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4th Year Revision > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the types of Thyroid cancer?

Which has best prognosis? Which has the worst?

A

Papillary: occurs in young patients
Follicular : common in women, over 50
Anaplastic: aggressive, often constricts airways
Medullary: Familial connection (MEN2), increased calcitonin levels

Best: Papillary Worst: Anaplastic

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2
Q

Most common type of thyroid cancer?

Classic features of it?

A

Papillary

  • Psammoma bodies
  • hypochromatic nuclei
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3
Q

What are MEN refer to? How many types?

A

MEN - multiple endocrine neoplasia

MEN 1, MEN 2A and MEN 2B

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4
Q

What conditions are associated with MEN 1? MEN 2A?

A

MEN1: the 3 P’s - Parathyroid, Pancreatic (& Pancreatic islet tumour) and Pituitary

MEN 2A: Phaechromocytoma, Parathyroid & Medullary thyroid cancer

Both are autosomal dominant inheritance

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5
Q

What is Phaeochromocytoma?

Presents as?

A

A tumour of the chromatin cells of the adrenal glands
Results in excess catecholamines (adrenaline)

Presents as: Resistant hypertension, severe headaches, anxiety, sweating, hyperglycaemia

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6
Q

Diagnostic test for Phaeochromocytoma?

Management?

A

Diagnosis: 24 urine catecholamines or serum metanephrines

Mx: Alpha blockers - phenoxybenzamine
Then add B blockers
Surgical removal is definitive management

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7
Q

What is Addisons Disease?

A

It occurs when there is adrenal insufficiency - resulting in lack of cortisol and aldosterone

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8
Q

Which blood test results will you see in Addisons?

A

Hyponatraemia & Hyperkalaemia & hypoglycaemia

Addisons = lack/no aldosterone and cortisol

Aldosterone acts to increase reabsorption of salt (Na) and water in kidneys to help increase blood pressure. Low levels of aldosterone means this does not occur and so there will be HYPOnatreamia

Potassium goes in the opposite direction to Na due to Na/K pump therefore there will be a HYPERkalaemia

Cortisol acts to promote gluconeogenesis by the liver to increased blood glucose. Low levels of cortisol means this won’t occur and so there will be a HYPOglycaemia

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9
Q

Addisons presents as?

A

Hypotension (can be postural) - no aldosterone
Pigmented skin (hyperpigmentation due to ACTH levels)
Fatigue,
Nausea
Cramps
Abdo pain

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10
Q

What is the diagnostic test for Addisons Disease?

A

Short Synacthen Test (stimulation test)
Give synacthen (synthetic ACTH) ideally in morning
then measure cortisol levels
Should double in normal patient by 30mins
Failure to double in this time - Addisons

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11
Q

Management for Addisons Disease?

A

Hydrocortisone (to replace lacking cortisol) and

Fludrocortisone (to replace lacking aldosterone)

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12
Q

What is hyperthyroidism? Types?

A

Hyperthyroidism is an excess of thyroid hormone production

Can be either:
Primary (pathology within thyroid gland)
or
Secondary (pathology before thyroid gland)

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13
Q

Give causes of hyperthyroidism. Explain each.

A

Grave’s disease - autoimmune condition where there are autoantibodies (TSH receptor stimulating antibodies) which mimic action of TSH

Toxic multi nodular goitre - nodules on the thyroid gland act independently of negative feedback and continue to produce excess T3 and T4

Thyroiditis - autoimmune condition of inflamed thyroid gland where thyroid tissue is destroyed and the stored T3 & T4 within the tissue is released resulting in high thyroid hormones
(eg. De quervains - presents with or just after viral infection - fever, neck pain, tenderness and dysphasia + hyperthyroid symptoms)

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14
Q

Presentation of Graves Disease?

A

Bilateral exophthalmos
Pretibial myxoedema
Anxiety, sweating, heat intolerance, weight loss, fatigue, menstrual irregularities such as oligomenorrhia

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15
Q

Management of hyperthyroidism

A

1) Carbimazole
2) Propylthiouracil
3) B blockers - Propanolol

Definitive management - Surgical removal

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16
Q

What is thyroid crisis or storm?

