hard questions endo Flashcards
what gene is mutated in congenital hypopituitarism? how is this seen on MRI?
PROP1
Hypoplastic gland
5 causes of acquired hypopituitarism
tumour trauma apoplexy infection pituitary surgery
which 2 conditions is radiotherapy given near pituitary?
acromegaly
nasopharyngeal tumour
which pituitary cells are most susceptable to rx damage>
somatotrophs and gonadotriohins
6 symptoms of sheehan’s
amehorrhea fatigue inability to breastfeed weight loss anorexia
how does apoplexy often present?
thunderclap headache
what may precipitate apoplexy?
anticoagulant use
what is the half life of t4
6 days
what condition is pulsatile GH/ACTH sensitive to?
Stress
how is hypopituitarism diagnoses?
history
dynamic pituitary function test
pituitary mri
what happens in a normal insulin stress test given to determine pit dysfunction?
cortisol and gh rise
what does a normal anterior pituitry loo like on mri
empty sella
how is cortisol replaced?
prednisolone
hydrocortosone 10 5 5
outline the 5 actions of vasopressin
vasoconstriction via v1 aquaporins via v2 upregulates uta1 and uta3 stimulates acth release concentrates urine
how does hte posterior putuitary look on MRI
white C shape
how do stretch receptors inhibit vasopressin release?
detect stretch and inhibit via vagus nerve. less stretch, less inhibition
5 causes of CDI?
BRAIN INJURY, BRAIN SURGERY, CONGENITAL, PIT TUMOUR, TB SARCOIDOSIS, AUTOIMMUNE
3 signs of diabetes insipidus?
hypernatraemia
dehydration
large vol of urine
which things are measured in the h2o deprivation test?
urine volume
urine osmolarity
plasma osmolarity
weight
what is the difference in plasma osmolarity in DI vs psychogenic polysipsia?
DI - high osmolarity
PP - low
4 signs of SIADH?
LOW VOLUME OF CONCENTRATED URINE
HIGH URINE OSMOLARTY,
LOW BLOOD OSMOLARITY - SIADH IS ESSENTIALLY SALT LOSS. HYPONATRAEMIA
Causes of SIADP?
HEAD INJURY, STROKE, TUMOUR, PHNEUMONIA, LUNG CANCER,
2 drugs causing siadh?
carbemazepine, SSRIs
what is a tumour of each anterior pituitary cell type called?
CUSHINGS, ACROMEGALY, PROLACTINOMA, TSHOMA, GONADOTROPHOMA
4 features which help classification of tumours radiologically?
SIZE, INTRA/SUPRASELLAR, AFFECTS OPTIC CHIASM? CAVERNOUS SINUS?
pathological causes of hyperprolactinaemia?
PCOS
CHRONIC RENAL FAILURE (NO SECRETION OF PROLACTIN), PRIMARY HYPOTHYROIDISM (TRH STIMULATES LACTOTROPHS)
5 drugs that may cause hyperprolactinaemia
antipsychotics ssris antiemetics oestrogen opiates
2 causes of false positive high prolactin?
macroprolactin (igG complex) and needle stress
what drug treats prolactinoma?
caberlogine - D2 receptor agonist
how is acromegaly screened for?
elevated IGF1
how is the glucose suppression test used to diagnose acromegaly? what may also be seen?
GIVE glucose , SHOULD SEE A FALL IN GH.
PARADOXICAL RIE IN GH. RAISED PROLACTIN TOO
1st line treatment for acromegaly?
transphenoidal surgery
medical treatments for acromegaly?
somatostatin (octreotide)
caberlogine
how does a non-functioning pituitary adenoma present?
PRODUCES NO HORMONES. STOPS ALL ANTERIOR PIT HORMMONES WORKING SOMETIMES HIGH PROLACTIN AS LESS DOPAMINE IF OBSTRICTED PIT STALE.
BITEMPORAL HEMIANOPiA
outline how thyroid follicular cells make thyroid hormone
TSH BINDS AND CAUSES PRODUCTION OF THYROGLOBULIN (TG). THIS GOES INTO THE COLLOID
NA/I ENTER VIA COTRANSPORTER. I INTO COLLOID
I UNDERGOES IODINATION
THE IODINATION OF I ACTIVATES TPO. TPO AND H2O2 MOVE INTO COLLOID. CATALYSIS OF IODINATION REACTIONS.
IODINE + THYROGLOBULIN UNDERGO IODINATION VIA TPO. MIT AND DIT. BOUND TO TG UNTIL RELEASED.
features of grave’s disease?
EXOPTHALMOS. WEIGHT LOSS. INCREASED APPETITE. HAIR THINNING. HEAT INTOLERANCE. PALPITATIONS. SMOOTH GOITRE WITH THRILL AND BRUIT. TREMOR. DIARRHOEA. TIREDNESS
what is another name for plummer’s disease?
hyperfunctioning adenoma
what is the effect of thyroxine on the sns?
THYROXINE STIMULTES THE SNS. SENSITISES BETA ADRENERGIC RECEPTORS TO CATECHOLAMINES
Why does lid lag occur in plummers?
