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Phase 2a > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Insulin sensitivity (increases/decreases) in acromegaly

A

decreases

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2
Q

What is a possible complication of acromegaly due to the tongue enlarging and obstructing the airway?

A

Sleep apnoea

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3
Q

The equivalent of acromegaly seen in children is called?

A

Gigantism

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4
Q

What is the most common cause of death in patients with acromegaly?

A

Dilated cardiomyopathy

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5
Q

What is the most sensitive diagnostic test for diagnosing acromegaly?

A

Serum insulin like growth factor-1

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6
Q

What happens to serum growth hormone levels after oral glucose tolerance test in patients with acromegaly

A

remain high

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7
Q

What are the signs of acromegaly?

A

increased lateral growth of bones and soft tissues
aural enlargement
maxillofacial changes (prominent forehead)
excessive sweating

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8
Q

What are the symptoms of acromegaly?

A

headache

hypogonadal symptoms

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9
Q

What is the most common cause of acromegaly?

A

pituitary adenoma: made up of somatotropin &raquo_space; continue to make excess GH&raquo_space; increase in ILGF-1

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10
Q

What GH receptor antagonist can be used to treat acromegaly?

A

Pegvisomant

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11
Q

Which somatostatin analog is used in acromegaly to inhibit the release of growth hormone?

A

Octreotide

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12
Q

How does acromegaly affect the glucose levels?

A

glucose levels are increased

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13
Q

In premenopausal women, hyperprolactinemia most commonly presents as….

A

amenorrhoea or oligomenorrhoea

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14
Q

Due to dopamine receptor antagonism which drug class are associated with galactorrhea and hyperprolactinemia?

A

antipsychotics

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15
Q

In postmenopausal women, hyperprolactinemia most commonly causes the manifestations of….

A

Brain mass effect

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16
Q

In hyperprolactinemia, serum prolactin is usually above what value?

A

200ng/dl

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17
Q

Which calcium channel blocked can cause hyperprolactinemia?

A

Verapamil

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18
Q

What is the best initial test for diagnosing hyperprolactinemia?

A

Serum prolactin

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19
Q

Before diagnosing hyperprolactinemia in a young woman, what do you need to rule out?

A

pregnancy

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20
Q

What does the hypothalamus secrete to suppress the release of prolactin?

A

dopamine

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21
Q

If the patient with primary hyperprolactinemia desires pregnancy, then what should the first line treatment be?

A

Surgical excision (Xbromocriptine)

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22
Q

What are the physiological causes of hyperprolactinaemia?

A

pregnancy and breast feeding

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23
Q

What is the preferred dopamine agonist for treating prolactinoma?

A

Cabergoline

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24
Q

Hyperthyroidism in a pregnant patient may result in what in the offspring

A

transient fetal hyperthyroidism

25
Q

What is an enlarged thyroid with multiple nodules that yields a hyperthyroid state

A

A multinodular goiter

26
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

27
Q

Patients with hyperthyroidism typically have (hypo/hyper) hypocholesterolemia

A

Hypo- due to increased LDL receptor expression

28
Q

How do reflexes present in hyperthyroidism?

A

brisk reflexes

29
Q

What would blood levels in hyperthyroidism show?

A

If primary cause: TSH low and unbound thyroid hormones high

30
Q

Give some cardiovascular complications of hyperthyroidism….

A

Premature ventricular contractions and atrial fibrillation (picked up on ECG)
It can also cause chest pain and palpitations

31
Q

How does hyperthyroidism affect basal metabolic rate?

A

Increased therefore leads to weight loss despite an increase in appetite

32
Q

Which antibodies are found in hyperthyroidism?

A
  • thyroid autoantibodies in ~75% of patients with Graves disease
    Thyroid autoantibodies = thyroglobulin and thyroid peroxidase (TPO)
33
Q

Which antibodies are found in hypothyroidism?

A

thyroid autoantibodies found in almost ALL patents with autoimmune hypothyroidism

34
Q

FAP is a genetic syndrome with autosomal dominant transmission associated with a mutation in which gene?

A

APC gene

35
Q

What is APC?

A

a tumor suppressor gene that regulates ß-catenin

Its mutation is associated with FAP (familial adenomatous polyposis

36
Q

What is the treatment for hyperthyroidism?

