Endocrinology Flashcards
1
Q
Diabetes
A
Raised glucose/lack of insulin
2
Q
Thyroid disorders
A
Too much/too little thyroid hormone
3
Q
Cushing’s
A
Raised cortisol
4
Q
Acromegaly
A
Raised growth hormone
5
Q
Conn’s syndrome
A
Raised aldosterone
6
Q
Diabetes insipidus
A
Lack of ADH
7
Q
SiADH
A
Raised ADH
8
Q
Hyperkalaemia
A
Raised K
9
Q
Hypercalcaemia
A
Raised Ca
10
Q
Parathyroid disorder
A
Too much/too little parathormone
11
Q
Hyperthyroidism - Causes
A
Graves’ disease
Toxic thyroid adenoma
Iodine excess
12
Q
Hyperthyroidism - Symptoms
A
Diarrhoea Weight loss Sweats Palpitations Tremor Menstrual disturbance
13
Q
Hyperthyroidism - Signs
A
Tachycardia
14
Q
Hyperthyroidism - Investigations
A
Thyroid function tests - TSH, T3/T4 Levels
Thyroid autoantibodies
Radioactive iodine isotope uptake scan
15
Q
Hyperthyroidism - Treatment
A
B-blockers (acute attack symptoms)
Carbimazole (antithyroid drug)
Thyroidectomy
16
Q
Graves’ disease - Pathophysiology
A
Autoimmune
Excess TH
17
Q
Graves’ disease - Symptoms
A
Eye discomfort, diplopia (double vision)
Clubbing
18
Q
Graves’ disease - Investigation
A
TRAb
Hyperthyroidism tests
19
Q
Graves’ disease - Treatment
A
Hyperthyroidism treatments - B-blocker, carbimazole
20
Q
Hypothyroidism - Causes
A
Thyroiditis
Iodine deficiency
Over-treatment of hyperthyroidism
21
Q
Hypothyroidism - Symptoms
A
Fatigue/tiredness/lethargy Weight gain Myalgia Oedema Constipation Menorrhagia
22
Q
Hypothyroidism - Signs
A
Bradycardia Ascites Pleural/pericardial effusions SOB Ataxia Dry, thin hair/skin Feel cold Reflexes relax slowly Round puffy face
23
Q
Differences between hyper/hypothyroidism
A
Hyper - Weight loss, increased appetite, prefer cool temp, tachycardia
Hypo - Weight gain, decreased appetite, prefer warm temp, bradycardia
24
Q
Acromegaly - Pathophysiology
A
Raised growth hormone occurring in adults after fusion of the epiphyseal plates
25
Difference between acromegaly and gigantism
Acromegaly - Adulta
| Gigantism - Children
26
Acromegaly - Causes
Pituitary adenoma
27
Acromegaly - Symptoms
Arthralgia
Sweating
Headache
28
Acromegaly - Signs
Massive growth of hands, feet, jaw, tongue
Darkening of skin
Deep voice
29
Acromegaly - Investigation
MRI pituitary fossa for adenomas
30
Acromegaly - Treatment
Transphenoidal surgery to remove adenoma
| Pegvisomant (GH antagonist)
31
Hyperaldosteronism - Pathophysiology
1) Excess aldosterone, independent of RAAS
2) Aldosterone works in kidney to cause K loss, Na/H2O retention
3) Excess therefore causes hypokalaemia and Na/H2O retention
32
Hyperaldesteronism - Causes
Conn's syndrome
| Adenoma
33
Hyperaldosteronism - Symptoms
Hypertension
| Hypokalaemia - Weakness, cramps, parasthesia, constipation
34
Hyperaldosteronism - Investigation
U&E
Increased aldosterone
CT adrenal
ECG - ST depression (hypokalemia)
35
Hyperaldosteronism - Treatment
Laparoscopic adrenalectomy
| Spironolactone (aldosterone antagonist)
36
Hyperparathyroidism - Causes
Adenoma
Parathyroid hyperplasia
Hypocalcaemia
37
Hyperparathyroidism - Symptoms
Hypercalcaemia - Weak, tired, thirsty, renal stones
Bone resorption causes pain, fracture, osteoporosis
Hypertension
38
Hyperparathyroidism - Investigation
Bloods - Increased PTH, Ca
| DEXA bone scan (osteoporosis)
39
Hyperparathyroidism - Treatment
Fluids
Surgery
Bisphosphonates
40
Hypoparathyroidism - Pathophysiology
Autoimmune destruction of parathyroid glands
41
Hypoparathyroidism - Causes
Congenital
| Surgical removal
42
Hypoparathyroidism - Signs and symptoms
Hypocalcaemia signs and symptoms
43
Hypoparathyroidism - Treatment
Ca supplement
Calcitriol
Synthetic PTH
44
Pseudohypoparathyroidism - Pathophysiology
Decreased response to PTH
| Bloods show low Ca, high PTH
45
Hypokalemia - Causes
1) Low K in serum (ECF) causes a water gradient out of the cell (ICF)
2) Increased leakage from ICF causing hyperpolarisation of myocyte membrane decreasing myocyte excitability
46
Hypokalemia - Investigations
ECG - T wave absent/inversion
47
Hypokalemia - Treatment
```
Oral K (mild)
IV K (severe)
```
48
Hyperkalemia - Investigations
ECG - T waves tall
49
Hyperkalemia - Treatment
```
Calcium gluconate (decreases VF risk)
Insulin (drives K into cells)
```
50
Hyper/hypokalemia - Causes
