endocrinology

Question 1

what part of brain regulates pituitary gland?

Answer 1

hypothalamus

Question 2

3 causes of bushings syndrome?

Answer 2

1. exogenous steroids
2. ACTH-secreting pituitary tumour
3. cortisol secreting adrenal tumour

Question 3

what is the HPA axis?

Answer 3

hypothalamus secretes CRH
pituitary secretes ACTH
adrenal cortex secretes cortisol

Question 4

how does cushings affect BP + glucose levels?

Answer 4

hypertension

hyperglycaemia

Question 5

how will cushings syndrome respond to dexamethasone?

Answer 5

will not be supressed

Question 6

4 causes of Addisons disease?

Answer 6

1. autoimmunity
2. suppression of HPA axis following steroid therapy
3. adrenal tumours
4. pituitary failure

Question 7

what is cushings syndrome

Answer 7

hypercortisolism

Question 8

oral feature of Addisons?

Answer 8

pigmented buccal mucosa

Question 9

how does Addisons affect BP + glucose levels?

Answer 9

hypotension

hypoglycaemia

Question 10

treatment for Addisons?

Answer 10

hydrocortisone or fludrocortisone

Question 11

what is the thyroid axis?

Answer 11

hypothalamus secretes TRH
pituitary secretes TSH
thyroid secretes thyroxine

Question 12

what is main role of thyroid?

Answer 12

controls metabolism

Question 13

3 causes of hyperthyroidism

Answer 13

1. autoimmune - graves disease
2. multi nodular goitre
3. thyroid adenoma

very rarely due to problem in pituitary

Question 14

example of an antithyroid drug?

Answer 14

carbimazole

iodide also used to treat hyperthyroidism

Question 15

4 causes of hypothyroidism

Answer 15

1. autoimmune destruction
2. surgical removal of thyroid
3. radio-iodine treatment
4. secondary to decreased TSH in pituitary disease

Question 16

what is myxoedema and what causes it?

Answer 16

caused by hypothyroidism
infilitrain of interstitial tissue with proteinaceous fluid

coarse face, bags under eyes, croaky voice

Question 17

how to treat hypothryoidism?

Answer 17

thyroxine tablets - levothryoxine

Question 18

what is the GH axis?

Answer 18

hypothalamus secretes GHRH
pituitary secretees GH
liver produces IGF-1

Question 19

cause of acromegaly?

Answer 19

pituitary tumour secreting GH

Question 20

how does acromegaly affect BP + glucose levels?

Answer 20

hypertension

hyperglycaemia

Question 21

how does PTH effect calcium levels

Answer 21

PTH increase blood calcium levels

Question 22

what causes hyperPTH

Answer 22

primary - parathyroid tumour

secondary - response to low calcium/vit D

Question 23

how may hypercalceima be identified on a dental radiograph?

Answer 23

loss of lamina dura

reduced cortical width of mandible + ground glass appearance

Question 24

2 causes of hypoparathyroidism

Answer 24

1. autoimmune

2. damage to parathyroid during surgery

Question 25

what is produced by C parafollicular cells in thyroid gland

Answer 25

calcitonin

Question 26

effects of calcitonin?

Answer 26

inhibits osteoclasts
leads to hypocalcaemia, hyposphophataemia

can be used to treat hypercalcaemia + pagets

Question 27

what are sulphonylureas?

Answer 27

used to augment insulin secretion - in T2DM has must have working B cells

-Ide

can cause lichenoid + erythema multiforme

Question 28

what is the first choice of oral hypoglycaemic in overnight patients?

Answer 28

metformin - type of biguanide

decrease gluconeogenese (carbohydrate –> glucose)

can cause taste disturbances

Question 29

what causes adrenal crisis?

Answer 29

stress - infections or severe pain

Question 30

features of Addisons crisis

Answer 30

hypotension, especially postural
weak + confused
feeble rapid pulse
abdominal pain
nausea
possible seizures

Question 31

treatment of Addisons crisis

Answer 31

lie flat
call for help

paramedics - 200mg IV hydrocortisone + IV fluids

Question 32

how to treat patients with steroid induced HPA suppression under LA?

Answer 32

essential to monitor BP

if >25% distolic drop then 100mg IV hydrocortisone

Question 33

how to treat patients with primary adrenal insufficiency under LA?

Answer 33

if difficult/stressful

double dose up to 20mg hydrocortisone for 24hrs

or

IV 100-200mg hydrocortisone 30mins prior

Question 34

how to treat patients with adrenal insufficiency under GA?

Answer 34

typically hydrocortisone 100-200mg IV 1 hour prior to surgery

or

100-200mg IV at induction + stay at double dose for 24hrs