A

1) antithyroid drugs- carbimazole
2) radioiodine- destroys follicular cells
3) surgery- removal of thyroid

37
Q

What are the side effects of thionamide drugs e.g. carbimazole?

A

most severe pot side effect = agranulocytosis = severe and dangerous leucopenia: manifests as sore throat, fever
and mouth ulcers
Common = rash

38
Q

Name 3 thyroid autoantibodies?

A

thyroglobulin
thyroid peroxidase (TPO)
thyroid stimulating antibodies (TRAb)

39
Q

What is the epidemiology for thyroid diseases?

A

mainly women
hypothyroidism (5%)
hyperthyroidism (2.5%)
goitre (15-20%)

40
Q

What ocular signs would you see in Graves disease?

A
  • Proptosis (protrusion of eye)- due to swelling of extra-ocular muscles (unable to close eye fully)
    DO NOT TREAT WITH RADIOACTIVE IODINE&raquo_space; destroys follicular cells&raquo_space; release of TH
    TO decrease risk of complications put on corticosteroids prior to treatment
41
Q

Who has a pre-disposition to thyroid disease?

A

female
onset of disease is common post-partum
HLA-DR3
environmental factors: stress, smoking, high iodine intake

42
Q

What is the presentation of graves disease?

A

diffuse goitre, preibial myxodema (orange peel appearance of ant aspect of lower legs), soft tissue swelling of hands, clubbing of fingers

43
Q

What are the signs and symptoms of hyperthyroidism?

A
  • weight loss despite increased appetite (increased metabolic demand)
  • heat intolerance (body producing more heat)
  • overstimulation of symp NS&raquo_space; anxiety, rapid HR, hyperactivity, insomnia, sweating
44
Q

What is a thyroid storm?

A

a life threatening complication of hyperthyroidism

  • body goes into a state of severe hyper metabolism
  • all normal symptoms exaggerated e.g. heat tolerance becomes high fever and rapid HR becomes cardiac arrythmias
45
Q

When can a thyroid storm develop?

A

can develop when person stops treatment, develops infection, has surgery

46
Q

What are the 3 types of hypothyroidism?

A

Primary- >99% dysfunction of thyroid gland (most due to Hashimotos thyroidosis)
Secondary- pituitary dysfunction (not enough TSH produced)
Tertiary- hypothalamic dysfunction

47
Q

What is the most common cause of hypothyroidism?

A

In low income countries = iodine def (don’t fortify foods with iodine)
in higher income countries = Hashimotos thyroidosis

48
Q

What are the signs and symptoms of hypothyroidism?

A
  • weight gain (despite loss of appetite) due to dec metabolic rate
  • cold sensitivity (body producing less heat)
  • slower HR, lethargy, constipation, mental slowness
  • myxoedema: swelling of soft tissues e.g. tongue- due to accumulation of glycosaminoglycans
49
Q

What will you see in Hashimotos disease?

A

Goitre due to hyperplasia and hypertrophy of gland

50
Q

In neonates what would the symptoms be?

A

excessive sleeping

- if not detected soon enough at risk of intellectual disabilities and delayed physical growth&raquo_space; shortened height

51
Q

What is a myxoedema coma?

A

affects people with poorly managed hypothyroidism that undergo a stressful situation eg. infection/surgery
mental slowness turns into altered consciousness and confusion
decreased body temp&raquo_space; hypothermia

52
Q

How would you diagnose hypothyroidism and what would you see?

A

blood levels of TSH, T3 and T4

  • in all cases thyroid hormone low
  • TSH varies (primary cause = high) (secondary cause = low/normal)
53
Q

What is the treatment for hypothyroidism?

A

thyroid hormone replacement therapy e.g. synthetic L-thyroxine (T4)

54
Q

Name a common thyroid hormone replacement drug used in hypothyroidism…

A

Levothyroxine

55
Q

Name a form of hypothyroidism that occurs in neonates and infants

A

Cretinism

56
Q

Patients with primary hypothyroidism can have galactorrhea due to increased amounts of which hormone?

A

thyrotropin-releasing hormone which stimulates prolactin

57
Q

What happens to LDL levels in patients with hypothyroidism?

A

LDL levels increase

58
Q

Why do patients with hypothyroidism commonly have periorbital puffiness and a hoarse voice?

A

increased amounts of hyaluronic acid in the interstitial tissue.

Phase 2a (7 decks)

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