endocrinology Flashcards
T/F if you have 2 hypoglycaemic episodes requiring help - do you need to surrender your driving license ?
True
What medication can cause HYPERglycaemia ?
Corticosteroids ie prednisolone, -cortisone, -methasone
What would thyrotoxicosis show on liver function tests
TSH down
T4 and T3 up
What is the most common cause for thyrotoxicosis
Grave’s
What type of antibodies do you see in Hashimoto’s
Anti-thyroid peroxidase antibodies
What is Hashimoto’s thyroiditis
An autoimmune disorder of the thyroid gland - associated with hypothyroidism (can be transient thyrotoxicosis in the acute phase)
X10 more common in women
Features of Hashimoto’s ?
Hypothyroidism
Goitre - firm and non-tender
Anti-thyroid peroxidase and also anti-thyroglobulin antibodies
What disease is MALT lymphoma associated with
Hashimoto’s
What is addisons disease
Autoimmune destruction of the adrenal glands resulting in primary hypoadrenalism > results in reduced cortisol and aldosterone being produced
Symptoms of addisons
Lethargy, weakness, anorexia, nausea, vomiting, weight loss, ‘salt-craving’, hyperpigmentation - especially at palmar creases (appearance of being tanned) , vitiligo, loss of pubic hair in women, hypotension, hypoglycaemia
Hyponatraemia, hyperkalaemia
Why does addisons cause hyperpigmentation
The adrenocorticotropic hormone (ACTH) is produced by the pituitary to stimulate the adrenals to produce steroid hormones, has the same precursor molecule as melanocyte-stimulating hormone (MSH) so increased production of ACTH has the side effect of raising MSH levels
First line management for DKA
IV fluids
What causes DKA ?
Uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies
Features of DKA
Abdominal pain
Polyuria, polydipsia, dehydration
Kussmauls +
Acetone-smelling breath
What are the main principles of management of DKA
First: IV fluids (isotonic saline)
Second: IV infusion of insulin @ 0.1unit/kg/hour
Next: correction of electrolyte disturbance
Then : long acting insulin should be continued
What is the virus that can cause DMT1
Coxsackie B
what should be monitored being put on amiodarone
TFTs
-amiodarone can cause thyroiditis > causing both hypo and hyperthyroidism
Amiodarone side effects
Hypothyroidism
Hyperthyroidism
Corneal deposits
Steven Johnson syndrome
Grey discolouration of the skin
Liver failure
Define sub-clinical hypothyroidism
High TSH
Normal T3 and T4
Features specific to Graves’ disease
Exopthalmos/proptosis - bulging of the eyes
Lid lag
Thyroid acropachy - soft tissue swelling in the extremities, nail clubbing, new bone growth in periosteum
Pretibial myxoedema
What is thyrotoxicosis
A syndrome caused by excess of thyroid hormones in the body
Usually caused by a sudden release of large amounts of stored hormones
What is hyperthyroidism
A condition characterised by an over activity of the thyroid gland , which produces excess thyroid hormone
Features of hyperthyroidism
Fine tremor
Finger clubbing
Sweating
Pretibial myxoedema
Goitre
Thyroid bruit
Lid retraction
Lid lag
Atrial fibrillation
High output heart failure
Diarrhoea
Muscle wasting
Proximal weakness
Primary causes of hyperthyroidism - caused by thyroid dysfunction
Graves
Toxic thyroid adenoma
Multinodular goitre
Silent thyroiditis
De Quervains
Radiation
Secondary causes of hyperthyroidism - not caused by thyroid dysfunction
Amiodarone
Lithium
TSH producing pituitary adenoma
