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Flashcards in 128 - General Endocrinology Deck (95):
1

What is the treatment plan for primary hyperparathyroidism?

  • Conservative fluids
  • Medical options are under trail
  • Surgery if meet criteria

 

2

What is the function of calcitonin?

It lowers the blood calcium levels and blood phosphate levels

2

Where in the brain is adrenocorticotropic hormone (ACTH) produced?

Anterior pituitary 

3

What are the symptoms of Addison's Disease?

 

  • Weight loss and anorexia
  • Hyper-pigmentation
  • Depression or confusion
  • Loss of body hair
  • Impotence or amenorrhea
  • Syncope and postural hypotension

 

3

What is the treatment for malignant hypercalcaemia?

  • Tumour ablation
  • IV fluids
  • Frusemide; taken with care
  • Bisphosphonates
  • Glucocorticoids
  • Calcitonin

4

What is Cushing's Syndrome?

It is a set of symptoms associated with prolonged elevated levels of cortisol

5

What are the investigations performed for the diagnosis of primary hyperparathyroidism?

  • Serum PTH
  • Hypercholaemic acidosis
  • Renal function; urea and creatinine
  • 24 hour urinary calcium
  • Elevated serum alkaline phosphatase
  • X-ray
  • Bone density scans
  • Ultrasound of kidneys

 

6

What is it in Addison's Disease that causes the hyperpigmentation?

Elevated levels of ACTH

6

What is the treatment of an Addisonian Crisis?

  • Hydrocortisone
  • Fluid correction

 

6

What is the most common cause of primary hyperaldosteronism in females?

Adrenal adenomas (Conn's syndrome)

6

What are the treatment options for Conn's syndrome?

  • Laparoscropic removal of adenoma
  • Low sodium diet
  • Spironolactone if hyperplasia

 

7

What are the 4 main types of hormones?

  1. Peptides and proteins
  2. Amino acid derivatives
  3. Steroids
  4. Fatty acid derivatives

7

How can severe magnesium deficiency affect the parathyroid glands?

It can paralyse them preventing the secretion of PTH

8

What are the major causes of hypercalaemia?

  • Primary hyperparathyroidism
  • Malignancy
  • Milk-alkali syndrome
  • Over-ingestion of Vit D
  • Sarcoidosis

9

What is the main treatment of male androgen deficiency?

  • Testosterone replacement therapy
  • Gonadotrophin replacement if sencondary hypogonadism
  • Type 5 phosphodiesterases for penile dysfunction

 

10

What are the criteria for referral to surgery for primary hyperparathyroidism?

  • Creatinine clearance < 60ml/min
  • Under 50 years old
  • Serum calcium > 0.25mmol over normal range
  • BMD -2.5 or less at any site
  • Previous fragility fracture

 

10

What type of condition does Albright's hereditary osteodystrophy cause?

Primary hypoparathyroidism

11

What investigations are performed to diagnose Addison's Disease?

 

  • Single cortisol measurement
  • Short or long ACTH stimulation test
  • 9am ACTH level
  • U & E's including glucose
  • Adrenal antibody test
  • CXR, AXR
  • Serum aldosterone

12

What hormones are normally secreted by a phaeochromocytoma?

  • Adrenaline
  • Noradrenaline

12

13

What are the functions of cortisol?

 

  • Help control blood glucose levels between meals
  • Increase amino acids levels in the blood
  • Promotes fat utlisation for energy
  • Stimulates liver to synthesise glucose via gluconeogenesis

14

How does PTH alter Ca2+ and PO4 levels?

  • It causes their release from bone by increasing osteoclast activity
  • It causes the kidneys to increase PO4 excretion
  • It increases Vitamin D production, thereby increasing dietary Ca2+ absorption

14

What is the most common cause of hypoparathyroidism?

Surgery on the neck that either removed the parathyroids or destroyed them

15

What must be present for the production of T3 and T4?

Iodides

17

Which one, T3 or T4, or more effective and which is more abundant?

T3 - more effective

T4 - more abundant

17

What are the biochemical effects of an increased PTH level?

  • Increased calcium in serum and urine
  • Decreased phosphate in serum, but elevated in urine
  • Increased chloride
  • Decreased bicarbonate

19

What molecule increases intracellularly when ACTH binds to its receptor?

 

cAMP

 

19

What are the symptoms of Cushing's syndrome?

  • Rapid weight gain and "moon-face"
  • Severe muscle wasting
  • Osteoporosis
  • Predisposition to diabetes
  • Hypertension
  • Depression
  • Hair growth (Hirsutism)/ acne
  • Brusing

 

20

What are the clinical signs of a phaeochromocytoma?

  • Hypertension
  • Tachycardia
  • Orthostatic hypotension
  • Glycosuria

21

What of the symptoms of symptomatic hyperparathyroidism?

  • Tiredness/malaise
  • Renal stones/ colic
  • Haematuria
  • Osteopenia
  • Nausea and vomiting
  • Pancreatitis
  • Bradycardia and heart block
  • Corneal calcification

22

What are the treatment options for phaeochromocytoma?

