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Finals > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Name hormones released by the anterior pituitary and which hormones stimulate this (6)

A 
GnRH --> FSH/LH
GHRH --> GH
Dopamine --> prolactin
TRH --> TSH
CRH --> ACTH
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2
Q

Name hormones released by the posterior pituitary (2)

A

vasopressin, oxytocin

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3
Q

Symptoms of pituitary tumours?

A
  • excess hormone production (acromegaly, gallactorrhea, cushings)
  • local tumour effects (headache, bitemporal hemianopia, hydrocephalus)
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4
Q

Ix for a pituitary tumour?

A

MRI pituitary, bloods - hormone levels, clinical exam

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5
Q

What is hypopituitarism?

A

deficiency of pituitary hormones or deficiency of hypothalamic releasing hormones

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6
Q

Causes of hypopituitarism?

A 
Neoplastic - primary/secondary tumours
Infective - meningitis/encephalitis
Vasc - sheeshans
Immune - pituitary antibodies
Congenital - kallman's
Trauma - skull fracture, surgery
FUNCTIONAL - anorexia, starving, emotional deprivation as a child.
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7
Q

features of hypopituitarism? by hormone…

A

low LH/FSH - reduced libido, amenorrhea, ED
low GH - short stature
low TSH - tired, slow thought, reduced HR

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8
Q

Mx of hypopituitarism?

A

hormone therapy (LH/FSH), steroids and thyroid replacemet

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9
Q

Pathway of GH

A

GHRH –> GH –> liver –> IGF1 –> metabolic changes

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10
Q

Symptoms of acromegaly?

A

appearance change, increase in hand and feet size, headache, sweating, poor vision, tired, increased weight, reduced libido, carpal tunnel, deep voice

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11
Q

Signs of acromegaly?

A

prominant supraorbital ridge, prognathism, large tongue, thick and greasy skin, spade like hands, carpal tunnel, galactorrhea

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12
Q

Ix for acromegaly?

A

plasma GH and IGF1 levels, glucose tolerance test, MRI pituitary, visual field test, pituitary hormone levels

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13
Q

Mx of acromegaly

A

transpenoidal resection
Somatostatin analogue - Ocreotide
Dopamine agonist - Cabergoline (both reduce GH production)

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14
Q

Which hormone inhibits the production of prolactin

A

dopamine

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15
Q

Causes of hyperprolactinaemia

A

prolactinoma, pituitary tumour, PCOS, acromegaly

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16
Q

Symptoms of high prolactin? (due to prolactinoma)

A

galactorrhea, oligomenorrhea, reduced fertility, ED, headache, visual field defects

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17
Q

Ix of a prolactinoma?

A

serum prolactin/TFT, MRI pituitary, visual field assessment

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18
Q

Mx of a prolactinoma?

A 
transphenoidal surgery
Dopamine agonist (cabergoline)
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19
Q

Causes of hypothyroidism?

A

autoimmune thyroiditis, iatrogenic (surgery/radiotherapy), drug induced (carbimazole/lithium), iodine deficiency

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20
Q

Symptoms of hypothyroidism?

A

tired, weight gain, anorexia, cold intolerance, reduced memory, depression, reduced libido, goitre, dry and brittle hair, constipation, menorrhagia

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21
Q

Signs of hypothyroidism?

A

mentally slow, poverty of movement, dry and thin hair, bradycardia, loss of eyebrows, cold peripheries, dry skin, slow reflexes

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22
Q

Ix of thyroid disease

A

TSH, T3 and T4 levels
Thyroid antibodies
FBC
thyroid US

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23
Q

Mx of hypothyroidism?

A

levothyroxine

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24
Q

Causes of hyperthyroidism?

A

graves - activating Abs to TSH receptor which stimulates thyroid activity
toxic multinodular goitre, solitary adenoma, de quervains, post partum thyroiditis

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25
Q

Symptoms of hyperthyroidism?

A

weight loss, increased appetite, irritable, restless, tremor, heat intolerance, itching, thirst, eye complaints, goitre

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26
Q

Signs of hyperthyroidism?

A

tremor, hyperkinesis, tachycardia/AF, full pulse, exopthalmos, lid lag and stare, goitre, bruit

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27
Q

Mx of hyperthyroidism?

A

Carbimazole - blocks thyroid hormone synthesis
radioactive iodine
thyroidectomy

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28
Q

What causes opthalmic graves disease?

A

Abs for TSH receptor also match those in the orbit. They bind and cause retro-orbital inflammation (swelling and oedema of extraocular muscles)

29
Q

Features of ophthalmic graves disease

A

reduced eye movements, symptoms of pressure and pain in the eye, gritty sensation

30
Q

Ix for ophthalmic graves disease?

A

MRI orbit, visual acuity

31
Q

features of male hypogonadism?

A

reduced libido, high pitched voice, thinned pubic hair, small soft testes, reduced muscle mass, osteoporosis

32
Q

Ix for male hypogonadism?

A

bloods - testosterone, FSH/LH levels
Chromosome analysis
prolactin levels
MRI pituitary

33
Q

What is the commonest cause of primary hypogonadism in males?

A

Klinefelter syndrome

34
Q

What is Addison’s disease?

A

destruction of the entire adrenal cortex due to organ specific antibodies

35
Q

Causes of low sodium?

