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Medicine Year 1 > Week 128 General Endocrine > Flashcards

Week 128 General Endocrine Flashcards

0
Q

Describe the signs and symptoms of Hypoadrenalism (adrenal insufficiency)

A 
Profound Hypotension (especially postural)
Vomiting
Diarrhoea
Abdo pain/salt craving
Increased skin pigmentation
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1
Q

Describe the signs and symptoms of Cushing’s syndrome.

A

Prolonged and inappropriate elevation of free corticosteroid levels.
Central Obesity & Moon Face, Plethora & Acne, menstrual Irregularity
Hirsutism, Hypertension, Diabetes,
Muscle wasting and weakness
Osteoporosis

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2
Q

What are the initial investigations of Cushing’s syndrome?

A 
Full Blood count, U&E, LFT, Bone profile
Thyroid stimulating hormone
Urinary free cortisol
Low dose dexamethasone suppression test
(Initial screen is positive if cushings)
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3
Q

Describe the investigations you would use for a patient with Addison’s disease.

A 
ACTH = <
Free cortisol = >
ACTH stimulation Test (Failure to rise)
U&E: >Na+, normal or < K+, < Urea
< Plasma renin & >Aldosterone
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4
Q

Whats is a rare cause of Addison’s often coming up in an EMQ?

A

Haemochromatosis

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5
Q

List common causes of Hypercalcaemia.

A

Primary Hyperparathyroidism (proliferation of cells secreting parathyroid hormone) accounts for about 90% of cases.

Malignancy 30-70% in hospital.
Excess vitamin D may cause Hypercalcaemia.

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6
Q

List the common causes of Hypocalcaemia.

A

Hypocalcaemia with high PTH = Chronic kidney disease (reduced hydroxylation of 25-hydroxy-vitamin D; Vitamin D Deficiency (decreased 25-hydroxylation in the liver)
Hypocalcaemia with low PTH = Hypoparathyroidism after neck surgery, acute pancreatitis, severe hypomagnesia, sepsis/major illness.

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7
Q

What happens to PTH and CA2+ in primary hyperparathyroidism?

A

Elevated both.

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8
Q

What happens to serum PTH and CA2+ in secondary hyperparathyroidism?

A

Increased PTH

Normal or LOW serum calcium

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9
Q

Describe the initial investigations you would conduct for a patient with hypercalcaemia.

A

Serum calcium - corrected for serum albumin
Above 2.65 mmol/L
ECG - look for shortened QT intervals,

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10
Q

Describe the initial investigations of a patient with hypocalcaemia.

A 
Calcium (adjusted for albumin)
Serum PTH (low = check magnesium) (high = check urea/creatnine)
Magnesium = low = magnesium deficiency
Urea/Creatinine = High = renal failure
Vitamin D = Low = Vitamin D deficiency
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11
Q

What are the clinical signs of hyperparathyroidism?

A 
Renal Stones
Corneal calcification
Muscle weakness
Tiredness
Polydypsia/Polyuria
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12
Q

What is the most common cause

of hypothyroidism?

A

Hasimoto’s throiditis
Autoimmune
F:M 12:1

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13
Q

What are the common causes of male Primary hypogonadism?

A

Androgen deficiency.
Klinefelter’s syndrome.
Surgical castration or trauma
Infections - orchitis ; age ; Chronic liver and kidney disease
Drugs, alcohol, chemotherapy, radiotherapy; androgen resistance

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14
Q

Name the typical causes of secondary hypogonadism in men.

A

Constitutional delayed puberty
CUSHINGS SYNDROME
drugs, opiates, anabolic steroids
Chronic disease, liver, kidney, HIV, diabetes
Ageing; obesity; Hypopituitarism; Hyperprolactinaemia

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15
Q

Clinical signs of Klinefelter’s?

