5. BAMS Endocrinology Flashcards Preview

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Flashcards in 5. BAMS Endocrinology Deck (11):
1

Where is aldosterone produced and what does it do

What is cortisol, where is it produced and what does it do

Explain the negative feedback loop involved in cortisol secretion

Explain the differences between the two types of pituitary tumours

Zona glomerulosa - increases salt and water retention and indirectly affects BP

Glucocorticoid, zona fasicularis and raises BP (normal maintenance), inhibits bone synthesis and lowers immune reactilivity

When there are low cortisol levels, the hypothalamus releases CRH, stimulating the anterior pituitary gland release ACTH. This acts on the adrenal gland stimulating cortisol secretion. When cortisol secretion is sufficient, it acts (negative feedback) to inhibit the secretion of CRH and ACTH

Functional adenoma - well-differentiated, hormone-producing
Non-functional adenoma - space-occupying, non-hormone-producing

2

What is caused by unregulated levels of growth hormone

What is acromegaly and list 4 clinical features of how it presents

Too high --> gigantism/acromegaly
Too low --> slow growth/metabolic changes

Appositional bone growth - enlarged hands, type 2 diabetes, reverse overbite, coarse features

3

Hyperthyroidism and Hypothyroidism

What is the main cause of hyperthyroidism and what is this caused by

List 5 common symptoms of hyperthyroidism

Describe hormone levels in primary and secondary hyperthyroidism

What is the main cause of hypothyroidism and what is this caused by

List 5 common symptoms of hypothyroidism

Describe hormone levels in primary and secondary hypothyroidism

List 3 thyroid disease investigations

How is a thyroid disease treated

Graves disease - autoimmune disease (auto-antibodies stimulate TSH receptors)

Heat intolerance, hypertension, weight loss, diarrhoea, increased HR, palpitations, lid lag, eyelid retraction

Primary - low TSH, high T3; secondary - high TSH and T3

Hashimoto's thyroiditis - autoimmune disease

Cold intolerance, weight gain, tired, constipation, slow HR, delayed reflexes

Primary - high TSH, low T4; secondary - low TSH and T4

Blood tests, ultrasound, tissue sample

Hyper - radioiodine, medications (B-blockers), surgery
Hypo - thyroxine tablets

4

Type 1 Diabetes Mellitus

How is diabetes diagnosed

What is type 1 diabetes

How can ketoacidosis and hypoglycaemia develop

List 5 symptoms of type 1 diabetes

What are 2 main causes of type 1 diabetes

2 RPG results > 11.1mmol/l glucose in blood. RPG involves GTT - 8hr fast, measure (6.1 < 6.1-70 > 7.0), 75g glucose load, measure 2hr later (7.8 < 7.8-11.1 > 11.1)

Autoimmune disease involving immune-mediated destruction of pancreatic B cells by auto-antibodies

Cells cannot metabolise glucose correctly, so fat is used --> build-up of acidic ketones (ketoacidosis) --> insulin treatment --> hypoglycaemia --> glucose required

Polydipsia, polyuria, tiredness, weight loss, increased appetite

Genetic (familial clustering) and environmental triggers

5

Type 2 Diabetes Mellitus

What is type 2 diabetes

List 3 features associated with type 2 diabetes

What are 3 main causes of type 2 diabetes

How is it diagnosed

List 6 diabetic complications patients may present with

List main treatments for type 2 diabetes

Describe 2 types of oral hypoglycaemic agents

Insulin-resistant - metabolic disorders --> metabolic syndromes

HTN, early accelerated atherosclerosis, obesity with abdominal distribution

Poor diet, obesity, sedentary/lack of exercise

By excluding type 1

Diabetic foot ulcer, retinopathy, neuropathy, nephropathy, poor wound healing, unusual infections

Weight loss, exercise, diet restriction

Insulin secretagogues - cause cells to release insulin
Insulin sensitisers - increase insulin cell sensitivity

6

Considering dentistry, what 5 side effects can diabetes have

Xerostomia, burning mouth syndrome, increased caries risk, ulcers, increased infection risk

7

Adrenal Hyperfunction and Hypofunction

What is Conn's syndrome

What is Cushing's syndrome and list 3 main causes

List 8 symptoms of Cushing's syndrome

Describe hormone levels in primary and secondary adrenal hyper function

What is Addison's disease and list 2 main causes

List 5 symptoms of Addison's disease

Describe hormone levels in primary and secondary adrenal hypo function

Excess aldosterone levels

Excess cortisol levels - adrenal adenoma, Cushing's disease and ectopic ACTH production

Muscle weakness, obesity with abdominal distribution, moonface, buffalo hump, diabetes features, thin skin, purpura, fractures, hypertension

Primary - low ACTH, high cortisol; secondary - high ACTH and cortisol

Destruction/dysfunction of adrenal gland - autoimmune and TB

Postural hypotension, weight loss, tired, weakness, loss of body hair (males), anorexia

Primary - high ACTH, low cortisol; secondary - low ACTH and cortisol

8

Therapeutic Steroids

What effect do they have on adrenal gland

List 6 adverse effects of therapeutic steroids

Cause adrenal gland suppression - enhance effects of glucocorticoids and mineralocorticoids

Hypertension, type 2 diabetes, osteoporosis, increased infection risk, peptic ulceration, thinning of skin

9

Steroid Prophylaxis

When is this used

List 3 features of therapeutic steroids

List 3 features of steroid use for Addison's

When increased physiological requirement anticipated

Hypertension tendency, supra physiological, all steroids exogenous

Hypotension tendency, physiological replacement, all steroids exogenous

10

Acute Adrenal Crisis

How does this develop

List 3 symptoms/signs

How is it managed

From Addison's disease due to insufficient cortisol levels

Vomiting, hypotension, coma

Treat problem, fluid resuscitation

11

List 6 causes of oral pigmentation

Race, drugs (contraceptive pill, antimalarials), melanoma, melanotic macule, smoking, pregnancy, chronic trauma, pigmented naevus