Endocrinology

Question 1

Aldosterone actions?
it is a?

what does it do in the DT?
CD?

Answer 1

mineralocorticoid steroid hormone

acts on nephrons

1) Na+ reabsorbed from DT
2) K+ secretion is increasted in DT

3) Hydrogen is secreted in CD

Question 2

angiotensinogen is found in the?

converted into? by?

Answer 2

liver
angiotensin 1 by renin

Question 3

Ang I > Ang II

Answer 3

angiotensin converting enzymes found in the lungs turn ang 1 > ang 2

Ang II acts on
cardiac cells
vasoconstricts
adrenal cortex > aldosterone

Question 4

Hypothalamus releases ______

this acts on anterior pituitary releasing GH

GH stimulates release of ____ from ____

this acts on?

Answer 4

Growth hormone releasing hormone

GH stimulates liver > IGF-1

> acts on muscles, bones, myocytes

somatostatin negative feedback

ghrelin (stomach) + feedback

Question 5

anterior pituitary releases 5 hormones

Answer 5

1) TSH
2) ACTH
3) GH
4) FSH/LH
5)prolactin

Question 6

where is aldosterone produced in the adrenal cortex?

Answer 6

zona glomerulosa

Question 7

adrenaline / catecholamines produced where in adrenal gland?

Answer 7

medulla

Question 8

Primary hyperthyroidism?

TFT result?

Answer 8

thyroid is dysfunction - excessive thyroid hormone

low / suppressed TSH
high t3/t4

Question 9

causes of hyperthyroidism?

Answer 9

Graves
Inflammation - thyroidistis
solitary toxic nodule
toxic multinodular goitre

Question 10

what are the antibodies in Graves disease?

Answer 10

TSH receptor stimulating antibodies

anti thyroid perioxidase Abs

Question 11

what imaging in thyroid disease?

Answer 11

radioisotope USS of thyroid gland

Question 12

how is a radioisotope scan carried out?

Answer 12

iodine given orally or IV

gamma camera detects gamma rays from the iodine

function info given

Question 13

radioisotope findings
Grave?
Toxic multinodular / adenoma

Thyroid cancer?

Answer 13

diffuse high uptake

focal uptake

abnormally low uptake

Question 14

Causes of hypothyroidism?

Answer 14

hashimotos thyroiditis
iodine deficiency

Question 15

what is complications of hyperthyroidism?

Answer 15

thyroid storm / thyrotoxicosis

AF >

exophthalmos
opthalmoplegia

pretibial myxoedema

Question 16

Thyroid storm management

Answer 16

admission to hospital
antithyroid medication

steroids
+ supportive care

Question 17

Medical management of Graves?

Answer 17

carbimazole - 40mg

propranalol - symptom control

Question 18

what 2 antibodies found in hashimotos?

Answer 18

anti thyroglobulin
anti thyroid perioxidase

Question 19

Mx of hypothyroidism?

how long till check?

Answer 19

Levothyroxine 50-100mcg od

8-12 weeks

Question 20

what would be considered a normalisation of thyroid?

Answer 20

TSH value 0.5-2.5 mU/l

Question 21

Pregnancy and hypothyroidism

levothyroxine changes?

Answer 21

dose increase by 25-50micrograms

Question 22

which supplements commonly given affect levothyroxine absorption?

Answer 22

iron
calcium

give 4 hours apart

Question 23

what 2 drugs can impact thyroid?

Answer 23

lithium

amiodarone

Question 24

levothyroxine is?

Answer 24

synthetic t4 > t3

Question 25

what are the 2 types of corticosteroid hormones?

Answer 25

glucocorticoids mineralocorticoids

Question 26

Cushing disease refers to?

Answer 26

pituitary adenoma > ACTH > cortisol

Question 27

causes of cushing syndrome

Answer 27

Cushing D adrenal adenoma paraneoplastic exogenous steroids

Question 28

Cushing syndrome diagnosis?

Answer 28

dexamethasone suppression test

Question 29

A normal response to dexamethasone abnormal

Answer 29

cortisol is suppressed lack of cortisol suppression indicates CS

Question 30

Ix cushing

Answer 30

FBC - wcc u&es - hypokalaemia MRI brain CT chest - SCLC CT abdo - adrenal tumour

Question 31

Mx of cushing? pituitary adenoma? adrenal?

Answer 31

trans sphenoidal surgical

Question 32

low dose dexamethasone dosage?

Answer 32

1mg given at night cortisol checked in the am failure of suppression of cortisol indicates? CS

Question 33

high dose dexamethasone test? differentiates between?

Answer 33

2mg pituitary / adrenal cause high enough to suppress pituitary adenoma bur nor adrenal

Question 34

excess growth hormone features?

Answer 34

superior bitemporal hemianopia frontal bossing sweaty large nose macroglossia prganthism

Question 35

acromegaly Ix? confirmatory test? what dose? what is normal?

Answer 35

Insulin Like Growth factor -1 > venous blood sample > immunoassay growth hormone suppresion test 75g of glucose drink > 2 hours later test GH > suppressed is normal

Question 36

Imaging for acromegaly

Answer 36

MRI brain to visualise pituitary adenoma

Question 37

definative mx of acromegaly?

Answer 37

transphenoidal surgery

Question 38

example of a somatostatin analogue?

Answer 38

octreotide

Question 39

which 2 can be used in medical management of acromegaly?

Answer 39

octreotide bromocriptine blocks GH release

Question 40

what is negative feedback to pituitary gland producing GH?

Answer 40

somatostatin

Question 41

Prolactinoma 1st line management?

Answer 41

dopamine agonist cabergoline bromocriptine

Question 42

causes of raised prolactin

Answer 42

prolactinoma pregnancy oestrogen stress PCOS acromegaly

Question 43

drugs causing prolactinoma?

Answer 43

metoclopramide haloperidol SSRI / opioid

Question 44

Initial tests for phaeochromocytoma

Answer 44

plasma free metanephrines 24hr urine catecholamines

Question 45

Mx of phaeo

Answer 45

alpha blockade > beta blockade >surgical removal of the tumour

Question 46

Adrenal insufficiency how to diagnose?

Answer 46

short synacthen test cortisol checked should double