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Passmed > Endocrinology > Flashcards

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
Q

What treatments are there for Graves’ disease?

A

Radioactive iodine therapy
Thyroidectomy
Anti thyroid agents- Carbimazole

26
Q

What is the difference between primary and secondary hypothyroidism?

A

In primary the abnormality lies with the thyroid gland, however in secondary the abnormality lies with the anterior pituitary gland

27
Q

What are some causes of primary hypothyroidism?

A

Hashimotos: autoimmune thyroiditis
Iodine deficiency
Thyroidectomy
Radioiodine treatment
Drugs like lithium, amiodarone, carbimazole

28
Q

What are some causes of secondary hypothyroidism?

A

Pituitary adenomas
Radiotherapy
Pituitary surgery

29
Q

What symptoms does hypothyroidism present with?

A

Weight gain
Fatigue
Dry skin
Course hair
Fluid retention
Cold intolerance
Non pitting oedema
Yellowish skin
Constipation
Menorrhagia

30
Q

How is hypothyroidism diagnosed?

A

Through thyroid function tests
TSH will be raised
T4 and T3 will be low

31
Q

How is primary hypothyroidism treated?

A

Levothyroxine : synthetic thyroid hormone
Regular checks every 3 months until levels of TSH have stabilised
If pregnant dose should be increased

32
Q

What are the possible side effects of levothyroxine?

A

Nauseas
Headaches
Restlessness
Palpitations
Shakiness

33
Q

How should a patient take levothyroxine?

A

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
Q

What 2 causes of hypothyroidism can cause a goitre?

A

Iodine deficiency
Hashimotos

35
Q

What extrathyroidal manifestations are present in graves?

A

Proptosis/ exophthalmosis
Eye pain
Photophobia
Lid retraction
Double/ blurred vision
Pretibial myxoedema
Thyroid achropachy
Goitre no nodules

36
Q

What investigations can be done for suspected graves?

A

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
Q

How is addisons disease treated?

A

Replacement hormones

Hydrocortisone: 20-30mg a day in 2-3 doses to mimic cortisol levels
Fludrocortisone

38
Q

Why are patients given intramuscular hydrocortisone?

A

To be taken in times of adrenal crisis

39
Q

In thyroid storm which medication is given?

A

Propranolol

40
Q

What is the difference between Cushing disease and Cushing syndrome?

A

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
Q

What are some causes of Cushing syndrome?

A

Cushing disease
Ectopic ACTH: small cell lung cancer
Endogenous steroids
Adrenal adenoma

42
Q

What symptoms are seen in Cushing syndrome?

A

Moon face
Central obesity
Depression
Hirsutism
Reduced libido
Bruising
Abdominal Stria
Buffalo hump
Acne

43
Q

What clinical signs can be seen in Cushing?

A

Hyperglycaemia
Hypernatremia
Hypokalemia
Hyperpigmentation
Osteoporosis
Proximal myopathy

44
Q

What investigations can be done for suspected Cushing syndrome?

A

24 hour urinary free cortisol
Bedtime salivary cortisol
Low dose overnight dexamethasone surpression test
Blood glucose
U&Es
FBC
Serum ACTH
MRI/CT

45
Q

If initial cortisol is high which test should be done in Cushing?

A

High dose dexamethasone suppression test

46
Q

How does the high dose dexamethasone suppression test work?

A

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
Q

In Cushing what cause would result in high serum ACTH?

A

Pituitary adenoma: Cushing disease
Ectopic acth production: paraneoplastic syndrome

48
Q

Explain the following results:

Low dose dexamethasone: not suppressed
High dose dexamethasone: suppressed
ACTH: low

A

Cushing disease

49
Q

Explain the following results:

Low dose dexamethasone: not suppressed
High dose dexamethasone: not suppressed
ACTH: high

A

Ectopic ACTH

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