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Phase 2A (HV) > Miscellaneous- Endo > Flashcards

Miscellaneous- Endo Flashcards

1
Q

Causes of hypoglycaemia

A

Diabetics- excess insulin or se of sulfonylureas
Non-diabetics- EXPLAIN (exogenous drugs, pitiatary insufficiency, liver disease, addisons, insulinoma, non-pancreatic neoplasm)

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2
Q

What is HHS

A

Hyperosmolar hyperglycaemia is a medical condition resulting in marked hyperglycaemia, hyperosmolality and mild/no ketosis

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3
Q

What is the tx for HHS

A

1) normalise osmolality
2) Fluid replacement
3) slow infusion of insulin
4) correct potassium if required and give lmwh

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4
Q

What are the lab values for DKA (glucose, ph, bicarbonate and ketones)

A

Glucose >11.1
Ph<7.3
Bicarbonate<15mmol
Ketones >3mmol

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5
Q

What is the treatment for DKA

A

1) fluid replacement IV 0.9% saline
2) intravenous infusion of insulin (administer slowly, 18-25 risk of cerebral oedema0
3) correction of electrolytes
4) long insulin should be continue, short insulin should be stopped

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6
Q

Causes of hyperglycaemia

A

Withdrawal/reduced insulin utilisation
Increase glucose production
Secondary to pancreatitis, Cushing/acromegaly, use of gloucocorticoids

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7
Q

Complication of diabetes

A

Micro vascular- nephropathy, neuropathy, retinopathy

Macrovascular- mi, stroke, pvd (gangrene)

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8
Q

What is a prolactinoma

A

Benign lactrophs adenoma secreting prolactin

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9
Q

What inhibits the production of prolactin

A

Dopamine

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10
Q

Sx of prolactinomas

A 
Oligomenorrhaea/ammenorrhoea 
Loss of libido 
Erectile dysfunction 
Galactorrhoea 
Infertility 
Osteoporosis 
Opthamaloplegia 
Headaches 
decrease facial hair
Weight gain
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11
Q

Tx for prolactinoma

A

1st line- dopamine agonist- cabergoline or bromocriptine

2nd line- transpenoidal surgery

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12
Q

Secretion of GH from anterior pituitary acts on the liver. What does the liver secrete in response to this

A

IGF-1

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13
Q

What are the sx of acromegaly

A 
Large forehead- frontal bossing 
Large nose 
Large hands and feet 
Large protruding jaw 
Large tongue 
Arthritis from imbalanced growth of joints
Skin tags 
Profuse sweating 
Headaches
Visual lesions

(exams will refer to increase in shoe size or ring size)

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14
Q

What substance can suppress GH

A

High levels of glucose

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15
Q

What are the ix for acromegaly

A

1st line- measure serum IGF-1 , Random serum growth hormone

GS- OGTT- Whilst measuring GH, high levels of glucose suppress GH

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16
Q

Tx for acromegaly

A

1st line- transphenoidal surgery
2nd line- Somatostatin analogues- octreotide
3rd line GH antagonist- pigvisomant
4th line- dopamine agonist- cabergoline or bromocriptine

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17
Q

What substance inhibits GH SECRETION

A

Somatostatin

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18
Q

What is Cushing syndrome

A

General term referring to excessive levels of cortisol

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19
Q

What is Cushing disease

A

Excess glucocorticoids resulting from inappropriate ACTH secretion due to pituitary tumour

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20
Q

What are the causes of Cushing

A

ACTH Dependant-
Ectopic tumour
Pituitary adenoma

ACTH Independent
Iatrogenic
Adrenal adenoma

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21
Q

List 5 functions of cortisol

A

1- increase in carbohydrate and protein catabolism
2- increase deposition of fat and glycogen
3- Na retention
4- increase k+ renal loss
5- diminished host responses to infection

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22
Q

Signs and symptoms of Cushing

A 
Purple striae 
Moon face 
Buffalo hump 
Hirsuitism 
Acne 
Central obesity 
Irregular menses/ED
Mood changes- depression, lethargy, psychosis 
Osteoporosis 
Increase bp
HTN
Increase glucose
Proximal muscle weakness
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23
Q

