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BRS Year 2 > Endocrinology pathologies > Flashcards

Endocrinology pathologies Flashcards

1
Q

Endometriosis:
What is it?
Symptoms?
Treatment?

A

Presence of functional endometrial tissue outside of the uterus

Treatments:
Hormonal
Laparascopic ablation
Hysterectomy
Bilateral Salpingo-oophorectomy
Symptoms:
Menstrual pain
Pain on intercourse
Menstrual irregularities
Infertility
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2
Q

Fibroids:
What are they?
Symptoms?
Treatment?

A

Benign tumours of the myometrium

Symptoms:
Usually asymptomatic
↑ Menstrual pain
Menstrual irregularities
Deep dyspareunia
Infertility

Treatment:
Hormones
Hysterectomy

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3
Q

Low testosterone
High FSH and LH
Diagnosis?

A

Primary testicular failure

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4
Q

What problems can low BMI, exercise and stress lead to in a male?

A

Acquired hypogonadotropic hypogonadism

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5
Q

Kallman’s syndrome:
What is it?
Symptoms?
Treatment?

A

Congenital hypogonadotropic hypogonadism
Failure of migration of GnRH neurons with olfactory fibres

Symptoms:
Cryptorchidism
Failure of puberty
-Lack of testicle development
-Micropenis
-Primary amenorrhoea
Infertility
Anosmia
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6
Q 
Hyperprolactinemia
What is it?
Causes?
Symptoms?
Treatment?
A

High levels of prolactin

Causes:
Prolactinoma
Pituitary stalk compression
Pregnancy and breastfeeding
Medications (dopamine antagonists)
PCOS
Hypothyroidism

Treatment:
Dopamine agonist

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7
Q

Klinefelter’s
What is it?
Symptoms?
Treatments?

A

Extra X chromosome (XXY)

Symptoms:
Tall stature
Low facial and chest hair
Breast development
Small penis and testes
Wide hips
Low bone density
Female like pubes
Narrow shoulders
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8
Q

How would I investigate infertility in a male?

A

Semen analysis
Blood tests- LH, FSH, fasting testosterone, SHBG, albumin, iron, karyotyping
Microbiology- urine test, chlamydia swab
Imaging

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9
Q

What could cause low FSH/LH/testosterone ?

A

Hyperprolactinemia

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10
Q 
Premature Ovarian Insufficiency (POI)
What is it?
Hormone levels?
Causes?
Symptoms?
Treatments?
A

Early menopause

Causes:
Autoimmune, genetic (fragile X or turners), cancer therapy

Symptoms:
Same as menopause

Low Oestrodial
High FSH and LH

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11
Q 
PCOS:
What is it?
Additional complications and treatment?
Diagnosis?
Treatment?
A

Polycystic ovarian syndrome- most common cause of female infertility

Complications: increased insulin resistant. Treat with metformin

Treatment:
Hirsuitism- Creams/wax/laser, anti androgens
Irregular menses/ Amenorrhea- Oral contraceptive pill / Metformin
Prevent endometrial cancer: progesterone
Infertility: Clomiphene, letrozole, IVF

How is PCOS diagnosed?
Rotterdam criteria- 2/3 out of:
-Oligo/anovulation- assessed by menstrual frequency
-Hyperandrogenism- acne, hirsutism, alopecia, high testosterone
-Polycystic ovaries

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12
Q

Turners:
What is it?
Symptoms?

A

congenital female condition where they are partially missing an x chromosome

Symptoms:
Short
Low hairline
Wide spaced nipples
Poor breast development
Amenorrhea
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13
Q

How would i investigate an infertile female?

A

Blood test
Pregnancy test
Microbiology
Imaging

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14
Q

How would I treat male infertility?

A

Give testosterone (if fertility not wanted)- Daily gel (tostran), 3 weekly IM injections, 3 monthly IM injection

Give gonadotropins (LH/FSH) if fertility wanted and hCG injections (acts on LH receptors)

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15
Q

How is ovulation induction encouraged?

A
  1. Lifestyle / Weight Loss / Metformin
  2. Letrozole (Aromatase inhibitor)
  3. Clomiphene (Oestradiol receptor antagonist)
  4. FSH stimulation (injection)
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16
Q

How is IVF carried out?

A

High dose of FSH to stimulate eggs
Prevent premature ovulation via GnRH agonist/antagonist
Give LH to allow egg maturation
Retrieve oocyte from ovary
Fertilisation in vitro or intracytoplasmic injection of sperm
Embryo incubation
Embryo transfer

17
Q

What are emergency contraceptives?

A

Emergency contraceptive pill : Ulipristat acetate 30mg (ellaOne) within 5 days, Levenorgestrel 1.5mg (Levonelle) within 3 days- less effective

18
Q

Ovarian hyperstimulation syndrome:
Causes?
Symptoms?