Choriocarcinoma
Gestational hyperthyroidism
Symptomatic relief of hyperthyroidism
Propranolol - bbs
Medical management of hyperthyroidism
Carbimazole
Propylthiouracil
Carbimazole is contraindicated with what
Early pregnancy
May be used in later stages
What is the definitive management of goitre
Radio-iodine
(*this is contraindicated in Graves’ disease)
What is thyroid storm
A rapid deterioration of hyperthyroidism with hyper-pyrexia, severe tachycardia, extreme restlessness, cardiac failure and liver dysfunction
Typically seen in hyperthyroid patient with an acute infection/illness and recent thyroid surgery
management of thyroid storm
High dose Carbimazole
B-blockers
Potassium iodine
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause
management of thyroid storm
High dose Carbimazole
B-blockers
Potassium iodine
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause
management of thyroid storm
High dose Carbimazole
B-blockers
Potassium iodine
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause
What precipitates thyroid storm disease
Surgery, trauma, infection, pregnancy
drugs that causes thyroid disease
Lithium
Interferon
Carbimazole
Amiodarone
What is Cushing’s
An endocrine disorder of glucocorticoid excess
Features of Cushings
Proximal myopathy
Striae
Bruising
Osteoporosis
DM
Obesity
HPTN
Hypokalaemia
Moon face
Acne and hirsutism
Interscapular and supraclavicualr fat pads
Centripetal obesity
Thin limbs
Thin skin
Impotence
A 34-year-old man presents to the GP with a 3-month history of weight gain and lethargy. He has a past medical history of Crohn’s disease which is adequately managed with budesonide 9mg daily. On examination, you note abdominal obesity, bruising of the arms, purple abdominal striae and reduced power in the proximal muscles of the arms and legs. Which of the following is the most likely explanation for this patient’s physical findings?
Cushings !
Excess of budenoside !!!
Investigations for Cushings - cortisol excess
24 hour urinary free cortisol
Low dose dexamethasone suppression test
Investigation for Cushings - localised
Plasma ACTH
High dose dexamethasone suppression test
Inferior petrosal sinus sampling
MRI of pituitary
CT chest and abdomen
Management of cushings
Metyrapone - blocker of steroid synthesis pathway
Ketoconazole - adrenolytci agent/anti-fungal?
Mifepristone - glucocorticoid antagonist
Pasireotide - somatostatin receptors
Most serious side effect of Carbimazole use in hyperthyroidism
agranulocytosis
First line treatment for hypogonadism in men
Testosterone therapy
A middle aged woman presents with symptoms of hypothyroidism - there is a diffuse non-tender goitre on examination
TSH is raised, T4 is low, anti-TPO is positive
This is a classical history for Hashimoto’s
Middle aged woman presents with thyrotoxicosis, goitre, exopthalmos and pretibial myxoedema
Anti-TSH receptor stimulating antibodies are positive
Graves’ disease
Anti-TPO antibodies
Hashimotos
TSH receptors antibodies
Graves
How does metformin work ?
Works by increasing insulin sensitivity and decreasing hepatic gluconeogenesis
Side effects of metformin
Lactic acidosis
GI upset
How do sulfonylureas work ?
Work by stimulating pancreatic beta cells to secrete insulin
This thyroid disorder is associated with hypothyroidism, painful goitre and raised ESR
Subacute thyroiditis (de Quervains’)
Addisons is associated with what electrolyte imbalance ?