Gold standard Ix for Cushing and the results presented

A

1mg dexamethasone
Low cortisol levels= normal
Normal/high cortisol levels= Cushing’s syndrome

8mg dexamethasone 
Low cortisol- Cushing diseases (pit tumour)
Normal/high cortisol- 
    ACTH low- adrenal Cushings 
    ACTH high- ectopic ACTH
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24
Q

Tx for cushings

A

GS- removal of tumour

Drugs-Metyrapone or ketoconazole (ek flash)
Drug class- Adrenal Steroid Synthesis Inhibitor

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25
What is cranial and nephrogenic diabetes insipidus
Cranial- decreased secretion of ADH Nephrogenic- insensitivity to ADH
26
Where is ADH secreted from
Supraoptic nucleus in posterior pituitary
27
List 5 causes of cranial and nephrogenic DI
Cranial - CNS infections - idiopathic - head trauma - brain/pituitary surgery - congenital - subarachnoid haemorrhage - autoimmune disorders Nephrogenic - electrolyte abnormalities (hyper/hypokalaemia) - systemic diseases - medications (lithium, cisplatin, gentamicin) - CKD - uropathy - inherited
28
What is the serum and urine osmolality in DI
Serum osmolality high | Urine osmolality is low
29
What is the Ix required in order to diagnose DI and it’s specific type
Gs- water deprivation test (urine osmolality low, serum osmolality high)- diagnoses DI Desmopressin test- distinguishes which type Cranial- (low serum osmolality, high urine osmolality) Nephrogenic- (low urine osmolality, high serum osmolality)
30
Sx of DI
``` Polyuria Polydipsia Children may have nocturia No glycosuria Dehydration Sx of hypernatraemia ```
31
Tx for cranial and nephrogenic DI
Cranial- give synthetic arginine vasopressin analogue desmopressin (DDAVP)- desmomelt tablets Nephrogenic- treat the underlying cause Low sodium diet
32
What are the three characteristics that are concurrent with SIADH
1- euvolaemia 2- hyponatraemia 3- increase urine na+ (high urine osmolality)
33
Causes of SIADH
- malignancy- ectopic or pituitary tumour - drugs- CARDISH (chemotherapy, antidepressants, recreational, diuretics, inhibitors (ssris, ACEI), sulfonylureas, hormones (desmopresssin)) - trauma - post operative - neurological- meningitis, encephalitis, SAH
34
Sx of SIADH
- absence of hyper/hypovolaemia - n+v Fatigue Headaches Muscle aches and cramps Hyponatraemia
35
Ix for SIADH
Diagnosis of exclusion. Short synacthen test to exclude adrenal insufficiency Serum sodium- low Urine sodium- high
36
Tx for SIADH
Acute severe hyponatraemia- IV hypertonic saline solution (3%) Acute mild hyponatraemia- fluid restriction Rx- tolvaptan- ADH receptor blocker
37
What is hypokalaemia
Serum potassium <3.5mmol/l
38
Causes of hypokalaemia
- increase GI loss (D+V) - reduced potassium intake- anorexia nervous a, bulimia - ckd Increase availability of insulin Increased potsssium excretion- loop diuretics Liquorice abuse
39
Sx of hypokalaemia-
``` Muscle weakness Hypotonia\hyporeflexia (sign) Cramps Tetany Palpitation Constipations Lethargy ```
40
What ecg changes are seen in hypokalaemia
Small/inverted T waves Prolonged PR interval ST depression segments U waves
41
What is the definition of hyperkalaemia
Serum potassium >5.5mmol/l
42
Causes of hyperkalaemia
``` Insulin deficiency Tumour lysis syndrome Haemolysis Trauma Extensive burns Acidosis ACE inhibitors/NSAIDs ```
43
ECG changes associated with hyperkalaemia
Tall tented t waves Long PR interval Wide QRS complex Absent/small P waves Ventricular fibrillations
44
Sx of hyperkalaemia
``` PHADI M Palpitations Hypereflexia Anxiety Diarrhoea Irritability Muscle cramps ```
