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MSRA revision > Endocrinology > Flashcards

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)
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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 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
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
Q

What is Grave’s Disease ?

A
  • An autoimmune disorder causing hyperthyroidism
  • Most common cause of hyperthyroidism
  • TSH receptor stimulating antibodies
26
Q

What are the classic symptoms of phaeochromocytoma?

A

episodes/spells of
- headaches
- palpitations
- diaphoresis
- severe hypertension

27
Q

What is a “thyroid storm?”

A
  • 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
Q

What is sick euthyroid

A
  • 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
Q

What is paraneoplastic Cushing syndrome?

A

Most commonly associated with small cell lung cancer - ACTH secreting tumour –> stimulates the adrenal gland to produce access cortisol —> Cushing disease

30
Q

What is the mechanism of hypercalcaemia of malignancy?

A

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
Q

What is the first step in the management of DKA?

A

IV fluids - sodium chloride 0.9%

32
Q

What is the most common pituitary tumour?

A

prolactinoma

33
Q

TRH thyrotropin releasing hormone stimulates with hormones to be released from anterior pituitary

A

TSH
and
Prolactin

34
Q

What is the function of calcitonin

A

calcitonin TONES down calcium levels

35
Q

Hashimotos thyroiditis

A

autoimmune destruction of the thyroid gland
High TSH
T3/T4 low
it is a type of primary hypothyroidism

36
Q

How do you diagnose Hashimoto’s thyroiditis?

A

Bloods test - antithyroid peroxidase (anti-TPO) antibody

37
Q

What eye sign of hyperthyroidism is ONLY present in Grave’s disease?

A

exophthalmos
occurs due to the autoimmune process causing inflammation around the eye socket

Lid lag can occur with all forms of hyperthyroidism

38
Q

What is another sign specific to grave’s disease?

A

pretibial myxedema

Occurs due to increased glycosaminoglycan deposition in the skin

39
Q

What are some complications of hyperthyroidism?

A
  • thyroid storm
  • atrial fibrillation
  • osteoporosis
40
Q

What is the most common type of thyroid cancer?

A

Papillary thyroid cancer
Has the best Prognosis of all thyroid cancers
Presence of psammoma bodies

41
Q

Medullary thyroid cancer

A

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
Q

What is diabetes insipidus

A

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
Q

How do you diagnose diabetes insipidus?

A

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
Q

How do you differentiate between the different causes of diabetes insipidus?

A

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
Q

What is the treatment for nephrogenic diabetes insipidus?

A

thiazide diuretic

46
Q

What is the definition of subclinical hypothyroidism?

A
  • high TSH
  • Normal thyroxine levels
    in a symptomatic patient
47
Q

What can you use to treat peripheral neuropathy in diabetes?

A

Neuropathic pain agents such as
- duloxetine - but not recommended if eGFR <30
- amitriptyline
- pregabalin
- gabapentin

48
Q

What are the important side effects of Metformin?

A

GI upset
Lactic acidosis (especially if AKI/renal failure)
Can cause B12 deficiency

49
Q

What is the first line management of hypoglycaemia in an unconscious patient?

A

20% glucose given IV

Glucagon IM can be given if no venous access but the above is first line

50
Q

What is Addison’s disease? what is the cause?

A

Adrenal insufficiency - low aldosterone, cortisol and androgen 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
Q

What are the clinical features of Addison’s disease?

A
  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
Q

What is the formula for working out serum osmolarity?

A

2na + urea + glucose

53
Q

How does diabetic amyotrophy present?

A
  • an asymmetrical neuropathy
  • Wasting of proximal leg muscles - quads, hips, buttocks
  • loss of reflexes
54
Q

What is the mechanism of microvascular damage in the diabetes?

A

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
Q

What are the features of Conn’s syndrome

A

Primary Hyperaldosteronism
- HTN
- hypokalaemia
- high aldosterone to renin ratio

MSRA revision (25 decks)

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