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Alice's finals cards > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which hormone is elevated in cushing’s syndrome?

A

cortisol

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2
Q

What are the features of cushing’s syndrome?

A

Round “moon” face
Central obesity
Abdominal striae
Buffalo hump
Proximal limb weakening

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3
Q

What are the causes of cushing’s?

A

Exogenous steroids
Cushing’s disease
Adrenal adneoma
Paraneoplastic cushing’s

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4
Q

Which test is used to diagnose Cushing’s

A

Dexamethasone suppression test

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5
Q

What is the result of the low dose dexamethasone suppression test in Cushing’s?

A

1mg of dexamethasone is given at night. In healthy people this should suppress the early morning spike of cortisol, in cushing’s it does not

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6
Q

What does the different results of the high dose dexamethasone suppression test mean?

A

8mg of dexamethasone is given.

In cushing’s disease (pituitary adenoma) this is enough to cause negative feedback and suppress the cortisol

In adrenal adenoma the cortisol is not suppressed but the ACTH is suppressed due to negative feedback

Where there is ectopic ACTH (eg SCLC) neither cortisol or ACTH are supressed because the ACTH release is independent of the hypothalamus

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7
Q

What investigations can be done for cushing’s disease?

A

Dexamethasone suppression test
24 hour urinary free cortisol
FBC
MRI brain, Chest CT, Abdo CT for tumours

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8
Q

What is the management of cushing’s disease?

A

Trans-sphenoidal removal of pituitary adenoma
Surgical removal of adrenal tumour
Surgical removal od tumour producing ACTH

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9
Q

What is addison’s disease?

A

Adrenal glands have been damaged which results in a reduction in the secretion of cortisol and aldosterone. This is primary adrenal insufficiency

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10
Q

What is secondary adrenal insufficiency?

A

There is inadequate ACTH. It is a problem in the pituitary gland

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11
Q

What is tertiary adrenal insufficiency?

A

Inadequate CRH release by the hypothalamus. Usually the result of patients being on long term oral steroids

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12
Q

What are the features of adrenal insufficiency?

A

Fatigue
nausea
Cramps
Abdominal pain
Bronze hyperpigmentation
Hypotension
Hypoglycaemia

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13
Q

What is seen on blood tests in adrenal insufficiency? In terms of ACTH and electrolyte abnormalities

A

Hyponatraemia
Hyperkalaemia
ACTH is high in primary and low in secondary

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14
Q

Which autoantibodies are present in adrenal insufficiency?

A

Adrenal cortex antibodies
21-hydroxylase antibodies

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15
Q

What is the test used to assess for adrenal insufficiency?

A

The short synacthen test

Give synacthen (synthetic ACTH) which would stimulate healthy adrenal glands to produce cortisol

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16
Q

What is the management of adrenal insufficiency?

A

Replace the steroids. Hydrocortisone to replace cortisol and fludrocortisone to replace aldosterone

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17
Q

What are the sick day rules for steroid therapy?

A

Double when ill

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18
Q

What is the presentation of an addisonian crisis?

A

Reduced consciousness
Hypotension
Hypoglycaemia, hyponatraemia and hyperkalaemia

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19
Q

What is the management of an addisonian crisis?

A

Intensive monitoring
Steroids
IV fluids
Correct hypoglycaemia

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20
Q

What are TSH and T3/4 levels in primary hyperthyroidism?

A

TSH= Low
T3/4= high

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21
Q

What are TSH and T3/4 levels in primary hypothyroidism?

A

TSH= high
T3/4= low

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22
Q

What are TSH and T3/4 levels in secondary hypothyroidism?

A

TSH= low
T3/4= low

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23
Q

What antibodies are present in thyroid disease?

A

Anti- TPO (graves and hashimotos)

Anti-thyroglobulin antibodies (graves and hashimotos)

TSH receptor antibodies (graves)

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24
Q

What can a radioisotope scan show of the thyroid?

A

Diffuse high uptake= graves
Focal high uptake= toxic multinodular
Cold= cancer

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25
Q

What is plummer’s disease?

