Endocrinology Flashcards
1
Q
WHAT IS ACROMEGALY?
What is it caused by?
https://www.youtube.com/watch?v=54h3IUbvHDU
A
Too much growth hormone from the pituitary gland
Tumour
or hyperplasia
2
Q
What does the hypothalamus release? What does this cause? In acromegaly
A
Release growth hormone releasing hormone
Stimulates pituitary to release growth hormone
Somatostatin (growth hormone inhibiting hormone)
Decrease growth hormone release from pituitary
3
Q
What do gigantism and acromegaly involve?
A
Increase in growth hormone
4
Q
What is the difference between gigantism and acromegaly?
A
Difference in when growth hormone is released
5
Q
When does gigantism occur?
A
Before the closure of the epiphyseal plates
End up very tall
6
Q
When does acromegaly occur?
A
After epiphyses fuse
Not tall
7
Q
At what age does acromegaly start?
A
At 20-40
8
Q
What are the symptoms of acromegaly?
Go through each topic RS etc
A
RS
Snoring
GI
“Wonky bite” (malocclusion)
Int
↑Sweating
Endo
↑Weight
UG
↓libido; amenorrhoea
MSK
Arthralgia; backache
Neuro
Acroparaesthesia; headache
9
Q
What are the signs of acromegaly?
A
Skin darkening
Acanthosis nigricans
Face
Big supraorbital ridge
Interdental separation
Macroglossia
Prognathism
Laryngeal dyspnoea
Spade-like hands and feet
Tight rings
Carpal tunnel syndrome
10
Q
What are the complications of acromegaly?
A
- *Impaired glucose tolerance** (40%)
- *Diabetes Mellitus** (15%)
Vascular
HTN
LVH
Cardiomyopathy
Arrhythmias
Colon cancer
11
Q
How can you diagnose acromegaly?
A
IGF-1 (somatomedin) tells tissues to grow
Elevated
Glucose tolerance test
75g or glucose
Wait 90 mins measure growth hormone levels
Will stay elevated! Should decrease
Growth hormone levels
Not usually used becaue pulsatile
CT or MRI
Could be no tumour, could be ectopic source
12
Q
What is the treatment of acromegaly?
A
Trans-sphenoidal Surgery
Radiation
Medications - suppress GH
Somatostatin anaologues
Octreotide
Recombinant GH receptor antagonist
Pegvisomant
13
Q
WHAT IS PROLACTINOMA?
A
14
Q
WHAT IS CUSHING SYNDROME?
https://www.youtube.com/watch?v=ea1sXgd5ui8
A
Endocrine disorder with elevated cortisol levels in the blood
15
Q
What is the cause of cushings DISEASE?
A
Pituitary adenoma making excess ACTH
16
Q
What does the hypothalamus secrete in cushing’s?
A
Corticotropin releasing hormone
17
Q
What does CRH stimulate?
A
Pituitary gland to release adrenocorticotropin hormone (ACTH)
18
Q
What does ACTH do?
A
Affects cells in the adrenal cortex of the adrenal glands
19
Q
What is the outer layer of the adrenal glands split into?
A
Zona glomerulosa
Zona fasiculata
Zona reticularis
20
Q
What is the zona festiculata?
A
Largest zone
Stimulate cells in this zone to secrete cortisol
Cortisol is a glucocorticoids
21
Q
What are glucocorticoids not?
What are they bound to?
How much is free in the blood?
A
Soluble in water
Cortisol-binding globulin
Only 5% free in blood
Less than that is active
22
Q
What happens to excess free cortisol?
A
Filtered in kidneys and put into urine
23
Q
What is free cortisol involved in?
(Type of cycle)
A
Part of circadian rhythm
High in moring
Low at night
24
Q
So if there is a problem with cortisol levels what would this lead to?
A
Problems with circadian rhythm
25
What happens to cortisol during stress?
What does it do?
(type of process)
**_Increaes_**
Increase gluconeogenesis
Increase lipolysis
Increase proteolysis
26
How does cortisol maintain blood pressure?
Increase sensitivity of peripheral blood vessels to catecholamines
Adrenaline and noradrenaline
This narrows the blood vessel lumen
27
What does cortisol do to the immune response?
Decereases the production and release of inflamatory medaitors
Prostaglandins and interleukins
Inhibiting T-lymphcytes
28
What is cortisol involved with in the brain?
Mood and memory
29
How does the body keep control of cortisol?
Negative feedback mechanisms
Decrease production of CRH and ACTH
Less CRH causes less ACTH too
30
What does excess cortisol lead to?
Overload of what it normally reacts with
Severe muscle, bone and skin breakdown
Hypertension
Inhibit gonadotropin releasing hormone from hypothalamus
Dampens inflammatory response
More susceptible to infections
Impair normal brain function
31
What does elevated breakdown of muscle, bone and skin cause?