Hyper - Low aldosterone
| Hypo - High aldosterone
51
Hyper/hypokalemia - Symptoms
Hyper (everything speeds up) - Cramping, weakness, paralysis, cardiac arrythmias/arrest - all due to over contraction of muscles and so drained of energy
Hypo (everything slows) - Constipation, weakness, cramping, cardiac palpitations/arrythmias
52
Calcium homeostasis is controlled by 2 factors
PTH (Parathyroid)
| Calcitonin (Thyroid)
53
Calcium in bone is stored as
Calcium phosphate
54
Hypocalcaemia - Causes (HAVOC)
```
Hypoparathyroidism
Acute pancreatitis
VitD deficiency
Osteomalacia
CKD
```
55
Hypocalcaemia - Signs and symptoms
```
Spasms
Peripheral parasthesia
Seizures
Increased muscle tone
Arrhythmias
```
56
Hypocalcaemia - Investigations
ECG - Long QT interval
57
Hypocalcaemia - Treatment
```
Adcal (mild)
Calcium gluconate (severe)
```
58
Hypercalcemia - Causes
Hyperparathyroidism
| Cancer
59
Hypercalcemia - Symptoms
Painful bones
Renal stones
GI - N&V, constipation, indigestion
60
Hypercalcemia - Investigations
FBC - PTH, Ca levels
U&E - Renal damage
XR
61
Hypercalcemia -Treatment
Bisphosphonates
| Saline
62
Difference between cushing's syndrome and cushing's disease
Cushing's syndrome - Excess cortisol
| Cushing's disease - Cushing's syndrome due to pituitary adenoma
63
Cushing's - Causes
Pituitary adenomas
| Adrenal adenomas
64
Cushing's syndrome - Symptoms
```
Cataracts
Ulcers
Striated skin
Acne
Hypertension
Increased infections
Obesity/weight gain
```
65
Cushing's - Investigations
Dexamethasone test - failure to suppress cortisol levels over 24hr period is diagnostic of cushing's
66
Cushing's - Treatment
Stop steroids
Transphenoidal removal of pituitary adenoma
Adrenalectomy/radio
67
T2DM - Risk factors
Male
Asian
Obese
Alcohol
68
T2DM - Investgations
Urine - polyuria/polydipsia (hyperglycaemic signs)
| Random, fasting, 2hr post-meal glucose levels
69
T2DM - Prediabetic Treatment
No meds!
| Lifestyle - diet, exercise, annual review
70
T2DM - Diabetic Treatment
```
Lifestyle
1st line - Metformin (monotherapy)
1st line - Metformin+DPP4i (gliptin)
2nd line - Metformin+glitazone
3rd line - Metformin+sulphonylurea
4th line - Metformin+glifazon
If dual therapy fails, then proceed to triple therapy with sulphonylurea each line
Finally move to insulin based therapy as last resort
```
71
Side effects of T2DM drugs
Hypoglycaemia
72
Weight changes with T2DM drugs
Metformin - Weight loss
Sulfonylurea - Weight gain
DPP4i/gliptin - No change
Glitazone - Weight gain
73
T1DM - Risk factors
Young
| Adolescent onset
74
T1DM - Signs and symptoms
Polyuria
Polydipsia (excessive thirst)
Weight loss
75
T1DM - Investigation
Signs of hyperglycaemia plus one/or more of: rapid weight loss, young, family history/personal autoimmune disease, ketosis
76
T1DM - Treatment
Only insulin!
77
Addison's disease - Pathophysiology
Autoimmune impairment of adrenal gland (low cortisol and aldosterone)
Opposite of cushing's syndrome
78
Addison's disease - Signs and symptoms
```
Lean/toned
Tanned
Depression
N&V
Abdo pain
Tired
```
79
Addison's disease - Investigation
Bloods - Low Na, high K (due to low aldosterone)
| Short ACTH stimulation test - Cortisol levels remain low = positive result
80
Addison's disease - Treatment
Hydrocortisone (replace cortisol)
| Fludrocortisone (replace aldosterone)
81
Diabetes insipidus - Pathophysiology
Lack of ADH from posterior pituitary or kidney not responding to ADH
82
Diabetes insipidus - Causes
Head trauma
Pituitary tumour
Drugs (lithium)
83
Diabetes insipidus - Signs and symptoms
Dehydration
Polyuria
Polydipsia
84
Diabetes insipidus - Investigation
Water deprivation test
85
Diabetes insipidus - Treatment
Desmopressin (cranial)
| Bendroflumethiazide (nephron)
86
SIADH (Syndrome of Inappropriate ADH secretion) - Pathophysiology
Excess ADH (Opposite to DI)
87
SIADH (Syndrome of Inappropriate ADH secretion) - Causes
Malignancy
Drugs
CNS disorder
88
SIADH (Syndrome of Inappropriate ADH secretion) - Signs and symptoms
Confusion
Anorexia
Nausea
Conc urine
89
SIADH (Syndrome of Inappropriate ADH secretion) - Investigation
Measure urine and plasma osmolarity
90
SIADH (Syndrome of Inappropriate ADH secretion) - Treatment
Restrict fluids
| Vasopressin receptor antagonist
