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Phase 2a - Endocrinology > Endocrinology Conditions B > Flashcards

Endocrinology Conditions B Flashcards

1
Q

Addison’s Disease - Description

A

decreased cortisol and aldosterone secretion, a.k.a. primary adrenal insufficiency

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2
Q

Addison’s Disease - Causes (2)

A

1) autoimmune (most common UK, 80%)

2) tuberculosis (most common WW)

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3
Q

Addison’s Disease - Pathophysiology (Autoimmune) (2)

A

1) autoimmune destruction of adrenal cortex

2) decreased cortisol and aldosterone secretion

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4
Q

Addison’s Disease - Symptoms (7)

A

1) fatigue
2) lethargy
3) nausea
4) vomiting
5) anorexia
6) weight loss
7) depression

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5
Q

Addison’s Disease - Signs (1)

A

1) hyperpigmentation

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6
Q

Addison’s Disease - Mnemonic (4)

A

1) thin
2) tired
3) tanned
4) tearful

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7
Q

Addison’s Disease - Complications (9)

A

1) shock
2) vitiligo
3) hyponatraemia
4) hypercalcaemia
5) hyperkalaemia
6) hypokalaemia (iatrogenic)
7) hypertension (iatrogenic)
8) osteoporosis (iatrogenic)
9) Cushing’s syndrome (iatrogenic)

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8
Q

Addison’s Disease - Investigations (2/3)

A 
initial
1) 9:00am cortisol (<100nM)
2) UnE (low Na+, high K+)
consider
1) 9:00am ACTH (>22pM)
2) short ACTH stimulation test (Synacthen) (cortisol<500nM)
3) insulin tolerance test
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9
Q

Addison’s Disease - Management (0/2/0)

A

medical

1) hydrocortisone (replace cortisol)
2) fludrocortisone (replace aldosterone)

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10
Q

Secondary Adrenal Insufficiency - Description

A

decreased cortisol and aldosterone secretion

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11
Q

Secondary Adrenal Insufficiency - Causes (2)

A

1) steroids
2) pituitary adenoma
3) Sheehan’s syndrome

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12
Q

Secondary Adrenal Insufficiency - Pathophysiology (2)

A

1) decreased CRH or ACTH secretion

2) decreased cortisol and aldosterone secretion

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13
Q

Secondary Adrenal Insufficiency - Symptoms (7)

A

1) fatigue
2) lethargy
3) nausea
4) vomiting
5) anorexia
6) weight loss
7) depression

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14
Q

Secondary Adrenal Insufficiency - Signs (1)

A

1) hyperpigementation

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15
Q

Secondary Adrenal Insufficiency - Mnemonic (4)

A

1) thin
2) tired
3) tanned
4) tearful

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16
Q

Secondary Adrenal Insufficiency - Complications (9)

A

1) shock
2) vitiligo
3) hyponatraemia
4) hypercalcaemia
5) hyperkalaemia
6) hypokalaemia (iatrogenic)
7) hypertension (iatrogenic)
8) osteoporosis (iatrogenic)
9) Cushing’s syndrome (iatrogenic)

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17
Q

Secondary Adrenal Insufficiency - Investigations (2/3)

A 
initial
1) 9:00am cortisol (<100nM)
2) UnE (low Na+, high K+)
consider
1) 9:00 ACTH (<5nM)
2) short ACTH stimulation test (Synacthen) (cortisol<500nM)
3) insulin tolerance test
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18
Q

Secondary Adrenal Insufficiency - Management (0/2/0)

A

medical

1) hydrocortisone (replace cortisol)
2) fludrocortisone (replace aldosterone)

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19
Q

Hyperkalaemia - Description

A

increased serum potassium

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20
Q

Hyperkalaemia - Causes (3)

A

1) decreased excretion
2) cellular redistribution
3) increased intake

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21
Q

Hyperkalaemia - Causes (Decreased Excretion) (3)

A

1) kidney disease
2) Addison’s disease
3) drugs (spironolactone, ACEi, NSAID)

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22
Q

Hyperkalaemia - Causes (Cellular Redistribution) (3)

A

1) metabolic acidosis
2) diabetic ketoacidosis
3) tissue necrosis (e.g. burns)

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23
Q

Hyperkalaemia - Causes (Increased Intake) (3)

A

1) high dietary potassium
2) potassium containing drugs
3) stored blood transfusion