(What does this produce)
**_Elevated blood glucose_**
**_High insulin levels_**
Targets adipocytes in center of body
Activates lipoprotein lipase
Accumulate more fat molecules
**_Cause_**
Moon face
Buffalo neck hump
32
How is hypertension caused by excess cortisol?
Amplifies effect of catecholamines on blood vessels
Cortisol cross reacts with mineralcorticoid recptors
Mineralcorticoids released from zona glomerulosa
Triggers mineralcorticoid effect which is increasing blood pressure by retaining fluid
ALDOSTERONE
33
What does the inhibition of gonadotropin releasing hormone do?
Messes up ovarian and testicualr function
34
What are the causes of Cushing's?
**_Exogenous cortisol_**
Medications (steroids)
**_Endogenous_**
_Pituitary adenoma_
Cushing disease
Cells don't invade other tissues
_Small cell lung cancer_
ACTH
_Tumour of the adrenal glands_
Adrenal carciomas
Adrenal adenoma
35
Why do steroids cause Cushing's?
Structure very similar to cortisol
Mimics action on tissue
Negative feedback on hypothamus and pituitary
36
How do the steroids affect the zona fesiculata?
Causes it to shrink in size
Because of lack of stimulation
37
How does a pituitary adenoma cause a rise in cortisol?
Causes the pituitary gland to secrete more ACTH
This affects the zona fasiculata
Causing it to grow in size
Secrete excess cortisol
38
What does a tumour on one adrenal gland do?
Divide abnormally and secrete excess cortisol
Suppress CRH and ACTH production
Other gland shrinks
39
What are the symptoms of Cushing's?
Muscle wasting and thin extemities
Easy brusing
Abdominal striae
Fractues - osteoporisis
Full moon shaped face
Buffalo hump
Truncal obesity
**_Hypergylcemia_**
Diabetes mellitius
Hypertension
Cardiovascular disease risk
Increase vulnerability to infections
Poor wound healing
Amenorrhea
Psychiatric
40
What is the diangosis of Cushing's?
**_ENDOGENOUS_**
Dexamethasone suppresion test
Low dose of dexamethasone (steroid)
Supressess ACTH production
Should cuase decrease cortisol levels
**_24 urine sample_**
Measuring free cortisol
**_Blood or saliva tests_**
Normal daily rise and fall of cortisol
41
What is the next stage after dexamethosone supression test?
**_ACTH plasma levels checked_**
**_Low_** ACTH gives diagnosis of
Adrenal adenomas and carcinoma
**_High_** ACTH gives diagnosis of
Cushing disease and ectopic ACTH production
42
What is the next stage if there is a high ACTH?
Injection of high amount of dexamethasone
Ectopic sites won't respond
43
What types of imaging can be used?
MRI of pituitary
CT of adrenals
CT of chest abdomen or pelvis for ectopic
44
What is the treatment for Cushing's?
**_Exogenous_**
Drug is gradually stopped
Adrenal crisis if too fast
Adrenal glands might be atrophied
**_Endogenous_**
Surgery
Adrenal steroid inhibitors
Ketoconazole and metyrapone
Most useful ectopic
45
What are you at risk of if you have your adrenals removed?
Nelson's syndrome
Skin pigmentation increase
46
WHAT IS SYNDROME OF INAPPROPRIATE SECRETION OF ADH?
(Start with what it results in)
https://www.youtube.com/watch?v=0NHT8ERUBo0
Hyponatremia and hypo-osmolality
From inappropriate, continued secretion of ADH
Despite normal or increased plasma volume
Which results in impaired water excretion
47
What hormone controls water retention in the body?
What is it also called?
What does it also do?
ADH (vasopressin)
Also contricts arteries
48
What happens with the different levels of ADH?
More gives more water retention
Less gives less water retention
49
Where does ADH have its action on the nephron?
Distal convoluted and the collecting duct
50
What are the channels called that move into the membranes in the nepheron?
Aquaporins
51
What happens to the plasma osmolality when water is drunk?
Drops
52
What part of the body controls water regualtion?
Hypothalamus
53
What does the hypothalamus signal?
Pituitary
54
What does the pituitary do?
Decrease ADH
Less water retention
Increase osmolality
55
What happens if ADH continues to be secreted even if the plasma osmolality is low?
Increase aquaporins and increased water retention
Dilutes blood
Which dilutes sodium and also takes up more space
56
What does this taking up of more space cause to happen(hormone)?
Decrease aldosterone
57
What does the decrease in aldosterone do?
Excretes more sodium
This makes water follows
However end up with a very low sodium osmolality
Leading to SIADH
58
What are the different types of SIADH?
**_Type A_**
**_Type B_**
**_Type C_**
**_Type D_**
59
What is type A SIADH?
Erratic
Independent of plasma osmolality
Massive increase of ADH
Massive increase of urine osmolality
60
What is type B SIADH?
Constant release of ADH
61
What is type C of SIADH?
Baseline concentration of sodium is low
But is stable
62
What is type D SIADH?
