Endocrinology Flashcards
1
Q
Recall some symptoms of acromegaly
A
Hyperhidrosis Hyperprolactinoma Hypopituitary Headaches Carpal Tunnel
2
Q
Describe the skin of an acromegaly patient
A
Thick and greasy
3
Q
In which endocrinological condition is bitemporal hemianopia a symptom?
A
Acromegaly
4
Q
Which specific blood test should be orderd for suspected acromegaly?
A
IGF-1
5
Q
Recall the medical and surgical options for acromegaly treatment
A
medical: bromocriptine, octreotide
surgical: transphenoidal hypophysectomy
6
Q
Differentiate primary and secondary adrenal insufficiency
A
Primary = AI: Addisson's Secondary = hypothalamopituitary disease
7
Q
What is the main endocrinological consequence of cessation of long-term steroid therapy?
A
Adrenal failure
8
Q
What are the presenting features of acute adrenal insufficiency?
A
Addissonian crisis = sudden haemodynamic collapse: hypotensive shock, tachycardia, pale, cold, oligouria
9
Q
What are the chronic features of adrenal insufficiency?
A
Dizziness, nausea, anorexia, depression, abdominal pain
10
Q
Recall 3 signs of adrenal insufficiency
A
Hair loss
Hyperpigmentation
Postural hypotension
11
Q
Which test is done to confirm a diagnosis of adrenal insufficiency?
A
Short synacthen
12
Q
Which test is done to determine pathological mechanism of adrenal insufficiency?
A
Long synacthen
13
Q
What is the main electrolyte imbalance resulting from adrenal failure?
A
Hyperkalaemia
14
Q
Define the carcinoid syndrome
A
Constellation of symptoms caused by systemic release of humoral factors from carcinoid tumours
15
Q
Recall 2 types of tumours that are commonly implicated in the carcinoid syndrome
A
- Slow-growing neuroendocrine tumours
2. Small bowel - enterochromaffin cell tumours that secrete 5-HT
16
Q
What are the main symptoms of the carcinoid syndrome?
A
Paroxysmal flushing, wheeze, tachycardia, abdominal pain (if enterochromaffin cell tumour)
17
Q
What is themain hormone implicated in the carcinoid syndrome?
A
5- HT
18
Q
What electrolyte imbalance is produced by Cushing’s syndrome?
A
Hypokalaemia
19
Q
What is the use of the LDDST and the HDDST?
A
LDDST = diagnosis of Cushing's HDDST = determine cause of Cushing's
20
Q
Recall 2 drugs that can be used to manage Cushing’s
A
Meyrapone
Ketoconazole
21
Q
Recall 2 options for the surgical management of Cushing’s syndrome?
A
Transsphenoidal hypophysectomy
Bilateral adrenalectomy
22
Q
Which part of the kidney does ADH act on?
A
Collecting duct
23
Q
Recall the medical management of central and nephrogenic diabetes insipidus
A
Central = desmopressin Nephrogenic = thiazide diuretics
24
Q
What is the main electrolyte imbalance that results from diabetes insipidus?
A
Hypernatraemia
25
Recall 2 auto-antigens related to T1DM
GAD
| anti-insulin
26
Recall the fasting and random blood glucose values indicative of DM
Fasting >7
| Random > 11.1
27
What abnormality is seen on an FBC of someone with a DKA?
High WCC
28
What do U&Es show in DKA?
Dehydration
29
Recall the 3 components of an initial management plan for a T1DM patient
1. Short-acting insulin eg. lispro TDS
2. Long-acting insulin OD
3. HbA1c every 3-6months
30
How is DKA managed?
1. Soluble insulin in normal saline
2. --> Subcut insulin for 1-2 days
3. Insulin will drive K+ into cells so replace potassium
31
What happens to HGO in T2DM?
Increases
32
Recall 2 monogenic causes of T2DM
MODY
| Mitochondrial diabetes
33
Recall the diagnostic criteria for T2DM
1 or more of the following present:
1. Symptoms + random plasma BM of >11.1
2. Fasting BM >7
3. 2-hour BM after 75g OGTT >11.1
34
What may happen to urine protein as a result of T2DM?
Microalbuminuria
35
Recall 3 medications for diabetes (and write another Q on this)
Metformin
Citagliptin
Sulphonylureas
36
What is the T2DM equivalent of DKA?
Hyperosmolar hyperglycaeimc state
37
How does the HHS differ from DKA?
No acidosis
38
What are the ranges for "impaired" fasting and random glucose?
