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MRCP Combined > Endocrine tests and concepts > Flashcards

Endocrine tests and concepts Flashcards

1
Q

Most common cause of hypothyroidism?

A

Hashimoto’s thyroiditis

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2
Q

Other causes of hypothyroidism?

A

Subacute thyroiditis (de Quervain’s)
associated with a painful goitre and raised ESR

Riedel thyroiditis
fibrous tissue replacing the normal thyroid parenchyma
causes a painless goitre

Postpartum thyroiditis

Drugs
lithium
amiodarone

Iodine deficiency
the most common cause of hypothyroidism in the developing world

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3
Q

Most common cause of thyrotoxicosis?

A

Graves disease

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4
Q

Other causes of thyrotoxicosis?

A

toxic multinodular goitre
Amiodarone

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5
Q

Antibodies in thyroid disease

A

Anti-thyroid peroxidase (anti-TPO) antibodies
TSH receptor antibodies
Thyroglobulin antibodies

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6
Q

Most common antibody test positive in Graves disease

A

TSH receptor antibodies are present in around 90-100%

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7
Q

Most common antibody test positive in Hashimoto’s thyroiditis

A

anti-TPO antibodies are seen in around 90% of patients

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8
Q

What is the TSH / T3/T4 in HYPOthyroidism?

A

T3/T4 Low
TSH HIgh

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9
Q

What is the TSH / T3/T4 in HYPERthyroidism?

A

TSH low
T3/T4 HIGH

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10
Q

What is the TSH / T3/T4 in subclinical hypeothyroidism?

A

TSH raised but T3, T4 normal

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11
Q

What is the TSH/T3/T4 in Secondary hypothyroidism

A

Both LOW

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12
Q

What is the TSH/T3/T4 in Sick euthyroid syndrome

A

Both LOW

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13
Q

Poor compliance with thyroxine TSH/T3/T4

A

T4 Normal but TSH HIgh

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14
Q

Treatment of hypothyroidism?

A

Thyroxine

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15
Q

Initial treatment of hyperthyroidism (Graves)

A

propanolol

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16
Q

Tx of Graves disease

A

carbimazole
Radioiodine treatment

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17
Q

CI of radioiodine tx

A

pregnancy
age <16
thyroid eye disease

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18
Q

How does carbimazole work?

A

blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

19
Q

Side effects of carbimazole?

A

agranulocytosis

20
Q

Treatment of thyroid storm?

A

symptomatic treatment e.g. paracetamol
treatment of underlying precipitating event
beta-blockers: typically IV propranolol
anti-thyroid drugs: e.g. methimazole or propylthiouracil
Lugol’s iodine
dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3

21
Q

Causes of Cushings syndrome?

A

ACTH dependent causes
Cushing’s disease (80%): pituitary tumour secreting ACTH producing adrenal hyperplasia
ectopic ACTH production (5-10%): e.g. small cell lung cancer is the most common causes

ACTH independent causes
iatrogenic: steroids
adrenal adenoma (5-10%)
adrenal carcinoma (rare)
Carney complex: syndrome including cardiac myxoma
micronodular adrenal dysplasia (very rare)

22
Q

2 most commonly used tests in Cushing’s syndrome?

A

Overnight dexamethasone suppression test
24 hour urinary free cortisol

23
Q

Test result if neither ACTH / cortisol suppressed

A

Ectopic ACTH syndrome

24
Q

Test result if cushing’s disease (i.e. pituitary adenoma → ACTH secretion)

A

Both suppressed

25
Q

Adrenal adenoma acth/cortisol tests

A

cortisol not suppressed, acth suppressed

26
Q

Acromegaly cause

A

In acromegaly there is excess growth hormone secondary to a pituitary adenoma in over 95% of cases. A minority of cases are caused by ectopic GHRH or GH production by tumours e.g. pancreatic.

27
Q

Features of acromegaly

A

coarse facial appearance, spade-like hands, increase in shoe size
large tongue, prognathism, interdental spaces
excessive sweating and oily skin: caused by sweat gland hypertrophy
features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
raised prolactin in 1/3 of cases → galactorrhoea
6% of patients have MEN-1

28
Q

Complications of acromegaly

A

Complications
hypertension
diabetes (>10%)
cardiomyopathy
colorectal cancer

29
Q

Tests for ACROMEGALY

A

Serum IGF-1 levels have now overtaken the oral glucose tolerance test (OGTT) with serial GH measurements as the first-line test. The OGTT test is recommended to confirm the diagnosis if IGF-1 levels are raised.

30
Q

Acromegaly MX

A

Trans-sphenoidal surgery
ocreotide (somatostatin analogue)

pegvisomant
GH receptor antagonist - prevents dimerization of the GH receptor

dopamine agonists
for example bromocriptine

31
Q

Normal fasting glucosse

A

Less than 6.0

32
Q

Impaired fasting glucose

A

< or = to 6.1

33
Q

Impaired glucose tolerance

A

impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

34
Q

Normal glucose tolerance

A

<7.8

35
Q

Diabetes insipidus CAUSES

A

Diabetes insipidus (DI) is a condition characterised by either a decreased secretion of antidiuretic hormone (ADH) from the pituitary (cranial DI) or an insensitivity to antidiuretic hormone (nephrogenic DI).

36
Q

Causes of Cranial DI

A

idiopathic
post head injury
pituitary surgery
craniopharyngiomas
infiltrative
histiocytosis X
sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
haemochromatosis

37
Q

Causes of nephrogenic DI

A

genetic:
more common form affects the vasopression (ADH) receptor
less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes
hypercalcaemia
hypokalaemia
lithium
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

38
Q

Investigations in DI

A

high plasma osmolality, low urine osmolality
a urine osmolality of >700 mOsm/kg excludes diabetes insipidus
water deprivation test

39
Q

Where is ADH secreted from

A

Posterior pituitary gland

40
Q

What does ADH do?

A

It promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.

41
Q

What would be the water deprivation test result NORMAL

A

Starting plasma osmolality: LOW
Final urine osmolality: >600
Urine osm. post-DDAVP: >600

42
Q

What would be the water deprivation test result in psychogenic polydipsia

A

Starting plasma osmolality: Low
final urine: > 400
Urine osm. post-DDAVP: >400

43
Q

What would be the water deprivation test result in Cranial DI

A

Starting plasma osm: HIGH
final urine < 300
urine osm post ddavp: > 600

Because the issue is with the brain so without water, normalises

44
Q

What would be the water deprivation test result in Nephrogenic DI

A

Starting plasma osm: HIGH
final urine < 300
Urine osm. post-DDAVP: < 300

Doesn’t matter if no water becausse issue is with the kidneys

MRCP Combined (58 decks)

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