A

Toxic multinodular goitre

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26
Q

What is exophthalmos a sign of?

A

Grave’s disease

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27
Q

Which antibody causes grave’s disease?

A

TSH receptor antibodies

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28
Q

What are signs of grave’s disease?

A

Anxiety and irritability
Sweating
tachycardia
weightloss
Fatigue
Frequent loose stools
Diffuse goitre
Exophthalmos
Pretibial myxoedema

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29
Q

What is de Quervain’s thyroiditis?

A

Presents with a viral fever, neck pain, dysphagia and tenderness. There is a hyperthyroid phase and then a hypothyroid phase. It is a self limiting condition which can be managed with NSAIDs for pain and beta blockers for the features of thyroiditis

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30
Q

How does thyroid storm present?

A

Hyperthyroidism, pyrexia, tachycardia and delierium

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31
Q

How is thyroid storm managed?

A

Fluid resus
Anti-thyroid meds e.g. propylthiouracil
beta blockers

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32
Q

How is hyperthyroidism managed?

A

Carbimazole (either titration block or block and replace regime)

Propylthiouracil is 2nd line

Radio iodine

Beta-blockers for symptom relief

Surgery is definitive

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33
Q

Which antibodies are associated with hashimotos thyroiditis?

A

Anti-TPO and antithyroglobulin antibodies

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34
Q

Which medications can cause hypothyroidism?

A

Lithium
Amiodarone

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35
Q

Whats is the presentation of hypothyroid disease?

A

Weight gain
Fatigue
Dry skin
Coarse hair and hair loss
Fluid retention
heavy or irregular periods
Constipation

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36
Q

What is the management of hypothyroid disease?

A

levothyroxine

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37
Q

What is the ideal concentration of glucose in the blood?

A

Between 4.4 and 6.1mmol/l

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38
Q

What are the 3 main problems in DKA?

A

Ketoacidosis
Dehydration
Potassium imbalance (serum potassium high, whole body potassium low)

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39
Q

What is a possible adverse effect of insulin therapy in DKA?

A

severe hypokalaemia leading to arrythmias

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40
Q

How does diabetic ketoacidosis present?

A

Polyuria
Polydipsia
N&V
Acetone smell to breath
Dehydration and hypotension
Altered consciousness

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41
Q

How is DKA diagnosed?

A

Hyperglycaemia
Ketosis
Acidosis

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42
Q

How is DKA managed?

A

FIG-PICK
F-fluids
I-insulin (actrapid 0.1 unit/kg/hour)
G-glucose
P-potassium
I-infection
C-chart fluid balance
K-ketone monitoring

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43
Q

What is the general rule regarding potassium infusion?

A

Dont infuse at a rate of >10mmol/hour

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44
Q

Why should diabetic patients cycle their injection sites?

A

Injecting into the same spot can cause lipodystrophy where the subcutaneous fat hardens and the patients cannot absorb insulin properly

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45
Q

What are the typical symptoms of hypoglycaemia?

A

Tremor, sweating, irritabilty, dizziness and pallor

46
Q

What are the management options for hypoglycaemia?

A

If mild, rapid acting glucose such as lucozade and slower acting carbohydrates

If severe, IV dextrose and intramuscular glucagon

47
Q

How often should HbA1c be measured?

A

every 3-6 months

48
Q

When should type 1 diabetics measure their blood sugar?

A

Waking, at each meal and before bed

49
Q

What is the pathophysiology (simplified) of type 2 diabetes?

A

Repeated exposure to glucose and insulin makes cells resistant to the effects of insulin. Beta cells become damaged by producing so much insulin that they start to produce less. This leads to chronic. hyperglycaemia

50
Q

How is an oral glucose tolerance test undertaken?

A

Take a fasting plasma glucose level, give 75g glucose drink then measure the plasma glucose 2 hours later

51
Q

What is the HbA1c range for pre-diabetes?

A

42-47mmol/mol

52
Q

What is the impaired fasting glucose range for pre-diabetes?