A

Small firm testes
Gynaecomastia, eunuchoid
Infertile, hyalinised seminiferous tubules
Elevated gonadotrophin and low testosterone levels
Two or more X chromosomes; learning disabilities

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16
Q

Clinical symptoms of Kallmann’s syndrome (2ndary Hypogonadism)

A

Low testosterone
Abscent facial hair, infertility, gynaecomastia, poor musculature.
Pubertal deficiency, eunochoid body proportions span 5cm >height
Bilateral small testis
Anosmia, colour blindness

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17
Q

What are the causes of Gynaecomastia?

A

Deficient testosterone sythesis
< oestrogen production
Drug induced

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18
Q

What is a typical cause of gonadal dysfunction in women?

A

Drugs
Noonan’s syndrome (46xx)
Turners Syndrome (45XO)
Disorders of hypothalamo-pituitary function or hyperprolactinaemia
Ovarian dysfunction, <androgen production (PCOS and Adr.Hyperpla.)

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19
Q

Describe symptoms and signs of hypogonadism in men AND women

A 
Amenhorrea/Weight loss
Gynaecomastia/Hirsuiitism/Small hard testis
Infertility
Poor muculature
Span <5cm than height
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20
Q

Describe initial investigations of Hypogonadism in men and women.

A

Testosterone, LH, FSH, Free T4, TSH, U&Es, LFTs
Prolactin
Oestradiol, Gnrh (gonadotrophin regulating hormone)

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21
Q

How do you differentiate primary from secondary hypogonadism?

A

Morning LH and FSH.
Testosterone
PRIMARY = >Testosterone, High/normal FSH & LH
SECONDARY = Low testosterone, high normal to high levels of LH and FSH.

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22
Q

You can use testosterone replacement therapy to treat WHICH clinical signs?

A

Loss of libido, erectile dysfunction, diminished intellect, depression
Lethargy, osteoporosis, loss of secondary sexual characteristics, loss of muscle and strength

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23
Q

Causes of PRIMARY Hypogonadism?

A

Noonan syndrome, Turner syndrome, Klinefelter syndrome, XY females with SRY gene immunity.

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24
Q

Causes of secondary hypogonadism?

A

Polycystic ovary syndrome
Kallmann syndrome
Haemochromatosis
Diabetes M

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25
Q

Turner syndrome is in ____ and Klinefelter is in ____.

A 
Females = Turner
Males = Klinefelter
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26
Q

How would you treat Hypogonadism?

A

Testosterone therapy.
Gonadotrophin therapy stimulates sperm production in secondary hypogonadism
Type 5 phosphodiesterase inhibitor (Sildenafil, alprostadil)

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27
Q

Treatment for Infertility?

A

Intracytoplasmic sperm injection (ICSI) after genetic assessment
Vasectomy reversal
Gonadotrophin-releasing hormone receptor - for secondary hypogonadism.

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28
Q

Foetal androgen deficiency is caused by a deficiency in _____.

A

5 alpha reductase.

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29
Q

Treatment for foetal androgen deficiency?

A

Pre-pubertal orchidectomy (testicle removal)

Oestrogen replacement.

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30
Q

turners syndrome will present with ____.

A

Primary amenorrhea.

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31
Q

PCOS presents with….?

A

Irregular bleeding from menarche, hirsuitism.

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32
Q

Ovarian/Adrenal tumour presents with…..?

A

Hirsuitism/virilisation

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33
Q

Congenital adrenal hyperplasia presents with…?

A

Progressive hirsuitism from menarche.

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34
Q

Prolactinoma presents with …?

A

Secondary amenorrhoea

Galactorrhea

35
Q

Precocious puberty is defined as _____.

A

Oestrogen secretion or cyclical ovarian activity before 7-8 years in girls.

Androgen secretion and spermatogenesis before 9-10 years in boys.

36
Q

Causes of central precocious puberty?

A

Idiopathic
Hypothalamic hamartoma
Pineal gland tumour
Hypothyroidism

37
Q

Investigations for central precocious puberty?

A

LHRH/LH, FSH test, MRI pituitary, Oestradiol, Ovarian ultrasound, Free T4, bone age.