A

Addison’s, dilutional hyponatraemia, SIADH

36
Q

Features of addison’s disease?

A

Insidious - lethargy, depression, anorexia, weight loss
postural hypotension due to salt and water loss
hyperpigmentation, vitiligo

37
Q

features of an addison’s crisis?

A

vomiting, abdo pain, weakness, hypoglycaemia, hypovolaemia

38
Q

Ix for addisons?

A

cortisol measurement, long and short ACTH test, adrenal antibodies
U&Es - hyponatraemia, hyperkalaemia, hypercalcaemia

39
Q

How do you manage addison’s disease?

A

hydrocortisone and fludrocortisone

40
Q

how do you manage an addison’s crisis?

A

hydrocortisone, 1L saline, 50mL dextrose and find precepitating cause

41
Q

What is cushing’s disease?

A

persistantly high circulating glucocorticoid levels

42
Q

Causes of cushing disease?

A

synthetic steroids as medication, pituitary producing ACTH, SCLC, adrenal adenoma, adrenal carcinoma

43
Q

Symptoms of cushing disease?

A

central weight gain, changed appearance, depression, insomnia, amenorrhea, reduced libido, thin skin, hair growth, polyuria, polydipsia

44
Q

Signs of cushings disease?

A

moon face, plethora, acne, hirsutism, thin skin, bruising, high BP, proximal myopathy

45
Q

How do you investigate cushing disease?

A

48 hour dexamethasone suppression test, 24 hour urinary free cortisol, circadian rhythm studies adrenal and pituitary CT/MRI

46
Q

Name some adverse effects of high circulating corticosteroid levels long term?

A 
CVS - HTN
GI - peptic ulcer/acute pancreatitis
RENAL - polyuria/nocturia
CNS - depression/euphoria/psychosis/insomnia
END - increased weight/diabetes/glycosuria
BONE - osteoporosis, proximal myopathy
SKIN - thinning/bruising
EYES - cataracts
47
Q

What are the features of diabetes insipidus?

A

polyuria, nocturia, compensatory polydipsia

48
Q

Causes of diabetes insipidus?

A

Hypothalamus - surgery, trauma, tumours, idiopathic
Damage to the hypothalamic stalk (ADH leak)
Nephrogenic - lithium, sickle cell

49
Q

Ix for diabetes insipidus?

A

measure Urine volume, do plasma UEs, measure urine osmolality, do water deprivation test, MRI hypothalamus

50
Q

Mx for diabetes insipidus?

A

desmopressin

51
Q

What is SIADH?

A

inappropriate secretion of ADH despite plasma hypotonacity

52
Q

Causes of SIADH?

A

SCLC, head injury, trauma, alcohol withdrawal, opiates

53
Q

Features of SIADH?

A

Mild hyponatraemia - nausea, irritable, headache

Severe - fit, coma

54
Q

Mx of SIADH

A

water restrict

demeclocycline

55
Q

name some causes of hypercalcaemia

A

PTH - primary and tertiary hyperparathyroid, ectopic PTH
malignancy - myeloma, bone deposits, increased osteoclast action
Increased vit D - self administered, sarcoidosis
endocrine - thyrotoxicosis, addisons

56
Q

What is primary hyperparathyroidism?

A

parathyroid adenoma/hyperplasia

57
Q

what is secondary hyperparathyroidism?

A

physiological compensatory hyperplasia of all glands due to prolonged reduced Ca (e.g. CKD/vit D deficiency)

58
Q

what is tertiary hyperparathyroidism?

A

parathyroid hyperplasia due to long standing secondary hyperparathyroidism

59
Q

hypercalcaemia symptoms?

A

bone pain, abdo pain, constipation, vomiting, renal calcuili

60
Q

Ix for hypercalcaemia?

A

Serum fasting Ph and Ca
Serum PTH
24hour urinary calcium
protein electrophoresis for myeloma

61
Q

Mx for hypercalcaemia?

A

rehydrate with saline
bisphosphonate
measure UEs

62
Q

Causes of hypocalcaemia?

A

increased phosphate - CKD, phosphate therapy
Reduced PTH - post thyroid/parathyroidectomy
Vit D deficiency - reduced UV exposure, malabsorption
Drugs - bisphosphonates

63
Q

Features of hypocalcaemia?

A

numbness around mouth, cramps, tetany, positive chvostek and trosseau sign, prolonged QT interval

64
Q

Causes for hypophosphataemia?

A

redistribution in cells, increased renal excretion, reduced intake and intestinal absorption

65
Q

features of hypophosphataemia?

A

muscle weakness, reduced heart contractility, cardiac failure, rhabdomyolysis

66
Q

Name endocrine causes of HTN

A

Renin - renal artery stenosis, renin-secreting tumour
Aldosterone - adrenal adenoma/hyperplasia
mineralcorticoids - cushings
catecholamines - phaeochromocytoma
GH - acromegaly

67
Q

What is primary hyperaldosteronism?

A

high aldosterone independant of RAAS

68
Q

Causes of primary hyperaldosteronism?

A

CONN’S - aldosterone secreting adrenal adenoma

Bilateral adrenal hyperplasia

69
Q

features of hyperaldosteronism

A

hypertension, reduced potassium

Finals (21 decks)

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