Endocrinology Flashcards
What is addison’s disease?
Adrenal insufficiency resulting in steroid deficiency
Two parts of the adrenal gland - what do they produce?
Medulla - adrenaline & noradrenaline (Sympathetic innervation)
Cortex - Glucocorticoid, mineralocorticoid, androgens (“salt, sugar, sex - deeper is sweeter”)
Main type of glucocorticoid and mineralocorticoid, what do they do?
Gluco. - CORTISOL results in increased glucose
Mineralo. - ALDOSTERONE results in Na and H20 retention therefore maintaining a reduced BP
(categories not exclusive, cortitsol has mineralo. functions too for example)
Symptoms of Addisons?
Tired - reduced cortisol results in decreased glucose
Decreased BP and increased HR - decreased aldosterone
Freckles and Hyperpigmentation - POMC increases. Melanocytes stimulated
Biochemical findings
Decreased Na+ and Increased K+
Low glucose
Correct investigations?
Random cortisol (remember diurnal activity…)
Short Synacthen test
Plasma renin and aldosterone
Adrenal antibodies
Management?
Give fluids then IV hydrocortisone (cortisol) and flucocortisone (aldosterone)
Regular Obs, renal function, daily bloods/BM/ect.
Home with oral hydrocortisone
Patient hypotensive and tachycardic - what is this?
Shock : end-organ hypo perfusion can manifest as confusion and decreased renal output
Blood pressure formula?
BP = CO x TPR
Therefore, shock can occur when one of these/both decrease beyond compensateble levels
Caused of decreased CO?
PUMP FAILURE - HF, MI, valvular disease
OBSTRUCTIVE - Tamponade, PE, AS, pneumothorax
Hypovolaemia - AAA, trauma, pancreatitis, N&V, fistula
AND ENDOCRINE - ADDISON’S DISEASE!
Causes of decrease TPR?
("DISTRIBUTIVE")
Sepsis
Drugs
Anaphylaxis
Neurogenic - spinal lesionWhat is LADA?
Latent autoimmune diabetes of adulthood
i.e. late onset of T1DM. Up to 15% of T2DM may actually have LADA.
Grades of hypertensive retinopathy?
Grade 1 - silver wiring or arteries and tortuoscity
Grade 2 - AND AV nipping
Grade 3 - AND flame shaped haemorrhages and cotton wool spots
Grade 4 - AND papiloedema
What are the two stages of diabetic retinopathy?
Non-proliferative: Microaneurysms Dot and blot hemorrhages Cotton wool spots Hard exudates VISION USUALLY NORMAL
Proliferative:
Macular oedema
New vascular growth
Retinal Haemorrhage
Vitreous Haemorrhage (sudden visual loss)
VISION CAN GO FROM NORMAL TO SIGHT-THREATENING
What is Cushing’s syndrome?
Syndrome caused by an increased amount of steroid in the body (can be iatrogenic or pathological)
What are the characteristic symptoms patients have?
C - cataracts/central weight gain U - Ulcers S - striae/skin changes (bruising) H - HTN, hirsutism, hyperglycaemia I - infections N - avascular necrosis of femoral head G - glycosuria O - osteoperosis I - immunosupresion D - diabetes
Treatment of overt hyperthyroidism?
Carbimazole and levothyroxine (plus beta blocker propanolol)
First line investigation in cuching’s syndrome?
Synacthin test (i.e. tetracosactide and check cortisol before and after)
What is the first line oral medication in type II diabetes?
Metformin
Discrete lumps on an enlarged goitre - diagnosis?
Multinodular goiter
Which nerve controls lateral gaze? What is it’s course through the cranium?
Abducens CN VI.
Courses through cavernous sinus and beneath pituitary fossa. A tumour in the sella region can cause lat gaze problems via pressing on cavernous sinus
In a diabetic patient, if you saw new vessel formation what does that tell you about their control?
Worsening diabetic control
What is the minimum amount of evidence you need to diagnose diabetes?
Any symptoms + random glucose of >11.1mmol/L
What are some characteristics of diabetic neuropathy?
Increased liklihood in elderly progressive pain, tingling, and tightness in both feet Glove and stocking pattern Reduces ankle reflexes Charcot's joints
Which drugs reduce dopamine levels and what are the side effects?
Prochlorperazine
Metoclopramide
Haloperidol
Domperidone?
SEs: hyperprolactinaemia and galactorrhoea
Breast discharge and decreased periods
What is the pharmacological treatment of hyperthyroidism?
Carbimazole and levothyroxine (to prevent iatrogenic hypoT)
What is the first line investigation in suspected Cushing’s syndrome?
Synacthin Test (tetracosactide - checking cortisol before and after)
