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Exam - M - endocrine pathology (Megan) > whore moans > Flashcards

whore moans Flashcards

1
Q

what is hypocalcaemia

A

low serum calcium

2.2-2.6mmol/L

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2
Q

what can cause hypocalcaemia

A 
hypoparathyroidism 
vitamin D deficiency 
diarrhoea 
liver and kidney disease
PPI
blood transfusions
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3
Q

how does hypocalcaemia present

A 
muscle twitches 
seizures 
fractures 
poor blood clotting 
ventricular tachycardia 
tetany
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4
Q

what are clinical tests for hypocalcaemia

A

chovstek’s - tap skin 1cm below zygomatic process, will cause facial twitch/spasm
trousseaus - use blood pressure band to compress arm, flexors will be activated and hand will twitch

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5
Q

what investigations should you do for hypocalcaemia

A

ECG
serum Ca, albumin and phosphate
PTH

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6
Q

how can you manage hypocalcaemia

A

oral Ca tablets
oral VD tablets if deficient
if serum Ca is below 1.9 this is an emergency
treat with IV calcium gluconate

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7
Q

what is hypoparathyroidism

A

when the parathyroid gland does not produce enough PTH resulting in low serum Ca

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8
Q

what causes hypoparathyroidism

A

thyroid/parathyroidectomy

autoimmune destruction of gland

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9
Q

how does hypoparathyroidism present

A

symptoms of hypocalcaemia

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10
Q

what is hypercalcaemia

A

increased serum calcium

3-3.5mmol/l above 3.5 is an emergency

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11
Q

what can cause hypercalcaemia

A 
hyperparathyroidism 
renal failure 
acromegaly 
MEN syndromes 
TB
sarcoidosis
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12
Q

how does hypercalcaemia present

A 
polyuria
nausea 
vomiting
constipation 
bone pain 
fatigue 
pancreatitis 
coma 
osteoporosis
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13
Q

what investigations could you do for hypercalcaemia

A

serum Ca, albumin, phosphate
U&Es
DEXA for osteoporosis

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14
Q

how do you treat hypercalcaemia

A 
rehydrate with 4-6l of 0.9% saline over 4-6hrs
IV bisphosphonates 
glucocorticoids 
calcitonin 
cinacalcet
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15
Q

what is primary hyperparathyroidism

A

gland makes PTH uncontrollably

high serum PTH and high Ca

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16
Q

what causes primary hyperparathyroidism

A

adenoma
hyperplasia of gland
carcinoma

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17
Q

how does primary hyperparathyroidism present

A 
stones, thrones, bones, moans, psychiatric overtones
Ca kidney stones 
polyuria 
constipation 
sore bones 
muscle weakness 
depression 
confusion
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18
Q

how can you manage hyperparathyroidism

A

remove tumour

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19
Q

what is secondary hyperparathyroidism

A

when renal failure or VD deficiency causes low absorption of Ca resulting in hypocalcaemia
the parathyroid gland reacts to this by releasing more PTH and undergoes hyperplasia
serum calcium is normal but PTH is high

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20
Q

what can cause secondary hyperparathyroidism

A

vitamin D deficiency

chronic kidney failure

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21
Q

how does secondary hyperparathyroidism present

A

symptoms of chronic renal failure

calcification of vessels

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22
Q

how can you manage secondary parathyroidism

A

correct VD deficiency

manage renal failure

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23
Q

what is tertiary hyperparathyroidism

A

when secondary hyperparathyroidism becomes primary over a long period of time
treat by surgical removal of part of the gland

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24
Q

what is primary adrenal insufficiency

A

hyposecretion of adrenal hormones

most commonly aldosterone and cortisol, can be sex steroids too

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25
Q

what can cause primary adrenal insufficiency

A

waterhouse-friederschein disease

sudden increase in BP causing rupture of vessels causing ischaemia

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26
Q

how does primary adrenal insufficiency present

A

hypotension
nausea
vomiting
confusion coma

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27
Q

what is Addison’s disease

A

chronic primary renal insufficiency due to destruction of adrenal cortex

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28
Q

how does addison’s disease present

A 
lethargy 
sore muscles, abdomen, joints 
depression 
diarrhoea 
vomiting
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29
Q

what can cause addison’s

A

autoimmune destruction
TB
metastatic carcinoma

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30
Q

what investigations would you do in addison’s

A

synacthen test

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31
Q

what are clinical signs of addison’s

A

hyperpigmentation (CRH is a precursor of melalin) - of buccal membrane, palmar creases
acanthesis nigricans
postural hypotension
weight loss

