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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
What is an enlarged thyroid with multiple nodules that yields a hyperthyroid state
A multinodular goiter
26
What is the most common cause of hyperthyroidism?
Grave's disease
27
Patients with hyperthyroidism typically have (hypo/hyper) hypocholesterolemia
Hypo- due to increased LDL receptor expression
28
How do reflexes present in hyperthyroidism?
brisk reflexes
29
What would blood levels in hyperthyroidism show?
If primary cause: TSH low and unbound thyroid hormones high
30
Give some cardiovascular complications of hyperthyroidism....
Premature ventricular contractions and atrial fibrillation (picked up on ECG) It can also cause chest pain and palpitations
31
How does hyperthyroidism affect basal metabolic rate?
Increased therefore leads to weight loss despite an increase in appetite
32
Which antibodies are found in hyperthyroidism?
- thyroid autoantibodies in ~75% of patients with Graves disease Thyroid autoantibodies = thyroglobulin and thyroid peroxidase (TPO)
33
Which antibodies are found in hypothyroidism?
thyroid autoantibodies found in almost ALL patents with autoimmune hypothyroidism
34
FAP is a genetic syndrome with autosomal dominant transmission associated with a mutation in which gene?
APC gene
35
What is APC?
a tumor suppressor gene that regulates ß-catenin | Its mutation is associated with FAP (familial adenomatous polyposis
36
What is the treatment for hyperthyroidism?
1) antithyroid drugs- carbimazole 2) radioiodine- destroys follicular cells 3) surgery- removal of thyroid
37
What are the side effects of thionamide drugs e.g. carbimazole?
most severe pot side effect = agranulocytosis = severe and dangerous leucopenia: manifests as sore throat, fever and mouth ulcers Common = rash
38
Name 3 thyroid autoantibodies?
thyroglobulin thyroid peroxidase (TPO) thyroid stimulating antibodies (TRAb)
39
What is the epidemiology for thyroid diseases?
mainly women hypothyroidism (5%) hyperthyroidism (2.5%) goitre (15-20%)
40
What ocular signs would you see in Graves disease?
- Proptosis (protrusion of eye)- due to swelling of extra-ocular muscles (unable to close eye fully) DO NOT TREAT WITH RADIOACTIVE IODINE >> destroys follicular cells >> release of TH TO decrease risk of complications put on corticosteroids prior to treatment
41
Who has a pre-disposition to thyroid disease?
female onset of disease is common post-partum HLA-DR3 environmental factors: stress, smoking, high iodine intake
42
What is the presentation of graves disease?
diffuse goitre, preibial myxodema (orange peel appearance of ant aspect of lower legs), soft tissue swelling of hands, clubbing of fingers
43
What are the signs and symptoms of hyperthyroidism?
- weight loss despite increased appetite (increased metabolic demand) - heat intolerance (body producing more heat) - overstimulation of symp NS >> anxiety, rapid HR, hyperactivity, insomnia, sweating
44
What is a thyroid storm?
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
When can a thyroid storm develop?
can develop when person stops treatment, develops infection, has surgery
46
What are the 3 types of hypothyroidism?
Primary- >99% dysfunction of thyroid gland (most due to Hashimotos thyroidosis) Secondary- pituitary dysfunction (not enough TSH produced) Tertiary- hypothalamic dysfunction
47
What is the most common cause of hypothyroidism?
In low income countries = iodine def (don't fortify foods with iodine) in higher income countries = Hashimotos thyroidosis
48
What are the signs and symptoms of hypothyroidism?
- 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
What will you see in Hashimotos disease?
Goitre due to hyperplasia and hypertrophy of gland
50
In neonates what would the symptoms be?
excessive sleeping | - if not detected soon enough at risk of intellectual disabilities and delayed physical growth >> shortened height
51
What is a myxoedema coma?
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 >> hypothermia
52
How would you diagnose hypothyroidism and what would you see?
blood levels of TSH, T3 and T4 - in all cases thyroid hormone low - TSH varies (primary cause = high) (secondary cause = low/normal)
53
What is the treatment for hypothyroidism?
thyroid hormone replacement therapy e.g. synthetic L-thyroxine (T4)
54
Name a common thyroid hormone replacement drug used in hypothyroidism...
Levothyroxine
55
Name a form of hypothyroidism that occurs in neonates and infants
Cretinism
56
Patients with primary hypothyroidism can have galactorrhea due to increased amounts of which hormone?
thyrotropin-releasing hormone which stimulates prolactin
57
What happens to LDL levels in patients with hypothyroidism?
LDL levels increase
58
Why do patients with hypothyroidism commonly have periorbital puffiness and a hoarse voice?
increased amounts of hyaluronic acid in the interstitial tissue.

Phase 2a (7 decks)

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