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Endocrinology Flashcards

1
Q

Which hormones are secreted by the anterior pituitary gland?

A
  1. FSH (follicle stimulating hormone)
  2. LH (Luteinising hormone)
  3. ACTH (adrenocorticotrophic hormone)
  4. TSH (thyroid stimulating hormone)
  5. GH (growth hormone)
  6. PRL (Prolactin)
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2
Q

What hormones are released by the posterior pituitary gland?

A
  1. ADH (anti-diuretic hormone)
  2. Oxytocin
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3
Q

What are the causes of hyperprolactinaemia? (high levels of prolactin)

A
  1. Pregnancy, suckling
  2. Prolactinoma (benign pituitary adenoma)
  3. PCOS
  4. Primary hypothyroidism (TRH increases)
  5. Anti-emetics such as Metoclopramide and Domperidone (dopamine receptor antagonist)
    And antipsychotics which are also dopamine antagonists
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4
Q

What stimulates prolactin release from the anterior pituitary gland?

A

TRH (thyrotropin releasing hormone)

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5
Q

What inhibits prolactin release?

A

Dopamine (secreted from the hypothalamus)

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6
Q

what are the symptoms of prolactinoma?

A
  • menstrual cycle dysfunction
  • galactorrhoea
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7
Q

What is the treatment for a prolactinoma?

A
  1. Bromocriptine or Cabergoline
    Both are dopamine receptor agonists (increasing dopamine levels and thus inhibiting prolactin release)
  2. If a macroprolactinoma or failed medical therapy then surgical resection of the tumour
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8
Q

How do Domperidone and Metoclopramide cause hyperprolactinaemia?

A

They block dopamine receptors –> less dopamine –> less inhibition of prolactin –> prolactin levels go up

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9
Q

Where is GnRH (gonadotropin releasing hormone) released from and what is its function?

A
  1. Released from the hypothalamus
  2. Stimulates the anterior pituitary to secrete FSH and LH
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10
Q

What is the classical eye finding in a pituitary adenoma?

A

A. Bitemporal hemianopia
Occurs due to compression of the optic chiasm and causes tunnel vision

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11
Q

What are the symptoms of a non-functioning pituitary adenoma?

A

A non-functioning pituitary adenoma is usually benign and is non-secretory
However it can cause:
1. Visual symptoms due to compression
2. Headache
3. Hypopituitarism due to pressure of the normal tissue
4. The “stalk effect” causing slightly elevated levels of prolactin (not as high as in prolactinoma)

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12
Q

What are the symptoms of hyperprolactinaemia in women?

A
  • amenorrhoea
  • infertility
  • galactorrhoea
  • osteoporosis

high Prolactin inhibits GnRH - the inhibiting ovulation

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13
Q

What are the symptoms of hyperprolactinaemia in men?

A
  • Impotence
  • loss of libido
  • galactorrhoea
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14
Q

What are the symptoms of hypercalcaemia?

A

Bones - aching bones, muscle weakness
Groans - Abdominal pain, nausea, vomiting, constipation, pancreatitis
Stones - Kidney stones, urinary frequency
Psychiatric moans - confusion, mood changes

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15
Q

What are the blood results in primary hyperparathyroidism?

A
  • High calcium
  • Low phosphate
  • HIGH ALP (increased bone turnover)
  • PTH is high or inappropriately NORMAL (in a healthy patient, PTH would be low in response to high calcium levels for example in bony mets - PTH would be surpassed)
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16
Q

What are the blood results in secondary hyperparathyroidism?

A

Typically occurs in vit D deficiency and chronic kidney disease - which impairs Vit D activation - thus causing low calcium levels
- Low calcium
- High phosphate
- PTH high (to try and increase Ca levels)

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17
Q

What hormones are secreted by the hypothalamus

A
  1. thyrotropin-releasing hormone (TRH)
  2. gonadotropin-releasing hormone (GnRH)
  3. Growth hormone-releasing hormone (GHRH)
  4. corticotropin-releasing hormone (CRH)
  5. somatostatin (GH inhibiting hormone)
  6. dopamine
    All are released from the hypothalamus and act on the anterior pituitary.
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18
Q

What is the most common form of pituitary tumour?