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32
Q

how can you manage addisons

A

hydrocortisone
fludrocortisone
increase dose when patient has infection or minor surgery
patient given emergency ID tag

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33
Q

what is addisonian crisis

A

sudden increased need for hormones causes acute symptoms

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34
Q

what can cause addionian crisis

A

sudden stopping of steroids/hormone therapy

bilateral adrenal haemorrhage

35
Q

how does addisionian crisis present

A 
hypotension
nausea, vomiting
pain in back abdomen and legs
dehydration 
weakness 
psychosis
coma
36
Q

what investigations could you do in addisonian crisis

A

bloods for cortisol and ACTH

37
Q

how could you manage addisonian crisis

A

Hydrocortisone Sodium succinate 100mg IV
IV saline
monitor BG
find underlying cause

38
Q

what is graves disease

A

autoimmune disease where antibodies are formed that mimic TSH and bind to receptors causing an increase in T3 and T4
TRH and TSH levels are low
the increased demand for TH causes hyperplasia (increased number of follicular cells) and hypertrophy of the gland
the antibodies also stimulate fibroblasts in eyes and skin causing them to make more glycosaminoglycans
causes hyperthyroidism

39
Q

what is toxic multinodular goitre

A

nodules develop on the gland that act independently of the TRH and TSH negative feedback and produce lots of TH (some TSH receptors are turned on constantly - like megan)
causes hyperthyroidism
usually caused by iodide deficiency - hypothalamus increases TRH and therefor TRH causing hypertrophy and hyperplasia of the gland - goitre develops

40
Q

what is the effect of a thyroid adenoma

A

the adenoma produces TH regardless of TH level in the blood

41
Q

what can happen when the thyroid gland is inflamed or damaged?

A

the hormones can all spill out causing hyperthyroidism

42
Q

how does hyperthyroidism present

A 
increased basal metabolic rate 
heat intolerance 
sweating 
fever 
anxiety 
muscle weakness 
osteoporosis if chronic 
loose stools 
hyperreflexia 
palpitations
43
Q

what is thyroid storm/ thyrotoxic crisis

A

severe hypermetabolism

life threatening

44
Q

what can cause thyrotoxic crisis

A

sudden stopping of therapy
infection
surgery

45
Q

how does thyrotoxic crisis present

A

pyrexia
tachycardia
delirium
arrhythmia

46
Q

what are specific clinical signs of graves disease

A

enlarged thyroid - goitre
exophthalmos (bulging of eye)
pretibial myxoedema
oedema

47
Q

what are specific clinical signs of toxic multinodular goitre

A 
enlarged thyroid 
hoarse voice 
airway obstruction 
dysphagia 
SVC syndrome - facial and arm swelling
48
Q

how can you treat hyperthyroidism

A

Carbimazole - 1st line
propylthiouracil
radioactive iodine ablation (+ levothyroxine if needed)
beta blockers
surgical removal
for thyroid storm - beta blockers, thionamides, glucocorticoids

49
Q

what investigations can you do in hyperthyroidism

A

TFTs

ECG

50
Q

what is primary hypothyroidism

A

thyroid gland doesn’t make enough hormones

51
Q

what can cause primary hypothyroidism

A

hashimoto’s thyroiditis - autoimmune destruction of thyroid gland
iatrogenic - thyroidectomy or iodine ablation
chronic iodine deficiency
congenital

52
Q

what is secondary hypothyroidism and what can cause it

A

there is not enough TSH to release TH

tumour of pituitary or hypothalamus

53
Q

how does hypothyroidism present

A 
weight gain 
loss of appetite 
cold intolerance 
lethargy 
constipation 
myxoedema - swelling of tongue and skin
54
Q

what is myxoedema coma and how does it present

A

extreme hypothyroidism due to surgery, infection
hypothermia
loss of consciousness
confusion

55
Q

what investigations could you do in hypothyroidism

A

blood hormone levels - TH will always be low, TSH only raised in primary disease (and low in secondary disease).
thyroid peroxidase antibodies for autoimmune disease

56
Q

how do you treat hypothyroidism

A

levothyroxine long term - start with a high dose and gradually reduce
TFTs every month

