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Year 4 General Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

FLAT PIG for anterior pituitary hormones

A

FSH
LH
ACTH
TSH

PRL
Intermediate - MSH
GH

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2
Q

too much hormone

A

try to suppress it

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3
Q

too little hormone

A

try to stimulate it

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4
Q

what imaging modalities would you use for adrenals and pituitary

A

CT - adrenal

MRI - pituitary

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5
Q

approaches to endocrine

A

phenotype
biochemistry: suppression/stimulation tests, levels
imaging

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6
Q

phenotype of hyperthyroidism

A 
heat intolerance 
weight loss 
anxiety 
tremor 
tachycardia 
palpitations 
diarrhoea 
oligo/amenorrhoea
exophthalmos 
dry skin and fine brittle hair 
pretibial myxoedema 
insomnia 
AF
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7
Q

biochemistry of primary hyperthyroidism

A

low TSH

high free T3/4

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8
Q

primary hyperthyroidism

A

problem with the thyroid itself resulting in negative feedback

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9
Q

secondary hyperthyroidism

A

pituitary abnormality resulting in thyroid abnormality

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10
Q

causes of primary hyperthyroidism

A 
Graves disease  
TMG 
Adenoma 
Thyroiditis
drugs - amiodarone
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11
Q

what is Graves disease

A

autoimmune condition
anti-TRAb - thyroid receptor antibodies
continuously stimulates iodine uptake into thyroid and production of T3/4
smooth goitre with bruit

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12
Q

features pathognomonic of Graves

A

pretibial myxoedema
Graves ophthalmopathy - asymmetrical swelling and exophthalmos
thyroid acropachy

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13
Q

management of sight threatening swelling of the eye

A

steroids

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14
Q

investigations for hyperthyroidism

A

thyroid levels
USS
nuclear medicine uptake scan

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15
Q

which ATD is used in the first trimester of pregnancy

A

PTU

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16
Q

ATD examples

A

carbimazole

PTU

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17
Q

management of hyperthryoidism

A

propranolol for symptoms (non-selective B blocker)
carbimazole, PTU
radioactive iodine
thyroidectomy

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18
Q

side effects of carbimazole and PTU

A

carbimazole - agranulocytosis

PTU - liver failure

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19
Q

risks of thyroidectomy

A

RLN damage

damage to parathyroids

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20
Q

thyroid storm

A

extreme hyperthyroidism

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21
Q

features of thyroid storm

A 
high temp
dehydration 
excess sweating 
sinus arrhythmia 
diarrhoea
pre renal failure 
weight loss 
myopathy 
CK rise 
delirious 
coma 
psychosis
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22
Q

management of thyroid storm

A 
1. propranolol 
PTU/carbimazole 
hydrocortisone 
2. iodine 
lithium 
look for underlying causes
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23
Q

phenotype hypothyroidism

A 
weight gain 
cold intolerance 
low mood 
low energy 
bradycardia 
constipation 
menorrhagia
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24
Q

biochemistry of primary hypothyroidism

A

high TSH

low free T3/4

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25
Q

causes of primary hypothyroidism

A 
autoimmune Hashimoto's 
thyroiditis 
post-hyperthyroidism treatment 
iodine deficiency 
amiodarone 
lithium 
interferon 
irradiation 
sarcoidosis 
amyloidosis 
surgery
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26
Q

management of hypothyroidism

A

levothyroxine

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27
Q

worry abut levothyroxine in elderly

A

suddenly increase their heart function which can exacerbate heart conditions eg HTN, HF

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28
Q

what is myxoedema coma

A

extreme hypothyroidism

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29
Q

features of myxoedema coma

A 
depressed 
thinning hair 
oedema 
bradycardia 
constipation 
carpal tunnel 
cool peripheries 
hypothermia 
loss of outer 1/3rd eyebrow hair
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30
Q

management of myxoedema coma

A

levothyroxine

steroids

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31
Q

hypothyroidism causes high/low MCV

A

high

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32
Q

symptoms of hypercalcaemia

A 
bones - bone pain 
moans - psychiatric
stones - renal 
groans - abdo pain 
thrones - constipation 
dehydration and thirst 
confusion 
polyuria 
myopathy 
depression 
short QT segment - ECG
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33
Q

treatment of acute hypercalcaemia

A

0.9% NaCl
IV bisphosphonates
identify cause and reverse it

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34
Q

symptoms of hypocalcaemia

A 
paraesthesia 
Trousseau sign - carpopedal spasm 
Chovsteks sign - twitching on tapping face
tetany 
long QT segment - ECG
fatigue and muscle weakness 
fits, seizures
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35
Q

treatment of acute hypocalcaemia

A

IV calcium gluconate 10ml, 10% over 10 min

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36
Q

management of acute hyperkalaemia

A 
ECG 
stop any infusion containing K
IV calcium gluconate to stabilise cardiac membrane 
IV insulin to drive K intracellularly 
salbutamol does the same 
haemodialysis is a last line
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37
Q

phenotype of reduced anterior pituitary function

A

large tumour bulk - adenoma - cause reduction in hormone production and therefore function

