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Endocrinology Flashcards

1
Q

How is type 1 diabetes diagnosed?

A

Hyperglycaemic with the following:
- Ketones
- Rapid weight loss
- Age onset <50
- BMI <25kg/
- Family history of autoimmune disease

Fasting glucose > 7mmol/l
Random glucose equal/ greater than 11.1mmol/l

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2
Q

What is a c-peptide test? What does it mean?

A

It is a blood test used to measure the levels of c-peptide in the bloodstream. C-peptide is released by the pancreas when it releases insulin, therefore high levels would indicate insulin is being released. This is used to help differentiate between type 1 and 2 diabetes.

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3
Q

What tests should be done if the patient has an atypical feature for type 1 diabetes?

A

C-peptide test
Diabetes specific auto antibodies

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4
Q

What auto- antibodies are tested for for diabetes?

A

Anti-GAD - glutamic acid decarboxylase
Islet cell antibodies (ICA, against cytoplasmic proteins in the beta cell)
Insulin autoantibodies (IAA)
Insulinoma-associated-2 autoantibodies (IA-2A)

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5
Q

Why is there hyperpigmentation in addisons disease?

A

Due to the destruction of the adrenal cortex, the anterior pituitary produces more ACTH to stimulate cortisol secretion. ACTH is produced from the cleavage of POMC which also produces MSH. MSH stimulate smelonocytes to produce melanin, resulting in pigmentation of palms

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6
Q

How is addisons disease diagnosed?

A

Serum cortisol
Short synacthen test
Urea and electrolytes
Blood glucose
Autoantibodies
Ct/MRI
SerumACTH
Thyroid function tests
FBC

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7
Q

What symptoms are seen in addisons?

A

Fatigue
Lethargy
Weight loss
Nausea
Vomiting
Hypotension
Dizziness
Hyperpigmentation
Increased thirst
Fainting

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8
Q

What clinical signs are found in Addisons?

A

Hypoglycaemia
Hypotension
Hyperkalemia
Hyponatremia

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9
Q

How does the short synacthen test work?

A

Patient is has serum cortisol measured initially
Patient given synthetic ACTH (250 micrograms IV)
Cortisol then measured 30 and 60 minutes after
Levels should be between 500-550nanomol/L or doubled

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10
Q

What levels of serum cortisol require hospital admission?

A

<100nanomol/ L

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11
Q

What must all patients with Addisons be given?

A

Emergency hydrocortisone injection
Steroid alert card

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12
Q

What are the causes of primary adrenal insufficiency?

A

Autoimmune
Infection( TB, HIV)
Genetic : CYP21A2
Cancer

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13
Q

Which zone of the adrenal cortex produces glucocorticoids?

A

Zone fasciculata

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14
Q

Which autoantibodies can present in Addisons disease?

A

Adrenal cortex antibodies
21-hydroxylase antibodies

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15
Q

What is the most common cause of primary hyperthyroidism?

A

Graves disease

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16
Q

What is Graves’ disease?

A

Autoimmune condition.
Antibodies against TSH receptor produced resulting in chronic stimulation and increased thyroid hormone levels

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17
Q

What is the first line treatment for Graves’ disease?

A

Radioactive iodine treatment

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18
Q

What are the contraindications to radioactive iodine therapy?

A
  • pregnancy
  • breastfeeding
  • planned pregnancy within.4-6 months
  • fathering a child within 4-6 months
  • active eye disease
  • suspected malignancy
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19
Q

What are the treatments for Graves’ disease?

A
  • thyroidectomy
  • radioactive iodine therapy
  • anti thyroid drugs
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20
Q

Which drug is used first line for anti thyroid therapy? What is the risk?

A

12-18 month course of Carbimazole
Risk of acute pancreatitis
Agranulocytosis

21
Q

What will thyroid function tests show in Graves’ disease?

A

TSH: low
T4: high
T3: high
TSH antibody: positive

22
Q

What are the symptoms of thyrotoxicosis?

A

Sweating
Heat intolerance
Weight loss
Increased appetite
Anxiety
Tremors
Irritability
Frequent loose stools
Insomnia
Fatigue

23
Q

What is first line treatment for graves?

