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4th year finals > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the most common cause of Acromegaly?

A

Pituitary Adenoma

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2
Q

Name all three causes of Acromegaly?

A

Pituitary Adenoma
Excess GHRH eg Lung Cancer or Pancreatic Cancer

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3
Q

When Acromegaly occurs alongside a GHRH Ectopic cancer like Lung or Pancreatic what is this called?

A

Paraneoplastic Syndrome

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4
Q

Growth hormone is released by what cells within what structure in response to GHRH?

A

Somatotropic Cells within Anterior Pituitary

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5
Q

GHRH is released from what structure?

A

Hypothalamus

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6
Q

GHRH stimulates what cells to release Growth Hormones?

A

Somatotropic

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7
Q

What is bitemporal hemianopia?

A

Loss of outer half of vision in both eyes due to pressure on optic chiasm

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8
Q

Which orthopaedic condition can be seen in Acromegaly?

A

Carpal Tunnel Syndrome

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9
Q

Name 12 common symptoms/signs of Acromegaly?

A

Coarse Facial Apperance
Spade Like Hands
Increase in Shoe Size
Macroglossia
Macrogathia
Interdental Spaces
Excessive Sweating
Headaches
Bitemporal Hemianopia
Galactorrhoea
Carpal Tunnel
Amenorrhoea

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10
Q

How to diagnose Acromegaly?

A

Serum IgF1 Levels increased

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11
Q

IgF1 is released/produced by what organ?

A

Liver

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12
Q

IgF1 + Growth Hormone release does what to GHRH?

A

Inhibits GHRH and Stimulates Somatostatin Release

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13
Q

How to confirm Acromegaly diagnosis?

A

OGTT

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14
Q

What will OGTT find in Acromegaly?

A

GH Suppressed

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15
Q

Raised prolactin can lead to what symptom?

A

Galatorrhoea

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16
Q

What type of surgery for Pituitary Adenoma in Acromegaly?

A

Transphenoidal

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17
Q

What medication is first line in Acromegaly and it’s actions?

A

Somatostatin Analogue eg Octerotide or Sandostatin

  • Directly inhibits release of Growth Hormone
  • Induces tumour shrinkage
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18
Q

Name common side effects of Somatostatin analogues eg Octerotide or Sandostatin?

A

Nausea, Diarrhoea, Cramp, Cholesterol Gallstones, Constipations, Hair Loss, Gallbladder Disease, Bradycardia

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19
Q

Second line medication in Acromegaly?

A

GH Receptor Antagonist eg Pegvisomant

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20
Q

What dopamine agonist can be used third line in Acromegaly?

A

Bromocriptine

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21
Q

If someone is unwell in Acromegaly and getting an infection what steroid should they take with an infection?

A

Hydrocortisone double or triple dose for 3-5 days

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22
Q

Name the common complications of Acromegaly? (7)

A

Hypertension
Diabetes
Cardiomyopathy
Colorectal Cancer/Polyps
Sleep Apnoea
Cardiomyopathy
Accelerated Osteoarthritis

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23
Q

Most common cause of Addisons Disease

A

Autoimmune Destruction of Adrenal Gland which reduces cortisol and aldosterone

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24
Q

Name Primary causes of Hypoadrenalism? (6)

A

Tuberculosis
Mets in Lung, Adrenal, Breast, Melanoma
Congenital Adrenal Hyperplasia
Menigoccal Septicemia (Waterhouse Frederichsen Syndrome)
HIV
Antiphospholid Syndrome

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25
Q

Name a secondary cause of Hypoadrenalism?

A

Pituitary Disorders

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26
Q

Name common symptoms in Addisons? (6)

A

Lethargy
Anorexia
Nausea/Vomit
Salt Crave
Skin Pigmentation
Vitiligo

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27
Q

Name 5 common electrolyte abnormalities in Addisons?

A

Hypotension
Hypoglycemia
Hyponatraemia
Hyperkalaemia
Metabolic Acidosis

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28
Q

How to Diagnose Addisons?

A

ACTH Stimulation Test (Short Synacthen Test)

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29
Q

What happens to bloods in Addisons? (4)

A

Reduced Na+ due to low aldosterone
Increased K+ due to low aldosterone
Decreased Glucose
High Urea

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30
Q

If Cortisol is High on ACTH Stimulation test what does that diagnose?

A

Addisons

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31
Q

How to Treat Addisons? (2)

A

Hydrocortisone and Fludrocortisone

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32
Q

Management of Intercurrent illness in Addisons?

A

Double Hydrocortisone
Fludracortisone dose stays same

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33
Q

What can cause an Addisonian Crisis?

A

Infection/Surgery
Adrenal Haemorrhage eg Waterhouse Frederichsen Syndrome
Steroid Withdrawal

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34
Q

Treatment of Addisonian Crisis?

A

Hydrocortisone 100mg IM or IV

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35
Q

What does the Adrenal Cortex produce? (5)

A

Aldosterone
Cortisol
Testosterone
Progesterone
Oestrogen

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36
Q

What does the Adrenal Medulla produce?