38
Q

What causes pseudo precocious puberty?

A

Adrenal and gonadal disease, HCG secreting tumours.

39
Q

Investigations for pseudo precocious puberty?

A

DHEAS

17 alpha oh –> Progesterone, HCG

40
Q

In precocious puberty, what happens to LH and FSH levels?

A

ELEVATED.

41
Q

What are the signs of premature ovarian failure?

A

Hypergonadotrophic amenorrhoea in women 6 months, vaginal dryness, menopausal flushes

Serum FSH >40 Mu/l

42
Q

which key investigation would you do for premature ovarian failure?

A

Serum FSH

43
Q

Clinical signs of Turners syndrome?

A 
Short stature
Lymphoedema
Webbed short neck
Wide nipples, short 4th metacarpal
absent 2ndary sexual characteristics, amenorrhea.
44
Q

What investigations would you conduct if you suspected turners syndrome?

A

FSH (<)
Bone age (delayed)
GH
FT4 TSH

45
Q

What are the biochemical abnormalities in Polycystic ovaries?

A

< prolactin
< testosterone
< LH/FSH ratio
Lowered sex hormone binding globulin Raised urinary oxosteroid excretion

46
Q

Investigations in polycystic ovaries?

A 
Elevated LH:FSH ratio
testosterone
Prolactin
Free T4 and TSH
17 alpha hydroxyprogesterone
47
Q

What are the clinical signs of an ovarian tumour?

A

Increased facial and body hair
Centrally plethoric
Cliteromegaly

48
Q

what investigations would you consider if you suspected an ovarian tumour?

A

Cortisol
Prgesterone

Dexamethasone suppression test.
CT scan abdo and pelvis.

49
Q

With androgen deficiency and or impaired sperm production in male hypogonadism, what do you treat with?

A

Testosterone replacement
Occasionally infertility treatment
Gonadotrophins
Phosophodiesterase Type V inhibitors

50
Q

What are the three clinical types of male hypogonadism?

A

Adult Deficiency
Pubertal Deficiency = eunochoid
Foetal deficiency = phenotypically female

51
Q

What are causes of androgen excess?

A

PCOS
Congenital adrenal hyperplasia
drugs
Adrenal and ovarian tumours

52
Q

What do you use Cyproterone acetate to treat?

A

ANDROGEN EXCESS

53
Q

WHAT ARE THE PRINCIPAL FUNCTIONS OF THE ENDOCRINE SYSTEM?

A

MAINTENANCE OF INTERNAL ENVIRONMENT IN THE BODY
INTEGRATION AND REGULATION OF GROWTH AND DEVELOPMENT
CONTROL MAINTENANCE AND INSTIGATION OF SEXUAL REPRODUCTION

54
Q

HOW DO ENDOCRINE HORMONES TRAVEL

A

BLOODSTREAM

55
Q

HOW DO AUTOCRINE HORMONES TRAVEL?

A

SECRETED AND ACT ON CELL THAT SECRETED THEM

56
Q

WHAT DO PARACRINE HORMONES ACT ON?

A

NEIGHBOURING CELLS

57
Q

HOW DO NEUROHORMONES TRAVEL?

A

SYNAPSES –> THEN TRAVEL VIA BLOODSTREAM

58
Q

WHAT GROUP OF HORMONES DO GH PROLACTIN, INSULIN, ACTH, LH AND FSH BELONG TO?

A

PEPTIDE HORMONES

59
Q

NAME FOUR STEROID HORMONES

A

CORTISOL
ALDOSTERONE
TESTOSTERONE
OESTROGEN

60
Q

NAME AN AMINO ACID DERIVATIVE HORMONE

A

THYROID HORMONE

61
Q

THE HYPOTHALAMUS SECRETES WHICH HORMONES?

A 
GNRH
TRH
CRH
GHRH
SOMATOSTATIN
62
Q

POSTERIOR PITUITARY SECRETES…?