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38
Q

causes of hypopituitarism

A

tumours - adenoma, craniopharyngeoma
vascular - Sheehans syndrome, severe hypotension
infection - meningitis, TB, syphilis, HIV/AIDS
hypothalamic disorders - tumours, functional, GHRH deficiency
iatrogenic - radiation, hypophysectomy
miscellaneous - sarcoidosis, haemochromatosis

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39
Q

features of hypopituitarism

A

secondary amenorrhoea in premenopausal women

bitemporal hemianopia

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40
Q

general order of loss of pituitary function

A 
GGAT
Gonadotrophins 
GH 
ACTH 
TSH
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41
Q

low LH and FSH is a post menopausal woman is a red flag?

A

yes

normally a post menopausal woman should have high LH and FSH and so if it low it might be due to a pituitary pathology

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42
Q

stimulation test for GH

A

insulin tolerance test

insulin to bring down blood glucose to stimulate GH

43
Q

in anterior pituitary hormone excess, it generally occurs to all hormones produced, true or false

A

false

usually one hormone goes beserk

44
Q

most common cause of hormone excess in anterior pituitary

A

adenoma

45
Q

FSH/LHomas tend to be detected quite late, true or false

A

true
usually removed surgically
can cause hypopituitarism

46
Q

features of ACTH excess

A 
Cushingoid appearance 
weight gain, puffy face, central obesity, striae 
thin skin, bruising, hirsutism, muscle wasting, osteoporosis, frontal balding, acne, buffalo hump
poor healing 
thin limbs 
^HTN 
^blood glucose 
fluid retention 
depression, psychotic, poor sleep
immunosuppression
47
Q

causes of Cushing’s

A

exogenous steroid use
Pituitary - Cushing’s disease
adrenal adenoma / hyperplasia
ectopic - SCLC

48
Q

investigation for excess cortisol

A

DXM suppression test

very potent steroid to feedback to pituitary to switch off ACTH and down regulate cortisol

49
Q

adrenal anatomical regions

A 
cortex outside (secretory)
medulla inside (neuroendocrine)
50
Q

layers of the cortex

A 
GFR
zona:
glomerulosa 
fasiculata 
reticularis
51
Q

what does zona glomerulosa secrete

A

aldosterone - minerlocorticoid

52
Q

what does the zona fasiculata secrete

A

cortisol - corticosteroid

53
Q

what does the zona reticularis secrete

A

adrenal androgens

- fairly clinical insignificant

54
Q

what does the adrenal medulla secrete

A

adrenaline
noradrenaline
- catecholamines

55
Q

what are steroid ultimately derived from

A

cholesterol –> pregnenolone –> steroid

56
Q

only glucocorticoids negatively feedback on ACTH, true or false

A

true

57
Q

what do the mineralocorticoids negatively feedback on

A

RAAS

58
Q

What is a cause of hypoadrenalism

A 
Autoimmune Addisons disease
Malignancy 
Freiderichson-Waterhouse syndrome - haemorrhage/hypotension
Infections - TB, HIV
Excess steroid therapy 
Haemochromatosis
59
Q

clinical features of hypoadrenalism

A 
hypotension 
dizzy 
weight loss 
tanned / hyperpigmentation of creases
hypoglycaemia
diarrhoea
60
Q

why do people with hypoadrenalism have tanned skin

A

^ ACTH production results in ^MSH causing bronzed skin

61
Q

why would you do a BM in someone with hypoadrenalism

A

low cortisol causes low glucose

62
Q

biochemical features of hypoadrenalism

A

hyponatraemia
hyperkalaemia
hypoglycaemia
low early morning cortisol

63
Q

dynamic testing for hypoadrenallism

A

synacthen test
give dose of ACTH to see whether there is a spike in cortisol levels
take bloods at 0, 30 and 60 min
(also measure ACTH at 0 min)

64
Q

further imaging for hypoadrenalism

A

CT adrenal

65
Q

management of hypoadrenalism

A

hydrocortisone (cortisol replacement)

fludrocortisone (aldosterone replacement)

66
Q

if patients are acutely unwell and have hypoadrenalism, what is important to have

A

steroid card and emergency hydrocortisone

67
Q

what adrenal gland hormones can you have too much of

A

aldosterone
cortisol
catecholamines

68
Q

function of aldosterone

A

mineralocorticoid
activates Na/K ATP channel and resorb Na at the kidney
water follows Na resulting in increased circulating blood volume and maintains BP

