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Phase 2 - General Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is Acromegaly?

A

Excess Growth Hormone due to a pituitary adenoma

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2
Q

What does Acromegaly cause?

Physical Attributes - not on face

A

Spade-like Hands and feet
Sweating
Proximal Myopathy

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3
Q

What does Acromegaly cause?

Conditions

A 
Hypertension
Cardiomegaly and HF
Diabetes (due to poor glucose tolerence)
Visual Field Disturbances (compression)
Fluid retention - Carpal Tunnel, OS Apnoea
Osteoarthritis
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4
Q

How do you investigate Acromegaly?

A 
Glucose Tolerence Test
Insulin Sensitivity
Bloods - glucose, GH, other pit hormones
Bloop Pressure
Urine Dip - glucose
MRI Pituitary Fossa
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5
Q

How do you treat Acromegaly?

A

Transphenoidal Approach
Radiotherapy (if cannot excise)
Medications to lower GH - receptor blocker, somatostatin analogues

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6
Q

What does Acromegaly cause?

Physical Attributes - facial

A

Coarse Features - square jaw, large nose and ears
Frontal Bossing
Wide Spaces between teeth
Macroglossia

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7
Q

What is Cushing’s?

A

Excess cortisol production due to ectopic secretion, an ACTH pituitary adenoma (DISEASE) or a adrenal adenoma
Iatrogenic

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8
Q

What are the physical features of Cushing’s syndrome?

A 
Moon Face
Acne
Buffalo Hump
Abdominal Fat
Purple Striae
Oedema - fluid retention
Bruising
Thin Skin and Hair
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9
Q

What are the disease states related to Cushing’s?

A 
Eyes- Glaucoma, Cataracts
High BP
Easy Bleeding
Steroid Diabetes
Fluid Retention 
GORD
Compressive - Visual Fields, Headaches
Osteoporosis
Immunocompromised
Oligomenorrhoea 
Mood Change
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10
Q

How do you investigate Cushing’s

A

TFTs (hypothyroid)
Early Morning Cortisol

Dexamethosone Suppression - low dose then high (halves Cortisol in DISEASE)

Bloods - glucose, FBC, Clotting (INR), pituitary hormones

MRI Pituitary
24 hour urine Cortisol

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11
Q

How do you treat Cushing’s?

A

Iatrogenic: Stop steroids

Adenoma: Transphenoidal Pituitary Removal or medical treatment if prolactinoma

Bilateral Adrenectomy
Radiotherapy (if adrenal carcinoma)

Treat Cancer (if ectopic) and fluconazole to lower Cortisol

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12
Q

What is Addison’s Disease?

A

Primary Adrenal Failure

Autoimmune destruction of the adrenal cortex, leading to insufficiency

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13
Q

What is Adrenal Failure?

Causes

A

Where adrenals are not able to produce steroids leading to symptoms
Can be due to long-term steroid treatment, sepsis, metastatic cancer, infections (TB)

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14
Q

What are the physical symptoms of Addisons?

A 
Cachexia/Weight Loss
Pigmentation - especially gums, folds of skin
Thin Hair
Thin Nails
Amenorrhoea 
Impotence
Dehydrated
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15
Q

What are the other symptoms of Addisons?

A 
Postural Hypotension
Tiredness, Lethergy
Loss of thirst, appetite
Mood changes - depression
High K+ and low Na+ (loss of aldosterone)
Hypoglycaemia
Weakness
Abdominal Pain and Vomiting
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16
Q

Investigations

A

Short synacthen test
BP - standing and sitting
Bloods - U&Es, cortisol, antibodies, ACTH, glucose, ABGs
Glucose fingerprick test

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17
Q

What is an addisonian crisis?

A

SEVERE Addisons. Usually due to a missed dose or upregulation of dose in illness
Can lead to death due to hypovolaemic shock, heart attack, hypoglycaemia

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18
Q

How do you treat an addisonian crisis?

A 
Steroids IV -hydrocortisone 
Fluids - IV, aggressive
Glucose
Monitor electrolytes - K+ may treating
Treat cause if has one
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19
Q

How do you treat Addisons

A

Hydrocortisone
Fludrocortisone
Emergency Kit
Sick Day Rules, Steroid Card

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20
Q

What is Thyrotoxicosis?

A

Hyperthyroidism

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21
Q

What are the causes of hyperthyroidism?

A 
Autoimmune - Graves disease
Toxic Goitre (old)
Toxic Adenoma
Ectopic Thyroid Tissue (Struma Ovarii, metastatic)
Exogenous
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22
Q

What are the symptoms of hyperthyroidism?

A 
Weight Loss
Gain of Appetite
Not able to sleep
Palpitations
Anxiety/Panic Disorders
Mood Changes
Menstrual changes 
Heat Intolerence
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23
Q

What are the signs of hyperthyroidism?

A 
Tachycardia/Arrhythmias (AF)
Fine Tremor
High BP
Goitre
Exophthalmos, lid lag and retraction
Sweaty
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24
Q

Investigating Thyroid?

A 
TFTs, thyroid antibodies
Cortisol
BP
ECG
Thyroid Examination
Technetium Uptake Scan
USS
25
Q

What is Grave’s Disease?

Risks?

A

Autoantibodies IgG bind to the thyrotrophin receptor causing goitre and upregulating hormone production

Middle aged, female, pregnancy, stress, other autoimmune conditions

26
Q

Treatment of Hyperthyroidism?

A

Beta Blockers
Carbimazole
Radioactive Iodine
Thyroidectomy and Levothyroxine

27
Q

Treating a thyrotoxic storm?