Hypercalcaemia
*globally reduced uptake on iodine - 131 scan
Subacute thyroiditis
Side effects of corticosteroids
Weight gain
Impaired glucose tolerance
Depression
Osteoporosis
Skin - striae, thinning, bruising
Avascular necrosis of the femoral head
*Nuclear scintigraphy reveals patchy uptake =
Toxic multinodular goitre
Vitamin D intoxication associated electrolyte
Hypercalcaemia
How do SGLT-2 inhibitors work
By stimulating pancreatic beta cells to secrete insulin
Sarcoidosis is associated with what type of electrolyte imbalance
Hypercalcaemia
What is sick euthyroid syndrome
What is the best investigation for Cushings
Overnight dexamethasone suppression test
Side effects of thiazolidinediones
Fluid retention and weight gain
(Think Pioglitazone = Pig —> weight gain)
Contraindication of pioglitazone
Heart failure
What is the MoA of sulfonylureas
Increase pancreatic insulin secretion
*hyperkalaemia, hyponatraemia, hypoglycaemia, hypotension, hyperpigmentation + lethargy
Addisons
Results from a high dose dexamethasone suppression test for an adrenal adenoma
Cortisol = not suppressed
ACTH = not suppressed
Results from high dose dexamethasone suppression test for pituitary adenoma
Cortisol = suppressed
ACTH = suppressed
Side effect of SGLT-2 inhibitors
Increased risk of UTIs
Which electrolyte imbalance can cause dehydration
Hypercalcaemia
What is the treatment of choice for neuropathic pain - diabetic
Amitriptyline , duloxetine , gabapentin , pregablin
What is MODY
A group of inherited genetic disorder affecting the production of insulin
What type of thyroid cancer has the best prognosis
Papillary thyroid cancer
What investigation for alopecia areata
TFTs
What medication can cause erythema nodosum
Sulfasalazine
*stuck on appearance - all brown on the head
Seborrheic keratosis
*40 year old with a history of hypertension, episodic palpatitations, excessive sweating, headaches and tremor
Phaechromocytoma
*painful goitre, raised ESR, hypothyroidism
Subacute thyroiditis
SLE makes you BALD - what is the mnemonic
B = butterfly rash
A = alopecia
L = livedo reticularis
D = discoid lupus
Adverse effect of Carbimazole
Myelosuppression / agranulocytosis
Which vascular lesions are Present from birth
Port wine stain + salmon patch
Water deprivation test results for cranial diabetes insipidus
Starting plasma osmolality = high
Urine osmolality after fluid deprivation = low
Urine osmolality after desmopressin = high
*if this was nephrogenic then osmolality after desmopressin would still be low (external)
Coeliac associated skin lesion
Dermatitis herpetiformis
Crohns associated skin lesion
Pyoderma gangrenosum
*mucosal involvement rash + new medication indicates ….
Steven Johnson syndrome
First line investigation for suspected primary hyperaldosteronism
Plasma aldosterone/renin ratio
How does glucagon oppose insulin
Via increased hepatic glycogenolysis
Abnormal metabolite in SIADH
Hyponatraemia
What is SIADH
Too much ADH > acts on proximal convoluted tubule > causing increased water reabsorption > dilute blood > (hyponatraemia) nausea vomiting fatigue confusion low blood pressure headaches
Severe = drowsiness
Moderate = muscle aches/weakness
Mild = nausea headaches
Cause of SIADH
Subarachnoid haemorrhage (brain injury)
Malignancy
SSRIs
How to differentiate between primary adrenal failure and secondary adrenal insufficiency
Skin pigmentation is present in primary adrenal failure
(This is due to adrenal gland not functioning properly adn secreting less cortisol —> pituitary gland releases more ACTH —> more MST = skin pigmentation
In secondary adrenal insufficiency - hypopituitarism ie not enough ACTH being secreted
Management of Addisons
Hydrocortisone (double dose)
Fludrocortisone
Differentiate between cushings disease and Cushing’s syndrome
Cushings disease = pituitary adenoma
Indications for losing license due to hypoglycaemia
Two episodes of hypo requiring help from someone else - have to declare to DVLA and not allowed to drive
