Endocrinology Flashcards

Question

Why is hydrocortisone important in pituitary failure?

Answer 1

Not getting cortisol is the most dangerous part of the disease We use hydrocortisone (orally) because it is short acting and so we can replicate the natural daily cycle of cortisol production Prednisolone is long acting and so would NOT be given

Answer 2

Double dose if febrile illness Double dose if fractured limb Surgery: IV hydrocortisone then double dose Gastroenteritis: Double dose, IM hydrocortisone Dental extraction: 20mg Severe shock: double dose Long haul flight: double dose

Answer 3

Acts on kidney collecting ducts and tubules (ADH) to allow water reabsorption into the bloodstream Sublingual, subcutaneous, oral Give at night then according to symptoms during the day Aim: control of polyuria then treatment should wear off for an hour prior to next dose to excrete free water load Check U+E to ensure Sodium is normal

Answer 4

``` Facial swelling Hair loss Dry skin Reduced heart rate Husky voice Hypothermia Goitre ```

Answer 5

``` Tremor Warm skin Agitation Goitre Exophthalmous (protusion of the eyeballs) Atrial fibrillation ```

Answer 6

``` Fatigue Constipation Weight gain Depression Menorrhagia Psychosis Hearing loss ```

Answer 7

``` Palpitations Diarrhoea Weight loss Sweating Heat intolerance Hunger & Thirst Anorexia ```

Answer 8

Restore wellbeing and to return TSH levels to normal Relieve symptoms Manage any underlying condition

Answer 9

TSH, T4, T3 Patient symptoms

Answer 10

Amiodarone Lithium Iodine Cholestyramine Ferrous sulphate Glucocorticoids

Answer 11

Contains 40% iodine, can cause both hypo and hyper It inhibits the conversion of T4 to T3 and the iodine can directly inhibit thyorid gland function (HYPO) Can also cause HYPER via an inflammatory process that causes increased release of thyroid hormones

Answer 12

Patients taking amiodarone or lithium Patients with diabetes Patients with AF Patients with hyperlipidaemia Patients with - Down's syndrome - Turner's syndrome - Addison's disease

Answer 13

``` HYPOthyroidism = high lipids HYPERthyroidism = lower lipids ```

Answer 14

``` o Palpitations o Anginal chest pain o Exercise intolerance o Atrial fibrillation o Exertional dyspnea o Cardiac hypertrophy o Systolic hypertension o Peripheral edema o Hyperdynamic precordium o Congestive heart failure ```

Answer 15

- Impaired cardiac contractility and diastolic function - Increased systemic vascular resistance - Decreased endothelial-derived relaxation factor - Increased serum cholesterol - Increased C-reactive protein - Increased homocysteine

Answer 16

Restoration of normal thyroid function would reverse the CV symptoms if caused by thyroid dysfunction

Answer 17

The clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency also in mineralocorticoids and adrenal androgens.

Answer 18

Adrenal cortex - Aldosterone, Cortisol and Androgens - Steroids (Mineralo-, Gluco- and Gonado-corticoids) Adrenal medulla - Epinephrine - Norepinephrine

Answer 19

Helping to regulate blood pressure. Helping to regulate the immune system. Helping the body to respond to stress. Helping to balance insulin in regulating blood sugar level

Answer 20

The hypothalamus receives input from the body (when more cortisol is needed) and produces corticotropin-releasing hormone (CRH) CRH stimulates the pituitary to secrete ACTH ACTH travels to the adrenal glands and stimulates the adrenal cortex to make more cortisol.

Answer 21

Cushing's syndrome - Most commonly drug induced - High ACTH secretion as the anterior pituitary becomes insensitive to the negative feedback - Excess cortisol Addison's disease - Destruction of adrenal gland - Autoimmune most common cause - Low cortisol - Lack of cortico and mineralo corticoids - High ACTH as less negative feedback from cortisol

Answer 22

Weakness Fatigue Anorexia Abdominal pain Weight loss Orthostatic hypotension Salt craving Hyperpigmentation (caused by increased ACTH)

Answer 23

LOW - Sodium - Blood sugar HIGH - Potassium - Urea - Calcium - Serum TSH

Answer 24

A = ALWAYS TIRED D = DIZZY WHEN STANDING D = DROP IN BLOOD PRESSURE ON STANDING I = INEXPLICABLE WEIGHT LOSS S = SKIN COLOUR CHANGES O = ONLY EATING SPARINGLY / ANOREXIA N = NO STRENGTH IN HANDGRIP OR LIMBS S = SICK OR NAUSEOUS

Answer 25

Hydrocortisone (Glucocorticoid replacement) Fludrocortisone (Mineralocorticoid replacement)

Answer 26

Dial 999! Parenteral hydrocortisone and IV fluids

Answer 27

Cardiac arrest Stroke Hypoglycaemic shock Hypoxia

Answer 28

Evidence from observational studies indicates that some adults taking corticosteroids for adrenal insufficiency (AI) have decreased bone mineral density (BMD). - Ensure good vitamin D and calcium intake. - Stop smoking and limit alcohol intake

Answer 29

``` Blood pressure Blood glucose Adrenal function Thyroid function U&E Signs & symptoms - Patient wellbeing ```

Answer 30

Fever 37.5 degrees or more = double normal dose 39 degrees or more = triple normal dose Serious injury - Take 20mg immediately in addition to normal doses Vomit once - Take 20mg immediately in addition to normal doses Vomit twice or more - Emergency injection of hydrocortisone

Answer 31

If you go on holiday - ensure to take ample supplies If you take part in strenuous exercise - Will need extra hydrocortisone, speak to your doctor If you work shifts or at night - You dosing schedule will probably need to be changed to match your work schedule. Speak to your doctor/prescriber.

Answer 32

``` Vomiting Abdominal pain Myalgia Joint pains Severe hypotension Hypovolemic shock ``` Emergency hydrocortisone injection!

Answer 33

Timing of steroid doses - Morning and lunchtime Doubling doses if patient is unwell Education on 'Sick Day Rules' Management of adrenal crisis Drug interactions - Oestrogen - Liquorice root interacts with fludrocortisone (check cough meds)

Answer 34

There is 20 times more T4 than T3 T3 is 3-4 times more potent than T4 T4 is converted to T3 by the liver and muscles