A 
Severe hyperthyroidism
Manage peripheral symptoms (Beta blockers, digoxin may be needed)
Treat precipitant (infection etc)
Fluids
Carbimazole - iodine -surgery
28
Q

What is Hypothyroidism?

A

Where there is insufficient thyroid hormone production

29
Q

What are the normal levels for thyroid hormones?

A

TSH 0.4 - 4
T4 9 - 25
T3 3.5 - 7.8

30
Q

What is Sick Euthyroidism?

A

Where the thyroid production is decreased when you are unwell
Normally all tests are low

31
Q

What are the causes of Hypothyroidism?

A

Autimmune - Hashimoto’s

Trauma

Iodine Deficiency (following HyperT treatment)

Pituitary Adenoma (secondary)

Drug Induced - antithyroid, lithium, amiodarone

32
Q

Who gets hypothyroidism?

A 
Also known as myxoedema
More common in middle aged females
Associated with other autoimmune conditions
Down's Syndrome
Genetic
33
Q

What is Hashimoto’s?

A

Autoimmune lymphocytic infiltration of the thyroid gland, leading to atrophy

34
Q

What are the symptoms of Hypothyroidism?

A 
Tiredness and lethergy
Mood- depression
Weight gain
Loss of appetite
Heavy periods
Cold Intolerence
Carpal Tunnel Syndrome
Goitre
Slow reflexes
35
Q

Signs of Hypothyroidism?

A 
Weight gain (toad face)
Bradycardia
Low BP
Thin Hair/Skin
Cold
Periorbital Oedema
Low cognition
36
Q

What is a toad-like face?

A

Seen in Hypothyroidism

Loss of hair - scalp, 1/3 eyebrows, dull expression, puffy lids, pale

37
Q

How do you treat Hypothyroidism

A

Levothyroxine (replacement of T4)

Can do:
Liothyroxine (T3)

38
Q

What is a Pheochromocytoma?

A

Noradrenaline/Catecholamine releasing medullary tumour of Chromaffin Cells
Most unilateral

Follow rules of 10:
10% bilateral, 10% malignant, 10% familial, 10% extra-adrenal

39
Q

Investigating a Pheochromocytoma?

A

24 hour Urine Metadrenaline Test

ECG, BP
Bloods - TFTs, Cortisol
Abdominal CT/MRI

40
Q

Treating a Pheochromocytoma?

A 
Alpha Blockers (and Beta Blockers if have heart disease)
Adrenalectomy
41
Q

Symptoms of a Pheochromocytoma?

A

The main three:
Headache
High Heart Rate
Sweating

Others:
Feeling doom/anxiety
Weight loss
Loss of sleep
Heat intolerance
Palpitations
Horner's syndrome
42
Q

Signs of a Pheochromocytoma?

A

Sweaty
BP high
Tachycardia

43
Q

What can trigger a Pheochromocytoma?

A

Compression to area of adrenal glands/Trauma

44
Q

What is hyperaldosteronism?

A

Raised aldosterone
Can be:
Primary: Adenoma- Conn’s, Hyperplasia
Secondary: renal stenosis/hypoperfusion (sepsis etc)

45
Q

What are the signs of hyperaldosteronism?

A

Fluid retention
High Na+, low K+
High BP
Polyuria and dipsia

46
Q

Treatment of hyperaldosteronism?

A

Treat underlying cause: Conn’s - removal

Spironolactone pre-op and for adrenal hyperplasia

47
Q

Investigating hyperaldosteronism?

A

Bloods: U&Es, Renin, Aldosterone
BP
Urine - glucose

48
Q

What is Diabetes Insipidus?

A

Insufficient ADH production leading to polyuria (>3L a day) and polydipsia

49
Q

Causes of Diabetes Insipidus?

A

Nephrogenic: Lithium,CKD, mutation

Neurogenic: Pituitary Stalk Compression/Damage to Pit.
Hypothalamus - infection, tumour, surgery

50
Q

Investigations of Diabetes Insipidus?

A

Blood and urine glucose and ketones
Serum and urine osmolarity, Na+
(Urine will be hypo-osmolar compared to normal)
Blood - U&Es (Na+ high due to attempted fluid retention)

Fluid deprivation test for 8 hours to see urine osmolarity: <300
Then give desmopressin to see response

51
Q

Treatment of Diabetes Insipidus?

A

Desmopressin (ADH analogue)

ADD thiazide and NSAIDs if nephrogenic

52
Q

Diagnosis of Diabetes Insipidus - Osmolarity?

Primary Polydipsia?

A

<300

>800

53
Q

What does giving desmopressin do?

A

if Diabetes Insipidus is nephrogenic then there is no response
If it is neurogenic then there is a response

54
Q

Signs of Diabetes Insipidus?

A

Thirst
Polyuria (nocturnal as well)
Hypernaturaemia
Palpable Bladder

55
Q

What do you do an Insulin Tolerance Test for?

A

GH and Cushings (ACTH)

Hypoglycaemia normally stimulates the production of these

56
Q

What are some causes of Hypopituitarism?

A 
Sheehan's syndrome - post-pregnancy necrosis of the pituitary
Trauma
Infection
Radiation
Surgery
Adenomas
57
Q

What are some signs that it is a pituitary adenoma?

A

Headaches
Changes in other Pituitary hormones
Visual field defects (temporal hemianopia)

58
Q

What order are hormones lost in pituitary failure?

A 
GH
FSH and LH
Prolactin
TSH
ACTH
59
Q

How do you treat a prolactinoma?

A

Dopamine Agonists - Bromocriptine or Cabergoline

Phase 2 - General Medicine (6 decks)

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