ADH normal
Massive increase in urine osmolality
63
What are the symptoms caused by in SIADH?
Derived from decreased sodium in the blood
64
What are the symptoms of SIADH?
Dehydration
Headaches
Nausea
Vomiting
Muscle cramps
Cerebral oedema, Confusion, Mood swings
Seizure, Coma, Death
65
What is the diagnosis of SIADH?
Symptoms and lab results
**_Blood_**
Low sodium and low osmolality
**_Urine_**
High urine osmolality and high sodium
66
What causes SIADH?
Infection
Strokes
Haemorrhage
MS
**_Drugs_**
Mood stabilizers
Anti-epileptics
**_Surgery_**
Increased ADH secretion
**_Ectopic ADH_**
Small cell lung cancer
67
What is the treatment for SIADH?
**_Treat underlying cause_**
Restrict daily intake of fluid
High salt and protein diet
Inhibit ADH secretion drugs
Tolvaptan
Hypertonic IV fluids
68
THYROID DISORDERS?
69
What are the hormones produced by the thyroid gland?
**_Triiodothyronine (T3)_**
Active version x5 more
**_Thyroxine (T4)_**
70
What do the thyroid hormones do?
Burn foods
Stimulates sympathetic nervous system
GI motility
Increase heart rate
Increase blood pressure
Temperature
71
What does the hypothalamus release?
TRH
72
What does the pituitary release?
TSH
73
WHAT IS HYPOTHYROIDISM?
Low production of thyroid hormones
74
What is primary and secondary hypothyroidism?
Primary is a reduction in thyroxin (T4)
Secondary is a reduction in TSH
75
What are the causes of primary hypothyroidism?
Primary atrophic hypothyroidism (No goitre)
Hashimoto’s thyroiditis (Goitre)
Iodine deficiency
Post-thyroidectomy / radioiodine / antithyroid drugs
Lithium / amiodarone
76
What are the causes of secondary hypothyroidism?
Hypopituitarism
77
WHAT IS HASHIMOTO's THYROIDITIS?
| (inside hypothyroidism)
Autoimmune disease
78
What are the antibodies in hashimoto's thyroiditis?
TRAbs = TSH receptor antibodies
Anti-Tg = Thyroglobulilin antibodies
TPOAb = Thyroperoxidase antibodies
79
What is the epidemology of hashimoto's thyroiditis?
Older Women
80
What are the symptoms of hypothyroidism?
**_RS_**
Hoarse voice
**_GI_**
Constipation
**_Int_**
Cold intolerance
**_Endo_**
Weight gain
**_UG_**
Menorrhagia
**_MSK_**
Myalgia, weakness
**_Neuro / Psych_**
Tired, low mood, dementia
81
What are the signs of hypothyroidism?
* *_B_**radycardic
* *_R_**eflexes relax slowly
* *_A_**taxia (cerebellar)
* *_D_**ry, thin hair / skin
* *_Y_**awning / drowsy / coma
* *_C_**old hands +/- ↓T°C
* *_A_**scites
* *_R_**ound puffy face
* *_D_**efeated demeanour
* *_I_**mmobile +/- Ileus
* *_C_**CF
82
What are the investigations for hypothyroidism?
**_TFT_**
TSH RAISED
**_Lipids/cholesterol_**
High
**_FBC_**
Macrocytosis
83
What are the associations of hypothyroidism?
**_AUTOIMMUNE_**
Type 1 Diabetes Mellitus
Addison’s disease
Pernicious anaemia
Primary biliary cirrhosis
**_INHERITED_**
Turner’s syndrome
Down’s syndrome
Cystic fibrosis
84
What is the treatment of hypothyroidism?
Levothyroxine (T4)
Higher doses in the young
85
WHAT IS HYPERTHYROIDISM?
Too much thyroid hormones
86
What are the causes of hyperthyroidism?
GRAVES’ DISEASE
TOXIC MULTINODULAR GOITRE
TOXIC ADENOMA
ECTOPIC THYROID TISSUE (mets / struma ovarii)
EXOGENOUS (Iodine / T4 excess)
DE QUERVAIN’S THYROIDITIS (post-viral)
87
What happens in graves disease?
What are the triggers?
Autoimmune
IgG autoantibodies bind to and stimulate TSH receptors
Infection, stress, childbirth
88
What are the classic symptoms of graves disease?
Eye disease, pretibial myxoedema, thyroid acropachy
Autoimmune (vitiligo, type 1 DM, Addison’s)
89
What are the symptoms of hyperthyroidism?
**_CVS_**
Palpitations
**_GI_**
Diarrhoea
**_Int_**
Heat intolerance
**_Endo_**
↓Weight, ↑appetite
**_UG_**
Oligomenorrhoea +/- infertility
**_Neuro / Psych_**
Tremor, irritability, labile emotions
90
What are the signs of hyperthyroidism?
