Endocrinology Conditions C Flashcards
Basic Knowledge
Hypercalcaemia - Description
increased serum Ca2+
Hypercalcaemia - Causes (5)
1) primary hyperparathyroidism
2) tertiary hyperparathyroidism
maligancy
3) myeloma/bone metastasis
4) lymphoma
5) lung/kidney
Hypercalcaemia - Pathophysiology (Myeloma/Bone Metastasis) (1)
1) increased bone Ca2+ resorption
Hypercalcaemia - Pathophyisology (Lymphoma) (4)
1) 1 α hydroxylase found in macrophages
2) increased calcitriol production
3) increased intestinal Ca2+ absorption
4) increased PCT Ca2+ reabsorption
Hypercalcaemia - Pathophysiology (Lung/Kidney Malignancy) (2)
1) PTH related peptide secretion
2) activity same as PTH
Hypercalcaemia - Symptoms (8)
1) polyuria
2) dehydration
3) thirst
4) kidney stones
5) confusion -> coma
6) short QT interval
no gut peristalsis
7) nausea
8) constipation
Hypercalcaemia - Signs (4)
1) bones
2) kidney stones
3) abdominal groans
4) mental moans
Hypercalcaemia - Comrobidities (2)
1) osteoporosis
2) acute pancreatitis
Hypercalcaemia - Diagnosis (1)
1) Ca2+ > 3.5mM
Hypercalcaemia - Management (4)
1) loop diuretic
2) parathyroidectomy
3) saline
4) bisphosphonates
Hypocalcaemia - Description
decreased serum Ca2+
Hypocalcaemia - Causes (7)
1) hypoparathyroidism
2) acute pancreatitis
3) vitamin D defiency
4) osteomalacia
5) chronic renal failure
(HAVOC)
6) thyroid or parthyroid surgery
7) pseudoparathyroidism
Hypocalcaemia - Pathophysiology (Hypoparathyroidism) (2)
1) decreased PTH
2) decreased serum Ca2+
Hypocalcaemia - Pathophysiology (Pseudohypoparathyroidism) (2)
1) target cells don’t respond to PTH
2) decreased serum Ca2+
Hypocalcaemia - Symptoms (4)
1) muscle spasm
2) paraesthesia
3) seizures
4) long QT interval
Hypocalcaemia - Signs (2)
1) Chvostek’s sign (facial nerve tap -> facial muscle spasm)
2) Trousseau’s sign (20mmHg above systolic blood pressure cuff -> hand spasm)
Hypocalcaemia - Comorbidities (1)
1) cataracts
Hypocalcaemia - Diagnosis (1)
1) low Ca2+
Hypocalcaemia - Management (4)
1) IV Ca2+ - acute
2) alfacalcidiol (vitamin D)
3) adcal
4) calcium gluconate
Primary Hyperparathyroidism - Description
increased PTH secretion
Primary Hyperparathyroidism - Causes (1)
1) parathyroid adenoma
(one gland - 80%)
(four glands - 15-20%)
Primary Hyperparathyroidism - Pathophysiology (2)
1) parathyroid adenoma
2) increased PTH secretion
Primary Hyperparathyroidism - Symptoms (2)
1) often asymptomatic
2) hypercalcaemia symptoms
Primary Hyperparathyroidism - Comorbidities (1)
1) hypercalcaemia
Primary Hyperparathyroidism - Diagnosis (2)
1) high PTH
2) high Ca2+
Primary Hyperparathyroidism - Management (1)
1) parathyroidectomy (1 or 4)
Secondary Hyperparathyroidism - Description
increased PTH secretion
Secondary Hyperparathyroidism - Causes (3)
1) vitamin D deficiency (main)
2) chronic renal failure
3) hypocalcaemia
Secondary Hyperparathyroidism - Pathophysiology (Vitamin D Deficiency / Chronic Renal Failure) (5)
1) no vitamin D activation - no calcitriol formed
2) decreased intestinal Ca2+ absorption
3) decreased PCT Ca2+ reabsorption
4) decreased serum Ca2+
5) increased PTH secretion
Secondary Hyperparathyroidism - Symptoms (2)
1) often asymptomatic
2) hypercalcaemia symptoms
Secondary Hyperparathyroidism - Comorbidities (2)
1) hypercalcaemia
2) tertiary hyperparathyroidism
Secondary Hyperparathyroidism - Diagnosis (2)
1) high PTH
2) low Ca2+
Secondary Hyperparathyroidism - Management (2)
1) calcium control
2) treat underlying cause
Tertiary Hyperparathyroidism - Description
increased PTH secretion
Tertiary Hyperparathyroidism - Causes (1)
1) secondary hyperparathyroidism (generally chronic renal failure related)
Tertiary Hyperparathyroidism - Pathophysiology (3)
1) prolonged secondary hyperparathyroidism
2) parathyroid hyperplasia
3) increased PTH secretion
Tertiary Hyperparathyroidism - Symptoms (2)
1) often asymptomatic
2) hypercalcaemia symptoms
Tertiary Hyperparathyroidism - Comorbidities (1)
1) hypercalcaemia
Tertiary Hyperparathyroidism - Diagnosis
1) very high PTH
2) high Ca2+
Tertiary Hyperparathyroidism - Management (1)
1) parathyroidectomy (1 or 4)
Hypoparathyroidism - Description
decreased PTH secretion
Hypoparathyroidism - Causes (4)
1) autoimmunity
2) radiation
3) Mg2+ deficiency
4) Di George syndrome
Hypoparathyroidism - Pathophysiology (Mg2+ Deficiency) (2)
1) Mg2+ required for PTH secretion
2) decreased PTH secretion
Hypoparathyroidism - Symptoms (1)
1) hypocalcaemia symptoms
Hypoparathyroidism - Diagnosis (2)
1) low PTH
2) low Ca2+
Hypoparathyroidism - Management (1)
1) alfacalcidol (vitamin D)
Prolactinoma - Description
increased PRL secretion
Prolactinoma - Causes (1)
1) pituitary adenoma
Prolactinoma - Pathophysiology (2)
1) pituitary adenoma
2) increased PRL secretion
Prolactinoma - Symptoms
1) amenorrhoea (F)
2) oligomenorrhoea (F)
3) galactorrhoea (F)
4) low libido (F)
5) erectile dysfunction (M)
6) decreased facial hair (M)
7) infertility/impotence
Prolactinoma - Comorbidities (1)
1) bitemporal hemianopia
Prolactinoma - Diagnosis (1)
1) high PRL
Prolactinoma - Management (1)
1) cabergoline (dopamine agonist)
Carcinoid Syndrome - Description
increased serotonin secretion
Carcinoid Syndrome - Causes (1)
1) carcinoid tumour
Carcinoid Syndrome - Pathophysiology (3)
1) carcinoid (neuroendocrine) tumour of enterochroffin-like cells
2) metastases to liver
3) increased serotonin secretion drains into hepatic vein
Carcinoid Syndrome - Symptoms (6)
1) asymptomatic (as tumour develops)
2) alcohol intolerance
3) weight loss
4) diarrhoea
5) bronchospasm
6) skin flushing
Carcinoid Syndrome - Diagnosis (2)
1) 24 hour urine sample for 5-HIAA (serotonin metabolite)
2) imaging
Carcinoid Syndrome - Management (3)
1) serotonin antagonist
2) octreotide (somatostatin analogue)
3) surgical removal of tumour
