Endocrinology

Question 1

Raised PTH leads to:

Answer 1

increased bone resorption -> increased Ca and phos
Increased Ca reabsorption from kidney
increase in active vit D production in kidneys

Question 2

factors that increase GH secretion

Answer 2

stress
exercise
hypoglycaemia
Glucagon

Question 3

incidentaloma f/u

Answer 3

check if functioning
if not and >1cm repeat MRI in6mo-1yr

Question 4

negative feedback on GH

Answer 4

glucose
somatostatin
obesity

Question 5

Bests creening test for acromegaly

Answer 5

IGF1

Question 6

Most common cause of acromegaly

Answer 6

98% GH producing pit tumour
most >1cm

Question 7

Treatment for acromegaly

Answer 7

surgery 1st line (50% cure rate with macroadenomas)
if not cured -> medical therapy (octreotide, lanreotide or pasireotide binding to SST2) rarely dopamine antagonists
if not succesful -> Rdx

Pasireotide causes new onset DM in 60% (also binds to SST5 on beta islet cells)

Question 8

Mortality in acromegaly

Answer 8

CVD in uncontrolled

Question 9

Most common cause of GH deficiency

Answer 9

pituitary tumour 50%

Question 10

First line treatment for prolactinoma

Answer 10

cabergoline (dopamine agonists)
- side effects: valvular heart disease, impuse control

surgery if doesn’t respond

Question 11

How does TBG (thyroid binding globulin) levels effect T4 levels

Answer 11

Free T4 the same
total T4 increased or decreased

Question 12

conditions which can effect TBG levels

Answer 12

Increased TBG -> OCP, preganacy , acute hepatitis
decreased TBG -> testosterone tx, steriods, anything which reduced general protein amounts

Question 13

MOst common cause of thyrotoxicosis

Answer 13

grave’s disease

Question 14

HLA with highest risk for Graves

Answer 14

HLA DR3

Question 15

Graves disease pathogenesis important surface markers

Answer 15

T cells present antigen to B cells
uses CD 40 to CD 154 (can be targeted by Iscalimab) -> inhibits autoreactive B cell activation
works in 50%

Question 16

Antibody markers for graves disease

Answer 16

TSH receptor antibodies
if they are negative can do scinti scan -> diffuse uptake over whole gland

Question 17

Treatment of graves

Answer 17

carbimazole 12-15mo (50% remission rate)
if relapse or dont go into remission -> radioactive iodine or thyroidectomy

Question 18

Side effects of carbimazole

Answer 18

most common rash and arthralgias
agranulocytosis (if repeat infections need CBE)
PTU -> hepatotoxicity, ANCA vasculitis

Question 19

Antithyroid medication in pregnancy

Answer 19

PTU in 1st trimester (carbimazole can cause issues)

Question 20

Antithyroid treatment in thyroid storm

Answer 20

PTU -> slows down thyroid hormone production and reduces peripheral conversion

Question 21

Risk factors for graves orbitopathy

Answer 21

smoking
radioiodine
letting pt become hypothyroid

Question 22

Treatment of severe graves orbitopathy

Answer 22

IV methylpred
can add cyclosporin, rituximab, RTx
tocilizumab
teprotumumab (anti-IGF1)
if still unresponsive -> surgery

Question 23

Treatment of choice in toxic multinodular goitre

Answer 23

radioactive iodine
Not likely to leave hypothyroid due to only targeting goitres

Question 24

Symptoms of hyperthyroidism next step

Answer 24

if TSH receptors negative
do scinti scan -> diffuse uptake graves
if no uptake -> thyroiditis

Question 25

Thyroiditis ab

Answer 25

TPO ab

Question 26

How to tell between T1 and T2 amiodarone

Answer 26

T1 - increased vascularisation on doppler T2 - reduced

Question 27

Hasimoto's ab

Answer 27

TPO antibodies

Question 28

Half life of thyroxine

Answer 28

7 days

Question 29

What to do with thyroxine dose when pregnant

Answer 29

incease by 30% (HCG can bind to TSh receptor and increase thyroid hormone and reduce TSH)

Question 30

Most common thyroid ca

Answer 30

pappilary arises from follicular cells Next most common follicular

Question 31

Monitoring ab in thyroid cancer

Answer 31

thyroglobulin

Question 32

Most comon cause of adrenal insuffiency in developed and developing

Answer 32

developed - autoimmune adrenalitis developing -> TB

Question 33

Risks and mechanism of autoimmune adrenalitis

Answer 33

DR3 and DQ2 and DR4 and DQ8 give 30x risk CD8 T cells and CD4 t cells react against 21-hydroxylase

Question 34

autoimmune polyendocrine syndrome 1

Answer 34

only in 15% adrenal insufficency hypoparathryroidism chronic mucocutaenous candidiasis AIRE gene mutation

Question 35

autoimmune polyendocrine syndrome 2

Answer 35

85% adrenal insuffiency autoimmune thyroid T1DM

Question 36

Diagnosis of adrenal insuffiency

Answer 36

Synacthen test abnormal <400 ACTH very high aldosterone low, renin raise DHEA low 21 hydroxase ab +ve

Question 37

Most comon enzyme deficiency in congential adrenal hyperplasia

Answer 37

21-hydroxylase

Question 38

Most common causes of mineralocorticoid excess

Answer 38

60% bilateral adrenal hyperplasia 27% adrenal adenoma

Question 39

Timing to stop medication when interpreting renin tests

Answer 39

6 weeks for diuretics and spiro 2-4 weeks all others

Question 40

Drugs that increase renin

Answer 40

ACEi Diuretics DHP CCB

Question 41

drugs that decrease renin

Answer 41

beta blockers

Question 42

Treatment for bilateral adrenal hyperplasia

Answer 42

Spironolactone, aim normal renin

Question 43

Most common types of adrenal incidentaloma

Answer 43

non-functioning 75% of functioning cortisol producing most common

Question 44

Concerning features for adrenal incidentalomas on imaging

Answer 44

HU >10 Slow washout <60% >4 cm

Question 45

How is calcium absorbed in the gut

Answer 45

passive between gap junctions active through TRP channels

Question 46

VItamin D function to calcium in gut

Answer 46

increased TRP and Ca APTase synthesis to aid uptake of calcium from gut

Question 47

Site of most calcium reabsorption in the kidney

Answer 47

proximal tubule