A

VASOPRESSIN

OXYTOCIN

63
Q

ANTERIOR PITUITARY SECRETES?

A 
FSH
LH; ACTH; MSH; ENDORPHINS; LIPOTROPIN; GH
TSH
CGA
PROLACTIN
64
Q

PLACENTA PRODUCES WHICH HORMONE?

A

hCG

65
Q

PANCREAS SECRETES?

A

GLUCAGON
INSULIN
SOMATOSTATIN

66
Q

THYNUS SECRETES WHAT?

A

THYMOSIN
THYMOPOIETIN
THYMULIN

67
Q

WHAT DO GLUCOCORTICOIDS DO?

A

CONTROL CARB METABOLISM
MODERATE INFLAMMATORY RESPONSE
RESPOND TO STRESS

68
Q

WHAT DO MINERALCORTICOIDS DO? (IE ALDOSTERONE)

A

CONTROL SALT BALANCE AND BP

69
Q

NAME THE DIFFERENCE BETWEEN WATER SOLUBLE AN LIPID SOLUBLE HORMONES

A

WATER: BIND TO RECEPTOR ON CELL MEMBRANE, FAST ACTING

LIPID: DIFFUSE THROUGH CELL MEMBRANE, BIND TO NUCLEAR RECEPTORS, SLOW ACTING

70
Q

GNRH ACTS ON THE ___.

A

PITUITARY

71
Q

FSH AND LH ACT ON THE ____.

A

OVARIES

72
Q

IF IT’S FEEDBACK CONTROLLED, ITS PROBABLY A ______ HORMONE.

A

PITUITARY

73
Q

WHAT IS THE FUNCTION OF THYROID HORMONES?

A

T3 AND T4: METABOLISM REGULATIN

CALCITONIN: DECREASE BLOOD CALCIUM AND BLOOD PHOSPHATE LEVELS

74
Q

T3 AND T4 ARE CONTROLLED BY ____.

A

ANTERIOR PITUITARY LOBE TSH/

75
Q

CALCITONIN IS CONTROLLED BY ______.

A

BLOOD CALCIUM LEVELS AND DIGESTIVE CHEMICALS.

76
Q

WHAT DOES ALDOSTERONE DO?

A

REGULATES MINERAL ELECTROLYTE LEVELS (BLOOD PLASMA ION CONCENTRATIONS)

77
Q

THE OVERALL EFFECT OF CORTISOL IS TO:

A

KEEP BLOODY GLUCOSE LEVELS BETWEEN NORMAL LEVELS BETWEEN MEALS

78
Q

CUSHINGS SYNDROME CAN LEAD TO HYPO____

A

KALAEMIA

79
Q

CUSHINGS IS CONFIRMED BY WHICH TEST?

A

DEXAMETHASONE SUPPRESSION

FREE CORTISOL

80
Q

ANY RAISED 17 HYDROXYPROGESTERONE LEVELS SHOULD LED YOU TO THINK OF WHICH CONDITION?

A

CONGENITAL ADRENAL HYPERPLASIA

81
Q

WHICH FORM OF CUSHINGS SYNDROME IS CORTISOL NOT RAISED IN?

A

ECTOPIC ACTH

82
Q

IF TESTOSTERONE IS RAISED, AND SO IS GH/FSH RATION IT IS LIKELY _____ (IN WOMEN)

A

POLYCYSTIC OVARY SYNDROME

83
Q

HYPERPIGMENTATION, RAISED ACTH AND LOW CORTISOL EQUALS WHAT?

A

ADDISONS!

84
Q

ACHONDROPLASIA IS ASSOCIATED WITH WHAT?

A

DISPROPORTIONATE SHORT STATURE.

85
Q

PROPORTIONAL SHORT STATURE WITH CENTRAL OBESITY IS ASSOCIATED WITH WHICH OF THE FOLLOWING?

A

GROWTH HORMONE DEFICIENCY

Medicine Year 1 (39 decks)

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