Things I don't know

Question 1

Features + severity of Graves eye disease

Answer 1

Question 2

Grave’s treatment ADRs

Answer 2

Carbimazole is preferred in most cases
ADRs agranulocytosis, rash/arthralgias, LFT derangement (PTU hepatitic, CBM cholestatic)
PTU can cause fulminant hepatotoxicity, ANCA +ve vasculitis
PTU in 1st trimester or thyroid storm

Question 3

Subclinical thyroid disease - effects and when to treat

Answer 3

Subclin hyper
- CVD, osteoporosis, dementia
- Treat if >65yo and TSH <0.1, or 0.1-0.4 with RFs
Subclin hypo
- Due to aging, obesity
- Treat if TSH >10, be careful if >70yo (CVD)

Question 4

Growth Hormone secretion and testing

Answer 4

Highest at midnight, short half life
Upregulated by GHRH, ghrelin, circadian rhythm, stress, poor nutrition
Downregulated by somatostatin, IGF-1
GH excess (acromegaly): OGTT
GH deficiency: insulin tolerance test, GHRH+arginine etc.

Question 4

Amiodarone-induced thyroid disease

Answer 4

Type 1
- Early, Jod-Baselow, underlying autonomous nodule
- US increased vascularity
- CBM, cease amiodarone

Type 2:
- Later, destructive thyroiditis
- US no vascularity, nuc med no tracer uptake
- Pred

Question 5

Appetite regulation

Answer 5

Stimulated by AgRP, NPY -> upregulated by ghrelin
Inhibited by POMC -> due to leptin effect

Question 6

Obesity drugs: actions, ADRs, contras

Answer 6

Orlistat
- Lipase inhibitor, decreases TG absorption
- Steatorrhoea, malabsorption

Phentermine
- Adrenergic agonist, central appetite suppression
- Constipation, dry mouth, palpitations
- Contra in IHD, SSRI, seizures, pregnancy

Topiramate
- GABA-R activator
- Cognitive slowing, dizziness
Contra in pregnancy, kidney stones

Bupropion/naltrexone
- Inihibits NAd/DA reuptake and reduces reward
- n+v, constipation, headache
- Contra in opioid use, seizures

Question 7

Pituitary adenomas - markers of prognosis

Answer 7

Bad prognosis
- <30yo
- Large, invasive and low T2 intensity
- Sparse granules
- SST2/SST5/D2 -ve
- Ki67 high

Question 8

Acromegaly treatment

Answer 8

1st line SSA
- Oct/Lan ADRs cholelithiasis, bradycardia, alopecia
- Pasireotide SSR5 causes hyperglycaemia
2nd line DA agonist
3rd line GH receptor antagonist pegvisomant
RTx slows tumour growth, only if medically poor

Question 9

Craniopharyngioma mutation

Answer 9

BRAF V600E

Question 10

Drugs inducing high prolactin

Answer 10

Anti-psychotics, anti-emetics, TCAs which have DA antagonism activity
Opiates
Verapamil
Oestrogen
Fluoxetine

Question 11

What is macroprolactin

Answer 11

○ Macroprolactin with Ig binding prolactin into complexes
§ Inactive form so no active hormonal function
§ Decreases clearance => spurious raised result
○ Consider if completely well and no symptoms
Test with polyethylene glycol addition which precipitates out macroprolactin complexes

Question 12

DA antagonist ADRs

Answer 12

Cabergoline: n+v, postural hypo, valvular heart disease
Bromocriptine: HTN, CVD, erythromelalgia, impulse control

Question 13

Pituitary deficiency hormone order

Answer 13

GH -> LH/FSH -> TSH -> ACTH

Question 14

Types of pituitary hypophysitis by how common

Answer 14

Lymphocytic
Granulomatous
IgG4

Question 15

Autoimmune Polyendocrine Syndrome 1 vs 2

Answer 15

APS1
- Autosomal recessive AIRE
- Ab against IL-17 and IL-22 => loss of Th17
- Mouth and nail fungal infection, hypoPTH, hypoadrenal, DM, functional asplenism

APS2
- Polygenic, HLA-DQ2/8
- Adrenal, thyroid, hypogonad, celiac, vitiligo, pernicious anaemia

Question 16

MEN 1 vs 2

Answer 16

MEN1
- MENIN gene
- PTH, pancreatic islet, pituitary

MEN2
- RET gene (auto dom)
- Medullary thyroid, phaeo
- 2a: PTH hyperplasia -> hyperCa
- 2b: Marfanoid, mucosal neuromas

Question 17

What causes HbA1c to go up or down

Answer 17

UP
- Iron/B12 deficiency, decreased erythropoiesis, longer RBC lifespan
- EtOH
- African American

DOWN
- EPO, iron, B12 replacement, reticulocytosis
- Renal failure
- Hb-opathies
- Pregnancy