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24
Q

Hyperkalaemia - Symptoms (5)

A

1) asymptomatic (until severe)
2) muscle weakness
3) lightheadedness
4) palpitations
5) chest pain

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25
Q

Hyperkalaemia - Signs (3)

A

1) tachycardia
2) arrhythmia
3) Kussmaul’s breathing (deep, laboured breathing)

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27
Q

Hyperkalaemia - Complications (1)

A

1) myocardial infraction

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28
Q

Hyperkalaemia - Investigations (2/0)

A

initial

1) UnE (K+>5.5mM, K+>6.5mM - medical emergency)
2) ECG (small P wave, long PR segment, wide QRS complex, tall T waves, VF)

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29
Q

Hyperkalaemia - Management (2/2/0)

A 
conservative
1) review medications
2) low dietary potassium
medical
1) treat underlying cause
2) polystyrene sulphonate resin (prevents absorption)
30
Q

Hyperkalaemia - Management (Medical Emergency) (1/2/0)

A 
K+>6.5mM
conservative
1) senior assistance
medical
1) calcium chloride
2) insulin
31
Q

Hypokalaemia - Description

A

decreased serum potassium

32
Q

Hypokalaemia - Causes (5)

A

1) diuretic (esp. thiazide)
2) Cushing’s syndrome
3) Conn’s syndrome
4) vomiting
5) diarrhoea

33
Q

Hypokalaemia - Symptoms (8)

A 
muscle
1) muscle weakness
2) hypotonia
3) hyporeflexia
4) tetany
5) cramps
other
6) lightheadedness
7) palpitations
8) constipation
34
Q

Hypokalaemia - Investigations (2/0)

A

initial

1) UnE (K+<3.5mM, K+<2.5mM - medical emergency)
2) ECG (long PR interval, depressed ST segment, small T waves, prominent U waves)

35
Q

Hypokalaemia - Management (1/2/0)

A 
conservative
1) change thiazide diuretics to spironolactone
medical
1) PO potassium (K+<3.5mM)
2) IV potassium (K+<2.5mM)
36
Q

Syndrome of Inappropriate Anti-Diuretic Hormone - Description

A

increased ADH secretion despite low serum osmolality

37
Q

Syndrome of Inappropriate Anti-Diuretic Hormone - Causes (4)

A

1) drugs (e.g. SSRI, NSAID, amiodarone)
2) respiratory conditions (e.g. pneumonia)
3) CNS conditions (e.g. meningitis)
4) tumours (e.g. small cell lung carcinoma)

38
Q

Syndrome of Inappropriate Anti-Diuretic Hormone - Symptoms (5)

A

1) nausea
2) vomiting
cerebral oedema (hyponatraemia)
3) headaches
4) confusion
5) coma

39
Q

Syndrome of Inappropriate Anti-Diuretic Hormone - Complications (2)

A

1) hyponatraemia
2) cerebral oedema
3) cerebral pontine demyelinosis (rapid recorrection)

40
Q

Syndrome of Inappropriate Anti-Diuretic Hormone - Investigations (4/1)

A 
initial
1) serum Na+ (<135mM)
2) serum osmolality (<280mmol/kg)
3) urine Na+ (>40mM)
4) urine osmolality (>100mmol/kg)
consider
1) saline infusion diagnostic trial (similar serum Na+)
41
Q

Syndrome of Inappropriate Anti-Diuretic Hormone - Management (1/3/0)

A 
conservative
1) fluid restriction (<1L/day)
medical
1) treat underlying cause
2) loop diuretic (e.g. furosemide)
3) IV hypertonic saline (severe)
42
Q

Diabetes Insipidus - Description

A

increased urine production

43
Q

Diabetes Insipidus - Types (2)

A

1) cranial diabetes insipidus

2) nephrogenic diabetes insipidus

44
Q

Diabetes Insipidus - Causes (Cranial) (6)

A

1) idiopathic (>50%)
2) transsphenoidal surgery (2nd most common)
3) posterior pituitary tumour
4) craniopharyngioma
5) trauma
6) genetic

45
Q

Diabetes Insipidus - Causes (Nephrogenic) (6)

A

1) iodine (>50%)
2) demeclocyline
3) chronic kidney disease
4) hypercalcaemia
5) hyperkalaemia
6) genetic

46
Q

Diabetes Insipidus - Pathophysiology (Cranial) (1)