  • Alpha blockade with phenoxybenzamine
  • Then beta blockade with propanolol
  • Surgery following these procedures

23

What is the long term treatment options for Addison's Disease?

 

  • Replacement glucocorticoid (hydrocortisone or prednisolone)
  • Mineralcorticoid 
  • DHEA may be beneficial

24

What 2 molecules can trigger the secretion of aldosterone?

 

  1. Angiotensin II
  2. ACTH

24

What 2 amines are secreted from the adrenal medulla?

  1. Adrenaline
  2. Noradrenaline

24

What is Addisonian Crisis?

It is a collection of symptoms caused by Addison's Disease and can be fatal:

  • Acute hypotension
  • Fever
  • Convulsions
  • Hyperkalaemia
  • Hypercalaemia
  • Hypoglycaemia

25

What are the symptoms of male androgen deficiency occuring in adults?

  • Small or absent testes
  • Gynaecomastia
  • Infertility/ sexual dysfunction
  • Small prostate
  • Reduced hair growth
  • Osteoporosis

26

How many patients develop tetany post-operatively following removal of the parathyroids?

About 50%

28

What is the most common cause of primary hypoadrenalism in Western countries?

Autoimmune

Anti 21-hydroxylase antibodies are produced and destroy the adrenal cortex

29

What are the symptoms of DiGeorge syndrome?

  • Cleft lip
  • Abnormal facies
  • Cardiac defects
  • Immune deficiency
  • Hypoparathyroidism

31

Name one of the glucocorticoids

Cortisol

32

What are the causes of primary hyperparathyroidism?

  • Single parathyroid adenoma
  • Diffuse hyperplasia of all the glands
  • Multiple parathyroid ademonas are a rare cause

 

33

What are the treatment options for hypocalcaemia?

  • Cholecalciferol for Vit D deficiency
  • Alfacalcidol
  • Oral calcium supplements

 

33

What is the main symptom of male androgen deficiency at puberty?

The development of eunuchoid body proportions

34

What are the symptoms of a phaeochromocytoma?

  • Anxiety & panic attacks
  • Palpitations
  • Tremor
  • Raynaud's phenomenon
  • Nausea and vomiting
  • Flushing

36

What are the investigations to confirm Cushing's Syndrome?

  • 48 hour low dose dexamethasone test
  • 24 hour urinary free cortisol measurements
  • Circadian rhythm

37

What are the symptoms of Klinefleter's?

  • Hypogonadism
  • Intellectual dysfunstion
  • Behavioural problems
  • Tall stature, with reduced muscle mass
  • Gynaecomastia 

39

What is Addison's Disease?

It is a primary adrenocortical insufficiency

There is reduced levels of cortisol leading to increased CRH and ACTH

40

What is the most common cause of primary hyperaldosteronism overall?

Conn's syndrome (adrenal adenoma)

41

What are the causes of Cushing's Syndrome?

ACTH-dependent:

  • Cushing's Disease
  • Ectopic ACTH
  • ACTH source unknown
  • Macronodular hyperplasia

ACTH-independent:

  • Adrenal adenoma
  • Adrenal carcinoma

42

What is the function of T3 and T4?

Control of metabolic processes:

  • Break down carbohydrates and fats
  • Synthesis proteins

 

44

What is the most common cause of congenital adrenal hyperplasia?

21-hydroxylase deficiency

45

What separates pseudo-pseudohypoparathyroidism from pseudohypoparathyroidism?

Pseudo-pseudohypoparathyroidism has similar bone deformities but there is normal biochemistry

46

Name one of the mineralcorticoids

Aldosterone

47

What molecule is mutated in psuedo-pseudohypoparathyroidism?

The GNAS gene

48

What hormones does the thyroid gland produce?

  • T3
  • T4
  • Calcitonin

49

What is the most common cause of primary hypoparathyroidism?

Chronic kidney disease

51

What 2 factors are involved in the regulation of ACTH release?

  • Corticotropin-releasing factor (CRF)
  • ADH

51

What investigations are performed for diagnosing a phaeochromocytoma?

  • Measurement or urinary catecholamines
  • Resting plasma catecholamines
  • Plasma chromogranin A
  • Clonidine suppression test
  • CT 
  • MRI
  • MIBG scan
  • Genetic testing

53

What investigations are performed in priamry hyperadosteronism?

  • Plasma aldosterone:renin ratio
  • Plasma aldosterone levels
  • Plasma renin levels
  • CT/ MRI
  • U & E's -> for K+ levels

55

What is a phaeochromocytoma?

A tumour of the sympathetic nervous system that secrete catecholamines

56

What molecule are steroid hormones dervived from?

Cholesterol

58

Which enzyme does Metyrapone inhibit?

11 ß-hydroxylase

59

What is hungry bones syndrome?

 

  • Avid uptake of calcium and phosphate by the bones
  • The parathyroids cannot compensate the deranged levels
  • Causes symptoms of hypoparathyroidism, namely hypocalcaemia

60

Who is most likely to have primary hyperparathyroidism?

Women aged over 60

61

What are the symptoms of hypoparathyroidism?

