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ENDOCRINE - RIA > mix of endo > Flashcards

mix of endo Flashcards

1
Q

what diagnosis does;

  • hyponatraemia
  • low plasma osmolality
  • high urine osmolality

suggest?

A

SIADH

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2
Q

List 8 hormones produced by the anterior pituitary gland

A
  1. GH
  2. TSH
  3. Gonadotrophins - LH + FSH
  4. Prolactin
  5. ACTH
  6. Endorphins - pain receptors in the brain
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3
Q

what is ACROMEGALY?

A

Excessive growth hormone secondary to a pituitary adenoma.

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4
Q

What are the features of acromegaly?

A

coarse facial appearance, spade- like hands, increase in shoe size, large tongue, excessive sweating and oily skin,

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5
Q

what is the name of the surgery to remove your pituitary gland?

A

transsphenoidal surgery

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6
Q

what is the mechanism of METYRAPONE?

A

inhibition of adrenal steroidogenesis

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7
Q

superior suprarenal artery arises from ____

A

INFERIOR PHRENIC ARTERY

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8
Q

middle suprarenal artery arises from ____

A

abdominal aorta

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9
Q

inferior suprarenal artery arises from _____

A

renal artery

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10
Q

what does the right suprarenal vein drain into?

A

inferior vena cava

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11
Q

what does the left suprarenal vein drain into?

A

left renal vein

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12
Q

what is the peak incidence of cushings disease?

A

25-45 years old

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13
Q

What is the guidance for steroid replacement for an Addisonian patient having surgery?

A

Hydrocortisone 100mg IV/IM every 6 hours

half daily dose each day post op.

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14
Q

name the 2 medications given pre op of trans-spehnoidal pituitary surgery to control the high cortisol.

A

KETOCONAZOLE
+
METYRAPONE

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15
Q

Name 2 hormones released from posterior pituitary gland.

A

OXYTOCIN
+
ADH/Vasopressin

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16
Q

What are the 2 disorders of ADH secretion?

A

DIABETES INSIPIDUS

SiADH

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17
Q

What are the 2 types of DIABETES INSIPIDUS?

A
  1. Cranial diabetes insipidus - posterior pituitary produces too little amounts of vasopressin
  2. Nephrogenic diabetes insipidus - kidney becomes insensitive to vasopressin and therefore does not make aquaporins and cause reabsorption of water from the kidneys into the blood.
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18
Q

What is the mechanism of action of ADH?

A

ADH acts on the collecting tubules of the kidney to increase the number of aquaporin channels allowing water to be absorbed into the blood. (therefore low levels cause water retention in urine causing polyuria and polydipsia).

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19
Q

What is SiADH

A

syndrome of inappropriate ADH secretion; causing excessive reabsorption of water from the collecting ducts into the blood.

20
Q

What are the clinical findings in SiADH?

A

Hyponatraemia (serum), due to water retention.

low serum osmolality
high urine osmolality

21
Q

what is the urine osmolality in SiADH and why?

A

High

SiADH causes high amounts of water reabsorption from the collecting ducts into the blood so water is retained which lowers Na in blood; high Na in urine; high urine osmolality.

22
Q

Which lung diseaes can cause SiADH?

A

Pneumonia + lung cancer

23
Q

name 2 drugs that can cause SiADH?

A

SSRI + carbamazepine

24
Q

What brain lesions can cause SiADH?

A

tumour
brain injury
stroke
intracranial bleed

25
Q

Name symptoms of Hyponatraeimia.

A

headache, nausea, dizziness

26
Q

name 4 causes of renal Na loss.

A

Addisons
Osmotic diuresis
Diuretic excess
Renal failure

27
Q

Name as many causes of Na loss elsewhere (other than renal loss).

A

Diarrhoea, vomiting, fistulas, burns, small bowel obstruction, trauma, CF, heat exposure

28
Q

What is BMI range for obesity?

A

30-39.9

29
Q

which hormones are deficient in addisons disease?

A

cortisol
+
aldosterone

30
Q

when does the pituitary gland release vasopressin?

A

when the amount of water in the body becomes too low.

31
Q

which test can differentiate between Pituitary and adrenal cushing’s

A

Plasma ACTH

32
Q

what is inferior petrosal sinus sampling test useful for?

A

differentiating between pituitary and ectopic cause of high ACTH

33
Q

What is the commonest cause of Cushing’s syndrome?

A

cushing’s disease = pituitary adenoma secreting high amounts of ACTH

34
Q

which enzyme does Metyropone block?

A

11 Beta hydroxylase

35
Q

what electrolyte abnormalities are found in Cushing’s

A

hypernatreaemia
hypokalaemia
high bicarbonate

36
Q

what is the mechanism of action of ORLISTAT?

A

Reduces fat absorption and should be taken with any meal containing fat.

37
Q

When should orlistat treatment be stopped?

A

If a patient has not lost more than 5% body weight within 12 weeks of treatment.

38
Q

Name the 3 layers of the cortex of the medulla + the hormones they produce.

A

Zona glomerulosa –> mineralocorticoid

Zone fasiculata –> glucocorticoid (cortisol)

Zone reticularis –> androgens

39
Q

What hormone does the adrenal medulla secrete?

A

Epinephrine + norepinephrine

40
Q

what is the first line test for assessing adrenal function?

A

midnight cortisol by salivary sample; 2 samples taken on 2 separate nights

41
Q

how is the overnight dexamethosone test carried out?

and what is a positive test?

A

1mg Dex given at 11pm and the serum cortisol is measured at 8am.

Positive test is high morning cortisol of more than 50 nanomol/L

42
Q

how is the low dose Dex test carried out?

A

0.5 mg of Dex taken 6-hourly for 2 days and serum cortisol is measured on day 0 + day 2.

serum cortisol should be undetectable (as the dex would suppress the pituitary release of acth thus cortisol release from adrenal)

43
Q

What is the cortisol result of high dose dex suppression test in pituitary source cushings?

A

cortisol is suppressed.

44
Q

what is the cortisol result of high dose dex suppression test in ectopic ACTH cause of cushings?

A

Cortisol is unchanged

45
Q

what is the result of high or low dose dex suppression test for adrenal tumours or ectopic ACTH?

A

no reduction in cortisol

ENDOCRINE - RIA (7 decks)

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