Mx?

A

Severe and often abrupt presentation of hyperthyroidism
Presents with: Fever, tachycardia, delirium + usual hyperthyroid symptoms

Mx - fluid resus, anti-arrythimics + propanolol + Carbimazole

17
Q

In what condition is there excess growth hormone?

A

Acromegaly

18
Q

What is the most common cause of Acromegaly?

A

Most common - Pituitary adenoma
Can be either macroscopic or microscopic
Macroscopic will see swelling and invading of the optic chiasm

19
Q

How does Acromegaly present?

A 
Prominent facial features: forehead and brow 'frontal bossing' 
Large hands and feet 
Large lower jaw 
Macroglossia 
Acanthosis ingrains of the axillae
20
Q

What two other conditions are associated with Acromegaly?

A

Hypertension

Diabetes

21
Q

How do you diagnose Acromegaly?

How do you manage it?

A

Diagnosis - IGF-1 level
- Oral glucose tolerance test

Management

  • Transphenoidal surgery to remove pituitary adenoma
  • Somatostatin analogue until surgery - Ocreotide
22
Q

What is SIADH?

A

Syndrome of Inappropriate ADH
- where inappropriate excess ADH is secreted by either the pituitary or another source such as a paraneoplastic cancer - small cell lung cancer

23
Q

What blood results do you see in SIADH?

A

As excessive ADH causes increased reabsorption of water - this dilutes the sodium circulating in the blood

Therefore there is hyponatraemia, and a high urine osmolality (more concentrated urine) and a low or normal serum/blood osmolality

24
Q

What are the symptoms of SIADH?

A

Confusion
Headache, fatigue, muscle aches and cramps
Severe cases: seizures and reduced consciousness

25
Q

What are the causes of SIADH?

A

Malignancy, particularly SMALL CELL LUNG CANCER
Infection, particularly atypical pneumonia and lung abscesses

Post-operative from major surgery
Head injury
Medications (thiazide diuretics, carbamazepine, vincristine, cyclophosphamide, antipsychotics, SSRIs, NSAIDSs,)
Meningitis

26
Q

How do you diagnose SIADH?

A

Kind of a diagnosis of exclusion

Results: Euvolaemia. U+Es - hyponatraemia. Urine sodium and osmolality will be high

CXR is first line imaging to look for lung infection of cancer as source

27
Q

Management of SIADH?

A

Treat cause
Fluid restriction - to try and balance out sodium level to normal

Demeclocycline can be used - inhibits ADH - rarely used in practice now though

28
Q

What is hypothyroidism?

A

Inadequate production of thyroid hormones T3 and T4

29
Q

Give examples of primary, secondary & tertiary hypothyroidism

A 
Primary Hypothyroidism
Hashimoto's Thyroiditis
Iodine Thyroiditis 
As a result of over treatment of hyperthyroidism 
Meds such as lithium

Secondary Hypothyroidism
Pathology of the pituitary causing hypopituitarism (can be infection, tumour, vascular, radiation)

Tertiary Hypothyroidism
Failure of hypothalamus to respond to TRH and/or secrete TSH

30
Q

What is Hashimoto’s thyroiditis?

A

Hashimoto’s Thyroiditis:
autoimmune of the thyroid gland and associated with anti-TPO antibodies & antithyroglobulin antibodies

Can initially cause a goitre but as it settles will cause atrophy of the thyroid gland

31
Q

Typical symptoms and signs of hypothyroidism?

A

Fatigue, weight gain, dry skin, coarse hair & hair loss, irregular periods (menorrhagia), constipation

32
Q

Diagnosis:
What do the following results indicate?

TSH - High, T3/T4 - Low

TSH - Low, T3/T4 - Low

A

TSH - High, T3/T4 - Low
- Primary hypothyroidism

TSH - Low, T3/T4 - Low
- Secondary hypothyroidism

(cause there should be a negative feedback loop and if T3/T4 is low then TSH should be high if higher centres are working properly)

33
Q

Management for hypothyroidism?

A

Levothyroxine

34
Q

What is a indication of severe pancreatitis?

A

Hypocalcaemia

4th Year Revision (14 decks)

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