Passmed- Endocrinology Flashcards
oral hypoglycaemic agents that treats DMT2. Works by increasing insulin sensitivity. Side effects=hypoglycaemia, fluid retention, elevated LFTs.
pioglitazone (aka glitazone)
“bones, stones, groans and psychic moans”:
polydipsia, polyuria
peptic ulceration/constipation/pancreatitis
bone pain/fracture
renal stones
depression
hypertension
80% due to adenoma
raised calcium, low phosphate
PTH may be raised or (inappropriately, given the raised calcium) normal
pepperpot skull
primary hyperparathyroidism
average blood glucose (sugar) levels for the last two to three months. Measurement used to check for diabetes. If it is 42-46 you have prediabetes, discuss exercise and diet with pt.
HbA1c
hashimoto's thyroiditis-- iodine deficiency lithium postpartum thyroiditis-- Riedel's thyroiditis Subacute thyroiditis (de Quervain's)-- amiodarone
causes of hypothyroidism
– = may have brief hyperthyroid/thyrotoxic phase initially, followed by longer hypothyroid phase.
Grave’s Disease(eye disease only in 30%)
toxic multinodular goitre
amiodarone
causes of hyperthyroidism
side effects of which medications?
endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia
Cushing’s syndrome: moon face, buffalo hump, striae
musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head
immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis
psychiatric: insomnia, mania, depression, psychosis
gastrointestinal: peptic ulceration, acute pancreatitis
ophthalmic: glaucoma, cataracts
suppression of growth in children
intracranial hypertension
neutrophilia
glucocorticoids (steroids).
Very high glucocorticoid activity, minimal mineralocorticoid activity=Dexamethasone, Betamethasone
Predominant glucocorticoid activity, low mineralocorticoid activity=Prednisolone
Glucocorticoid activity, high mineralocorticoid activity= Hydrocortisone
Minimal glucocorticoid activity, very high mineralocorticoid activity= Fludrocortisone
side effects of which medications?
fluid retention
hypertension
mineralocorticoids(steroids).
Very high glucocorticoid activity, minimal mineralocorticoid activity=Dexamethasone, Betamethasone
Predominant glucocorticoid activity, low mineralocorticoid activity=Prednisolone
Glucocorticoid activity, high mineralocorticoid activity= Hydrocortisone
Minimal glucocorticoid activity, very high mineralocorticoid activity= Fludrocortisone
e.g. would want to give dexamethasone for patients with raised intracranial pressure secondary to brain tumours.
hypertension
hypokalaemia
alkalosis
bilateral idiopathic adrenal hyperplasia is the cause in up to 70% of cases
high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
high-resolution CT abdomen and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess
…what is the disease?
Conn’s syndrome (aka Primary Hyperaldosteronism)
numerous distinct syndromes involving tumors of the endocrine glands. They are inherited autosomal dominant disorders. The term “xxx” is used if two or more endocrine tumors types, known to occur as part of one of the defined “xxx” syndromes, occurs in a single patient and there is evidence for either a causative mutation or hereditary transmission.
xxx=MEN, multiple endocrine neoplasia. There are 3 main types of MEN:
MEN type 1= 3 P’s(Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia; Pituitary (70%); Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration))
MEN type 2a= 2 P’s (Parathyroid (60%); Phaeochromocytoma(adrenals) +Medullary thyroid cancer
MEN type 2b=Phaeochromocytoma(adrenals) +medullary thyroid cancer)
Oral hypoglycaemic drugs used to treat DMT2. They work by increasing pancreatic insulin secretion and hence are only effective if functional B-cells are present. Side effects: hypoglycaemic episodes, weight gain.
Glicazide (sulfonylureas)
The standard HbA1c target in type 2 diabetes mellitus is …?mmol/mol
48 mmol/mol
one of the top five causes of cancer in children, accounting for around 7-8% of childhood malignancies. The tumour arises from neural crest tissue of the adrenal medulla (the most common site) and sympathetic nervous system. Features: abdominal mass pallor, weight loss bone pain, limp hepatomegaly paraplegia proptosis
neuroblastoma
not enough of the hormone cortisol and, often, not enough aldosterone as well. Usually due to autoimmune disease. high plasma potassium(hyperkalaemia) high urinary sodium hyperpigmentation depression/irritability sexual dysfunction abdo/joint/muscle pain low BP decreased appetite and weight loss extreme fatigue diagnosed via ACTH stimulation test: cortisol does not rise in this ACTH stimulation test. In a healthy person, they would rise after administration of synthetic ACTH.
Addison’s Disease (primary adrenal insufficiency)
(in seocndary adrenal insufficiency, the ACTH stimulation test would show the same results for that of a person with primary adrenal insufficiency, however they may appear normal at early stages in the disease as the adrenal glands have not yet atrophied enough to stop being able to produce cortisol in response to synthetic ACTH).
Primary= ACTH high, cortisol and aldosterone levels low.
Secondary=ACTH low, lowering levels of cortisol over course of disease.
Metabolic acidosis is associated with it.
ECG changes seen include tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole.
Causes of this problem: acute kidney injury drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin** metabolic acidosis Addison's disease rhabdomyolysis massive blood transfusion
Hyperkalaemia
Plasma potassium levels are regulated by a number of factors including aldosterone, acid-base balance and insulin levels.
Metabolic acidosis= because hydrogen and potassium ions compete with each other for exchange with sodium ions across cell membranes and in the distal tubule.
- beta-blockers interfere with potassium transport into cells and can potentially cause hyperkalaemia in renal failure patients - remember beta-agonists, e.g. Salbutamol, are sometimes used as emergency treatment
- *both unfractionated and low-molecular weight heparin can cause hyperkalaemia. This is thought to be caused by inhibition of aldosterone secretion
Causes of XXX with alkalosis: vomiting thiazide and loop diuretics Cushing's syndrome Conn's syndrome (primary hyperaldosteronism)
Causes of XXX with acidosis: diarrhoea renal tubular acidosis acetazolamide partially treated diabetic ketoacidosis
Magnesium deficiency may also cause XXX.
XXX=Hypokalaemia