Fasting: 5.6-6.9
Random: 7.8-11.0
39
What is the most common cause of hyperthyroidism?
Grave's disease
40
Recall 3 signs of Grave's disease seen in the hands
Palmar erythema
Sweaty and warm
Tremor
41
Describe 2 signs of hyperthyroidism in the limbs
Proximal myopathy
| Hyperreflexia
42
Which endocrinological condition can cause lid lag?
Hyperthyroidism
43
Differentiate the possible causes of hyperparathyroidism depending on if it is primary or secondary
```
Primary = parathyroid adenoma/ hyperplasia
Secondary = chronic renal failure, vit D deficiency
```
44
Describe the serum calcium in each type of hyperparathyroidism
Primary: hypercalcaemia
Secondary: hypocalcaemia
Tertiary: hypercalcaemia
45
Describe the serum Vit D in each type of hyperparathyroidism
Primary: high
Secondary: low
Tertiary: low
46
Recall the symptoms of hypercalcaemia
Bones, stones, abdominal groans and psychiatric groans
47
Which 2 products of the liver should be measured in suspected hyperparathyroidism?
ALP
| Albumin
48
What sort of diuretics can exacerbate hypercalcaemia?
Thiazides
49
What is the main risk of a parathyroidectomy?
Hitting recurrent laryngeal nerve
50
Recall the possible aetiologies of primary female hypogonadism
Dysgenesis (Turner's)
| Damage (chemotherapy, autoimmune)
51
Recall the possible aetiologies of secondary female hypogonadism
Functional (stress, EDs)
Hypothalamopituitary tumours
Infiltrative disease eg sarcoidosis/ amyloidosis
52
What imaging would you do in female hypogonadism?
Pituitary MRI to see if there is a tumour
53
What would cause gonadal dysgenesis in males?
Kleinfelter's
54
What is the name given to GnRH deficiency in men?
Kallman's
55
What blood tests would be done to investigate male hypogonadism?
Serum SHBG, Albumin, testosterone, LH and FSH
56
Describe the levels of DHT, FSH and LH in primary and secondary male hypogonadism
Primary: low DHT, high LH and FSH
Secondary: low DHT, normal FSH and LH
57
What is hypopituitarism?
Cessation of production of ANTERIOR pituitary hormone
58
What are the 2 main symptoms of pituitary apoplexy?
Headache
| Visual field loss
59
What is the name of the autoimmune cause of hypothyroidism?
Hashimoto's
60
Recall the mnemonic for and the symptoms of hypothyroidism
```
MOM'S SO TIRED
Memory loss
Obesity
*Malar flush*
Slowness
Skin dryness
Onset is gradual
Tiredness
Intolerance to cold
Raised BP
Energy levels fall
Depression
```
61
Recall the 5 key symptoms of myxoedema coma
```
Hypothermia
Hypoventilation
Hyponatraemia
Heart failure
Confusion
```
62
Recall the management of myxoedema crisis
```
O2
Rewarming
Rehydration
IV T4
IV hydrocortisone
```
63
What is multiple endocrine neoplasia?
Autosomal dominant predeliction to develop endocrine tumours
64
Recall the subtypes of multiple endocrine neoplasia
Men 1, Men 2a and Men 2b
65
To which tumours are Men1 sufferers predisposed?
Pituitary adenoma
| Parathyroid tumours
66
To which tumours are Men2a/b sufferers predisposed to?
Parathyroid tumours
Medullary thyroid tumours
Phaeochromocytoma
67
What BMI is definitive of obesity?
>30kg/m^2
68
Define osteoporosis
Bone mass of more than 2.5 standard deviations below the mean achieved by healthy adults
69
What is the most likely cause of primary osteoporosis?
Menopause
70
Recall some causes of secondary osteoporosis
Malignancy
Cushing's
Steroid drugs
Malabsorption
71
What are the most common fractures in osteoporosis?
Neck of femur
Vertebral
Colles' fracture (distal radius, after falling on out-stretched hand)
72
Recall the mnemonic for and bloods taken in suspected osteoporosis
CAP
Calcium
ALP
Phosphate
73
What unusual symptoms may present alongside Paget's disease of the bone?
Headaches and deafness
74
Recall the CAP in Paget's disease of the bone
Calcium: normal
ALP: high
Phosphate: normal
75
Where do most phaeochromocytomas occur?
Chromaffin cells of adrenal medulla
76
What is the most likely cause of Paget's disease of the bone?