**_HANDS_**
Palmar erythema; warm, moist skin; fine tremor
**_PULSE_**
Tachycardia; SVT; AF
**_FACE_**
Thin hair; lid lag / retraction
**_NECK_**
Goitre; nodules; bruit
91
What are the investigations for hyperthyroidism?
**_TFT_**
Increase T4 and T4
**_FBC_**
Normocytic anaemia
**_ESR (↑)_**
**_Calcium (↑)_**
**_LFT (↑)_**
**_Thyroid autoantibodies_**
**_Visual fields, acuity, eye movements_**
92
What is the treatment for hyperthyroidism?
**_β-blockers_**
Propanolol(rapid control of symptoms)
**_Antithyroid medication_**
Carbimazole SE = AGRANULOCYTOSIS
Block and replace (carbimazole + thyroxine)
**_Radioiodine (131I)_**
**_Thyroidectomy_**
93
What are some causes of goitre?
Physiological
Graves’ disease
Hashimoto’s thyroiditis
De Quervain’s
94
What are the thyroid cancers?
Papillary (60%)
Follicular (≤25%)
Medullary (5%)
Lymphoma (5%)
Anaplastic
95
WHAT IS PRIMARY ADRENAL INSUFFIENCY?
https://www.youtube.com/watch?v=V6XcBp8EV7Q
The adrenal glands can't produce enough hormones
Aldosterone and cortisol
Primary refers to the adrenal glands themselves
96
What can addison's disease be?
Acute and chronic
97
What are the different layers of the adrenal glands?
**_Cortex_**
Zona glomerulosa
Zona fasiculata
Zona reticularis
**_Medulla_**
98
What does the zona glomerulosa produce?
Aldosterone
99
What does the renin, angiotensin aldosterone system do?
Decrease potassium
Increase sodium
Increase blood volume and pressure
100
What is aldosterone stimulate by?
Renin
101
What is aldosterones actions?
Bind to receptors on the distal convulted tubules
**_Sodium potassium ion pumps of principal cells_**
Work harder
Drive potassium into cell from blood
Flows down concentration gradient into urine
At same time sodium goes in the opposite direction
Water also moves into blood
Increasing blood pressure
**_Proton/ATP pumps in alpha-intercalated cells_**
More protons secreted into urine
Bicarbonate pumped into blood
Increases pH
102
What is produced in the zona fasiculata?
Cortisol and glucocorticoids
103
How is cortisol released?
Hypothalamus releasing corticotropin releasing hormone
Acts on pituitary
This releases adrenocorticotropin into blood
Acts on zona fasiculata
104
What is special about cortisol?
Lipid soluble and can act on many cells in the body
105
What is a function of cortisol?
Gluconeogensis
From muscle
and fat
106
What does insulin do?
Reduce glucose levels in blood
107
What does the zona reticularis do?
Make androgens
E.g. deyhydroepiandosterone
Precursor to testosterone
108
What does testosterone do in males?
Contributes to development of male reproductive tissue
Secondary sex characteristics e.g. facial hair and adams apple
109
What is testosterone do in females?
Growth spurt in development
Underarm and pubic hair during puberty
Increase sex drive in adulthood
110
What is the production of androgens stimulated by?
ACTH
111
What happens to the adrenal cortex in primary adrenal insufficiency?
Gets progressively damaged
112
What are the causes of primary adrenal insuffiency?
In developed countries
**_Autoimmune destruction_**
Unclear reason
Developing countries
**_Tuberculosis_**
Infection spreads from lungs to adrenal glands
**_Metastatic carcinoma_**
113
What does the adrenal cortex have which allows it to keep healthy?
High functional reserve
Allows it to keep up with small amount of cells present
114
What do the symptoms of primary adrenal insufficiency depend on?
Which part of the adrenal cortex has been destroyed
115
What happens if the zona glomerulosa is destroyed?
Aldosterone levels fall
Leads to high potassium levels in the blood
Low sodium - hyponatremia
Low sodium water moves out of the blood vessels
Hypovolemia
High protons in blood
Metabolic acidosis since it's caused by the kidneys
116
What are the symptoms if the zona glomerulosa is affected?
Cravings for salty foods
Nausea and vomiting
Fatigue
Dizzyness
117
What happens if the zona fasiculata is destroyed?
Cortisol falls
Inadequate glucose levels in times of stress
Pituitary glands become overactive
Since usually cortisol has negative feedback on pituitary
Produces proopiomelinocortin
Precursor to ACTH and MSH
118
What are the symptoms if the zona fasiculata is destroyed?
Fatigue in times of stress
Hyperpigmentation on knuckles and joints
119
What happens if the zona reticularis is destroyed?
Men not affected
Testes major source of male androgens
Females
Loss of pubic hair
decreased sex drive
120
What does primary adrenal insuffiency usually need to cause symptoms?
Symptoms often slow,
Major stressor comes along
Injury, surgery or infection
Cause symptoms to appear
Sudden need for aldosterone and cortisol
121
What is it called when the body suddenly needs aldosterone or cortisol and the body can't deliver?