A

Adrenaline
Noradrenaline

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37
Q

What is Barter’s Syndrome?

A

Inherited cause of Severe Hypokalaemia due to defective chloride absorption at ascending loop of henle

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38
Q

Symptoms of Barter’s Syndrome? (5)

A

Fail to Thrive
Polyuria/Dypsia
Hypokalaemia
Normotension
Weak

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39
Q

What mode of inheritance is Congenital Adrenal Insufficiency?

A

Autosomal Recessive

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40
Q

What happens to the anterior pituitary when low cortisol is produced?

A

High levels of ACTH secreted which can stimulate production of adrenal androgens

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41
Q

Most common cause of Congenital Adrenal Insufficiency?

A

21 Hydroxylase Deficiency

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42
Q

How does 21 Hydroxylase Deficiency present? (3)

A

Virilisation of Female Genitals
Precocious Puberty in Males
Salt Losing Crisis

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43
Q

How does 11 Beta Hydroxylase Deficiency present?

A

Virilisation of Female Genitals
Precocious Puberty in Males
Hypertension/Hypokalaemia

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44
Q

Diagnosis of Congenital Adrenal Insufficiency?

A

ACTH Stimulation

45
Q

What happens if Congenital Hypothyrodism is not treated within first four weeks of life?

A

Irreversible Cognitive Impairment

46
Q

How is congenital hypothyrodism diagnosed?

A

Heel Prick Test

47
Q

Symptoms of Congenital Hypothyrodism? (5)

A

Prolonged Neonatal Jaundice
Delayed Milestones
Short and Puffy Face
Macroglossia
Hypotension

48
Q

Cushings Syndrome Pathophysiology?

A

Excess Corticosteroids and Glucocorticoids

49
Q

Most common cause of Cushings Syndrome/Disease?

A

ACTH Dependent: Pituitary Tumour secreting ACTH

50
Q

Causes of Cushings Syndrome? (4)

A

Pituitary Tumour
ACTH Independent eg Steroids for Asthma, IBD
Adrenal Adenoma/Carcinoma
Severe Alcohol/Depression

51
Q

Symptoms of Cushings? (8)

A

Central Obesity
Purple Striae
Oedema
Plethoric Faces
Buffalo Hump
Moon Face
Proximal Muscle Atrophy
Poor Wound Healing

52
Q

Signs of Cushings? (5)

A

Hypokalaemia Metabolic Acidosis
Hypertension
Often Osteoporosis/Osteopenia
Impaired Glucose Tolerance
Very Low Potassium with Ectopic ACTH Secretion

53
Q

Diagnosis of Cushings Disease (with cause of Pituitary Adenoma)

A

Overnight Dexamethasone Suppression Test (Suppressed Cortisol and ACTH)

54
Q

Diagnosis of Cushings Syndrome?

A

Overnight Dexamethasone Suppression Test (Not suppressed cortisol and suppressed ACTH)

55
Q

Test to diagnose location of Cushings?

A

Plasma ACTH
- Suppressed: ACTH Indep Cause
- High ACTH: Dependent Cause

56
Q

Treatment of Cushings? (5)

A

Surgery to remove Tumour
Steroid Replacement Therapy
Adrenal Hormone Synthesis inhibitors: Ketoconazole, Etomidate, Metyrapone
Destroy Adrenocortical Cells: Mitotone
Radiotherapy

57
Q

Cushings increases the risk of what 4 conditions?

A

Increased Risk of Infection
Hypertension
Heart Failure
Diabetes

58
Q

What is Carbimazole used for?

A

Thyrotoxicosis

59
Q

Mechanism of Carbmiazole?

A

Blocks thyroid peroxidase = reduces thyroid hormone production

60
Q

Carbmiazole adverse effects? (2)

A

Agranulocytosis
Crosses placenta but may be used in low doses in pregnancy

61
Q

Side effects of Fludrocortisone? (2)

A

Fluid Retention
Hypertension

62
Q

Side effects of Prednisolone? - Psychiatry (4)

A

Insomnia
Mania
Depression
Psychosis

63
Q

Side Effects of Prednisilone (skin) - 7

A

Impaired Glucose Regulation
Increased Appetite
Hyperlipidemia
Moon Face
Buffalo Hump
Striae
Proximal Myopathy

64
Q

Side effects of Prednisilone - Rheumatology/MSK (2)

A

Osteoporosis
Avascular Necrosis of Femoral Head

65
Q

Side effects of Prednisilone - Infection/GI (5)

A

Susceptibility to Severe Infection
Reactivation of TB
Peptic Ulcers
Acute Pancreatitis
Neutrophilia

66
Q

Side effects of Prednisilone - Neuro (2)

A

Growth Suppression
Intracranial Hypertension

67
Q

Androgen Insensitivity Syndrome, 5a Reductase Deficiency, and Male Pseudohermatophoriditism carry what karotype?

A

46 XY

68
Q

Androgen Insensitivity Syndrome inheritance?