Familial (30% are inherited)
77
Recall the mnemonic for and the symptoms of phaeochromocytoma
```
Catecholamines Produce Headache And Difficulty When Passing Stool
Constipation
Palpitations
Headache
Anxiety
Dyspnoea
Wheezing
Pain
Sweating
```
78
What is the first line investigation is suspected phaeochromocytoma?
24-hour urine catecholamine levels
79
What are non-functioning pituitary tumours defined as?
Tumours of the pituitary that do not produce any active hormones
80
What is the most common type of non-functional pituitary adenoma?
Macroadenoma (>1cm)
81
What symptoms may present in a non-functioning pituitary tumour?
Headache
| Visual changes
82
Define PCOS
Characterised by: oligomenorrhoea, hyperandrogenism
| Associated with: obesity, T2DM, dyslipidaemia
83
Recall 3 *signs* of PCOS
Hirsuitism
Acne
Acanthosis Nigrans
84
Which hormones will be high in the blood of someone with untreated PCOS?
LH
| DHT
85
What is the most common cause of primary hyperaldosteronism?
Conn's (adrenal adenoma)
86
What causes hypertension and hypokalaemia in primary hyperaldosteronism?
Autonomous aldosterone overproduction --> increased sodium and water retention --> hypertension + decreased renin production.
Increased retention --> K+ loss
87
Recall the symptoms of hypoaldosteronism
Usually asymptomatic
88
How can you confirm a diagnosis of primary hyeraldosteronism?
Salt load and failure to suppress aldosterone
89
What is the "postural test" used for?
Determining cause of hyperaldosteronism
90
How do you perform a postural test?
8am with pt lying down: measure renin, cortisol and aldosterone
~4 hours of being upright~
If aldosterone decreases: adrenal adenoma
If renin and aldosterone increase: adrenal hyperplasia
91
Recall the medical management of bilateral adrenal hyperplasia
Spironolactone and amiloride
| These are *potassium-sparing*
92
Which demographic is prolactinoma most common in?
Pre-menopausal women
93
Recall some symptoms of prolactinoma in women
Galactorrhoea
Hirsuitism
Reduced libido
Amenorrhoea
94
Recall some symptoms of prolactinoma in men
Reduced beard growth
Reduced libido
Erectile dysfunction
~very subtle symptoms~
95
What specific blood test must be done in suspected prolactinoma and why?
TFTs
| High TRH stimulates prolactin secretion
96
Recall the medical management of prolactinoma
DA agonists like cabergoline/bromocriptine
97
Recall the mnemonic for and the causes of SIADH
```
SIADH CAUSES
Small cell lung cancer
Injury
Abscess
Disease of lungs
Haemorrhage
Carbamazepine
Aspergillosis
U-ther lung causes (pneumonia, bronchiectatsis)
Surgery
EtOH withdrawal
Sarcoidosis
```
98
What electrolyte imbalance is associated with SIADH?
Hyponatraemia
99
What are the signs of hyponatraemia?
Extensor plantar reflexes
| Hyporeflexia
100
What are the 4 types of thyroid cancer?
Medullary
Papillary
Follicular
Anaplastic
101
Recall the symptoms of thyroid cancer
Slow-growing neck lump
Odynophagia
Hoarseness
102
What TFTs would you expect in a thyroid cancer patient?
Normal
103
What is a thyroid nodule?
Abnormal growth of thyroid cells that form a lump in the gland and are usually non-functioning
104
What sort of thyroid nodules are most likely to be malignant?
Single ones (benign are usually multiple)
105
What is the most common cause of thyroiditis in the UK?
Hashimoto's thyroiditis
106
What are the symptoms of thyroiditis?
Pretty much those of an under-active thyroid
107
Recall the antibodies present in Hashimoto's disease
Anti-TPO
| Anti-TG
108
What is osteomalacia?
Disorder of bone matrix mineralisation
109
What sort of drugs can cause vitamin D deficiency?
Anti-convulsants
110
How does a lack of vitamin D affect kidney function?
Can cause renal phosphate wasting
111
What must you include in an examination for hypocalcaemia?
Try and elicit Chovstek's sign and Trousseau's sign
112
What electrolyte imbalance is common in vitamin D deficiency and osteomalacia?
Hypocalcaemia
113
What is the most commonly seen type of fracture in osteomalacia?
Looser's zone fractures
114
Recall the mnemonic for and the complications of hypocalcaemia
```
CATs go Numb
Convulsions
Arrhythmias
Tetany
Numbness
```