Addisonian crisis (acute primary adrenal insufficiency)
122
What are the symptoms of addisonian crisis?
Pain in back abdomen or legs
Vomiting and diarrhoea leading to dehydration
Low blood pressure leading to loss of consciousness
Death
123
What syndrome can cause an addisonian crisis?
Waterhouse-friderichsen syndrome
Causes blood vessels in adrenal glands to rupture
124
How can you diagnose addison's disease?
**_ACTH hormone test_**
Small amount of synthetic ACTH injected
Measure cortisol and aldosterone produced
Both will be low
**_Bloods_**
FBC(anaemia, eosinophilia)
U&E(↓Na+, ↑K+, ↑Ca2+, ↑Urea)
BM(↓)
125
What is the treatment for addison's disease?
Homones
Cortisol
Aldosterone
Androgens
Take for life
Stopping can lead to crisis
126
WHAT IS SECONDARY ADRENAL INSUFFICIENCY?
Lack of ACTH
and therefore cortisol
127
What are the causes for secondary adrenal insufficiency?
**_Medications_**
Glucocorticoids
Pituitary mass or infection
128
Why is aldosterone unaffected in secondary adrenal insufficiency?
Aldosterone secretion independent of ACTH
129
What is the diagnosis of secondary adrenal insufficiency?
**_Bloods_**
Low cortisol
130
What is the treatment for secondary adrenal insufficiency?
Glucocorticoid analogues
131
WHAT IS CONN'S SYNDROME?
https://www.youtube.com/watch?v=JBfkGNr01V8&t=1s
Hyperaldosteronism
Adenoma of the glandular epithelial cells
Secrete too much aldosterone
132
If there is high aldosterone levels, what will the ion levels be in the blood?
Potassium low
Sodium high
Less protons
133
What do the ions in the blood in conn's syndrome cause?
Hypertension
Metabolic alkolosis
134
What are the symptoms of Conn's syndrome?
Headaches and flushing
Constipation
Weakness
Heart rhythm changes
135
What is the diagnosis of Conn's syndrome?
**_Bloods_**
High levels of aldosterone
Low levels of renin
136
What is the treatment for Conn's syndrome?
**_Potassium sparing diuretic_**
Spirinolactone
**_Surgery_**
Remove tumour
137
WHAT DIABETES MELLITUS?
Trouble moving glucose from blood into cells
High level in blood
Not alot in cells
138
How does the body control movement of glucose in and out of cells?
Insulin
Decrease glucose
Glucagon
Increase glucose
139
Where are the hormones released from to monitor blood glucose?
Islets of langerhans
Beta cells in the middle release insulin
Alpha cells on the periphery release glucagon
140
What happens in a cell when insulin is released into the blood?
Insulin in the blood binds to receptors on muscle cells or adipose tissue
Causes vesicles containing glucose transporters to fuse with membrane
Allows glucose to enter
141
What does glucagon do?
Causes the liver to make glucose from other sources
Breaks down glycogen into glucose
Put into blood
142
What happens in diabetes mellitus?
Too much glucose in blood
143
How much of the population has diabetes mellitus?
10%
144
What are the different types of diabetes?
Type 1
10%
Type 2
90%
145
What is type 1 diabetes mellitus?
Body doesn't produce enough insulin
146
What does the immune system do in type 1 diabetes and what type of hypersensitivity is it?
Bodies own cells attack the pancreas
Type 4 hypersensitivty reaction
Cell-mediated response
147
What are antigens made up of?
Peptides
Polysaccarides
Lipids
148
What is the process that gets rid of T cells which attack our own cells called?
Self tolerance
149
What happens with type 1 diabetes which loses self tolerance?
Genetic abnormality
Loses self tolerance of T cells attacking beta cells
T cells attract other T cells
150
What happens if beta cells are destoryed?
Glucose accumilates in blood
151
What genes encode the MHCs?
What chromosome are they on?
HLA system
Chromosome 6
152
Which genetic genes are affected in type 1 diabetes?
HLA-DR3
HLA-DR4
No everyone develops diabetes
153
What are the symptoms of type 1 diabetes?
Polyphagia
Glycosuria
Polyuria
Polydipsia
154
How does polyphagia happen?
Glucose can't get into cells
Starved of glucose
Adipose tissue breaks down fat
Muscles break down protein
Causes weight loss and hunger
155
How does glycosurina and polyuria happen?
Lots of glucose in blood goes into urine
Since glucose is osmotically active it draws water into it leading to polyuria
156
How does polydipsia happens?
Since there is so much urination it leads to move drinking
157
What are some complications of diabetics with bad control?
Vascular disease
Nephropathy
Neuropathy
Diabetic foot
Retinopathy
158
What is the treatment for type 1 diabetes?
Lifelong insulin injections
Education
159
What is a big complcation of type 1 diabetes?