A

6.1-6.9 mmol/l

53
Q

What is the HbA1c level for a diabetes diagnosis?

A

> 48mmol/mol

54
Q

What is the random glucose level for a diagnosis of diabetes?

A

> 11mmol/l

55
Q

What is the fasting glucose level for a diagnosis of diabetes?

A

> 7mmol/l

56
Q

What is the OGTT level for a diagnosis of diabetes?

A

> 11mmol/l

57
Q

What is the HbA1c target for a new type 2 diabetic?

A

48mmol/mol

58
Q

What is the HbA1c target for diabetics who are beyond metformin treatment?

A

53mmol/mol

59
Q

What is the first line treatment for diabetes?

A

Metformin titrated from 500mg OD as tolerated

60
Q

What is the second line treatment for diabetes?

A

Metformin +

Sulfonylurea, pioglitazone, DPP-4 inhibitor and SGLT-2 inhibitor

61
Q

What is third line treatment for diabetes?

A

Triple therapy with metformin or metformin and insulin

62
Q

What type of drug is metformin?

A

Biguanide

63
Q

What effect does metformin have on weight?

A

It is considered to be a weight neutral drug so does not effect a patient’s weight

64
Q

What are the notable side effects of metformin?

A

Diarrhoea and abdo pain
Lactic acidosis

65
Q

What kind of drug is pioglitazone?

A

Thiazolidinedione

66
Q

What are the notable side effects of pioglitaozne?

A

Weight gain
Fluid retention
Anaemia
Heart failure
Extended use may increase the risk of bladder cancer

67
Q

What is the most common sulfonylurea?

A

Gliclazide

68
Q

What are the notable side effects of sulfonylureas?

A

Weight gain
Hypoglycaemia
Increased risk of CVD and MI

69
Q

What is the most common DPP-4 inhibitor?

A

Sitagliptin

70
Q

What are the notable side effects of DPP-4 inhibitors

A

Increased risk of pancreatitis

71
Q

What is a common GLP-1 mimetic?

A

Exanatide

72
Q

What are the notable side effects of GLP-1 mimetics?

A

GI tract upset
Weight loss
dizziness
Hypoglycaemia

73
Q

What is a common SGLT-2 inhibitor?

A

Empagliflozin

74
Q

What are notable side effects of SGLT-2 inhibitors?

A

Glucoseruria - causing UTI
Weight loss

75
Q

Name 3 rapid acting insulins

A

Novorapid
Humalog
Apidra

76
Q

Name 3 short acting insulins

A

Actrapid
Humalin S
Insuman Rapid

77
Q

Name 3 long acting insulins

A

Lantus
Levemir
Degludec

78
Q

Name 3 combination glucose

A

Humalong 25
Humalog 50
Novomix 30

79
Q

What causes acromegaly?

A

Excessive growth hormone most commonly due to unregulated hormone secretion by a pituitary adenoma

80
Q

Which visual field defect can occur in acromegaly?

A

Bitemporal hemianopia

81
Q

What are the presenting features of acromegaly?

A

Prominent forehead and brow
Large nose, tongue, hands and feet
Arthritis
HTN
Hypertrophic heart
Type 2 diabetes
Colorectal cancer

82
Q

Which investigations should be done for acromegaly?

A

Insulin like growth factor
OGTT
MRI brain

83
Q

What is the management for acromegaly which is caused by a pituitary adenoma?

A

Trans-sphenoidal surgical removal

84
Q

Which medications can be used to block growth hormone?

A

Pegvisomant - most effetive (GH receptor antagonist)
Somatostatin analouges (octreotide)
Dopamine agonists (bromocriptine)

85
Q

Which cells produce parathyroid hormone?

A

Chief cells

86
Q

How does parathyroid hormone raise blood calcium levels?

A

Increases osteoclast activity
Increases calcium absorption from the gut
Increases calcium
Increasing vitamin D activity

87
Q

What are the symptoms of hypercalcaemia?