57
Q

what is acromegaly

A

extra GH after growth plates have closed

58
Q

what is gigantism

A

excess GH in kids before growth plates have closed

59
Q

what can cause acromegaly

A

pituitary adenoma secreting GH

MEN 1 syndrome

60
Q

how does acromegaly present

A 
large hands and feet 
large jaw 
gaps between teeth 
large forehead 
soft tissue swelling 
large tongue 
carpal tunnel syndrome 
diabetes (GH increases insulin resistance)
61
Q

what investigations could you do in acromegaly

A

blood GH levels
MRI for pituitary adenoma
GH suppression test
oral glucose tolerance test

62
Q

how do you treat acromegaly

A 
somatostatin analogues 
GH receptor antagonists 
dopamine agonists
pituitary tumour removal 
removal of any other causative tumour
63
Q

what is hyperprolactinemia

A

high levels of prolactin in the blood

64
Q

what can cause hyperprolactinemia

A 
prolactinoma 
pregnancy 
polycystic ovary disease 
tumour in hypothalamus secreting prolactin releasing hormone or in pituitary secreting prolactin
lactation
stress 
dopamine depleting drugs
65
Q

how can hyperprolactinaemia present in women

A

menstrual irregularity
lactating when not pregnant
infertility

66
Q

how can hyperprolactinaemia present in men

A 
gynecomastia 
impotence 
visual disturbances 
headache 
decreased facial hair
67
Q

what investigations could you do in hyperprolactinaemia

A

blood prolactin level > 550mu/l

pregnancy and polycystic ovary test

68
Q

how can you treat hyperprolactinaemia

A

dopamine agonists

increase calcium and vitamin D uptake because risk of osteoporosis

69
Q

What is the first presentation of thyroid cancer?

A

A solitary hard painless lump on the thyroid gland. it can cause hoarseness and trouble swallowing if it gets too big.

70
Q

what does non functional thyroid cancer mean?

A

They don’t produce signs of hyperthyroidism or hypothyroidism.

71
Q

What is the diagnosis of thyroid cancer made with?

A

Thyroid ultrasound. Radioiodine scan - where radio iodine is injected and taken up by cells which make thyroid hormone, usually thyroid tumours don’t make thyroid hormone so they are ‘cold nodues’

72
Q

what is the definitive diagnostic test for thyroid cancer?

A

Fine needle aspiration.

73
Q

what is the treatment for thyroid cancer?

A

partial or total thyroidectomy followed by thyroid hormone replacement.

74
Q

what is primmery hyperaldosteronism?

A

aldosterone s a mineralocirtocoid. it increases sodium reabsorption, and increases hydrogen secretion and potassium secretion.

Conns syndrome - when the adrenal gland produces too much aldosterone, the renin is low because of the high blood pressure entering the kidneys.

75
Q

Where does stage 2 of the RAAS system occur? (mediated by ACE hormones)

A

In the lungs.

76
Q

which hormone stimulates the release of aldosterone?

A

Angiotensin II

77
Q

what is the cause of Conns syndrome?

A

adrenal adenoma - most common cause.
bilateral adrenal hyperplasia
familial hyperaldosteronism.
adrenal carcinoma

78
Q

What is secondary hyperaldosteronism?

A

where renin is causing the increase in aldosterone - renin will be high.

79
Q

what is the main cause of secondary hyperaldosteronism?

A

when theres reduced blood flow to the kidneys, tricking them into thinking the blood pressure is too low:
renal artery stenosis, heart failure, atherosclerosis.

80
Q

what is the investigation for hyperaldosteronism?

A

to check the renin:aldosterone ratio

  • high aldosterone : low renin (primary hyperaldosteronism)
  • High aldosterone : high renin (secondary hyperaldosteronism).

Blood pressure, hypokalaemia, alkalosis.

81
Q

treatment of aldosteronism?

A

aldosterone antagonists - spironolactone, eplenerone.
surgery - remove adenoma.
percutaneous angioplasty - to stent the renal artery.

82
Q

what does hyperaldosteronism cause?

A

it is the leading cause of secondary hypertension.

83
Q

when is radioactive iodine for hyperthyroidism contraindicated?

A 
pregnant women (can't get pregnant within 6 months)
can be around pregnant women or children for 3 weeks 
must have limited contact with anyone for days after receiving the dose.
84
Q

which mood stabilising drug can cause hypothyroidism?

A

Lithium - inhibits production of thyroid hormone.

Exam - M - endocrine pathology (Megan) (14 decks)

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