69
Q

what is the RAAS

A

Angiotensinogen is produced in the liver
Renin from the kidneys break this down into Ag I
ACE then breaks this into Ag II
Ag II then acts on the kidneys to resorb Na and causes

70
Q

What is Conns syndrome

A

excess aldosterone

71
Q

clinical features of aldosterone excess

A

treatment resistant HTN

72
Q

biochemistry of aldosterone excess

A

hypokalaemia

technically hypernatraemia but because water follows Na, Na levels remain normal

73
Q

dynamic testing for aldosterone excess

A

renin:aldosterone ratio
renin low
aldosterone high

74
Q

what suppression test do you do for aldosterone excess

A

2L saline suppression test

75
Q

examples of aldosterone antagonist drugs

A

spironolactone

eplerenone

76
Q

why do people with Conns disease cause hyperchloraemic metabolic alkalosis

A

hyperchloraemia

aldoseterone causes retention of HCO3 and loss of H

77
Q

people with addisons disease get metabolic acidosis/alkalosis

A

acidosis

78
Q

treatment of Conns disease

A

surgical removal of Conns tumour

or spironolactone treatment

79
Q

what adrenal disease causes cortisol excess

A

Cushing’s syndrome

80
Q

phenotype of Cushings syndrome

A 
buffalo hump 
central obesity 
limb muscle weakening - proximal myopathy 
frontal balding 
striae 
moon face 
hypertension 
IGT 
thin skin, easy bruising
81
Q

dynamic testing for cushings

A

DXM suppression test

82
Q 
response to DXM suppression test in: 
adrenal 
pituitary 
ectopic 
as a cause of Cushings
A

adrenal - suppressed in low dose DXM
pituitary - suppressed in high dose DXM
ectopic - very high, no suppression

83
Q

drug for cushings syndrome

A

metyrapone

only used for elderly people

84
Q

what disease is caused by excess catecholamines

A

phaeochromocytoma

tumour of chromaffin cells

85
Q

clinical features of phaeochromocytoma

A 
headaches 
hyperglycaemia 
sweating 
palpitations 
pallor 
hypertension 
postural symptoms 
episodic symptoms
86
Q

investigation for excess catecholamines

A

24 hour urine metanephrine collections
(2 collections)
plasma also (2nd line test)

87
Q

medical management of phaeochromocytoma and why

A

alpha (phenoxybenzamine/doxazosin) then beta blockers
alpha receptors are in blood vessels
beta receptors are in the heart
this should be done before surgery to prevent squeezing out pre formed hormones causing a crash response

88
Q

why alpha then beta blockade in phaeochromocytoma

A

blocking beta first would mean that adrenaline would saturate the alpha receptors and cause extreme vasoconstriction and hypertension

89
Q

functional imaging for phaeochromocytoma

A

MIBG scan

90
Q

10% rule for phaeochromocytoma

A 
bilateral 
malignant 
genetic 
kids 
extra adrenal
91
Q

which vitamin is essential for Ca metabolism

A

Vit D3

92
Q

which mineral is important for calcium regulation

A

Mg

without it, PTH cannot be released or work properly

93
Q

how many parathyroid glands in the body

A

4

94
Q

where does PTH act

A

bone - osteoclasts activates
kidneys - increased Ca resorption and decreased PO4
gut - increased Ca + PO4 reabsorption

95
Q

classifications of parathyroidism

A

primary
secondary
tertiary

96
Q

primary hyperparathyroidism

A

idiopathic inappropriate secretion of PTH
^PTH + Ca
low PO4

97
Q

secondary hyperparathyroidism

A

appropriate hypersecretion of PTH secondary to low Ca
^PTH
low Ca and PO4

98
Q

tertiary hyperparathyroidism

A

autonomous hypersecretion of PTH / 2ndary HPT gone beserk

most commonly seen in CKD

99
Q

phenotype of hypercalcaemia

A 
bones - osteoporosis
stones - renal 
groans - abdominal 
moans - psychiatric 
thirsty polydipsia 
polyuria
100
Q

imaging for parathyroids

A

sestamibi scan

101
Q

causes of hypercalcaemia

A 
Endocrine - HPT, MEN, FHH
Malignancy - mets, PTHrp, myeloma 
Granulomatous disease - sarcoid, TB 
miscellaneous - AKI, milk alkali syndrome 
Medications - lithium, thiazides, vit D
102
Q

first investigation in someone with hypercalcaemia

A

PTH levels

103
Q

management of hypercalcaemia acutely

A

IV fluids

bisphosphonates

104
Q

addisons can cause hypercalcaemia?

A

yes

Year 4 General Medicine (16 decks)

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