Diabetic ketoacidosis
160
What happens when the body breaks down fat?
Turns fat into fatty acids
161
What does the liver turn the fatty acids into?
Ketone bodies
Acetoacitic acid
Ketoacid
Beta-hydroxybutyric acid
Reduced ketone
162
What are ketone bodies used for?
Energy by cells
163
What can ketones do to the blood?
Make the blood acidic
164
What does making the blood acidic do to the body to compensate?
Kussmaul respiration
Deep/labored breathing
To reduce CO2
Reduce acidity
165
What transporter to cells have on their surface?
Proton potassium transporter
166
When there is no insulin what problem does this cause for cells?
Insulin also activates a potassium sodium pump
If there is none like in diabetes pump doesn't work
More potassium stays outside of the cell
Gets into blood and causes hyperkalaemia
167
What does the body do with all the potassium in the blood with diabetes?
Excretes it
But levels of potassium in cells stays low
168
What is the high anion gap in diabetes?
Large measured difference in negative and positive ions
This is from ketoacid build up
169
How can a diabetic ketoacidosis happen in somebody who already has insulin treatment?
A stress e.g. infection
Release of epinephrine
Release of glucagon
More glucose in blood
Loss of glucose in urine
Loss of water
Dehydration
Need for alternative energy
Generation of ketone bodies
170
What do the ketone bodies break down into? What does this cause to the breath?
Acetone
Fruity smell
171
What does ketoacidosis cause?
Nausea
Vomiting
Mental status changes
Cerebral oedema
172
What is the treatment for diabetic ketoacidosis?
Fluids for dehydration
Insulin to lower blood glucose
Electrolytes (K+)
173
What is type 2 diabetes mellitus?
Body makes insulin but the cells don't respond
Not fully understood
174
What happens when insulin gets to the cell?
Cells don't respond
Transporters don't go to the membrane
Insulin resistance
175
What are the risk factors for type 2 diabetes?
Obesity
Lack of exercise
Hypertension
176
What is thought to be a cause of diabetes type 2?
Excess of adipose tissue releases free fatty acids and adipokines
These two molecules can cause inflammation
This is related to insulin resistance
177
What genetic factors show genetic link with diabetes type 2?
Having a twin with type 2 diabetes dramitically increases the risk of having diabetes in the twin
178
What happens to the glands in the pancreas as a result of the cells not responding to insulin?
Secrete more insulin leading to beta cell hyperplasia and hypertrophy
179
What is normoglycemia?
Insulin levels high when cells don't respond to insulin
Blood glucose levels remain normal
180
What other protein do the beta cells release?
Islet amyloid polypeptide (amylin)
181
What happens in the beta cells of the pancreas after a while when they are trying to compensate?
Hypotrophy and hypoplasia
182
What happens when the beta cells of the pancreas decrease?
Less insulin leading to hyperglycemia leading to polyuria etc etc
183
What is different from type 1 diabetic ketoacidosis from type 2 diabetic ketoacidosis?
Insulin and glucagon balance is okay
so diabetic ketoacidosis doesn't occur
184
What is the state that is much more common in type 2 diabetes?
Hyperosmolar, hyperglycemic state
185
What does hyperosmolar, hyperglycemic state cause?
Plasma osmolarity from dehydration
Increase concentration in glucose in blood
Sometimes mild ketoemia and acidosis
186
What happens to the cells in HHS?
They shrivel up as water leaves them to go into the blood
187
What does increased water in blood vessels do?
Lead to increased urination
and total body dehydration
188
What does total body dehydration lead to?
Mental status changes
189
What does HHS overlap with?
Diabetic ketoacidosis
190
What are the test for diabetes?
**_Fasting glucose_**
No food or drink for 8 hours
7 mmol/l or over indicates diabetes
**_Non-fasting or random glucose_**
Over 11.1 mmol/l
**_Oral glucose tolerance_**
Over 11.1 mmol/l at 2 hours
**_HbA1C_**
Percentage or red blood cells with glucose on
48 or higher
191
What is a complication of diabetes in blood vessels?
Cause damage to microvasculature
Hyalinearteriscleorsis
In capillaries basement membrane thickens
Makes hard to oxygen transfer
Hypoxia
Medium and large wall damage
Athersclerosis
192
What systemic problems can diabetes cause?
Retinopathy
Kidneys
Nephrotic syndrome
Nerves
Decrease in sensation
Stocking-glove distribution
193
WHAT IS CARCINOID SYNDROME?
What three symptoms are under the syndrome?
Specific type of tumour
Causes neuroendocrine cells to secrete hormones
**_Syndrome_**
Diarrhoea
SOB
Flushing
194
Where are neuroendocrine cells found?
Epithelial layer of GI organs and lungs
195
How are neuroendocrine cells activated and what can they release?
**_Nerves_**
Serotonin
Histamine
Bradykinin
Prostaglandins
196
Where is somatostatin released from and what does it act on?
What does it inhibit?
