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Phase 2a Summaries > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the name of the dopamine agonist used in acromegaly and prolactinoma?

A

Cabergoline

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2
Q

What is the pathophysiology of acromegaly?

A

Increased secretions of GH from pituitary tumour or hyperplasia. GH stimulates soft tissue growth through increased secretion of insulin like growth factor 1.

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3
Q

What two hormones does the posterior pituitary secrete?

A

Vasopressin (supraoptic nucleus) and Oxytocin (paraventricular nucleus)

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4
Q

What is the action of oxytocin?

A

Smooth muscle contraction in uterus, and lactation in the breast

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5
Q

What is the action of vasopressin?

A

ADH - acting on collecting ducts - reabsorption of water so decrease urine output
Also causes arteriolar constriction which leads to peripheral vascular resistance and increase BP

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6
Q

Name 5 hormones secreted in hypothalamus that cause secretions in anterior pituitary?

A 
Thyrotropin releasing hormone (TRH) 
Corticotropin releasing hormone (CRH) 
Gonadotropin releasing hormone (GnRH) 
Growth hormone releasing hormone (GHRH) 
Dopamine
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7
Q

Which 6 hormones are secreted in the anterior pituitary?

A
  1. FSH
  2. LH
  3. GH
  4. Prolactin
  5. ACTH
  6. TSH
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8
Q

What is the action of prolactin?

A

Stimulates lactation in the breasts

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9
Q

Which hormone from hypothalamus stimulates prolactin release and which hormone inhibits it?

A

TRH - stimulates prolactin release

Dopamine- inhibits it (overrides TRH)

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10
Q

What negative feedback loop is caused by increased prolactin?

A

Causes decreased of GnRH release from hypothalamus

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11
Q

Which nucleus in the hypothalamus controls the circadian rhythm?

A

Suprachiasmatic nucleus

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12
Q

Name the two most common causes of primary adrenal insufficiency?

A

Addisons disease and CAH (congenital adrenal hyperplasia)

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13
Q

Name 5 signs and symptoms of adrenal crisis?

A

Hypotension, hypoglycaemia, hyponatraemia and hyperkalaemia, fatigue and fever

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14
Q

Why do you get hypoglycaemia, hyponatraemia, hyperkaelamia in adrenal crisis?

A

Lack of production of aldosterone, causes hyponatraemia and hypoerkalemia because aldosterone is not reabsorbing Na in kidneys, hypoglycaemia because cortisol isn’t producing

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15
Q

What is the immediate management of adrenal crisis?

A

Hydrocortisone

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16
Q

In acromegaly why is GH plasma levels non-diagnostic?

A

GH is pulsatile- increases in stress, sleep, pregnancy and puberty

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17
Q

What are the 3 stages of diagnosis in acromegaly?

A
  1. Plasma GH levels
  2. Glucose tolerance test (should be no suppression of glucose)
  3. IGF-1 levels
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18
Q

Give 4 signs of acromegaly?

A

Acral enlargement, maxiofacial changes, scalp folds, curly hair

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19
Q

What are the 3 stages of treatment for acromegaly?

A
  1. Transphenoidal surgery
  2. Medical therapy
  3. Radiotherapy
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20
Q

Give two disadvantages to using radiotherapy in acromegaly?

A

Delayed response

Can cause hypogondism

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21
Q

Which are the 3 medications used in acromegaly treatment in order of effectiveness?

A
  1. Somatostatin analogue - eg IM octreoride
  2. GH receptor antagonist eg Pegvisomant
  3. Dopamine antagonist eg oral cabergolin
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22
Q

Give 4 symptoms of acromegaly?

A

Amenorrhoea, loss of libido, headache, sweating, snoring, skin darkening, weight gain and low voice

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23
Q

Give 3 causes hyperprolactinaemia?

A
  1. Prolcatinoma
  2. Compression of pituitary stalk –> decreased dopamine
  3. Drugs eg dopamine antagonists
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24
Q

What medication would you use to treat prolcatinoma?

A

Dopamine agonist eg Oral Cabergoline

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25
Q

Give 3 common presentations of prolactinomas?