ACTIVATION OF BETA RECEPTORS HOLDS LIDS OPEN
5 features of a thyroid storm
HYPER PYREXIA, ARRYTHMIA/TACHYCARDIA, CARDIAC FAILURE,
DELIRIUM,
JAUNDICE
which 3 drug types reduce thyroid hormone synthesis?
thionamides
KI
radioiodine
2 examples of thionamides
PTU
CARBIMAZOLE
what beta blockers are given to treat symptoms of hyperthyroidism?
propanonol
how is thyroid storm treated?
KI
when is KI given?
KI GIVEN BEFORE SURGERY. STOPS BLEEDING AFTER SURGERY AND STOPS THYROID PRODUCTION VIA WOLFF CHAIKOFF. KI BLOCKS IODINATINO OF THYROGLOBULIN ANS INHIBITS TPO AND TH SYNTHESIS
side effects of thionamides?
agranulocytosis
rashes
how is viral thyroiditis showin on iodine imaging scan?
no uptake at all
which 5 enzymes does angiotenisin 2 activate?
21, 11, 18 hydroxylases
side chain cleavage enzyme
3 hydroxysteriod dehydrogenase
which 5 hormones are swithced on in cortisol production?
11,17,21 hydroxylase
side chain cleavage
3 hydroxysteriod dehydrogenase
3 main causes of primary adrenal failure?
immune
congenital adrenal hyperplasia
tb
2 causes of addisons
tb autoimmune
features of adrenal crisis?
LOW BP. SYNCOPE, VOMITING, DIARRHOEA, HYPOGLYCAEMIA, FEVER, HYPONATRAEMIA
what are the consequences of adrenocortical failure?
HYPOTENSION, DEATH
LOW GLUCOSE DUE TO GLUCOCORTICOID DEFICIENCY
what drug is given to replace aldosterone?
flurocortisone
why do babies with complete 21 hydroxylase deficiency need IV fluids asap?
because they can have an addisonian crisis
when and how does partial 21 HD present?
GIRLS - VIRILUSIATION.AND HIRSUTISM
BOYS PRECOCOOUS PUBERTY
how is partial 21 HD treated?
prednisolone
why does 11 hydrocylyase deficiency cause hypertension?
low aldosterone but the precursor 11 deoxycorticosterone acts like aldosterone
which hormones are deficient in 11hd?
cortisol and aldosrerone
what is seen in 17hd?
no puberty
hypertension
hyperaldosteronism
low glucose (low glucocorticoids)
first investigation to find cause of cushing’s?
24h free cortisol
what test is key for cushing’s diagnosis?
dexamethosone suppression test
2 drug classes used to control steriod levels?
enzyme inhibitors
receptor blockers
how does metryapone work?
when is it given (hyperadrenalism)?
side effects?
INHIBITS 11-B-HYDROXYLASE. PRIOR TO SURGERY/AFTER RADIOTHERAPY.
HIRSUTISM, SALT RETENTION
how does ketoconazole work?
inhibits 17 hydroxylase
how is cushings treated surgically?
TRANSPHENOIDAL PITUITARY SURGERY, BILATERAL ADRENALECTOMY
how is spironolactone used to treat conn’s (primary hyperaldosteronism)
CONVERTED TO CANRENONE. COMPETATIVE ANTAGONIST OF MINERALOCORTICOID RECEPTOR.
can cause:
GYNECOMASTIA, MENSTERAL IRREGULARITIES (PROGESTERONE INHIBITOR)\
why is epleronone better than spironolactone?
less gynecomastia as less binding to sex steroid receptors
how are phaos managed
SURGERY,
ALPHA BLOCERS,
BETA BLOCKERS (PREVENT TACHY),
IV FLUID TO STOP BP CRASH
outline the process of calcitriol formation in the body
UVB - PRE D3 - DR
LIVER: D3 - 25 HYDROXYLASE - 25 OH CHOLECHALCIFEROL
KIDNEY: 1- ALPHA - HYDROXYLASE - CALCITRIOL
effect of calcitriol on bone
osteoblastic
effect of pth on bone
osteoclastic
effects of pth?
INCREASE BREAKDOWN OSTEOCLASTS!!!!
B)INCREASE REUPTALE OF CALCIUM, INCREASED EXCRETION OF PO43-
SIMULATES ALPHA HYDROXYLASE SYNTHESIS (for calcitriol)
C) INCREASE REABSORPTION OF BOTH
how does fgf 23 regulate phosphate?
INHIBITS NA/PO43- COTRANSPORTER IN PCT
INHIBITS CALCITRIOL SYNTHESIS
symtpms of hypocalcaemia
Convulsions
Arrythmia
Tetany
numbness and tingling
what is chvosteck’s sign?
tap zygomatic arch see spasm
what is trosseaus sign
carpopedal spasm
4 causes of low pth related hypoparathyroidism
IMMUNE DESTRUCTION OF PT GLANDS
THYROIDECTOMY
MAGNESUUM DEFICIENCY
CONGNEISAL - AGENESIS OF PTH
symptoms of hypercalcaemia
LETHARGY, STONES, DEPRESSION, CONSTIPATION, PANCREATITIS, DYSPEPSIA, FATIGUE
3 main causes of hypercalacemia?
primary hyperparathyroidism
adenoma of pth gland
bone mets (and sccs make pth related peptide)
excess vit d
why is primary hyperparathyroidism have low phospahte?
pth increases remocal in kidney
what is seen in tertiary hyperparathyroidism?