Hypothalamus + GI tract
Acts on surface of neuroendocrine cells
Serotonin
197
What happens to serotonin?
What is it metabolised to?
What happens to the reamining serotonin?
Goes to the liver through the portal vein where it is metabolised
5-hydroxyindoleacetic acid
Goes into blood stream
198
What are the actions of serotonin?
**_GI_**
Increased motility and peristalsis
**_Blood vessels_**
Taken by platelets and constrict blood vessels
**_Heart_**
Stimulates fibroblasts to make collagen
199
Where is the most common place for a cacinoid tumour and what do they also produce more of?
GI tract
Somatostatin receptors
200
Where is the most common site for a neuroendocrine tumour to metastisize?
Liver
201
What is often neccesary for carcinoid syndrome?
Why?
Metastatisis to the liver
Liver normally metabolises the hormones released from the tumours so they build up
Causing symptoms
202
What does the increase in histamine and bradykinin do?
Dilates blood vessels causing flushing
203
What does the increase in serotonin cause?
**_Fibrosis of heart_**
Tricuspid valve regugitation
Pulmonary stenosis
**_Bronchoconstriction_**
Asthma
Shortness of breath
```
**_Reduces tryptophan_**
Reduces niacin (vit b3)
Pellagra
```
204
What are the symptoms of carcinoid syndrome?
Diarrhoea
SOB
Flushing
Itching
205
What are symptoms of carcinoid syndrome worsened by?
Alcohol
Emotional stress
206
What is the diagnosis for carcinoid syndrome?
CT scan
**_Octreoscan_**
Inject radioactive labelled octreotide
Binds to increase number of somatostatin
**_Urinalysis_**
5-hydroxyindoleacetic acid
**_Blood tests_**
Niacin deficiency
207
What is the treatment for cacinoid syndrome?
**_Somatostatin analogues_**
Octreotide
**_Decrease_**
Emotional stress
Alcohol
**_Carcinoid tumour_**
Surgery
Chemo
208
WHAT IS HYPOCALCEMIA?
Low calcium in the blood
\<8.5mg/dl
209
What detects a change in calcium?
Parathyroid cells called calcium sensing receptor
210
What does parathyroid hormone do?
More
Increases release of calcium from bones
Kidneys to absorb more calcium
Kidneys to synthesie more calcitriol
Calcitriol makes the GI tract absorb more calcium
Keep extracellualr calcium in range
8.5-10mg/dl
211
What happens if there is a high ph or alkolosis?
Very few protons around
COO- form of albumin
More negative
Calcium attracts more to albumin
Less free ionized calcium
Symptoms of hypocalcemia
212
What are the causes for hypocalcaemia?
**_Vit D deficiency_**
Diet
Lack of sunlight
Malabsoption
**_Magnesium deficiency_**
**_Hypoparathyroidism_**
213
What are the other sings and symptoms of low calcium?
Chvostek's sign
Trousseau's sign
Muscle cramps
Abdominal pain
Perioral tingling
Seizures
214
How do you diagnose hypocalcemia?
Low calcium in blood \<8.5mg/dl
**_ECG_**
Prolonged QT interval
Prolonged ST segments
Arrythmias
**_Lab tests_**
Parathyroid hormone
Vitamin D
Albumin
Phosporus
Magnesium
215
What is the treatment of hypocalcemia?
Normalize calcium levels
Calcium gluconate
Vitamin D supplementation
216
WHAT IS HYPERCALEMIA?
Higher than normal calcium levels in the blood \>10.5mg/dl
217
What happens when there is a low ph or acidosis?
Lots of protons
COO- pick up a proton
Become COOH
More COOH becomes more positive
Calcium and albumin repel eachother
Increase in ionized calcium in blood
218
Whatare some causes of hypercalcemia?
**_Increased osteoclast activity_**
Increased parathyroid
**_Too much vitamin D_**
Diet or from supplements
**_Medications_**
Thiazide diuretics
Increased reabsorption
219
What do the kidneys do when there is hypercalcemia?
Dump more calcium in urine
Hypercalciuria
Loss of fluid
Dehydration
Leads to calcium oxalte stones
220
How is hypercalcemia diagnosed?
High levels of calcium in blood \>10.5mg/dl
**_ECG_**
Bradycardia
AV block
Short QT interval
Osbourne wave
**_Lab tests_**
Parathyroid
Vitamin D
Albumin
Phosphorus
Magnesium
221
What is the treatment of hypercalcemia?
HYDRATION
DIURETICS
GLUCOCORTICOIDS (EXCRETION)
BISPHOSPHONATES
222
WHAT IS DIABETES INSIPIDUS?
Lack of ADH
223
What happens from a lack of ADH?
Water not sufficiently reabsorbed from collecting duct
Large amounts of undiluteurine
224
What are the symptoms of diabetes insipidus?
Polydipsia
Polyuria
Dehydration
Hypernatremia
225
What is central and nephrotic diabetes insipidus?
