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203 > Diagnostic Endocrine Disorders > Flashcards

Diagnostic Endocrine Disorders Flashcards

1
Q

To investigate thyroid marker of choice is?

A

TSH

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2
Q

FT3 is used to diagnose?

A

Hyperthyroidism, monitor therapy for carbimazole PTU and radioactive iodine

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3
Q

Signs of hyperthyroidism?

A

Agitation, fine tremor, warm moist skin, palmar erythema, muscle wasting, pruritis, gynaecomastia, sinus tachycardia, atrial fibrillation

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4
Q

Extrathyroid manifestations of graves that are rare?

A

Thyroid acropachy (digital clubbing and swelling of fingers and toes)

Thyroid dermopathy

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5
Q

Difference between toxic multinodular goitre and subacute thyroiditis?

A

Non tender thyroid nodules in toxic multinodular goitre and tender firm enlargement in subacute thyroiditis

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6
Q

Assessments in hyperthyroidism?

A

TRAbs (TSH receptor antibodies) if graves accepted or pregnant

Inflammatory markers such as CRP if thyroidits

TPOAbs (thyroid peroxidase antibodies), if postpartum thyroiditis suspected

FBC and LFT, if about to start anti thyroid drugs

Ultrasound

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7
Q

What can affect thyroid axis?

A

Age: mild TSH elevation

Pregnancy: TSH suppression late first trimester

Drugs: TSH suppression with dopamine, high dose glucocorticoids, amphetamines bromocriptine amiadorone

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8
Q

Excessive exogenous levothyroxine can cause?

A

Thyrotoxicosis not hyperthyroidism

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9
Q

A change in ft4 can result in tsh results changing by?

A

> 100 fold

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10
Q

What happens in sick euthyroid?

A

Body switches off hpa axis

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11
Q

During starvation what happens to thyroid levels?

A

Less conversion of t4 to t3

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12
Q

Cortisol mimics action of?

A

Aldosterone

Hence greater reabsorption na and water

Hypertension

Loss of k and h (increased HCO3-)

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13
Q

Causes of cushings?

A

Pituitary adenoma, ectoping acth secreting tumour
Adenoma, adrenocorticol rest tumour (islands of adrenal tissue that remian within gonads during development), nodular adrenal hyperplasia

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14
Q

Diagnotic tests for cushings?

A
  1. Identify spontaneous hypercortisolism, mild vs pseudo
  2. Determine whether acth dependent or independent
  3. Where is acth coming from
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15
Q

Discriminatory signs of cushings?

A

Easy bruising, facial plethora (swelling), proximal myopathy (weakness), striae, weight gain in children and reduced growth velocity

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16
Q

Tests for cortisol?

A

24 urine free cortisol, because 2%is free.

If 4x upper limit of normal

Dexamethasone suppression 1mg, cortisol suppressed less than 40 rule out cushings

Late night salivary cortisol:

17
Q

What happens in lactic alkalosis?

A

Alkalosis switches on phosphofructokinase which will double lactate production

18
Q

Metyrapone test?

A

Decreases serum cortisol, causing increase in 11-deoxycortisol

19
Q

Low cortisol can cause tanning because?

A

Pro-opio melanocortin causes MSH melanocyte stimulating hormone and acTH, beta endrophin and lipotropin

Because low cortisol causes high ACTH which causes pro-opio melanocortin

20
Q

In sick thyroid what happens to hormones?

A

Low TSH low T4 and T3

21
Q

In late first semester what happens to TSH?

A

Low

22
Q

Difference between primary and secondary adrenal insufficiency?

A

In primary lack of aldosterone but high ACTH, secondary normal aldosterone but low ACTH

23
Q

Test for adrenal insufficiency?

A

Short synacthen test

250 micro gram or IV synthetic ACTH

Take bloods at 0 mins and 60 mins

Normal results is a rise of cortisol over 550 nmol/l

24
Q

High IGF1 may be seen in?

A

Pregnancy and puberty, acromegaly

25
Q

What to look for acromegaly?

A

High Igf1

26
Q

High glucose suppresses?

A

Growth hormone

27
Q

To check for diabetes what test?

A

Water deprivation test then desmopressin- cranial diabetes

28
Q

Superior vena cava obstruction symptoms SVCO?

A 
Chest pain 
Cough
Dysphagia
Pleural effusion
Strider
Oedema
Cyanosis
29
Q

What can cause SVCO?

A

Lung cancer
Metastatic disease
Lymphoma

30
Q

How to test for acromegaly?

A

Oral glucose tolerance test 75g oral glucose then fasting

Take GH and glucose

GH less than 0.4 micro gram/l is a pass

In acromegaly over 5 micro gram

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