*incidental finding of hypokalaemia and hypertension on check-up suggests
Primary hyperaldosteronism
Investigation for primary hyperaldosteronism
Plasma aldosterone/renin ratio
ABG picture seen with Cushings disease
Hypokalaemic metabolic alkalosis
What does this indicate
Cushings disease
- cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone
Causes of Cushing’s syndrome
-corticosteroid therapy
-ACTH - dependent (pituitary adenoma —> ACTH secretion aka Cushing disease, also ectopic ACTH secretion secondary to malignancy eg small cell lung cancer)
- ACTH - independent (adrenal adenoma)
What are the 2 commonly used tests for Cushing’s syndrome
-overnight dexamethasone suppression test
-24 hour urinary free cortisol
Interpret this bitch
Other than hypoglycaemia what can sulphonylureas cause
Ie GLICLAZIDE
Can cause weight gain also
9am cortisol of
1. >500nmol/l
2. <100nmol/l
3. 100-500nmol/l
- Addisons very unlikely
- Definitely abnormal
- Should prompt a ACTH stimulation test to be performed (short synacthen test)
What drug that causes a flare up of gout also cause hypercalcaemia
Thiazide diuretics
Pituitary or adrenal adenoma
Pituitary adenoma
An adrenal adenoma would show no suppression of either (ACTH independent)
Why is GH not a diagnostic investigation of acromegaly
GH levels vary throughout the day and so are not helpful
1st line investigation for acromegaly
Serum IGF-1 levels
Diagnostic investigation for acromegaly
OGTT
What is the most common drug which side effect is gynaecomastia
Spironolactone
If metformin not tolerated in T2DM what is next first line
DPP-4 inhibitor or pioglitazone or sulfonylurea
What to do with an Addisons patients medication when they have an intercurrent illness
Double hydrocortisone dose but keep fludrocortisone dose the same
When to give beta blockers in Graves’ disease
Help to control symptoms to new presenters
(Carbimazole is slow to effect, despite being 1st line, so patient needs symptomatic treatment with propranolol first)
What is this ABCDE assessment suggestive of ?
(10 year old boy brought to hospital by parents due to being confused and drowsy this morning - normally fit and well)
DKA
GCS of 12/15 = confusion
Abdominal pain
Blood glucose unrecordable = DKA
Cba making a question
*nuclear scintigraphy reveals patchy uptake
Toxic multinodular goitre
*unrelenting high BP and hypokalaemia should indicate what disease
Primary hyperaldosteronism
Causes primary hyperaldosteronism
70% - bilateral idiopathic adrenal hyperplasia
20-30% - adrenal adenoma
Management of primary hyperaldosteronism
Bilateral idiopathic hyperplasia = spironolactone
Adrenal adenoma = surgery (keyhole)
Mxm of Addisonian crisis
- hydrocortisone 100mg im or iv
- 1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
- continue glucocorticoid 6 hourly until stable
- oral replacement may begin after 24 hours
What is Waterhouse - Friderichsen syndrome
Often a pre-terminal event and is associated with profound sepsis and coagulopathy
*adrenal gland showing evidence of diffuse haemorrhage
*lipid rich core nodule of adrenal gland on CT
Benign incidental adenoma
Often will present with recurrent episodes of non-specific abdominal pain with normal obs.
*urinary VMA and plasma metanephrines are elevated
Phaeochromocytoma
Most common type of pituitary tumour
Prolactinoma (hypersecretion of prolactinoma)
Features of prolactinoma
Galactorrhoea
Amenorrhea
E.D
Headache
Bitemporal hemianopia
Investigation for suspicion of pituitary tumour
MRI of pituitary tumour
Blood tests
Treatment for prolactinoma
Dopamine agonists - cabergoline (1st) , bromocriptine
Can also undergo trans-sphenoid surgery or radiotherapy
Diagnosis of acromegaly
GH should normally be suppressed to below 0.4ug/l after OGTT but is not in acromegaly
In fact there is a paradoxical rise
Treatment of acromegaly
Pituitary surgery —> retest OGTT —> still not satisfactory ?
Then —> somatostatin analogue (ocreotide) , cabergoline , pegvisomant or even radiotherapy
Where does a craniopharyngioma derive from ?