**_Central problem with hypothamus and pituitary_**
ADH low
**_Nephrotic problem with kidneys_**
ADH high
226
What are the causes of central diabetes insipidus?
Tumour
Lack of blood supply (incSheehan’s)
Impact/fracture
Surgical
Autoimmune
227
What are the nephrogenic causes of diabetes insipidus?
Lithium toxicity
Release of obstruction
Hypercalcemia
Hypokalaemia
228
How can you determine the cause of diabetes insipidus?
Give desmopressin
If urine output falls, osmolality increases
Suggests central
229
What is the treatment of diabetes insipidus?
**_Central_**
Desomopressin
**_Diuretics_**
Hydrocholorothiazide
230
Why do you give a patients diuretics with nephrotic diabetes insipidus?
Promote water AND SALT LOSS
Activate RAAS!!
231
WHAT IS HYPERKALAEMIA?
High amount of potassium in the blood
\> 5.5mmol/L
232
What are the causes of hyperkalaemia?
**_External_**
Beta blocker
ACEi
**_Internal_**
Diabetes mellitus
Acidosis (H+ for K+ that are inside cells)
Rhabdomyolysis
Oliguric renal failure
Addison’s
Burns
233
What can hyperkalaemia lead to?
Myocardial excitability → VF and cardiac arrest
234
How can you diagnose hyperkalaemia?
**_ECG_**
Tall tented T waves
Small P waves
Wide QRS (eventually becoming sinusoidal)
VF
235
What is the treatment for hyperkalaemia?
**_Insulin_**
Drive K+ into cells
**_Treat underlying cause_**
**_Polystyrene sulfonate resin_** (binds K+ in gut)
**_Calcium gluconate_** (Stabilize membrane potential)
236
WHAT IS HYPOKALAEMIA?
Low potassium in blood
\< 3.5mmol/L
237
What are the causes of hypokalaemia?
**_External_**
Diuretics; V/D
**_Internal_**
Excess Insulin
Alkolosis
Cushing’s
Conn’s (Increased aldosterone)
238
What are the symptoms of hypokalaemia?
**_Smooth muscle_**
Constipation
**_Skeletal muscle_**
Weakness
Cramps
239
How is hypokalaemia diagnosed?
Low potassium in blood
**_ECG_**
Prolonged QT interval
Prolonged PR interval
U wave
Arrthymias
240
What is the treatment for hypokalaemia?
Treat underlying cause
Supplements
Potassium sparing diuretics
241
WHAT DOES THE PARATHYROID DO?
What does this hormone do?
Release parathyroid hormone
Increases bone resorption
Increases calcium absorption in kidneys
Increases Vit D synthesis in kidney
Vit D increases GI absorption
242
What does the thyroid release in high levels of calcium?
What does this do?
Calcitoin
Increase bone deposition
Decrease kidney absorption of calcium
243
WHAT IS HYPERPARATHYROIDISM?
Increase in parathyroid hormone
244
What are the different causes of hyperparathyroidism?
**_Primary_**
Adenoma
**_Secondary_**
PTH is high to attempt to correct persistently low calcium levels
**_Tertiary_**
After many years of uncorrected secondary hyperparathyroidism
245
What are the symptoms of hyperparathyroidsm?
STONES, BONES and GROANS
**_Increased Ca2+_**
Weak, tired, depressed, thirsty, renal stones, abdopain.
**_Bone resorption_**
Pain, fractures, osteopenia/porosis.
**_Increased BP_**
Check Ca2+ in hypertension.
246
What are the tests for primary hyperparathyroidism?
**_PTH_**
High
**_Calcium_**
High
**_Phosphate_**
Low
**_Phosphatase_**
High
247
What is the treatment for primary hyperparathyroidism?
Treat underlying cause
248
What are the causes of secondary hyperparathyroidism?
**_CKD_**
**_vit D deficiency_**
GI disease such as bypass and Crohn’sare also possible
249
What are the symptoms for hyperparathyroidism?
Bony
Osteomalacia
250
What are the tests for secondary hyperparathyroidism?
**_PTH_**
High
**_Calcium_**
Low
**_Phosphate_**
High
**_Phosphatase_**
High
251
What is the treatment for secondary hyperparathyroidism?
Treat underlying cause
Bisphosphonates
252
WHAT IS HYPOPARATHYROIDISM?
Low levels of parathyroid hormone
253
What are the causes of hypoparathyroidism?
**_Primary_**
AI, congenital (Di George syndrome)
**_Secondary_**
Radiation, surgery, hypomagnesaemia
254
What are the signs of hypoparathyroidism?
Hypocalcaemia
SPASMODIC
Spasms
Trousseau’s on inflation of cuff
anxious
seixures
Chvostek’s – tap facial nerve over parotid – corner of mouth twitches.
255
What is the treatment of hypoparathyroidism?
Ca2+ supplements
Calcitriol (prevents hypercalciuria)