A
  1. Amenorrhoea
  2. Infertility
  3. Decreased libido and increased weight
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26
Q

What 3 signs would you expect to see in Conn’s syndrome?

A

Hypernatraemia, hypokalaemia and hypertension

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27
Q

What would you see on an ECG in a patient with Conns?

A

Hypokalaemia = flat T waves, ST depression and long QT

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28
Q

What is a) initial screening and b) diagnostic investigation in Conns?

A

a) Plasma aldosterone: renin ratio

b) aldosterone antagonist ef oral spironalactone

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29
Q

Name 2 treatment methods for Conns?

A
  1. Laproscopic aldrenalectomy

2. Oral spironolactone

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30
Q

How do you diagnosis secondary adrenal insufficiency?

A

Low ACTH and normal mineralocorticoid

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31
Q

What is the pathophysiology behind secondary adrenal insufficiency?

A

Lack of ACTH due to problems with the HPA axis - most common cause is iatrogenic

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32
Q

What are the two causes of primary adrenal insufficiency?

A
  1. CAH - congenital adrenal hyperplasia

2. Addisons

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33
Q

Give 3 causes of Addisons disease?

A

Adrenalitis, infections eg TB, adrenal infarction, metastases from lungs and stomach

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34
Q

Name 3 symptoms you can get due to cortisol deficiency in addison’s?

A

Fatigue, muscle weakness, hyper pigmentation, abdominal pain

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35
Q

Name a symptom you can get due to a) aldosterone deficiency and b) androgen deficiency in addison’s?

A

a) Postural hypotension

b) Loss of libido and menstrual irregularities

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36
Q

Name 4 things you would see on a blood test for a patient with Addisons?

A
  1. Hypnatraemia, hyperkalaemia, hypoaldoesteronism, eosinophils and anaemia
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37
Q

Which adrenal antibody may be present in Addison’s disease?

A

21 hydoxylase antibody

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38
Q

Name 2 diagnostic tests you would perform in addison’s?

A
  1. Short ACTH stimulation test using tetracosaride

2. 9am ACTH levels

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39
Q

Give 2 treatment methods for addison’s disease?

A
  1. Replace cortisol with hydrocortisone

2. Replace mineralcorticoaids with fludrocortisone

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40
Q

What is diabetes insidipidus?

A

Passage of large volumes of dilute urine due to impaired water reabsorption in kidney - passage of urine >3L

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41
Q

Give 3 cranial causes of diabetes insipidus?

A

Idiopathic, congenital defect in ADH gene, tumour eg posterior pituitary and trauma

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42
Q

Give 3 nephrogenic (resistant to ADH) causes of diabetes insipidus?

A

Metabolic (hypercalacermia, hypokalaemia)
Drugs (Lithium)
Osmotic diuresis (diabetes mellitus)
Inherited

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43
Q

What is the clinical presentation of diabetes insipidus?

A

Polyuria, compensatory polydipsia, hypernatraemia (lethargy, weakness), dehydration

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44
Q

How do you differentiate cranial and nephrogenic causes of DI?

A

Water deprivation test then

Desmopressin stimulation - urine not concentrated in nephrogenic

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45
Q

Give a treatment method for a) nephrogenic and b) cranial causes of diabetes insidipidus?

A

a) Thiazide diuretics eg oral bendrofluromethiazide

b) Give oral desmopressin

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46
Q

What should the normal blood glucose be between?

A

3.5-8mmol/L

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47
Q

Give 4 causes of secondary Diabetes?

A

a) Pancreatic pathology eg Haemochromatosis
2. Endocrine disease eg acromegaly
3. Drug induced eg thiazide diuretics
4. Maturity onset diabetes of youth (MODY)

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48
Q

Which tissue type is type 1 diabetes associated with?

A

HLA DR3 and HLA DR4

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49
Q

Which other autoimmune diseases are associated with type 1 diabetes?

A

Autoimmune thyroiditis, coeliac disease, addison’s disease, perncious anaemia

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50
Q

Name 5 of the presenting features of type 1 diabetes?

