Endocrinology 🚦 Flashcards
what is cushings syndrome
refers to signs and symptoms that develop after prolonged abnormal elevation of cortisol
What are brown tumours
Tumours of bone that arise in settings of excess osteoclast activity such as hyperparathyroidsim
Consists of fibrous tissue woven bone and supporting vasculature
Adverse effects of SGLT-2 inhibitors
Urinary and genital infection secondary to Glycosuria
Normoglycaemic ketoacidosis
fornier gangrene
Increased risk of lower limb amputation - feet should be closely monitored
Where is prolactin secreted from
Anterior pituitary
Why would testicular tumours cause gynaecomastia
Testicular tumours secrete beta HCG which increases oestrogen levels promoting the proliferation of breast tissue
Tx polymyalgia rheumatica
Corticosteroids
What is Kallmans syndrome
Recognised cause of delayed liberty secondary to hypogonadotropic hypogonadism
X linked recessive
Features of kallmans syndrome
Delayed puberty
Hypogonadism
Ansomia - usually the clue given in many questions “lack of smell in a bit with delayed puberty”
LH, FSH levels inappropriately low
Patients normal or above average height
Cleft lip/palate seen in some
Management of kallmans syndrome
Testosterone supplementation
Gonadotropin supplementation
adverse effects of sulfonylureas
weight gain
hypoglycaemia
adverse effects of pioglitazone
weight gain
fluid retention
anaemia
heart failure
adverse effects of DPP-4 inhibitors
GI upset
symptoms of URTI
pancreatitis
adverse effects of biguanides - metformin
lactic acidosis
GI disturbance
adverse effects of thiazolidinediones - gliclazide
fluid retention
weight gain
worsening heart failure
adverse effects of GLP-1 Analogues
hypoglycaemia
GI upset
diagnosis of type 2 diabetes
if symptomatic one of the following results:
random blood glucose = 11.1
fasting blood glucose = 7
2 hour glucose tolerance = 11.1
HbA1C= 48mmol/mol
what is gastroparesis
caused by autonomic dysfunction of the vagus nerve leading to delayed gastric emptying and presents with
morning nausea
offensive egg-smelling burps
early satiety
abnormal stomach movements
a complication of type 2 diabetes
cushing’s syndrome features
picture the patient as very round in the middle with thin weak limbs and then imagine the effects of high levels of stress hormone:
round in the middle with thin limbs:
round moon face
central obesity
abdominal striae
buffalo hump
proximal limb muscle wasting
high levels of stress hormone:
hypertension
cardiac hypertrophy
hyperglycaemia
depression
insomnia
extra effects:
osteoporosis
easy bruising and poor skin healing
test of choice for diagnosing cushing’s syndrome
dexamethasone suppression test
initially giving the patient the low dose test if its normal cushings can be excluded, if not then high dose test
to perform the test pt takes dose of dexamethasone at night and their cortisol and ACTH is measured the morning
what is cortisol
primary stress hormone that increases blood sugars
what is ACTH
a hormone released by the pituitary gland that triggers the adrenal gland to release cortisol
what is cushings disease
refers to the specific condition where a pituitary adenoma (tumour) secretes excessive ACTH
normal result for the dexamethasone suppression test
normally dexamethasone suppresses the release of cortisol
most common cause of cushings syndrome
exogenous corticosteroid exposure
causes of pseudo-Cushings syndrome
chronic alcoholism
results of dexamethasone suppression test that would indicate ectopic ACTH secretion and what does that mean
when neither cortisol and ACTH have been suppressed
ectopic ACTH secretion is most common in small cell lung cancer and carcinoid tumours
results of dexamethasone suppression test that indicates adrenal adenoma
cortisol not being suppressed but ACTH is
results of dexamethasone suppression test that indicates pituitary adenoma
both cortisol and ACTH become suppressed
what other symptoms would a patient present with if ectopic ACTH release was the cause of their “cushings symptoms” e.g purple striae
any features suggestive of lung cancer
smoking history
haemoptysis
clubbing
what is De Quervain’s (subacute) thyroiditis
describes the presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of HYPERTHYROIDISM
self-limiting condition and only requires supportive treatment with NSAIDs
management of hyperthyroidism
first-line carbimazole
second line propylthiouracil
propanolol for sx relief
radioactive iodine
surgery
hyperthyroidism features specific to graves disease
positive TSH antibodies
eye involvement
pretibial myxoedema
blood results that show hyperthyroidism
raised T3 AND T4
suppressed TSH
blood results that show hyperthyroidism
raised T3 AND T4
suppressed TSH
complications of hyperthyroidism
thyroid storm
atrial fibrillations
high output heart failure
what is toxic multinodular goitre
nodules develop on thyroid gland that act independently and continuously produce excessive thyroid hormone
presents commonly in pts aged over 50 with numerous firm nodules in the goitre
second most common cause of hyperthyroidism
most serious side effect of carbimazole
agranulocytosis
first line treatment for a thyrotoxic storm
PO proplythirouracil
complication of thyroid storm
presents with tachycardia
confusion
nausea
vomiting
high fever
thyroid storm