Rathke’s pouch
What are the paediatric consequeleae of craniopharyngioma
Can cause: hydrocephalus, growth retardation
Which sex is more commonly seen with Cushing’s syndrome
Women (aged 20-40)
Cushing’s syndrome due to pituitary adenoma is also known as
Cushings disease
ACTH dependent and ACTH - independent causes of Cushing’s syndrome
Which Cushing’s test do you need to repeat to confirm
Overnight dexamethasone
name
T/F T4 is more potent than T3
F - T3 is more potent than T4 and is very biologically active
Which molecules carry T3 and T4
TBG and TBPA
Most common cause worldwide of hypothyroidism
Lack of iodine in diet
Management of hypothyroidism
Levothyroxine
*painful goitre, viral trigger, low uptake of iodine, high ESR
Subacute thyroiditis / De Quervains
Most common cause of hyperthyroidism
Graves
Treatment of subacute thyroiditis
Usually self limiting
*low intake of scintigraphy ,
T4 = high when early, low late, then normal
T3 = low when early, high in late, then normal
Subacute thyroiditis
= Nodular thyroid disease
Asymmetrical uptake on scintigraphy
Treatment of hyperthyroidism
Carbimazole
Propylthiouracil (better in pregnancy)
[in Graves start at a high dose]
Symptomatic = propranolol
What is thyroid storm
The sudden release of hormones from the thyroid gland
Severe hyperthyroid symptoms
Big Cockneys Hit Foreign People
Mnemonic to remembering how to treat thyroid storm
B = beta blockers
C = Carbimazole
H = hydrocortisone
F = fluids
P = precipitating cause
What do you have to do after having a radioactive ablation of thyroid
Pretty much avoid everyone
- avoid close contact with kids and pregnant ladies
- dont share a bed
- avoid pregnancy for 6 months
Carbimazole causes agranulocytosis
= weakened immune system so small infections indicate vulnerable individual NEED TO BE SEEN IMMEDIATELY
Would need to do a throat swab
*hoarseness of voice can be due to what
Damage to recurrent laryngeal
*psommoma bodies and orphan Annie nuclei (big hair) histologically
Papillary thyroid cancer
Most common thyroid cancer
Papillary
2nd most popular thyroid cancer
Follicular
3rd most ‘popular’ thyroid cancer
Medullary
Arises from C-cell and has amyloid deposits
Associated with MENIIa (as well as phaeochromocytoma and papillary thyroid cancer)
Which thyroid cancer has the worst prognosis
Anaplastic
*is treated with chemotherapy
Investigation of thyroid cancer
TFT, US guided FNA, US neck, laryngoscopy
Mxm of thyroid cancer
Surgery / radioablation
Anaplastic = chemotherapy
Which glands are involved in calcium homeostasis
PTH
*thirst, dehydration, confusion, polyuria, myopathy, osteopenia, fractures, depression, abdominal pain, pancreatitis, ulcers, renal stones
STONES GROANS BONES PSYCHIC MOANS
Refers to all symptoms that come with hypercalcaemia
An overactive parathyroid would proceed what blood tests
Raised Ca ++
Raised serum PTH (or normal)
Raised urine calcium
Acute treatment of hypercalcaemia
Fluids - rehydrate with 0.9% saline
Consider loop diuretics and Biphosphonates
cba making a question
3 common causes of hypocalcaemia
Hypoparathyroidism
Vit D deficiency
Chronic renal failure
Main hormones that the pancreas produces
Insulin and glucagon
Which cells of the pancreas release glucagon in response to low glucose levels
Alpha cells
Which cells of the pancreas release insulin in response to high glucose levels
Beta
Side effects of metformin
GI upset
Lactic acidosis
Side effects of thiazolidinediones
Weight gain
Water retention (HF)
Increase in risk fractures
(Pioglitazone)
- tides
GLP-1 agonists
- gliptins
DPP-IV inhibitors
What is produced in the zona reticularis
Androgens
Where is cortisol produced
Zona fasciculata
Where is aldosterone produced
Zona glomerulosa
Commonest cause of primary adrenal insufficiency
Addisons
Symptoms of Addisons
Weight loss
Fatigue
Dizziness
Low BP
Abdo pain
Vomitting
Skin pigmentation
How to diagnose Addisons
Biochemistry
Short synACTHen test (measures cortisol after ACTH administration , should increase from around 250 to over 550 mol/l)
ACTH increases
Aldosterone decreases
Autoantibodies
Management of Addisons
Hydrocortisone
Fludrocortisone
CANNOT STOP THESE SUDDENLY (Addisonian crisis)
What is a phaeochromocytoma ?
