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Phase 2a > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is type 1 diabetes mellitus?

A

Autoimmune destruction of pancreatic beta cells within the Islets of Langerhans resulting in insulin deficiency

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2
Q

What is type 2 diabetes mellitus?

A

Insulin resistance

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3
Q

Give some risk factors for type 2 diabetes.

A
  • Older
  • Central obesity
  • Sedentary lifestyle
  • Hypertension and/or hyperlipidaemia
  • African/Caribbean ancestry
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4
Q

Describe the clinical presentation of diabetes.

A
  • Polyuria
  • Polydipsia
  • Weight loss
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5
Q

How is type 2 diabetes diagnosed?

A

Symptomatic individual:
ONE glucose result in diabetic range (fasting/random)

Asymptomatic individual:
TWO separate glucose results in diabetic range (fasting/random/2 hr postprandial)

Symptomatic/asymptomatic individual:
ONE HbA1c result in diabetic range

Diabetic values:

  • Fasting > 7 mmol/L
  • Random or 2 hr postprandial > 11.1 mmol/L
  • HbA1c > 48 mmol/L
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6
Q

Describe the conservative management of type 2 diabetes.

A

Lifestyle advice, e.g. weight loss, take regular exercise etc.

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7
Q

Describe the pharmacological management of type 2 diabetes.

A
  • 1st line = Metformin (Biguanide)
  • 2nd line = Metformin + Gliclazide (Sulfonylurea)
  • 3rd line = Metformin + Gliclazide + Sitagliptin (DPP4i)
  • 4th line = insulin therapy
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8
Q

Side effects of pharmacological therapies for type 2 diabetes.. which cause weight gain/loss?

A
  • Biguanides = weight LOSS (also cause GI disturbance: nausea, anorexia)
  • Sulfonylureas/glitazones = weight GAIN
  • DPP4 inhibitors = no change
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9
Q

How is type 1 diabetes diagnosed?

A

Signs of hyperglycaemia (polydipsia, polyuria) AND ONE of the following:

  • Ketosis
  • Rapid weight loss
  • Age of onset <50 years
  • BMI <25 kg/m2
  • Personal/family history of autoimmune disease
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10
Q

Describe the management of type 1 diabetes.

A

Insulin

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11
Q

What are the microvascular and macrovascular complications of diabetes mellitus?

A

Microvascular =
Diabetic neuropathy, retinopathy, nephropathy

Macrovascular =
CVD

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12
Q

What is hyperthyroidism?

A

Excess thyroid hormone

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13
Q

What are the causes of hyperthyroidism?

A
  • 2/3 cases = GRAVES DISEASE
  • Toxic multinodular goitre
  • Toxic thyroid adenoma
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14
Q

What are the symptoms and signs of hyperthyroidism?

A

Symptoms:

  • Weight loss
  • Diarrhoea
  • Sweating, palpitations, tremor (anxiety)
  • Amenorrhoea

Signs:

  • Tachycardia
  • Lid lag/retraction
  • Exophthalmos
  • Onycholysis
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15
Q

How is hyperthyroidism investigated?

A

Thyroid function tests:

  • Primary = low TSH and high T3/T4
  • Secondary = high TSH and high T3/T4

Thyroid autoantibodies:

  • Thyroid peroxidase
  • Thyroglobulin
  • TSH receptor antibody

Radioactive iodine isotope uptake scan

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16
Q

Describe the pharmacological management of hyperthyroidism.

A
  • Beta blockers for rapid symptom control

- Carbimazole (antithyroid drug)

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17
Q

Describe the interventional management of hyperthyroidism.

A

Thyroidectomy

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18
Q

What is Graves’ disease? Extra signs present with Graves’ disease?

A

Autoimmune induced excess production of thyroid hormone (via TSH receptor antibody)

Signs - Graves’ ophthalmology:

  • Extraocular muscle swelling
  • Eye discomfort
  • Excessive lacrimation
  • Diplopia
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19
Q

What is hypothyroidism?

A

Too little thyroid hormone

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20
Q

What are the causes of hypothyroidism?

A
  • Hashimoto’s thyroiditis

- Iodine deficiency

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21
Q

What are the symptoms and signs of hypothyroidism?