45
Tx of hyperkalaemia
If cardiotoxicity present on ecg- stabilise cardiac membrane by IV CALCIUM GLUCONATE/CHLORIDE If no cardiotoxicity- combined insulin/dextrose infusion w/ nebulised salbutamol Additionally Remove potassium- calcium reasonium
46
What is conns syndrome
Aka primary hyperaldosteronism. Too much aldosterone secreted by adrenal glands
47
Causes of primary hyperaldosteronism
- bilateral cortical adenoma * - bilateral adrenal adenoma - familial hyperaldosteronism
48
What is the role of the hormone aldosterone and where is it secreted from
- increases sodium reabsorbtion from DCT - increases potassium excretion from DCT Secreted from zona glomerulosa of adrenal cortex
49
What are the Sx of conns syndrome
``` HTN lethargy (low potassium) Mood disturbances (low potassium) Difficulty concentrating (low potassium) Nocturia Polyuria Weakness/cramps Parasthesia ```
50
Ix for conns
Plasma potassium is low GS- Aldosterone to renin ratio high aldosterone and low renin- primary hyperaldosteronism high aldosterone and high renin- secondary hyperaldosteronism
51
Tx for conns
1st line- aldosterone antagonist- spironolactone, eplerenone Gs- laparoscopic adrenalectomy
52
Sx of hyponatraemia
``` Altered mental status Oedema Nausea and vomiting Poor skin turgor Low urine output ```
53
What are the complications of hyponatraemia
Seizures Coma Death Cerebral oedema
54
Sx of hypernatraemia
Diarrhoea and vomiting Impaired thirst Weight loss Decreased jugular venous pressure (hypovolaemia) CNS manifestations- intracranial haemorrhage, seizures, death
55
What is Addison’s disease
Primary adrenal insufficiency (low cortisol, high ACTH) An autoimmune condition where adrenal glands have been damaged, resulting in reduced secretion of cortisol and aldosterone
56
What are the causes of Addison’s disease
``` UK and developed countries- autoimmune Most common cause worldwide- TB Metastases Meningococcal septicaemia HIV ```
57
Sx of Addison’s disease
``` Hyperpigmentation of the palmar creases Lean Weight loss Weakness Lethargy Vitiligo Loss of pubic hair in women Loss of libido Nausea and vomiting ``` Signs Hyponatraemia Hyperkalaemia
58
Ix of Addison’s disease
1st line- FBC, electrolytes (low Na, high K), serum glucose (low) Gold standard- short syncathen test (synthetic ACTH given but cortisol still low) Other- presence of 21-hydroxylase adrenal autoantibodies (non-specific)
59
Tx for Addison’s disease
1st line- hydrocortisone (glucocorticoid) + fludrocortisone (mineralocorticoid)
60
Tx in Addisonian crisis
``` Intensive monitoring Paraenteral steroids (IV hydrocortisone) IV fluid resuscitation Correct hypoglycaemia Monitor electrolytes and fluid balances ```
61
What is secondary adrenal insufficiency
Characterised by ⬇️cortisol ⬇️ACTH, normal aldosterone and normal renin
62
What are the levels of aldosterone and renin in Addison’s disease
⬇️aldosterone | ⬆️renin
63
What are the causes of secondary adrenal insufficiency
``` Exogenous glucocorticoids Adrenal adenoma/carcinoma Surgery Infection Hypoplasia of pituitary gland ```
64
Sx of secondary adrenal insufficiency
``` Weakness Lethargy Anorexia Vomiting Hypoglycaemia Hypotension ```
65
Ix for secondary adrenal insufficiency
Gs- short syncacthen test- cortisol will increase
66
Tx for secondary adrenal insufficiency
Glucocorticoid replacement- prednisalone, hydrocortisone
67
What is carcinoid syndrome
Is the release of serotonin and other vasoactive peptides into the Systemic circulation from a carcinoid tumour
68
What cells do carcinoid tumour arise from
Neuroendocrine cells
69