An adrenaline secreting tumour
Where is adrenaline produced
Adrenal medulla
Prophylactic medications for phaeochromocytoma
Alpha block - phenoxybenzamine
Beta block - atenolol , propanolol
Fluid replacement
*before surgery to remove need alpha block of doxasozin
MENI vs MENII
Which disease fall under MENIIa
Phaeochromocytoma
Medullary thyroid cancer
Parathyroid hyperplasia
What disease fall under MENIIb
Phaeochromocytoma
Medullary thyroid cancer
Mucosal neuroma
How to treat PCOS
Metformin = 1st line
Define infertility
Failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sex in a couple who have never had a child (in absence of a know reason)
What regulates GnRH in the menstrual cycle
Oestrogen
Progesterone
Kisspeptin
Which hormone is responsible for ovulation
LH
Also responsible for corpus luteum formation
Hormone responsible for follicular development
FSH
Where is oestrogen secreted
Primarily by the ovaries
Adrenal cortex as well
(And placenta)
What is affected in primary Hypogonadism
Testes - high LH/FSH
“Hypergonadtrophic hypogonadism”
What is affected in secondary hypogonadism
Hypothalamus/ pituitary affected, the testes are capable of normal function
Low LH/FSH
What is Kleinfelters’
47 XXY
Affected men are typically infertile
Increases incidence of cryptochidism —> learning disability and pyschosocial issues
Risks associate with klinefelters
Breast cancer
Non-Hodgkin lymphoma
What is Kallman’s
Hypogonadism and anosmia
Mechanism of action of DPP-4s (sitagliptin)
Increases levels of incretins such as GLP-1 and GIP
MoA metformin
Increases cell sensitivity to insulin
MoA pioglitazone/ glitazones / thiazolidinediones
Increases adipogenesis —> causing cells to become more dependent on glucose for an energy source
MOA sulphonylureas / gliclazide
Increase intracellular calcium to increase insulin release
This drugs binds to ATP-sensitive potassium channels on pancreatic beta cells causing depolarisation of calcium ions into the beta cells
Granules of insulin to be released
Which hormone is deficient in central DI and where does it act
-ADH
-collecting duct
What is lipodystrophy
Insulin can cause small subcutaneous lumps at injection sites
Which hormone is secreted in response to a hypo
Glucagon
Where do SGLT-2 inhibitors act
Renal proximal convoluted tubules
Where do sulphonylyreas act
Pancreatic beta cells
Deficiency of what enzyme is a common cause of congenital adrenal hyperplasia
21-hydroxylase deficiency
Mechanism of action of antidiuretic hormone
Promotes water re-absorption by the insertion of aquaporin-2 channels
What does this guy have ?
Small cell lung cancer - with paraneoplastic syndrome (caused by antidiuretic hormone secretion)
Function of ADH
Conserves body water
Deficiency of what enzyme leads to congenital adrenal hyperplasia
21-hydroxylase
Which diabetes medication causes glycosuria
SGLT-2s
Klinefelters syndrome karyotype
47 XXY
Features = tall, lack of secondary sexual characteristics, small and firm testes, infertile
Diagnosis by chromosomal analysis
What causes Kallman’s
Failure of GnRH-secreting neurons to migrate to the hypothalamus
What is androgen insensitivity syndrome
X-linked recessive condition due to end organ resistance to testosterone causing genotypically male children to have a female phenotype
What does release of ADH do ?
