investigations for Addison's
1. U&E → hyponatraemia, hyperkalaemia, blood glucose (high) GOLD STANDARD = short synACTHen test = ACTH stimulation test - presents with low cortisol, high ACTH - plasma renin high, aldosterone low
70
Treatment for Addison's
- glucocorticoids → oral hydrocortisone/prednisolone to replace cortisol - mineralocorticoids → fludrocortisone to replace aldosterone - double dose of steroid when there is infection, trauma, surgery, nightshift work
71
What is SIADH?
- syndrome of inappropriate ADH | - large amounts of ADH secretion → water reabsorption in CD
72
Causes of SIADH
- post-op from major surgery - infection → atypical pneumonia, lung abscess - head injury - medications → thiazide diuretics = most common
73
Signs and Symptoms of SIADH
- headache - nausea - fatigue - muscle cramps - confusion - severe hyponatraemia
74
Investigations for SIADH
- diagnosis of exclusion - U&E = hyponatraemia - urine Na+ and osmolality = high exclude causes of hyponatraemia - -ve short synACTHen test - no D&V - no history of diuretic use - no AKI/CKD
75
What is Hyperkalaemia?
high K+ | >5.5
76
Causes of Hyperkalaemia
impaired excretion - AKI/CKD - drugs eg ACEi, NSAIDs, beta blockers - renal tubular acidosis - addisons → decreased aldosterone increased intake - IV K+ therapy - increased dietary intake shift to EC - metabolic acidosis - rhabdomyolysis - decreased insulin - tumour lysis syndrome
77
Symptoms of Hyperkalaemia
- fatigue - lightheadedness - weakness - chest pain - palpitations
78
Signs of Hyperkalaemia
- arrhythmias → potential cardiac arrest - reduced power and reflexes - flaccid paralysis
79
Investigations for Hyperkalaemia
- ECG - bloods - urine osmolality and electrolytes
80
Treatment for Hyperkalaemia
- cardiac monitoring - calcium gluconate → protects myocardium - insulin/dextrose/nebulised salbutamol → drive K+ IC
81
What is Hypokalaemia?
low K+ | <3.5
82
Causes of Hypokalaemia
increased excretion - renal disease - drugs eg thiazide/loop diuretics, laxatives - GI loss → D&V - Conns → increased aldosterone decreased intake - dietary deficiency/fasting - liquorice abuse shift to IC - metabolic alkalosis - drugs eg insulin, SABA/LABAs
83
Investigations for Hypokalaemia
- ECG - bloods - urine osmolality and electrolytes
84
Treatment for Hypokalaemia
- K+ → PO/IV | - other electrolytes as required
85
What are the two types of DI?
cranial and nephrogenic
86
Pathophysiology of DI
- impaired water resorption from kidneys - large volumes of dilute urine due to reduced ADH - impaired ADH secretion from posterior pituitary = cranial - impaired response of the kidney to ADH = nephrogenic
87
Symptoms of DI
- polyuria - polydipsia - dehydration
88
Causes of Cranial DI
- idiopathic - congenital - tumour - trauma - infection
89
Causes of Nephrogenic DI
- inherited - metabolic → low K, high Ca - drugs → Li - chronic renal disease
90
Diagnosis of DI
GOLD STANDARD = 8hr water deprivation test - then desmopressin test → establish cranial or nephrogenic - cranial MRI
91
Treatment of DI
- mild = manage conservatively → rehydration - cranial = desmopressin (synthetic ADH) - nephrogenic = if cause persists → bendroflumethazide
92
What is Primary Hyperparathyroidism?
- excessive secretion of PTH | - 1 PTH gland produces excess PTH
93
What is Secondary Hyperparathyroidism?
- excessive secretion of PTH | - increased secretion of PTH to compensate for hypocalcaemia
94
What is Tertiary Hyperparathyroidism?
- excessive secretion of PTH | - autonomous secretion of PTH even after corrrect of Ca2+ deficiency due to CKD
95
How does PTH raise Ca2+ levels?