A

Symptoms:

  • Weight gain
  • Constipation
  • Fatigue, myalgia
  • Menorrhagia

Signs:

  • Bradycardia
  • Reflexes relax slowly
  • Ataxia
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22
Q

Describe the pharmacological management of hypothyroidism.

A

Synthetic thyroid hormone (levothyroxine)

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23
Q

What is acromegaly? What is gigantism?

A

Acromegaly = Increased production of growth hormone occurring in adults (after fusion of epiphyseal growth plates)

Gigantism = Increased production of growth hormone occurring in children

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24
Q

What is the main cause of acromegaly?

A

Pituitary adenoma

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25
What are the symptoms and signs of acromegaly?
Symptoms: - Acroparasthesia - Arthralgia - Sweating - Headache Signs: - Massive growth of hands, feet and jaw - Widely spaced teeth - Puffy lips, eyelids and skin - Deep voice
26
How is acromegaly investigated?
NOT random growth hormone test - GH is a pulsatile protein and levels vary throughout day Administer glucose: - Normally glucose suppresses GH levels - If given glucose and GH levels still high, this is diagnostic for acromegaly MRI pituitary fossa for adenoma
27
Describe the pharmacological/interventional management of acromegaly.
- Transsphenoidal surgery to remove adenoma | - GH antagonist, e.g. pegvisomant
28
What is hyperaldosteronism?
Excess aldosterone production, independent of RAAS | Aldosterone works in kidney to cause potassium loss- excess causes hypokalaemia and sodium + water retention
29
What are the causes of hyperaldosteronism?
- 2/3 cases = CONN'S SYNDROME (a solitary, benign adrenocortical adenoma) - Bilateral adrenocortical hyperplasia
30
What are the symptoms of hyperaldosteronism?
Symptoms of hypokalaemia = - Cramps - Constipation - Paraesthesia - Arrhythmias
31
How is hyperaldosteronism investigated?
U+E = hypokalaemia ECG - signs of hypokalaemia: No POT and no T, but a long PR and a long QT ADRENAL CT is diagnostic
32
Describe the pharmacological/interventional management of hyperaldosteronism.
Depends on cause... - Treat hypokalaemia (give K+) - Pharmacological = spironolactone (aldosterone antagonist) - Interventional: laparoscopic adrenalectomy
33
What is Cushing's syndrome? What is Cushing's disease?
Cushing's syndrome = excess cortisol + loss of hypothalamic pituitary axis feedback + loss of circadian rhythm Cushing's disease = all of above + CAUSED by pituitary adenoma
34
What are the causes of Cushing's syndrome?
ACTH independent causes: - Iatrogenic - STEROIDS!! - Adrenal adenoma ACTH dependent causes: - Cushing's disease (pituitary adenoma)
35
Describe the symptoms of Cushing's syndrome.
- Weight gain/truncal obesity - Hirsuitism - Acne - Moon face/buffalo hump - Striae
36
How is Cushing's syndrome investigated?
Dexamethasone suppression test: - Dexamethasone usually suppresses cortisol levels - Failure of dexamethasone to suppress cortisol levels over 24 hr period is diagnostic of Cushing's syndrome MRI for pituitary adenoma
37
Describe the management of Cushing's syndrome.
Depends on cause: - If iatrogenic then stop steroids - Adrenal adenoma = adrenalectomy, radiotherapy - Cushing's disease (pituitary adenoma) = transsphenoidal removal of pituitary adenoma
38
What is Addison's disease?
- Autoimmune destruction of the adrenal cortex resulting in primary adrenal insufficiency (adrenal impairment resulting in low cortisol and low aldosterone levels)
39
What are the leading causes of primary adrenal insufficiency in the UK and worldwide?
- Worldwide = TB | - UK = Addison's disease
40
Describe the symptoms of Addison's disease.
- Hyperpigmentation of the skin - Depression - Abdominal pain, nausea and vomiting
41
Describe the investigation of Addison's disease.