A
  1. Polyuria
  2. Polydipsia
  3. Muscle and weight loss
  4. Blurred vision
  5. Pruritus valence and balantis
  6. Hunger due to decrease useable energy source
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51
Q

Which 3 factors would lead to an immediate diagnosis of type 1 diabetes if 2/3 were present?

A

Weight loss, short history of severe symptoms and moderate/large urinary ketones

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52
Q

What are the 3 main types of insulin given in type 1?

A
  1. Short acting soluble insulin
  2. Short acing insulin analogue
  3. Long acting insulin
53
Q

Give 4 complications of insulin treatment?

A
  1. Hypoglycaemia
  2. Injection site - lipohypertrophy
  3. Insulin resistance
  4. Weight gain
54
Q

Give 3 biochemical factors you need to make a DKA diagnosis?

A
  1. Hyperglycaemia >11mmol/l
  2. Raised plasma Ketones (>2 on urinary dipstick)
  3. Metabolic Acidosis, plasma Hco3 <15mmol
55
Q

Give 4 complications of DKA?

A

Hypotension
Cerebral oedema
Adult Respiratory Distress syndrome
Arrhythmia (if K+ unmanaged)

56
Q

Give 3 signs of DKA?

A

Hyperventilation (Kussmal breathing) , hypotension, tacycardia, ketonic breath, coma

57
Q

Give 3 symptoms of DKA?

A

Polyuria, polydipsia, cause, vomitting, drowsiness, confusion

58
Q

Give 4 symptoms of hypoglycaemia?

A

Sweating, tremor, drippiness, confusion, sweating, hungry, personality change

59
Q

What does EXPLAIN stand for in non-diabetic causes of hypoglycaemia?

A

Exogenous drugs, pituitary insuffieicny, liver failure, addison’s, islet cell tumour,non-pancreatic neoplasm

60
Q

Name 4 factors for diabetes diagnosis?

A
  1. Random plasma glucose >11mmol/L
  2. Fasting plasma glucose >7mmol/l
  3. Oral glucose tolerance test]
    a) fasting >7mmol
    b) after 2 hours >11 mol
  4. HbA1c >6,5% normal
61
Q

Give 3 risk factors of type 2 diabetes?

A
  1. Overweight/obese
  2. Family history
  3. Hypertension, increased triglycerides/cholesterol
  4. South Asia
62
Q

What is the first line treatment of T2 diabetes?

A

Lifestyle changes: Dietary factors, weight loss and exercise, ACE inhibitors and statins

63
Q

Which 3 medications are used to treat diabetes mellitus?

A
  1. Metformin - increase insulin sensitivity and reduce rate of gluconeogenesis in liver
  2. Sulfonyura (gliceride) - increases insulin
    3.
64
Q

Name 5 complications associated with poor glycemic control?

A
  1. Diabetic neuropathy
  2. Diabetic nephropathy
  3. Peripheral vascular disease
  4. Diabetic retionopathy
  5. Stroke / MI
65
Q

What is the function of the parathyroid?

A

Releases PTH in response to decreased calcium levels - increases calcium reabsorption in kidneys and decreases calcium excretion - stimulates hydrolysis of 25-hydroxyvitamin D to caclitriol

66
Q

Give 5 symptoms/ signs of hypercalcaemia as a result of primary hyperparathyroidism?

A

Renal stones. painful bones, abdominal groans (Gi upset, nausea) psychiatric moans (lethargy, fatigue and memory loss)

67
Q

What would the lab results show in primary hyperparathyroidism?

A

Increase PTH, Increase Ca, decrease phosphate,

68
Q

What would the lab results show in primary hyperparathyroidism?

A

Increase PTH, Decrease Ca, increase phosphate, increase alkaline phosphate

69
Q

What are the causes of secondary hyperparathyroidism?

A

Chronic kidney disease and vitamin D deficiency

70
Q

Which lab result excludes hyperparathryoidism (primary, secondary and tertiary)?

A

Low PTH

71
Q

Which 4 tumours can cause hypercalcaemia of malignancy ?

