Endocrinology Conditions B

Question 1

Addison’s Disease - Description

Answer 1

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

Question 2

Addison’s Disease - Causes (2)

Answer 2

1) autoimmune (most common UK, 80%)

2) tuberculosis (most common WW)

Question 3

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

Answer 3

1) autoimmune destruction of adrenal cortex

2) decreased cortisol and aldosterone secretion

Question 4

Addison’s Disease - Symptoms (7)

Answer 4

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

Question 5

Addison’s Disease - Signs (1)

Answer 5

1) hyperpigmentation

Question 6

Addison’s Disease - Mnemonic (4)

Answer 6

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

Question 7

Addison’s Disease - Complications (9)

Answer 7

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

Question 8

Addison’s Disease - Investigations (2/3)

Answer 8

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

Question 9

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

Answer 9

medical

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

Question 10

Secondary Adrenal Insufficiency - Description

Answer 10

decreased cortisol and aldosterone secretion

Question 11

Secondary Adrenal Insufficiency - Causes (2)

Answer 11

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

Question 12

Secondary Adrenal Insufficiency - Pathophysiology (2)

Answer 12

1) decreased CRH or ACTH secretion

2) decreased cortisol and aldosterone secretion

Question 13

Secondary Adrenal Insufficiency - Symptoms (7)

Answer 13

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

Question 14

Secondary Adrenal Insufficiency - Signs (1)

Answer 14

1) hyperpigementation

Question 15

Secondary Adrenal Insufficiency - Mnemonic (4)

Answer 15

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

Question 16

Secondary Adrenal Insufficiency - Complications (9)

Answer 16

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

Question 17

Secondary Adrenal Insufficiency - Investigations (2/3)

Answer 17

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

Question 18

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

Answer 18

medical

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

Question 19

Hyperkalaemia - Description

Answer 19

increased serum potassium

Question 20

Hyperkalaemia - Causes (3)

Answer 20

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

Question 21

Hyperkalaemia - Causes (Decreased Excretion) (3)

Answer 21

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

Question 22

Hyperkalaemia - Causes (Cellular Redistribution) (3)

Answer 22

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

Question 23

Hyperkalaemia - Causes (Increased Intake) (3)

Answer 23

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

Question 24

Hyperkalaemia - Symptoms (5)

Answer 24

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

Question 25

Hyperkalaemia - Signs (3)

Answer 25

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

Question 27

Hyperkalaemia - Complications (1)

Answer 27

1) myocardial infraction

Question 28

Hyperkalaemia - Investigations (2/0)

Answer 28

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)

Question 29

Hyperkalaemia - Management (2/2/0)

Answer 29

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

Question 30

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

Answer 30

``` K+>6.5mM conservative 1) senior assistance medical 1) calcium chloride 2) insulin ```

Question 31

Hypokalaemia - Description

Answer 31

decreased serum potassium

Question 32

Hypokalaemia - Causes (5)

Answer 32

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

Question 33

Hypokalaemia - Symptoms (8)

Answer 33

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

Question 34

Hypokalaemia - Investigations (2/0)

Answer 34

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)

Question 35

Hypokalaemia - Management (1/2/0)

Answer 35

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

Question 36

Syndrome of Inappropriate Anti-Diuretic Hormone - Description

Answer 36

increased ADH secretion despite low serum osmolality

Question 37

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

Answer 37

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)

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

``` 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+) ```

Question 41

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

Answer 41

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

Question 42

Diabetes Insipidus - Description

Answer 42

increased urine production

Question 43

Diabetes Insipidus - Types (2)

Answer 43

1) cranial diabetes insipidus | 2) nephrogenic diabetes insipidus

Question 44

Diabetes Insipidus - Causes (Cranial) (6)

Answer 44

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

Question 45

Diabetes Insipidus - Causes (Nephrogenic) (6)

Answer 45

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

Question 46

Diabetes Insipidus - Pathophysiology (Cranial) (1)

Answer 46

1) decreased ADH secretion

Question 47

Diabetes Insipidus - Pathophysiology (Nephrogenic) (1)

Answer 47

1) decreased ADH efficacy

Question 48

Diabetes Insipidus - Symptoms (4)

Answer 48

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

Question 49

Diabetes Insipidus - Complications (4)

Answer 49

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

Question 50

Diabetes Insipidus - Investigations (4/3)

Answer 50

``` 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) ```

Question 51

Diabetes Insipidus - Management (0/5/0)

Answer 51

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

Question 52

Hypernatraemia - Description

Answer 52

increased serum sodium

Question 53

Hypernatraemia - Causes (7)

Answer 53

``` 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) ```

Question 54

Hypernatraemia - Symptoms (6)

Answer 54

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

Question 55

Hypernatraemia - Complications (1)

Answer 55

1) cerebral oedema (iatrogenic)

Question 56

Hypernatraemia - Investigations (4/2)

Answer 56

``` 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) ```

Question 57

Hypernatraemia - Management (1/5/0)

Answer 57

``` 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) ```

Question 58

Hyponatraemia - Description

Answer 58

decreased serum sodium

Question 59

Hyponatraemia - Types (3)

Answer 59

1) euvolaemic 2) hypervolaemic 3) hypovolaemic

Question 60

Hyponatraemia - Causes (Euvolaemic) (2)

Answer 60

1) syndrome of inappropriate anti-diuretic hormone) | 2) diuretic

Question 61

Hyponatraemia - Causes (Hypervolaemic) (5)

Answer 61

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

Question 62

Hyponatraemia - Causes (Hypovolaemic) (3)

Answer 62

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

Question 63

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

Answer 63

1) asymptomatic

Question 64

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

Answer 64

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

Question 65

Hyponatraemia - Symptoms (<125mM) (2)

Answer 65

1) confusion | 2) irritability

Question 66

Hyponatraemia - Symptoms (<115mM) (2)

Answer 66

1) seizure | 2) coma

Question 67

Hyponatraemia - Complications (2)

Answer 67

1) cerebral oedema | 2) central pontine myelinolysis

Question 68

Hyponatraemia - Investigations (6/0)

Answer 68

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

Question 69

Hyponatraemia - Management (1/3/0)

Answer 69

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