ACTH stimulation test: - Give ACTH (synacthen) and measure cortisol levels - Normally, ACTH would cause a rise in cortisol levels; in Addison's, cortisol remains low after giving ACTH Test for 21-hydroxylase adrenal autoantibodies U+E: hyperkalaemia and hyponatraemia (due to low levels of aldosterone)
42
Addison's disease can result in hyperkalaemia... a) Describe the ECG changes you would see with hyperkalaemia b) Describe the non-urgent and urgent management of hyperkalaemia
a) Small P waves, tall T waves, wide QRS complex b) Non-urgent = polystyrene sulfonate resin Urgent = calcium gluconate, insulin
43
Describe the pharmacological management of Addison's disease.
- Hydrocortisone to replace cortisol | - Fludrocortisone to replace aldosterone
44
What is diabetes insipidus?
EITHER - Too little ADH secretion from posterior pituitary (cranial DI) - OR kidney not responding to ADH (nephrogenic DI)
45
What are the causes of diabetes insipidus?
Cranial DI: - Head trauma - Pituitary adenoma Nephrogenic DI: - Drugs, e.g. Lithium
46
What are the symptoms of diabetes insipidus?
- Polyuria - Polydipsia - Dehydration
47
How is diabetes insipidus investigated?
Water deprivation test: - Restrict fluid - Measure urine osmolarity - +ve for DI if urine osmolarity remains low - Differentiate between cranial and nephrogenic DI by using desmopressin (ADH analogue)
48
Describe the pharmacological management of diabetes insipidus.
- Cranial DI - desmopressin | - Nephrogenic DI - bendroflumethiazide, NSAIDs
49
What is SIADH?
SIADH stands for 'syndrome of inappropriate secretion of ADH' Too much ADH being secreted from posterior pituitary
50
What are the causes of SIADH?
- Malignancy - Drugs - CNS disorders
51
What are the symptoms and signs of SIADH?
Symptoms: - Confusion - Nausea - Anorexia Signs: - Concentrated urine
52
How is SIADH investigated?
Measure urine osmolarity (v high) and plasma osmolarity (v low)
53
Describe the management of SIADH.
- Treat underlying cause if possible - Restrict fluid intake - Vasopressin receptor antagonists ('vaptans')
54
What is hyperparathyroidism? What are the types of hyperparathyroidism? Give examples of what causes each type
Too much PTH secreted from parathyroid glands into bloodstream - Primary, most commonly caused by parathyroid adenoma - Secondary - when a condition such as kidney failure or vitamin D deficiency lowers calcium levels, so parathyroid glands produce more parathyroid hormone
55
Does PTH reduce/increase serum calcium levels? Describe the mechanisms by which it achieves this
PTH increases serum calcium levels by... - Stimulating osteoclasts to resorb bone to release calcium into blood - Stimulating kidneys to reabsorb more calcium from urine into blood - Stimulating gut to absorb more calcium
56
Describe the serum PTH and calcium results for... a) primary hyperparathyroidism b) secondary hyperparathyroidism
a) high PTH, high calcium | b) high PTH, low calcium
57
Describe the management of hyperparathyroidism
``` Primary = surgery to remove parathyroid adenoma Secondary = treat underlying condition, e.g. kidney disease, vit D deficiency ```
58
What are the symptoms of hyperparathyroidism?
STONES, BONES, MOANS, GROANS Kidney stones Bone pain/tenderness Depression/fatigue Abdominal pain, constipation
59
What is hypoparathyroidism? | What are the causes of hypoparathyroidism?
Too little PTH secreted from parathyroid glands into bloodstream Causes: - Surgical (removal of parathyroid glands) - Autoimmune
60
What are the symptoms and signs of hypoparathyroidism?
HYPOcalcaemia: Symptoms: - Paraesthesia (especially around mouth and lips) Signs: - Chvostek's sign (twitching of facial muscles when ficial nerve is tapped) - Trousseau's sign (spasm caused by inflating BP cuff around upper arm) - Long QT interval
61
Describe the management of hypoparathyroidism
Treat hypocalcaemia: - Urgent = IV calcium glucoronate - Maintenance = Adcal D3 Treat underlying cause, e.g. autoimmune with steroids
62
Give some signs of DKA
Kussmaul's breathing Vomiting Loss of consciousness Pear drop breath

Phase 2a (16 decks)

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