- bone resorption - gut/renal absorption - activates vitamin D - when blood Ca2+ levels are too high, PTH glands produce less PTH
96
Causes of Hyperparathyroidism
1. adenomas = main, hyperplasia of all glands 2. CKD, low vitamin D 3. develops from prolonged secondary hyperPTH
97
Signs and Symptoms of Hyperparathyroidism
- bones = bone pain - stones = renal calculi - moans = psychic moans - groans = abdominal groans - hypercalcaemia
98
Investigations for Hyperparathyroidism
- PTH/bone profile → high PTH/Ca2+, low phosphates 1. raised Ca2+ 2. low serum Ca2+, high PTH 3. raised Ca2+ and PTH - DEXA scan - xray → salt and pepper degradation - US for stones
99
Management of Hyperparathyroidism
- watchful waiting 1. surgical removal of adenoma, bisphosphonates 2. Ca2+ correction, treat underlying cause 3. Cinacalet (Ca2+ mimetic), total/part parathyroidectomy
100
What is Primary Hypoparathyroidism? Causes?
- reduced pTH production due to gland failure - autoimmune destruction - congenital = DiGeorge syndrome → 22q11 del
101
What causes Secondary Hypoparathyroidism?
- surgical removal | - decreased Mg+ → required for PTH secretion
102
Risk Factors for Hypoparathyroidism
- other autoimmune disorders
103
Pathophysiology of Hypoparathyroidism
- low PTH - hypocalcaemia and hyperphosphataemia | - neurons become more excitable
104
Symptoms of Hypoparathyroidism
CATS go numb - convulsions - arrhythmias - tetany - spasm - numbness
105
Signs of Hypoparathyroidism
- Chvostek's sign → facial nerve induces spasm | Trousseau's → BP cuff causes wrist flexion and fingers to pull together → carpopedal spasm
106
Investigations for Hypoparathyroidism
- bloods → bone profile = decreased Ca2+/PTH, increased/normal phosphate - ECG = prolonged QT and ST segments
107
Treatment for Hypoparathyroidism
- IV Ca2+ - AdCal D3 = calcitriol - synthetic PTH is required
108
What is pheochromocytoma?
- adrenal medullary tumour that secretes catecholamines (adrenaline) - very rare
109
Causes of pheochromocytoma
occur in certain familial syndromes - multiple endocrine neoplasia (MEN) syndrome - neurofibromatosis - von-Hippel Lindau disease
110
Symptoms of pheochromocytoma
- headaches - profuse sweating - palpitations - tremor - pallor
111
Signs of pheochromocytoma
- HTN - postural hypotension - hypertensive retinopathy
112
Investigations for pheochromocytoma
- plasma metanephrines and normetanephrines - 24hr urinary total catecholamines - CT → look for tumour
113
Treatment for pheochromocytoma
without HTN crisis: 1. alpha blockers → phenoxybenzamine - most patients eventually get tumour removed then managed medically with HTN crisis 1. antihypertensive agents → phentolamine
114
Signs of hypocalcaemia
- paraesthesia - tetany - seizures - basal ganglia calcification - cataracts - Chvostek's and Trousseau's
115
ECG abnormalities in hypocalcaemia
long QTc interval
116
Causes of hypocalcaemia
- hypoparathyroidism - acute pancreatitis - hypophosphataemia - hypomagnesaemia - diuretics
117
Signs of hypercalcaemia
- BONES - renal STONES - psychiatric GROANS - abdominal MOANS typical presentation = thirst, polyuria, constipation
118
ECG abnormalities in hypercalcaemia
short QTc interval
119
Causes of hypercalcaemia
- malignancies → myeloma, bone metastases, lymphoma | - hyperparathyroidism → primary and tertiary
120
ECG abnormalities in hypokalaemia
- flat T waves - ST depression - long QT interval - prolonged PR interval - ST depression - flat T waves - prominent U waves
121
ECG abnormalities in hyperkalaemia
- tall tented T waves - ST elevation - short QT interval - small/absent P waves - prolonged PR interval - wide QRS interval - tall tented T waves

Phase 2a Resits (10 decks)

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