A

Renal stones
Painful bones
Abdominal groans (N+V. constipation)
Psychiatric moans (depression, psychosis and fatigue)

88
Q

What causes primary hyperparathyroidism?

A

Uncontrolled parathyroid hormone

PTH=high
Calcium= high

89
Q

What causes secondary hyperparathyroidism?

A

Insufficient vitamin D, chronic renal failure which causes hyperplasia of the parathyroid glands

PTH=high
Calcium= low

90
Q

What is the role of aldosterone?

A

It is a mineralcorticoid
Increases sodium reabsorption for the distal tubule
Increases potassium secretion from the distal tubule
Increases hydrogen secretion from the collecting ducts

91
Q

What is conn’s syndrome?

A

Primary hyperaldosteronism. Adrenal glands produce too much aldosterone which causes low serum renin

92
Q

What causes secondary hyperaldosteronism?

A

Excessive renin stimulates the adrenal gland to produce more aldosterone

93
Q

What is the main cause for excessive renin production

A

The BP in the kidneys is significantly lower than in the rest of the body. Usually due to renal artery stenosis

94
Q

What are the investigations for hyperaldosteronism?

A

Renin/aldosterone ratio:

High aldosterone, low renin= primary

High aldosterone, high renin= secondary

Hypokalaemia and alkalosis on bloods

95
Q

What is the management of hyperaldosteronism?

A

Aldosterone antagonists: eplerenone and spironolactone

Treat the underlying cause (surgical removal of adenoma or renal artery angioplasty)

96
Q

What is the role of ADH?

A

Stimulates water reabsorption from the collecting ducts of the kidneys

97
Q

what electrolytes changes are caused by SIADH?

A

euvolaemic hyponatraemia

98
Q

What are the symptoms of SIADH?

A

Headache
Fatigue
Muscle aches and cramps
Confusion
Severe hyponatraemia

99
Q

What are some causes of SIADH?

A

Malignancy (SCLC)
Neuro - stroke & haemorrhage
Infection - TB & pneumonia
Drugs - Sulfonylureas, SSRIs, carbamazepine

100
Q

How is SIADH diagnosed?

A

It is a diagnosis of exclusion

101
Q

How is SIADH managed?

A

Correct sodium slowly to prevent central pontine myelinolysis

Fluid restriction
Tolvaptan (ADH receptor blockers)

102
Q

What causes diabetes insipidus?

A

Lack of ADH, lack of response to ADH

Can be nephrogenic or cranial

103
Q

What are causes of nephrogenic diabetes insipidus?

A

Drugs (lithium)
Intrinsic kidney disease
Electrolyte disturbances

104
Q

What are causes of cranial diabetes insipidus?

A

Hypothalamus does not produce ADH

Brain tumours
head injury
brain infections
brain surgery or radiotherapy

105
Q

What is the presentation of diabetes insipidus?

A

Polyuria
Polydipsia
Hypernatraemia

106
Q

What investigation results would be indicative for diabetes insipidus?

A

Low urine osmolality
High serum osmolality
water deprivation test

107
Q

How does the water deprivation test diagnose diabetes insipidus

A

Patient is deprived of water for 8 hours, urine osmolality is measures. Synthetic ADH is provided and urine osmolality is measured again after 8 hours

Cranial= low after deprivation, high after ADH

Nephrogenic= low and low

Primary polydipsia= high and high

108
Q

How is diabetes insipidus managed?

A

Desmopressin

109
Q

What is a phaeochromocytoma?

A

A tumour of the chromaffin cells which secretes unregulated and excessive amounts of adrenaline

110
Q

How is phaeochromocytoma diagnosed?

A

24 hour urine catecholamines
Plasma free metanephrines (breakdown product of adrenaline

111
Q

What are the symptoms of phaeochromocytoma?

A

Anxiety
Sweating
Headache
HTN
Palpitations

112
Q

What is the management of phaeochromocytoma?

A

Alpha blockers
Beta blockers (once established on alpha blockers)
Adrenalectomy

Alice's finals cards (23 decks)

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