Endocrinology Flashcards

1
Q

Acromegaly

features and investigation

A

acess growth hormone

clinical Features
Large hands and feet
Outward growth of the jaw and head with increased interdental spacing and macroglossia
Headaches
Erectile dysfunction
Voice change
Increased sweating
Mood disturbances
Fatigue.
  1. measure IGF-1.
  2. growth hormone is measured following intake of oral glucose (Oral Glucose Tolerance Test) to see if growth hormone is inappropriately suppressed
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2
Q

Acromegaly management

A

First line treatment for acromegaly is trans-sphenoidal surgery.
Other options for refractory cases or for patients who cannot undergo surgery:
Somatostatin receptor ligands (SLR) such as Octreotide
Pegvisomant (GH analogue)
Cabergoline (Dopamine agonist)
Radiotherapy

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3
Q

Primary Causes of Adrenal Insufficiency (addisons .)

A

Primary Causes of Adrenal Insufficiency (Addison’s)
Auto-immune (most-common)
Surgical removal
Trauma
Infections (Tuberculosis: more common in the developing world)
Haemorrhage (Waterhouse-Friderichsen syndrome)
Infarction
Less common: neoplasm, sarcoidosis, amyloidosis

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4
Q

Addisons clinical features

A

Clinical Features
Hypotension
Fatigue and weakness
GI symptoms
Syncope
Pigmentation (due to an increase in ACTH pre-cursors).
Approximately 60% of patients with auto-immune Addison’s disease have vitiligo or other autoimmune endocrinopathies.

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5
Q

Amiodarone induced thyrotoxicosis

managment

A

Management
Treatment depends on the underlying type and may involve anti-inflammatories such as steroids plus anti-thyroid drugs (Carbimazole).
Close discussion with the Cardiology team is important to decide whether the Amiodarone needs to be stopped or substituted.
Abnormalities if thyroid function can occur in up to 50% of patients taking Amiodarone.

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6
Q

Cushing’s syndrome

investigation

A

To identify cortisol excess:

24 hour urinary free cortisol
Low-dose Dexamethasone suppression test
Localisation:

Plasma ACTH
High-dose dexamethasone suppression test
Inferior petrosal sinus sampling
MRI of the pituitary
CT Chest and Abdomen (suspected tumour)
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7
Q

Medical Management of cushings

A

Blockers of the steroid synthesis pathway should be used first line, with Metyrapone the most commonly used.

Other treatments include Ketoconazole which is an adrenolytic agent, Mifepristone which is a glucocorticoid antagonist and Pasireotide which binds to somastostatin receptors.

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8
Q

Causes of cranial DI

A
idiopathic
post head injury
pituitary surgery
craniopharyngiomas
histiocytosis X
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
haemochromatosis
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9
Q

Causes of nephrogenic DI

A

genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes: hypercalcaemia, hypokalaemia
lithium
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

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10
Q

Cranial DI deprevation tests

A

Starting plasma osm. high
Final urine osm. supressed
Urine osm. post-DDAVP (dex) high

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11
Q

nephrogenic DI deprevation tests

A

Starting plasma osm. high
Final urine osm. supressed
Urine osm. post-DDAVP (dex) supressed

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12
Q

Management of ertile dysfuntion

A
Depends on cause
Psychosexual therapy
Oral phosphodiesterase inhibitors (Sildenafil)
Vacuum aids
Intra-cavernosal injections
Prosthesis
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13
Q

Causes of Smooth Goitre

A
Graves' disease
Hashimoto's disease
Drugs (e.g. lithium, amiodarone)
Iodine deficiency/excess
De Quervain's thyroiditis (painful)
Infiltration (e.g. sarcoid, haemochromatosis)
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14
Q

Causes of Nodular Goitre

A
Toxic solitary adenoma
Non-functional thyroid adenoma
Multinodular goitre
Thyroid cyst
Cancer
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15
Q

primary hyperparathyroidism i

A

‘bones, stones, abdominal groans and psychic moans’
polydipsia, polyuria
peptic ulceration/constipation/pancreatitis
bone pain/fracture
renal stones
depression
hypertension

raised calcium, low phosphate Phosphate (Low)

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16
Q

Secondary hyperparathyroidism

A

PTH (Elevated)
Ca2+ (Low or normal)
Phosphate (Elevated)

17
Q

Tertiary hyperparathyroidism

A

Ca2+ (Normal or high)
PTH (Elevated)
Phosphate levels (Decreased or Normal)

18
Q

Amiodarone Side Effects

A
Hypothyroidism (more common than hyperthyroidism)
Hyperthyroidism
Corneal deposits
Stevens-Johnson syndrome
Grey discoloration of the skin
Liver failure