A

A prolactinoma (benign adenoma - causing hypersecretion of prolactin)

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19
Q

The hormone prolactin has a negative effect on which hormone?

A

High prolactin exerts negative feedback on Gonadotropin releasing hormone (GnRH) - it inhibits GnRH which in turn inhibits FSH and LH thus inhibiting ovulation in breast-feeding mothers - natural contraception while breast feeding.

In prolactinoma it leads to infertility and low libido.

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20
Q

The hormone TRH released from the hypothalamus stimulates the anterior pituitary gland to produce which 2 hormones?

A

thyroid-stimulating hormone (TSH) and prolactin

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21
Q

What is Sheehan syndrome?

A

Sheehan syndrome is hypopituitarism caused by ischemic necrosis of anterior pituitary gland due to blood loss and hypovolaemic shock.

Most commonly due to post partum haemorrhage

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22
Q

What is the cause of acromegaly?

A
  • A (benign) pituitary adenoma that secretes excess growth hormone
  • GH stimulates the release of insulin-like growth factor 1
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23
Q

What is the treatment for acromegaly?

A
  • Transphenoidal surgery
  • Octreotide (somatostatin analogue) which supresses GH production
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24
Q

What is toxic multinodular goitre?

A
  • 2nd most common cause of hyperthyroidism
  • 2 ore more functioning thyroid nodules that secret excess thyroid hormone
25
What is Grave's Disease ?
- An autoimmune disorder causing hyperthyroidism - Most common cause of hyperthyroidism - TSH receptor stimulating antibodies
26
What are the classic symptoms of phaeochromocytoma?
episodes/spells of - headaches - palpitations - diaphoresis - severe hypertension Excess adrenaline and noradrenaline
27
What is a "thyroid storm?"
- severe, acute hyperthyroid state - Low TSH, high T3/T4 - Tachycardia - Pyrexia - precepitated by an acute event such as infection or surgery. - Typically in an untreated or partially treated patient - Can occur after radioactive iodine therapy
28
What is sick euthyroid
- Thyroid function tests show low T3/T4, normal TSH - May be mistaken for hypothyroidism but pt is clinically euthyroid and the abnormal results are due to acute illness/fasting/trauma/sepsis
29
What is paraneoplastic Cushing syndrome?
Most commonly associated with small cell lung cancer - ACTH secreting tumour --> stimulates the adrenal gland to produce access cortisol ---> Cushing disease
30
What is the mechanism of hypercalcaemia of malignancy?
1) Paraneoplastic syndrome - cancer cells secrete PTH related protein - typically seen in squamous cell lung ca. PTH low, PTHrP high, Ca2+ high 2) Direct boen destruction by metastases Low PTH Low PTHrP High Ca2+
31
What is the first step in the management of DKA?
IV fluids - sodium chloride 0.9%
32
What is the most common pituitary tumour?
prolactinoma
33
TRH thyrotropin releasing hormone stimulates with hormones to be released from anterior pituitary
TSH and Prolactin
34
What is the function of calcitonin
calcitonin TONES down calcium levels Used in the treatment of hypercalaemia Released from thyroid gland
35
Hashimotos thyroiditis
autoimmune destruction of the thyroid gland High TSH T3/T4 low it is a type of primary hypothyroidism
36
How do you diagnose Hashimoto's thyroiditis?
Bloods test - antithyroid peroxidase (anti-TPO) antibody
37
What eye sign of hyperthyroidism is ONLY present in Grave's disease?
exophthalmos occurs due to the autoimmune process causing inflammation around the eye socket Lid lag can occur with all forms of hyperthyroidism
38
What is another sign specific to grave's disease?
pretibial myxedema Occurs due to increased glycosaminoglycan deposition in the skin
39
What are some complications of hyperthyroidism?
- thyroid storm - atrial fibrillation - osteoporosis
40
What is the most common type of thyroid cancer?
Papillary thyroid cancer Has the best Prognosis of all thyroid cancers Presence of psammoma bodies
41
Medullary thyroid cancer