PTH and calcium high
due to lack of kidney fucntion so lack of cholecalciferol
what is given as a vit d replacement in a) nromals and b ) renal failue
a) 25 hydroxyvitamin D
b) alfacalcidol (1-alpha hydrozycholecalciferol)
5 Testicular causes of infertility
TRAUMA, TUMOUR, INFECTION, CONGENITAL ANATOMICAL ABNORMALITY (CRIPORCHIDISM, VARICOELE, TOXINS)
5 post testicular causes of infertility
CONGENITAL ABSENCE OF VAS DEFERENS,
OBSTRUCTIVE ASOSPERMIA, ERECTILE DYSFUNCTION, VASECTOM
2 causes of of ovarian infertility
PCOS, ANNOVULATION, CORPUS LUTEUM ISUFFICIENCY
3 tubal causes of infertility
endometriosis, infection, tumour
2 cervical causes of infertility?
ineffective sperm pepetration due to chronic cervicitis and antisperm antibodies
4 treatment options for endometriosis
OESTROGEN, LAPAROSCOPIC ABLATION* HYSTERECTOMY
what are fibroids
benign tumours of myometrium
3 hormonal treatments for fibroids?
oestrogen, progesterone, gnrh agonist
what happens in kallmann sydrome
KALLMANN - ANOSMIA AND INFERTILITY DUE TO FAILURE OF GNRH NEURONES TO MIGRATE FROM OLFACTORY PLACODE TO HYPOTHALLAMUS
symptoms of kallmanns
ANOSMIA, UNDESCENDED TESTES,
LACK OF TESTICLE DEVELOPMENT,
MICROPENIS, PRIMARY AMENNHOREA,
INFERTILITY
describe klinefelters
hypergonadotrophic hypogonadism
what imaging is done for male infertility
scrotal uss
mri pit
what i the diagnostic criteria for pcos called?
rotterdam
what is turners?
hypergonadotrophic hypogonadism
what scorring system is used for hisutism
ferimann gallway
what heart deformity cn occur in turners syndrome>
coarctition of aorta
how is male hypogonadism initially diagnosed?
2 morning measurements of testosterone
what are three weekly and 3 monthly testosterone injections
3 weekly - sustanon
3 monthly - nebido
2 drawbacks of testosterone replacement
increases haematocrit
measure psa for cancer
how does FSH increase sperm production
acts on sertolic cells casuing spermatogenesis
how are gonadotrophins given to induce spermatogenesis
- hcg
2. fsh
treatment for ovulation induction?
- weight loss/metformin
- letrozole
- clomiphene
how does letrazole work
aromatase inhibitor (less e2 more fsh negative feedback) fsh needed for ovulation induction
how does clomiphene work
e2 receptor modulator
wht happens in the oocyte retrieval stage of IVF
large dose of fsh to grow follicles
give gnrh modulator to prevent LH surge
what is given to cause LH exposure to mature eggs? what is the 2nd choice available?
- HCG GIVEN TO MATURE EGGS
2. gnrh agonists
how is fertilization done if male factor infertility
ICSI
how does the ius work
secretes progesteone into the uterus
what is ellaone and what does it do
ulipristol acetate
inhibits progesterone receptor
how does levonelle work
synthetic progesterone prevents ovulation
why is transdermal e2 safer than oral in HRT?
due to liver metabolites - increases crp, triglycerises
when is cvd risk not elecated on pill?
if started before 60
2 benefits of hrt
better symptoms
less osteoporisos
what hormones are given to transgender women
gnrh agonist
antiandrogens
oestrogen
2 examples of antiandrogens
spironolactone
cyproteone acetate
what is the name of the model depicting the decrease in beta cell mass in the disease course?
eisenbach model
outline what happens immunologically in t1dm?
PRESENTATION TO CD4 CELLS
ACTIVATION OF CD8 CELLS WHICH LYSE B CELLS
CYTOKINES MAKE IT WORSE.
T REGS DEFECTIVE
which areas of genes are responible for t1dm susceptibilty
hla
4 examples of hits causing diabetes
enteroviral infection
cows milk
seasonal variation
microbiota
what is found in serum of t1dm?
anti b cell antibodies
3 beta cell proteins which antibodies attack?
gada
ia-2a
znt8
describe the physiological insulin production?
BASELINE AND SPIKES AFTER MEALS THEN SPIKES AGAIN - 2ND PHASE INSULIN PRODUCTION
how is insulin altered to make it long acting?
bound to zinc
how does insulin pump therapy work?
delivers fixed units of short actin constantly. must bolas themselves.
4 types of problematic hypoglyarmia
excessive frequency
impaired awareness
nocturnal
recurrent
how is a hypo treatted in unconcious patients?
IV glucose