A

X Linked Recessive

69
Q

Androgen Insensitivity Syndrome physiology?

A

Results in end organ resistance to testosterone causing genotypically male children to have female phenotype

70
Q

Presentation of Androgen Insensitivity Syndrome? (2)

A

Vagina and Testes
No Uterus

71
Q

Diagnosis of Androgen Insensitivity Syndrome (2)

A

Elevated Testosterone, Oestrogen and LH

72
Q

5a Reductase Deficiency Syndrome inheritance?

A

Autosomal Recessive

73
Q

5a Reductase Deficiency Syndrome physiology

A

Inability of males to convert testosterone to dihydrotestosterone

74
Q

5a Reductase Deficiency Syndrome presentation (3)

A

Ambigious Genitalia in Newborn Period
Hypospadias common
Virilization at Puberty

75
Q

21 Hydroxylase Deficiency presentation? (4)

A

Simple Virilising
Salt Wasting
Late Onset/Non Classical
Turns little girls into little boys and little boys into little men

76
Q

21 Hydroxylase Deficiency - Which would be most effective at suppressing adrenal androgen production in classical CAH?

A

Hydrocortisone

77
Q

Carbimimazole is used to manage what condition?

A

Thyrotoxicosis

78
Q

Mechanism of Carbimazole

A

Blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin

79
Q

Adverse effects of Carbimimazole?

A

Agranulocytosis

80
Q

Most common cause of Thyrotoxicosis

A

Graves Disease

81
Q

Features specific to Graves Disease

A

Exopthalmos
Opthalmoplegia
Pretibial Myxoedema
Digital Clubbing
Soft tissue swelling of hands and feet
periosteal new bone formation

82
Q

Thyroid acropachy in Graves is a triad of?

A

Digital clubbing
Soft tissue swelling of hands and feet
Periosteal new bone formation

83
Q

Which antibodies are specific to graves?

A

TSH Receptor Stimulating and Anti Thyroid Peroxidase antibodies

84
Q

What does Thyroid sctinigraphy show in Graves

A

diffuse, homogenous increased uptake of radioactive iodine

85
Q

How to treat Graves disease?

A

Propranolol for Symptoms
Carbimiazole
Radioiodine treatment

86
Q

After radioiodine treatment how long should pregnancy be avoided?

A

4-6 months following treatment

87
Q

Hashimoto Thyroditis is typically associated with?

A

Hypothyrodism

88
Q

Features of Hashimoto Thyroditis

A

Goitre

89
Q

Hashimoto Thyroditis is associated with the development of?

A

MALT Lymphoma

90
Q

Causes of Primary Hypothyrodism

A

Hashimoto Thyroditis
Subacute Thyroditis (De Quervain)
Riedal Thyroditis
After Thyroidectomy/Radioiodine
Lithium/Amidarone/Carbmiazole
Iodine Deficiency

91
Q

Hashimoto Thyroditis is an autoimmune disease associated with what three conditions?

A

IDDM
Addisons
Pernicious Anaemia

92
Q

Features of Hypothyrodism?

A

Weight Gain
Lethargy
Cold Intolerance
Dry Skin and Hair
Non Pitting Oedema
Constipation
Menorrhagia
Decreased Deep Tendon Reflexes
Carpal Tunnel

93
Q

Treating Hypothyrodism?

A

Levothyroxine

94
Q

What happens in pregnancy to Thyroxine Binding Globylin?

A

Increases but Free Thyroxine uneffected

95
Q

How to treat Thyroxicosis in Pregnancy?

A

Propylthiouracil in FIrst Trimester
Carbmiazole outside of this

96
Q

Is thyroxine safe during pregnancy?

A

Yes and will need increased dose

97
Q

How to recognise subclinical hyperthyrodism?

A

Normal T4 and Low TSH

98
Q

Causes of Subclinical Hyperthyrodism?

A

Multinodular Goitre

99
Q

How to recognise subclinical hypothyrodism?

A

TSH raised but T3/T4 Normal

100
Q

Best prognosis thyroid cancer?

A

Papillary

101
Q

Which is cancer is of parafollicular cells and secretes calcitonin?

A

Medullary Thyroid Cancer

102
Q

Which thyroid cancer has to the worst prognosis?

A

Anaplastic

103
Q

Management of Papillary and Foillcular thyroid cancer?

A

Total Thyroidectomy
Radioiodine

104
Q

Subacute Thyroiditis (De Quervain) associated with?

A

Painful Goitre and Raised ESR

105
Q

Precipitating events of Thyroid Storm?

A

Thyroid or Non Thyroidal Surgery
Trauma
Infection
CT Contrast

106
Q

How to treat Thyroid Storm?

A

IV Propranolol
Propylthiouracil

107
Q

On Thyroid Nuclear Sctinigraphy reveals patchy uptake what is this?

A

Toxic Multinodular Goitre

108
Q

How to treat Toxic Multinodular Goitre

A

Radioiodine Therapy

4th year finals (37 decks)

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