A

Radioactive iodine therapy

24
Q

What are the contraindications to radioactive iodine therapy?

A
  • pregnancy
  • planned pregnancy in 4-6 months
  • fathering a child in 4-6 months
  • have active thyroid eye disease
25
What treatments are there for Graves’ disease?
Radioactive iodine therapy Thyroidectomy Anti thyroid agents- Carbimazole
26
What is the difference between primary and secondary hypothyroidism?
In primary the abnormality lies with the thyroid gland, however in secondary the abnormality lies with the anterior pituitary gland
27
What are some causes of primary hypothyroidism?
Hashimotos: autoimmune thyroiditis Iodine deficiency Thyroidectomy Radioiodine treatment Drugs like lithium, amiodarone, carbimazole
28
What are some causes of secondary hypothyroidism?
Pituitary adenomas Radiotherapy Pituitary surgery
29
What symptoms does hypothyroidism present with?
Weight gain Fatigue Dry skin Course hair Fluid retention Cold intolerance Non pitting oedema Yellowish skin Constipation Menorrhagia
30
How is hypothyroidism diagnosed?
Through thyroid function tests TSH will be raised T4 and T3 will be low
31
How is primary hypothyroidism treated?
Levothyroxine : synthetic thyroid hormone Regular checks every 3 months until levels of TSH have stabilised If pregnant dose should be increased
32
What are the possible side effects of levothyroxine?
Nauseas Headaches Restlessness Palpitations Shakiness
33
How should a patient take levothyroxine?
Once a day 30-60 mins before breakfast, before caffeine or any other medications If you miss a dose, take it as soon as you remember However if it’s close to the time for the next dose just skip the forgotten dose
34
What 2 causes of hypothyroidism can cause a goitre?
Iodine deficiency Hashimotos
35
What extrathyroidal manifestations are present in graves?
Proptosis/ exophthalmosis Eye pain Photophobia Lid retraction Double/ blurred vision Pretibial myxoedema Thyroid achropachy Goitre no nodules
36
What investigations can be done for suspected graves?
Thyroid function tests TSH receptor antibodies test If above negative then technetium scan of thyroid gland If thyroid nodule is palpated then: ultrasound scan, or radioactive iodine uptake scan ECG
37
How is addisons disease treated?
Replacement hormones Hydrocortisone: 20-30mg a day in 2-3 doses to mimic cortisol levels Fludrocortisone
38
Why are patients given intramuscular hydrocortisone?
To be taken in times of adrenal crisis
39
In thyroid storm which medication is given?
Propranolol
40
What is the difference between Cushing disease and Cushing syndrome?
Cushing syndrome refers to the set of features caused by increased levels of glucocorticoids in the body Cushings disease refers to a pituitary adenoma causing excessive production of ACTH
41
What are some causes of Cushing syndrome?
Cushing disease Ectopic ACTH: small cell lung cancer Endogenous steroids Adrenal adenoma
42
What symptoms are seen in Cushing syndrome?
Moon face Central obesity Depression Hirsutism Reduced libido Bruising Abdominal Stria Buffalo hump Acne
43
What clinical signs can be seen in Cushing?
Hyperglycaemia Hypernatremia Hypokalemia Hyperpigmentation Osteoporosis Proximal myopathy
44
What investigations can be done for suspected Cushing syndrome?
24 hour urinary free cortisol Bedtime salivary cortisol Low dose overnight dexamethasone surpression test Blood glucose U&Es FBC Serum ACTH MRI/CT
45
If initial cortisol is high which test should be done in Cushing?
High dose dexamethasone suppression test
46
How does the high dose dexamethasone suppression test work?
Serum cortisol is measured on the morning of day 1 Patient takes 2mg of dexamethasone 6 hourly Cortisol is measured again on the morning of day 3
47
In Cushing what cause would result in high serum ACTH?
Pituitary adenoma: Cushing disease Ectopic acth production: paraneoplastic syndrome
48
Explain the following results: Low dose dexamethasone: not suppressed High dose dexamethasone: suppressed ACTH: low
Cushing disease
49
Explain the following results: Low dose dexamethasone: not suppressed High dose dexamethasone: not suppressed ACTH: high
Ectopic ACTH

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