Where do carcinoid tumours most commonly arise from
GI tract, lungs, ovaries, thymus - small intestine malignancy most common - appendix the most common site in GI tract - Liver most common site for metastasise
70
Sx of carcinoid syndrome
``` Flushing- upper face and trunk Diarrhoea Bronchospasm Fibrosis, heart valve thickening Pellagra (niacin deficiency) Dermatitis ```
71
Ix for carcinoid syndrome
1st line- urinary 5 hydroxyindoleacetic acid test (raised levels) Gs- chromagranin-A-octreoscan (pts should avoid banana, chocolate and caffeine) Other- CXR/CT/MRI chest and pelvis
72
Tx for carcinoid syndrome
- surgery | Somatostatin analogue- octreotide
73
What is serotonin syndrome
An excess of synaptic serotonin in the CNS
74
What is the classical triad of manifestations in serotonin syndrome
Neuromuscular excitation Autonomic effects Altered mental status
75
Sx of serotonin syndrone
Neuromuscular excitation- hypereflexia, clonus, tremors Autonomic hyperactivity- vomiting, diarrhoea, hypertension, tachycardia, hyperthermia, mydriasis Altered mental status- confusion, anxiety, agitation
76
What is phaechromocytoma
A tumour arising from catecholamine producing chromaffin cells of adrenal glands
77
What is the classic triad of symptoms in phaechromocytoma
Palpitations Headaches Diaphoresis
78
Sx of phaechromocytoma
``` Perspiration Palpitations Pallor Pain (headache) High bP ```
79
Ix for phaechromocytoma
24hr urine collection for catecholamines, metanephrines, normetanephrines, creatinine and serum free meta and normetanephrines (elevated) CT/MRI Scan
80
Tx for phaechromocytoma
Surgery Alpha blockers- Doxazosin Beta blockers- propanalol
81
Causes of hypercalcaemia
CHIMPANZEES ``` Calcium supplements Hyperparathyroidism Iatrogenic (thiazide) Milk alkali Padgett disease of the bone Acromegaly and Addison’s Neoplasia Zollinger-Ellison syndrome Elevated vitamin D Elevated vitamin A Sarcoidosis ```
82
What is the definition of Impaired Glucose Tolerance
A glucose level of 7.8-11mmol/L after an oral glucose tolerance test
83
What substance is responsible for the hyperpigmentation in addisons?
Pro-opromelanocortin (POCM)- a precursor to both ACTH and MSH (Melanocyte Stimulating Hormone)
84
What is the MOA and SE of carbimazole
MOA- inhibits thyroid peroxidase | SE- agranulocytosis
85
How do you calculate anion gap
(Na + k)-(cl+hco3)
86
List 5 Sx of hyperthyroidism
``` Weight loss Heat intolerance Diarrhoea Oligomneorrhoea Increased sweating ```
87
List 5 Sx of hypothyroidism
``` Weight gain Constipation Menorrhagia Cold intolerance Lethargy Dry skin/coarse hair Lateral loss of 1/3 eyebrow ```
88
List 3 primary and secondary causes of hyperthyroidism
Primary- Graves Toxic multi modular goitre Toxic adenoma ``` Secondary Lithium Amiadorone Overdose of levothyroxine Gestational Iodine excess ```
89
Tx for hyperthyroidism
Carbimazole- inhibits thyroid peroxidase | Propylthiouracil
90
Name two se of levothyroxine
Osteoporosis | Arrhythmias
91
Most likely cause of primary Hyperparathyroidism
Solitary adenoma (80%) Hyperplasia Multiple adenoma Carcinoma
92
Definitive/gs tx for primary Hyperparathyroidism
Total parathyroidectomy
93
Give 5 symptoms of hypercalcaemia
``` Abdominal pain Renal stones Polyuria Bone pain/fractures Depression ```
94
Name 3 types of cancers that can cause SIADH
Small cell lung cancer Lymphoma Prostate cancer Pancreatic cancer
95
List 3 complications of acromegaly
OSA T2DM Cardiomyopathy HTN
96
When is metformin contraindicated
When eGFR is less than 30n

Phase 2A (HV) (13 decks)

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