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JL Endocrinology > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Which follows which - water or sodium?

A

Water follows sodium everywhere

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2
Q

What is sodium controlled by?

A

Mineralcorticoid activity

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3
Q

What does mineralcorticoid activity refer to?

A

Sodium retention in exchange for potassium and/or hydrogen ions

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4
Q

Which steroid has the most mineralcorticoid activity?

A

Aldosterone

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5
Q

What is water controlled by?

A

ADH

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6
Q

What two things does ADH act on renal tubules to cause?

A
  1. Water re-absorption and thus

2. Antidiuretic effect

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7
Q

What does increased ADH do to urine?

A

Concentrated urine - low ADH causes dilute urine

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8
Q

What type of urine osmolality does concentrated urine have?

A

High

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9
Q

Give two reasons why sodium might be low due to water high being too high?

A

Decreased excretion - SIAD

Increased intake

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10
Q

Give two reasons why sodium might be low due to too little sodium?

A

Increased sodium loss - Addisons, Gut and Skin

Decreased sodium intake

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11
Q

Give two reasons why sodium could be high due to too little water?

A
  1. Increased water loss in diabetes insipidus

2. Decreased water intake

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12
Q

Give some reasons why sodium could be high due to too much sodium?

A
  1. Some IV medications are given as sodium salts
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13
Q

What condition can present with a craving for salty foods and increased pigmentation in hand creases?

A

Addisons

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14
Q

What is the basic problem in addisons?

A

Adrenal insufficiency so cant make enough steroids, CANT retain sodium in kidneys, loses sodium in ECF and becomes dehydrated

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15
Q

In addisons - what does hypotension come from?

A

Decreased ECF

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16
Q

What causes excess pigmentation in addisons?

A

ACTH excess and degraded reveals protein inside called MSH

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17
Q

What is the basic problem in diabetes inspidisu?

A

Disruption of pituitary or stalk so cant secrete ADH from posterior pituitary

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18
Q

How do you treat diabetes inspidus?

A

Desmopressin

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19
Q

If you suspect adrenal insufficiency then what must you measure?

A

Cortisol and ACTH but if patient unwell then give sodium replacement

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20
Q

Name two non-trophic hormones secreted from anterior pituitary?

A

GH and prolactin

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21
Q

What pouch is the anterior pituitary derived from?

A

Rathke’s

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22
Q

Name three types of cell in the anterior pituitary histology?

A
  1. Acidophils
  2. Basophils
  3. Chromophobe
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23
Q

Name two acidophils in anterior pituitary and name their hormone?

A

Somatotrophs - GH

Mammotrophs - PRL

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24
Q

Name three basophils in anterior pituitary and name their hormone?

A

Corticotrophs - ACTH
Thyrotrophs - TSH
Gonadotrophs - FSH/LH

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25
Q

What is the condition where there is ischaemic necrosis of the anterior pituitary?

A

Sheehan syndrome

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26
Q

What syndrome are pituitary adenomas associated with?

A

MEN1

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27
Q

`What is the most common functional tumour in the pituitary?

A

Prolactinoma

28
Q

Give three symptoms of prolactinomas?

A

Infertility, lack of libido and amenorrhoea

29
Q

What type of pituitary problem can sarcoidosis, TB and haemorrhages cause?

A

Panhypopituitarism

30
Q

What is a craniopharyngioma derived from?

A

Remnants of Rathke’s pouch

31
Q

What are the three zones of the cortex in adrenal gland?

A

Zona glomerulosa
Zona Fasciculata
Zona Reticularis

32
Q

What do the layers of adrenal cortex secrete?

A

Mineralocoreticoids - G
Glucocorticoids - F
Sex steroids - R

33
Q

In the medulla of adrenal gland - what cells secrete catecholamines?

A

Neuroendocrine cells

34
Q

Name an acute disease that leads to hypofunction of adrenocortical gland?

A

Waterhouse Friderichsen

35
Q

What colour are adrenocortical adenomas?

A

Brown/yello

36
Q

What syndrome can primary hyperaldosteronism cause?

A

Conn’s

37
Q

Give three common causes of Addison’s?

A

Autoimmune
TB, HIV
Metastatic malignancyt

38
Q

Name two adrenal medullary tumours?

A

Phaeochromocytoma

Neuroblastoma

39
Q

Name a neoplasm derived from chromaffin cells of the adrenal medulla?

A

Phaechromocytoma

40
Q

How do you lab diagnose phaeochromocytoma?

A

Detection of urinary excretion of catecholamines and metabolites

41
Q

What is ohaeochromocytoma associatd with?

A

Secondary hypertension

42
Q

Characteristically what do tumour cells do in phaeochromoxytomas?

A

Form nests (zellballen)

43
Q

What two things is phaeochromoxytoma a feature of?

A

MEN1 ,2

44
Q

What system regulates aldosterone?

A

Renin angiotensin system

45
Q

How do you treat adrenal insufficiency such as addisons?

A
  1. Hydrocortisone as cortisol replacement

2. Fludrocortisone as aldosterone replacement

46
Q

What is the commonest cause of secondary adrenal insufficiency?

A

Exogenous steroid use

47
Q

What are the diferences between addisons and secondary adrenal insufficiency?

A

Skin pale - no increased ACTH

Aldosterone production intact

48
Q

For secondary adrenal insufficiency - how is it managed?

A

Just hydrocortisone

49
Q

hypertension + hypokalaemia =

A

Primary aldosteronism - conns

50
Q

What drug works on the mineralcorticoid receptor to help in primary aldosteronsim ?

A

Spironolactone

51
Q

How do you confirm aldosterone excess?

A

Measure plasma aldosterone and renin and express as ratio - if raised then do saline suppression test.

52
Q

Name the commonest congenital adrenal hyperplasia?

A

21alpha hydroxylase deficiency - autosomal recessive

53
Q

How do you diagnose congenital adrenal hyperplasia?

A

Basal 17-OH progesterone

54
Q

What disease does genital ambiguity suggest in females?

A

Congenital Adrenal Hyperplasia

55
Q

What condition do labile hypertension, postural hypotension, paroxysmal sweating, headache and feeling of impending doom suggest?

A

Phaeochromocytoma

56
Q

What is an extra adrenal tumour called?

A

Paraganglioma

57
Q

In a phaeochromocytoma what to chromaffin cells reduce chrome salts to?

A

Metal chromiim resulting in brown colour reaction

58
Q

What is the classical triad for phaeochromocytoma?

A

Hypertension
Headache
Sweating

59
Q

Give two medications for phaeochromocytoma?

A

phenoxybenzamine (alpha-blocker)

propranolol (beta-blocker)

60
Q

What are medullary thyroid canacer, parathyroid hyperplasia nad bilateral phaeochromocytomas associated with?

A

MEN2

61
Q

What inheritancd is Voin Hippel Lindau sndrome?

A

Dominant

62
Q

In VHL syndrome - what does gene mutation lead to?

A

Accumulation of HIF proteins and stimulation of cellular proliferation

63
Q

For type I diabetes diagnosis what does fasting BG have to be and what does random have to be?

A

Fasting over 7

Random over 11

64
Q

How do you screen for congenital thyroid disease?

A

Guthrie test

65
Q

With congenital thyroid disease -what does absence of thyroxine after 3 months lead to?

A

Cretinism

JL Endocrinology (12 decks)

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