A

Squamous cell lung tumour, renal and breast (secrete parathryoid like protein)
Bone infiltration due to multiple myeloma and secondary metastatses
Lymphoma

72
Q

What would the lab results show in hypercalcaemia of malignancy?

A

Low PTH as tumour produces parathyroid like protein, high calcium, low albumin

73
Q

In acute severe hypercalcaemia what would be your management steps?

A

Saline - increase fluid
Bisphosphonates
Steroids eg prednisolone

74
Q

Why is the phosphate high in primary hypoparathyroidism?

A

Phosphate reabsorption from the kidney is reduced by PTH. Thus if PTH levels are low, serum phosphate will rise (more will be reabsorbed).

75
Q

What is the most common cause of hypocalcaemia and what is the mechanism behind this?

A

Secondary to increased phosphate levels in CKD. Decrease calcitriol production and phosphate rentention

76
Q

Give 3 causes of vitamin D deficiency?

A

Reduced UV exposure,
Malabsorption
Anti-epilieptic drugs

77
Q

How do you treat acute hypocalcaemia?

A

IV calcium gluconate

78
Q

How do you treat vitamin D deficiency?

A

Oral colecalciferol

79
Q

How do you treat hypoparathyroidism?

A

Calcium supplements + calcitriol

80
Q

Name 2 signs you would see in hypocalcaemia?

A

Trousseau’s sign- carpopedal spasm (hand spasm)

Chvostek’s sign - twitching of ipsilateral facial muscles on facial nerve

81
Q

What is the clinical presentation of hypocalcaemia?

A

SPASMODIC (Spasms, personal parasthesia, anxious, seizures muscle tone increase, orientation impaired, dermatitis, impetigo hepetiformis, Choveks sign

82
Q

What would the lab results be in hypoparathyroidism?

A

Low serum calcium, low PTH, high phosphate

83
Q

Name 4 investigations you could perform in hypercalcaemia?

A 
X-Ray eg pepper pot skull 
DXA bone density scan 
High resolution CT 
Radioisotope scanning 
Parathyroid ultrasound
84
Q

What is the definition of osmolality?

A

The concentration of a solution expressed as the total number of solute particles per kilogram

85
Q

What is the definition of hyponatraemia?

A

Serum sodium <135mmol/L

Severe <125mmol/l

86
Q

Give the 4 main causes of hyponatraemia?

A

SIADH, blood sample from drip arm, renal failure, malignancy, iatrogenic

87
Q

Give 4 symptoms of hyponatraemia? (quicker the onset the worse the symptoms)

A

Headache, lethargy, anorexia and abdominal pain, weakness, confusion, agitation, coma (severe cases)

88
Q

Name 3 drugs which causes SIADH?

A

Carbamazepine, thiazides, MAO inhibitors

89
Q

What is the clinical presentation of hyperkalaemia?

A

Fast, irregular rapid pulse, chest pain, weakness, muscle pain, fatigue, kaussmaul respiration if metabolic acidosis

90
Q

Give the 2 main causes of hyperkalaemia?

A

AKI
Drugs eg Spironalactone, ACE, NSAIDS
(accosted with Addisons)

91
Q

Name 3 characteristics of an ECG in a patient with hyperkalaemia?

A

Tall tented T waves, small P waves and a wide QRS

92
Q

Name 3 characteristics of an ECG in a patient with hypokalaemia?

A

Small inverted T waves, prominent U waves, long PR interval and depressed ST segments

93
Q

Give a cause of a false hypocalcaemia?

A

Low serum albumin

94
Q

If serum calcium is low, what changes to QT interval?

A

It gets longer

95
Q

Give 3 causes of hypocalcaemia?

A

Vitamin D deficiency leading to osteomalacia

96
Q

Give 4 causes of hypoparathyroidism?

A

Syndromes, genetic, surgical, radiation, autoimmune, infiltration, magnesium deficiency

97
Q

What is pseudohypoparathyroidism?

A

Resistance to parathyroid hormone

98
Q

What hand abnormality would you see in pseudohypoparathyroidism?

A

short fourth metacarpal

99
Q

What are the two most common causes of hypercalcaemia?

A

Malignancy

Primary hyperparathyroidism

100
Q

How does lymphoma cause hypercalcaemia?