A

1) decreased ADH secretion

47
Q

Diabetes Insipidus - Pathophysiology (Nephrogenic) (1)

A

1) decreased ADH efficacy

48
Q

Diabetes Insipidus - Symptoms (4)

A

1) polydipsia
2) polyuria
3) nocturia
4) no glycosuria

49
Q

Diabetes Insipidus - Complications (4)

A

1) hypernatraemia*
2) hyponatraemia (iatrogenic)
3) kidney dysfunction
4) bladder dysfunction

50
Q

Diabetes Insipidus - Investigations (4/3)

A 
initial
1) serum osmolality (>300mmol/kg)
2) urine osmolality (<200mmol/kg)
3) urine dipstick (exclude diabetes mellitus)
4) 24 hour urine collection (>3L)
consider
1) water deprivation test*
2) desmopressin stimulation test (cranial vs nephrogenic) 
3) brain MRI (cranial cause)
51
Q

Diabetes Insipidus - Management (0/5/0)

A

medical

1) treat underlying cause
2) IV fluids
3) desmopressin (cranial)
4) thiazide diuretic (nephrogenic)
5) NSAID (nephrogenic)

52
Q

Hypernatraemia - Description

A

increased serum sodium

53
Q

Hypernatraemia - Causes (7)

A 
fluid loss
1) renal loss (e.g. DI, uncontrolled DM)
2) gastrointestinal loss (diarrhoea, vomiting)
3) sweat loss (fever, burns)
inadequate water intake
4) inability to drink water (e.g. dementia)
5) impaired thirst mechanism
sodium overload
6) Cushing’s syndrome
7) drugs (saline, sodium bicarbonate)
54
Q

Hypernatraemia - Symptoms (6)

A

1) polydipsia
2) lethargy
3) weakness
4) confusion
5) irritability
6) coma

55
Q

Hypernatraemia - Complications (1)

A

1) cerebral oedema (iatrogenic)

56
Q

Hypernatraemia - Investigations (4/2)

A 
initial
1) UnE
2) serum Na+ (>145mM, >155mM - severe)
3) serum osmolality (>295mmol/kg)
4) urine osmolality (>150mmol/kg)
consider
1) water deprivation test (DI)
57
Q

Hypernatraemia - Management (1/5/0)

A 
conservative
1) monitor
medical
1) treat underlying cause
2) IV fluids
3) desmopressin (cranial DI)
4) thiazide diuretic (nephrogenic DI)
5) loop diuretic (sodium overload)
58
Q

Hyponatraemia - Description

A

decreased serum sodium

59
Q

Hyponatraemia - Types (3)

A

1) euvolaemic
2) hypervolaemic
3) hypovolaemic

60
Q

Hyponatraemia - Causes (Euvolaemic) (2)

A

1) syndrome of inappropriate anti-diuretic hormone)

2) diuretic

61
Q

Hyponatraemia - Causes (Hypervolaemic) (5)

A

1) drip arm (20%)
2) Addison’s disease
3) diarrhoea
4) vomiting
5) trauma (e.g. burns)

62
Q

Hyponatraemia - Causes (Hypovolaemic) (3)

A

1) cardiac failure
2) hepatic failure
3) renal failure

63
Q

Hyponatraemia - Symptoms (130mM-135mM) (1)

A

1) asymptomatic

64
Q

Hyponatraemia - Symptoms (125mM-130mM) (5)

A

1) headache
2) lethargy
3) weakness
4) abdominal pain
5) anorexia

65
Q

Hyponatraemia - Symptoms (<125mM) (2)

A

1) confusion

2) irritability

66
Q

Hyponatraemia - Symptoms (<115mM) (2)

A

1) seizure

2) coma

67
Q

Hyponatraemia - Complications (2)

A

1) cerebral oedema

2) central pontine myelinolysis

68
Q

Hyponatraemia - Investigations (6/0)

A

1) UnE
2) serum Na+ (<135mM)
3) serum osmolality
4) urine osmolality
5) TFT (exclude hypothyroidism)
6) 9:00am cortisol (exclude Addison’s)

69
Q

Hyponatraemia - Management (1/3/0)

A 
conservative
1) fluid restriction (euvolaemic, hypervolaemic)
medical
1) treat underlying cause
2) IVI hypertonic saline (acute<48hours)
3) IVI isotonic fluid (chronic>48hours)

Phase 2a - Endocrinology (5 decks)

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