5% of all thyroid cancers A cancer of the parafollicular cells of the thyroid which secret calcitonin This cancer is associated with MEN IIa and IIb.
42
What is diabetes insipidus
Insufficient ADH or lack of response to ADH Intracranial -e.g. posterior pituitary gland not producing ADH Nephrogenic: kidneys do not respond to ADH Thus you are unable to re-absorb water properly from the kidneys and unable to concentrate urine You get: - polyuria - polydipsia - increased thirst - hypernatraemia - dehydration
43
How do you diagnose diabetes insipidus?
water deprivation test - which is basically Fluid restriction Normal response: urine becomes more concentrated/urine osmolality increases Diabetes inspires: unable to concentrate urine despite fluid restriction - urine output remains high and urine Is still dilute - urine osmolality remains low
44
How do you differentiate between the different causes of diabetes insipidus?
Administration of desmopressin (ADH analogue) Intracranial DI - good response to demsopressin and urine concentrates - urine osmolality increases Nephrogenic DI - no response to desmopressin because the ADH receptors on the kidneys are not working
45
What is the treatment for nephrogenic diabetes insipidus?
thiazide diuretic
46
What is the definition of subclinical hypothyroidism?
- high TSH - Normal thyroxine levels in a symptomatic patient
47
What can you use to treat peripheral neuropathy in diabetes?
Neuropathic pain agents such as - duloxetine - but not recommended if eGFR <30 - amitriptyline - pregabalin - gabapentin
48
What are the important side effects of Metformin?
GI upset Lactic acidosis (especially if AKI/renal failure) Can cause B12 deficiency
49
What is the first line management of hypoglycaemia in an unconscious patient?
20% glucose given IV Glucagon IM can be given if no venous access but the above is first line
50
What is Addison's disease? what is the cause?
Adrenal insufficiency - low aldosterone, cortisol production from adrenal glands 1. Most commonly autoimmune - thus ACTH is high 2. In developing countries caused by military TB affecting the adrenal gland.
51
What are the clinical features of Addison's disease?
1. high ACTH 2. hyponatraemia (due to low aldosterone) 3. hyperkalaemic metabolic acidosis 4. hypoglycaemia 5. hypotension (due to low aldosterone) 6. hyperpigmentation (due to to high ACTH) 7. oesinophilia
52
What is the formula for working out serum osmolarity?
2na + urea + glucose
53
How does diabetic amyotrophy present?
- an asymmetrical neuropathy affecting peripheral nerves - Wasting of proximal leg muscles - quads, hips, buttocks - loss of reflexes
54
What is the mechanism of microvascular damage in the diabetes?
Microvascular complications triad: 1. neuropathy 2. nephropathy 3. retinopathy All are affected by "non enzymatic glycosylation" of the basement membrane Eyes and nerves are also damaged due to "osmotic damage" caused by high glucose levels
55
What are the features of Conn’s syndrome
Primary Hyperaldosteronism - HTN - hypokalaemia - hypokalaemic metabolic alkalosis - renin low - high aldosterone to renin ratio Cause: aldosterone secreting adenoma
56
Congenital adrenal hyperplasia
- caused by the enzyme deficiency so aldosterone and cortisol are not produced in the adrenal gland 21 alpha hydroxyls deficiency is most common deficiency - low aldosterone - Low cortisol - Hyperkalaemic metabolic acidosis - Hypotension - Increased androgen production due to alternative pathways being used Ambiguous genitalia in females Precocious puberty in boys
57
What are the main causes of hypercalcaemia?
1. primary hyperparathyroidism 2. malignancy (due to PTH related protein or bone mets) 3. myeloma 4. paget disease 5. Zollinger Ellison syndrome 6. Hyperthyroidism can cause increased bone turnover 7. Sarcoidosis 8. Addison’s disease to increased reabsorption of fluid and electrolytes including calcium in the nephron 9. Excessive Vit D or calcium supplements
58
What is the cause of primary hyperparathyroidism?
80% due to single hyper functioning adenoma 20% are due to diffuse hyperplasia of all 4 glands Also associated with Men 1 and 2a

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