A

Lymphoma has macrophages, macrophages express 1 alpa hydroxyylase which converts 25-hydroxyvitamin D to 1,25 hydroxyvtaiman D

101
Q

What is the major a) extracellular and b) intracellular cation?

A 
Extracellular = Sodium 
Intracellular = Potassium
102
Q

How is osmolality measured?

A

Measured by an osmometer by freezing point

103
Q

Name two methods to diagnose diabetes insidious?

A

Water deprivation test

Hypertonic saline infusion and measurement of AVP (vasopressin)

104
Q

Name 3 tests you would do in a patient with hyponatraemia?

A
  1. Plasma osmolality
  2. Urine osmolality
  3. Plasma glucose
  4. Urine sodium
105
Q

What is a craniophayngioma?

A

Squamous epithelial remnants of Rathke’s pouch

106
Q

What do patients with meningioma usually present with?

A

Loss of visual acuity

Endocrine dysfunction and visual field defects

107
Q

Give 4 consequences of large masses in the pituitary?

A
  1. Visual field defects
  2. CSF rhinorrhoea
  3. Headaches
  4. Cranial nerve palsy
108
Q

What is first line imaging in pituitary dysfunction?

A

MRI

109
Q

Why does a patient need a long acting insulin?

A

Gluconeogenesis, glycogenloysis

110
Q

What are the non-pharmacological management of diabetes?

A

Education - self - management
DAFNE - type 2 diabetes
Exercise - HbA1c <48

111
Q

In pregnancy what are risks for someone with type 1 diabetes?

A

Pre-eclampsia, miscarriage

112
Q

What level is hypoglycaemia?

A

<3mmol, symptoms <4mmol

113
Q

What are the symptoms of hyperthyroid?

A

Tachycardia, sweating, palpitations, hungry, weight loss

114
Q

What is the main causesof hyperthyroid?

A

Graves disease (40-60%)
Toxic multi nodular goitre
Toxic adenoma - bright red hot spot

115
Q

What are triggers of hyperthyroid?

A

Addisons, Type 1 DM, Pregnancy, Stress, Infection

116
Q

What is one of the methods in administrating carbimazole?

A

Block and replace (higher dose carbimzaole) and T4

117
Q

What are the functions of PTH?

A

Increase calcium reabsorption in kidney, increase osteoclast activity (increase calcium), activate vitamin D

118
Q

What is the difference between gigantism and acromegaly?

A

Gigagantism when your growth plates haven’t fused

119
Q

What is the role of Incretins?

A

Released after eating , increase pancreatic B cells to produce insulin to decrease blood glucose and promote satiety

120
Q

Which patients are most at risk of diabetic retinopathy?

A

Long term diabetes, insulin treatment, poor glycemic control and pregnancy

121
Q

In diabetic retinopathy what would you see on fundoscopy?

A

Cotton wool spots, haemorrhage, microanuerisms, macular thickening

122
Q

Give 4 signs of vascular disease in a patient with diabetes?

A

Diminished pedal pulse, cold feet, weak skin and nails, absence of hair on legs

123
Q

Give two educational programmes provided for patients with type 2 diabetes?

A

Desmond, DAFNE

124
Q

Give 5 components of the diabetic review?

A

Take BP, review blood glucose control, review HbA1c and cholesterol levels, advise change in regimen, eye and foot examination, take height and weight

125
Q

What are the triggers for diabetic ketoacidosis?

A

Infection, surgery, MI, pancreatitis, chemotherapy, antipsychotics, non-compliance

126
Q

Give some treatments you would use in diabetic ketoacidosis?

A

Saline bolus (if BP low), IV rapid acting insulin, K+ replacement

127
Q

What are you worries about in a patient with hyperglycaemia?

A

DVT - give prophylaxis

128
Q

What is Phaeochromoctoma?

A

Catecholamine producing tumour arising from chromatin cells - usually found in adrenal medulla

129
Q

What is the triad of presentation in Phaeochromoctoma?

A

Episodic headache, sweating, tacycardia - hypertension

Phase 2a Summaries (12 decks)

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