A

Causes: Prolonged exposure to hCG during IVF

Symptoms:
Pleural effusion
Ascites
Renal failure
Ovarian torsion
19
Q

What medication can be used to support transgender women/men?

A

Trans Men- Testosterone injections or gels, progesterone to suppress menstrual bleeding

Trans Women- high dose oestrogen, reduce testosterone via GnRH agonists (desensitisation of HPG axis) and anti androgen medication

20
Q 
Graves disease
What is it?
Causes?
Hormone levels?
Symptoms?
Treatment?
A

An autoimmune condition where antibodies bind to and stimulate the TSH receptor in the thyroid causing a smooth goitre (enlarged thyroid) and hyperthyroidism

Cause:
Autoimmune

Hormone levels:
High TSH
Low T3 and T4

Symptoms:
Smooth goitre
Exophthalmos
Sweatiness
Mostly female and young
Weight loss with increased appetite
High pulse
Oligo/amenorrhea
Swollen ankles and shins (pretibial myxoedema)
Tremor
Diarrhoea

Diagnosis:
Lid lag test

Treatment:
Thionamides- propylthiouracil and carbimazole
Potassium iodide
Radioiodine
Beta blockers (only helps with symptoms -fast acting)

21
Q

Plummers disease
What is it?
Symptoms?
Hormone levels?

A

Benign toxic nodular goitre of thyroid (NOT autoimmune) that causes hyperthyroidism- one large benign growth and the rest of thyroid shrinks

Same as grave’s disease but NO pre-tibial myxoedema or exophthalmos

Treatment:
Thionamides- propylthiouracil and carbimazole
Potassium iodide
Radioiodine
Beta blockers (only helps with symptoms -fast acting)

22
Q

Thyroid storm
What is it?
Symptoms?

A

Untreated hyperthyroidism= lots of excess thyroxine

Symptoms:
Hyperpyrexia (fever)  > 41oC
accelerated tachycardia / arrhythmia
cardiac failure
delirium / frank psychosis
hepatocellular dysfunction; jaundice

Need urgent in hospital treatment- 50% mortality untreated
Treat with radioiodide

23
Q

Viral thyroiditis
What is it?
Symptoms?
Diagnosis?

A

Virus attacks thyroid gland causing pain and tenderness. Thyroid stops making thyroxine and starts making viruses instead

Symptoms:
Painful dysphagia
Hyperthyroidism
Pyrexia
Thyroid inflammation

Diagnosis:
They have no iodine uptake at all (cells are too inflamed), this wouldn’t happen in Graves or Plummers- scan would be empty

24
Q 
Addison's disease
What is it?
Symptoms?
Diagnosis?
Treatment?
A

Primary adrenal failure. Autoimmune disease where the immune system decides to destroy the adrenal cortex (commonest in UK) OR tuberculosis of the adrenal glands (commonest cause worldwide)
Pituitary starts secreting lots of ACTH and hence MSH

Symptoms:
Increased pigmentation
Autoimmune vitiligo may coexist
No cortisol or aldosterone, so low blood pressure

Diagnosis:
9am cortisol (should be high in a healthy patient)
ACTH level
Short synACTHen test - give 250 ug synacthen IM (synATCHENen mimics ACTH and stimulates ACTH release. In healthy patient cortisol should increase)

Treatment:
Fludrocortisone (50-100mcg)
Hydrocortisone three times daily (10 (morning) + 5 (lunch) + 2.5 (dinner)) OR
Prednisolone 3mg daily

25
Q

Congenital adrenal hyperplasia

Onset?
Causes?
Hormone levels?
Treatment?

A

Onset:
From birth

Causes:
Commonest cause is by 21-hydroxylase deficiency (missing gene). Can be complete (complete loss of gene) or partial (mutation)

Symptoms:
Symptoms begin at birth
Salt losing addisonian crisis, become floppy and drowsy

Treatment:
Saline

26
Q

Partial 21 hydroxylase deficiency
Onset?
Symptoms?

A

Onset:
Any age as they survive birth

Symptoms:
Hirsuitism (excess testosterone)
Virilisation in girls
Precocious (early) puberty in boys (excess testosterone)

27
Q

11- hydroxylase deficiency
Symptoms?
Hormone levels?

A

Symptoms:
Excess buildup of 11-deoxycorticosterone which behaves like aldosterone
Hypertension and hypokalemia
Virilisation (due to excess testosterone)

28
Q

17 hydroxylase deficiency
Symptoms?
Hormones?

A 
Symptoms:
Hypertension
Hypokalaemia 
Sex steroid deficiency 
Glucocorticoid deficiency (low glucose).

Hormones:
Deficient- cortisol and sex steroids
Excess- 11-deoxycorticosterone and aldosterone (mineralocorticoids)

BRS Year 2 (110 decks)

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