MLA Endocrinology Flashcards by Malgorzata Szymaniak

What is Addison’s disease?

AKA primary adrenal insufficiency
- Impaired synthesis/release of glucocorticoids and mineralocorticoids

Causes: 75-90% autoimmune, or infections like TB and CMV or steroid use

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Who is most likely to get Addison’s disease?

Women (90%)
Those with other autoimmune disease

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What are some symptoms of Addison’s disease?

Fatigue
Muscle weakness
Anorexia
Loss of libido (hypoandrogenism)
Goitre

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What is an Addisonian crisis?

An acute state of severe cortisol and aldosterone deficiency

Symptoms: severe weakness, severe abdo pain, nausea, vomiting, profound hypotension, reduced consciousness

Management: IV hydrocortisone, fluid resuscitation, and electrolyte monitoring

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What is the function of glucocorticosteroids in the body?

AKA corticosteroids

Function: supress immune response, balance stress response, glucose and protein homeostasis, inti-inflammatory

Eg. cortisol

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What is the function of mineralocorticoids in the body?

Regulate salt and water balance

Eg. aldosterone

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What is Cushing’s syndrome?

Too much cortisol

Causes obesity and stunted grow in children
Excess hair in women
Irregular periods
Erectile dysfunction

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What is the pathophysiology of gestational diabetes?

The placental hormones cause insulin resistance and the pancreas can’t produce enough hormones to overcome these effects

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What is the management of gestational diabetes?

1st line: exercise and dietary changes
2nd line: meds like metformin insulin

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What is the pathophysiology of diabetes insipidus?

Issues with ADH

Nephrogenic: kidneys don’t respond to ADH
- Mostly hereditary. Also caused by chronic kidney disease, pregnancy, electrolyte imbalances

Central: pituitary gland doesn’t produce enough ADH
- Mostly caused by trauma to the pituitary gland or tumours

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What are the symptoms of diabetes insipidus?

Polyuria
Extreme thirst

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How is diabetes insipidus diagnosed?

Fluid deprivation test

Neurogenic DI: low [urine] normalises with desmopressin.
Nephrogenic DI: low [urine] regardless of desmopressin.
Primary polydipsia: high [urine]

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What is the pathophysiology of diabetic ketoacidosis?

When there is not enough glucose because of not enough insulin so the body breaks down fat for energy. If prolonged, the ketones build up and cause acidosis

Affects type 1 diabetics

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What is the function of albumin?

Produced in the liver

Function: prevents fluids from leaking out of vessels and it carries hormones and enzymes

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How is albumin linked to diabetic nephropathy?

Damaged vessels of the kidneys will leak proteins like albumin into the urine which can be detected to diagnose diabetic nephropathy

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What are the causes of secondary hypertension?

Aldosteronism
Cushing’s syndrome
Sleep apnoea
Hyperparathyroidism
Endocrine disease
Phaeochromocytoma

How can hyperlipidaemia occur?

Mainly diet, lifestyle, and genetics

Also diabetes, hypothyroidism, cushing’s syndrome, anorexia nervosa

What is a hypermolar hyperglycaemia state?

AKA HHS
- Very high sugar levels in T2DM without presence of ketones causing dehydration and confusion

What are some causes of hyperparathyroidism?

Primary causes
- Parathyroid hyperplasia
- carcinoma
- Ectopic secretion

Secondary causes
- Vitamin D or calcium deficiency
- Kidney failure

What are the symptoms of hyperparathyroidism?

Usually asymptomatic

Can cause increased thirst, depression, nausea and vomiting, constipation, confusion, high BP, palpitations, hair loss

What are the complications of hyperthermia?

Eg. heat stroke or heat exhaustion
- Precipitated by dehydration

Kidney and liver damage
Rhabdomyolysis
Confusion
Headache

What are some complications of hypothermia?

Kidney failure
Pancreatitis
Arrhythmias
Frostbite
Pulmonary oedema

What is osteomalacia?

‘Bone softening’ caused by prolonged vitamin D deficiency

Treatment: correct the cause, offer surgery for deformities

What are the different thyroid disease?

Hashimoto’s: autoimmune hypothyroidism
- Causes fatigue, constipation, dry skin, hair loss, goitre, menstrual changes

Graves: autoimmune hyperthyroidism
- Causes bulging eyes, weight loss, anxiety, fatigue, fast metabolism

What are the causes of SIADH?

- Pituitary abnormality - Malignancy (small cell lung cancer) - Meds like antidepressants - Hypothyroidism

What are the clinical findings of a pituitary tumour?

- Sudden headache - Visual changes (loss of peripheral vision) - Menstrual irregularities and erectile dysfunction

What's a short synacthen test?

It measures persons ability to produce cortisol Synacthen is injected and that stimulates the adrenal glands, followed by two blood tests to measure cortisol levels

What's Conns disease?

Primary hyperaldosteronism Symptoms: High blood pressure, poor vision, headaches, muscular weakness, muscle spasms

What is the difference between thyrotoxicosis and thyroid storm?

Thyroid storm: when there is end organ damage Both are a complications of hyperthyroidism but thyrotoxicosis is first Often caused by Graves disease

What's the most common cause of asymptomatic hypercalacaemia?

Almost always primary hyperparathyroidism Sometimes malignancy but that has symptoms

What is Trousseaus test?

Tie a cuff around the arm and increase the pressure for 3 mins Positive test is flexion of the hand if there is hypocalcaemia

How can ketones be decreased in the blood?

Give dextrose and insulin at the same time to stop neoproduction of ketones

How does HSS kill?

It causes the blood to 'thicken' because of the excess glucose so the patient is at high risk of clots and occlusions

What is a Charcot's foot?

Characterised by 5 D's: Density change, Destruction, Debris, Distension, Dislocation - Progressive destruction of the joints Often caused by gout and diabetes mellitus

What are the characteristics oh Horner's syndrome?

1. Partial ptosis (drooping or falling of the upper eyelid) 2. Miosis (constricted pupil) 3. Facial anhidrosis 4. Enopthalmos (sunken eyes appearance) 5. Hoarse voice

What is acromegaly?

Abnormal growth of hands, face, and feet caused by an overproduction of growth hormone by the pituitary gland Screened using insulin-like growth factor 1 (IGF-1)

What's Adie syndrome?

A rare neurological disorder that affects the pupil of the eye and the autonomic nervous system