Increase blood pressure and decreases plasma osmolality
Keeps water in the blood
What syndrome is associated with low secretion of ADH
Cranial DI
What conditions are associated with hypersecretion of ADH
SIADH / ADH secreting tumour
Treatment of SIADH
Mannitol —> for cerebral oedema / water leaking out of blood vessels bc there is not enough salt to keep it in
What disease come under MEN IIa
Medullary thyroid cancer
Hypercalceamia
Phaeochromocytoma
(Hyperplastic syndromes)
What is cortisol
A glucocorticoid
How does metformin work
Increasing insulin sensitivity and decreasing hepatic gluconeogenesis
What is a common drug that raises blood glucose levels
Glucocorticoids
Name 2 diseases - other than DM - that can cause damage to insulin producing cells
Chronic pancreatitis
Haemochromatosis
What is the hormone responsible in Cushing and what is its Main effects
- Cortisol
- Upregulation of alpha-1-adrenoceptors on arterioles
You are a monkey
What is Waterhouse friedrichson
Failure of adrenal gland secondary to adrenal haemorrhage after a severe bacterial infection
What are the 2 obesity hormones
Ghrlepin and leptin
Ghrelin gains appetite
Leptin lowers appetite
Which hormone makes you feel full
Leptin
Which hormone is known as the hunger hormone
Ghrelin
What are the two hypothalamic hormones which increase the secretion of prolactin
Prolactin releasing hormone
Gonadotropin releasing hormone
Where is GLP-1 released
Ileum - this hormone release in response to oral glucose load
When would you add exenatide (GLP-1 mimetic) to metformin + sulphonylurea
If:
BMI >35kg/m2 in people of European descent and there are problems associated with high weight
Or
BMI < 35kg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities
Which receptors - when their stimulation is enhanced - causes palpitations and increased heart rate
Beta 1 receptors
*brown bone tumours
Hyperparathyroidism - arise in setting of excess osteoclast activity
They appear brown because haemosiderin is deposited at the site
What is Bartter’s syndrome
Is a rare inherited disorder due to mutated NKCC2 channels which presents with polydipsia, polyuria and a tendency to dehydration
Results from defective NKCC2 channel in the ascending loop of Henle
What is the first hormone secreted in response to hypoglycaemia
Glucagon
Hypotestosteronism is associated with what bone condition ?
Osteoporosis
(Think - hypotestosteronism —> woman have less testosterone —> women get menopause —> after menopause osteoporosis big risk factor)
Investigation for pituitary adenoma
MRI pituitary
Conditions that can cause secondary hyperaldosteronism
Liver cirrhosis
Congestive cardiac failure
Renal artery stenosis
(Due to increased circulation renin levels)
Which diabetes drug can cause lactic acidosis
Metformin (is a biguinide)
Side effects of metformin
Lactic acidosis and Gi disturbance
Side effects of sulfonylureas
Hypoglycaemia and weight gain
Side effects of pioglitazone
Fluid retention —> worsening heart failure
Weight gain
Side effects of SGLT-2s (flozins)
DKA when used with insulin
Increased risk of UTI
Side effects of DPP-4 inhibitors
Hypoglycaemia and GI upset
Side effects of GLP-1 analogues
Hypoglycaemia , GI upset
Classical presentation of phaeochromocytoma ?
High BP
Headache
Sweating
Anxiety
Young person
Why do you get sleep apnoea and snoring in acromegaly
Due to excess GH causing growth of soft tissues in pharynx
(Also excess tissue growth surround median nerve causing Carpal Tunnel syndrome)
Management of Addisonian crisis
Resuscitation with IV fluids
Sick day rules for people wit addisons
Double up on hydrocortisone when ill
Adrenal insufficiency due to destruction of adrenal cortex leading to destruction of glucocorticoid production describes what disease
Addisons
Metformin management of someone fasting for Ramadan
Continue the 3 500mg doses
Take the morning does before Suhoor (pre-sunrise meal)
Combine 2 afternoon doses at Iftar (after sunset meal)
Management of menopause with periods every few months
Cyclical combined hormone replacement therapy
*hypernatreamia, hypertension, hypokalaemia
Conns - primary hyperaldosteronism
Action of aldosterone
Increases reabsorption of sodium , increases secretion of potassium
What cells in the distal convoluted tubule are responsible for sensing the concentration of sodium chloride
Macula dense cells
What converts T4-T3 ?
(Thyroxine to thyronine)
The enzyme : iodothyronine 5’deiodinase
*propylthiouracil inhibits this conversion
What is a precursor to all steroid hormones
Cholesterol
What long - term medication can predispose someone to T2DM
Corticosteroids - prednisolone