  • Paraesthesiae
  • Circum-oral numbness
  • Cramps
  • Anxiety
  • Tetany
  • Convulsions
  • Dystonia
  • Psychosis

62

What other medical conditions are associated with a phaechromocytoma?

  • Multiple Endocrine Neoplasia (MEN) type 1, 2a or 2b
  • Von-hippel-Lindau syndrome
  • Phakomatoses
  • Neurofibromatosis
  • Tuberose sclerosis
  • Ataxia-Telangestasia
  • Struge-Weber syndrome

63

What is the most common cause of primary hyperaldosteronism in males?

Bilateral adreanl hyperplasia

64

What groups of hormones does the adrenal cortex secrete and which part of the cortex secretes which?

  • Mineralocorticoids - Outer layer
  • Glucocorticoids - Middler layer
  • Sex hormones - Inner layer

66

What 2 groups of hormones are dervived from tyrosine?

  1. Thyroid hormones
  2. Catecholamines

67

What are the treatment options for Cushing's Syndrome?

  • Metyrapone
  • Pituitary or adrenal surgery
  • Oncology therapy

Ketoconazole can also be used with Metyrapone

67

What are the clinical presentations of primary hyperaldosteronism?

  • Hypertension
  • Hypokalaemia
  • Muscle wasting
  • Nocturia
  • Cardiac and retinal damage

 

68

What are the effects of primary hyperaldosteronism?

  • Sodium retention 
  • Potassium loss leading to hypokalaemia
  • Hypertension

 

69

What investigations are carried to test for hypoparathyroidism?

  • Serum urea and creatinine
  • PTH levels in serum
  • Parsathyroid antibodies
  • Vit D levels
  • Magnesium levels
  • X-ray of metacarpals

70

What are the causes of primary hyperalsosteronism?

  • Adrenal ademona (Conn's syndrome)
  • Adrenal hyperplasia
  • Adrenocortical cancer

71

What type of hypogonadism does Kallmann's syndrome present with?

Secondary Hypogonadism

73

What are the complications of Cushing's Syndrome?

Death from:

  • Hypertension
  • Myocardial infarction
  • Infection
  • Heart failure

75

What are possible complications following surgery for primary hyperparathyroidism?

  • Hypocalcaemia
  • Hungery bone syndrome

 

76

How many live births per year are affected by a 21-hydroxylase deficiency?

15,000 births per year

77

What are the clinical maneestations of congenital adrenal hyperplasia?

  • Adrenal failure  Addison like symptoms
  • Clitoral hypertrophy
  • Precocious puberty with hirsutism
  • Amenorrhoea

78

What syndrome is associated with parathyroid carcinomas?

Hyperparathyroidism-jaw tumour syndrome

79

What are the symptoms of Albright's hereditary osteodystrophy?

  • Short stature
  • Round face
  • Short neck
  • Brachydactyly
  • Shortened metacarpals
  • Subcutaneous ossifications
  • Reduced intelligence
  • Dimpled knuckle when fist is formed

 

81

What is Aldosterone's function?

 

Regulates mineral electrolyte levels in the blood (Na+ & K+)

83

How does a 21-hydroxylase deficiency lead to adrenal hyperplasia?

  • It causes a decrease in cortisol secretion
  • This leads to increased levels of ACTH through feedback mechanisms
  • This causes hyperplasia of the adrenals to maintain normal coritsol levels

 

84

What is the incidence of Addison's disease?

3-4 per million/year

85

What is the function of PTH?

Increases blood calcium levels and decreases blood phosphate levels

86

What is DiGeorge syndrome?

It is a genetic disorder causing neonatal hypoparathyroidism

87

What is the most common cause of hypercalaemia?

Primary hyperparathyroidism

88

What are the common causes of hypocalcaemia?

  • Chronic kidney disease
  • Hypoparathyroidism; DiGeorge's syndrome
  • Rickets/ Osteomalacia
  • Psuedohypoparathyroidism
  • Drugs such as bisphosphonates
  • Acute pancreatitis

 

89

Describe Klinefelter's syndrome?

  • Most common cause of male hypogonadism
  • Caused by extra X chromosomes
  • Typically 47 XXY

90

What are the causes of malignant hypercalcaemia?

Squamous cell tumours of the lung or breast with bone metastases

91

What are the symptoms of hypocalcaemia/ hypoparathyroidism?

  • Tetany
  • Paresthesias
  • Siezures
  • Organic brain syndrome
  • Cataracts
  • Calcification of basal ganglia

 

92

Which decades of life do phaeochromocytomas usually present?

4th and 5th decade of life

93

What is the treatment plan for congential adrenal hyperplasia?

  • Dexamethasone
  • Cyproterone acetate
  • Oestrogen

 

94

What happens to the adrenal cortex in Addison's disease?

 

The entire adrenal cortex is destroyed

95

How does primary and secondary hypogonadism differ?

Primary hypogonadism:

  • Low testosterone
  • Elevated FSH and LH

Secondary hypogonadism:

  • Low testosterone
  • Low or normal FSH and LH